Deli- PT150716CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicantjj
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Address of Applicant I 7l7 -i> /() - l -y/vw —r-.,� '7x5O i i
Phone Number 73q ',3gOgf Fax Number
Location of Construction (address, if available): W ` O�cf
Subdivision Section # Block # Lot #
OR Survey/Abstract # F Acreage
Location description (attach vicinity snap):
1.
N
Type of proposed construction or development:
(' Residential Alteration of a natural waterway drainage course
tG"'Non-Residential C' Other (describe & attach drawing or sketch)
Placement of Fill (in right-of-way or on private property)
Description of Construction Permit requested:
Paving [Median or Landscape
R'Sidewalk [Water Main
E Drive Approach VC7 R.C.P.
Excavation Sanitary Sewer Main
7 Fire Lane Flume
Bridge 7v' Inlet
F Box Culvert
Rip Rap
Fill Area
Drainage Channel Excavation
[-] Slope Protection/Retaining Wall
F] 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: $ Date Paid:
NOTE: A separate excavation permit is required anytime pavement is cut or when there is ivork in the
fight -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 yo r name indicates your acceptance of the terms and conditions of this form:
Sign ture of Applicant Contact Number
(044clv�) Fly
Signature of Inspector Contact Number
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? C, Yes C No
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional 'information required? C Yes C No
Are other federal, state, or local permits required? C Yes C No
*PET PPLICATION APPROVED C PERMIT APPLICATION DENIED
1 Date
Applicant shall indemnify andforever 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.