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ROW2012-00062 i T IGARD City of Tigard December 6, 2012 Fisk Communication Attn: John Hall 2705 NE 65`'' Ave. Vancouver, WA 98661 Re: Permit No. ROW2012 -00062 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: SEG1966 - Adjacent to 14735 SW 84 Ct. Project Name: Comcast Job No.: Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $240.00. 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 $ Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees. 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 City of Tigard Tca><n Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Fisk Communications Contracting DATE: 12/3/2012 Attn: John Hall 2705 NE 65c Ave. REQUESTED BY: Dianna Howse Vancouver, WA 98661 Tim Lehrbach TRANSACTION INFORMATION: Receipt #: 187472 Case #: ROW2012 -00062 Date: 7/10/12 Address /Parcel: SEG1966 Adjacent to 14735 SW 84 Ct. Pay Method: cxez, T ci/2.6 Project Name: Comcast EXPLANATION: Per applicant's request as job was canceled. Refund 80% of permit 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 $240.00 TOTAL REFUND: $240.00 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ' FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY - . : Case Refund Processed: Date: s. By: 1: \ Building \ Refunds \RefundRcquest.doc s 09/01/2011 C/ City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT : r Request Permit Action fap,//P- T 1 G n 1. 1) 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 CA City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL /VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). fl INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). n REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: ROW 2.012 -- 00062_ Site Address or Parcel #: SEG \ 66 arkiace,n+ +0 14 SW ( 64-4 CA Project Name: Comcas-\- Subdivision Name: Lot #: EXPLANATION: Appli card- c nd coni-rooth 1nTOr uS - E - hak - the, job Was C.a+n r.P,kela . See . Signature: 0 / Date: 1 0 I / 5 Print Name: i..ehr 1 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 thanof the land use application fee when an application is withdrawn or canceled before any review effort has been expended. not more thailf 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 Sys Admin: Date By Rte tt' Admin: Date 4,1 4- By� ��m��`"' ,6 4 ,r 300 ' O Refund Processed: Date B .Q14 Invoice Processed: Date B (f % Permit Canceled: Date .TATAIII B IMA,9 arcel Ta • Added: Date B Receipt # Date Method Amount $ 1:\ Building \ Forms \RegPermitAction.doc Rev 05/25/2012 g �Yt7 Tim Lehrbach From: Kenny Fisher Sent: Thursday, October 25, 2012 8:00 AM To: Tim Lehrbach Subject: FW: Right of Way permits From: Fisk Communications [mailto:fcclocates@comcast.net] Sent: Wednesday, October 24, 2012 4:16 PM To: Kenny Fisher Cc: Sarah office; Catherine Subject: Re: Right of Way permits Kenny, Here is the updates for these permits: 1) Permit # ROW2012 -00080 at 9365 SW View Terr....this job is still pending, will be routing next week. We had many issues with the neighbors and sub on direction and set up. 2) Permit #2012 -00062 at 14735 SW 84` Ct....this job was canceled on 7/16 3) Permit #2012 -00025 at 10275 SW Hoodview Dr....This job was completed on 6/5 I will look into the other job with the sw issues and get up an update on the repairs. Thanks John Hall FISK Communication Contracting Inc. From: fccsteve(c�comcast.net To: "Kenny Fisher" <Kenny(a�tigard- or.gov >, fccoffice(a�comcast.net, fcclocates(c�comcast.net Sent: Tuesday, October 23, 2012 5:54:12 PM Subject: Re: Right of Way permits Could.one of you respond to this. Sent from my Motorola Smartphone on the Now Network from Sprint! Original message From: Kenny Fisher <Kennv(tigard- or.gov> To: "'Steven Loy (fccsteve @comcast.net) "' <fccsteve @comcast.net> Sent: Tue, Oct 23, 2012 23:09:41 GMT +00:00 Subject: Right of Way permits Hello Steve, I am once again updating the Right of Way permits within Tigard. These are all for Comcast. Is there a way to get whomever heads up these projects to call myself at 503 - 816 -6146 (KennyPtigard- or.gov) or Zen Dutson at 503 - 718 -2472 (zen@tigard-or.gov). This is stated on the permit conditions. Thank You for any help you can give me. Can you update me on the status of these projects in Tigard? Also ROW2012 -00020 between 9790 and 9810 was