ROW2011-00000 •
APPLICATION FOR 4$
WORK IN RIGHT-OF-WAY (ROW) PERMIT el
Development Engineering TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 FAX (503) 624-0752
FOR STAFF USE ONLY
General Information: Nal vur -SACiSo4rc�ro,1
Right-of-Way
Property Address/Location(s): SW Pine St at Hall Blvd and Hall Blvd Case No.: 0 V 01 -o^ y'-
from Pine St to Park Place. Receipt No.:_j4,./Ct.S{t . Cfi./. Ov, Pt rl
Date: ✓✓ y.�
*Applicant's Name:NW Natural Application Accepted By:
Address.
220 NW 2nd Av Revised 3/4/09
City/State:Portland OR Zip:97209
Primary Contact: Diana Way I REQUIRED SUBMITTAL INFORMATION
Phone:503-226-4211 X 4386 Fax:503-273-4822
Submit a scaled sketch of the
Contractor's Name: proposed work to be done
CCB# Expiration:
Address:
Professional Engineered Plans are
City/State: Zip: required for:
Phone: Fax:
• Street Widening
• Subdivision Infrastructure
Plans By: • Main utility line extension:
Address: •
City/State: ,Zip:
Phone: Fax:
Description of work: Cutting 4"gas main to abandon. Looks like
we'll be making a cut on Pine, possibly Hall at Pine and a cut just N of Park PI. For questions on the design of this job,
please contact Bob Keller at 503 816 0299. NWN20016-02
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES NO •
If so, please specify(MLP, SDR,SUB, etc.)case#: •
Is the work related to a BUILDING PERMIT? YES NO •
If so, please specify (BUILDING PERMIT)case#:
*NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide
financial assurance for the work.
c\documents and settings\caw\desktop\row permit application.docx
N , L.
.
W+E lif 1 t
5'
i4 '
'''' ''.• -,-,,i;
SSW PINE . ..... ' , sT s•'—'—
./..,
. ,
A:,"."
,I(PRUCE t 1, , Sr
:M.'"WrSCP\r9 I
"I'':
1 ' 1
, a
...,. .
,j1 i. I- 1 ' ••,'
, 5 I
t,--
.
. ..1.:
‘.1
-",".„ .....r '• t •
,..,'-...,,,• t,
-- T• .
.,..
. .
CR...C.10W
'ff7.4:41.P.::::::In't':: •V. .. y er''''
'4^.7;.-.7tr---:..'w:=,-::' •":,,,,soc'ss ,, ,,,,,,
-' - — --- -- '"=.5i:•':-.11:1i,:-..-7-1'•:'-'1"- '''''o.' t_'II ,
--=
1: •;.:,LF^,,?.t.t7,=;:"''''"'-'-'''''...--••••=!.=-=-7'.1
'^' - -I-T -r----rr
—_1-
.'•--=',17,7,...,:,•'=".";°"‘------------4, I ' .
.....
,.,... fksla M.:,,;_486GW—S,r Wwo 273's ra:p we Zrsaw.ilrewg_
!1.W Ncttural ° '' V..,
,,..,.,
—
,..............,,.................. ;;;;.......";= 7. .....::',
—
f.r. ..-,......
CP I I L.1/1410.1101I 1.144 SE at ',.T. L.. -
ru, .....y. ICX Wst• i
Kristie Peerman
From: Way, Diana <d1s@nwnatural.com>
Sent: Wednesday, September 21, 2011 8:32 AM
To: ROW Permits
Subject: 200612-01 / request for utility permit from NW Natural
Attachments: 200612.01 approved sketch.PDF; 200612-01 Tigard_permit request.pdf
I am hereby requesting a permit from your jurisdiction. The permit application and/or our engineered sketch is attached to
this e-mail. We plan on scheduling the work upon receipt of approved permits and finishing by 10/31/11. If you have any
questions please contact Bob Keller at(503) 816-0299.
Thank you,
Diana Way
NW Natural
Engineering Coordinator
(503)226-4211 ext 4386
Fax(503)273-4822
dl s(W.nwnatural.corn