ROW2012-00102 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 0 1 D
:1 ■ ~ Request Perm Action '° �
/02/02 7�'
q
l ! k , A 1: 11 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner El Applicant El Contractor , City Staff
R P Name:
" • • • • CE TO: (Business or Individual
Mailing Address:
City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL /VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
El REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: g o ( A ) 2- r' 00 102--
Site Address or Parcel #: 6 QOse 04--n l' 4
Project Name: &OW & j e /T
Subdivision Name: / / Lot #:
EXPLANATION: A [ S ■ of k /I/ or / tri ! 4e P0(-)
v 0 i 1) A,PL t 1
Signature: / / /4"1/' Date: / 2A- 1/ 2_
Print Name: ' , U//k .
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 SO% 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 2 -4 weeks for processing refunds.
FOR OI:I:IcI.: l SF: ()NI.)
Rte to S s Admin: Date B Rte to ^.-'_ Admin: Date AM31 B !,7
Refund Processed: Date /I/ ,9- B '•, Invoice Processed: Date By
Permit Canceled: Date /1„1./A7 f/ By •A. , Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
•
APPLICATION FOR
WORK IN RIGHT -OF -WAY (ROW) PERMIT
Development Engineering. YI k &L
p
/3/25 SlV Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX (503) 624 -0752
1 • r 9' 1 t, FOR STAFF USE ONLY
• General Information: ', ""� ' 4'no/.0 /
Right -of -Wa
Property Address /Location(s): 6980 SW VARNS ST Case No.: tWW! -c111` 001
Receipt No.:
Date: 11111111-
*Applicant's Name: COMCAST Application Accepted By: WC/
Address: 14200 SW BRIGADOON CT ecvimd3 /4iU9
City /State: BEAVERTON, OR Zi 97005 //' Z 7 -/2 100
ry Randy Primary Cont act: y Shields REQUIRED SUBMITTAL INFORMATION
Phone: 360 - 828 -3547 Fax:
•
Contractor's Name: FISK COMMUNICATIONS CONTRACTING Submit a scaled sketch of the
185632 08/01/2013 proposed work to be done
CCB# Expiration:
Address: 2705 NE 65th Ave
City /State: VANCOUVER, WA Zi 98661 Professional Engineered Plans are
360 - 314 -4454 360- 314 -4456 required for:
• Phone: Fax
G Street Widening
• Subdivision Infrastructure
Plans By: • Main utility line extension:
Address:
City /State: Zip: -
Phone: Fax:
Description of work: Directional drill from the SOUTH side of
SW VARNS ST oolna NORTH to oroperty line, placirc 2" schedule 60 pipe with CATV Service wire. to provide CATV service
for 6980 SW YARNS ST.
Estimated value of work (within the public right -of -way): $ 6385.00
Is work related to a LAND -USE DECISION? YES ❑ NO II
If so, please specify (MLP, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? YES ❑ NO II
If so, please specify (BUILDING PERMIT) case #:
*NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide
financial assurance for the work.
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Tim Lehrbach
From: Tim Lehrbach
Sent: Wednesday, December 12, 2012 9:31 AM
To: Fisk Communications
Cc: Catherine; ROW Permits
Subject: RE: ROW permit application for 6980 SW VARNS ST
•
Follow Up Flag: Follow up
Flag Status: Completed
Categories: Misc. Correspondence
Good, morning,
The portion of SW Varns described and shown in the application is a private street and not in a city right -of -way, so no
permit requirement applies, here. This application was voided, but word of this action had not reached me, so I do
apologize for our delayed response. .
Thanks,
Tim
Tim Lehrbach
Permit Technician Assistant
City of Tigard I Community Development
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 718-2594
timIPtisard- or.Rov
From Fisk Communications [mailto:fcclocates @comcast.net]
Sent: Monday, December 10, 2012 10:35 AM
To: ROW Permits
Cc: Catherine
Subject: Re: ROW permit application for 6980 SW VARNS ST
Can I get a status on this permit request?
thanks
John Hall
FISK Communication Contracting Inc.
From: "Catherine Stricker" <fcccatherine@gmail.com>
To: rowpermits antigard- or.gov
Cc: "John H Locates" <fcclocates @comcast.net>
Sent: Wednesday, November 7, 2012 3:30:11 PM
Subject: ROW permit application for 6980 SW VARNS ST
Hello,
1
•
Attached is a ROW permit application and map for the above referenced address for your
review and approval.
Thank you for your time.
Catherine Stricker
Fisk Communications Contracting Inc.
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may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained .
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
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