Neighborhood CU-PT130607 A copy of the approved permit must be on the job site at all times.
CC: Applicant r .... ' t w • OP Page 1 of 4
Public Works COFTELL
Permit File Rev. 06/2012
Orig. to Project File *:,,,j;. 06-04- 1 3 A�3:28 R C VD
& ERIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
Submit permit application to the Engineering Dept.,Town Center,255 Parkway Blvd.or e-mail to engineer @coppelltx.gov(see button below)
Date of Submittal: 06/04/13 Applicant's Job # / Work Order # 31)FAOXK
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Yes C: No C
�] Plans provided and approved (Erosion Control/Safety fences must be installed prior to beginning work)
Project Name/Location or address 380 S Denton Tap Rd Coppel1,Tx
General Contractor Henke's Sr McCoy/Cliff Stephens Contact# 214-326-3011
E-mail address to return permit martinez.mike@veri zon.nom
Representative: Paul Messenheimer
Franchise gat Telephone#: 972 318 5186
Companyt
E-mail address:Paul.m.messenheirnerQonie.veri zon.corn
(for contact if needed/if e-mail of approved permit is desired/permit cannot be e-mailed unless complete)
Utility Company Represented:
C Oncor Electric Delivery CF Atmos Energy C Verizon C SBC/ AT&T
C Time Warner Cable C CoSery Electric/Gas C` Other
General pescripopti of Work fln accordance with Ord No 200 •944) PLEASE ATTACH FLAN OF:PROPOSED WORK
Directional bore appro C 21 0tfrom existing 2x3 handholc ibehind X49 Lakewood Ct to Van Webber Dr and prrocee f South to
location of Customerconduitfor 360 S Denton Ta Rd"
Estimated Start Date 08/17/13 Estimated Completion Date* 07/03/13
* Completion requires submittal of Completion Verification Notice (see page 4)
>Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason:Contact will be made 48hrs prior to const. C'' Yes C■ No
>Is removal of existing streets, alleys, or sidewalks necessary? C Yes C■ 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
applicant's expense)and barricading according to the Texas Manual on Uniform Traffic 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 972-462-5155.
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department @ 972-304-3600
Fire Department @ 972-304-3512
Street Department @ 972-462-5150
Engineering Department @ 972-304-3679
>Attach barricade plan /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 Work Order(franchise only)and/or 1 set of prints showing proposed work.
locates for existing franchise utilities must be done 4 ihours prior to beginning work.
i4,1,For City utility locates, call, 972-462-5155%to:schedule 48 horzs prior to beginning work.
The application with signatures of Franchise and Contractor representatives must be submitted to Engineering
Dept.for approval prior to beginning work. Submittals by e-mail should go to engineer @coppelltx.gov.
Printing your name indicates your acceptance of the terms and conditions of this form:
(if you want the approved permit returned via e-mail,provide a valid e-mail address on Page 1.)
Mike Martinez 06/04/13
Signature of Utility Company Representative Date
Cliff Stephens 06/04/13
Signature of Contractor Representative Date
I.
014115
Sig`atur . .A Representative Date
Comments
>NOTE: Notify City Inspector at 972-304-3679 prior to beginning work and prior to
backfill for concrete, trench, ditch and open pit inspections. Backfill must meet
all construction standards approved by the City of Coppell.
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.
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