ROW2012-00052 Er
T IGARD
City of Tigard
October 18, 2012
NW Natural
Attn: Colleen O'Brien
220 Nay/ In Ave.
Portland, OR 97209
Re: Permit No. ROW2012 -00052
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: Near 10685 SW Greenburg Rd.
Project Name: NW Natural
Job No.: 3361009
Refund Method: ❑ Check # in the amount of $
❑ Credit card "return" receipt in the amount of
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
® Trust account "deposit" receipt in the amount of $300.00.
Current Trust account balance is $8,500.00.
Comment(s): Permit cancelled as it was a duplicate of ROW2012 -00050 submitted on
6/4/2012.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
M I
q CITY OF TIGARD RECEIPT
. 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 188795 - 10/16/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ROW2012 - 00052 $ 300.00
Total: $- 300.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Trust Account NWNDEP DHOWSE 10/16/2012 $- 300.00
Payor: NW Natural
Total Payments: $ - 300.00
Balance Due: $0.00
Page 1 of 1
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Reqiiestjbr Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: NW Natural DATE: 10/4/2012
220 NW 2n Ave.
Portland, OR 97209 REQUESTED BY: Dianna Howse
Attn: Collenn NI. O'Brien Hap
TRANSACTION INFORMATION:
Receipt #: 187079 Case #: ROW2012 -00052
Date: 6/7/2012 Address /Parcel: Near 10685 SW Greenburg
Pay Method: Trust Project Name: Job #3361009
EXPLANATION: Duplicate permit application (see ROW2012- 00050). Refund 100% of application fee.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
ROW Permit Fee 100 - 0000 -43114 $300.00
TOTAL REFUND: $300.00
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager , t i //At_
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ON
Case Refund Processed: I Date: /p / /6Aa By:
I: Building \Refunds \RcfundRc s 09/01/2011)
Cit y o f Tigard • COMMUNITY DEVELOPMENT DEPARTMENT fr-
IIIII g
■ Request Permit Action
l ; , , \ ,. l , 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor j2c City Staff
(check one)
REFUND OR Name: / ! % Jdived
INVOICE TO: (Business or Individual)
I
milaiR A-czyt NW 15 E
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL /VOID PERMIT APPLICATION.
III REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: P.0 D/ - '—OD 2
Site Address or Parcel #: L 1. 16 4 d ge iph•g S W 6 4L45'
Project Name: Jt) 10 A •,/0G
Subdivision Name: Lot #:
EXPLANATION: J /th trt OW 2-D/2.- 0,06 - 0
Signature: el Grp Date: 9 ,/ 5" a _
Print Name: 2■ 4( A Grf,lr S
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B Rte t. Admin: Date 4/59562. B 46,
Refund Processed: Date /0,7r /0 B : ;; Invoice Processed: Date B
Permit Canceled: Date /p /b /,,1 ;• v A • arcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
CITY OF TIGARD RIGHT OF WAY PERMIT
Permit #: ROW2012 -00052
= COMMUNITY DEVELOPMENT
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 06/07/2012 y 7
TIGARD 13125 SEG406 t. f
Jurisdiction: Tigard St
Site address: 7
Subdivision: Lot:
Project: NW Natural
Project Description: In front of 10685 Greenburg Rd. (facing Cascade Blvd.), installing 1 "(P) svc, to be installed off of 1 "(W)
main on W 10' of Cascade Blvd., using bore and john deer, flaggers. 433 6/001
•
Owner: FEES
Description Date Amount
ROW Permit Fee 06/07/2012 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
COLLEEN O'BRIEN
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503 - 226 -4211
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:
Issued By: [�
Special Conditions (See Attached) i/ 1 /87
Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2012 -00052
Type: Condition Name: Status: Severi :
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 Kenny Fisher, at 503 - 816 -6146 or email at
kenny @tigard -or 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.
k 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.
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.
