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Fresenius-PT130806 ' 0`3-05-1 3 A 9 :54 RCVD y w tT- g'7 to q. '"r 3. _,..o n: ?.,�.. T. #n a � ,� ces��t a o t�d permi m st13ont i�fe ,'hIIti ri"i �. ,�mss.5'"� d�"F���7�'-.x 3�Z' •a�'54,E�i T li E • C I T Y F' '3' .+ xra �- "� `� s'- tp�: > 4 L '' s a $tfge of 4 COPPEL <, � - c,. r R ¢. .r$ a �c tom' .. ;4-„ h -+wryry ay1 /� �'' P..a 5 F ,�3 $ „ . [ 4► yr REA G `�.'J- .'''a,,. ` f3 � aez g _ ���F�ktf1J�� b, aa " " J® .s_! t ` z�r x o ifinnx i iI n► psl ntro�i to g,6�liErrl L t i u te'ib'1t r I'�kv��p, 1%441 ovii4 Vti Date of Submittal: S ' S~ 13 Applicant's Job#/Work Order# 32 1 5-,CIP. PERMIT FEE: $100 (No charge to franchise utility companies with ROW Use Agreement) Refer to City of Coppell Ordinance No.2001-944. Certificated Telecom Provider? Y 67 EMAIL ADDRESS FOR SUBMITTAL: en_ineer -the. I elltx.,:ov _ __._ Plans provided and approved? (Erosion Control/Safety Fences must be installed prior to beginning work) 1 .Cw Btu•Re-Plow'," , ALe et'trfcS Project Name/Location or address General Contractor Contact# Email address to return approved permit t;o.k,1i jI,h ,DiVeoe.Coyly D],. Representative: A • ; 'P��:E;u a Telephone#: 469. 2 /-5-1cr ergency#: �-24(- $2 cc g Email address: eg',�'[d+n QNLoe, Cars (for contact if needed/if email of approved permit is desired/permit cannot be emailed unless complete) Utility Company Represented: 4Oncor Electric Delivery 0 Atmos Energy 0 Verizon 0 AT&T/SBC 0 Time Warner Cable 0 Time Warner Telecom 0 Other Ge l Description of Work(in accordance with Ordinance 2001-944)Provide 1 set of rp ints• �►�,o vct 0Vettie x�P ,2;1)•%A r,,-�,eo 551'6 B e rtt �n1 b. (N D/G6;1vd Kepkrrtuo - wia.,lc aovi,Y) F � t yx -4+ y mo / ; t � m &t. Dd e - x 4. ('4)111 pktra 1e3uxte 'mspZo i r . 0omplefo i t o (p 4 4Was City Utility Dept. costa ted to locate existing and> _round u�ilities? Yes 0 No, If not, reason /I p O/ diNG f g t1tg eD lIs removal of existing streets, alleys or sidewalks necessary? Yes No (!I 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. is 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 • 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. �,T Attach the Franchise Work Order(if applicable)and I set of prints showing the proposed work. 4 ri0 s i S PIis tl t t .mus r n 20 7c�, LPlC mag arw 5% 1'. 6 r' b s 1v.-.' 6i ato- aca I uleY-�oohs for iazvegin t g or ti 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 engineer( coppelltx.gov. If y. ant the approved per • returned via email,provide a valid email address on Page 1. ' -.'iirbe emailed unless required signatures are present. Sigi of Utility Co.;,iepres-. : ' e Printed Name y Date /` * eK .$ " r� ignature of Co tractor Representative Printed Name Date t:na ure o • ity Representative Printed Name Dat COMMENTS: NOTE:Notify Engineering Dept.at 972-304-3679 prior to beginning work and for open trench,ditch or pit inspection prior to backfilling. Backfill material must meet City of Coppell standards. Applicant shall indemn f 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, blocking, excavation,cutting, tunneling, or other work performed by the applicant under permit from the City, if such permit is granted Ii i I ZIA6651 i i t L 0rb1 391166% R:FC 100A .. 'rqzi 661 in 398465 R:DG 1i+ 661636 �0 a D. 1'1' 0 G 1'. 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