P_Service Drop
THE.CITY.OF
RIGHT-OF-WAY USE PERMIT
APPLICATION
For
SERVICE DROPS ONLY
cOPPELL
1\ Ii
Submit permit a~plication to the Engineering Dept., Town Center, 255 Parkway Blvd.
Date of Submittal:
Project Address:
General Contractor:
Address:
Permit issued to Company / Representative:
Telephone #:
Emergency Telephone #:
Utility Company Represented:
D Oncor Electric Delivery
D Time Warner Cable
D Atmos Energy
D CoServ Elect.
D Verizon
D Other*
DSBC/ AT&T
* If "Other" is checked, please note that franchise or right-of-way use agreements will be required.
General Description of Work
~ 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
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
NoD
NoD
~ 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 Contractor Representative
Printed Name
Date
Signature of City Representative
Printed Name
Date