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ROW2012-00043 � , a CITY OF TIGARD RIGHT OF WAY PERMIT - COMMU DEVELOPMENT Pe rmit #: ROW2012 -00043 Date Issued: 04/25/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: SEG1994 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Communications Project Description: At the intersection of Beef Bend and Hwy 99, relocationof Frontiers' pedestal at intersection to resolve conflicts with an ODOT project WO #51351- 5099219 Owner: FEES Description Date Amount ROW Permit Fee 04/25/2012 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: . LARRY WHEELER 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 503 - 512 -9356 Total $300.00 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee /Applicant Signature: Aldt/ Issued By: `IA,(-e Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2012 -00043 Type: Condition Name: Status: Severity: ROW 20- TRENCH - PATCH /SAFETY /LBILITY Applied Notice A temporary hard - surface patch (Cold mix A.C. or Hot mix A.C. base paving) shall be placed on trenches within roadways at the end of each day's work. No trench, on site or off site, shall be left at any time in an unsafe condition. The permit holder is responsible for and is liable for hazards or damage resulting from the work. ROW 21- REPAIRS REQ - INSPTR OPINION Applied Notice Work provided for under the permit shall include repair of existing facilities (roads, ditches, etc.) as may be necessary, in the City Inspectors opinion, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the permit holders expense. ROW 22 -AS- BUILT /ENGR CERTIF REQ Applied Notice At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public right -of -way shall submit complete "as- built" drawings showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineers certification of installation compliance (form attached). ROW 23 -DAILY INSP REPORTS REQ Applied Notice The permit holders Engineer /Inspector shall submit daily inspection reports, on a weekly basis, to the City's Inspector. (see Developer- Engineer Agreement note #5). ROW 24- TESTS /REPTS TO VALIDT CLMS Applied Notice The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's engineer or contractor to validate claims of material or construction adequacy /compliance. Such tests /reports shall be provided at the permit holder's expense. ROW 25- RELEASE - WAIVER REQ Applied Notice The permit holder shall provide a copy of a properly executed Release & Waiver document to the City for each ownership disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction. ROW 26- MONUMENT PROTECTION REQ Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders expense. ROW 27 -PROB SOLVING - RESPON PARTY Applied Notice The permit holder shall provide to the City Inspector, in writing, the names and 24 -hour emergency telephone number of two (2) persons who have authority to resolve problems, take corrective action and, in general, will be responsible in case of an emergency. The permit holder shall notify the City Inspector, in writing, of any /all assignment changes. ROW 28- CONSTR SAFETY - RESPON PARTY Applied Notice The permit holder shall cause his contractor to provide to the City Inspector, in writing, the name and 24 hr emergency telephone number of a designated "Competent Person" responsible for construction safety as per OR -OSHA, Chap. 437, Div. 3 Construction, Subdivision P - Excavations. The contractor shall notify the City Inspector of any /all assignment changes. ROW 29- ESMT /RT OF ENTRY - RESPON