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Home My WebLink AboutApplication (2) FOR OFFICE USE ON LY CASE NO.: Iq DATE SUBMITTED- TIME: 10: 4o CITY OP COLLEGE STATION STAFF: Home ofTvwAdM Unimsity' PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION MINIMUM SUBMITTAL REQUIREMENTS: V$250 PIP Application Fee. ❑ Application completed in full. This application form provided by the City of College Station must be used and may not be adjusted or altered. Please attach pages if additional information is provided. ❑ Indemnity agreements from abutting property owners. ❑ Attach four (4) copies of a facility layout plan, which shall include the following: ❑ Location, identification, and dimensions of ROW and pavement edge/curb. ❑ Location of all proposed improvements. ❑ Location of all public utilities (existing) - dimensioned from right-of-way or back of curb, material, size. ❑ A signage plan - include dimensions of sign(s), location from back of curb, materials, elevation drawing (if applicable). ❑ Drainage and/or erosion control plan (if applicable). ❑ Proposed waterway alterations with supporting drainage report (if applicable). ❑ Landscape plan showing the location and type of plantings - existing and proposed, both common names and scientific (if applicable). ❑ The cost estimate for relocating any public facilities associated with the work (if applicable). ❑ An electrical plan (if applicable). ❑ Sealed irrigation / plumbing plan (if applicable). ❑ Sealed structural plan showing details with anchoring, attachment, and material description (if applicable). ❑ Private utility plan-dimensioned from right-of-way or back of curb, material, size (if applicable). LOCATION OF IMPROVEMENTS: 6" p APPLICANT/PROJECT MANAGER'S INFORMATION (Primary contact for the project): Name t~ K tCHAf2i if-re Seuir A!iy ~t nrrrtTii ' ri- C': E-mail Street Address _5_~ 1Trfr.`tiA►~`+ r3 T,t'~, J `f City C e t I 1 w i, c,(,i State r Zip Code 2& Phone Number 171 '70 MT Fax Number 4/79--- e f~ _~l 51; PARTY RESPONSIBLE FOR MAINTENANC (If party is a group, please provide information for contact person): Name j~ledar1 ZE f f~H ~r uTry~~' ~ 61, 7-4 3"tck" E-mail r ~ . SPtttA Ct~ Ceti 17 Street Address I "T C i 5f; V T"'r4ii k rL11' b PL-471 a:'&- Pk city ti 5f t Ti State T Zip Code Phone Number 97i ` k g / 3 Fax Number ~ 7q_G 9 L ~ 1 ~ 10/09 Page 1 of 4 INDEMNIFICATION Date: 5 1 01 6) Indemnitor. &c rFr K V 41z-/ r C Indemnitor's Address: / 1 t,' 1 j c if i r/&k L' l ~1 T l i /O/L' ' (including county) Indemnitee: CITY OF COLLEGE STATION indemnitee's Address: 1101 Texas Avenue (including county) Brazos County College Station, Texas 77840 LEGAL DESCRIPTION OF PROPERTY: Syrvf}li,~l~y P{{ l1 h~te~ !G'1 ~•eT 'yV 19c~s 5;1d ~cc~rrrrcfv art-C44hlr[3Nsr To the fullest extent permitted by law, 1/we the owners of the property described above (Indemnttor), shall indemnify, hold harmless, and defend the Indemnitee, its officers, agents, and employees from and against any and all claims, losses, damages, causes of action, suits and liability of every kind, including all expenses of litigation, court costs, and attorney's fees, for injury to, or death of, any person, for damage to any property, or for any breach of contract, arising out of or in connection with the installation, operation, and maintenance of the facilities authorized by the Private Improvement Permit issued by Indemnitee to , including, but not limited to, any premise defect or special defect arising out of or in connection with said facilities. This Indemnification shall apply regardless of whether such injuries, death, damages, or breach are caused by the NEGLIGENCE or omission of Indemnitee, the contractor installing said facilities, or any third party. All provisions of this Indemnification shall be binding upon and inure to the benefit of the undersigned and the City of