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
This document is a Base Civil Engineering Work Clearance Request from Ellington AFB (EF) in Texas. The request is to allow work on Contract No. EF103 involving excavation or utility disturbance per the attached sketch. The work may impact aircraft or vehicular traffic flow, base utility services, fire and intrusion alarm systems, or routine base activities. The work clearance request is used to coordinate the required work with key base activities to minimize disruption. Specific precautionary measures to be taken before and during the work are described.
The related state and local contract opportunity is for the HUSH HOUSE POWER RESTORATION BLDG 1395 project. TMD is seeking a contractor to remove and replace wire from existing conduit and install new 15 kV wire for a transformer located at the 147th Attack Wing facility in Houston, Texas. The project is located in Harris County. No further details are provided about pricing, set asides, incumbents, funding, or the contract term.
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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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