PFI2019-00265 'Orb
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ��/2_7(
is Request for Permit Action
T I G A ai 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business orindividual) Brett Sherwood, Frontier Communications
Mailing Address: 4155 SW Cedar Hills Blvd
City/State/Zip: Beaverton, OR 97005
Phone No.: 503-578-9014
PLEA ACTION FOR THE ITEM(S) CHECKED (1):
X CANCE OID PERMIT APPLICATION.
UND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: PF12019-00265
Site Address or Parcel#: Adjacent to 14944 SW 89th Ct.
Project Name: Bore along ROW on 89th. Ct. & Sheckla Dr. to service new customer.
Subdivision Name: N/A Lot #: N/A
EXPLANATION: Permit has been inactive since 8/15/2019, Fee has not
been paid by applicant.
Signature: �7 Date: 12/16/202.0
Print Name: Jeremy Tamargo
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits poor to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date Z Fi Ze By -VI
Refund Processed: Date Invoice Processed: Date By
Permit Canceled: Date 7ii1, tie Byrn Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_ 8.doc
RECEIVED /a
City of Tigard AUG 15 2019
M. I
PFI#:�O/ / — 69��?�ENGINEERING DEPARTMENT
CITY OF TIGARD
Public FacilitieRSAl ' i nt (PFI) Permit
r r.
PROJECT INFORMATION
I t
u RK� S� o G1, C - m- r m1'Per TYPE OF WORK
Project name: iv TYPE 1—Franchise Utility Work
Brief description of Ci . project: 6d r� cthw RRob.) 6 n performed byNWN,PGE, or utility
agencY
4 S Ga.�.{Zla pr A serv?C_0_, ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer
V _ ,i1 GIB fOr _ _ ,r Work performed for the purpose of
1�flie^J lV/V�f • Sidewalk installation or repair
• Driveway approach installation and repair 1
SITE INFORMATION p�/r� • Sanitary sewer lateral installation and
Location (address if available): ('f,/ fill 8 lq el main line tap
`^ � ❑ TYPE 3 d with Scaled Development whirk
ch
`�'O! — performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Name: �.
, +Te-,r- (OmVYKAA (�•�-•��rin CV • Mainline installation for sanitary sewer,
�C �� � storm sewer, Tigard water, and Tigard
Mailing address: K/ edger Kitts Ol yd water service area
City/State: elelkIer'1LJ)I\ /O 1r` Zip: 160✓ ❑ TYPE 4—Small Cell Technolou
El TYPE 5—Tigard Triangle
Phone:
Email: Phone: NOTE: Type 1 and 2 applications may be
Q,�44- C'„ r YG0O0„J emailed to rnwrn rmii=;a.ti"ird-or.yoi.
Contact name: i1✓✓Y 't✓IT gorv+r t vl /��
Phone: 3 - S 7� - clot Li Email: & rth TT-corn
CONTRACTOR INFORMATIIOON 0 Same as applicant Name: CD(ik G'W' CC*A'��,l'( A Or\ CCB Number: 18
5 it(O
Mailing address: I 2-16 S o2Uc&k. Cir. City/State: `OrV1i2. hAvs/612' Zip: C 1113
Phone: 463- IR- 31-iKS Email: pj (LOw60SOhiC061/1(or?.COV}
ENGINEER INFORMATION
Name: e' XWOod ceiar I� J, }J
Mailing address: `ttS(J- U ( IItIS City/State: 9r"lo�/61`— /Zip�:_617bd�
Phone: 3 ,G✓7 g -'t D� ( Email: 'f lif (.CX�o TIC . COVYV
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000):$ (within the public right-of-way)
Is work related to a LAND USE DECISION? ❑Yes l2 to Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-orgov • 503-718-2421 • Page I of 4
f
APPLICANTS
NOTE: Person specified as'Applicant"shall be designated"Permittee"and shall provide financial assurance for
work,if required by the city pursuant to TMC 15.04.140.
' With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,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 must sign this application in the space provided or submit a written authorization with this
application. Franchised or licensed Utilities arc nut required to obtain the owner's signature on the application.
I,the applicant,certify that:
• To the best of my knowledge,all the information provided within this application package is complete and
accurate.
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the
subject property.
• If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
�Js�va� 0.4)00.4
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
'^ STAFF USE ONLY
m
Case No: �Fi2O/9-1 &fermit fee:$.3t-J Received by: Date: �®
Approved by: K. � Date: 8/2.01 1' Notified by: Al- Date: 8-124I 19
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4
•
CONTACTS:
OSP Const:PJ Fellows 503-519-3445
OSP Engineer:Brett Sherwood 503-578-9014
SW SCHECKLA DR Facil Tech:Laurel Kielty 425-263-4006
OSP Inspct:Ron Hayhurst 503-292-3345
LOUONO NORTH
SW 89TH CT
CO
ROW 30 R
8806 ID. I IS.
0 (/) FOR FOR
CO 13O-
CO
CONDUIT
I
391' C SW SNECRLA DR
BORE PRVT PROP. m LOgONC EAST
THEN ALONG ROW ROW CAR
I' I p I
FOR FOR
\1Kw CONWIT
*WIN Use=Me WV 10 RIUMN WI CALL III if Off YOU DC8/1. ffijiw..
14944 .- T.a w/mon ratio
,&e n,.vrarlY town
...,,nI 7. ,rNww. PERMR DRAWING
1 N�a,a,.....:..'..„, COIRIA PIh 14944 SW 89TH CT
PROJECT C.O.AREA: TIGARD
NURSER': EXCH.CODE:51�3355]1
DRAWN DATE: ENGR55HE WOOLLL���NTY:WASHINGTON
8/15119 PHONE:503-578-9011IE'.5151
SCALE:1=50 TAXIKSTRICT: DWG 1 OF I
TWNSHP: RHO: SEC.
Page 80 2011 Edition
5.3 Two-Lane, Two-Way Roads
Shoulder Work w/ Minor Road Encroachment Diag. 300
Use this detail for non-freeway work which extends into a travel lane and
maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane
can not be maintained, or when traffic can not safely pass by in both lanes
simultaneously, use the appropriate lane closure diagrams—for example,
Diagrams 310 through 350.
A lane closure may be appropriate for conditions such as high traffic
volumes, high speeds, and inadequate approach sight distance to the work
space, or heavy equipment adjacent to the travel lane.
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. Cones shall be placed along the entire length of the work space. If a
protection vehicle is used and work is in place one hour or less,the
taper and tangent devices may be omitted.
4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there
is limited sight distance, consider placing cones or tubular markers on
centerline.
5. An arrow board in caution mode or truck-mounted PCMS with
"SHOULDER WORK"or other appropriate message may be used for
higher visibility.
Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs Buffer
Speed A I B C Space
20 50
25 100 100 100 75
30 100
40 350 350 350 150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 81
Shoulder Work w/ Minor Road Encroachment Diag. 300
ROAD
WORKAHEAD 1•
•
Initial
Warning A •
Sign
it Hi
(Optional) •
• •
• • • nu
•
111
Protection Vehicle
w/TMA(both Optional)al)
See Chapter 4 •
Buffer
•
10' •
minimum •
•
A
NARROWS
(Optional)
B
life - FOR°
WORK
AHEAD
Initial
Warning
Sign
December 2011 Chapter 5