APPLICATION FOR
WORK IN RIGHT -OF -WAY (ROW) PERMIT l o
Development Engineering T1GAKD
/3125 SW !full Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 624 -0752
FOR STAFF USE ONLY
General Information:
Right -of -Way
Property Address /Location(s) : 10685 SW Greenburg Rd r _ I 04, Case No.: ROW201 L
#3361009 Receipt No.:
Date:
'Applicant's Name: NW Natural / Colleen M. O'Brien Application Accepted By:
Address. NW 2nd Av Revised 3/4/09
City /State: Portland OR Zip: 97209 Xy/� ! 7 ( 23p p
Primary Contact: - REQUIRED SUBMITTAL INFORMATION
Phone: 226 -4211 X 4347 Fax: 503- 273 -4822
Contractor's Name: Clark / NWN Submit a scaled sketch of the
proposed work to be done
CCB# Expiration:
Address:
City /State: Zip: Professional Engineered Plans are
required for:
Phone: Fax:
• Street Widening
NW Natural (Richard Patterson) • Subdivision Infrastructure
Plans By: • Main utility line extension:
Address: as above
City /State: Zip:
Phone: Fax:
Description of work: Installing 1 "(P) svc, to be installed off of 1 "(W)
main on W 10' of Cascade Blvd, using bore and john deer, flaggers
Estimated value of work (within the public right -of -way): $$300.00
•
Is work related to a LAND -USE DECISION? YES I NO
If so, please specify (MLP, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? YES I I 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..aocu is anc sen,ngs\wwnaasawPUOW po,mX appOcatgn.cocx
14 )cvti IV /l)
,- N., — a
N \ _
1 • , DAK d ST. .
. N \ Fie
Q W ' J
C i s
♦ / ♦ \ I g
\ S
, ., ,
, , ,...., .
1 , . ,
i. W ,. _ .... �(
/ N S. \
rit , ( `—t-- -- --.. ,\
a
\
^ a � t> a � '''\ r 0� a w Yf 7I �.
\III Ir `� dla N
-4. . t .... .
.. .„., 1 5 r„a a 5 SHADY IN - — - — — _ _ _
.E -m. 7 £ t\;.... o- e '1 e d \
E - :- F N. 1 ot e
9 war or .vs
� BIVD. =Z. u it . r
F m a ' $a @ y
•iur.P `
4
§ Q O' 9 CREEK
y � , P r
F a 0
o N. P
•r�
NW Natural PLAT: 1- 041 -019 COUNTY: WASHINGTON 'C 05/04/12 08:19
(503)226 -4211 TOWNSHIP: T01 S RANGE: R01 W SECTION: 35NW SCALE: 1 IN = 177 FT USER ID: rep
"^ ° ti`" °* ' ° '°` ^' - s..� r + k.�'`� ; 3 5; ": . " } s^K 1,'"}, . . ,•r�; >eg7!' a> K 1 }� )p ,,,.,.
I ° sk ® r44 ;^ r `:y. « } ..' 5. ` i ' x :,a, 4 'Mrr J' " ' Flat'. • s . ° ! i d [ 9 '.W , - F,4 ) 0' •M{a.
' ° , ' r Fc:.. 1 ,r �' t t .sl tp J�! • ' j �.s i ! ; 7 a� , e a. �- ' t� + *v.,.x y, 11,4 )0'3 + -C.
- ..'i .'•, ; • , �8 : i i:,s -1, ' t c '?3{ , ""5 +, ,. _ i ,i i . . - +. ky i t . ra _.� As..r° °I r-4:4 C :c `s r,`'• R �
' ,..' -: .J.,- ....' t X� .j ...,:,..4=,..4,-....,..,I,,,-,r,;, <q< ;1 ;"' S.fT �{ 1 • { s t4F . +s 1 , , - : i 9 ° F v .. •• . , , ' L F F • c •
` '.s i.,'+ } . ? e � 4 -'. K . -'` T i 1'' r f �. ' d, r Y r'�r' -' �9:
j >. ,lf j • 'u y'. 'r i, „ al ix t ,,- , .r ,.f-,.t_.` -' n > y . ti +e�'Z A+ � *-, t 4.7, , . �•'+ L. 4,t• : t, T rj ` ,�
+ ; +r w t� s' t } ,�,,,,, «� t "�F. M1 "'"' , 'r ,t � ° � .. '�+ � � t� ','.7``�' 3 ,r� - t om gryyti t s .s r.° �,z +g +r� t °. ° �
.. r ' • k r► - . . • - ,,,t, ' . - i �j �. ' i 4 t t l {' ` . 5" d7 r .;.'tn. T .. !-' ,. rid. f " t i :L: a s ` , n '"
,�,]��, � { 'l I' � � ���,� sR "� . J ' � " a o , L � !!!z'j f y ,. ,� � °+ . rf'ifrt,,. ` .�s '# � ri .; ..^')..
