Cambridge Phase 1-PT060123CC: Applicant
Pnblic Works
Permit File
Orig. to Project File
COFFEi~gT, ~ C' T ¥' O r gt~ml~0J~[~L~J Page lof4
FILE COPY
RIGHT-OF-WAY USE PERMIT APPLICATION
Permi! va/id for 90 calendar days from date cf ~pproval z~'~'I'~'7~&'7~ ~31; ~l~.~
Submit permit application to the En~ineerin~ Dept., Town Center, 255 Parkwa;y Blvd. ~'~l~ta'/Z-~
Date of Submittal: /- ~- ,2 oo,~ Applicant's Job # / Work Order # 5'~')~[/,/e~' DROP I~tt~'l''
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Francbise/RO tV Use AgreemenO
License Agreement Approved (date) /__/ Certificated Telecom Provider? ~) N
[] Plans provided and approved
(Erosion Control/safety fences ntttst be installed prior to beginning work)
Project Name / Location: q~,-q ~//-XTZ.~' C_.~'~'~ ~.
General Contractor:
Permit issued to Company / Representative: /J0o:,t~¥ Co~,o,,,,xlc~.t-.'.~ /.g'e¢.o c321{&.~
Address: ~ot3.1. I~q/,~y 0,. (~,,rol14-'~ t T~ 7ffl~ /
Telephone ~: qT~-qsv4~g~ Emergency Telephone ~: q 72-~-~7~
Utility Company Represented:
[] TXU Electric Delivery Co. [] Atmos Energy (formerly TXU Gas) [] Verizon [] SBC [] ComCast Cable
[~ AT&T Local Services [] Grande Corn (formerly CoServ) [] CoServ Electric/Gas [] Other
If "Other" is checked, please note that franchise or right-of-way use agreements will be requirer and need
Council approval prior to begiuning work. Permit camtot be approved ltnti! that time.
General Description of Work (provide 3 sets of plans):
Estimated Start Date /- 3~-~o~ Estimated Completion Date* g-~-~o~
* Completion requires submittal of Completion Verification Notice (see page 4)
> Was contact made with City and/or utility companies to locate existing utilities.'?
ffNO, Reason: YES ~ NO ~
~ Is removal of existing streets, alleys, or sidewalks necessary? YES ~ NO ~
ff YES, must have Ci~ inspection prior to concrete replacement
Right-of-Way Use Permit Application Page 2 of 4
Revised 06/03
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.
rt as good condition as bef0re~the commencement of ~v0rk{grai~,ng~,'~amage,
CALL 972/462-5155 TO SCHEDULE PUBLIC WORKS FINAL INSPECTION.~
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 only) and/or 3 sets of prints showing proposed work.
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
Signature of'Utility'Com~ny l~presentative
Printed Name
Date
Signa~gr,e'~6f Contractor Representative
Si~amre of City Re?)sentative
Comments:
Printed Name Date
Printed Name
l' L3
Date
NOTE:
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 at~d 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 Cio',
if such permit is granted.
NCTCOG Page 1 of 1
NCTCOG Maps
http://dfwmaps.com/print.asp?Layers=on&AERIAL03=on 1/19/2006
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