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Date of Submittal: 1 0- — 13 Applicant's Job#!Work Order# 3 Z o ( q 0
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?
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EMAIL ADDRESS FOR SUBMITTAL: enineer(alcoppelltx.gov,
Q Plans provided and approved?(Erosion Control/Safety Fences must be installed prior to beginning work)
on
Project Name/Location or address f Rc M LOt tSl rcS
General Contractor Contact#
Email address to return approved permit
w Representative:
p Zbf x Emergency#: ' 61'2.4,(- Sr2 3
Telephone#: e— ,!�
g o Email address: ki C K • l e-tel.` t oh1 �a/,�, <p VII
(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&T/SBC
0 Time Warner Cable 0 Time Warner Telecom 0 Other
�► eral Description of Work(in accordance with Ordinance 2001-944) Provide 1 set of prints,
It - 3 4,14-A t.. 040,344g To <1„sirotvvas it3D MRAwr '?;t' NS/roemG
Estimated tar Ate .RM" 3
Gom tetion requires�l is ectiuI1 a lZ ii ntnpkt n�e1ritiea�tiott Notice(page 4)
*Was City Utility Dept.contacted to locate eliisting underground utilities? Yes No IT
If not,reason 61 ►T $ If(.7( &' t?ke.-5,tb ' l7ftcN 4BFfoLt s
5Thievr op c 0 3 rgu
Is removal of existing streets, alleys or sidewalks necessary? Yes I I. No ' JI
if Yes,project rust have City inspection prior to concrete replacement.
Right-of-tray 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
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.
,t 7 f.1)cates far wash tg franchise uhirtzes usk e dne4$hhours pri r to begtmmpg work
"or ityutilt igcaies,call 9 2462 o scler ule 48 hours prior to begninnng work.
1:, s . � s ... w ry .. . . ..,.
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 cccoppelltx.gov.
yo want the a••roved e mit returned via email,provide a valid email address on Page 1.
f e nnot .ss equired si;natures are present.
lir l j_ r f f ty
at e of Utility ,;,.t presentafi -_ rinted✓Name Date
frfc74
Signature of C•ntr. : ' 411.sentative Printed Name Date
'11214411111 kt l-EL a 2u& 1°I Li•
gn;'u : • t'ty Representative Printed Name Date
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 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.
ONCOR ELECTRIC DELIVERY SAFETY HANDBOOK
SECTION 9—Work Area Protection Revised 7/06/2007
, - -
NOTES:
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