College Station, Texas, and their respective successors and assigns. ~ WhF/TF/ELD Tiffs ,~.f Property ner Pnnted Name 1Piyf~~ STATE OF TEXAS § 1 § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this 2a day of 2009 by Af It-, RICHARD LEITCH Notary Public in and for Notary Public, State of Texas the State of Texas +c MY Commission Expires Auyuat OS, 2012 10/08 Page 3 of 4 IDENTIFY THE FOLLOWING: pe ✓ The total valuation of the work: $ 1 ~~rd I he total valuation of the signage: l o a~~ Estimated cost of future relocation/remodel of improvements: $ ( X00 The total footage of the site: I h cc 's ~ The total linear feet of water lines crossing under paved road: N.A. IDENTIFY THE TYPE OF WORK TO BE PERFORMED: ❑ Awnings Structural Contractor: ❑ Benches Number of Benches: ❑ Bike racks Number of Bike Racks: ❑ Cafe *Structural Contractor: ❑ Canopy *Structural Contractor. Demolition Structural Contractor: LC.~_ j'_[W r r ;;,r ❑ Electrical Master Electrician: ❑ Facade Structural Contractor: ❑ Irrigation System State Licensed Irrigator: ❑ Landscaping *Landscape Architect/Company: ❑ Masonry fence *Structural Contractor: 54 Sign(s) *Sign Contractor: I y Cc, a _C OF 4 is`- 57-/j i/ C %L~, ❑ Waterway Alterations Design Engineer: ❑ Wood fence *Structural Contractor: ❑ Other (please describe) Identify party to perform this work: *The stained items may not require that structural contractors, sign contractors, or landscapers perform the work - contact applicable City Departments for determination I hereby verify that the information contained in this application is true and complete, to the best of my knowledge. 1 understand that the City has the authority to inspect the work to be conducted within the public right-of-way at any time. l alsq understand that this permit may be revoked at any time at the discretion of the City Officials. It - / L,'CK r- /0 Signature and Ube C~ y 0 rj Date Conditions of Approval: Authorization of City Engineer Date approved 10/09 Page 2 of 4 FOR OFFICE USE ONLY CASE NO.: _ M_ . r/1 DATE SUBMITTED- Il1 Cm OP COLLEGE STATION TIME: D Home ofTff"Ad'M Unimyit, STAFF: n PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION MINIMUM SUBMITTAL REQUIREMENTS: V$250 PIP Application Fee. ❑ Application completed in full. This application form provided by the City of College Station must be used and may not be adjusted or altered. Please attach pages if additional information is provided. ❑ Indemnity agreements from abutting property owners. ❑ Attach four (4) copies of a facility layout plan, which shall include the following: ❑ Location, identification, and dimensions of ROW and pavement edge/curb. ❑ Location of all proposed improvements. ❑ Location of all public utilities (existing) - dimensioned from right-of-way or back of curb, material, size. ❑ A signage plan - include dimensions of sign(s), location from back of curb, materials, elevation drawing (if applicable). ❑ Drainage and/or erosion control plan (if applicable). ❑ Proposed waterway alterations with supporting drainage report (if applicable). ❑ Landscape plan showing the location and type of plantings - existing and proposed, both common names and scientific (if applicable). ❑ The cost estimate for relocating any public facilities associated with the work (if applicable). ❑ An electrical plan (if applicable). ❑ Sealed irrigation / plumbing plan (if applicable). ❑ Sealed structural plan showing details with anchoring, attachment, and material description (if applicable). ❑ Private utility plan-dimensioned from right-of-way or back of curb, material, size (if applicable). LOCATION OF IMPROVEMENTS: j~ ~1 GizAjk(',.. Otvgoiv KGB D fCctq "k APPLICANT/PROJECT MANAGER'S INFORMATION (Primary contact for the project): Name ~ltrfr3fil ~ `°usnri+t~ ~~xln7f}r'•1 I' E-mail Sf')0 (-t CG 1.