Townhouses-PT051202A copy of the approved permit must be on the job site at all times.
CC: Applicant T H E C 1 T Y O F Page 1 of 4
Public Works COPPELL COPY
Permit File
Orig. to Project File
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ExA s ,89 DDD
RIGHT -OF -WAY USE PERMIT APPLICATI 0 �I
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
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: PcloeA"I1 � •• s�' >* P� L 1,.�. r �.. J J� - c� -eeo „ d f— c-e
General Contractor: A� f 4rf
Permit issued to Compan / Representative: `T�Kci I �'��•, e- X
Address: �"/ g h C� rr l k•� L rc s [
Telephone #: q - 72 3 3 - e l i Emergency Telephone #: q ? 2- $r7o -) ,,(7
Utility Company Represented:
R Electric Delivery Co. ❑ Atmos Energy (formerly TXU Gas) ❑ Verizon ❑ SBC ❑ ComCast Cable
❑ AT &T Local Services ❑ GrandeCom (formerly CoServ) ❑ CoSery 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.
Genera Description of Work (provide four (4) sets of plans):
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r 6— h f r.. �� S �� ; er - Y
Estimated Start Date f _ �' S 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 VO, Reason: YES ❑ NO ❑
➢ Is removal of existing streets, alleys, or sidewalks necessary? YES ❑ NO ❑
if YES, must have City 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.
Areafsl aff6cUd must be restored to as good condition as before" the commertcelnetit of work (goading;. drainage, .
vegetation, and erosion control). CALL 9721462 -5135 TO S'CHEDULE R1fS FINAL Ii Wff,CTION..
➢ 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 erints showing ro posed work.
Gol ,taots`�Ust ba made to locaterex s it"g utilities �8 hovers P0b� t4 ,b.,'9 I nnin� �i�cirk;
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
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Signature of U lity Company Representative krinted Name Date
Signature of Contractor Representative
Printed Name
Signature of City Repres tative Printed Name
➢ Comments:
Date
Z -1 -CA
Date
➢ NOTE: Notify City Inspector at 972 - 304 -3679 prior to be"innin,g 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.
Page 3 of 4
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