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Fresenius-PT130828 A copr cif the aPPto�ed putt jxtusl nn the tt3b site at all Times T K E • C i T Y O F C Apphc nt ur Rev(12 2012' Originatito LF/,FI.LI q 5 i s a v C R GH OF WAY USE PERMIT APPLiti, N Permtt tea# fcf dsjrcinn iliee date'ofapproi?aJ` Submit r m� it a pP lication to En ineerin Pent;Town Cefitert 255 Parkway Blvd.Co 7p ell'1X 7501 9 N) N Date r2 7"-� te of Submittal: 3 Applicant's Sob#/Vrork Carder# 3,2/ 736 PERMIT FEE: S100 (No charge to franchise utility companies with ROW Use Agreement) 2 Refer to City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Y I d EMAIL ADDRESS FOR SUBMITTAL: eneineeriii,coppelltx.gov E Plans provided and approved?(Erosion Control/Safety Fences must be installed prior to beginning work) Project Name/Location or address Te14- U L'r GMs 1: Ii iii Ter-1.e >wtrc ° General Contractor Contact # Email address to return approved permit ,. Representative: t ` l< f t e/I1 05 Telephone#: 24 'g 2 Emergency#: t ' — g Email address: '- 7A +► ° (for contact if needed/if email of approved permit is desired/permit cannot be emailed unless complete) Utility Company Represented: Oncor Electric Delivery 0 Atmos Energy 0 Verizon 0 AT&TISBC 0 Time Warner Cable 0 Time Warner Telecom 0 Other General Description of Work(in accordance with Ordinance 001-944) Provide 1 set of prints. ,/V-T 0 leg fdevi ? FOettlt. 't'l / ae 4Z> '� vereti 77 t`PL..t,°,,r C A)vot ri 5t- tikes, 1 mere (7(1(.5 � s , � rc eo r. , Esttfnated Mart Date Estimated Completion Date* � * in letton�rerltnre3 tnspe icon at d ubmlttal of 0514)1e-6(4 Verification Notice(page 4) *Was City Utility Dept. conttet d to locate ext n underground utilities? Yes No MI If not, reason 40ev r P+tj ' J GfC-3 -ef) Ira- R 5._ .t?f_ rG ),.,t. iIs removal of existing streets, alleys or sidewalks necessary? Yes ' 11 No if Yes,project nuts!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 Unifortn 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. fa. 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 gif 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. AT. Attach the Franchise Work Order(if applicable)and I set of prints showing the proposed worlc. r Locates tor gusting franchise utilities must be done 48 hours prior to beginning work. For City utility 972-462-5155 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 enuineer(Acoopelltx.aov. lip nt the approved permit returned via email,provide a valid email address on Page 1. <14:I If winnot be es • equired signatures are present. Xizg Are1,14.3 ,49 27-7i _.„-- Signat of tit'`ty Com 510r'epresentative Primed Name Date ieier fr3xvfoj Z7 - 1$ Signature of Contrac or t.- -sentative Printed Name Date •••••4■ CiA414. errts-iir__ i st:na u!ilin'ty Representative Printed Name Date [4> COMMENTS: NOTE:Notify Engineering Dept. at 972-31M-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 indemnify 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 Map Map _: :. . _ I.:,-;:, ,: r.--,,,,,,:111,1?1,-.r..t 7.:!-:*. '-, ..,_ ''.-7-- '''...:,:-. ...t.-1. : . ' ' '-'` ' , ,r,„.:::,,,,,,. •,,,'...': . - .. * AetZ r ,i',',",".;-","",",""fr . 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