Valley R Baptist-PT 940322City of Coppel! - Public Works Department
Address. -
Phone:
~mergency Phone:
Representing:
InspeCtOr: ~. '~,~4.~ Phone:
IIave ,~i City and/or Franchise Utilities Been Contacted a~
Will It Be Necessary to Excavate Street,
Pavement7 YES (attach permit)
Alley or Sidewalk
X so
Representative(s) of the Franchise/Contractor must adhere to all
construction standards approved by the City of Coppell, which
includes but is not limited to: Compaction of Trenches and Bores,
and Barricading according to the Texas Manual on Uniform Traffic
Control Devices. ~rea(s) affected must be restored to as good
condition as before the commencement of work.
Any excavation requiring closing of a street
reported to the Police, Fire, and Public Works
to closing (462-1144, 462-1133 and 462-8495).
or alley must be
D~pa_~tments prior
Attach Work Order (Franchise Only)
PAGE 2
PERMIT
Attach Barricading/Detour Plan if a lane or street closure is
applicable.
Franch~se/Contr~ctok Representative
Date
Franchise 0/nsp~ctor/or City Inspector
Date
A~p!icant shall indemnify and forever hold harmless agains~ each
and eve~; claim, demand or cause of action =hat may be made or come
against it by reason of or if any way arisinq ou~ of the closure,
blockinq, excavating, cutting, =unneling, or o~her work by the
applicant under permit from the City, if such perm. it is granted.
P Er~IT. PHB
Ail contractors will contact Public Works @ 462-8495 to have
trenches and/or open cuts inspected prior to back fill operation
taking place. Staff will be sent to inspect the project.
* NO W-ET BORES ALLOWED!
[~nside C/L [] R/W
[] Outside C/L
TOWN PLANT
SCHOOL DIST.
,
LONE STAR GAS COMPANY
Sketch of ! Completed / Project
LOCATION -~ )~ ~//' ~/~
citK or town
(i other than location)
I (Dallas & Tarrant Counties)
I~1 '
CO. NO.: ~//0
E./RR NO. ?¥' -- ¢ / ; ?
MAP SHEET NO.(s) L/.? ~.~
SUMMARY OF PIPELINE CHANGES IN
DISTRIBUTION PLANTS
ABANDONED
Size
NEW INSTALLATION
Feet
Original ER No. or Date of Installation for replacement and
retirement projects only:
Date of thJs report } ~ ~ /~
sy W,