Windsor Estates-PT050805: iA copy of the approved permit must be on the job s!teatal!tmes!:
CC: Applicant
Public Works
Permit File
Orig. to Project File
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
Submit permit application to the En~ineerin~ Dept., Town Center, 255 Parkway' Blvd.
FILE COPY
Date of Submittal: ~. t./.O~' Applicant' s Job # / Work Order # ,~/'7.:~ lq O
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use AgreemenO
License Agreement Approved (date) __/ / Certificated Telecom Provider?
[] Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
ProjectName/Location: ~O~/a~,~l.e' g~ree/- ~t;.~ ~t ~q
General Contractor: ~'la.l~(~ c
Y N
Permit issued to Company / Representative:
Address: /0/~ ~ ~//~ /
Telephone g: q 72 ') >~ 'f f/7 Emergency Telephone
Utility Company Represented:
[~'lCxu Electric Delivery Co. [] Atmos Energy (formerly TXU Gas) [] Verizon [] SBC [] ComCast Cable
[] AT&T Local Services [] GrandeCom (formerly CoServ) [] CoServ Electric/Gas [] 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 four (4) sets of plans):
Estimated Start Date
~'--///- p,C-- Estimated Completion Date*
* Completion requires submittal of Completion Verification Notice (see page 4)
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
Ri~ht-of-Wa~, Use Permit Application Pave 2 of 4
Revised 06/03
Representative(s) of the Contractor must adhere to ail 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.
Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department ~ 972-304-3600
Fire Department ~ 972-304-3500
Street Department ~ 972-462-5150
Engineering Department ~ 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 ~ and/or 3 sets of ~rints showin
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
Signatur ity Company Representative ~Printed Name Date
Signature of Contractor Representative
Sig[ature of City Rel~sentative
~ Comments: Plr0 -~ P.~i,~' V~
Printed Name Date
~k~rl~.~_ ~Ma.4H~4v.~ ~.ff- OS-
Printed Name Date
NOTE:
Notifr CiO; Inspector at 972-304-3679 prior to beginning work and prior to
backfill for concrete, trench, ditch and open pit inspections. (Backfill must meet
ail 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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