HomeMy WebLinkAboutApplication (09-200)Lc
FOR OF I E USE 1ONLY
1 Case No.: 1'At-V
(* f/4
Date Submitted:
CITY OF COLLEGE STATION
phnniq o-Drrrfopnvnt Srnim
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP)
MINIMUM SUBMITTAL REQUIREMENTS
$150 PIP permit application and review fee
Attach 4 copies of a facility layout plan, which may 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
If applicable, the facility layout plan must include the following
(these may be drawn on separate sheets):
A signage plan - 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)
The cost estimate for relocating any public facilities associated with the work
An electrical plan
Irrigation/Plumbing plan (must be sealed)
A Structural plan showing details with anchoring, attachment, and material description (must be sealed)
Private utility, plan -dimensioned from right-of-way or back of curb, material, size
Attach one copy of the following:
Indemnity agreements from abutting fee owners
APPLICANT/PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated with the project):
Name �(llid ut _ r^v✓C� E-Mail baJJfieQQ tosctvavp,uS
Street Address l l Vuuv . �i • F. Ise S
City r S State Zip Code -7 7 T40
Phone Number Fax Number 9 ii. ZGO- 356(
PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person):
Name -bQ
Street Address
City A4AJs0r1 `) State '�X Zip Code fobI
Phone Number 71Fax Number
IDENTIFY THE FOLLOWING: 3SR- `t 441
The total valuation of the work:
The total valuation of the signage:
Estimated cost of future relocation of improvements: $
The total square footage of the site:
Page 1 of 4
The total linear feet of water lines crossing under paved road: j k
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
❑
Awning
Structural Contractor:
Benches
Number of Benches
❑
Bike racks
Number of Bike Racks:
❑
Cafe
*Structural Contractor:
❑
Canopy
*Structural Contractor:
Demolition
Structural Contractor:
❑
Electrical
Master Electrician:
❑
Facade
Structural Contractor:
Irrigation system
State Licensed Irrigator:
Landscaping
*Landscape Architect/Company:
❑
Masonry fence
*Structural Contractor:
❑
Sign(s)
*Sign Contractor:
❑
Waterway Alterations
Design Engineer:
❑
Wood fence
*Structural Contractor:
Other (please describe):
Identify party to perform this work: <jj LteAQ Qk
*The starred items may not require that structural contractors, sign contractors, or landscapers perform
the work - contact applicable City Departments for determination
that the information contained in this application is true and complete, to the best of my knowledge. I
it the City ha� the authority to inspect the work to be conducted within the public right-of-way at any
T erstand th this permit may be revoked at any time at the discretion of the City Officials.
bo /,-) 9
signature
Conditions of Approval:
Date applied
Authorization of City Engineer Date approved
Page 2 of 4
INDEMNIFICATION
DATE: l ((0 20
INDEMNITOR: --lp�'J4,rk �e n nnewcT
INDEMNITOR'S MAILING ADDRESS: I (0 SOD \Ae" ro [a • i o0
(including county)
AJJA soh J X _ 7 Soo
INDEMNITEE: City of College Station
INDEMNITIEE'S MAILING ADDRESS:
(including county)
LEGAL DESCRIPTION OF PROPERTY:
Lo+6 5-00) Sue -
Zoe l3o�e(�
(got 6ec'n'd '-4)
1101 Texas Avenue
Brazos County
College Station, Texas 77842
To the fullest extent permitted by law, I/we 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
tifq facilitie authorized by the Private Improvement Permit issued by Indemnitee to
ojry Ci16Y [(�t _ l / 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.
C7 �eco.ic� 5+,r`•d' ^r""4mt 611) LI-f-
-f6wto,4 a, �(�6ti1:� . AMR
Pr erly Owner J
a
Printed Name
Property Owner
Printed Name
THE STATE OF TEXAS §
COUNTY OF ?X470� § ACKNOWLEDGMENT `
This in m nt was acknowledged before me on the -HA day of e Y 20� by
> u. � -)l.
DEE L. WALLRATH dj
Notary Public, State of Texas
My Commission Expires Notary Public in and for the State of Texa
June 20, 2012
TI4E STATE OF TEXAS §
§ ACKNOWLEDGMENT
COUNTY OF §
This instrument was acknowledged before me on the day of
Notary Public in and for the State of Texas
Page 4 of 4
20 , by
(*fl""
CITY OF COLLEGE• STATION
pl arcing b Deg rlopnrcm s""w
FOR OFFICE USE ONLY
Case No.:
Date Submitted:
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP)
MINIMUM SUBMITTAL REQUIREMENTS
$150 PIP permit application and review fee
Attach 4 copies of a facility layout plan, which may 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
If applicable, the facility layout plan must include the following
(these may be drawn on separate sheets):
A signage plan - 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)
The cost estimate for relocating any public facilities associated with the work
An electrical plan
Irrigation/Plumbing plan (must he sealed)
' A Structural plan showing details with anchoring, attachment, and material description (must be sealed)
Private utility, plan -dimensioned from right-of-way or back of curb, material, size
Attach one copy of the following:
L✓J Indemnity agreements from abutting fee owners
APPLICANT/PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated with the project):
Name 7 `1" 1 �R (fps v� n E-Mall I
—I--' �-IfAli2�-- loSQ d'bV f] S
Street Address _6l l (�K... - 1, . e
City (- State TK Zip Code Z7 8 CEO _
Phone Number Z�. Sr`t b , �z 54 Fax Number 922. ?-GO- 35 ( 1-
PARTY R/E1SecP--,Q,NcSg-�)BLE FOR MAI TENANCE (if arty is a group, lease provide information for contact person):
Name0.Cl�lT `J,
u o a wee., E-Mail ::h2 no k cz L' eA: .-t .(. o N
Street Address Ito Son
Cityirk 0;aori J State
Phone Number_ 71 it
IDENTIFY THE FOLLOWING:
The total valuation of the work: $ ,
The total valuation of the signage: $.
