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Level 3-PT221102A copy of the approved permit must be on the job site at all times Page 1 ofRIGHT-OF-WAY USE PERMIT APPLICATION Rev.08/2020 Permit Valid for Days From Date of Approval All activity authorized by this permit shall be in accordance with %∗#26∋4ΘΗςϑΓ6ΓΖΧΥ.ΘΕΧΝ)ΘΞΓΤΠΟΓΠς%ΘΦΓΧΠΦ the City of Coppell Public Rights-of-Way Management ordinance No. 2001-944 Date of Submittal:__________________ Applicant’s Job # / Work Order #_____________________ Project Name / Location and Address:__________________________________________________ Permit Fee: $100.00 (No fee for applications submitted on behalf of Utility Companies with a current Public Rights-of-Way Management Ordinance Registration).S.P.C.O.A. Certificate #____________________ Utility Company Information: Oncor Electric Delivery Atmos Energy Frontier Spectrum Level 3 Other:________________________________________________________ Utility Company Representative:____________________________________________________ E-mail Address:__________________________________Telephone:______________________ Contractor Information: General Contractor:______________________________________________________________ General Contractor Representative:_________________________________________________ E-mail Address:__________________________________Telephone:______________________ Project Information: General Description of Proposed Construction (Attach2ΝΧΠ2ΤΘΗΚΝΓ5ΓΓ2ΧΙΓΗΘΤ∋ΖΧΟΡΝΓ Estimated Start Date:_______________ Estimated Completion Date:_________________ Has and/or utility companies been contacted 48 hours prior to locate existing utilities? Yes No If No, state reason:_________________________________________________ Is removal of existing streets, alleys or sidewalks necessary? Yes No If YES, repair must have a City inspection prior to completion. Call 972-304-3679. Is closure of any traffic lanes or driveway approaches necessary? Yes No If YES, a traffic control plan in accordance with TMUTCD standards must be submitted, and the following departments must be notified of the location and duration of the closure: Police Department, 972-304-3600 Fire Department, 972-304-3512 Street Department, 972-462-5150 Engineering Department, 972-304-3679 Traffic lane closures are allowed from 9:30 a.m until 3:30 p.m. ONLY unless otherwise approved by the City Engineer. Work activity is permitted from 7:00 a.m. until 7:00 p.m., Monday through Friday only 10/27/2022 22238 840 West Sandy Lake Rd, Coppell, Texas .ΓΞΓΝ.ΩΟΓΠ /ΚΕϑΧΓΝ4[ΠΓΤ /ΚΕϑΧΓΝ4[ΠΓΤ∀.ΩΟΓΠΕΘΟ 1ΠΓ)ΝΘ∆ΧΝ6ΓΝΓΕΘΟ #ΩΥςΚΠ4ΘΥΓ ΧΤΘΥΓ∀ΘΠΓΙΝΘ∆ΧΝςΓΝΓΕΘΟ %ΘΠςΤΧΕςΘΤςΘΡΝΧΕΓ∗&2∋ΨΚςϑ(Κ∆ΓΤΘΡςΚΕ%Χ∆ΝΓ)#6ΤΧΕΓΤΨΚΤΓΧΝΘΠΙΧΠΦΕΤΘΥΥΚΠΙ 54Θ[ΧΝ.ΠΧΠΦ0ΘΤςϑΡΘΚΠς&ΤΗΘΤ.( Right of Way Use Permit Application Page 2 of This application, with signatures of Utility and Contractor representatives, must be submitted to the Engineering Department for approval prior to commencing work.Printing your name and date on this form indicates your acceptance of the terms and conditions of this application. 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. ________________________________________ ___________________________________ Signature of Utility Company Representative Date ________________________________________ ___________________________________ Signature of Contractor Representative Date ________________________________________ ___________________________________ APPROVED City Representative Date DENIED Comments: E-mail address to return completed permit:__________________________________________________ Submit permit application by e-mail to engineer@coppelltx.gov, or deliver application to the Engineering Department, Town Center Business Park, 265 E Parkway Blvd, Coppell, TX 75019 SUMMARY OF REQUIREMENTS FOR WORK WITHIN THE CITY OF COPPELL RIGHTS-OF-WAY OR EASEMENTS A copy of the valid approved City of Coppell permit is required on the project site at all times. Property owners (commercial and residential) adjacent to the project must be notified of the project timeline and provided contractor names and phone numbers. No access to private property without prior coordination with property owner. Proper erosion control measures must be taken, in accordance with the Coppell Erosion Control Ordinance No. 91-514. Follow Texas MUTCD standards for work in traffic zones. Lane closures require the use of a ΗΝΧΥϑΚΠΙΧΤΤΘΨ board for advance warning. Grading shall be restored or improved, and sod replaced when necessary. 10/27/2022 /ΚΕϑΧΓΝ4[ΠΓΤ∀.ΩΟΓΠΕΘΟΞΚΞΚΧΠΦΓΝΓΘΠ∀ςΙΧΚΠΕΠΓς 11/02/2022Scott Latta X Right of Way Use Permit Application Page 4 of Contact Coppell Public Works1ΡΓΤΧςΚΘΠΥ at 972/462-5150 to schedule an inspection with Utility and 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 or Address:_______________________________________________________ Sub-contractor Company Name:____________________________________________________ 24 hr. Contact Number:____________________________________________________________ Date of Verification Appointment:_________________________ Time:____________________ -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? No Yes, follow-up scheduled for:__________________________ Inspected by:__________________ of Streets Maintenance Division on _______________ and found to be acceptable, not acceptable because:___________________________ Follow-up needed? No Yes, follow-up scheduled for:__________________________ A copy of this completed notice can be e-mailed to ςϑΓ %ΘΡΡΓΝΝ2 ublic Works 1ΡΓΤΧςΚΘΠΥ&ΚΞΚΥΚΘΠ , or delivered to the address below: City of Coppell Public Works Department1ΡΓΤΧςΚΘΠΥ&ΚΞΚΥΚΘΠ 816 S. Coppell Road Coppell, TX 75019 COMPLETION VERIFICATION NOTICE .ΓΞΓΝ.ΩΟΓΠ 9ΓΥς5ΧΠΦ[.ΧΜΓ4Φ%ΘΡΡΓΝΝ6ΓΖΧΥ 1ΠΓ)ΝΘ∆ΧΝ6ΓΝΓΕΘΟ#ΩΥςΚΠ4ΘΥΓ