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CITY OF COLU'GE STATION
Home of Texas ACW University'
FOR OFFICE USE ONLY
CASE NO.: 10. 05001-74
DATE SUBMITTE "!a-lb
TIME: o-
STAFF:
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION
Pov MINIMUM SUBMITTAL REQUIREMENTS:
$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:
United ay o the Brazos Valley, Inc., 909 Southwest Parkway E. College Station, TV-77840
Comer of Southwest Parkway E & Central Park Lane
APPLICANT/PROJECT MANAGER'S INFORMATION (Primary contact for the project):
Name United Way of the Brazos Valley E-mail hroraback@uwbv.org
Street Address 909 Southwest Parkway E
City College Station
Phone Number 979-696-4483
PARTY RESPONSIBLE FOR MAINTENANCE (If party is a group, please provide information for contact person):
Name Hank Roraback E-mail hroraback@uwbv.org
Street Address 909 Southwest Parkway E
City College Station
Phone Number 979-696-4483
State Texas Zip Code 77840
Fax Number 979-696-4490
State Texas Zip Code 77840
Fax Number 979-696-4490
10/09 Page 1 of 4
ti
IDENTIFY THE FOLLOWING:
0 0
The total valuation of the work: $ 300.00
The total valuation of the signage: $0
Estimated cost of future relocation/remodel of improvements:
The total footage of the site: 100
The total linear feet of water lines crossing under paved road:0
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:
❑
Electrical
Master Electrician:
❑
Facade
Structural Contractor:
❑
Irrigation System
State Licensed Irrigator:
❑
Landscaping
*Landscape Architect/Company: Volunteers
❑
Masonry fence
*Structural Contractor:
❑
Sign(s)
*Sign Contractor:
❑
Waterway Alterations
Design Engineer:
❑
Wood fence
*Structural Contractor:
❑
Other (please describ
e) 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
understand that the City
also understand that this
$0
ation contained in this application is true and complete, to the best of my knowledge. I
e authority to inspect the work to be conducted within the public right-of-way at any time. I
t may be revoked at any time at the discretion of the City Officials.
Aolz-mod rl3/J d
Signature and title
Date
Conditions of Approval:
Engineer Date approved
Au" on ation of I
J
10/09
Page 2 of 4
Ee
INDEMNIFICATION
Date: August 13, 2010
Indemnitor: United Way of the Brazos Valley
Indemnitor's Address: 909 Southwest Parkway E
(including county) Brazos County
College Station, 7X 77840
Indemnitee: CITY OF COLLEGE STATION
indemnitee's Address: 1101 Texas Avenue
(including county) Brazos County
College Station, Texas 77840
LEGAL DESCRIPTION OF PROPERTY:
Lot 1 Block A Eastmark subdivision phase 1
To the fullest extent permitted by law, Ilwe 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 expense of litigation, court costs, and attorney's
fees, for injury to, or death of, any person, for damage to any property, or fo ny breach of contract, arising out of or in
connection with the installation, operation, and maintenance of the facilities uthorized by the Private Improvement Permit
issued by Indemnitee to United Way of the Brazos Valley , includin , but not limited to, any premise defect or special
defect arising out of or in connection with said facilities. This Inde nification shall apply regardless of whether such
injuries, death, damages, or breach are caused by the NEGLIGEN or omission of Indemnitee, the contractor installing
said facilities, or any third party.
All provisions of this Indemnification shall be binding upgrf and inure to the benefit of the undersigned and the City of
College Station, Texas, and their respective successors d assigns.
Property Owner Printed Name
STATE OF TEXAS §
§ KNOWLEDGEMENT
COLITY OF BRAZOS §
Subscribed and sworn to before 7M`6 Notary Public, this day of 2009 by
Notary Public in and for
the State of Texas
10/09 / Page 3 of 4
d
i
Property Owner Printed Name
STATE OF TEXAS §
§ ACKNOWLEDGE T
COUTY OF BRAZOS §
Subscribed and sworn to before me, a Notary Publi , this day of , 2009 by
Notary Public in and for
the State of Texas