CF-Coppell Rd SC-PT010622A copy of the approved permit must be on the job site at all times.
T H E G i T Y O F
COPPELL
T 0
~ X A .c ~ 9 4
DRY BORE /STREET CUT /SAW CUT PERMIT
IN
RIGHT-OF-WAY /EASEMENT
Submit permit request to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date: ~ - ~ ~ - ~
PERi17IT 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:
General Contractor: ~ - f~ ~ p 5/
Permit issued to Company /Representative: O /J /, ~ ~ ~
Address:
Telephone #: ~~~~~6 ~ Emergency Telephone #: ~7~ Z _ L~ 3~(- 0 6 LZ
Utility Company Represented:
^ TXU Electric =µ ^ TXU Gas
^ CoServe Comm ^CoServe Elect.
~Verizon
^ 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):
> Was contact made with City and/or utility comp Hies to locate existing utilities?
if NO, Reason: 2 y ~ 0 ~ 2S 1'3 ~~~~°„t~l~lG-- YES ^ NO ^
> Is removal of existing streets. alleys, or sidewalks necessary? YES n NO
^ SWBell ^ Paragon/AT&T Broadband
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 Manuol on Uniform Traffic
Control Devices. Area(s) affected must be restored to as good condition as before the commencement of work
(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 ®972-304-3600
Fire Department (g~ 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 p.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.
o~ ~ t'~L U/~ ~ ~ - l ~-1 - vI
Signaturepf Utility Company Representative Printed Name Date
Signature of Contrac
p~C.l b
Printed Na
(~/Cj - o!
Date
Kev. ~iZl RR~^1 6.2't-
Signature of City R re ive Printed Name 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 backfdl for
concrete, trench, ditch and open pit inspections.
(Backf:ll must meet all construction standards approved by the City of CoppeU)
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 fmm the City, if such
permit is granted.
SC~~Eo1"=1~~'
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VERIZON sll AREA STATE: rx
DIVISION: NCENTRAL EXCH.: 5647 REM. CD.: 000
W.C.; 4620 WO NO.: 3POO4AC CONTROL NUMBER:
TITLE: REMOVE/REPLACE POLES TAX DST.:
TWP: RNG.: SEC.: SAL:
DATE: 06/14/01 REV. DATE: CALE: 1'=100'
FILE: Wpl ORWN ENG APRVD PRINT
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