Applied Notice It is the sole responsibility of the permit holder to provide for proper right -of -entry and /or easements prior to starting work. Proof of right -of -entry, or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the permit holder's failure to obtain or provide for proof of right -of -entry or easements. ROW 01- CUSTOM CONDITION Applied Notice <Custom Condition goes here> ROW 02- PERMIT & PLAN REQ ON SITE Applied Notice A copy of the permit and all attachments, and a copy of the approved construction plan and all amendments shall be available at the work area. All work shall conform to the permit terms, conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's Standards and Specifications and to these General Conditions. Changes to any of the aforesaid must be approved by the City, in advance of work performance. ROW 03 -TRAF CTRL - SPECIF (CITY) Applied Notice The City's standard specification for traffic control is "Manual on Uniform Traffic Control Devices for Streets and Highways ", U.S. Dept. of Transportation, F.H.A., 1988 Ed. ROW 04 -TRAF CTRL -CONTR RESPON FOR Applied Notice Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in accordance with a City (job specific) approved traffic control plan. A copy of the approved traffic control plan shall be available at the work area. ROW 05 -TRAF CTRL -ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time, without having first obtained written approval from the City Engineer. The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide Emergency Services (Tigard Police Dept., Tualatin Fire & Rescue) and to Tri -Met and Tigard School District. ROW 06 -TRAF CTRL - ADVANCE WARNING Applied Notice Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance notification sign at each end of the construction area 72 hours (min.) before initiation of construction work. ROW 07 -TRAF CTRL -PRIV PROP ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not, shall be cause for work stoppage until effective access is established. ROW 08 -TRAF CTRL - DEVICES IN PLACE Applied Notice Traffic control devices, flagpersons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. ROW 09 -TRAF /NOISE CTRL -WORK HRS Applied Notice No work will be permitted during the hours of darkness, nor between 9:00 p.m. to 7:00 a.m. Monday through Friday, nor between 9:00 p.m. to 8:00 a.m. Saturday, nor between 9:00 p.m. to 9:00 a.m. Sunday. ROW 10 -TRAF CTRL -MIN LANE WIDTH Applied Notice Minimum travel lane width shall be eleven (11) feet; pedestrian travel shall also be provided for. ROW 11 -TRAF CTRL -CITY CAN MODIFY Applied Notice The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic and to assure public safety. ROW 12 -INSP 24 HR NOTICE REQUIRED Applied Notice The permit holder or his contractor shall notify the City's inspector Zen Dutson, at 503 - 718 -2472 or email at zen @tigard- or.gov twenty -four (24) hours prior to commencing work, twenty -four (24) hours prior to any staged inspection, and after completing work covered by the permit. ROW 13- HAZARDS -CERT OF INS Applied Notice Maintenance of the work area and approach roads is the responsibility of the permit holder. The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. A copy of the permit holders Certificate of Insurance shall be available at the work area. ROW 14- DEBRIS - MATERIALS Applied Notice The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate cleanup and stoppage of work to accomplish cleanup. ROW 15- EROSION CTRL REQ Applied