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HomeMy WebLinkAboutApplication FOR OFFICE USE ONLY_ CASE N O.: ( 1-40 Grffr"4 DATE SUBMITTED' J I 1 TIME: 014 CITY OF COLLEGE STATION STAFF: Home of Texas AetrM University° PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION MINIMUM SUBMITTAL REQUIREMENTS: A i $350 PIP Application Fee. El 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). 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: Landscaping to be installed in the SH 6 & SH 40 Caprock Crossing Entrance medians within the right -of -way APPLICANT /PROJECT MANAGER'S INFORMATION (Primary contact for the project): p Name C a Rock Texas E -mail lesse.durden @caprocktx.com Street Address 2809 Earl Rudder Freeway S, Ste. 203 City College Station State Texas Zip Code 77845 Phone Number 979- 307 -0321 Fax Number 979- 314 -7606 PARTY RESPONSIBLE FOR MAINTENANCE (If party is a group, please provide information for contact person): Name Brazos Texas Land Development E -mail lesse.durden @caprocktx.com Street Address 2809 Earl Rudder Freeway S, Ste. 203 City College Station State Texas Zip Code 77845 Phone Number 979- 307 -0321 Fax Number 979 314 - 7606 Page 1 of 10/10 IDENTIFY THE FOLLOWING: The total valuation of the work: $ 20,000.00 The total valuation of the signage: $ 0 Estimated cost of future relocation /remodel of improvements: $ 0 The total footage of the site: 1350 sf SH 40 Entrance & 1040 sf SH 6 Entrance 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: Dan Doyen (# 0019639) - Four Comers Landscape & Irrigation © Landscaping *Landscape Architect/Company: Four Comers Landscape & Irrigation ❑ Masonry fence *Structural Contractor: ❑ Sign(s) *Sign Contractor: 111 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. n 7JZ// Sig ure and title Date Conditions of Approval: Authorization of City Engineer Date approved 10/10 Page 2 of 4 INDEMNIFICATION Date: Indemnitor: Indemnitor's Address: (including county) Indemnitee: CITY OF COLLEGE STATION indemnitee's Address: 1101 Texas Avenue (including county) Brazos County College Station, Texas 77840 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. All provisions of this Indemnification shall be binding ..on and -nure to the benefit of the undersigned and the City of College Station, Texas, and their respective success rs and as • ns. Ste-, 41 �S/)1 4 ` , D, a R ' 3. : arty Owner Printed Name STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this day of , 2009 by Notary Public in and for the State of Texas 10/10 Page 3 of 4 Property Owner Printed Name STATE OF TEXAS § § ACKNOWLEDGEMENT COUTY OF BRAZOS § Subscribed and sworn to before me, a Notary Public, this day of , 2009 by Notary Public in and for the State of Texas 10/10 Print Form Page 4 of 4