PFI2018-00194 VOIDED
PF12018 00194
Nw NATURAL
V /Y
0
City of Tigard e COMMUNITY 1)1,.V EI,OI ML.N1' DEI AR'I'MENT
Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • \V<v-\v.tigar�gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigard-or.gov
FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
❑ 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-n 2.-U [S — w tciy'
Site Address or Parcel #:
Project Name: 1� 1�1/1M
Subdivision Name: Lot#:
EXPLANATION:
Signature: ACA= Date:
Print Name:
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of.
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE, ONLY
Route to Sys Admin: Date By Route to Records: Date / B
Refund Processed: Date /y f� B Invoice Processed: Date B
Permit Canceled: Date BParcel Tag Added: Date B
1:\Building\Forms\RcgPcrmitAction_ 92314.doc
Agnes Lindor
From: Agnes Lindor
Sent: Thursday, July 26, 2018 12:23 PM
To: Forge, Jamison; ROW Permits
Subject: RE: RETRACT: NW Natural Application for ROW Permit WO#3547398
I found the permit (PF12018-00194), and will go ahead and cancel it. Thanks,
Agnes Lindor Associate Planner
City of Tigard Community Development
13125 SW Hall Boulevard
Tigard, Oregon 97223
Phone: 503.718.2429
Email: AgnesL@turd-or.gov
From:Agnes Lindor
Sent:Thursday,July 26, 2018 12:05 PM
To: Forge,Jamison <Jamison.Forge@nwnatural.com>; ROW Permits<rowpermits@tigard-or.gov>
Subject: RE: RETRACT: NW Natural Application for ROW Permit WO#3547398
What is the permit number? I will cancel the permit.
Thanks,
Agnes Lindor I Associate Planner
City of Tigard J Community Development
13125 SW Hall Boulevard
Tigard, Oregon 97223
Phone: 503.718.2429
Email: A$nesL@tigard-or.gov
From: Forge,Jamison [mailto:Jamison.Forge@nwnaturaLcom]
Sent:Thursday,July 26, 2018 11:58 AM
To: ROW Permits<rowpermits@tigard-or.gov>
Subject: RETRACT: NW Natural Application for ROW Permit WO#3547398
Good morning!
My engineer just informed me that the conflict with this storm facility has been resolved and permit is
no longer needed. Please cancel processing. Thank you!
9000 SW Durham Rd- Tigard HS
Thank you,
Jamison Forge
NW Natural—Technical Coordinator
503.226.4211 x4542 I nwnatural.com
1
From: Forge, Jamison
Sent: Tuesday, July 24, 2018 7:49 AM
To: 'ROWpermits@tigard-or.gov'
Subject: NW Natural Application for ROW Permit WO#3547398
Please see attached for ROW permit application. Thank you!
Thank you,
Jamison Forge
NW Natural—Technical Coordinator
503.226.4211 x4542 I nwnatural.com
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
V !*) RECEIVED
�, `� J U L 2 4 018
City of Tigard 2
.'� PUBLIC WORKS — ENGINEERING CITY C.`�=' '�GAl?n
z °fin PLAN N1NG/*L:'�i 3.!iEERING
Public Facility Improvement (PFI) Permit
an:.: ..sae..w.ryylv... ... yw:is mY.'^"^�Ls^3'."^H"- Fe•ww=�
}. �1..}"AY.' _."�� " .iur1"�.SLss�'e.1u..:�}`.,sa•e ati�'.Lraa`..4w'rauuwrY... - _. _ -.w.�,.W. <1"�'4,m..�l" :.ro-...r..e'+..:t.... ..»
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
✓❑ TYPE 1—Franchise Utility Work
Check one: 0 Utilities ❑Sidewalk/driveway approach ®Street improvements performed by NWNT, PGE
Detailed description: Replace/Lower 10'of 1"steel gas main for storm anutility agency.
water facility install ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose ot:
- Sidewalk installation or repair.
• Dciveway approach installation
Property address/location(s): Tigard High School and/or repair
9000 SW Durham RoadC67 f7 - Sanitary sewer lateral installation
and/or main line tap
Applicant. NW Natural ❑ TYPE 3—Full scale Development
pp Work performed with Land use
Address: 220 NW 2nd Ave approval which includes any of
City/state: Portland,OR Zip: 97209 the following:
Phone: 503-226-4211 Email: Jamison.Forge@NWNatural.com - Subdivisions or Partitions
Contact name: Jamison Forge Phone: 503-226-4211x4344 • Street widening
- Mainline installation for Sanitary
sewer, Storm sewer,Tigard water
Contractor: and/or Tigard Water Service Area
CCB#: Expiration:
.address: SUBMIT COMPLETED APPLICATION TO:
City/state: Lip: City of Tigard
Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: Rich Girard ro=crmits@tigard-or.gov
Address:
FOR s,rAFF USE ONLY
City/state: Zip:
Phone: 503-226-4211x22967 Etnail: R2G@NWNatural.com Case No.: IZ Za
Contact name: Rich Girard Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000): 250 Additional fees: $
(within the public right-of-way) Application accepted:
: .J�..,
Is work related to a LAND-USE DECISION? ❑ Yes 0 No iiyDate:
If so,please specify (NILI?SDR,SUB, etc.) case #: Application reviewed:
By: Date•
Is work related to a BUILDING PERMIT? ❑ Yes 0 No Applicant notified:
If so,please specify(BUILDING PERNII I�case#: By: Date:
I:\ENG�Perm3tAppkitions\pfl application Rev.IQ/16/2D17
City ofTigard 13125 SW Hall Blvd. - Tigard,Oregon 97223 - -vwwtigard-or.gov - 503-718-2421 • Page 1 of4
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
k With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when 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. franchised
Utilities are not required to obtain the owners signtature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or itnposed upon the subject
pro er .
