ROW2011-00050 •
•
Community Development
Request for Permit Action
TI'GARD.
TO: CITY OF TIGARD
. Building Division Services Coordinator •
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 \ww. tigard- or.gov
FROM: I 1 Owner Applicant n Contractor ® City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
n CANCEL PERMIT APPLICATION. V 0 1 0
1 REFUND PERMIT FEES (attach receipt, if available).
1 1 INVOICE FOR FEES DUE (attach case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ROW2011 -00050
Site Address or Parcel #:
Project Name: Comcast
Subdivision Name: Lot #:
EXPLANATION: Permit to be reissued at later date
Signature: ,SitAl2"L ( J4Q l Date: 7/20/11
Shirley Treat
Print Name:
Refund Policy
I The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use apphcation fee for issued permits.
d) not more than 80% of the building plan review fee when an apphcation is canceled before any plan review effort has been expended.
c) not more than 80 of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
Rte to S s A ,FOR OFFICE USE„ ONLY
dtnn: Date B - Rte to •.: Admin: Date ,pAi B
Refund Processed: Date s✓AM B Isaia Invoice Processed: Date By
Permit Canceled: Date f' ff B c`el Tat Added: Date B
Recei t # Date Method Amount $
L \ Budding \ Forms \RegPermitAction.doc Rev 07/26/07
,, C ITY OF TIGARD RIGHT OF WAY PERMIT
Y .
J:- CO MMUNITY DEVELOPMENT Permit #: ROW2011 00050
Date Issued:
ITIG 4,RD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421
Parcel: SEG1097
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: In front of 12900 SW Walnut PI., Comcast is proposing to directional bore /hard surface cut a min of 36"
below grade and place (1) 2" conduit in the City of Tigard right of way
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRONSON ADAMS
10831 SW CASCADE AVE
TIGARD, OR 97223
PHONE: 503 - 596 -3778
Total $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Perm ittee /Applicant
Signature:
Issued By:
Special Conditions (See Attached)
Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
V O I D RECEIVED
" City of Tigard
JUL 1 2 2011
"t w �
b Applica For Work In The R ',r .
_; ,,$ ROW Permit
FOR STAFF USE ONLY
General Information: /
Right -of -Way Q 'l 9 2�� - ova
Property Address /Location(s): 12900 SW walnut PI 1 a Case No.: �IJ[2 �,0 c7l/
Receipt No.:
Date: —7 ! o-/ / 11
*Applicant's Name: Comcast Attn: Bronson Adams Application Accepted By: S_ E"1
Address: 10831 SW Cascade Ave Revised 7/1/10 /& h 3 -/
City /State: Tigard �L gard Zip: 97223 ce G.•, "? .2,a // a
Primary Contact: Bronson Adams REQUIRED SUBMITTAL
Phone: (503) 596 -3778 Fax: (503) 596 -3813 INFORMATION
Contractor's Name: Tennessee Cable Services
CCB# 7745° Expiration: 10 /25/2011 Submit a scaled sketch of the proposed
work to be done
Address: 2310 E. 2nd St.
City /State: Vancouver, WA Zip 98661
Phone: (360) 696 -8900 Fax: (360) 696 -9119 Professional Engineered Plans are required
for:
Plans By: K x B • Street Widening
Address: 4120 SE International Way
• Subdivision Infrastructure
e Main utility line extension:
City /State: Milwaukee, OR Zip: 97222
Phone: (503) 650 -6041 Fax: (503) 650 -7390
•
- 1.curpin \ masters \land use applications Aro.. app.docs
Description of work: Comcast is proposing to Directional Bore /Hard Surface cut a min of 36' below grade
and place (1 (-2" conduit in the City of Tigard right -of -way.
Estimated value of work (within the public right -of -way): $ 7.2.0 r 1
Is work related to a LAND -USE DECISION? YES I NO IN ,..trery44 b \1 C
If so please specify (MLP, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? YES NO I ®I 3:4 (f► R . 4 ' '
If so please specify (BUILDING PERMIT) case #:
I "NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work.