Estimated cost of future relocation c
The total square footage of the site:
Zip Code.
Fax Number girl-Z(o5 , p-t �z
The total linear feet of water lines crossing under paved road: 0 Jim
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
❑
Awning
Structural Contractor:
Benches
Number of Benches
❑
Bike racks
Number of Bike Racks:
❑
Cafe
*Structural Contractor:
❑
Canopy
*Structural Contractor:
Demolition
Structural Contractor: 5&e , aQ
❑
Electrical
Master Electrician:
❑
Facade
Structural Contractor:
L
litigation system
State Licensed irrigator:
Landscaping
*Landscape Architect/Compan f
❑
Masonry fence
*Structural Contractor:
❑
Sign(s)
*Sign Contractor:
❑
Waterway Alterations
Design Engineer:
❑
Wood fence
*Structural Contractor:
Other (please describe):
Identify parry 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 verelly that the information contained in this application is true and complete, to the best of my knowledge. I
understaq hat the -City fithe authority to inspect the work to be conducted within the public right-of-way at any
time. 1 s understand the this permit may be revoked at any time at the discretion of the City Officials.
Applica is signature Date applied
Conditions of Approval:
Authorization of City Engineer Date approved
Page 2 of 4
INDEMNIFICATION
DATE: 1 ^ ((o , 20_C�_
C5 ae ol\gyp Z�r
MEMNITOR: r � „
INDEMNITOR'S MAILING ADDRESS: (o 8co �tV P / o�/a �Ce • 100
(including county)
INDEMNITEE: City of College Station
MAILING ADDRESS:
(including county)
LEGAL DESCRIPTION OF PROPERTY:
1 c)+5 5— o,) S U4- Zo 3oLce-tt
(qo t Sec —'A S{•) ,
1101 Texas Avenue
Brazos County
College Station, Texas 77842
To the fitllest extent permitted by law, Uwe 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
facilities4q authorized by the Private Improvement Permit issued by Indemnitee to
P
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 whe her such
injuries, death, damages, or breach are caused by the NEGLIGENCE or omission of Indemnitee, the contractor
installing said facilities, or any third party.
C5
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.
THE STATE OF TEXAS §
COUNTY OF iGZU� §
Property Owner
Printed Name
ACKNOWLEDGMENT
j This in rum nt was acknowledged before lYt me on the ��O day of iY, 200j, by
l YIbtVIGS� �.� _ ��i.J��
err
:,o`^• •`± DEE L. WALLRATH
! _ Notary Public, State of Texas
' »:
�.a, �,,' My Commission Expires
June 20, 2012
THE STATE OF TEXAS §
COUNTY OF §
A UZ
Notary Public in and for the State of Texas
ACKNOWLEDGMENT
This instrument was acknowledged before me on the day of
Notary Public in and for the State of Texas
I'age 4 of 4
20_, by
INDEMNIFICATION
DATE: ` (tom 20jn
INDEMMTOR:
INDEMNITOR'S MAILING ADDRESS:
fineludim county)
INDEMNITEE: City of College Station
INDEMKIT] E'S MAILING ADDRESS:
(including county)
LEGAL DESCRIPTION OF PROPERTY:
C�O t Secxm.ot ��
1101 Texas Avenue
Brazos County
College Station, Texas 77842
T
10 the fullest extent permitted by law, I/we the owners of the property described above (Indemnitor), shall
indemnify, hold harmless, and defend the Indemnitee, its officers, agents, and employees firm 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
facilities thorized by the Private Improvement Permit issued by
1� i 0 Inspeci l d to
�C�l_.L,�,� �.1), including, but not limited #o, any premise defect or special defect
arising out of or in LZ.tm s n W .: h said facilities_ This Indeur i n_ft ar t; _ _e*t shall apply regardless ofwbether SUGh
injuries, death, damages, or breach are caused by the NFfiiLIGENC% or omission of Indemnitee, the contractor
installing said facilities, or any third party.
Page 3 Of 4
All Provisions of this Indemnification shall be bind
Citv of College Station, Texas, and their respective
Pro erty Owner
ie undersigned c
This in m@nt was acknowledged before me on the fn day g f 20 nci by
i 11biYtCt 7 �� ITC±i�V t " r ,
�nnr ve
,,a ��,
-
w"`•c
DEE L, WpLLRATH
Notary' Public, State
°a'�or,
of Texas
N+v Commrssran Expires
��"
'",„`
Jane 20, 2012
Notary Public in and for me State
Texa
THE STATE OF TEXAS §
COUNTY OF § ACKNOWLEDGMENT
This instrument Was acknowledged before me on the day of
Notary Public in and for the State of Texas
20_, by