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Application (12-11)
FOR OFFICE USE ►�LY CASE N O.: e 1 11 P- ff 4 DATE SUBV _TTED:,_ CPT OF COLLEGE STATION TIME: Home of Texas AekM Uniuei;ity STAFF: r PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION MINIMUM SUBMITTAL REQUIREMENTS: M $350 PIP Application Fee. Ca 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. ❑ Notarized 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). E Sealed irrigation / plumbing plan (if applicable). ❑ Sealed structural plan showing details with anchoring, attachment, and material description (if applicable). DI Private utility plan- dimensioned from right -of -way or back of curb, material, size (if applicable). LOCATION OF IMPROVEMENTS: Near the southwest corner of Lot 1, Block One - Callaway Subdivision, Phase Three and crossing Marion Pugh Drive approximately 200 feet north of its intersection with Holleman Drive. APPLICANT /PROJECT MANAGER'S INFORMATION (Primary contact for the project): Name RME Consulting Engineers (c/o Rabon Metcalf, P.E.) E -mail rabon @rmengineer.com Street Address PO Box 9253 City College Station State TX Zip Code 77842 Phone Number (979) 764 -0704 Fax Number ( 764 -0704 PARTY RESPONSIBLE FOR MAINTENANCE (If party is a group, please provide information for contact person): Name ACC OP (Marion Pugh) LLC E -mail xgarcia @americancampus.com Street Address 12700 Hill Country Blvd., Ste. T -200 City Austin State TX Zip Code 78738 Phone Number (512) 732 -1000 Fax Number (512) 732 -2450 10/10 Page 1 of 4 IDENTIFY THE FOLLOWING: The total valuation of the work: $ 24,000.00 The total valuation of the signage: $ Estimated cost of future relocation /remodel of improvements: $ 1,750.00 The total footage of the site: The total linear feet of water lines crossing under paved road: —96 L.F. of 4" Forcemain under Marion Pugh ROW 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: Approx. 96' of 4" forcemain and casing *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 within the public right -of -way at any time. I also understand this permit may ► - revoked at any time at the discretion of the City Officials. Signature an title ��« /��� 1 Date Conditions of Approval: Authorization of City Engineer Date approved 10/10 Page 2 of 4 P ' N. ! 2 l Property Owner Printed Name STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Su scribed and sworn to before me, a Notary Public, this A V l ti day of ()(tih't CW' by - I I� n L) Gliati h YIM V! �� ion.. s tIl l � CHRISTINA CRAIN YOUNG __ N Notary Public, State of Texas My Commission Expires Vie ;4 1 : 4 ' I"Iy 2" 2019 No . .., .. r - ,, , -1 T the State of Texas 10/10 1 Print Form 1 Page 4 of 4 PLANNING Sr ENGINEERING PROJECTS COMPLETENESS WORKFLOW V./Ledger (MA) IN Neighborhood Park Zone No. 1 (JPaz) ELI,Create and Attach Address (MA) TIA's (JG) New Development List (CC) ❑ Completeness Review (MH) M &B Closure (MT) giMemo to Applicant ( CCj CiP(SAM / Aerial (JPaz) y� Greenways (VG) 27 Impact Fee Area N ` r\ (JPaz) Lan Application / Bin Assignment (MA) y[f Communit Park Zone No. 5 (JPaz) Impact Fee Note in Naviline (MA) PROJECT MANAGER PLATS: If an ETJ minor plat, BCaldwell and BGeorge e- mailed when approved. Yes N/A TREES: Final Plats (SF or Townhome): Are trees required for this plat? Yes No SIDEWALKS: Plans / Plats (Sidewalk Fund): Are sidewalk fees required? Yes No Sidewalk Zone no.: $5/ sq. ft. X sq. ft. = $ Total Amt. Due PARKLAND DEDICATION: Neighborhood Park: Zone Fee per Lot $ Total $ I Acquisition Costs Fee: $ No. of Lots /Units: Single - family Multi- family D evelopment Costs Fee: $ No. of Lots /Units: Single- family Multi- family _ Community Park: Zone Fee per Lot $ Total $ Acquisition Costs Fee: $ No. of Lots /Units: Single - family Multi- family Development Costs I Fee: $ No. of Lots /Units: Single - family _ Multi - family Total Parkland Fees Due: $ Fees in Naviline (Initial): IMPACT FEES (assessed at Plat, due at BP – see Impact Fee Chart): Fee: $ PROJECT STATUS (Please provide action taken and date) Action Date Staff: CC: P &Z: ZBA: DRB: LC: Notes: Project Complete (Initials): FINAL PLAT RECORDATION — _ J Ej Tax Certificate ❑ AutoCad File [] Outstanding Fees Addresses I P - Project Archived by: Date: ;- (.1 ) V' INDEMNIFICATION Date: Indemnitor: ACC OP (Marion Pugh) LLC Indemnitor's Address: 12700 Hill Country Blvd. (including county) Suite T-200 Austin, TX 78738 (Travis Co.) 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 One - Callaway Subdivision, Phase Three 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 the facilities authorized by the Private Improvement Permit issued by Indemnitee to ACC OP (Marion Pugh) LLC , 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 Station, as, and their resp live successors and assigns. r ^,�I �� am S • t41 11- Property Owner Printed Name STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this 0A day of y U(0y1(v0V6Un V nr 60 { tZ �YrAT!Y,e�ce.tcHRISYINA CRAIN YOUNG == tary Public, State of Texee a, My Commission Expires the State of Texas 10/10 Page 3 of 4