Bellacere Addn-PT130409 A copy of the approved Permit must be on the job site at all times.
CC: Applicant OP P ELL Page 1 of 4
Public Works `.' l✓ ilev. U212012
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RIGHT-OF-WAY USE PERMIT"'APPLIC T N
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Q Permit valid for 90 days from the date of approval.. 13 A 09:09 R C V
Submit permit application to Engineering Dept.,Town Center,255 Parkway Blvd.Coppell TX 75019
Date of Submittal: ^ g' (3 Applicant's Job#/Work Order# 32a/ 7, ----
PERMIT FEE: S100 (No charge to franchise utility companies with ROW Use Agreement)
Refer to City Coppell of Cpell Ordinance No. 2001-944. Certificated Telecom Provider? A' It
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EMIAII_,ADI)RESS F()12 SIJB'd1"I TAT, : env,ineet.ei<colpirelli‘.t ov
EPlans provided and approved? (Erosion Control/Safety Fences must be install prior to beginning work)
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Project Name/Location or ad ess L ..+ 01. :`p i I ey' 1 o CL i~ � 4°X).
General Contractor (FOR t3LL ACaEayontact it
Email address to return approved permit I'f'K. F-ieIdt n t Ncof .6arh
Representative: 't 1< t1 i:1
g Telephone #: ' *",2 f- - .,+'° Emergency#: 42i- z5`
< r Email address: t•cI,fi /d &. 0A)GO Co r
— (for contact if needed/if email of approvg permit is desired/permit cannot be ernailed unless complete)
Utility Company Represented:
Oncor Electric Delivery 0 Atmos Energy 0 Verizon 0 AT&T/SI3C
0 Time Warner Cable 0 Time Warner Telecom 0 Other
General Description of Work(in accordance with Ordinance 2001-944) Provide I set of prints.
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Estimated Start Date' ;- 1 Estimated Completion Date* `' /' //13
'Completion requires inspection and submittal of Completion Verification Notice (page 4).
*Was City Utility ept. contacted to locatsrexistin , underground utilities? Yes fl No
If not, reason r 0 P164(et, p,pc2 LA(rig) -..-
6:v I*t.. ; C� 6",c,14,PCe
C Is removal of existing streets, alleys or sidewalks necessary? Yes -LL No
if Yes,project must have City inspection prior to concrete replacement.
Right-of-Way Use Permit Application Page 2 of 4,
Representative(s)of the Contractor must adhere to all construction standards approved by the City of
Coppell, which includes but is not limited to: Erosion Control Ordinance, compaction requirements
(density tests may be required at the applicant's expense) and barricading according to the
Texas Manual on Uniform Traffic Control Devices.
Affected area must be restored to same condition as before the commencement of work
(grading,drainage,vegetation and erosion control).
To schedule a Public Works final inspection as required on Page 4,call 972-462-5155.
Any excavation requiring the closing of a street/alley must be reported to the following prior to closing:
Police Dept. 972-304-3600 Fire Dept. 972-304-3512
Street Dept. 972-462-5150 Engineering Dept. 972-304-3679
E> Attach a barricade plan or trench safety plan if a lane or street closure is required. NOTE: Street
closures are allowed from 9:00 a.m. until 3:30 p.m. ONLY unless otherwise approved by City Engineer.
Attach the Franchise Work Order(if applicable)and 1 set of prints showing the proposed work..
Locates for existing franchise utilities must be clone 48 hours prior to beginning work.
For City utility locates,call 972-462-5135 to schedule 48 hours prior to beginning work
This application with signatures of Franchise and Contractor representatives must be submitted to Engineering
Department for approval prior to beginning work. Submittals by email should go to engineerq,coppelltx.gov.
If ' want the approved permit returned via email,provide a valid email address on Page I. ed-1
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Per ' cannat be-en-Tailed unle III required signatures'are present. if
Sr na re of Utili r ompan ' epresentative 'tinted Name Date
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--- row itet ek re‘t.hi Te(461/4/s,
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Signature of Contract. Re — - 'native Printed Name Date
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(\11 t(-'444 CIALeA cf I'1 1 li
ure ..ity Representative Printed Name Date
COMMENTS:
NOTE:Notify Engineering Dept. at 972-304-3679 prior to beginning work and fir open trench,ditch or pit
inspection prior to backfilling. Backfill material must meet City of Coppell standards.
Applicant shall inc./env-10,and forever hold harmless the City of Coppell against each and every claim, demand, or
cause of action that may be made or come against it by reason of or if in any way arising out of, the closure, No:.king-
excavation,cutting, tunneling or other work performed by the appliCant under permit from the City, it.5zech permit is
granted
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