Windsor Estates-PT020319i'
A copy of the approved permit must be on the job site at all times.
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C -OF -WAY USE PERMIT APPLICATION
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Submit permit request to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: Q
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: I
General Contractor:
Cr
Permit issued to Company / Representative: eo H 1'+`11TO/f
Address: 6g tl A ELm Sf t_t?W!SVr'l � . JY _Z2267
Telephone #: 1zr; Emergency Telephone //:
Utility Company Represented:
❑ TXU Electric ❑ TXU Gas Mferizon ❑ SWBeu ❑ Paragon/AT &T Broadband
p 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
if NO, Reason: 4XII& Aj
to locate existing utilities?
YES ❑
9 Is removal of existing streets, alleys, or sidewalks necessary? YES ❑
if YES, must have City inspection prior to concrete replacement
NO [L�
NO [[�
A
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 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 Department ® 972 304 - 3600
Fire Department @ 972- 3043500
Street Department @ 972- 3043546
Engineering Department 0 972- 3043679
> Attach barricade plan / trench safety plan if a lane or street closure is required.
NOTE. Street closures are allowed from 9:00 a.m. undl 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.
Oct U
Signature f Utility Company Representative Printed Name Date
Signature of Contractor ep sentative Printed Na Date
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duk. a l;�X 12re� urr�� 3 i Z
Signature of City Representative Printed Name Dat
g tY P
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
> Comments: fthvo} fta b "'o C own •
Follo T% 1r LCMD re I s Orr � +r�ocff i e W+61.
> NOTE: Notify City Inspector at 97 -304-3679 prior to beginning wo and prior to baekf:ll 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.
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WORK SAFELY
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NOTE AREA SPLICING,B0NDING &
GROUNDING WILL BE
DONE PER GTEPS•
VERIZON SII AREA
STATE TX
DIVISION:
EXCH.:
5647
REM. CD.: 000
W.C.: 4620 IWO
NO.: 3P004DW
ICONTROL NUMBER:
'TITLE: BDC WINDSOR ESTATES
TAX DST.:
TWP:
I RNG.:
SEC.: I
SAL:
DATE: 01/30/02
IREV. DATE: Isc
ALE: 1' =40'
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NOTE
AREA-SPLICING,BONDING
&
GROUNDING
WILL BE DONE
PER GTEPS.
VERIZON S11
AREA
STATE: TX
000
DIVISION:
IEXCH.:56471
REM. CD.:
NON LOADED
W.C.: 4620 IWO
NO.:
3PO04DW
ICONTROL NUMBER:
XCONN 3206
921 OE FOREST RD
IPIO 3592498
TITLE: BOC WINDSOR
ESTATES
ITAX DST.:
TOTAL LOOP: 23419'
TWP-
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SEC.-
SAL:
PIC 22G
PULP 26G
PIC 26C
PIC
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PIC DB LOSS: 11-26
PIC ;24G TP 2
D A T E: 01130102
REV. DATE:
Isc LE: 1*=40'
c. o 0
15'
11 6'
7923'
104o8,
25361
RESISTANCE: 1525.q
ISD — 03/30/02
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APRVO
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1 PRINT
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