City of Tigard 1 13125 SW I all Blvd., Tigard, OR 97223 503 -7 15 -2464 1 wlvw.tigard- or.gov Page 1 of 1
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,, JUL 1 2 2011
, ? ,. Ci ty of Ti gar d
' Application For Work In The R G tow: „...A.,,,,,,,44
ROW Perm
FOR STAFF USE ONLY
General Information:
Right -of -Way � i / I _ S
Property Address /Location(s): 12900 SW Walnut PI 1 p j " Case No.: - IJ((,/ U��
Receipt No.:
Date: –7 1 16"/ 1/
*Applicant's Name: Comcast Attn: Bronson Adams Application Accepted By: S.. 'T/20
Address: 10831 SW Cascade Ave Revised 7/1/10
To ,—.), City /State: Ti Zip: 97223
Primary Contact: Bronson Adams REQUIRED SUBMITTAL
Phone: (503) 596-3778 Fax: (503) 596-3813 INFORMATION
" Za 7 /7/ —
Contractor's Name: Tennessee Cable Services
CCB# 77450 Expiration: 10/25/2011 Submit a scaled sketch of the proposed
work to be done
Address: 2310 E. 2nd St.
City /State: Vancouver, WA Zi 96661
Phone: (36 696 -8900
� Fax: (360) 696-9119 Professional Engineered Plans are required
GaH� 1,- ivy for:
Plans By: K & B • Street Widening
Address: 4120 SE International Way • Subdivision Infrastructure
City /State: Milwaukie, OR Zip 97222
• Main utility line extension:
Phone: (503) 650 -6041 Fax: (503) 650 -7390
Nd e 1:curpin \masters \land use applications \row app.docx
�� Description of work: Comcast is proposing to Directional Bore /Hard Surface cut a min of 36" below grade
and place (1) -2" conduit in the City of Tigard right -of -way. w
• /// . ,1 et T ., e / 'Al , C - a ` - ) ' - t
v t 5-/ / " - ; lt/ ✓ • Ae H.`i, / .r�wj,4.10 , l / .' Mg-e .d 4 dE� ei e
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Estimated value of work (within the public right -of -way): $
so3 , 2/8 • L 5 ,r . .6.6
Is work related to a LAND -USE DECISION? YES n NO ® 1 r1-A -J o d r Y.90
If so please specify (MLP, SDR, SUB, etc.) case #: ✓
Is the work related to a BUILDING PERMIT? YES n NO •
If so please specify (BUILDING PERMIT) case #:
*NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work.
City of Tigard I 13125 SW Hall Blv , ,•- , Tigard, OR 97223 1 503- 718 -2464 � www.tigard- or. 1 Page 1 of 1
CONSTRUCTION NOTES:
/ N
/ 1. ALL WORK AREAS TO BE
/ 0.-12620 C -12770 t
RESTORED TO LIKE OR BETTER
W E CONDITION.
N 2. ALL OTHER UTILITIES ARE BASED
OFF EXISTING LOCATES OR UTILITY
S STRUCTURES.
\ \
01 \ \� 3. IT'IS THE CONSTRUCTION
\ CONTRACTORS RESPONSIBILITY
�_ / \ \ TO CALL FOR LOCATES BEFORE
DIGGING.
G
G / I C '
i P SURFACE R FACE DIRECTIONAL BORE/HARD
S M RE /HARD
Q %i�I /. / i /I
5
5. TRENCH SYMBOLOGY -
/ ',
, 1 c.NA JOB NAME & CONTACT INFO:
\ \ Contact: Bronson Adams
Office - (503) 596 -3778
c � ° �c a Fax - (503) 596 -3813
\ Email - Bronson_adams @cable.comcast.com
so' / X
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C-12909 8. _/‘ / \ \ .
a � � 10831 SW Cascade Ave
� 9�� \ - \ Tigard, OR 97223
7 �/ \ /0 \ _ ` 4120 SE INTERNATIONAL WAY
Y /y \ MILWAUKIE, OR 97222 111 1 / \ �- \ DIRECTIONAL BORE/HARD Emal kben @atLnet Desi By: 969 (503) 650 -6041
• �7 SURFACE CUT (1)-2 SJTE A DDRES S:
' CONDUIT A MIN. OF 36'
BELOW GRADE. 12900 W alnut PI
T igard, R 97223
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\� nEV. DATei otscrtmrIov UESW0 CIfECKEuI 31700 00
1 mat I City of TIgara Permit
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SCALE PROJECT IIUMBOR
c -NA 1" 1. 40'
\ \ / SHEET NUMBER TITLE
Walnut PI Conduit Damaged
1 City of Tigard Permit
FILEN. NE
SHEET OF Walnut PI Conduit Damaged
1 1
Community Development
Request for Permit Action
•
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant n Contractor ® City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL PERMIT APPLICATION. V 0 1 D
❑ REFUND PERMIT FEES (attach receipt, if available).
n INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ROW2011 -00050
Site Address or Parcel #:
Project Name: Comcast
Subdivision Name: Lot #:
EXPLANATION: Permit to be reissued at later date
Signature: ,dJ 1jt4 Date: 7/20/11
Shirley Treat
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Admin: Date 6 / // By • t/ '
Refund Processed: Date By By , Invoice Processed: Date By
Permit Canceled: Date d7 / /// By ;!• • ' . el Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
, CITY OF TIGARD RIGHT OF WAY PERMIT
11 91 - COMMUNITY DEVELOPMENT Permit #: ROW2011 -00050
Date Issued:
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421
Parcel: SEG1097
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: In front of 12900 SW Walnut PI., Comcast is proposing to directional bore /hard surface cut a min of 36"
below grade and place (1) 2" conduit in the City of Tigard right of way
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRONSON ADAMS
10831 SW CASCADE AVE
TIGARD, OR 97223
PHONE: 503 - 596 -3778
Total $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee /Applicant
Signature:
Issued By:
Special Conditions (See Attached)
Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
V O I D RECEIVED
at ii City of Tigard JUL 1 2 2011
Application For Work In The T itu
e G
ROW Permit
FOR STAFF USE ONLY
General Information:
Right-of-Way h M _ , vu
d5
Property Address /Location(s): 12900 SW Walnut PI ( °'q °'q -1 Case No.: W1J �(J U
Receipt No.:
Date:
*Applicant's Name: Comcast Atm: Bronson Adams Application Accepted By: S_ � � _
l
Address: 10831 SW Cascade Ave Revised 7/1/10 /! /3 vvrei
Tigard 972 23 u4- L 7 • "' / ' " * i
City/State: Zi Z
Primary Contact: Bronson Adams . REQUIRED SUBMITTAL
Phone: (503) 596 -3778 Fax: (503) 596 -3813 INFORMATION
312- I ' "
Contractor's Name: Tennessee Cable Services
CCB# 7745° Expiration:10 /25 /2011 Submit a scaled sketch of the proposed
work to be done
Address: 2310 E. 2nd St.
City/State: Vancouver, WA Zip: 98661
Phone: ( 696 -8900 Fax: (360) 696-9119 Professional Engineered Plans are required
for:
Plans By: K & B • Street Widening
Address: 4120 SE International Way
• Subdivision Infrastructure
City /State: Milwaukie, OR
Zip 97222
• Main utility line extension:
Phone: (503) 650 -6041 F ax: (503) 650 -7390
I:curpin \masters \land use applications \row app.docx
Description of work: Comcast is proposing to Directional Bore /Hard Surface cut a min of 36" below grade
and place (1 )-2" conduit in the City of Tigard right -of -way.
Estimated value of work (within the public right -of -way): $ 7. 2.0 t 1 I
Is work related to a LAND -USE DECISION? YES 0 NO • .,,,,,,,;� t � . 1 �f ,�_',
If so, please specify (MLP, SDR, SUB, etc.) case #: "" " •� ' ___ r �
/Y l "' 1 I
Is the work related to a BUILDING PERMIT? YES NO 3: 4 ( f R . nM ' „l. - Ali-
If so please specify (BUILDING PERMIT) case #:
*NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work.
City of Tigard I 13125 SW Hall Blvd., Tigard, 2
Tigard OR 97223 503- 718- 24 .... www.tigard-or.gov 464 I www.tigard- or.gov I Page 1 of 1
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RECEIVED
City of Tigard JUL 1 2 2011
I in
' Application For Work In The R
• T T cG Y , G
TIGA.R,D ROW Permit
FOR STAFF USE ONLY
General Information:
Right -of -Way wW � n ( IIZ C 1
Property Address /Location(s): 12900 SW Walnut PI I V� "1 Case No.: d�/ ( V
Receipt No.:
Date: -1 I it II
*Applicant's Name: Comcast Attn: Bronson Adams Application Accepted By: S.- C IT I
Address: 10831 SW Cascade Ave Revised 7/1/10
7 City/State: Tigard Zip: 97223
, -) Primary Contact: REQUIRED SUBMITTAL
� , onac Bronson Adam Q
Phone: (503) 596 -3778 Fax: (503) 596 -3813 INFORMATION
Contractor's Name: Tennessee Cable Services
CCB# 77450 Expiration: 10/25/2011 Submit a scaled sketch of the proposed
work to be done
Address: 2310 E. 2nd St.