Notice Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q. requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion control. ROW 16- REPAIRS -LIKE MATERIALS REQ Applied Notice Property disturbed by construction activity shall be seeded with a standard grass mix; shrubs, flowers, barkdust, existing signs, pavement markings, mailboxes, etc., shall be reestablished, reinstalled or replaced, with like kind and material. ROW 17- DRAINAGE CONTROL REQ Applied Notice Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent private property, public property and the receiving system is not adversely impacted. The City may, at any time, order corrective action and stoppage of work to accomplish effective drainage control. ROW 18- UTILITIES PRELOCATION REQ Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. Copies of the rules may be obtained from the Center by calling (503) 232 -1987. If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders expense. ROW 19- UTILITY LOCATIONAL CONFLICT Applied Notice Contractor must verify all existing utilities for both vertical elevation and horizontal location prior to start of work (pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall coordinate the work with affected utility agencies. " City of Tigard 7 .7 ' 4 Application for Work in the Right-of-Way Permit Lin GAIii • GENERAL INFORMATION REQUIRED suBmiTTAL Property Address/Location(s): INTERSECTION OF BEEF BEND AND HWY I N1 R MATI ON 99 SEE ATTACHED DRAWINGS / Submit a scaled sketch of the FRONTIERS PROJECT W.0.# 51351-5099219 p wurkto be done, • FRONTIER COMMUNICATIONS Traffic Control Plan *Applicant's Name: • Filing Fcc $300.00 4155 SW CEDAR HILLS BLVD Address: 4-' 2 C' / 2 i5 42 , ,, BEAVERTON, OR. 97005 Cop owe: Zip: LARRY WHEELER Primary Contact: Right 503-512-9356 lax: 503-643-0977 Case it: ptv 'kola- opoq3 Phone: Receipt Iti I 8 fr 4 0 Contractor's Name: NORTH SKY COMMUNICATIONS Date: '41 Aril 2 -- CCB U: Expiration: 1141171 03/01/14 Application Accepted By: ,bmesiar 10860 SW CLUTER DR Rea/441/7/0/PM/ Address: SHERWOOD OR 97140 City/State: Zip: Phone: 503-647-9991 Fax: 503-647-9991 LARRY WHEELER Plans By: 4155 S.W CEDAR HILLS BLVD Address: BEAVERTON, OR. 97005 City/State: Zip: 503 Fax: 503 I) hone: Description of work: RELOCATION OF FRONTIERS' PEDESTAL AT INTERSECTION OF BEEF BEND AND HWY 99 TO RESOLVE CONFLICTS WITH AN ODOT PROJECT. Estimated value of work (within the public right-of-way): $ .... Is work related to a IAND-USE DECISION? fl YES rz NO If so, please specify (NII,P, SI)R, SUB, etc.) case it: Is the work related to a BUILDING PERMIT? 11 YES ILI NO If so, please specify (M1.1 SD, SUB, etc.) case /1: City of Tigard I 13125 SW II all Blvd., Tigard, OR 97223 I 503-718-24(0 I WWW.1 iga t d-or.gov I Page I of 2 APPLICAN'1'S:'li) consider an application complete, you will need to submit ALL of the REQUIRED SU 13MIT'lAL ELEMENTS as described on the front of this application in the "Required Submittal Elements" box. 'NOTE: Person specified as "_-Applicant" shall be designated "Permitter:" and shall provide financial assurance for the work. •\Vhen 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. Applicant's Signature Date Owner's Signature Date Owner's Signature Date °� 7-~ ) A a r._ccl'Vul's S gnalurc Date (` /1 LARRY WHEELER ACCESS DESIGNER 503 512 - 9356 Print Name Title Phone Number Signatures of each owner of the subject property are required. G u y of 1 ir'ard I 13125 SW I tall Blvd.,'1'ig OR 97223 I 5O3 -718 -2164 I www.til,ard.or.gov I Page 2 of 2 GENERAL CONTRACTOR NOTES BURIED & UNDERGROUND CABLE AND CONDUIT VI',I\ITY \ / A n p v L THE CONTRACTOR IS RESPONSIBLE FOR COMPLIANCE WITH THE ORDINANCES OF STATE OF OREGON DURING ALL PHASES OF CONSTRUCTION BEING COMPLETED ON THIS WORK ORDER. 