Carter Addn 3-PT130123LSc-c_6(i M ri�4
[_ rA copy of the approved permit must be on the job site at all times. I
CC: Applicant
T H 15 a 1 T Y D F
Pa Y-'i { e1gl�4
Public WorlsL� i) $
Permit Pale Rev. 07/2010
Orig. to Project File ? F R C V D
RIGHT -OF -'WAY USE PERMIT APPLICATION
Permit valid far 90 c:alewlar days from date of approval
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: --- 2 ?a B Applicant's Job # 1 Work Order #
PERNUT FE, E: $100.00
(No charge to Utility Companies with approved I`ranchise /ROW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001.944. Certificated Telecom Provider? Y N
Plans provided and approved
(ilrosion Control /safety fences must he installed prior to beginning work)
Project Narne / Location: (.A 1- A ZLA- ttr—t
General Contractor:
%nntart. #
(o ,� ,
Permit issued to Company l Representata vGXVe: C5/Uali.
Address: 700 AL 5'r lvi , Zu Ce, . '7( -,oSq
Emergency Telephone #:
Utility Company Represented:
��'' P i
�cor Electric Delivery Atmos Energy [� Verizon E] SBC/ AT &T
] �T`ime Warner Cable CoSery Electric /Gas E( Other
General DescAption of Work (provide four [4] sets of prams): In accordance With Ord. No. ZQ01 -944.
Estunated Start Date ' --2 Estimated Completion Date* cr/ — a
=i' Completion requires submittal of Completion Verification Notice (see page 4)
Was contact inade with City and /or utility companies to locate existing utilities?
if NO, Reason: YES NO
➢ Is removal of existing streets, alleys, or sidewalks necessary? YES NO
if YES, must have City inspection p for to Concrete replacement
Right -o£ -Way Use Permit Application Page 2 of 4
Representatives) of the Contractor must adhere to all construction standards approved by the City of Coppeli, witich
includes but is not limited to: Erosion Control Ordinance, compaction requirements (density tests may be required at
the applicants expense) and barricading according to the Texas Manual on UnVortn Vaf le Control Devices.
Area(s) affected must be restored to as good condition as before the commencement of work (grading, drainage,
vegetation, and erosion control). To schedule Public Works final inspection: (Page 4) call 972462 -5155.
A Any excavation requiring closing of a street /alley must be reported prior to closing to the following:
Police Department 0 972 -304 -3600
Fire Department Q 972- 304 -3500
Street Department 0 972- 462 -5150
Engineering Department @ 972-304 -3679
➢ Attach barricade plan / trench safety plan if a acne or street closure is required.
NOTE: Street closures are allowed from 9.00 a.m. until 4:00 P.m. ONLY unless otherivise approved by CYty
Engineer.
> Attach Work Order (franchise only) and /or 4 sets of prints showing proposed work.
�ontacts must be made to locate existing utilities 48 Fours prior to beginning work.
(Application with original signatures should be submitted to the Engineering .Department before approval.)
e�mpany ignatiae of Utility r
iguature of Contractor Representative
I
Si natu?e _ I C epresentative
Y Comments:
➢ NOTE
hackfill for concrete, trcA
all construction standards
Printed Name Date
Printed Name Date
Printed Name D�1te
d
a .open ,fit inspections.
by the City of Coppell.
DcP-ils
work and prior to
Backfill must meet
Applicant Mill indemnify and forever hold harmless against the City of Coppell each cartel every claims,
demand or cause of action that may be made or come against it by reason of or if any way arising out of the
closure, blocldng, excavating, slatting, tunneling, or other work by the applicant under permit front the City,
if such permit is granted.
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