-k-ft C/P U- Street Address L' i,' rff k " & ki, ° _111 TIC till.. 1)City 5-Tr} -I, Cio State X Zip Code a Phone Number '7757 69R IC C3 Fax Number f .7- ( :~E' 1 PARTY RESPONSIBLE FOR MAINTENANC (If party is a group, please provide information for contact person): 3 M m Name,,~►1 ~t~ riot /'uTrtre°!3 Wrt~Ts`t =rr ' E-mail SI ttir+ C` Gn t z c~` , j~ i" f_ Street Address f ITC I 5 _V_rr41j rc . 471 a ~u L City _Co" c c tc i r~ 57_t. T; eli ; State _ TX Zip Code Phone Number Fax Number - Cgs;2 A L 10/09 Page 1 of 4 INDEMNIFICATION Date: _ 5 1 01 6) - Indemnitor. tndemnitor's Address: / G cc i NI K' J/ ' ~+L''T14Ti1t (including county) ~N.-2 e S Indemnitee: CITY OF COLLEGE STATION indemnitee's Address: 1101 Texas Avenue (including county) Brazos County College Station, Texas 77840 LEGAL DESCRIPTION OF PROPERTY: r~ j-Hou'r m)1 Atf it1 l~jtt'Ct*r i^G>T Lrl / 17Cj< S ti>7~ (Crflrii4", ~REA -~Gklyl sus To the fullest extent permitted by law, Itwe the owners of the property described above (Indemnitor), shall indemnify, hold harmless, and defend the Indemnitee, its officers, agents, and employees from and against any and all claims, losses, damages, causes of action, suits and liability of every kind, including all expenses of litigation, court costs, and attorney's fees, for injury to, or death of, any person, for damage to any property, or for any breach of contract, arising out of or in connection with the installation, operation, and maintenance of the facilities authorized by the Private Improvement Permit issued by Indemnitee to , including, but not limited to, any premise defect or special defect arising out of or in connection with said facilities. This Indemnification shall apply regardless of whether such injuries, death, damages, or breach are caused by the NEGLIGENCE or omission of Indemnitee, the contractor installing said facilities, or any third party. All provisions of this Indemnification shall be binding upon and inure to the benefit of the undersigned and the City of College Station, Texas, and their respective successors and assigns. e~ Gv#1TF/ELD Property ner Punted Name 90164 STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this 2a-tt day of 2009 by RICHARD LEITCH No ryPublic in and for [PUN' Notary Public, State of Texas the State of Texas +r My Commission Expires •~;r Au9W OS, 2012 10109 Page 3 of 4 IDENTIFY THE FOLLOWING: pe ✓ The total valuation of the work: $ t~ i i The total valuation of the signage: $_`p wlavOluml Estimated cost of future relocation/remodel of improvements: $ ( X00 The total footage of the site: I ~ cc Si- The total linear feet of water lines crossing under paved road: A. IDENTIFY THE TYPE OF WORK TO BE PERFORMED: ❑ Awnings Structural Contractor: ❑ Benches Number of Benches: ❑ Bike racks Number of Bike Racks: ❑ Cafe *Structural Contractor: ❑ Canopy *Structural Contractor. Demolition Structural Contractor: C-0-y- G-,t r.C-4=0~1 ❑ Electrical Master Electrician: ❑ Facade Structural Contractor: ❑ Irrigation System State Licensed Irrigator: ❑ Landscaping *Landscape Architect/Company: ❑ Masonry fence *Structural Contractor: + c Sign(s) *Sign Contractor: 1,3 ( 1`i y t ❑ Waterway Alterations Design Engineer: ❑ Wood fence *Structural Contractor: ❑ Other (please describe) Identify party to perform this work: *The starred items may not require that structural contractors, sign contractors, or landscapers perform the work - contact applicable City Departments for determination I hereby verify that the information contained in this application is true and complete, to the best of my knowledge. 1 understand that the City has the authority to inspect the work to be conducted within the public right-of-way at any time. I also understand that this permit may be revoked at any time at the discretion of the City Officials. Signature and title S f ye) rj Date Conditions of Approval: Authorization of City Engineer Date approved 10/09 Page 2 of 4