North Lake-PT161117A copy of the approved permit mint be on the job site at all times.
CC: Applicant
H i- c I r rr• a R Page 1 of 4
Public Works
COFFELL
Permit File
Rev. 0612012
Orig. to Project Filet
°
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days. f -om 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: IIA -16' Applicant's Job # / Work Order #19 33o 13
PERMIT FEE: $100.00
(No charge to Utility Companies with approved FranchiseIRCW Use Agreement)
Refer to the City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Yes C No �
F Plans provided and approved (Erosion Control/Safety fences must be installed prior to beginning work)
Project Name/Location or address 1}� ( jfGsj�'-ti s1 i tiweS f� MW 5ffl&f L -5e psrom
General Contractor Contact #
E-mail address to return permit_ 'eg s 1�"1G e05 #0A)tp(Z,, eo M
Representative: Wi GR( Ffeldt'oij
Franchise Telephone #: 4 �' 62-
Company:
one _�2
E-mail address: ;cK. r'P c ("o M
(for contact if needed/if e-mail of approved permit rs desired/permit cannot be e-mailed unless complete)
Utility Company Represented:
XOncor Electric Delivery C Atmos Energy Verizon C' SBC/ AT&T
C, Time Warner Cable (' CoSery Electric/Gas i" Other
General Description of Work (1n accordance with Ord.IVo.2001-s44): PLEASE ATTACH PLAN OF PROPOSED WORK
op ve- l vo r ftve 17 ova wifer, f > A c floss TLEP e. r��s�>+��t.
t 24o! U �{N��R NIS .T,1 6" � Ael
Estimated Start Date / ' !r IL Estimated Completion Dates 12- 31-1 &
*+Completion requires submittal of Completion Verification Notice (see page 4)
Was contact made with Cit and/or utility companies to locate existing utilities?
if NO, Reason: LOZA7t� Will Ge PlRuOICP 4$ "ro
FINVOL 7.0 ; 6 & t N e,.
FIs removal of existing streets, alleys, or sidewalks necessary?
if YES, project must have Cityinspection prior to concrete replacement
C' Yes XNo
C Yes XNo
Riebt-of-Wav Use Permit Annfication Nee 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 for 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 streetfalley 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
rAttacb barricade plan { trench safety plan if a lane or street closure is required..
NOTE: Street closures are allowed from 9:00 a.m. unti1330 p.m. ONLYunless otherwise approved by City
Engineer.
:-Attach Work Order (franchise only) andlor 1 set of prints showing proposed work.
Locates for existing franchise utilities must be done 48 hours prior to beginning work.
For Ci utili locates, cal[$7 —462-5155 to schedule 48 hours prior to beginning work.
tY �'--- -
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@coneellix.gov.
Printin your name indicates your ac ptance of the terms and conditions of this #orrn:
(if you a tb a r ed o ail, provide a valid e-mail address on Page 1.)
- //- I- It
Signature of t' ity C mpany Representative Date
Signature of UOkractor Representative Date
Signature of City Representative
Comments
Date
17 November 2016
➢NOTE. Noti y City Mspector at 972-304-3679 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 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.
i 1f C i T Y. 0 F
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS -OF -'WAY OR EASEMENTS
Listed below are minimum requirements for utility relocation projects:
Page 3 of 4
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.Irrigation repairs must be performed in a timely manner.
7.Follow OSHA recommended trench safety at all tunes.
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 - 1800 DIG TESS and/or the following:
CITY OF COPPELL UTILITIES DIVISION coppelltx.gov/utility-operations-division
9721462-5155
CITY OF COPPELL ENGINEERING DEPT.
9721304-3679
HOMEOWNER ASSOCIATIONS
9721304-3678 (Planning Department)
TIME WARNER CABLE FEDERAL EMERGENCY MGMT. ADMIN
2141 320-5455 (Mike Rasmussen)
9401 898-5138
AT&T LOCAL NETWORK
TEXAS COMM. on ENVIRONMENTAL QUALITY
2141215-3031 (Rich Millenman)
8171 588-5800
COSERV Gas & Electric
DENTON CO. LEVEE DISTRICT
9401321-7800 x 7624 (Greg Ward)
2141 352-5118 (Richard Hightower)
EXPLORER PIPELINE
Atmos Energy
9181493-5100 (Patrick Nwakoby)
972/3364-4428 (Clary Dickinson)
ONCOR Electric Delivery
9721 323-8917 (Larry Redick)
VERIZON COMMUNICATIONS
1 800 DIG TESS for line locates
9721 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 Dept 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 i - C I fi Y 0
COFFELL
a
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 1 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
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