Time Slice Tech-PT090421
A copy of the approved permit must be on the Job site at all times.
cc: Applicant 11 IDlIii1liilI'fi'\\DIE:Ifil~ E . C I T Y ."0 ,.
PlIbli~ W.o~kS ~lrrlro\YJW ~O PPEll
Pcrnut FII~ ~~~<~. ;.I~Ii.J' ~
* .~ ~.~ * fI/' . Jf.. . -.-
I"I?'~ ' '. ~~ 04-01-J 9P05.4,
Ori2. tll Prujcct File I .\ .i .' ~. q ,
Pngc 1 of 4
ReI', 11107
RCVD
RIGHT-OF-WAY USE PERMIT APPLICATION
I't!mlil l'Olid/or I)() l'alt!lIdar days /1'0/1/ dOle ofaf'f'ro\'{J/
Submit permit upplicatioll to the En~ineerill~ Dept., Town Center, 255 Purkwu)' Blvd.
Date of Suhmittal: ~~ Applicant's .Job /I I 'York Order /I
PERMIT FEE: S 100.00
(No c1wrge to Utilit)' Compmlie.\' witll approl'ell Frlllldli,~e1ROW Use I\greemelll)
ReFer to the City of Coppell Ordinance No. 2()OI-944. Certificated Tdecom Provider'! Y N
o
Plans provided and approved
(Erosioll COlllroll.mfet)' !elU.'es mllst he ;Il.\'lllllell prior to begillllillg work)
NO[T\\la)( ~ (' np p (?)) 3 f)
Project Name / Location:
Gelleml Contractm': --r;;;,.,
Contuct /I 517 - W ~ (.\ - .5m..2-
Permit issul'<1 to Com pall).. I Rcprcsc~t.ti,.c: --r.~jlLLL 7lthQ")u1</ ~. jllao~ (~o"
Address: 'poO j'~h'l ill jri'. Z.()o----K~(M'\{,=r~ 21P-~
Telepholle II: en - kd ti ~}f) 7. 2.. Emergenc)' Telephcme II: 6} 7 "I!)" LJ - (pC; )'"2,
Utilit)' Company Represented:
o One"r Electric Deli\'ery
o Tillll' Warner Cahl{'
o AtlllllS EnerJ.:~'
o CoSer\' Electric/Gas
o V{'rizon
~ Other
o SBCI AT&T
Ge eral Description of \Vork (prtH'ide four [4/ sels of pla1ls): In accordunce with Onl. No. 2001-944,
h.' clr / P. ' . (. ,. . ,
Estimated Start Date ~ - 1 S - DCl Estimated Completion Datl'. ~ / O~
,
'" Completion requires suhmittal of Completion Verification Notice (see pu~e 4)
, Was contact made with Cit)' and/or utilit), companies to locate existing utilities?
ifl'lO, Reasoll: }\)O,1IJ?/r1fJ lA.,.ldl +,JIlJ P'tl(1 YES 0
".. Is remo\'al of existing strl'Cts, alle)'s, or sidewulks necessuQ"? YES 0
if rES, mllstlllll'e City inspectioll prior to COil crete replacement
NO~
NO I1l
Right..of-\\'a)' Use Permit Application
Page 2 of 4
Repr('selUati~'e(s) of the COlltractor mmt ailhere to all comtructioll stalldards aplmH'ed by the Cit)' of Coppell. which
illcludes hilt Lv Iwt limited 10: ErosiOIl COlUrol OnlilUlllce, compactioll requireme"ts (ile"sity lests ilia)' be requireil ill
the Ilpp/iCllllls expe"se) af/(I barricading accordil/g to the 1'exm MWlllllloll U"iform Traffic COl/trol Devices.
Areat!;) affected mlLst be rl-stOrl.t1 10 as ~ood condition as before the commencement of work (J:nulinJ:. draimlJ:c,
\'c~e1atiun. and erosion control). To schedule Public Works filial illSpe('timl (page 4) Clll/ 972-462-5155.
,. An). cxcuyatiol1 requiring closing of a street/aile)' rnusl be rl'I)()rted prior to closing to the follo\ving:
PoliC(~ Department @ 972-304-3600
Fire Department @ 972-304-351)0
Street Department @ 972-462-5150
Engim.'Cring Departm{'llt @ 972-304-3679
" Attach barricade plan I trench sllfel)' plan if' a hme or street closure is required.
;VOTE: Street closures are al/oweil from 9:00 a.m. umil 3:00 p.m. ONt." ullle.n otherwise apprm'eil by Cil)'
H"gil/eer,
,. Attach Work Ord{'r (franchise onl~') and/or 4 sets of' prints showing proposed work.
Contacts must be made to locate existing utilities 48 hours prior to beginning work.
(Applicatioll ....ith origi"al sigllalures SllOult/ be submitted tiJ the Ellgilleeri"g Departmellt before apprm'fll.)
Signa lure of Utility Company RjPrcsclllativc
Primed Name
Dale
A' G
-.:;;).htlll ~ (i J L
Primcd Namc
4-1- 01
Date
City Representative
MU.A~L- ~~
Printed Name
'11'7-( I:;~
Date
,. ClImn1{~nts: {Ate -n\.t. fl.Vo1-1 bv Pxi oW P~luQ 'I\} '&.6V10/NC,:/.
(AN L...A\C- ru..<...J :tQ_~ ^'1h'hc... c:! at e..-A .I.\{;1 L~~~,
>- NOTE: Notify City Illspector III 972-304-3679 prior /0 begitlllillK work alld prior /0
backfill for COil crete, trench, ditch alld ope II pit inspectiolls. Backfill must meet
all cOllstructioll stalldards approved by the City of Coppell.
Applicalll sllall indemnify and Jore....er Iwld lIarmless against the City oJ Coppe// earh alld e....ery claim.
demand or cause of action Thar may be mode or come agaill.ft it by reason oJ or if any l\-on)' arising Olll of the
closure. blocking. e.xcm'at;ng. fUlfing. tunneling, or other work by the applicam under permiT from tile City.
!l such permit is grallfed.