Level 3-PT150317Right- of -Wav Use Permit Application pane 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
applicant's expense) and barricading according to the Texas Alanual 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). To schedule Public Works final inspection (Page 4) call 972- 462 -5155.
.--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. until3:30 n.m. ONLY unless otherwise approved by City
Engineer.
âś“Attach Work Order (franchise only) and /or 1 set of prints showing proposed work.
The application with signatures of Franchise and Contractor representatives must be submitted to Engineering
Dept. for approval prior to beginning work. Submittals by e-mail should go to engineer(opcoppelitx.gov.
Printing your name indicates your acceptance of the terms and conditions of this form;
(if you want the approved permit returned via e-mail, provide a valid e-mail address on Page 1.)
Signature of Utility Company Representative Date
ulvey
Signature of Contractor Representative
Signature of City Representative
Comments
Pothole 12" Water line crossing.
Date
17 March 2015
Date
>NOTE: Notify City Inspector at 972- 304 -3679 prior to beginning work and prior to
backfill for concrete, trench, ditch and open pit inspections. Backfzll 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 ~vary 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.