performed around April. There is still a coring in the sidewalk that needs to have the cold mix removed and the core filled with concrete. Thanks. DISCLAIMER: E -mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 CITY OF TIGARD RIGHT OF WAY PERMIT IN II COMMUNITY DEVELOPMENT Permit #: ROW2012 -00062 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 07/10/2012 Parcel: SEG1966 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 14735 SW 84th Ct. - directional drill from the east side of SW 84th Ct. at property line of 14750 & 14730 going west to property line of 14755 & 14733 to CATV pedestal placing 2 inch schedule 80 pipe with CAN service wire. Owner: FEES Description Date Amount ROW Permit Fee 07/10/2012 $300.00 PHONE: c errxco ecil il Contractor: \ PHONE: s1 cL FAX: Applicant: RANDY SHIELDS 14200 SW BRIGADOON CT. BEAVERTON, OR 97005 PHONE: 360- 828 -3547 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. tt licant Sign �(Z Signature: ure: Issued By: e4 Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY APPLICATION FOR A ., WORK IN RIGHT -OF -WAY (ROW) PERMIT n Development Engineering �" `�` 13125 SWV Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 624 -0752 FOR STAFF USE ONLY General Information: Right -of -Way t� �, Property Address /Location(s): 14735 SW 84th Ct Case No.: R Wuc 00 -boo& Receipt No.: Date: 7 " S - /< *Applicant's Name: COMCAST Application Accepted By: Address: 14200 SW BRIGADOON CT Revised 3/4/09 rc.vd 191 C •I (4.(p f is City /State: BEAVERTON, OR Zi 97005 Af0 7■• it 4 3.00 Primary Contact: Randy Shields REQUIRED SUBMITTAL INFORMATION Phone: 360- 828 -3547 Fax: Contractor's Name: FISK COMMUNICATIONS CONTRACTING Submit a scaled sketch of the 185632 2/24/2011 proposed work to be done CCB# Expiration: Address: 2705 NE 65th Ave City /State: VANCOUVER, WA Zip 98661 Professional Engineered Plans are 360- 314 -4454 360- 314 -4456 required for: Phone: Fax: • Street Widening • Subdivision Infrastructure Plans By: • Main utility line extension: Address: City /State: Zip: Phone: Fax: Description of work: Directional drill from the East side of SW 84th Ct at property line of 14750 & 14730 going West to property line of 14755 & 14733 to CATV pedestal p acing ' sc e.0 e 80 pipe wit •Ti service wire. Estimated value of work (within the public right -of -way): $ $385.00 x 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 n NO F- If so, please specify (BUILDING PERMIT) case #: I *NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide financial assurance for the work. i:feng'sike_mccwght of weyVow permit appho hon.d000 Conditions for ROW2012 -00062 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 Kenney Fisher, at 503 - 816 -6146 or email at kenny @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. 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. 57Ye€r 3 Row !b' APPro c 011 36" A Ale4-6c1 - 4 we 4-1a nG (L17 5 H733 36' IoW '1b 5buTkr, Cur Sw vvtvr Dack 5 f-- -)I 3g l , �' -- 5 w $ y Cf -- Ped �--� Cupt, - - Row — -- — — — y � Sty l X175' 11 173 0 Fisk Communications Contracting Inc. 360 -314 -4454 0 BEAV 0335 Beaverton 131 Issue Date Job # House Si Address Pending Permit Commercial Node Instructions 04/30/12 262189 14735 SW 84th Ct, 97224 No Yes No TG18C Road bore, SW bore Call 1st OM 1 phfl 2 Name Drawn by Locate Info/Thomas Guide Cross Street & Distance Yes (503) 639 -9402 - Elliott, Pamela R &M C53 (-4 Sw MuttDoCk sr Bore footage Drop status Drop lengh City / Municipality Reason for call 1st: Extra notes: NEEDS DROP BURY W /SIDEWALK AND STREET 7/G AILD /./AA.0 <` rev BORE 150FT DROP /DROP GOES UNDER THE HOUSE AND IS TEMPED TO THE NIEBOR SUB WOULD LIKE A` —______> TO BE CONTACTED DURING THE DROP BURY �" BECAUSE THEY HAVE A SPRINKLER SYSTEM RBD 6 $ RD2 I J '' IN �- 2 RRB 3y J 1 �I 1 55 / J 3 RDB RSB V r — / CON l FMP 3°' I y' Cutover Sw Cutover v 0 r I -- �- I Oct ----- > 3y, ai 3 iti SW N 73a • r • CITY OF TIGARD RECEIPT n k c ! :. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 .