Deforest Court-PT020905General Contractor:
Address:
A copy of the approved permit must be on the job site at all times.
T H E C 1 T Y O F
COPPELL
r
Permit issued to Company Representative:
7'
RIGHT -OF -WAY USE PERMIT APPLICATION
Submit permit request to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: (37-05 _Q c�
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) l
Project Name Location: LC h e' f orP<�' 04' 5u bd i v (s 1(111 SPa f ze
�o 1-(1,6L Leu /t /E 7x
Telephone 97 ,2- 93 06d,-2 Emergency Telephone
Utility Company Represented:
El TXU Electric TXU Gas ‘izon 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):
TroncH LablE. fryln-t f6_cks 1 4,29 L— ?57,S ot1 ef, Rd.
+0 pr. virdP. serL/(rAo +or 1) ffre,s± C0(40 Riau.
Was contact made with City and /or utility companies to locate existing utilities?
if NO, Reason: L fi Pr(o r fruct /4 t( YES NO [z
Is removal of existing streets, alleys, or sidewalks necessary? YES
if YES, must have City inspection prior to concrete replacement
NO
Right -of -Way Use Permit Application 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 a1
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, drainag
vegetation, and erosion control).
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department 0 972 304 -3600
Fire Department 0 972- 304 -3500
Street Department 0 972- 304-3546
Engineering Department !B? 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. until 3:00 p.m. ONLY unless otherwise approved by City
Engineer.
Attach Work Order (franchise only).
Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of
work.
Signature ,pf Utility Company Representative
Signature of Contractor R pr- sentative
J I) TN JV
Signature of City Representative
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
Comments:
NOTE:
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Printed Name
Printed Name Dat
Date
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Date
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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.