CF-Coppell Rd SC-PT010802 CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
1. Name of Applicant: ~~
Address: ~O3 ~'./v{~.~
Z. Location of Construction (~dresV:
Subdivision Section # Block # Lot #
OR
Survey/Abstract # Acreage t i
Lo~tion d~cription (~ach vicini~ ~p): ~.~ ~
3. Type of pro~sed co~t~ction or devdopment:
( ) Residential ( ) Alteration of a na~ral wate~ay dr~age cour~
(~) Non-re~dential ( ) O~er (descdbe& ~ach drawing or sketch)
( ) Placement of F~ (in ~ght-of-way or on pdv=e prope~)
4. Description of Construction Permit requested:
(-9~Paving (.~Medlan or Landscaping ( ) Box Culvert
(,~fSidewalk (.9~Water Main ( ) Rip Rap
(.~ Drive Approach .~l~lf:. ]~/? ~v e...~) ( ) Fill Area
(.fi'Excavation (,q~Sanitary Sewer Main ( ) Drainage Channel Excavation
(o/Fire Lane ( ) Flume ( ) Slope Protection/Retaining Wall
( ) Bridge ( ) Inlet (.'~Parking Lot
· :. Please provide the name, address and 24 hour phone number for supervisor of every
contractor working under this general permit.
5. All construction shah be in compliance with, but not limited to, the City of Coppe~
Subdivision Ordinance, Standard Construction Details, Streetscape Plan and approv~,~
plans. The contractors shall adhere to the City's Erosion and Sedimentation Ordinance~
6. Applicant shah provide a copy of approved plans, specifications and related cost esth~
or contract of the proposed construction for the purpose of permit fee calculations.
(~ONSTRUCTI(~N DEVELOPMENT PERMIT APPLICATION i. Page 2
7. A Construction Permit Fee in accordance with the City of Coppell Fee Ordinance shall be
paid prior to beginning work.
Amount Due: A//A 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 closing of a lane of traffic, street, or alley must be approved by the
Engineering Dept. with notification to the following prior to closing:
Police Department @ 972-304-3600
Fire Department @ 972-304-3500
Street Department @ 972-304-3546
Engineering Department @ 972-304-3679
> Attach barricade plan / trench safety plan of a lane or street closure. (Required)
Note: Street closures are allowed from 9:00 a.m. until 3:00 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 to schedule meeting.
Signature of Applicant~ Printed Name Date
°'City Inspector Contact Number(s)
FOR CITY USE ONLY
Is the f'dl area located in an identified flood hazard area? ( ) YES ( ) NO
If YES, then a Floodplain Development Permit is required before any construction can begin.
Is additional information required? ( ) YES ( ) NO
Are other federal, state, or local permits requires? ( ) YES ( ) NO
(~I~ERMIT APPLICATION APPROVED ( ) PERMIT APPLICATION DISAPPROVED
/ ' ~ity ~pproval Date
Applicant shall indemni~ and forever hoM ~less ag~nst the C~ of Coppe~ each a~ eve~ c~im, de.nd
or cause of ~aon thm ~y be ~e or come ag~nst ~ by re.on of or if ~y w~ a~g out of the c~su~,
blocMng, excav~ng, cuing, mnneHng, or other work by the ~plic~t under pe~ fmm. the C~, ~ such
pe~ is gmnted.