E. Belt Line @ Ledbetter Rd/Coppell TX T H E c $ T Y ' O F Pagel of 4
COPPELL
6 pip fl DRY BORE/STREET CUT SAW CUT PERMIT APPLICATION
RIGHT-OF-WAY/EASEMENT
Submit permit application to the Engineering Dept.,Town Center,255 Parkway Blvd.or by e-mail to engineer @coppelkx.gov(see button below)
Date Submitted:0 2-0 3-2 014 Work Order#(if applicable)
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Ei Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name/Location: E. Beltline Rd @ Ledbetter Rd.
Company Name: Explorer Pipeline
Address:PO Box 2650 Tulsa, OK 74101
Telephone#:918-493-5100 Emergency Telephone#:918-493-5100
Permit issued to(Contractor Name) Bobcat Contracting
Utility Company Represented:
C Oncor Electric Delivery C Atmos Energy C Verizon C SBC/AT&T
C Time Warner Cable C CoSery Electric/Gas (i Other* IFvninror Pinolino
*If"Other"Is checked,please note that franchise or right-of-way use agreements will be required.
General Description of Work(provide copy of approved plans):
Dig up existing 12" Pipeline in beltline Rd to check for a pipeline defect
➢Was contact made with City and/or utility companies to locate existing utilities?
if NO,Reason: Yes (: No C
>Is removal of existing streets,alleys,or sidewalks necessary? Yes (i No C
if YES,must have City inspection prior to concrete replacement
A COPY OF THE APPROVED PERMIT MUST BE ON THE JOB SITE AT ALL TIMES.
Dry Bore/Street Cut/Saw Cut Permit 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 applicants expense)and barricading according to the Texas Manual on Uniform Traffic Control Devices. Area(s)
affected must be restored to as good condition as before the commencement of work (grading, drainage,
vegetation,and erosion control).
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department @ 972-304-3600
Fire Department @ 972-304-3512
Street Department @ 972-462-5150
Engineering Department @ 972-304-3679
:.Attach barricade plan/trench safety plan if a lane or street closure is required.
NOTE: Street closures are allowed from 9:00 a.m.until 4:00 p.m.ONLY unless otherwise approved by City
Engineer.
➢Attach Work Order(franchise only).
Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of
work.
Printing your name indicates your acceptance of the terms and conditions of this form:
Brian Dedeke 02-03-2014
Signature of Utility Company Representative Date
David Latimer 02-03-2014
Signature of Contractor Representative Date
Digitally signed by Michael Garza 2/4/2014
ou,
Michael Garza DN:email=cn=Micmgarza@coppehael Garza,o=City
ll:goof Coppell,,c US=
Date:2014.02.04 16:48:23-06'00'
Signature of City Representative Date
(Application with signatures needs to be submitted to the Engineering Department before approval.)
ot
➢Comments: 6,L)C 4' -'T- rfN"K Tt4O,' Y\ (O6)-51 to 'S I
>NOTE: Notify City Inspector at 972-304-3679 prior to beginning work and prior to backfill for concrete,trench,ditch and
open pit inspections. Backfill must meet all construction standards approved by the City of
Coppell.
Applicant shall indemnify and forever hold harmless against the City of Coppell each and every claim,demand or
cause of action that may be made or come against it by reason of or if any way arising out of the closure,blocking,
excavating,cutting,tunneling,or other work by the applicant under permit from the City,if such permit is granted.
T H E I Y - 4 F Page 3 of 4
COFFELL
ti.
k 5
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS-OF-WAY OR EASEMENTS
Listed below are minimum requirements for utility relocation projects:
1.A copy of the valid approved City of Coppell permit is required on the project at all times.
2.Notify adjacent property owners(commercial&residential)of project timeline;provide them with contact
names and phone numbers.
3.Proper erosion control measures must be taken.
4.Follow Texas MUTCD standards for work in traffic zones.
5.Sod is to be replaced when necessary.
6.Irrigation repairs must be performed in a timely manner.
7.Follow OSHA recommended trench safety at all times.
8.Repair existing utilities that are damaged,including but not limited to clean-outs,water valves,and SS
manholes.
9.Densities may be required in trench lines(ASTM).
10.Care and repair of street signage is the responsibility of the contractor.
1 1.No work is to be done in collector roadways before 9:00 a.m.or after 3:00 p.m.
12.Prior notice of work activity on weekends and holidays must be in writing.
13.Line locates must be performed in advance by contacting-
CITY OF COPPELL UTILITIES DIVISION coppelltx.gov/utility-operations-division
972/462-5155
CITY OF COPPELL ENGINEERING DEPT.
