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Old Town Phase 3- PT151022 (2)A copy of the approved permit must be on the job site at all times. CC: Applicant Y K s- C e Y Y - OF Page 1 of 4 Public Works COFFELL Permit File Rev. ©6/2012 x �+' ; Orig. to Project File 6 RIGHT-OF-WAY USE PERMIT APPLICATION Permit valid for 90 calendar days from date of approval Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd. or e-mail to engineerc&coppelltx.gov {see button below) Date of Submittal: ' _' Applicant's Job # / Work Order #.32q4340 PERMIT FEE: $100.00 (No charge to Utility Companies with approved FranchiseIROW Use Agreement) Refer to the City of Coppell Ordinance No. 2001 - 944. Certificated Telecom Provider? Yes (_ Nax F Plans provided and approved (Erosion ControllSafety fences must be installed prior to beginning work) Project Name /Location or address 3 ' S }r [r, f - g, j�m~ o srizewr. General Contractor Contact # E -mail address to return permit 'GK , Irl�l +V1 olyeotz. df�Q Representative: Telephone #: -261,57- ec E -mail address:t` (for contact if needed /if a -mail of approved permit is desiredlpermit cannot be e- mailed unless complete) Utility Company Represented: `Oncor Electric Delivery f Atmos Energy C Verizon C SBCf AT &T (- Time Warner Cable (- CoSery Electric /Gas f- Other General Description of Work fln accordance with Ord. No.2001-9441: PLEASE ATTACH PLAN OF PROPOSED WORK Po Ve Estimated Start Date + ,I Estimated Completion Date* aG ! ► hr * Completion requires submittal of Completion Verification Notice (see page 4) r Was contact made with City and/or utility companies to locate existing utilities? if NO, Reason: Lo f ) i+V ( j i� C � + � �,► t� of OF rIs removal of existing streets, alleys, or si ewalks necessary. if YES, project must have City inspection prior to concrete replacement C Yes 010 No C Yes (1 No Ri ht -of -Wa • Use Permit Aimlication Pa e 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 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). 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. 344 -3600 Fire Department @ 972- 304 -3512 Street Department @ 972 -462 -5150 Ebgineering Department @ 972- 304 -3679 YAttach barricade plan 1 trench safety plan if a lane or street closure is required. NOTE. Street closures are allowed from 9: 00 a.m. until3:30 p.m. ONLY unless otherwise approved by City Engineer, ➢Attach Work Order (franchise only) and/or 1 set of prints showing proposed work. Locates for existing franchise utilities must be done 48 hours prior to beginning work. For City utility locates, call 972 - 462 -5155 to schedule 48 hours Prior to beginning 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 @coppelltx.gov. PrintjiVyour name in�rerm t ceptance of th rnvs and conditions of this form: (if y ttlie ap u it r ed vi , provide a valid a matt ad /dress on Page i.}J Signature of Utility CofiWy Representative Date lo- r- 1 Signature of Cont actor presentative Date Gc9 � 22 October 2015 Signature of City Representative Date Comments ➢NOTE: Nom City Inspector! at 972 -3114 -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 clgitn, demand or cause of action that may be trade or carne 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. Page 3 of 4 COPPELL r # A x UTILITY RELOCATION CHECKLIST FOR WORK WITHIN CITY OF COPPELL RIGHTS -OF -'WAY OR EASEMENTS Listed below are minimum requirements for utility relocation projects: LA, 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.hTigation 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. 13.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 -1 800 DIG TESS and/or the following: CITY OF COPPELL UTILITIES DIVISION o- el� ltx.gov futility - operations - division 9721462 -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 -5455 (Mike Rasmussen) 940/ 898 -5138 AT &T LOCAL NETWORK TEXAS COMM. on ENVIRONMENTAL +QUALITY 214/ 215 -3031 (Rich Milleninan) 817/ 588 -5800 COSERV Gas & Electric DENTON CO. LEVEE DISTRICT 940/ 321 -7800 x 7624 (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 1 800 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. 17.Contractor is required to contact Public Works Division for Completion Verification Notice. (see pg. 4) T w IC - c i T v: o _f Page 4 of 4 COPPELL 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 Project Location / Applicant's Work Order # cif appficableJ, Sub - contractor Company Name 24 hr.Contact Number Date of Verification Appointment Time of Verification Appointment INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PUBLIC WORKS PERSONNEL •: *Inspected by of Utilities Maintenance Division on and found to be acceptable / not acceptable because Fallow -up needed? C Yes (-No Follow -up scheduled for •: ►Inspected by of Streets Maintenance Division on and found to be acceptable / not acceptable because Follow -up needed? (- Yes C` No Follow -up scheduled for A copy of this completed notice can be provided to the address be or e- mailed by using the button below: City of Copper Engineering Dept. 255 Parkway Blvd., Coppell TX 75019 Off ice: 972-304-3679 Fax: 972 -304 -3570 Submit by E -mail I I Print Form .~.-~.'�......~.. .^.......,~...~.�.....-`,� � ...-~....-,.._.~~~- ^^^~^^^^^^~-^^'`~^^- ' - ^^^~~ ^...~~^-^^^^^-^' ' ..°^�:.................. ' l `- - -- -H9 .�."...........~...... ' ~ �.~~....'~/... _.��` ,.~, \ by \6U6TO M�� / [ ! � ICU Lf mtloQ 391G 131 :CIO -36644 916640 p 6�360019 '%G1104 La P a 0) 3916743 rm lull- B 50 god we / &LY _-. 13� mmu/ 0 �� �a�_ °°w N' | ^^^-'~^-`---- ' ~'^~-`^^^~^^~..~'v- 7 ............ | / ^~~....~..~.,.....~. g ~ ' .� .. � � ~�' ��� � 85 ~~ ��~� ° [W 39IG571 '1m0mo ~mmmwo� '30�mm 5X INO 460 y\ 6f 1,T CKf 6OUK66 LOGkr�O Nw GOR��� MAIN �� �'ovNc. °� °� H� .� ~- _ ---1 �� | -=°"°"` � .� � ' R \ , ^ , , --lPJ| ��W, ��� j '3�15 ELECTRIC C, HOP IWO-UP1114 Oplolf owf umu (a