HomeMy WebLinkAbout10-00500262- 00075063CITY OF COLLEGE STATION
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FOR OFFICE USF. ONLY
CASE NO.:
DATE SUBMITTED:
TIME:
STAFF
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION
MINIMUM SUBMITTAL REQUIREMENTS:
❑ $350 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.
P(ANotarized indemnity agreements from abutting property owners.
❑ Attach four (4) copies of a facility layout plan, which shall include the following:
E) Ngcation, identification, and dimensions of ROW and pavement edge/curb.
[Z] Location of all proposed improvements.
[Location of all public utilities (existing) - dimensioned from right-of-way or back of curb, material, size.
P" 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).
p,Proposed waterway alterations with supporting drainage report (if applicable).
Landscape e plan showing the location and type of plantings - existing and proposed, both common
names and scientific (if applicable). v p ON 6 (4k, ,
The cost estimate for relocating any public facilities associated with the work (if applicable).
[ W An electrical plan (if applicable).
Sealed irrigation / plumbing plan (if applicable).
OZO~ 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:
7
LICANT/PROJECT MANAGER'S INFORMATION (Prima contact for the ro'ect)e
APP ry P 1
Name ~rjyjv I L/ fT/1-i e > ~E-mail 'I re Vol' /F 13 G 'Vc,
Street Address U1:4-`( T 4Z
City 5 State Zip Code y
Phone Number 6D 4 1-( <5-c) 7 t) Z- `7 Fax Number
PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person):
Name E-mail
Street Address
City
Phone Number
State
Fax Number
Zip Code
10/10 Page 1 of 4
I iDLNTIFY THE FOLLOWING:
The total valuation of the work: $
The total valuation of the signage: $
Estimated cost of future relocation/remodel of improvements:
The total footage of the site: D
The total linear feet of water lines crossing under paved road:
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:
❑
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:
*The starred items may not require that structural contractors, sign contractors, or landscapers perform the work -
contact applicable City Departments for determination
1 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. 1
also understaod,that this permit mgy-bejrevoked at any time at the discretion of the City Officials.
Signature and title
Conditions of Approval:
)1-Z2-Z6t(
Date f
t rization of ity Engineer
v
I--S-11
Date approved
10/10 Page 2 of 4
INDEMNIFICATION
Date: I \ - 2-7-211) 1-0
Indemnitor: ~ r ✓u / e) (L _L
Indemnitor's Address:
(including county) C j TV ~ ~f,~/
Indemnitee: CITY OF COLLEGE STATION
indemnitee's Address: 1101 Texas Avenue
(including county) Brazos County
College Station, Texas 77840
LEGAL DESCRIPTION OF PROPERTY:
T~- Y-,~ s 4NIJ,
Printed Name /
To the fullest extent permitted by law, 1(4 the owners of the property described above (Indemnitor), shall indemnify, hold
harmless, and defend the Indemnitee, t s 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 Sion, Texas, and theiL.LWective successors and assigns.
Prope
STATE OF TEXAS
COUTY OF BRAZOS
EMENT
Subscribed and sworn to before me, a Notary Public, this day of MO.
GINA SOUTHERLAND
Notary Pubic State of Texas
MvCornrn-ssicin Expires
SEPTEMBER 4, 2013
Notary
the State of Texas
, 2009 by
r
10/10 Page 3 of 4
Property Owner
STATE OF TEXAS §
§ AC OWLEDGEMENT
COUTY OF BRAZOS §
~f~ ce-a~
Printed Name
, 2009 by
Subscribed and sworn to before me, a Notary Public, this day of ~kMzv-
otary Public/fn- and for
♦
PPY PU GINA SOUTHERLAND
e State of -Texas = "
Notary Public State of Texas
My Commission Expires
SEPTEMBER4,2013
10/10 Print Form Page 4 of 4
PIP Conditions for Jogging Trail in Drainage ROW
The entire area of jogging trail is within FEMA regulated floodway of Bee
Creek Tributary A. If the loose gravel becomes a maintenance problem due
to floodwaters, then a more permanent surface may be required. No
improvements above natural grade that might impede the flow of
floodwaters will be allowed. City reserves the right to revoke permit if
maintenance of the adjacent drainage ROW becomes a problem.
Trail owner is responsible for maintenance of trail and adjacent drainage
ROW that the trail traverses through. City is not responsible for maintenance
of jogging trail within drainage ROW, nor repair of trail if damaged by
routine maintenance of the drainage ROW.
l