Park West CC(7)-PT060817A copy of the approved permit must be on the job site at at #imes.
MCC: Applicant T H E c i T v o F ~ ~~ ~~ O~~ page 1 of 4
Public Works COPPELL
Permit File d D D D [1
Orig. to Project File ,, o
F ~ 9
X A S t 8
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: Applicant's Job # /Work Order # 3 FO ~ O A ~(
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
License Agreement Approved (date) / / Certificated Telecom Provider? Y N
^ Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name /Location: ~~
General Contractor: fJs vs
Permit issued to Co
Address: o~ ,
/ry C.o ~f •r~
/ Representati/v~e: ~D
~ 11 ..~ ~ v // .~ ~~
- C iiq.• /mss A7o ~'~'J s
Telephone #: 9 7 v1- 93 ~ - b i/ ~ Emergency Telephone #: ~!Y SO >~ ~0/8
Utility Company Represented:
C~~
^ TXU 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 Descriptio•~ of Work (provide four (4) sets of plans): /~ d'/p
• V ~ ~
~~
Estimated Start Date 9-L ~-' O 6
•C D
Completion Date* 9- ! ^ O G
- Was contact made with City and/or utility companies to locate existing utilities?
if 1Y0, Reason: YES ^ NO ^
- Is removal of existing streets, alleys, or sidewalks necessary? YES ^ NO ^
if YES, must have City inspection prior to concrete replacement
~v~
L! t
~N~
* Completion requires submittal of Completion Verification Notice (see page 4)
.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 annlicants expense) and barricading according to the Texas Manual on Uniform Traffic Control Devices.
Area(s) a#fectecl must be restored to ss Qood condrtibg as before the comn~egcement of worlt (grading, drainage,
vegetation; 3tad~erosion control): CALL 9T21d6Z-S;fSS`7'O.SCHED'ULEPU~itLIC'Wt)R1Z~' F~'1',4`L IN~`PEC'TIO~~'.
- 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. unti13:00 p. m. ONLY unless otherwise approved by Ciry
Engineer.
Attach Work Order (franchise onl )and/or 3 sets of riots showin ro osed work.
Contacts m<JSt be made to Locate existing utilities 48 hpurs prior to begiDning work.
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
~ign7RGre of Utility Com any Repr ntative
,;~1 ~.~.
Signature of Contractor Representative
~ ____ ~ ~
Signature of City Representative
Comments:
~~ ~Uln~
~ ~~.
Printed Name ate ~~jG/./
Chap Ie5 i'1'~l~ rr. S 5 I ~ aL
Printed Name Date
~~
Printed Name
8/i7/~~
Date
- NOTE: Notify City Inspector at 972-304-3679 prior to be~innin~ 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 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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