ROW2011-00044 APPLICATION FOR OD
11 1
WORK IN RIGHT -OF -WAY (ROW) PERMIT
Development Engineering TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 624 -0752
FOR STAFF USE ONLY
General Information:
Right -of -Way
Property Address /Location(s) Treehill Ct & SW 119th PI Case No.: &3 2 I / —0 t '
Treehill Partition SEA, 2 77.5' Receipt No.:
Date: "[ /
/// •
*Applicant's Name: Natural Application Accepted By:_ r P
220 NW 2nd Av
Revised • • &' (' �` / /'/
Address: 220
City /State: Portland OR Zip: 97209
Primary Contact:Patty House REQUIRED SUBMITTAL INFORMATION
Fax: 503- 273 4822 x 4331
Phone: 226 -4211 X
Contractor's Name: Clark Submit a scaled sketch of the
52281 proposed work to be done
CCB# Expiration:
Address. #A SW Cipole Rd
City /State: Tualatin Zip: Professional Engineered Plans are
503 644 2137 503 - 520 -8763
Phone: required for:
Fax:
• Street Widening
NW Natural • Subdivision Infrastructure
Plans By: • Main utility line extension:
Address:
City /State: Zip:
Phone: Fax:
Description of work: lnstall 185ft of 2" poly main. Tie in at N side of
Treehill Ct inside property. Cross Treehill Ct to S side and down private Dr to serve 3 new construction lots.
Estimated value of work (within the public right -of -way): $
Is work related to a LAND -USE DECISION? YES NO
If so please specify (MLP, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? YES NO
If so please specify (BUILDING PERMIT) case #:
*NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide
financial assurance for the work.
c \documents and settings \caw\desktop \row permit application.docx
CROSS SECTIONS GENERAL NOTES N
I. Call the billowing Utilities Notification Center
48 hours rior to any excavation- W E
Oregon. 1- 600 -332- 2344
25' 1 < 6' D . Washmgtrn: 1 -600- 424 -5555
1 J 2 Fill out construction sketch as -bolt supplied with S
d joh packet and return with walk order Only one
W as -built is required.
B 3 All distribution mains must have a minimum depth of
24" and servtees must have a minimum depth of lb"
C CL unless there is an approved variance
4, All lransnusstun lines must have a minimum depth of
CC 30" to Class 'I' locations and 36" In Clans '2.3. & 4'
locations. unless thew is an approved vanance.
2' -). Ot- 5, Wnttrn dimensions on this construction sketch
have precedence over waled dimensions -
E/S 6 pressure Intl shall he tested in accordance will 74'
standards in CFA and Engineering Standard Practice.
7 Test medium for class "a" vain shall he air, unless 14059 ( )
07)
otherwise noted. Test medium for class "C-F" main t.
shall be water. unless otherwise noted
8 For Class C or higher lone. see Design Document and a
VARIANCE (5) Rydrostauc Report a
vanancetsl made
Reasmisl 6 7 a J
- TRACT E 8 C1-
MtAgaeon raven (e a./ ',01'` N 8 °' g = g_ F FUSE &
nnr,„at Name 'Signaler*: Date # N. I h — QJ INSTALL:
#12D10 TREEVIE 6 i ❑ 1 #Anode
Class "B" PRESSURE TEST INFORMATION (circle & label test area on as -built drawing) (00) (CPUT ` CT. T
7 16150 10 11
V� 12 la
Test by NNG — Other_ _, _ 4 _ zn• � _ / ( / 11990 616 (YB91 STA
cat
.e ietiro or N u z J pl(I7, <1400o — _ ,6 _ — ^m
Print I....< t . 014111 d �- (WI - t'l- � e m if!. - �� p ^
A - seal s3' - 9 / v , t a6,-) m � _
= e�
g a trP'u ~O e �a rJ gl� old /� #nas7 l6
♦14155 M " I¢ ta 1,1-/ (99)
C (99) a P. REDWOOD ,,,P,6,/ '-0 +38 2 "IPI'98IJT -173'
TREEHILL CT. '
( CPUT) . �g ry > ¢ 4s`a0y '0+00 297' - � (CPUT)
2 ° t - 2 � f �.o
E
.. 131' 662'_ 1 1 \ , ,-
} .. TR
F #16199 (C I
PI R(P f I 9 9 ';
(99) F
483
1 L \\ �9� 1
LL
WELDS \` y
X- CERT. OPER. PM PM 1 2
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY # ORDER # 7 1 +47
INSTALL 185' 2" P 8 P24 .216 60 57 45 710 03347173
3
0 50 100 INSTALL:
+NW Natural Feet 0 L
Engineering Department tin = 100 ft
ADDRESS CITY COUNTY STATE DESIGNED L2C DATE 06/23/2011
SW TREEHILL COURT TIGARD WASHINGTON OR DRAWN KDC DATE 06/24 /2011
BETWEEN MO
APPROVED DATE
SW 119TH PL SW GAARDE ST
NAME CREW LOA. DATE
Treehi113 Lot Partition PLATTED DATE
PLAT TWN RNG SEC JOB TYPE:
1-045- 017T02S R01W NW 10 New Construction Mains
PM #: PROJECT/REVISION.
03347173 00005299