2. THE CONTRACTOR IS RESPONSIBLE FOR LOCATING AND SAVING FROM DAMAGE ALL SUBSTRUCTURES LOCATED WITHIN THE GAARDE MCDONALD WORK AREAS COVERED BY THIS WORK ORDER. SHOULD DAMAGE OCCUR, THE CONTRACTOR SHALL BE SOLELY RESPONSIBLE FOR ALL DAMAGES AND REPAIRS TO ANY SUBSTUCTURE. GN 3. IF STREETS ARE TO BE SAWCUT, ALL WORK WILL COMPLY WITH GN COUNTY SAWCUT AND COMPACTION SPECIFICATIONS. SELECT �� BACKFILL MAY BE REQUIRED N` 4. ALL SUBSTRUCTERS ARE TO BE EXPOSED BY THE CONTRACTOR PRIOR BULL MOUNTAIN TO CROSSING. 5. CONTRACTOR IS TO PROVIDE ALL CRUSHED ROCK, ASPHALT AND CONCRETE REQUIRED FOR BACKFILL AND RESTORATION BY THIS WORK WORK AREA ORDER. THIS SHALL INCLUDE THE REMOVAL AND REPLACEMENT OF 0 J GRASS SOD AS REQUIRED Ca� 6. ALL EXCESS BACKFILL IS TO BE REMOVED FROM THE WORK SITE AND ' NO TRENCH IS TO BE LEFT OPEN OVERNIGHT. 7. ALL EXCAVATION AREAS ARE TO BE RESTORED TO ORIGINAL DURHAM CONDITION OR BETTER. 8. ALL TRAFFIC CONTROL AND LANE CLOSURES ARE TO BE COORDINATED WITH THE CITY OF STATE OF OREGON AGENCY. PUBLIC SAFETY SHALL BE OF THE HIGHEST PIORITY. 9. THE CONTRACTOR IS RESPONSIBLE FOR ADHERING TO ALL . FRONTIER SYSTEM AND/ OR OSHA SAFETY REQUIREMENTS PERTAINING TO CONTACT INFORMATION ALL WORK OPERATIONS SCHEDULER - JOSH SIMS 503 684 -8417 10. ALL WORK IN THE COUNTY RIGHT -OF -WAY IS TO BE PERFORMED IN INSPECTOR - JAMES ANDVIK 503 936 -2021 ACCORDANCE WITH THE CONDITIONS OF THE STATE OF OREGON PERMIT. CONSTRUCTION - CHRIS BATES 503 649 -7943 FACILITIES - MICHELE CRISMAN 503 643 -0181 ENGINEERING - LARRY WHEELER 503 512 -9356 NOTE AREA tr FRONTIER 9WN AREA STATE: OR WO DRIVER PERMITS JOINT POLE POINT OF CONTACT DIVISION: Pacific Co I EXCH.:5460 REM. CD.: NUL O FTTP GROWTH THOMAS BROS. CUTS REQUIRED JFN /NJUNS • KILOVOLTS W.C.: 5460 IWO NO.: 5099219 CONTROL NUMBER: ❑ FTTP OVERLAY MAP • a YES ❑ NO CONSTRUCTION MUNICIPALITY 0007 JFN /NJUNS • Lee • COPPER 655 C6 ❑ NO JPN REDUIRED TITLE: TORO ROMV MOVE CP AN TAX DST.: ❑ CONDUIT ONLY MUNICIPALITY JOINT TRENCH ❑ DIAL.A DIG POLE JPN JPN ENGINEER LARRY WHEELER ❑ BLANKET "IA" VOLTAGE CONSTRUCTION START 6/18/12 ❑YES w NO ❑ FLAGGING OWNER TO FROM PHONE NO. 503 512 -9356 TOPS 2S RNG.: 1W SEC.: IOAC SAL: XXX IN SERVICE DATE 7/31/12 ❑ TCP /TRAFFIC 0 0 0 POWER IJT.USE)IBUR.JT.1 Q CONTRACTING • TECH. DETAILED (NOT BLANKET) ❑ ❑ 0 CATV DATE: 04/05/12 )REV. DATE: SCALE: 1" :50.00' SCCN REM) PHONE NO. CONSTRUCTION COMPLETE 8/31/12 ❑ YES r NO REM, ❑ NO PERMIT REQUIRED Q Q ❑ FRONTIER FIELDED BY NORTH EXPOSED DRWN ENG APRVD PRINT FILE: WPI TIGARD LLW LLW I OF 4 SEE SHEET TO CO •70980 SW BEEF BEND RD " 17183 "1740 . !Mb _ _ "2294 " d, SLM18-24 PVC -2 WAY "5297 J UG r , 9000+2R4:901-1800 25FT "17400 t 5297 ( x) M H 3 6 j'. "2294 R4:1 -90 +1801- 2000 +400XD) J 1995 100' 108+47 MC 280492 J J J "7815 "7815 AEF6 -26 REMOVE CABLE 200X0 +2R4 :2001- 2200 +200X0 M H 1 3 2 "2658 se 70980 (PP) AKF 4 —24 ., "2658 (PPX1� 2R4:1 -400 cp � E - STU -24 65' "44202 J V C2R4:18 200 ? +400XCD . PULL CABLE JO MC 529238 IN CONDUIT "2797 "7814 REMOVE STUB MKF18 -26 AEF6 -26 0+00 44202 7:1- 1400.400X0 CD 2R4 :1801- 200.200X0 YJ0864 -SM J FC2042 :1- 576 +48X0 +240XD C � � Z C7 (o ^i0 /Q/ J J J J "3211 v , o, V YG024 —SM "7776 `� TIO16:1 -24 SLM18 -24 c 44 2R4 :I -1800 J CD C J j „Zr °202 PO J /**4 "24735 YGD- ADSS96 -SM 5518-24 j .1 1 ' .