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Old Town Pavillion-PT130715 A copy of he approved permit must be on the job site at ail times. Page 1 of 4 CC:APPlicant : ' COF;IFIE1y ,1-/ - T ', , _ Rev.02/2012 c; '‘Piiblieltiblies7.- — Original to Lk:I:FILE ' ' R 10-FiTbF-WAY USEP,ERNiii APPLICATION =- p F!Rim\i,,,,, ' ,,,, ,,, ,,,Pern;;I valfaforgo.i 1 aj;s'fi:Win i,1.7c.la'f e-ofapproval..'.- 1..\ ' submit permit application to Engineering Dept,,Town Center,255 Parkway Blvd.Coppell TX 75019 - i 0 7, Date of Submittal: 7 )O 0 I_ - ' 7 Applicant's Job i=4 /Work Order# 1 3! q17 c-) < cD PERMIT FEE: $100 (No charge to franchise utility companies with ROW Use Agreement) Refer to City of Coppell Ordinance No.2001-944. Certificated Teleconai'Provider? Y tt \j) ENIAII,ADDIZ.ESS FOR St'BMITT‘1, : eileiilet . tx. (). . . ;- ----___ Plans provided and approved?(Erosion Control/Safely Fences must be installed prior to beginning work) Project Name /Location or address £ P fr,e ii - )eVi'llt6,4) Er2. P1414,12iPtik,rS General Contractor ---_—_ Contact# - Email address to return approved pei mt • 't t I if( reid*64 Representative: Telephone#: 46'9-26./-5-,25'75-- Emergency#: 4é? 74(-.sri_S-SP- ..... 7- Email address: f<i4 4 , /,-,:e 401.'45 ...4- 0A- o . to Ai (for contact if needed!if email of approved permit is desired/permit cannot be emailed unless complete) Utility Company Represented: - I cor-` Electric 1)eux.e.1:44.) 0 Atnios Energy 0 Verizon 0 AT&T/SRC 0 Time Warner Cable 0 Time Warner Telecom 0 Other General Description of Work(in accordance with Ordinance 20,701-.9442provit,le_f1..,_si:teot prints. Caivretitz,rega GW4U14' / i k;) 3 -.14 143of of-- 1 et,Wsc--. Pki'frtAAti T-st, e.24f71/6 4";N.Att IT:, A-apHltir ov , t .t -a- 3 ekAsE ?soio OiouPf it2Ap.cfcili.netes. Estimated Start Date 7-.24- 13 Estimated Completion Date* *Completion req, uires inspection and sutimiltai of C°111Pleti°11Verification Notice(page 4). *Was City Utility Dept. contacted to locate exi_stingindergrouene? u4tilieticts'Lltla'.ses 0 No W If not, reason pl& L.0 etA're-<, i.v..1 1 1 R Veouc-11- 1a Di&a"(v& . Is removal of existing streets,alleys or sidewalks necessary? Yes 0 No if Yes,project must have city inspection prior to concrete replacement. Right-of-Way Use Permit Application Page 2 of 4 Representative(4 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 1:› 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 I set of prints showing the proposed work. 'Locates for existing franchise utilities Must be done 48 hours prior to beginning work. For City utility locates,call 972-462-5155 to schedule 48 hours prior to beginning work. . , This application with signatures of Franchise and Contactor representatives must be submitted to Fugitteering Department for approval prior to beginning work.Submittals by email should go to engincerconpelltx gov. you want the approved permit returned via email,provide a valid email address on Page 1. mit cannot be entailed unles required signatures are present. / 4J 4-MoKASOPF,.0e------ t , . '''';'4 7- 110 - 13 Wit ure of Irnv ,- -Represent ate Printed Name Date 1 ,c 14 re ,,, ' / 011111 7- fo - 13 i ignature of Contrz 171Lrresentative-- fdy5 Printed Name Date A— - siqnat 77n.y Representative Printed Name Date COMMENTS: NOTE:Notify Engineering Dept. at 972-304-3679 prior to beginning work alit/for open trench,ditch or pit inspection prior to backfilling. Backfill material must meet City of Coppell standards. 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