ROW2013-00065 RECEIVED
JUL 31 2013
1 11 City of Tigard CITY OF TIGARD
Application for work in the Right- of -Wa 'ermit
General Information: Q awl' STAFF USE ONLY
Property Address /Location(s): Sr-76 -1, a1 C.1 Zco Right -of -Way n ^I � �
S W G REE_NZ UR G RD 187 N/0 SW LOCUST ST Case No.: L�IJ
r p Receipt No.: n J 0.,
*Applicant's Name: EL L E C Tr IC L I G HT NA V E Date: 1131113
Address: 1 tO 1 ME LLO BLUR SUITE 1{00 Application Accepted By:
City /State: Q b RT L R ND 1 D1; zip 9'1232 Revised 7/1/11 Vo idea 6
P Contact: PAUL 3ENSEN R 1 A a0
D3 - �L 5 3 - C . 81 REQUIRED SUBMITTAL
Phone: 303. Fax: 3 INFORMATION
Contractor's Name: STA N D RRD ��IL1 CONTR R CTORS
� '� Submit a scaled sketch of the proposed
CCB# L0�/ 9 '1 Expiration: 65 - — [ 0/� U1 L 1 work to be done
Address: 1209 EULEK RD KE
City /State: R U RuRR, OR zip: 97062
Phone: 5b3 - 8'19 Traffic Control Plan - 2 f8Z8 Fax: 563 - (�78- Z ?21 • Filing Fee $300.00
Plans By:
I:curpin \masters \land use applications \ row app.donc
Address:
City /State: Zip:
Phone: Fax:
Description of work DTR E G T" BORE 70 OF 2 ti CONDUIT UNDER SW GREEN BURG RD
Estimated value of work (within the public right -of -way): $ � 80, 8 O
Is work related to a LAND -USE DECISION? YES NO .x
If so please specify (MLP, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? YES NO K
If so please specify (BUILDING PERMIT) case #:
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Prxmi+ hot reep II
City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 718 -2468 I www.tigard- or.gov Page I of
APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as
described on the front of this application in the "Required Submittal Elements" box.
*NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work.
*When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in possession
with written authorization from the owner or an agent of the owner. The owner(s) must sign this application in the space
provided or submit a written authorization with this application.
BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject
property.
• If the application is granted, the applicant will exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All of the above statements in the plot plan, attachments, and exhibits transmitted herewith, are true; and the applicants so
acknowledge that any permit issued based on this application, may be revoked if it is found that any such statements are
false.
♦ The applicant has read the entire contents of the application, including the policies and criteria, and understands the
requirements for approving or denying the application.
( 2 • ‘ \ , . _ . a7 -08 -13
Applicant's Signat Date
Owner's Signature Date
Owner's Signature _ Date
Authorized Agent's Signature Date
?PM - ZEN SEM _ SR OSP ENGINEER' - .503- 133.5322 •-•
Print Name Title Phone Number
Signatures of each owner of the subject property are required
City of Tigard I 13125 SW.Hall Blvd., Tigard, OR 97223 I 503 - 718 -2468 I www.tigard-or.gov I Page 2 of2
Page 84 2011 Edition
Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a two -lane, two -way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT) with good
sight distance as discussed below.
1. Use truck - mounted flashing warning lights on work and protection
vehicles. See Section 4.3 — Lights and Lighted Signs for exceptions.
2. For added visibility, a truck - mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340 — Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5 -4) should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the "Flagger Ahead" (CW23 -2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set -up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The "ONE LANE ROAD AHEAD" (W20 -4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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