MA 0702-CS120302COPPELL
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CONS"MUMON DEVII.0P11rIE1VIT PERMIT APPLICATION
Name of Applicant: 9,&i Y�e ( Submitted:
Address of Applicant: h1;1TW [}k'_•)
Phone Number: CC410 �50S- 35 �' FAX NUMBER:
Location of Construction (address, of "ailabler
OR
subanision
Section #
Snriwey/Abstroa # Acreage
Location description (attach tpiefidly imp):
Block # Lot #
1. Type of proposed construction or development:
Residential O Alteration of a natural waterway drainage course
() 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:
( ) Paving ( ) Median or Landscaping O Box Culvert
( ) Sidewalk
( ) Drive Approach
( ) Excavation
( ) Fire Lane
( ) Bridge
( ) W r Main
( ) R.C.P. a��A�r.�
itary Sewer Main
( ) Flume
( ) Inlet
( ) Rip Rap
06 Fill Area
( ) Drainage Channel Excavation
( ) Slope Protection /Retaining Wall
( ) 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: $ 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.
➢ 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 a 972- 3043600 Street Department a 972 - 462 -5150
Fire Department @l 972 - 3043500 Engineering Dept. (get 972- 3043679
➢ Attach barricade plan / trench safety plan of a lane or street closure. (Required)
➢ It is a requirement of this permit that As -Built Drawings be turned in at the end of
this project. As- Builts consist of 1 set full size paper copy, 1 set full size mylar and
CD with Autocad.dwg files.
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.
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Sig ature of Applicant Printed Name Contact Number
W01 5-1�0 IVY
City Inspector Contact Number(s)
FOR CITY USE ONLY
Is the IM area located in an identified flood hazard area? ( ) YES ( ) NO
If YES, a Ploo*fim Development Penult is required before any construction can begin.
Is additional information required? ( ) YES ( ) NO
Are other federal, state, or local permits required? ( ) YES ( ) NO
WLvERmFr LIGATION APPROVED O P)rRmrr APPLICATION DENIED
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 come 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.