7c... J pp� ' -4 1 .1L� " . ,x t k )} ` �' .m,....-ri -..5,,,-.,-..4.1....:i f k a �ti. z t +' x c;4.±°`. t :. - e", a
sx ..i,'A y � tt� � "�,:' rl t`•l' y f e ++. a t '�` t ..+� J• 7 4`r� - .r>.. i' �a l'4 y " ?. '-:r .. 7 ",� .
�h'* ...4V.,: ' ' � il � :- ,''j-. ^ . ti$e 1— t°-'424 '4' /"C:1 � 4 S J e s y rl ?Of -L3+ V : 4 4 . •4.�r . d » ke r .4 '� *„ t '?a '2,c
44'''''' 1 Sl I t s.7. 7 b' ' ! ttr-:,,:c.4 . t -, r s t,', ',1', i afh"t }r; ?Off-, L v t" i P{ • "', ° �
` � x e+-i �t � � "rt*. '�'Y }t � ti � ,J - Li � ! � s 1 i r ,171'•;;)",4•'=''' d + � 4;,,-;:'.7.Z''4:1 � . L'fr M1x�x1" kM1R � i�4 J ' � Kf . 1 ' °l ✓ Pa 1,f"
4 s 7 { r it C 7 S F 2/'�� + *.
• '..'",• s >,-.R.,,,-`-- t w� + w r i :1 4 + . . n k r f '
Fc " i ... g L F s 't at I _ tr . ' — T S ! r � . � Q i a � . S �i �'i:+i3+:..K• .K " `"�Q :. :
.. -7, • - , i
�� t e r . i i t•
%t • � r ' ' Z 4 , `,.i.4..,:,...";",„:,..;•,.'„,:,,,,:,!.:4,_. rsf .` f trt ,. Diversion into a Cont
2 W m
. Left Turn Lane
� v . s � Xa ; • ` i .. r Iv
4 .. S4 !RS^ r �l� MsY f _ S. �wi _
y t S a;+l �i r F ti r+0. co-
r f '1 i t, r" A a •• '�
.,,;?-&.:e . '''i{ it
_ `` • ICI
�5 t JA � � g { . :j
20 :" S° <+ � r a4 4. ' � B j t
f
r ! rf r� y
4 t 47- .. }.
Yet • 2
•'..• 'A.:A.4 gP.A`v.11,k.:1-;% - •;1.;;:.: r - * - CENTEF>
.)'‘.44/.:ikti•?I'' ‘ 1 ,4 ' ' ' ' . 0;1 ' g r;S 1. ', .1 4
f 4 Arm i I. 1 t '', ti
xl t ° v s!
ci !
t • {, Fn a a t- at .
, d� Icy h r a4 wf ' v
. .
.� "ffM1M1 Y 5 S
1 I
• ,
r 4 Y� { 1t
L/2
� q y `H �* r 2-I.- �. ! y f T , Y ' ° I r Posted Sign
. '"4` ,�,, l
. r1 i - ��,rr } • Speed Spacing (ft) Butler
..1a ‘4. �jt4 4 ^6 t f4.a , iirir i ; s • (mph) A B (5) s
S• i! ) 30 50 - C
R t .- l ti✓•V," v <ti M I or less 100 100 100
s�*i • : ! a 35.40 350 350 250
� " rp Syr • 4` , r - . t w j ,, t 45.55 500 500 350 1
+ v s
,�Y. r S r \, { �5�; ?"Zt i' '" I1
+� '` e}t��lt 'Y k
Bu ffer
a S t+7‘,4. _ I II
.
�b �S , ' .�..y t S r III :i
,,, r
^l9.. "..f t F 7 S A I {
...
� i 2 i , ry .
N
lit s,'134� ° 1 v i
' 7e4. 3 . : q r l
, ; . f 1 ,, , (Optional Taper)
1. p. ° Jk°Lt .. /' + t y t d ...
• • 'S. ' t t rrf r � 1' L /2 I A
d�j #t f 4 r •
eta t�}� } ` r .1 • 1 .
