ROW2014-00061 CITY OF TIGARD RIGHT OF WAY PERMIT
IN COMMUNITY DEVELOPMENT Permit#: ROW2014-00061
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/05/2014
Parcel: SEG3571
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Adjacent to 11400 SW Fonner Street. Install 42'2"(p)main to tie into existing 1"(w)main. Main on the
12'from GI in ROW.4 x 5 street cut, hole hog. SEG 3571
Owner: FEES
Description Date Amount
ROW Permit Fee 06/05/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
LORENE NICHOLS
220 NW 2ND AVE
PORTLAND 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 f714 pr ,
Signature: 1,T- rlJ1
Issued By: tyta 41611014--
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2014-00061
Type: Condition Name: Status: 122.21A LL
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<name>, at<phone#>or email at<email address>,
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.
RECEIVED
JUN 0 4 2.014
71 City of Tigard CITY OF TIGARD
n PLANNING/ENGINEERING
- Application for Work in the Right-O f Way
TI ARD ROW Permit
Property Address/Location(s):SW Fortner ST (1 11. 00) FOR STAFF USE ONLY
5 '5"�(s -' Right-of-Wayj__, ,1
Case No.: 1"V'V "- 1
*Applicant's Name:NW Natural Application Accepted:014 By:lie--
e--
Address:220 NW 2nd Ave
Portland OR 97209 Application Reviewed:t' 4- "ltiy;�AR
city/stare, "zip:
Lorene Nichols $300.00 Application Fee Due: Yes pi No
I rtman Contact: _
503-226-4211 x4372 503-273-4822 Applicant Notified: ��
Phone: Fax: �/ O IP
Email:
eln@nwnatural.com
Receipt No.: AO
REQUIRED SUBMITTAL
Loy Clark/Wanda Taylor INFORMATION Contractor's Name:
CCI3#52281 Expiration:
PO Box 1369 • Application form,completed and signed
Address: • Submit one(1)copy of scaled sketch of
City/State:Tualatin OR Zip:97062 _ the proposed work to be done
Phone:503-783-1171 Fax: • Submit one(1)copy of traffic control
waa clark.com plats
Fn�aiL ndt to� Y
Professional Engineered Plans arc required
Plans By:NW Natural-same as above for.
Address: • Street Widening
City/Stare: Zip: • Subdivision Infrastructure
phony. F ax: • Main utility line extension
Email: t:euepin\nustcrs\hn4 tm opp.catios \R.w opp.docs I Rev.7;i" :
Description of work:install 42'2"(p)main to tie in to existing 1" (w)main!Main on the 12'from c/I in ROW/4x5 street cut
/hole hog/Project 00013543
Estimated value of work(within the public right-of-way): $2.50 x 42'=105
Is work related to a LAND-USE DECISION? YES U NO i
If so, please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES l NO 14
If so, please specify(BUILDING PERMIT)cas .
Signature of Applicant/Pennittee R V, ./ . Date:06/04/14
Print Name:Lorene Nichols Tide:Engineering Coordinator
CIt1 otTigard 1 13125 '\C" h hall lilvd.."I'tgarcl, OR')-223 1 503-,18-'_'lfrl I «ticvr tig:0d-nr )c
CROSS SECTIONS GENERAL NOTES N 5 ' 6 -"
I Call the following I Ielmes Notification Centel 612709 .4
8' 18 � 8' ex hours fetm to any MAYnhm. W(EE) pat
rregon 811+r 1.800012--2144 W E 1„ W• °
y' 9' Waahmgton 811 or I-IICO.424.5535 =$ Cr Ma ie rE ft ih 1•
4-- —► 2 A fTENTION.Oregon law recur.you to follow e'. ) '�
C L J tales adopted by the Oregon Uttllh Notification ' I I —
W a W Center Thou rules are ad forth m OAR 952.001- I I �——— J
7 p B B 6 0090.You moo obtain maples of the Meshy calling I 1 4 t� / d
ll a the center.(Note.the telephone number for the Oregon • i't
Iltdtts Notification Center is(503)232-1987 to 8I1) CO 012753
H2731
X C I Fill out consDwchon sketch as-bmlt supplied wtlh (� (931 ,_PO)
O 2' doh packet and return with work order Orin one 1 ` .7 (5S1 •1AS I-
awhoathHteyDtred INSTALL: "TI (e\POT( 3 fh
W/S PRIVATE DRIVE EIS 4 All dtxnMnton maims must have ammtmum depth of I sin.
24'and aeRteea moat hove.minimum depth of 18 0 TF w/LW 8 TL I — 2 775 $
unless there to n swum. i 8 1134 jai g^.
5 All transmnnon lines must have•minimum depth of O 1#Anode ss I I __— Ia
Tn'm Clam'I'locations and 36'no Class 2,:,&A R •
CALL SEVEN DAYS PRIOR TO START OF DRY UTILITY TRENCH loo.tiona.unless there a an approved variance 1 (P) CO
CALL FOUR DAYS PRIOR TO SHADING TO SET INSPECTION DATE 6tk-ntten dtniennom on thus nmAructian sketch 1 1 _—�.
CONTACT DAN SIMONE*503.706.0159 have precedence over scaled dimennons
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7 Fteasurn test shall he tested in accordance with I A MI 7
ALL DEPTHS MEASUR ED FROM FINAL GRADE I '
standards m and d Enginemg Standard Pi aauc
ROAD b '
' FIELD R Teat medium for class'5'main shall be au.unless F.3 1 +
SIDE MIN I ,SIDE otherwise noted Test medium for class"C-F"muu — _ LW
shall h r.e wate unless otherwise noted -t'i� �1 U_ — _
/ i//////// N For(:lass('or Mgher teas.see Design Dsx;ummt and R-1•lwh'63 G— 0i42;
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MEASURED ``% P f•' g a'• Y.I it e!Y
FROM
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PROPOSED 0 3,
FINAL •
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GRADE f CONT•OLLta ', ~
12"REC. BACKFILL , V¢
(6'MIN.) ,/' (SAND OR ROCK-i ' Cr : S
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TRENCH REQUIREMENTS '
FOR JOINT UTILITY USE 12'-01
MAIN EXTENSION INSTALL:
Q LW
WELDS VARIANCE(s)
%X- CERT. OPER. PM PM v....(o P.+
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY 0 ORDER S -
INSTALL 42. 2' P B P24 .216 60 57 45 710 03412799 Roman N1
INSTALL 146. 2' P B P24 .216 50 57 45 710 03412800 on*rl.n.han(N.,):
Award Nan.. ISion.M. I D.
tl NW Natural
0 50 '°°
�Feet Class"B" PRESSURE TEST INFORMATION (drde&label test area on as -built drawing)
Engineering Department 1in=100ft Test byNNG —Other
ADDRESS CITY COUNTY STATE DESIGNED BMK DAME 05/21Q014 ANN We by s�• nom.. Dos GO T... LNG T.. T.t Rat LA....M.a
SW FONNER ST TIGARD WASHINGTON OR DRAWN KDC DATE 060173,2014 A
BETWEEN AND --
SW 113TH PL APPROVED BMK 00TE 06AH2O14 B
NAME CREW LDP. DATE
C
BEAN PARTITION
ON PTTED DATE D -
PLAT 1010 RLw SEC PIPELINE ID- NEW CONSTRUCTION MAINS E
1-043-018 TO2S RO1W NE 3
03412799 00013543 F
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