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Permit File
Orig. to Project File .. r '* \) ...
Page 1 of 4
8
RIGHT-Of-WAY USE PERMIT APPLICATION
Permit validfor 90 calendar days from date of approval
Submit permit a~plication to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal: 7-Z 7.. 2,007 Applicant's Job # / Work Order # 9fJFtJ/lJB
PERMIT FEE: $100.00 I()~~ rNIJEPFNDE'Nc.E
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
License Agreement Approved (date) / / Certificated Telecom Provider? (9 N
o Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location: ~!)~ PF "" n t::.N CE.
General Contractor:
Permit issued to Company / Representative: /<.LAA5 M€YE fl
Address: 307 N. I?OG~R5 IRaJ/Alq, ~ ?'s~, I
Telephone #: 972. ~.1. <In-j Emergency Telephone #: 97e. 972.. (;,tJl 7
Utility Company Represented:
o TXU Electric Delivery Co. D Atmos Energy (formerly TXU Gas) ~Verizon D SBC D ComCast Cable
o AT&T Local Services D GrandeCom (formerly CoServ) 0 CoServ Electric/Gas D 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 he approved until that time. .
General Description of Work (provide four f1J. sets of plans):
'msaLE.
1~~ LNP~fENOE~C~ bA
,,? , tJi1fV tJ Ha(-e,
Estimated Start Date 8-' -~()01
DLd~fA J. :1.~" C;tt..tJ J)UL:..7 -m ~('T7ntJ
I -::J
Estimated Completion Date* 9- IS' - ~O() 7
* Completion requires submittal of Completion Verification Notice (see page 4)
~ Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES G:1
~ Is removal of existing streets, alleys, or sidewalks necessary? YES 0
if YES, must have City inspection prior to concrete replacement
NOD
NO[2t
"
Ri~~t;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 CopieD, which
inc des but is not limited to: Erosion Control Ordinance, compaction requirements (density tests may he required at
applicants expense) and barricading according to the Texas Manual on Uniform Traffic Control Devices.
~ 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 1 trench safety plan if a lane or street closure is required.
NOTE: Street closures are a/lowed from 9:00 a.m. until 3:00 p.m. ONLY unless otherwise approved by City
Engineer.
~ Attach Work Order franchise onl ) and/or 3 sets of rints showin
(Application with original signatures needs to be submitted to the Engineering Department hefore approval.)
~~~
Sign re of UtIlity Company RepresentatIve
~~ HA'WMh/
Printed Name
r:. 80 '-a<:;
Date
...:r , .c 8.. itrle++
Printed Name
r--~ -0 (0
Date
<~
Signa . of City Representative
M\L~I..- (~-zA
Printed Name
..., I'Y..> J C' "
Date
~ Comments: (0r"If,.Ac.':"fn1t rv\J'i.'j c,uP>;V\ IT CCt-APl..~\l~ v Tfe,.t=:k"l4'77 0\0..-.1 t-".^y'J)c,...~,
LOt-.iT(l.AcTOr, ,...A..1<..\' (~Al.L-- '14"L -YII71.. -GIf;S roe.. 'P..J1',C.IL- WQ(-K;~
~;V.AL TN~f'E"CI1~N. rAH..V<Z-~ TO cc ~DlJ\..-e ~NVfZcnol.J Mf\\t' DIi:"'-'AY
~()i1Ill-E .Pt....~(n
);> NOTE: Notifv Citv Inspector at 972-304-3679 prior to bef!inninJ! work and prior to
backfill for concrete, trench, ditch and open pit inspections. (Backfill must
meet all construction standards approved by the City of Coppel/.)
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 4 of 4
THE.CITY.OF
corrEll
."*'-.lfl
e-t !>< ~q
.... s . 1
UTILITY RELOCATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Contact City of Coppell Public Works Division at 972-462-5155 to schedule an inspection
with Utility & Streets personnel to verify that your project has been completed to City of
Coppell specifications. Failure to schedule verification inspection may delay future projects.
Franchise Utility Name
Project Location / Applicant's Work Order # (if applicable)
Sub-contractor Company Name
24 hr.Contact Number
Date of Verification Appointment
Time of Verification Appointment
INFORMA nON BELOW TO BE COMPLETED BY CITY OF COPPELL PERSONNEL
.
.:. Inspected by
oJ Utilities Maintenance Division on
and Jound to be acceptable / not acceptable because
Follow-up needed? NO / YES Follow-up scheduled/or
.:. Inspected by oJ Streets Maintenance Division on
and found to be acceptable / not acceptable because
Follow-up needed? NO / YES
Follow-up scheduledJor
A copy of this completed notice is to be provided to:
City of Coppell Engineering Dept.
255 Parkway Blvd., Coppell TX 75019
Office: 972-304-3679 Fax: 972-304-3570
Aug 27 07 04:04p
Debbie Ingram
972-462-5199
p.1
Page 4 of 4
THE CITV OF
COPPELL
~~~~
J- .~ . ()
~ )( ." . ......" q.
1'\ oS \
-row~ t-h/,LS/ZS OF COPPfL[
VTILITYRELOC'ATION IN RIGHT-OF-WAY OR EASEMENT
COMPLETION VERIFICATION NOTICE
Contact City of Coppell Public "Vorks Division at 972-462-5155 to schedule an inspection'
with Utility & Streets personnel to verify that your project has been completed to City of
CoppeD specifications. Failure to schedltle verification inspection may delay future projects.
Franchise Utility Name !/ e /2 J Z ~ZJ )) '.
Project Location I Applicant's Work Order # (it applic:able) 9# ZJ / .jJ j}
/0 4';)- /~dgj)CAJdcJ.)c:g
Sub-contractor Company Name ;C::/ An :? f'24-{t' r e~
24 hr.Contact Number Lf1 ~ ...../JZZl .-- t I :3 c,
Date of Verification Appointment
Time of Verification Appointment
ff..j.1-07 . /&:~"..
Follow-up scheduledfor
.:. Inspected by of Streets Maintenance Division all
and found to be acceptable / /lot acceptable because
Folio w-up J2eeded? NO / YES Follow-up scheduled for
III A copy of this completed notice is to be provided to:
City of CoppeJl Engineering Dept.
255 Parkway Blvd., CoppelI TX 75019
Office: 972-304-3679 Fax: 972-304-3570
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COPYRIGHT 2006 by MAPSCO, INC. - ALL RIGHTS RESERVED 0
BOOK PAGE 1003
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date file name job number
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Place, and Addition to the City of Coppell recorded In Volume
Revised: 10-13-2000
86155, Page 5582, Deed Records, Dallas County, Texas. Revised: 9-22-2000
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