Park West Lot 1 Blk 3R-PT150624T M a - C I T V - a F
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CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicant S►'ti %, �, R.G,�pNE, Date Submitted V!s
Address of Applicant
Phone Number Fax Number otW
Location of Construction (address, if available): Isov�t'KwFS"�2N—E L6 .
Subdivision es;- Section # Block # 3'CZ, Lot #
OR Survey/Abstract # 1 ZClAcreage 5z: -
Location
Location description (attach vicinity map): Sou - K COT
1. Type of proposed construction or development:
C' Residential C' Alteration of a natural waterway drainage course
C Non -Residential C' Other (describe & attach drawing or sketch)
C' Placement of Fill (in right-of-way or on private property)
2. Description of Construction Permit requested:
❑ Paving
❑ Median or Landscape
❑ Sidewalk
❑ Water Main
❑ Drive Approach
C.P.
❑ Excavation
❑ Sanitary Sewer Main
❑ Fire Lane
❑ Flume
❑ Bridge
❑ Inlet
Box Culvert
Ca -*'Rip Rap
❑ Fill Area
Drainage Channel Excavation
❑ Slope Protection/Retaining Wall
❑ Parking Lot
Provide an attachment containing the name and 24 -hr. contact phone number
of supervisor(s) for every contractor working under this general permit.
3.All construction shall be in compliance with, but not limited to, the City of Coppell Subdivision
Ordinance, Standard Construction Details, Streetscape Plan and approved plans. The
contractors shall adhere to the City's Erosion Control & Sedimentation Ordinance.
4.Applicant shall provide a copy of approved plans, specifications and the related cost estimate or
contract for the purpose of permit fee calculation verification.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Page 2
5.A Construction Inspection Permit Fee shall be paid prior to beginning work, in accordance with
the City of Coppell Fee Ordinance. See Page 3 for calculation formula.
Amount Due: $—I C.- , 4 Date Paid: -Po r we ' 02) Ka�nf-4G–
NOTE: A separate excavation permit is required anytime pavement is cut or when there is work in the
right-of-way not approved by the City Engineer.
➢Any work requiring closure of a lane of traffic, street, or alley must be approved in
advance by the Engineering Dept., with notification to the following prior to
closure:
Police Department @ 972-304-3600 Street Department @ 972-462-5150
Fire Department @ 972-304-3512 Engineering Dept. @ 972-304-3679
➢Attach barricade plan / trench safety plan of a lane or street closure. (Required)
➢It is a requirement of this permit that As -Built Drawings be turned in at the end of
this project. As-Builts consist of 1 set full size paper copy, 1 set full size mylar and a
CD with Autocad.dwg files.
NOTE. Street closures are allowed from 9:00 a.m. until 3.30 p.m. ONLY
unless otherwise approved by City Engineer.
➢A pre -construction meeting is required prior to beginning work related to this permit.
Contact the inspector assigned to your project to schedule the meeting.
Printing your name indicates your acceptance of the terms and conditions of this form:
Signature of Applicant
I vl *Z1,✓.1 ,M A --Pi . n
Signature of Inspector
aA- ==-�—\�-7
Contact Number
Contact Number
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? u C No
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional information required?
C' Yes kio
Are other federal, state, or local permits required? C Yes �( o
P RMIT APPLICATION APPROVED C PERMIT APPLICATION DENIED
City Date
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 N R- c I T"Y O F Page 3
COPPELL
A ?, 't
INSPECTION FEE CALCULATION SHEET
Project NameAQ�L�nJcs; �MMc�C� Date
As per the City of Coppell Subdivision Regulations, the Developer shall pay 4% of the cost of the items to be permitted and inspected by
the Engineering Department and dedicated to the City. The Developer shall pay 2% of the items to be inspected by the Engineering
Department, but not dedicated to the City such as parking lots, private utilities, private drainage systems and so forth. Inspection fees are
due on or before the date of the Pre -construction Meeting.
In order to verify the inspection fee due, please provide a copy of the development contract(s) and this spreadsheet with
completed calculations to the Engineering Dept. The contract(s) should indicate the cost to construct the following
improvements:
Grand Total (total of
both colored fields) i
Submit byE-mail Print Form
PUBLIC IMPROVEMENTS
CONTRACT AMOUNT
X/0 ° _
PRIVATE IMPROVEMENTS
CONTRACT AMOUNT
° =
X2%=
Paving
Water
Sanitary Sewer
Storm Sewer
1O/�`�1
Alleys
Sidewalks
Other
Total
Grand Total (total of
both colored fields) i
Submit byE-mail Print Form