+LG Receipt Number: 187472 - 07/10/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2012 -00062 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 151780 CCAINES 07/10/2012 $300.00 Payor: Mark Fisk Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1 • y CITY OF TIGARD RIGHT OF WAY PERMIT 1 ' COMMUNITY DEVELOPMENT Permit #: ROW2012 -00062 1 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 07/10/2012 T E G.rl .4tn g Parcel: SEG1966 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 14735 SW 84th Ct. - directional drill from the east side of SW 84th Ct. at property line of 14750 & 14730 going west to property line of 14755 & 14733 to CAN pedestal placing 2 inch schedule 80 pipe with CAN service wire. Owner: FEES Description Date Amount ROW Permit Fee 07/10/2012 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 14200 SW BRIGADOON CT. BEAVERTON, OR 97005 PHONE: 360- 828 -3547 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. Signature: t plicant , Issued By: Cs- a . -�-2� Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2012 -00062 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 Kenney Fisher, at 503 - 816 -6146 or email at kenny @ tgard - 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. 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 , . GARD 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): 14735 SW 84th Ct Case No.: � � (A) O %2 -600(A Receipt No.: Date: U212 " - I *Applicant's Name: COMCAST Application Accepted By: Address: 14200 SW BRIGADOON CT Revised 3 /4/09 r c o d. b. City /State: BEAVERTON, OR Zi 97005 ,ro 7•S• /2 30es• Primary Contact: Randy Shields REQUIRED SUBMITTAL INFORMATION Phone: 360- 828 -3547 Fax: Contractor's Name: FISK COMMUNICATIONS CONTRACTING Submit a scaled sketch of the 185632 2/24/2011 proposed work to be done CCB# Expiration: Address: 2705 NE 65th Ave City /State: VANCOUVER, WA Zi 98661 Professional Engineered Plans are 360- 314 -4454 360 -314 -4456 required for: Phone: Fax: • Street Widening • Subdivision Infrastructure Plans By: • Main utility line extension: Address: City /State: Zip: Phone: Fax: Description of work: Directional drill from the East side of SW 84th Ct at property line of 14750 & 14730 going West to property line of 14755 & 14733 to CATV pedestal placing 2" schedule 80 pipe with CATV service wire. Estimated value of work (within the public right -of -way): $ $385.00 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 n NO II If so please specify (BUILDING PERMIT) case #: *NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide financial assurance for the work. i:\engMike_mcc1ight of way,ow permit appliwfion.doc • • • CITY OF TIGARD RECEIPT n g 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 187472 - 07/10/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2012 - 00062 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 151780 CCAINES 07/10/2012 $300.00 Payor: Mark Fisk Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1 • 5TYe€r 3y Row !b' APPr6x Dpert, 36" Iti7 53 / Y733 16' i r ` r te' — _ - W G _ 1O& fia 5.u-r4, 51- y 'r oack 5 r- -fir 3 � — 5 w y C f —' Raw — -- --- cp3w �- 1 /Y730 Fisk Communications Contracting Inc. 360 -314 -4454 0 - . BEAV 0335 Beaverton B1 Issue Date Job N House N Address Pending Permit Commercial Node Instructions 04/30/12 262189 14735 SW 84th Ct, 97224 No Yes No TG18C Road bore, SW bore Call 1st ON 1 ON 2 Name Drawn by Locate Info/Thomas Guide Cross Street & Distance Yes (503) 639 -9402 - Elliott, Pamela Rem 1-4 Sw ,vW( Dvck sr 4s Bore footage Drop status Drop lengh City / Municipality Reason for call 1st: Extra notes: NEEDS DROP BURY W /SIDEWALK AND STREET T /C,Ano Ap,a L Cr, - BORE 150FT DROP /DROP GOES UNDER THE HOUSE AND IS TEMPED TO THE NIEBOR SUB WOULD LIKE y -______> TO BE CONTACTED DURING THE DROP BURY � BECAUSE THEY HAVE A SPRINKLER SYSTEM RBD 6g RD2 r_—_ RRB 3 I 1 1 /973 3 RSB '/ r — CON FMP 3els • Cutover / y sw Cutover O r t 3 f at i Su, I L.I3, cb /y�734 a Cheryl Caines From: Cheryl Caines Sent: Tuesday, July 10, 2012 8:39 AM To: 'Fisk Communications' Cc: 'Steve Loy'; 'Sarah office' Subject: RE: ROW Permit application for 14735 SW 84TH CT Attachments: SPC_Permits12071007310.pdf Attached please find the approved permit and receipt for payment. Cheryl Caines Planner on Duty (503) 718 -2421 From: Fisk Communications Jmailto:fcclocates@ comcast.netl Sent: Wednesday, June 27, 2012 4:41 PM To: ROW Permits Cc: Steve Loy; Sarah office Subject: Re: ROW Permit application for 14735 SW 84TH CT City of Tigard, Please find attached a ROW permit for the above referenced address for your review and approval. Thanks, John Hall FISK Communication Contracting Inc.