Shake & Shingle 3-PT130214 --
T H E • C I T Y • O F
COPPELL
X , 6
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicant: ,- 1CL1 F.' etiki, 4/C10/ 1 Date Submitted: 41
Address of Applicant: !;I:‘,00 Pial .t ill 1)21U AUU' ;< 1t `r I rii00
Phone Number: ' '12 15 t, .;g 06. FAX NUMBER:
Location of Construction (address, if available): z,ao C BEL:r-_1;4 E (11 Co1,'1 ?"X ;170ti
Subdivision Section # Block# Lot#
OR
Survey/Abstract# Acreage
Location description (attach vicinity map): 5 it--r
1. Type of proposed construction or development:
( ) Residential ( ) Alteration of a natural waterway drainage course
p() Non-residential ( ) Other (describe& attach drawing or sketch)
( ) Placement of Fill (in right-of-way or on private property)
2. Description of Construction Permit requested:
(X) Paving QC) Median or Landscaping ( ) Box Culvert
(X) Sidewalk ( ) Water Main (X) Rip Rap
( ) Drive Approach (X) R.C.P. ( ) Fill Area
( ) Excavation ( ) Sanitary Sewer Main ( ) Drainage Channel Excavation
(x) Fire Lane ( ) Flume (,X) Slope Protection/Retaining Wall
( ) Bridge 0X) Inlet (X) Parking Lot
Provide an attachment containing the name and 24-hr. contact phone number
of supervisor(s) for every contractor working under this general permit.
3. All construction shall be in compliance with, but not limited to, the City of Coppell
Subdivision Ordinance, Standard Construction Details, Streetscape Plan and approved plans.
The contractors shall adhere to the City's Erosion Control& Sedimentation Ordinance.
4. Applicant shall provide a copy of approved plans, specifications and related cost estimate or
contract for the purpose of permit fee calculation verification.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION Page 2
5. A Construction Inspection Permit Fee shall be paid prior to beginning work, in accordance
with the City of Coppell Fee Ordinance. See Page 3 for calculation formula.
Amount Due: $ 1 ,156. 39 Date Paid:
NOTE: A separate excavation permit is required anytime pavement is cut or when there is work in the
right-of-way not approved by the City Engineer.
y Any work requiring closure of a lane of traffic, street, or alley must be approved
in advance by the Engineering Dept., with notification to the following prior to
closure:
Police Department @ 972-304-3600 Street Department @ 972-462-5150
Fire Department @ 972-304-3500 Engineering Dept. @ 972-304-3679
Attach barricade plan / trench safety plan of a lane or street closure. (Required)
NOTE: Street closures are allowed from 9:00 a.m. until 3:00 p.m. ONLY unless otherwise approved
by City Engineer.
A pre-construction meeting is required prior to beginning work related to this permit.
Contact the inspector assigned to your project to schedule the meeting.
httr,-N MKT■4 '2A L1. "O .
SfnatIe of`Aidplicant Printed Name Contact Number
t/14-2' Li Lift S-1 110 .1 /
City Inspector Contact Number(s)
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? ( ) YES (\01O
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional information required? ( ) YES 0 NO
Are other federal, state, or local permits required? ( ) YES NO
( ERMIT APPLICATION APPROVED ( ) PERMIT APPLICATION DENIED
��e& Z Il (13
y Approval Date
Applicant shall indemnify and forever hold harmless against the City of Coppell each and every claim, demand
or cause of action that may be made or conic against it by reason of or if any way arising out of the closure,
blocking, excavating, cutting, tunneling, or other work by the applicant under permit from the City, if such
permit is granted.
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RATCLIFF CONSTRUCTORS, L.P. Capita' l 84
One° 4-2652 0 0 5 9 2 0
4200 Beltway Drive ALEXANDRIA, LA
Addison, TX 75001
(972) 432-9969
DATEFebruary 14, 2013
PAY Thousand Seven Hundred 30/100**Fifty—Eight & DOLLARS$
g 3" *2,758.30*
TO THE ORDER OF
RATCLIFF CONSTRUCTORS, L.P.
City of Coppell
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L_ J AUTHORIZED IGNATURE
DATE DESCRIPTION INVOICE NO. AMOUNT DISCOUNT DEDUCTIONS NET AMOUNT'd
2/14/13 Inspectio for Water, Sanitary & Storm Sewer $2758.30
e CASH , 0p p �
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