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HomeMy WebLinkAboutApplication (11-203) FO USE ON Y CASE NO DATE SU L) CITY OF COLLEGE STATION TIME: ;� � Home of T vas A&dl University STAFF: F � - PRIVATE IMPROVEMENT IN PUBLIC ROW MIT (PIP) LI TI N 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. 1 Notarized indemnity agreements from abutting property owners. U 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). L 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: State Highway 6 South Frontage Road and Bay St., i.e. The entrance to the South Hampton Subdividion APPLICANT /PROJECT MANAGER'S INFORMATION (Primary contact for the project): Name South Hampton Homeowners Association E -mail daugsburger @southhamptonhomeownr Street Address P.O. Box 11643 City College Station State TX Zip Code 77842 Phone Number 979- 777 -6811 Fax Number none PARTY RESPONSIBLE FOR MAINTENANCE (If party is a group, please provide information for contact person): Name Dan Augsburger - South Hampton HOA President 2011 -2012 E -mail daugsburger @southhamptonhomeownr Street Address 1613 Mariners Cove City College Station State TX Zip Code 77845 Phone Number 979-777 -6811 Fax Number 10/10 Page 1 of 4 IDENTIFY THE FOLLOWING: The total valuation of the work: $ , / SO O' The total valuation of the signage: $' Estimated cost of future relocation /remodel of improvements: $' The total footage of the site: 'pk (ce-- Si ,2 a / C.14 d d Ili' ra 7I9 The total linear feet of water lines crossing under paved road:60' aprox. IDENTIFY THE TYPE OF WORK TO BE PERFORMED: 1 Awnings Structural Contractor: ❑ Benches Number of Benches: _J Bike racks Number of Bike Racks: ❑ Cafe *Structural Contractor: ❑ Canopy *Structural Contractor: ❑ Demolition Structural Contractor: © Electrical Master Electrician: Britt Rice Electric - as subcontractor for H & B Construction, LTD ❑ Facade Structural Contractor: Irrigation System State Licensed Irrigator: S LP j 6 f1 © Landscaping *Landscape Architect /Company: um rIi 6 keil �j011 ❑ 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: UG trench, el. pole and road bore - H & B Const., LTD *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. I also understand that this permit may be revoked at any time at the discretion of the City Officials. . 1 . 1 Signature and title Date Conditions of Approval: Authorization of City Engineer Date approved 10/10 Page 2 of 4 INDEMNIFICATION Date: / ,),--' I j Indemnitor: u IslAs-tics7t9A.,,s CO kl Indemnitor's Ads 0 L (including county) Co /lr . S' i 0LA, 1, , 7 ? ° Indemnitee: CITY OF COLLEGE STATION indemnitee's Address: 1101 Texas Avenue (including county) Brazos County College Station, Texas 77840 LEGAL DESCRIPTION OF PROPERTY: 1223 Ebbtide Cv, College Station, TX, (legal) South Hampton PH 2, Block 4, Lot LR2 and 1220 Windrift CV, College Station, TX (legal) South Hampton PH 1, Block 1, Lot LR3 To the fullest extent permitted by law, I /we the owners of the property described above (Indemnitor), shall indemnify, hold harmless, and defend the lndemnitee, 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 lndemnitee, 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. ,— 1. Property Owner `° Printed Name �� a d - w._ w 1 /-i✓f ; t om-°-(c0 - STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this ' day of Y6- V� 6)/ ' by I 4 I: A ,RA P ie GINA SOUTHERLAND 1 P ' . Notary Public State of Texas 1 Notary Public in an' • r . ' * � , My C ommission Expires � �s /'� , : y P' ) . the State of Texa - l ` q,,), SEPTEMBER 4, 2013 10/10 Page 3 of 4 r O t✓ Property Owner Printed Name ,,// tt - meet f�tf H 14 STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this , day ofe ) /;I by I 1A %u / .a GINA S®UTHE N Notary Public in and r I t Notary Public. State of Texas 1 + *+ `► * th- State of Texas � .;' My Commission Expires ° ,F SEPTEMBER4,2013 1 10/10 Print Form Page 4 of 4