P_Bore/Street Cut permit
THE.CITY.OF
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COPPELL
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DRY BORE / STREET CUT / SAW CUT PERMIT APPLICATION
FOR WORK IN
RIGHT-OF-WAY / EASEMENT
Submit permit application to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date Submitted: Work Order # (if applicable)
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use Agreement)
D Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning work)
Project Name / Location:
Company Name:
Address:
Telephone #:
Emergency Telephone #:
Permit issued to (Contractor Name)
Utility Company Represented:
D Oncor Electric Delivery
D Time Warner Cable
D Atmos Energy
D CoServ Elec/Gas
D Verizon
D Other *
D SBC / AT&T
* If "Other" is checked, please note that franchise or right-of-way use agreements will be required.
General Description of Work (provide copy of approved plans):
~ Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES D
~ Is removal of existing streets, alleys, or sidewalks necessary? YES D
if YES, must have City inspection prior to concrete replacement
NOD
NoD
Dry Bore / Street Cut / Saw Cut Permit
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 applicants expense) and barricading according to the Texas Manual on Uniform Traffic Control Devices.
Area(s) affected must be restored to as good condition as before the commencement of work (grading, drainage,
vegetation, and erosion control).
~ 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 / trench safety plan if a lane or street closure is required.
NOTE: Street closures are allowed from 9:00 a.m. until 4:00 p.m. ONLY unless otherwise approved by City
Engineer.
~ Attach Work Order (franchise only).
~ Contact must be made with City and utility companies to locate existing utilities 48 hours prior to beginning of
work.
Signature of Utility Company Representative
Printed Name
Date
Signature of Contractor Representative
Printed Name
Date
Signature of City Representative
Printed Name
Date
(Application with original signatures needs to be submitted to the Engineering Department before approval.)
~ Comments:
~ 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, tunneling, or other work by the applicant under permit from the City,
if such permit is granted.
THE.CITY.OF
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COPPELL
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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 WorkOrder # (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 PERSONNEL
.:. Inspected by
of Utilities Maintenance Division on
and found to be acceptable / not acceptable because
Follow-up scheduled for
of Streets Maintenance Division on
Follow-up needed? NO / YES
.:. Inspected by
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