Park West CC(7)-PT010911i
A copy of the approved permit must be on the job site at all times.
T H E C I T Y O F
COPPELL
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STREET CUT /SAW CUT PERMIT ~ ~,
DRY BORE /
~ ~'~
RIGHT-OF-WAY /EASEMENT
Submit ermit request to the En ' eerin De t., Town Center, 255 Parkway Blvd.
P~„fca ~e.orS .
` Date: - /~ - _ -~
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
^ Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name /Location: ~ ~ q ~ SULl4t'f~ BELTL//I/~ ~ll'
General Contractor: f~,~iN~ELs ~ ~ c Coy
Permit issued to Company /Representative: ~D/If ~/~ T /I~
Address: S ~7't'd ~ ~L~ r~ ~S'~//~G T~~AS
Telephone /t: 9 72 - ~3 ~- olo ZZ Emergency Telephone #:
Utility Company Represented:
^ TXU Electric ^ TXU Gas
^ CoServe Comm
^ CoServe Elect.
Verizon ^ SWBell ^ Paragon/AT&T Broadband
^ 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 Description of Work (provide copy of approved plans):
/~. ~.{/4~;t~r ~' C~r3Le Zoa 6~• ~°o.~t .~~s7%v~f ~1idt/~bL~ Zz st '~T
~~fesT % ~rs~.v9 ~ "wc CysTok~rL ow,1~c 4~ Co.~J•o~i~' .
Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: ~ ~ r'/Dl/I~.S B6~o~F /~7VC~iM~ S~T YFS ^ NO
Is removal of existing streets, alleys, or sidewalks necessary? YES ^ NO
if YES, must have City inspection prior to concrete replacement
Dry Bore /Street Cut /Saw Cut Permit Page 2
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. ,4rea(s} affected must be restored to as good condition as before the commencement of wont
(grading, drainage, vegetation, and erosion control).
- Any excavation requiring closing of a street/alley must be reported prior to closing to the following:
Police Department f~ 972-304-3600
Fire Department ~ 972-304-3500
Street Department ~ 972-304-3546
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 a.m. ONLY unless otherwise approved by
City Engineer.
- Attach Work Order (franchise only).
> Contact must be made with City and utility companies to locate existing utilities 48 hours prior to
beginning of work.
Signature. f Utility Company Representative Printed Name .Date
Signature of Contractor ep sentative Printed Na Date
~~a. Tt~r vLe..~ ~~ -D I
Signature of City Representative Printed Natne Date
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
- Comments•
- 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 and every claim, demand
or cause of action that may be made or come against u 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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