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",r4Stibmit Permit application to Engineering pept4.Town Center,2z -.Parlovay Blvd.Coppell TX 7b019
Date of Submittal: 12 /9-13 3,,,9 47(4
Applicant's Job#/Work Order# 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? Y /0
EMAIL ADDRESS FOR SUBMITTAL: engineerritecoppelitx.sav_
(2:1 Plans provided and approved?(Erosion Control/Safety Fences panit be installed prior to beginning work)
Getti t„, .J.L. r.D, 1J1- .017 4,09act+.4 lc
Project Name!Location or address.„,ge-Lftiomr /-40)1P6- P810c041-4' Olfeekleo 0 rolAPPOZ‘flemPID
General Contractor Contact# - -
Email address to return approved permit - -
w 4.1.- Representative; ( I'?g r.eiti.tn,
Telephone#: 40-24i- 2.5 C Emergency#: 4Cq-,261.- 5-2..4'5-
Email address: Pe6(<r Fi7elit.1.‘5e0Ate.og.6001
(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
Gecral Description of Work(in accordance with Ordinance 2001-944)Provide 1 set of prints.
Vg' o 'e 3 751 OF 0 Vete 4ei4o c----t. e...rie,'6 ..f. i epie.,
N$111..et(.g g e
vi eo,
cir," teloiga6t20 up,0 Olvritz five
t aritj zi' #1-r EA5e6-16,07-,
t inafS,.,,1,ta,,,qr---4--i, at-:,e., ttl::.i,4 u4" 'ima e c oppieio De* 02
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Completion reU ;inspection su,nittn1, eovm-pifioi Veilea+ion NOfe,(page )
•
t*AVas City Utility Dept. contacted to locate existing underground utilities? Yes D No MI
If not, reason 1„.aelt,t1-6.5 Witt ge feem ,r(b 48 i-kttA l'A..4Pez
're? 9rfiiti- i?r•-• 62-PS'riZt4.4,rtov,
tis removal of existing streets, alleys or sidewalks necessary? Yes ® No)41
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.
et 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 MM.ONLY unless otherwise approved by City Engineer.
It. Attach the Franchise Work Order(if applicable)and 1 set of prints showing the proposed work.
6aies-f&existing fAnclnse tihti mit be doi?e 48 hours prior tO-Pegintting work.
6iti'iiiiiil,iiii444,5iMik :i4iiiik48 i9iii- -iiirii'i)pgi4iiing 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 enaineer(ikoppelltx.zov.
,,,..
* If . I want the approved per*,'.. eturned via email,provide a valid email address on Pagel.
<7-1
'ermit la"se mailed unless• required signatures are present.
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I 40/ ' 44 /2' 13- (.7
Sig at of Utif y Corn.- Representative *rinted Name Date
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oer- . I K gehf; i7 102- tg-13
Signature of Con ract. ' -presentative •rinted Name Date
444 -
fart 0e-ii_ ces,._ latipio
S ::n7.,7111111 ity Representative Printed Name Date
COMMENTS: 411t.
(PhSAk. (fa 4A/ Atieciedji IC .,0/611,1
NOTE:Notify Engineering Dept at 972-304-3679 prior to beginning work and for open trench,ditch or pit
inspection prior to btzekfilling. Backfill material must meet City of Coppell standards.
Applicant shall indemn andforever 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 ow of the closure, blocking,
excavation,cutting, tunneling, or other work performed by the applicant under permit from the City, if such permit is
granted
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