HomeMy WebLinkAboutPIP ApplicationFOR OFFICE USE ONLY
Case No.: 08'-;Jd]
Date Submitted: q /I W /0'6 ) i
CITY OF C OLLEGE STATION
N 11111ing C' D<velopme111 Services
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP)
MINIMUM SUBMITTAL REQUIREMENTS
D ~mit application and review fee
Attach 4 copies of a facility layout plan, which may include the following: D Location, identification, and dimensions of ROW and pavement edge/curb)
D Location of all proposed improvements
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D Location of all public utilities (existing) -dimensioned from right-of-way or back of curb, material, size
If applicable, the facility layout plan must include the following
(these may be drawn on separate sheets):
~e--J*In -include dimensions of sign(s), location from back of curb, materials, elevation drawing
Drainage and/or erosion control plan
Proposed waterway alterations with supporting drainage report
Landscape plan showing the location and type of plantings (existing and proposed, both common names
and scientific) -*'-"\ ~ ;t'\3 ~ ~~~ d;~ D The cost estimate for relocating any public facilities associated with the work D An electrical plan D Irrigation/Plumbing plan (must be sealed) D A Structural plan showing details with anchoring, attachment, and material description (must be sealed) D Private utility, plan-dimensioned from right-of-way or back of curb, material, size
Attach one copy of the following:
D Indemnity agreements from abutting fee owners
APPLICANT/PROJECT MANAGER'S INFORMATIO (Party responsible for completion of all work associated with the project):
Street Address \qa'-l L~r @.--•
City C=\\~ ~\Cl'--State_~----"-----Zip Code -,-,r{lw
Phone Number °r]c,,-7 3°'1-771( Fax Number ____________ _
PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person):
E-Mail _ _:o;,,,,;;~-=-u\5'4-'~=...;:;-Xx.s--==--e""-. -='i+-"~-"----==-o_. ~---
Street Address So3 Cc\~ ~""'-
City Co».ur'6~, State "R Zip Code _ll_JF-"-t4--=-o ___ _
Phone Number °(JC\~-v.,'1.--rn=i Fax Number ____________ _
IDENTIFY THE FOLLOWING:
The total valuation of the work: $ 1.-\-£" \L ----'-----"''--'---------------------~
+.he total vali 1ation of the signage: $-. ________________________ _
Estimated cost of future relocation of improvements: $ ---'-':....:\'"""Cic-'----------------
The total square footage of the site: ~-Oc .O f t "" --=~)'--~--'---------------------
Page 1 of 4
The total linear feet of water lines crossing under paved road : _....::50:::::..._ _____________ _
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
D Awning Structural Contractor:
@' Benches Number of Benches \
D Bike racks Number of Bike Racks:
D Cafe *Structural Contractor:
D Canopy *Structural Contractor:
D Demolition Structural Contractor:
D Electrical Master Electrician:
D Facade Structural Contractor:
@" Irrigation system State Licensed lrrigator: ¥0~ \U'l-~who!'--
Gr Landscaping *Landscape Architect/Company: W>z.cc.~ ~ro~~
D Masonry fence *Structural Contractor:
D Sign(s) *Sign Contractor:
D Waterway Alterations Design Engineer:
D Wood fence *Structural Contractor:
D 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. I
understand that the City has the authority to inspect the work to be conducted with in the public right-of-way at any
time. I also understand that this perm it may be revoked at any time at the discretion of the City Officials.
~
Applicant's signature Date applied
Conditions of Approval: -;_v-~m0S\Ya-r ht~)J®d \t?mo.1V1.tcli•1 ,risi\odt'bj of
\>r[i'..tE--t C--c.ovY\m \ 0 ~}') s e c\n \) YLJri +c_ o u e_t-N °'" ' ~ -""vo'-t ~
Authorization of City Engineer Date approved
Page 2 of 4
INDEMNIFICATION
DATE: j~A-r ;.r!i (_,, __ _,.< r,__v_~-----, 20_!)_.r
I/
INDEMNITOR:
INDEMNITOR'S MAILING ADDRESS:
(including county)
INDEMNITEE: City of College Station
INDEMNITIEE'S MAILING ADDRESS:
(including county)
LEGAL DESCRIPTION OF PROPERTY:
1101 Texas Avenue
Brazos County
College Station, Texas 77842
To the fullest extent permitted by law, Vwe 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.
Page 3 of 4
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.
Printed Name
THE STATE OF TEXAS
COUNTY OF fKftl o5
§
§
§
Property Owner
Printed Name
ACKNOWLEDGMENT
/} This instrument was acknowledged before me on the ____/2 day of .Y pWbete , 20___af, by
l_'C65fl/i I/) 0 ,'in.1-lb • I
THE STATE OF TEXAS
COUNTY OF -----
§
§
§
~an~ofTexas
ACKNOWLEDGMENT
This instrument was acknowledged before me on the __ day of _____ _
Notary Public in and for the State of Texas
Page 4 of 4
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