ROW2013-00104 RE'e%, . -, ,, ,,, - :
City of Tigard OCT 14 201;'
IIII ,1111
_ .£ Application for Work in the Right-Of-Way
TIGARD ROW Permit
Property Address/Locati n(s): SW Coronado St s/of SW Barbur Blvd FOR STAFF USE ON Y
S �j 40' 3-19 M� °o°T A�R�
1 Right-of-Wa'� ,r
Case No.: 1-44A/v2-01 --CO(C4
4
NW Natural NWN Job#R00011028
*Applicant's Name: 1pl 14 By: AIL--Application Accepted:
Address:220 NW 2nd Ave
Application Reviewed:/0:2.1. a,,, By:21
City/State:Portland OR zip:97209
Christine Jeibmann $300.00 Application Fee Due: Yes 0 No¢�
I rimary Contacr: ;31 �a/I(o r;2�(� ��t 2 L t011 1 I 1J /
Phone:(503)721-2463 Fax: (503)2'73-4822
Applicant Notified: Pr
Email:
NWNPERMITS @nwnatural.com Receipt No.: N�
REQUIRED SUBMITTAL
Contractor's Name: applicant to complete construction INFORMATION
CCB# Expiration: • Application form,completed and signed
Address: • Submit one(1) copy of scaled sketch of
City/State: Zip: the proposed work to be done
Phone: lax:
• Submit one(l) copy of traffic control
plan
Email:
Professional Engineered Plans are required
Plans By: NW Natural for:
Address:220 NW 2nd Ave • Street Widening
City/Stare:Portland OR zip:97209 • Subdivision Infrastructure
921-0314 (503)273-4822 • Main utility line extension
Phone:(360)
1 ax:
Email:R2G @nwnatural.com Icurp ln`,nua c.4.1,1usealphcl∎MSlnxtnpp.docs ( Ito..7/19/12
Description of work: SW Coronado St s/of SW Barbur Blvd
Estimated value of work(within the public right-of-way): $472.50
Is work related to a LAND-USE DECISION? YES 0 NO V
If so, please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? Y• D NO .rJ
If so, please specify(BUILDING PER
II
case# :'
Signature of Applicant/Permittee: fr Date:10-11-2013
Print Name:Christine Jeibmann for NW Natural Title:Engineering Coordinator
.. _.. City of Tigard 13125 SW Hall
ty ga I f Blvd.,Tigard,OR 97223 I 503-718-2464 I www.tigard-or.gov
i /
CROSS SECTIONS GENERAL NOTES N
I Call the following l hilithu Notification Center
48 hams prior to any excavation W E
Oregon ell or l-800-132-2144
Washington XI or 1-800-424.5555
2 ATTENTION.Oregon law requires you to follow S
rules adopted by the Oregon I1Wity Notiticatun
Center.Those rules are set forth m OAR 952-001-
0090 You may ollaln copies of the rules by calling
the center.(Note the telephone number for the Oregon
Utility No(Ilication Center is(507)232-1987 or 8111.
1 Fill out construction sketch as-built supplied with
Job packet and return with work order Only one
as-built is required. Q
4 All distribution mains must have a mmlmum depth of 141 W
24"and services must have a mtmmun depth M 18' h w
unless there a an approved variance —a 6• l-
5 All transmission lines must have a mmtmtun depth of It.. <
111"in Class'1'locations and 16"in Class'2,3,&4' 0 =
locations.unless there is an approved variance. Z j_
f\Konen dimensions on this conarucnon sketch D, V
have precedence over scaled dunenswru Iii d OW) Da 5127
7 Pressure test shall be tested in aco:udunce with ii 198' r s j F
standards as CFM and Engtneetmg Standard practice.
VARIANCE(SI 8 Test medtttm fot class"B"maul shall be au,unless U)
otherwise noted Test medium for clay•C-F"main ❑ CUT 6 CA' Q •BS21
v t.Ma IM nowt: shall he water,unless otherwise noted. i _ 1021 1'(P) Tr.®
it For Class C or higher teas,.see Design Document and re 1— D 66
Roman(0 Hydrostatic Report w to
s: 1,i f
arateen tro.o Ot.n) S (n —
Aotnni Name ISwt+a• 10.5. \ —
• 4
i' iy N
Class"B" PRESSURE TEST INFORMATION (circle&label test area on as -Witt drawing) ' _ -4 R_2lWl7l
Test by NNG —Other S A - 6 —r VD
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r D.. °` Tti :. a..N....aM. I\, .. P�„6�1G�W�9'� — —S SARBUR l8 r
1 1
Cf w. -0 l". p G1F T Gl
D f' v,.00.17 — —. BOND
E TIED — ft 0+p0 e -1.--D_ �; ST. — —
0 6 Np,D
F e = OR�2—W— 5
WELDS r I e( 47 • 8
%X- CERT. OPER. PM PM NOTE MAIN IS R(r)91 '
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY# ORDER# W 7D I 2D 200. C
INSTALL 189' 2" W B API 5L B .154 60 57 45 114 03394917 R oar p R
_ (Mn 108•
ABAN 198' 1" W B 114 03394916
u�
❑ BOND
ii N N
o,, O O
'";) N W Natural 050 0 5 0 Feetv�els w
Engineering Department 1 in=100 ft `�'
ADDRESS CRY COUNTY STATE DESIGNED R2G DATE 09/26/2013
SW CORONADO ST PORTLAND WASHINGTON OR DRAWN KDC DATE 09/17/2013
BETWEEN AND
APPROVED DATE.
SW BARBUR BLVD
NAME CREW LD0. DATE
RELOCATE MAIN PLATTED DATE
PLAT TWN MSG SEC PIPELINE ID- woe TYPE:
1-041-022 TO1S RO1W NE 36 PUBLIC WORKS
w a: PROJECT/REVISIONS
03394917 00011028
1