Dry Clean & Donut-PT020410· A copy of the approved permit must be on the job site at all times.
T H I~ · C I T Y · 0 F
COP?-ELL
RIGHT-OF-WAY USE PERMIT APPLICATION
Submit permit request to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal:
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
License Agreement Approved (date) __/__/ Certified Telecom Provider? Y N
[] Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location: _~ ~zL, F'_~ f'~'7'/ ,~,~,~,~C'//~ 4~-_~/~--a/
General Contractor: ~ ,f~ ,
Permit issued to Company / Representative:. ~ ~c~d''
Address: ./_~,/,.~ ,/,JY/,,'~/'~/ .ZT/~. ('~.-/'//'~,~Z;~ ~
Telephone #: ~'~/O~ .. ~/'~ Emergency Telephone #: ~/-.,~O~7"
Utility Company Represented:
[] Oncor Energy Delivery Co. [] TXU Gas [] Verizon [] SWBell
[] Paragon/AT&T Broadband~] CoServe Comm [] CoServe Elect. [] 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.
General Description of Work (provide copy of approved plans):
//~ ..,
Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES~ NO
Is removal of existing streets, alleys, or sidewalks necessary? YES [] NO_'~
if YES, must have City inspection prior to concrete replacement
Right-of-Wa~ Use Permit Appli¢~_Oon Page 2
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
the applicants 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).
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Deparhaent 0 972-304-3600
Fire Deparhaent ~ 972-304-3500
SWeet Department ~ 972-304-3546
Engineering Department ~ 972-304-3679
Attach barricade plan / trench safety p!an if a lane or street closure is required.
NOTE: Street closures are allowed from 9:00 a.m. until 3:00 p.m. ONLY unless otherwise approved by City
Engineer.
Attach Work Order (franchise only).
work.
~S~gnature,~ [~l:i~ty'Company Representative
Signature of C6ntractor Rep
Signature of City Representative
Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of
Printed Name
Date
Printed Name
Date
Printed Name
Date
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
~ Comments: ~(~ (~[~.~'~VI-~A ~)~--~ ~/~':~(J ~l~O'~l'~- {~-''~ ~~'
~ 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.