HomeMy WebLinkAboutApplication FOR OFFICE U ONLY
r"4 Case No.: l6 � ' 6
D ate Submitted: / i/.L'
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Nanning &Development Services AC.
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP)
MINIMUM SUBMITTAL REQUIREMENTS
lEr $150 PIP permit application and review fee
, VAttach 4 copies of a facility layout plan, which may include the following:
Er Location, identification, and cliaj of ROW and pavement edqe /cub)
W Location of all proposed improvements
111 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
0 Landscape plan shoyving the location and type of plantings (existing and proposed, both common names
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and c ) ✓
❑ - The cost estimate for relocating any public facilities associated with the work
❑ - An electrical plan
4- E Irri n /Plumbing plan (must be CP-)
❑ , A Structural plan showing details v�ith anchoring, attachment, and material description (must be sealed)
y ❑ - Private utility, plan- dimensioned from right -of -way or back of curb, material, size eILc ` _
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 roject):
Name _ , , , : , + ., E- Mail , SA/./Q4_k'4 5 19 /'4 . Cen%
Street Address fI0 n/ /t/VI S- V Pr. Z # /O d"
City C e// , 57,..0 -/ State Zip Code 7 7 1 -6
Phone Number g yi - 17 .4.4 Fax Number ' j 'II- 0 i �.. 6 y
PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person):
Name S t4,34_ Ae 4/!/ E- Mail ste/A .4_,I 1 3/0 /c.1 et �( u
, Gdh-i
Street Address f16/ 1).441/44"Jf' Pe, /tj
City C 5 / State Zip Code 2 7 g y
Phone Number g / k - k 2 V1 :OW 2 Fax Number
IDENTIFY THE FOLLOWING:
The total valuation of the work: $ /0, c f 1
..,
The total valuation of the signage: $
Estimated cost of future relocation of improvements: $
The total square footage of the site: . S r
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The total linear feet of water lines crossing under paved road: c7
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: 4z i., 1, 41 , 7
la Landscaping *Landscape Architect/Company: tje�a A
❑ 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
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 that this permit may be revoked at any time at the discretion of the City Officials.
4/2y DP
Applicant's signature Date ap lied
Conditions of Approval:
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Authorization f City Engineer Date approved
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INDEMNIFICATION,
DATE: , 20
INDEMNITOR:
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INDEMNITOR'S MAILING ADDRESS:
(including county) 4 tJL tll e U 1 c t l j
avreuxua •
INDEMNITEE: City of College Station
INDEMNITIEE'S MAILING ADDRESS: 1101 Texas Avenue
(including county) Brazos County
College Station, Texas 77842
LEGAL DESCRIPTION OF PROPERTY:
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
, 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.
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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.
Property Owner Property Owner
Printed Name Printed Name
THE STATE OF TEXAS §
§ ACKNOWLEDGMENT
COUNTY OF §
This instrument was acknowledged before me on the day of , 20 , by
Notary Public in and for the State of Texas
THE STATE OF TEXAS §
§ ACKNOWLEDGMENT
COUNTY OF §
This instrument was acknowledged before me on the day of , 20 , by
Notary Public in and for the State of Texas
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