� f tt Y ,, �� yZT
f f : v r i q f _ • ,
47't f ` ia >•1 ' i • I t B 1E i •
t S 1 :- r f / � �
- ROAD
` } Diagram No. 430 I EA r
i r + • F u .C
81 t
• i ' '4r» i3i>rfi . t ,
U47 t � r RRS. � 'ar x.aa+radr " 1, `rla a*dt
Yq
CITY OF TIGARD RIGHT OF WAY PERMIT
f * ' COMMUNITY DEVELOPMENT Permit #: ROW2012 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 06/07/2012
-i
Parcel: SEG406
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: In front of 10685 Greenburg Rd. (facing Cascade Blvd.), installing 1 "(P) svc, to be installed off of 1"(\N)
main on W 10' of Cascade Blvd., using bore and john deer, flaggers. 4133 6/004
Owner: FEES
Description Date Amount
ROW Permit Fee 06/07/2012 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
COLLEEN O'BRIEN
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503 - 226 -4211
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: /
Issued By:
Special Conditions (See Attached)
Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2012 -00052
Type: Condition Name: Status: Severity:
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 Kenny Fisher, at 503 -816 -6146 or email at
kenny @tigard -or 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.
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.
APPLICATION FOR 11 1 1
WORK IN RIGHT -OF -WAY (ROW) PERMIT f
TIARD
Development Engineering
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):
SW Greenburg Rd LI a.6 Case No.: K; @� C 6"Z --C) C) 5 2_
#3361009 Receipt No.:
Date:
`Applicant's Name: Natural / Colleen M. O'Brien Application Accepted By:
Address: NW 2nd Av Revised 3/4/09
Portland OR 972 1 o O
City/State: Zip: 6. 7 • ! 2 t� -'—'
Primary Contact: REQUIRED SUBMITTAL INFORMATION
Phone: 226 -4211 X 4347 Fax : 503- 273 -4822
Contractor's Name : Loy Clark / NWN Submit a scaled sketch of the
proposed work to be done
CCB# Expiration:
Address:
Professional Engineered Plans are
City /State: Zip: required for:
Phone: Fax:
• Street Widening
NW Natural (Richard Patterson) • Subdivision Infrastructure
Plans By: • Main utility line extension:
Address : same as above
City/State: Zip:
Phone: Fax:
Description of work: Installing 1 "(P) svc, to be installed off of 1 "(W)
main on W 10' of Cascade Blvd, using bore and john deer, flaggers
Estimated value of work (within the public right -of -way): $$300.00
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 0
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:ldocuments and sedmgsloeMAdeskapVow perms appeatan.docx
14) TVWD
e
\ \ / \ \ u n III
N OAK �t ST a
I
. \ I »r � \
e
�a1 �9 N.
/�
N. / \..... \
8 -i. •
75 ` \
..* --*- _ _____ _...) ,-----...,,
,� N.
.. �` q 1 d ,,.
ri 1 -- -i— / --- -...., N. .:‘ \
a. q e r a y,,,.,,y €€
..4 r
;; b t , r # •� # s SHADY W. — - — - — — _ _ —
E ? 4 WD
0° CAS ;ADE a `Q a I 9 t. _
E x y
E Biva wn""
e
w arm °f rEQ eL •
w .p I
r y •m+ a
♦ g}}g
N ! b
4 t 4-O 9 CREEK
9 ' ^+ 1
NW Natural PLAT: 1- 041 -019 COUNTY: WASHINGTON
-Cr 05/04/12 08:19
(503)226 -4211 TOWNSHIP: T01S RANGE: R01W SECTION: 35NW SCALE: 1 IN = 177 FT USER ID: r:p
4
(
tinuou
i
Diversion into a Con
•
2 -Way Left Turn Lane
ROAD K , •
WO RN
` AHEAD
B I1 1
•
•
l y
.
cEN1e i
NEE I I .
CLOSED
"gt AHEAD
55,s
A
I I -
7
1
U
2 •
Posted Sign
• Speed Spacing (fl) Buffer
•
or less (mph) A 8 (
" . I 30 100 100 50- tt
100
35 -4 35 0 360 250
i
45 -55 500 500 350 t
Buffer s
I d 'k
,u,
.. � I 1 - 1
1.
:
• -
' U2 ,,
(Optional Taper) I I • r
4
•
U2 I A
{t
. „
•
sue:. t �� S de r s,
l 1 B
' �_ ROAD
Diagram No. 430 I WOR
81 ■
, , ..., ,. i 7...7:::.. , : I
__ W.. �.x ,d, r .- > .,,_ • . •,
. ,.. . . .
| ^
I a-
35 B040 C
\S S 00 .
•
�x ~ .�
`
3. :/
10770
Feel
63
. \
immmimmoommil
�5en � u \ "