Duke Freeport- PT160331T H;. C I T Y O >r
COPPELA "e- -,4 W -L
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicant bud Cun4,ci#w ilii led Date Submitted 3 Z�' I
Address of Applicant 1112W (100 s itwy, 5u/!e
X
Phone Number Iq%z' 3101 — (p 7ZJ6 Fax Number 7 7Z - :%1- 6 �
Location of Construction (address, if available): 620 5. ft` i-+ i`k1un %�roj
Subdivision UJR r ° "n Section # "— Block # Lot //
OR Survey/Abstract 11 Acreage
Location description (attach vicinity map): NE cu mer 0� mfetwchwi off' Whel L6
10
2.
Type of proposed construction or development:
C Residential C' Alteration of a natural waterway drainage course
P11% Non -Residential C Other (describe & attach drawing or sketch)
C' Placement of Fill (in right-of-way or on private property)
Description of Construction Permit requested:
Paving 'fa Median or Landscape
[� Sidewalk Water Main
Drive Approach R.C.P.
[ ' Excavation %Sanitary Sewer Main
Fire Lane ❑ Flume
❑ Bridge 0 Inlet
❑ Box Culver:
❑ Rip Rap
0 Fill Area
❑ Drainage Channel Excavation
❑ Slope Protection/Retaining Wall
A 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: $3Z _ _ Date Paid:
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 Appli t
Signature of Inspector
(-7-1 � 67`16 30 )
Contact Number
Z t qO6 5Z2
Contact Number
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? c Yes (X No
If YES, a Floodplain Development Pennit 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 No
l' PERMIT APPLICATION APPROVED f PERMIT APPLICATION DENIED
'City Approval 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 H a• e t T T• o F Page 3
COPPEL ' L
INSPECTION FEE CALCULATION SHEET
Project Name 1 Date 1 3/2"
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:
Paving
PUBLIC IMPROVEMENTS
CONTRACT AMOUNT
° _
hd`/°
PRIVATE IMPROVEMENTS
K2°°
✓� �!
`l �% (U
ICJO/NTRACTAMOUNT
_l (pLw
� / 2, yt�
Water I
51 �g
2 i�• y0
1�7$��
��11t0. 3�
Sanitary Sewer
13512Z2-
2ZZStorm
StormSewer
f V
371 765
21 X% 30
Alleys
NA
N l!
0
/ j/+
Sidewalks
(�'
17YZ, zy
311W
7bZ 80
Other
I V A
14
N#
A
Total
i 3 zzg.N
I-5 pV j� zy
Grand Total (total of� I �j Q�O`
both colored fields) Q Q
cn Fe hr La o �9, 2a6.
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