P_ROW Use LA copy of the approved permit must be on the job site at all times.
T H E • C 1 T Y • O F
CC: Applicant COPPELL Page 1 of 4
Public Works , * Rev. 02/2012
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Original to LF/FILE X A h ' 5
RIGHT-OF-WAY USE PERMIT APPLICATION
Permit valid for 90 days from the date of approval.
Submit permit application to Engineering Dept.,Town Center,255 Parkway Blvd.Coppell TX 75019
Date of Submittal: Applicant's Job#/Work Order#
PERMIT FEE: $100 (No charge to franchise utility companies with ROW Use Agreement)
Refer to City of Coppell Ordinance No. 2001-944. Certificated Telecom Provider? Y / N
EMAIL ADDRESS FOR SUBMITTAL : enzineer(a,coppelltx.gov
Plans provided and approved?(Erosion Control/Safety Fences must be installed prior to beginning work)
Project Name/Location or address
General Contractor Contact #
Email address to return approved permit
,. Representative:
v a Telephone#: Emergency#:
o Email address:
(for contact if needed/if email of approved permit is desired/permit cannot be emailed unless complete)
Utility Company Represented:
0 Oncor Electric Delivery 0 Atmos Energy 0 Verizon 0 AT&T/SBC
0 Time Warner Cable 0 Time Warner Telecom 0 Other
General Description of Work(in accordance with Ordinance 2001-944)Provide 3 sets of prints.
Estimated Start Date Estimated Completion Date*
*Completion requires inspection and submittal of Completion Verification Notice (page 4).
Was City Utility Dept. contacted to locate existing underground utilities? Yes 0 No
If not, reason
f♦Is removal of existing streets, alleys or sidewalks necessary? Yes ® No
if Yes,project must have City inspection prior to concrete replacement.
Right-of-Way Use Permit Application Page 2 of 4
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 applicant's expense) and barricading according to the
Texas Manual on Uniform Traffic Control Devices.
Affected area must be restored to same condition as before the commencement of work
(grading,drainage,vegetation and erosion control).
To schedule a Public Works final inspection as required on Page 4,call 972-462-5155.
Any excavation requiring the closing of a street/alley must be reported to the following prior to closing:
Police Dept. 972-304-3600 Fire Dept. 972-304-3512
Street Dept. 972-462-5150 Engineering Dept. 972-304-3679
Attach a barricade plan or trench safety plan if a lane or street closure is required. NOTE: Street
closures are allowed from 9:00 a.m. until 3:30 p.m. ONLY unless otherwise approved by City Engineer.
Attach the Franchise Work Order(if applicable)and 3 sets of prints showing the proposed work.
Locates for existing franchise utilities must be done 48 hours prior to beginning work.
For City utility locates,call 972-462-5155 to schedule 48 hours prior to beginning work.
This application with signatures of Franchise and Contractor representatives must be submitted to Engineering
Department for approval prior to beginning work. Submittals by email should go to engineer@coppelltx.gov.
If you want the approved permit returned via email,provide a valid email address on Page 1.
Permit cannot be emailed unless all required signatures are present.
Signature of Utility Company Representative Printed Name Date
Signature of Contractor Representative Printed Name Date
Signature of City Representative Printed Name Date
COMMENTS:
NOTE:Notify Engineering Dept. at 972-304-3679 prior to beginning work and for open trench,ditch or pit
inspection prior to backfilling. Backfill material must meet City of Coppell standards.
Applicant shall indemnify and forever hold harmless the City of Coppell against each and every claim, demand, or
cause of action that may be made or come against it by reason of or if in any way arising out of the closure, blocking,
excavation, cutting, tunneling, or other work performed by the applicant under permit from the City, if such permit is
granted.
T H E • C I T Y • o F Page 3 of 4
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X A S 6
UTILITY RELOCATION CHECKLIST FOR WORK WITHIN
CITY OF COPPELL RIGHTS-OF-WAY OR EASEMENTS
Listed below are minimum requirements for utility relocation projects:
1. A copy of the valid approved City of Coppell permit is required on the project at all times.
2. Notify adjacent property owners (commercial & residential) of project timeline; provide them with contact
names and phone numbers.
3. Proper erosion control measures must be taken.
4. Follow Texas MUTCD standards for work in traffic zones.
5. Sod is to be replaced when necessary.
6. Irrigation repairs must be performed in a timely manner.
7. Follow OSHA recommended trench safety at all times.
8. Repair existing utilities that are damaged, including but not limited to clean-outs, water valves, and SS
manholes.
9. Densities may be required in trench lines (ASTM).
10. Care and repair of street signage is the responsibility of the contractor.
11.No work is to be done in collector roadways before 9:00 a.m. or after 4:00 p.m.
12. Prior notice of work activity on weekends and holidays must be in writing.
13. Line locates must be performed in advance by contacting -1 800 DIG TESS and/or the following:
CITY OF COPPELL UTILITIES DIVISION coppelltx.gov/utility-operations-division
972/462-5155
CITY OF COPPELL ENGINEERING DEPT.
972/ 304-3679
HOMEOWNER ASSOCIATIONS
972/ 304-3678 (Planning Dept.)
TIME WARNER CABLE FEDERAL EMERGENCY MGMT. ADMIN.
214/ 320-5455 (Mike Rasmussen) 940/ 898-5138
AT&T LOCAL NETWORK TEXAS COMM. on ENVIRONMENTAL QUALITY
214/ 215-3031 (Rich Millenman) 817/ 588-5800
COSERV Gas & Electric DENTON CO. LEVEE DISTRICT
940/321-7800 x 7624 (Greg Ward) 214/ 352-5118 (Richard Hightower)
EXPLORER PIPELINE Atmos Energy
918/493-5100 (Patrick Nwakoby) 972/ 360-4428 Gary Dickinson
ONCOR Electric Delivery 1 800 DIG TESS for line locates
972/ 323-8917 (Larry Redick) (344 - 8377) or
VERIZON COMMUNICATIONS www.texasonecall.com
972/ 318-5277
14. Contaminants must be removed from work area daily and disposed of properly outside the City.
15. Streets, sidewalks and alleys must be kept clean of construction material and debris.
16. "Clean-up" requires returning work area to pre-project condition or better.
17. Contractor is required to contact Public Works Division for Completion Verification Notice. (see pg. 4)
Page 4 of 4
T H E C 1 T Y O F
COPPELL
F =^ f q
A S 18
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
INFORMATION BELOW TO BE COMPLETED BY CITY OF COPPELL PUBLIC WORKS PERSONNEL
❖ Inspected by of UTILITIES Maintenance Division on
and found to be acceptable /not acceptable because
Follow-up needed? NO/ YES Follow-up scheduled for
Inspected by of STREETS Maintenance Division on
and found to be acceptable /not acceptable because
Follow-up needed? NO/ YES Follow-up scheduled for
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