CRDC 14-01PT161206A copy of the approved permit must be on the job site at all times.
CC: Applicant
r` C' T Y O F Page 1 of 4
Public Works
Permit File
IFF Rev. 06/2012
CO
Orig. to Project File
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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 engineer@coppelltx.gov (see button below)
Date of Submittal: a l� 1 Applicant's Job # / Work Order # i
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
Eg—P'rns provided and approved (Erosion Control/Safety fences must be installed prior to beginning work)
Project Name/Location or address ; &af I 'C.-'ey IDN P
General Contractor ' 4 r LLC Contact #
E-mail address to return permit 40f
C9A'�loo .Po M
Representative:
Telephone #:
E-mail address: -
(for contact if needed/if e-mail of approved permit is desired/permit cannot be e-mailed unless complete)
Utility Company Represented:
C- Oncor Electric Delivery C Atmos Energy 0 Verizon (7 SBC/ AT&T
Q Time Warner Cable C, CoSery Electric/Gas Comer ��Jc ,p Z -
Estimated Start Date Estimated Completion Date* ; /�g f
* 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.C: No
➢Is removal of existing streets, alleys, or sidewalks necessary? C Yes C,f- o
if YES, project must have City inspection prior to concrete replacement
Richt-of-Wav Use Permit Aunlication Pane 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 @ 972-304-3600
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. until3:30 p.m. ONLYunless otherwise approved by City
Engineer.
);,,Attach Work Order (franchise only) and/or 1 set of prints showing proposed 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 oved permit returned via e-mail, provide a valid e-mail address on Page 1.)
Signature f Utility Company Representative Date
Signature of Kcontractor Representative Date
Signature of City Representative Date
Comments
➢NOTE: Notify City Inspector 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.