Frontier-PT160812A c 3W cPF the aF1 rcR#ed perr rit mast be an ti-tejab site at all firrms.
CC: Applicant
Public Works
Permit File
Orig. to Project File
T N a • C 1 T Y • O F
COFFELL
r
Page 1 of 4
Rev. 06/2012
RIGHT-0F-VIAV USE PERMT 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 engineer@coppelltx.gov (see button below)
Date of Submittal: 08/12/2016 Applicant's Job # / Work Order # damage 123 E SANDY LK
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Yes C: No C'
❑ Plans provided and approved (Erosion Control/Safety fences must be installed prior to beginning work)
Project Name/Location or address PHONE LINES DAMAGED AT 123 E SANDY LAKE RD, COPPELL
General Contractor HENKELS AND McCOY Contact# 214-507-1722
E-mail address to return permit william. jezewski@ftr. com
Representative: GREGORY MICK
Franchise Telephone#: 972-318-5277
Company:
E-mail address: gregory. . n. mick@f tr. . com
(for contact if needed/if e-mail of approvedpermit is desired/permit cannot be e-mailed unless complete)
Utility Company Represented:
• Oncor Electric Delivery C Atmos Energy C Verizon C SBC/ AT&T
• Time Warner Cable C CoSery Electric/Gas (* Other FRONTIER COMMUNICATIONS
General Description of Work (in accordance with Ord. No. 2001-944): PLEASE ATTACH PLAN OF PROPOSED WORK
FRONTIER PLANS TO DIG UP DAMAGED PHONE LINES AT 123 E SANDY LAKE RD. LINES WERE DAMAGED BY ROAD BORE MADE
BY WATER LINE CREW.
Estimated Start Date 08-12-2016 Estimated Completion Date* 09-12-2016
* Completion requires submittal of Completion Verification Notice (see page 4)
➢Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: EMERGENCY UTILITY REPAIR (' Yes C NO
➢Is removal of existing streets, alleys, or sidewalks necessary? Yes C No
if VES, project must have City inspection prior to concrete replacement
Right-of-Wav Use Permit ADDlication Paae 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.
Areas) 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. until 3:30 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.
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.)
GREGORY MICK '10-12-2016
Signature of Utility Company Representative Date
STEVE FORSYTHE 10-12-2016
Signature of Contractor Representative
Signature of City Representative
Comments
Date
�Jl' 12 -16
Date
➢ NOTE: Notify City Inspector at 972-304-3679 prior to beNotifpCity Inspector at 972-304-3679 prior to be inningwork 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 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 M s • c l r Y.—* -p Page 3 of 4
COPPELL
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS-OF-WAY OR EASEMENTS
Listed below are minimum requirements for utility relocation projects:
1.A 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.
Urrigation 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.
11.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 - 1800D/G TESSand/or the following:
CITY OF COPPELL UTILITIES DIVISION coppelltx.gov/utility-operations-division
972/ 462-5155
CITY OF COPPELL ENGINEERING DEPT.
972/304-3679
HOMEOWNER ASSOCIATIONS
972/ 304-3678 (Planning Department)
TIME WARNER CABLE
214/ 320-5455 (Mike Rasmussen)
AT&T LOCAL NETWORK
214/ 215-3031 (Rich Millenman)
COSERV Gas & Electric
940/ 321-7800 x 7624 (Greg Ward)
EXPLORER PIPELINE
918/ 493-5100 (Patrick Nwakoby)
ONCOR Electric Delivery
972/ 323-8917 (Larry Redick)
VERIZON COMMUNICATIONS
972/318-5277
FEDERAL EMERGENCY MGMT. ADMIN.
940/ 898-5138
TEXAS COMM. on ENVIRONMENTAL QUALITY
817/588-5800
DENTON CO. LEVEE DISTRICT
214/ 352-5118 (Richard Hightower)
Atmos Energy
972/360-4428 (Gary Dickinson)
1800 DIG TESS for line locates
(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 H a, C I T T O/
COFFELL
A I
UTILITY RELOCATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Page 4 of 4
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 # (if applicable)
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
Follow-up needed? (Yes C No
v Inspected by
Follow-up scheduled for
of Streets Maintenance Division on
and found to be acceptable / not acceptable because
Follow-up needed? C Yes C No Follow-up scheduled for
A copy of this completed notice can be provided to the address b
or e-mailed by using the button below:
City of Coppell Engineering Dept.
255 Parkway Blvd., Coppell TX 75019
Office: 972-304-3679 Fax: 972-304-3570
Submit by E-mail Print Form
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2006 Edition
Table 6H-2. Meaning of Symbols on Typical Application Diagrams
Arrow panel
Arrow panel support or trailer
000 (shown facing down)
HChangeable message sign or support trailer
❑
Channelizing device
®
Crash Cushion
Direction of temporary traffic detour
�►
Direction of traffic
Er -
Flagger
High level warning device
(Flag tree)
GOD -----O
Luminaire
Pavement markings that should be
removed for a long term project
FSign
(shown facing left)
®
Surveyor
0
Temporary barrier
®
Temporary barrier with warning lights
Traffic or Pedestrian signal
®
Truck mounted attenuator
0
Type III Barricade
Warning lights
®
Work space
o
Work vehicle
Page 6H-5
2006 Edition
Figure 6H-21. Lane Closure on Near Side of Intersection (TA -21)
F N
Note: See Table 6H-2
for the meaning
of symbols.
Posted
Speed
MPH
"X" Sign
Spacings
Feet
30 or
Less
120
35
160
40
«"; 40
45
3 0
50
400
55
500
60
600
65
700
70
800
1 l t t
Page 6H -d7
.1.
t t i
Typical Application 21
Work Vehicle
(optional)
(optional)
Buffer Space
(optional) �b�t
h
X LANE / w,
BLOCKED
1 2
X
X
<WORK
AHEAD/
i"