Alexander Ct-PT071031
A copyof the approved permit must be on th
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Permit FIle "'.' " . .
Orig. to Project File + r '* . \) 4f.
Page 1 of 4
A Ii
RIGHT-Of-WAY USE PERMIT APPLICATION
Permit valid for 90 calendar days from date of approval
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
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Date of Submittal: )0 -.- 0 r
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
Applicant's Job # / Work Order #
License Agreement Approved (date)
/
/
Certificated Telecom Provider? Y N
D Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location: If LEX/1AJ[)~ ~ CD L\ ~-r
General Contractor: {}~I2-C LE .:j 8("',e.z.AJ{;. a:: life.'
,
Contact # ~(\€ Cr.. ks 9);)-38~ - 43S-3
Permit issued to Company / Representative: 0 ErJ NZ- C J"o rJ e s
Address: ILtD'J;) ();Jlr.1IJ...~ l/.Jc7 F",,'-wus iJ'~N-J../rk' 7>~7Lj
Telephone #: Emergency Telephone #: L/~ 9-:;2 b /-;20 10
Utility Company Represented:
o TXU Electric Delivery Co. ~ Atmos Energy (formerly TXU Gas) 0 Verizon 0 SBC 0 Com Cast Cable
o AT&T Local Services 0 GrandeCom (formerly CoServ) 0 CoServ Electric/Gas 0 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 [41 sets of plans):
::L.1 '"tel II [:'&1 S /\ Jr.:,'S'r""c.+LV'e' ;;(O)C k~
c\ f(~ .~ "~q.;,c; f+vlh~ 1/"\ f!~ bile L...., [!---r;:.SS..'\' c.
-'- "\ (I f') (
r 0< ro (\ S /l'\qt.........
'f,) 1e "/1 5~ II~J ce-O<l.~'rc;'
---------------------------------------------------
: Estimated Start Date J()'~'-D 7 Estimated Completion Date* ~-7- 0 7 :
I ......."... ....... ...... . ..' .... '.' ..... ..... .., .' '.' '.. I
~ - - - - ~t~rrrrs~~fJJ~~'l!JJIIII'"~~.=.~_<<@.I~!ll&lI.,d._I!fI.ft.4Jtt:- _ __,
>- Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason:C"'.....tr.:.c..f;.J.- ,-,",.iI CC)h,t<cf (,~ri/u+;Jlf.-ej f{'~{- f..;J YESD
0"''; t....., -f. G.'"
>- Is removal of existing streets, alleys, or sidewalks necessary? YES D
if YES, must have City inspection prior to concrete replacement
NO~
NO~
Rev. 6/06
Right-of-\Vay 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 l"lanual on Uniform Traffic Control Devices.
Area s) affected must be restored to as
vegetation, and erosion control)
~ Any exca\ation 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
T Attach barricade plan / trench safety plan if a lane or street closure is required.
NOTE: S'treet closures are allowed F011l 9:00 a.m. until 3:00 p.m. ONLY unless otherwise approved by City
Enginee r.
r Attach Work Order (franchise only) and/or 4 sets of prints showing proposed work.
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
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Signature of Utility C npany Representative
-1-(~ ,.Ie.lei L. {-IC~l-l-5
Printed Nam~
jtJ-1i. ('7
Date
Signature of Contractor Representative
Printed Name
Date
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~S.......' ~f(Y-R .
Jgna1ure 0 ,It} epresentatlve
f'..I\.~Mt:L &t<< LA
Printed Name
/. J-SJ/ ft1) 1
Date
y Comments:
).;> NOTE: ~Toti.fY City Inspector at 972-304-3679 prior to beKinninK 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 lIldemnij}' and forever hold harmless against the City (~f Coppel! each and every claim,
demand or calise c~r action that may be mode or come against it by reason of or !f any way arising out of the
closure, blocklllg. excavating, cutting, Tunneling, or other work by the applicant under permit from the City,
!fsllch permir IS granted.
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