Austin Place-PT070501A copy of the approved permit musf be an the.job site at all times.
CC: Applicant ~ ~ M E C T Y O F
Public Wor OPPELL
Permit File ~
Orig. to Project File ~ ~ ~ ~ ~ ''~~ ` ~
T ~ ~ ~ ~ o
~ x A .c t 5 9
RIGHT-OF-WAY USE PERMIT APPLICATION
Page 1 of 4
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:
PERMIT FEE:
$100.00
G~;ca~- Y.~~"-.
Applicant's Job # /Work Order # `~`pFOIIJ B
(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: ~0/~ A~T ~ 7 ~ T n~ 11 ia~N RoGI-C ~ f~
General Contractor:
Contact #
Permit issued to Company /Representative:
Address: ~ n ''7 Al 7P. n r.. i-l? S T I
Telephone #: 972 , 7,`r,~, cl,S'~J Emergency Telephone #: 9'72, ~`~2.6 D/ 7
Utility Company Represented:
^ TXU Electric Delivery ^ Atmos Energy ~ Verizon ^ SBC/ AT&T
^ Time Warner Cable ^ GrandeCom ^ 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 Description of Work (provide four [4] sets of plans):
~01ZE RT S'74 ZN~(~FN DOCK Uti' riPPRsI S-D' PL/~C~ l%" Ut.LC'T
rn ~. ~_ ~ ~~. t~ ~~ P >~~E~ ~ ~ ~llN, ~S'~"/~ff,~ ~ T71~ N F,E'Q~?~ ~ ~I~-T~
Estimated Start Date S- /~ _ 2U0 ~ Estimated Completion Date* ~ _ ~Q _~L17
,,
_ _ _ * Completion requires submittal of Completion Verification Notice (see ease 4) _ _ _
r Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES ^ NO ^
Is removal of existing streets, alleys, or sidewalks necessary? YES ^ NO ^
if YES, must have City inspection prior to concrete replacement
Rev. 6/06
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.
Area{s) affected must be restored to as food condition as before the commencement of work. (grading, drainage,
vegetation, and erosion control). To schedule Public Works~nal inspection (Page 4) call 972-462-5155.
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
>Jngineering Department Q 972-304-3679
- Attach barricade plan /trench safety plan if a lane or street closure is required.
NOTE: Street closures are allowed front 9:00 a. m. until 3:00 p. m. ONLY unless otherwise approved by City
- ~
Engineer.
attach Work Order (franchise only) and/or 4 sets of prints showing proposed work.
Contacts must be 'made to locate existing utilities 48 hours prior to beginning work.
(Applicatiot: with original signatures needs to be submitted to the Engineering Department before approval.)
Si azure of Ut lity Company Representative
Sig ure of Contra for Representative
Signature City Representative
Comments:
cT~oc/ A/e IJM /+.S/ ~ =~~{-d 7
Printed Name Date
~M f~i4-~~ S - ~--~Z
Printed Name Date
Printed Name 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 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, tr~nneling, or other work by the applicant under permit from the City,
if such permit is granted.
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WIRE CENTER: ~. ` ' C' ~ . .
WORK ORDER NO '=:' r>r'r~'i1.
HUB NO:
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CAUTION 11!
~osn
EIC15TkIG UTAITIES AND VMIOEACRDUID FACNJIDES H~AT®
ON 7NESE PLANS HAVE BEdI IDCARD iR0V1 REfEAENCE.
EIiDAWVNNI. IT SHALL BE 1NE RESPDN91gUTy Di THE
OCNIRAGTOR T9 VEA1iT BDTH HDRRDNTAILY AID VERTICALLY
N# I.CCAIN7N OF ALL E>IIS11110 tT11VliR3 AND UIDERIi1WND
FACLi1E6 PRICK TA CpIf1RUCTlDIi, TO TlJtE NECESSARY
PRECAU110H3 NI ORDER TD PROTECT ILL fACSI'AES
ENCOUNIERFD. INE CONTRACTOR SIUiI PRESERVE AND
PROTECT ALL E7d5IMC O1R11N3 F1i011 DAMAGE DURING
CONBIRUCAON.
..,, for
ExCh.' W,C. • W. ,
G : C.D~ LL- Stater
Doter y`3~ • a7 Rev. Dates Dl Rei,'
E ;tner:
ovsd 19721 ~ ~~
peel
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:17:11 PM