972/304-3679
HOMEOWNER ASSOCIATIONS
972/304-3678(Planning Department)
TIME WARNER CABLE FEDERAL EMERGENCY MGMT.ADMIN.
214/320-5433(Phillip Gwin) 940/898-5138
AT&T LOCAL NETWORK TEXAS COMM.on ENVIRONMENTAL QUALITY
214/215-3031 (Rich Milleman) 817/588-5800
COSERV Gas&Electric DENTON CO.LEVEE DISTRICT
940/321-7800 x7624(Greg Ward) 214/352-5118(Richard Hightower)
EXPLORER PIPELINE Atmos Energy
918/493-5100(Patrick Nwakoby) 972/360-4428(Gary Dickinson)
ONCOR Electric Delivery
972/323-8917(Larry Redick)
VERIZON COMMUNICATIONS 1800 DIG TESS for line locates
972/318-5277 (344-8377)
14.Contaminants must be removed from work area daily and disposed of properly outside the City.
15.Streets,sidewalks and alleys must be kept clean of construction material and debris.
16."Clean-up"requires returning work area to pre-project condition or better.
Contractor is required to contact Public Works Division for Completion Verification Notice.(see pg.4)
T H E G ! T Y t3 F
COFI'ELL
UTILITY RELOCATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Contact City of Coppell Public Works Division at 972-462-5155 to schedule an
inspection with Utility & Streets personnel to verify that your project has been
completed to City of Coppell specifications. Failure to schedule verification inspection
may delay future projects.
Franchise Utility Name Explorer Pipeline
Project Location /Applicant's WorkOrder#of applicable)
Beltline Rd. @ Ledbetter Rd.
Sub-contractor Company Name Bobcat Contracting
24 hr.Contact Number 817-805-2990
Date of Verification Appointment
Time of Verification Appointment
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PERSONNEL
❖Inspected by of Utilities Maintenance Division on
and found to be acceptable/not acceptable because
Follow-up needed?C'Yes C No Follow-up scheduled for
❖Inspected by of Streets Maintenance Division on
and found to be acceptable/not acceptable because
Follow-up needed?r Yes C No Follow-up scheduled for
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A copy of this completed notice can to be provided to the address below
or e-mailed by using the button below:
City of Coppell Engineering Dept.
255 Parkway Blvd.,Coppell TX 75019
Office:972-304-3679 Fax: 972-304-3570
Submit by E-mail Print Form
1 CC
N RA NOT S "s'' N al
I THE CONTRACTOR IS RESPONSIBLE FOR MAINTAINING ADEQUATE SITE DRAINAGE THROUGHOUT TIE y
DURATION OF THIS PROJECT. il 0 1
THE CONTRACTOR IS RESPONSIBLE FOR OBTAINING AL Fj re ff
2. APPROVALS BEFORE CONSTRUCTION GINS. L NECESSARY PERMITS AND a?
1. THE CONTRACTOR IS RESPONSIBLE FOR MAKING HIS OWN DETERMINATIONS AS TO THE TYPE `1 ry i
AND LOCATION OF UNDERGROUND ITIUTIES AND OTHER UTILITIES AS MAY BE NECESSARY _ J
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TO AVOID DAMAGE THERETO. CIA ":= VJ::'I'F
a THE CONTRACTOR STALL NOT PLACE FILL OR WASTE MATERIAL ON ANY PRIVATE PROPERTY WITHOUT PROJECT R
PRIOR WRITTEN PERMISSION FROM THE PROPERTY OWNER AHE OWNER. EXCESS EXCAVATED LOCATION
44 POyk Oq
MATERIAL SHALL BE DEPOSITED IN LOW AREAS OR MONO NATURAL AGE WAYS THAT WILL
RESTRICT THE NATURAL FLOW OF WATER. IF THE CONTRACTOR PLACES EXCAVATED MATERIAL IN LOW ''
