HomeMy WebLinkAboutApplication (14-169) CASE� NO.:FOR OFFICE USE ONLY
(
L'
DATE SUBMITTED: )WI14
TIME: 1 3D
CITY OF COLLEGE STATION � A
Home of lexa,A&M University' STAFF: `vl
PRIVATE IMPROVEMENT IN PUBLIC ROW PERMIT (PIP) APPLICATION
MINIMUM SUBMITTAL REQUIREMENTS:
❑X $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.
❑ Notarized indemnity agreements from abutting property owners.C No V 9.O l l
Attach four(4)copies of a facility layout plan, which shall include the following:
Er 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).
Q' Landscape plan showing the location and type of plantings - existing and proposed, both common
names and scientific (if applicable).
[v]' 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:
ICBCS MP Hall
415 Stasney Street College Station 77840
APPLICANT/PROJECT MANAGER'S INFORMATION (Primary contact for the project):
Name Habib Tai E-mail 4dsystemdesign @gmail.com
Street Address 47 Lake Sterling Gate Dr.
City Spring State TX Zip Code 77379
Phone Number (281) 716-2847 Fax Number
PARTY RESPONSIBLE FOR MAINTENANCE (If party is a group, please provide information for contact person):
Name Islamic Community Center of Bryan College Station (ICBCS) E-mail naumansheikh@gmail.com
Street Address 415 Stasney Street
City College Station State TX Zip Code 77840
Phone Number 979-777-8557 Fax Number
10/10 Page 1 of 4
IDENTIFY THE FOLLOWING:
The total valuation of the work: $35,000
The total valuation of the signage: $0
Estimated cost of future relocation/remodel of improvements: $0
The total footage of the site: 350 sft
The total linear feet of water lines crossing under paved road:0
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
❑ Awnings Structural Contractor:
O Benches Number of Benches: 1
❑ Bike racks Number of Bike Racks:
❑ Cafe *Structural Contractor:
❑ Canopy *Structural Contractor:
El Demolition Structural Contractor: TBD
❑ Electrical Master Electrician:
❑ Facade Structural Contractor:
El Irrigation System State Licensed Irrigator: TBD
❑X Landscaping *Landscape Architect/Company: TBD
❑ 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.
gOSLO rptlrrN>
i re and title Date
Conditions of Approval:
Authorization of City Engineer Date approved
10/10 Page 2 of 4
INDEMNIFICATION
Date:
Indemnitor: Not Applicable
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:
NOT APPLICABLE
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 upon and inure to the benefit of the undersigned and the City of
College Station, Texas, and their respective successors and assigns.
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 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 I Page 4 of 4