City/State: Vancouver, WA Zip 98661
Phone: l360> 696 -8900 F ax: (360)696-9119 Professional Engineered Plans are required
dour j n•,'d//T 8i /A for:
Plans By: K & B • Street Widening
Address: 4120 SE International Way
• Subdivision Infrastructure
97222
Main utility line extension:
M ilwaukie, OR
City/State: Zip:
j ` Phone: (503) 650 -6041 F ax: (503) 650 -7390
N o a 1:curpin \masters \land use applications \row app.docx
—2_ Description of work: Comcast is proposing to Directional Bore/Hard Surface cut a min of 36" below grade
and place (1 )-2" conduit in the City of Tigard right -of -way. 1 J
Th• a / TG cc�Df/"r� rtJi �'1 a rl
O t, S1/ &i:3 16u lid .. A • Ana.'.. j 1 04,47 ,"T i °ric/ de
Estimated value of work (within the public right -of -way): $ C1 . ~�
5 7, . i .06E3
Is work related to a LAND -USE DECISION? YES III NO ❑ fo- P9 0 -b4; r.I o h c y 00
If so, please specify (MLP, SDR, SUB, etc.) case #: J
Is the work related to a BUILDING PERMIT? YES n NO ❑
If so please specify (BUILDING PERMIT) case #:
I *NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503 - 718 -2464 I www.tigard- or.gov I Page 1 of 1
T-
CONSTRUCTION NOTES:
N
/ c -ioeTG 1 . ALL WORK AREAS TO BE
c -12nn RESTORED TO LIKE OR BETTER
W / E CONDITION.
N
\ 2. ALL OTHER UTILITIES ARE BASED
OFF EXISTING LOCATES OR UTILITY
S STRUCTURES.
/ 3. IT IS THE CONSTRUCTION
CONTRACTORS RESPONSIBILITY
��l TO CALL FOR LOCATES BEFORE
G DIGGING.
G\<(� / C -12860 4. DIRECTIONAL BORE /HARD �� 5 / � QP l SURFACE CUT SYM. - =1�
5
■ -- -
5. TRENCH SYMBOLOGY - - -
/ .
/ C -NA JOB NAME 8 CONTACT INFO:
Contact: Bronson Adams
\ R
Office - 596-3778
■ o , Fax Fax - (503) 3) 5 596.3813 3813
\ A B' Email - Bronson_adams @cable.comcast.com
/ 50'
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4L / / II ' . "• ,VorncVsst
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�/I /- 10831 SW Cascade Ave
/" \ 96 Tigard, OR 97223
� / \ G S A \ 4120 SE INTERNATIONAL WAY
� SURE 10
/� � . MILWAU OR 97222
// ` \. //' // \ RE \ Email: kDeng@atlnel Design By: 1(8.81 (SOT)050 -6041
,\
/ - • DIRECTIONAL BOMARD
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, //T SURFACE CUT (1 RE
CONDUIT A MIN. OF 36'
/' BELOW GRADE. SITE ADDRESS:
1290U Walnut PI
Tigard, OR < "/ .. /////// 2S1 W0 BD97223
\ � REV DESCRIPTION DESIGN CHECKED APP0.0�tD,
\
1 777111 City of Tigard Penn9
\ /
\ /
\ /
\ /: SCALES PROJECT NUMBER
C -NA 1" _ 40'
\ / SHEET NUMBER TITL
Walnut PI Conduit Damaged
•
1 City of Tigard Permit
FILENAME,
SHEET OP Walnut PI Conduit Damaged
1 1
MESSAGE CONFIRMATION
07/13/2011 11:42
DATE S,R —TIME DISTANT STATION ID MODE PAGES RESULT
07/13 02'28" 5035963813 TX 03 OK 0000
07/13/2011 11:39 NO.070 P01
RECEIVED
City of Tigard JUL 1 2 2311
1 114
Application For Work In The R f) .,4,
-TIGAR.O ROW Permit
^ � amu��atm�m �a�ys��a , �om��aacrrrrra.Krw+�a.�
FOR STAFF USE ONLY
General Information: D,�, • a) Property Addrees/Location(e): p t Right-of-Way Case No -w wL(.� 0/1' az
,2233 sw Mow Po < <' ')
Receipt No.:
- Date: -, i tr3'I I/
*Applicant's Name: Comreei am: &onion Adams Application Accepted By: S. Tie »r
Address: '°‚ 6WCucadsAve Revised 7/1/10
7 City/State: Taunt zi 07229
Primary Contact: , pnaeG9nAgaTIU REQUIRED SUBMITTAL.
Phone: (503) 588.3T7a p ax: minim-ma INFORMATION
Contractor's Name: Ten e* ee Caala Servloso
CCB## 71'460 , Expirstaon:'onsnot , Submit a scaled sketch of the proposed
Address: 2310 E. 2nd a. work Co be dole
City/State: vancauver, WA 20 :08861