• 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 and the statements in any 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.
07/24/2018
applicant/.iluthori Agent's`.ignature Print name Date
SIGNATURES of each owner of the subject property, if required.
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityo/Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of4
2011 Edition Page 107
Diversion into a Continuous Left Turn Lane Diagram 430
ROAD
WORK 1+1
AHEAD
Ihl
I y t
CENTER
LADE
CLOSED
AHM
A
II
U2 I • I
Buffer
Protection Vehicle
wrrMA(both Optional)
See Chapter 4
Buffer
•
• U2
I •
U2 I • I A
II
lht B
ROAD
WORK
AHEAD
December 2011 Chapter 5
Page 106 2011 Edition
Diversion into a Continuous Left Turn Lane Diagram 430
Diagram 430 shows work in the travel lane(s) next to a continuous two-way
left turn lane with one direction of traffic diverted into the continuous two-way
left turn lane.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3— Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. When two or more travel lanes are reduced to a single lane before the
diversion, each lane shall be closed separately. Layout traffic control
according to ODOT Standard Drawing TM 852 for 5-lane sections.
4. A shifting taper(L/2) may be added in the diverted traffic direction
across the continuous two-way left turn lane (as shown). This option is
recommended when the speed is 45 mph or greater.
Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs Buffer
Speed A B C Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
CROSS SECTIONS GENERAL NOTES N
90, 1.Call the following Utilities Notification Center
48 hours prior to any excavation: _—L
,nl C
Oregon: 811 or 1-800-332-2344 V V C
Washington: 811 or 1-800-424-5555
J 22r
22.5 22.518.5 14.5' J.410-40, CL 2.ATTENTION:Oregon law requires you to follow
a d3 .D �� rules adopted by the Oregon Utility Notification S
II�
O M I M C I M 1 O> 1 O Center.Those rules are set forth in OAR 952-001-
0 -C L O 'a 0090.You may obtain copies of the rules by calling
E W B B 1W C E the center.(Note:the telephone number for the Oregon
ifi i Center i 2 2-198 or 811 .
Utility Notification on Ce to s(503) 3 7 )
3.Fill out construction sketch as-built supplied with UW
job packet and return with work order. Only one
as-built is required. = Q
00
23' EX. MAIN-*0 '40-- 4.All distribution mains must have a minimum depth of �
24"and services must have a minimum depth of 18" QO F—
$/$ SW DURHAM R D N/S unless there is an approved variance. 2' N co
5.All transmission lines must have a minimum depth of
00
30"in Class'1'locations and 36"in Class'2,3,&4'
locations,unless there is an approved variance. 12'
VARIANCES 6.Written dimensions on this construction sketch c i—' 0'
Variance s made: ` have precedence over scaled dimensions. 10 314"(W)'56
1 ) 7.Pressure test shall be tested in accordance with
standards in CFM and Engineering Standard Practice.
Reason(s): 8.Test medium for class"B"main shall be air,unless -
otherwise noted. Test medium for class"C-F"main +
Mitigation taken (if any): shall be water,unless otherwise noted. + R 1-(W)'82SW DURHAM RD
9.For Class C or higher tests,see Design Document and / + — —
Hydrostatic Report. i 1 I COv
Approval Nam �
e sigrue: Date:
/ I �' o 0 1
o 1
LOWER 10'- 1"(W) MAIN FOR -
Class B PRESSURE TEST INFORMATION(circle &label test area on as-built drawing) STORM WATER FACILITY c 1
Test by N N G— Other �; a 1
Test Pipe Steel- Pipe Test ON OFF PauI UJ
Area Size Poly Footage Pressure Date Time Date Time YM Gauge 0 Print Name and Initial I J
I 0
A 117'1 00^ 114' o a
th N o
co
B 150' (W) 00
C AUDITORIUM
D 1�9
E
F "
o
13
o-- 280' 1
KITCHEN 1"(P) 1
vi
o =
o � 10
787' ~ 1
Order Street Description Plat number Costing Pipe size Type 3 1
3547398 9000 SW Durham Road Replace/Lower 1"(W) main for Storm Water Facility 1-047-020 Z114 S-0100 SM04 o N
(W) 1'(W)'97 8 LW u, 05'
SHOP _
0 50 100 � 19-4
220 o
NW Natural Feet � �
Engineering Department 1 in = 100 ft �� i
ADDRESS CITY COUNTY STATE DESIGNED KDB DATE 07/20/201 160'1 1•�w)'s7 87'
9000 SW DURHAM RD TIGARD WASHINGTON OR DRAWN KDC DATE 07/23/201
BETWEEN AND
APPROVED R2G DATE 07/23/201
SW 92ND AVE
NAME CREW LDR. DATE
TIGARD HS STORM FACILITY LOWERING PLATTED DATE
PLAT TWN RNG SEC PIPELINE ID- JOB TYPE:
1-047-020 T02S R01 W NE 14 PUBLIC WORK MAINS
PM N: PROJECT/REVISION*
03547398 00022144