Park West CC(3)-CS000425~8/05×99 08:32 CITY OF CO~PELL ENGINEERING 4 540 W ELM ~T N0,190 Q02
DRY BORE / STREET CUT / SAW CUT
PERMIT
RIGHT-OF-WAY / EASEMENT
Date: O~- ?--,f"- ~0
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franch~e/ROW Use Agreement)
Plans provided a~l approved
(Erosion Control/safety fences must be' installed prior to beginning work)
Project Name/Location: ~tOT~A MCG
Genera]Contractor:
Permit issued to Company/Representative: L~7"~ - ~oa
Address: .5'qO ~__,_ ~L/~ Le~,a,o,:LL% 7-~
Tclqaholle #: ~clq3 ~ c/-O(oL~. ,Emergelley Telephone #:
Utility Company Represented:
E7 TXU ET Lone Star
~ CoServe Corem EY CoServe Electric
$~ GTE EY SWBell ET Paragon
Other
If "Other" is checked, please note that franchise or right-of-way use agreements will be required
and need Council approval prior to beginning work,. Permit cannot be approved until that time.
Iql Il III
General Description of work (provide copy ofapprovedplam):
~y c/g,. v,~ Co~/~tfn' E~ ~to/o~ 77/~-...~ar//
Was contact made with City and/or utility companies ~o~ocate existing utilities?
if NO. Reason: YES ~7- NO E7
Is removal of existing streets, alleys or sidewalk~ necessary?
if YES, must have O'ty inspection prior to concrete replacement
m NO m
CITY OF COPPELL ENGINEERING ~ 540 W ELM ST
N0.190
Dry Bor~ / Street Cut / Saw Cut Pm~t
Fage 2
requtrtmenu(dent,y tex~ may be re~dred at the at~caa~"~t) and borticad~#.according-to
· the Te~at Manuat on Unifortn ~c. Control Oevicet. Area(s) a~ecr~mutt be* rtgortdtO atgOod
· COndition tu before tIw.co .~ ofworl~ (grading, drainage, veg~m, attd~ control). '
Any excavation requirina closin~ of a sueW. ll~ must be n~:orml prior to clming to t~ following:
Attach barricade Man/trench ~fety ptan ~f a tane.or ~rtn ctoturt it *nvuired: ~
Note: Street closurgt are allowed from 9.~00 a~ m,_~..$.~O p.m.. on19 tm.!e~ etimn~te approved by
City Engineer.
~, AUach Work Order (franclfise only).
Contact mu~ be made ~ Oty and u~ty .~ t~ locate extttfng utlttt~ ,Ia Itoun prior to
besinn~ng of work.
Ill II II Illlllll
Sig~tu~e of Contgcmr ~'i~~tive ~
Date
Date
Signature of City ~m~vc .....
Note: Notify Oty lntpector at 972/304-$679 prior to begitming wor~ and prior to bad, Il for
:concrete. trench, ditch and open pit intpeaiom.
(Bad~ll rnm't meet all constru~on sttmdar~ at~mv~ by the City of Coppeli.)
Applicant shall Indemnify and fore~er hold'~~ againtt eac~ and ~ clalm, demand or mute
of ac~'on ~ may be made or COme againtt it by. reaton of or ~f any way ar~ing out of the clo~#,
blocking, e~cavatingo cutting, tunneling, or other wont by the applicant under perm~., frorn tht C~ty,
if such permit i~ granted.