Waterside P1-PT 930913Bore/Excavation in Public Right-Of-Way Permit
City of Coppell - Public Works Department
Date: ~ / /~ / q3 Project Name: ~F~/~$/~F
Permit
Issued To: Name:
Address:
Phone:
Emergency Phone:
Type of Work/General Description:
IIave /%11 City and/or Franchise utilities Been Contacted and
Existinq Utilities Located: ~z ~-;~-~ YES NO
will It Be Necossa~-y to Excavate Street, A~ley or Sidewalk
Pavement? YES (attach per. it) ./ NO
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. Area(s) affected must be restored to as good
condition as before the commencement of work.
Any excavation requirinq closing of a street or alley must be
reported to the Police, Fire, and Public Works Departments prior
to closing (462-1144, 462-1133 and 462-8495).
A~=ach Work Order (Franchise Only)
PAGE 2
PERMIT
Attach Barricading/Detour Plan if a lane or street closure is
applicable.
Franchise/Contractor Representative
Date
Appro~ec~(
Inspector/or City Inspector
Da%e
Date ! "~
Applicant shall indemnify and forever hold harmless against 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
applican~ under permit from the City, if such permit is granted.
P Mr~MIT. 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.
LONE STAR GAS COMPANY
[~ Inside C/L [] R/W
[] Outside C/L
Proposed } Project
Sketch of { Completed
LOCATION
city or town
TOWN PLANT
(if other than location]
(Dallas & Tarrant Counties)
SCHOOL DIST.
Co. No.: /~.'~ Region
ER/RR NO.
MAP SHEET NO.(s)
SUMMARY OF PIPELINE CHANGES IN
DISTRIBUTION PLANTS
RETURNED TO NEW INSTALLATION
ABANDONED WAREHOUSE
Size Kind Feet Size Kind Feet Size Kind Feet
Original ER No. or Date of Installation for replacement and
retirement projects only:
Date of this report _ ~ r-,-'~y,''~ -