--j j j "24735 FT233:1 -96 14:1-900.2R4:901-1800 U J .i *199 Y6054 —SM / /) . CD TO RSU ft S 4 ; FRONTIER 9WN AREA STATES OR k A DIVISION: Pacific Ce I EXCH.:5460 REM. CD.: NUL �' K�:.�YaT� W.C.= 5460 Iwo NO.: 5099219 CONTROL NUMBERS SEE SHEET O I \ '[: lee TITLE: TORO RDMV MOVE CP AN TAX DST.: • IMA VOL MANHOLE D :JT.::S :BUR.JTTAGE .: TWP: 2S I RNG.: 1w ISEC.s 10AC SAL: xXX ExPo DATE: 04/05/12 REV. DATES SCALE: 1=100.00' • PR FILE: WP2 DAWN ENG APRVO PRINT TIGARO LLW LLW 2 OF 4 V " 575 (PPO VC -2 WAY} KF2 -26� �75FT N70979 (PPR)� N:1601-1800) 1995 84' p, MC 280682 si , y ' VC -2 WAY 7 7FT "17402 (PPR) 4 ' co Co v " 0`' r'/ ,t O 6575 5400 �� �qq5 5068 "5297 (PPX) N "6577 -0 :0.9 BOV � MG 2 AKF15 -26 AKF2 -26 . . -�O� 0°I N DAN:1601 - 1800 a) ` I BpO p 2R4:1-90 +1801-2000+400X4 V Y O P' 4 IN PVC-2 WAY X °� 61 +30 "6563 N p 0 �� 114 20FT "70985 (PP) "6558 (PP ) ^ ; ''� " A KF15 -26 � 6572 MKFI5 - 26 v 7 70979 4 IN PVC -2 WAY OAN :1 -15 0) AKF15 -26 DAN:1 -1500 °D DAN:1 - 1500 Z s ood ' 30FT "70990 (PP) MC 995 92' MC 1 6577 I L493 I 5 a t9 ; "70992 (PP) v P4 P3 I c d AKF18-24 "70980 (PP) N bdbbv)2 0 501 P2 a "17402 a' x x "6563 36486 G'`'• #6558 DAN:1-1800 1800 AKF4 -24 Y " 0 ■ CD 0 70980/ PULL CABLE IN 2R,4:1-.400 �_ "6572 70993 Z - " 70985 CONDUIT \\ _ `! "5297 CONDUIT BLE IN PVC - WAY 4 IN SCHEDULE 80 -1 WAY c., ,, LOCATE AND ATTACH 25FT "17400 20FT " 70993 (PP) "70992 "17400 TO EXISTING CONDUIT SW BEEF BEND RD PLACE RISER SEE SHEET 2 / "' E4 EXISTING , CONDUIT NEW 0` CONTROL 0' ii EXISTING 2 -4' PVC POINT POLE 2 -4° PVC • 28 .4 )if 3' 1 e ›' 5 \u FRONTIER 9WN AREA STATE: OR r BEEF BEND ' 14 38 DIVISION: Peeafae Co I EXCH.: 5460 REM, CD.: NUL K!LOVOLIS W.C.= 5460 IWO NO.: 5099219 CONTROL NUMBER: 0.00 TITLE: TORO RDMV MOVE CP AN TAX DST.: • PRIMARY VOLTAGE TWP: 2S I RNG.: 1W ISEC.: 10AC SAL: XXX W T.USE) IBUR.J T.) DATE: 04/05/12 IREV. DATE: SCALE: 1' :50.00' PLACEMENT DETAIL EXPOSED DRWN ENG APRVD PRINT TIGARD FILE: WP3 LLW LLW 3 OF 4 TO MH131 SHEET 2 FOR CABLE TO C.O. C'O (2 801 - 2000 +400X ZUKF 15 -266 2R4:1 -400 Q X AKF4 -24 00 © o 00 Qo (900XD +2R4 :901 -180f� 0 0 Q E (UGSLM18 -24) NO MH OR DUCT INFO 7F001CB O 00 N x N •d' . I -. OD @ (.0 CQ co o @ �' Y 2R4:1801- 2000 +400XD o cr w @ g N a 1 -STUB M c rN � LC) N N D X N O I + 1 C0 + + N O I— >- @ CO co X @ Z LL @ > @ @ w 1- LL„ Q' @ i Y O. •i, 1 N co 'Cr. L1- N .j N / N D CC N + 0 CO N U 0 h co 1 lL ® I-- .--, N I Er o o N 2R4 :1801- 2200 +200XD # >- UGUKF6 -26 54 +34 RSU L2 MH36 ®® • 0 2R4 :1 -1800 MH132 108 +47 va► ® 4 ® UGSLM18 -24 5106TA 546 - 121784 UG2S1W10.D 0 0 © 0 BEEF BEND RD & FRONTAGE RD 0 0 FRONTIER qWN AREA STATE: OR REV 03/05/08 SEP DIVISION: Pacific Ca I EXCH.:5460 REM. CO.: NUL KILOVOLTS W.C.: 5460 TWO NO.: 5099219 'CONTROL NUMBER: Lee TITLE: TORO ROW MOVE CP AN I TAX DST.: • N H 13 2 PRIMARY V"LT*GE TWP: 2S I RNG.: 1W ISEC.s 10AC SAL: XXX :JT.USE:IBUR.Jra TO MH133 DATE: 04/05/12 /REV. DATE: SCALE: I':50.00' EXPOSED DRWN ENG APRVO PRINT TIGARD FILE: WP4 LLW LLW 4 OF 4 avrt Zo86oVOTONM 1 0060VOTAM TO960VOTONMI •0860VOTAM bOL60VOTAM4 + 1 TOL60VOT0 NME:0160VOTAM Z0L60VOTAM TOL60V0THJTOL UNAU 11.1A2 0 ti16ZTV0T l8ZTVOT StS TT StSTT StSTT StSTT SVSTT u CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 - 503.639.4171 Ti CARD Receipt Number: 186480 - 04/25/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2012 -00043 ROW Permit Fee 100 - 0000 -43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 043024 STREAT 04/25/2012 $300.00 Payor: Fran Hoag Frontier Communications Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1