ESBD_368991_1724082976624_ATTACHMENT G.W - Ellington AFB (EF) AF103_REV.pdf
PDF 28 KB Posted
- Attached to
- HUSH HOUSE POWER RESTORATION BLDG 1395
- Solicitation number
- TMD24-ANG-WJ-24142008
- Issued by
- Harris County, Texas
About this file
The document is a Base Civil Engineering Work Clearance Request form used by the U.S. Air Force at Ellington Air Force Base in Texas. This form is required for any work, either contracted or in-house, that may disrupt aircraft or vehicular traffic flow, base utility services, fire and intrusion alarm systems, or routine installation activities. The form coordinates the required work with key base activities to minimize customer inconvenience and identify potentially hazardous work conditions.
The related state and local contract opportunity is for the removal and replacement of wire from existing conduit and installation of new 15 kilovolt wire for a transformer located at Building 1395 of the 147th Attack Wing in Houston, Texas. The contract is being solicited by the Texas Military Department (TMD) and is located within Harris County, Texas. No additional details are provided regarding response dates, award dates, contract term, or pricing.
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DATE PREPARED
BASE CIVIL ENGINEERING WORK CLEARANCE REQUEST
(See Instructions on Reverse)
1. Clearance is requested to proceed with work at on Work Order No.
, Contract No.
, involving excavation or utility disturbance per attached sketch. This area has has not been staked or clearly marked.
2. TYPE OF FACILITY/WORK INVOLVED
G. AIRCRAFT OR VEHICULAR TRAFFIC FLOW
A. PAVEMENTS
D. FIRE DETECTION & PROTECTION SYSTEMS
H. SECURITY
B. DRAINAGE SYSTEMS
E. UTILITY
OVERHEAD
UNDERGROUND
I. OTHER
C. RAILROAD TRACKS
F. COMM
OVERHEAD
UNDERGROUND
4. DATE OF CLEARANCE
3. DATE CLEARANCE REQUIRED
5. SIGNATURE OF REQUESTING OFFICIAL
6. TELEPHONE NO.
7. ORGANIZATION
REMARKS
(Use Reverse for additional comments)
REVIEWER'S NAME AND INITIALS
ORGANIZATION
8.
A. ELECTRICAL DISTRIBUTION
B A S
B. STEAM DISTRIBUTION
E
C. WATER DISTRIBUTION
C I
D. POL DISTRIBUTION
V I L
E. SEWER DISTRIBUTION
E N
F. ENVIRONMENTAL
G I
G. PAVEMENTS/ GROUNDS
N E E
H. FIRE PROTECTION
R I
I. ZONE
N G J. OTHER (Specify)
9. SECURITY POLICE
10. SAFETY
11. COMMUNICATIONS
12. BASE OPERATIONS
13. CABLE TV
14. COMMERCIAL UTILITY COMPANY
TELEPHONE
GAS
ELECTRIC
15. OTHER (Specify)
APPROVED
DISAPPROVED
16. REQUESTED CLEARANCE
17. TYPED NAME AND SIGNATURE OF APPROVING OFFICER (Chief of Operations Flight or Chief of Engineering Flight) 17a. DATE SIGNED
PREVIOUS EDITIONS ARE OBSOLETE.
AF IMT 103, 19940801, V3
Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign Click to sign
INSTRUCTIONS
The BCE work clearance request is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic flow, base utility services, protection provided by fire and intrusion alarm system, or routine activities of the installation. This form is used to coordinate the required work with key base activities and keep customer inconvenience to a minimum. It is also used to identify potentially hazardous work conditions in an attempt to prevent accidents. The work clearance request is processed just prior to the start of work. If delays are encountered and the conditions at the job site change (or may have changed) this work clearance request must be reprocessed.
18. REMARKS. (This section must describe specific precautionary measure to be taken before and during work accomplishment. Specific comments concerning the approved method of excavation, hand or powered equipment, should be included.)
AF IMT 103, 19940801, V3
(REVERSE)
8.2.1.3158.1.475346.466429
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