THAT WILL CAUSE FLOOD DAMAGE,HE WILL BE RESPONSIBLE FOR ALL DAMAGE RESULTING N — BLLTLINE RD. t d
SUCH FILL.AND HE SHALL REMOVE THE FILL AT HIS EXPENSE
ET
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5 CONTRACTOR SHALL CONTACT 1 AN0-DIG AT (SDI-BSJJJ AND CITY OF COPPELL PUBLIC
WOR KS DEPARTMENT PRIOR TO ANY EXCAVATION. n li ..e
b 6 THfCONTRACTHALL BE RES E FOR PUBLC SAFETY DUR NG CONSTRUCT ON AND WILL TI STRUCT BARRRICA ONF W O \ON STE NS C RCAOES SHALL BE IN CONFORMANCE WTN THE TF%AS M
7. DURING CONTRACTOR SHALL KEEP EXCAVATED TRENCHES FREE OF U1IUZWATERAO0 OTHER WATER "THE NG COCONTR TON IF NECESSARY.THE CONTRACTOR SHALL UT THAT IT DEW TER NC PROCEDURES IN ,¢ Lt
ORDER TO CONTROL GROUNDWATER DURING CONSTRUCTION SUCH THAI T DOES NOT AFFECT HIS RT' ._
CONSTRUCTION WORK.(NO SEPARATE PAY ITEM) #P-_ =° ._
0. THE PROTECT TORE ISORESP ONS BLE DEBRIS EFROMG STREETS.PARKING AREAS,SIDEWALKS,ETC.,ADJACENT TO
LOCATION MAP
B. LL ASSUME RESPONSIRRITT FOR PROTECTION OF ALL UTILITIES IN THE
,xE DoHRR.GTOR BHA
CONSTRUCT ON OF TH B PPOJECi
1D. CONTRACTOR IS CAUTIONED THAT ONE CALL LOCATES UTILTES THAT SUBSCRIBE TO THEIR SERVICE ONLY. -- - -' ° _
CONTRACTOR IS RESPONSIBLE TO CONTACT NOTED UTILITY PROVIDERS IN THE AREA DIRECTLY IF THEY - + �� __
ARE NOT LISTED AS RESPONDING TO ONE-CALL. �'(- 3x d R <.10
11 ALL I BOR TO BE PERFORMED IN ACCORDANCE WITH ALL APPLICABLE AND LATEST OSHA STANDARDS. ... �: u�4
INCLUDING BIIT NOT L NRED TO TRENCH SAFETY ' s v.- V
12. CONTRACTOR SHALL AVOID MANEUVERING MACHINERY AND EQUPMENT ON„AVER SURFACES IF IT BECOM[5 'w' .,,�, - +
NECESSARY,CONTRACTOR SHALL TAKE NECESSARY MEASUREATOGEENSURE NO DAMAGE THE TO THE ��' ...o._,. .o.,.�„�,� '`�`.A_.._ --.,. '+ •+A° « •
PAVEMENT. CONTRACTOR IS RESPONSIBLE TO REPAIR ANY HE CAUSES TO SATISFACTION F THE r
CITY 3 ! , •"".A^'+ywwi.. . -..
11. CONTRACTOR SHALL NOT LEAVE ANY TRENCH OPEN OVERNIGHT.IF IT BECOMES NECESSARY TO LEAVE TRENCH b, x ,,, ,, , ,
OPEN OVERNIGHT IT SHOULD BE PROTECTED WITH STEEL PLATING,CTBf OR APPROVED EQUIVALENT. r �r r f
-=n sr.#�„ UAW:
f
IN PLACE PRIOR START OF CONSTRUCTION,AND m? ' `
1 ALL RE WARY EROSION CONTROL MEASURES SHALL BE "' ^p;-4°°.1TCN F/L MS v rts
1 MUST RE INSTALLED IN ACCORDANCE WITH MANUFACnRER'S SPECIFICATIONS. .. A P E 1 _
15. TEMPORARY EROSION CONTROL MEASURES SHALE BE INSTALLED USING BEST MANAGEMENT PRACTICES 3 TB� . _ L
AND T MANNER TO PREVENT CONSTRUCTOR RELATED SEDIMENT TO FLOW DOWNSTREAM INTO $.;� J ,"rC ;>
W 5 { 'A - �*
16. TE M ON CONTROLS SHALL BE INSPECTED AHD NA NRA Nf0 SUCH TO INSURE THEIR INTENDED ;" R° R'.
PERT E , .. O.
NOTIFY CITY INSPECTOR AT DITCH PRIOR TO BEGINNING WORK AND PRIOR TO BACKFILL 1 ,q.4%µ " "A„'
'J DiCH AND OPEN P1 INSPECTIONS.BACKFLL MUST MEET ALL CONSTRUCT ON E `' 1 `^-�'N gd 'q �2 z>
FOR CONCRETE,TRENCH. „a a ,, ,:} J 410• r
STANDARDS APPROVED BY THE CRT OF COPPELL wswnu
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CONCRETE PAVEMENT PER CITY� _ TON
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STANDARD IST LS 7032717.00 10 ==4 UJ
REFUGE TOE 2110JB51a Yi
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2D DATE JANUARY 20
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