Small Wireless Facility Permit Application Packet

• Small Wireless Facility Permit Application Form • Building Permit Application Form • Electrical Permit Application Form • Plumbing Permit Application Form • Engineering Application for Small Wireless Facility Only Packet • Engineering Application for Small Wireless Facility Only Project Checklist • Street Tree Permit Application Form • Street Opening Bond and Instructions

Form Revised 08/2021

Page 1

Date: Application Information (as Authorized by Owner) Applicant Name: Address:

Email: Phone: Owner Information (Owner of Small Wireless) Owner Name: Address:

Email: Phone: Contractor Information Contractor Name: Address:

Email: Phone: CCB#: Location Information ___ Private Property ___ Right-of-Way Property Owner Name (if on Private property): Email: Phone: Site Address:

Map & Tax Lot #: Zoning District: Latitude & Longitude/Coordinates: Direction & Distance from Intersection:

ACKNOWLEDGEMENTS Does the proposed facility meet the Federal Communication Commission’s (FCC) definition of small wireless facility? ____ Yes

A proposed schedule for the installation and completion of the small wireless facility is provided. Installation of an approved small wireless facility shall be completed within 365 calendar days of its approval.

____ Yes

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021

Small Wireless Facility Application

Site Development Division sitedevelopmentplansubmit@beavertonoregon.gov

Page 2

The proposal shows compliance with Beaverton Code chapter 4.15, Utility Facilities in the Public Right-of-Way. ____ Yes

The small wireless facility does not jeopardize the physical integrity or shorten the lifespan of the existing structure/pole. ____ Yes

The small wireless facility does not materially interfere with or degrade any existing public safety communications system. ____ Yes

Small wireless facilities will not create discernable vibration at adjacent property lines. ____ Yes

Odor and noise levels from the small wireless facilities will meet Oregon Department of Environmental Quality standards. ____ Yes

The small wireless facility request is for: ____ Collocation on an existing pole/structure (Substantial Change*) ____ New pole/structure** ____ Replacement of an existing pole/structure (Substantial Change*) *If the request is not a substantial change, then the proposal requires an eligible facility request only.**Includes complete replacement of a pole/structure that does not currently house a small cell facility.Application Requirements:

____ Application Form

____ Application Deposit ($3548)

____ Construction Drawings, signed and stamped by a registered Oregon engineer

____ Site Survey, signed and stamped by a registered Oregon surveyor

____ Photo Simulations

____ Project Narrative and Justification, as provided in Section 2.4, 2.6 and 2.7 and Section 3, if applicable

____ RF Compliance Report, certified by an RF engineer

____ Regulatory Authorization under Federal and Oregon law

____ Property Owner’s Authorization – if structure is located outside of ROW only

____ Other agency approval attached, such as Oregon Dept. of Transportation or Washington County, if

applicable

____ Service provider letter (SPL) from Clean Water Services

Page 3

____ Yes ____ No ____ N/A Building permit application is attached

____ Yes ____ No ____ N/A Electrical permit application is attached

____ Yes ____ No ____ N/A Plumbing permit application is attached

____ Yes ____ No ____ N/A Engineering application for small wireless facility only is attached

____ Yes ____ No ____ N/A Street Tree permit application is attached

____ An engineer’s cost estimate, per City form

____ A Performance bond is attached for value of 100% of all public asset work. *

*Insufficient value of performance bond will be cause for denial.

By my signature, I certify that I have read this application and agree that the supplied information above is correct. I agree to comply with all applicable City ordinances and State laws pertaining to the proposed construction and hereby authorize City representatives to enter upon the above property for inspection purposes. I understand and agree to pay all costs to repair or replace any property damaged while work is being performed under this permit and acknowledge that failure to pay these costs when due will constitute a violation of the terms of the permit and the City may avail itself to any and all legal remedies.

Authorized Signature: ____________________________________________ Date: _______________

Form Revised 09/2021

Building Permit Application Community Development Department, Building Division City of Beaverton 12725 SW Millikan Way / PO Box 4755

Beaverton, OR 97076

Phone: (503) 526-2403; Fax: (503) 526-2550

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www.BeavertonOregon.gov/bib

OFFICE USE ONLY

Date Received: Permit No.:

Date Issued: By:

Payment Type:

TYPE OF WORK

New construction Demolition

Addition/alteration/replacement Other:

CATEGORY OF CONSTRUCTION

1- and 2-family dwelling Commercial/industrial

Accessory building Multi-family

Master builder Other:

JOB SITE INFORMATION AND LOCATION

Job site address:

City/State/ZIP:

Suite/bldg./apt. no.: Project name:

Cross street/directions to job site:

Subdivision: Lot no.:

Tax map/parcel no.:

DESCRIPTION OF WORK

PROPERTY OWNER TENANT

Name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

APPLICANT CONTACT PERSON

Business name:

Contact name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

CONTRACTOR

Business name:

Address:

City/State/ZIP:

Phone: Fax:

CCB lic.:

REQUIRED DATA: 1- AND 2-FAMILY DWELLING

Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application.

Valuation

Number. of bedrooms:

Number of bathrooms:

Total number of floors:

New dwelling area: square feet

Garage/carport area: square feet

Covered porch area: square feet

Deck area: square feet

Other structure area: square feet

REQUIRED DATA: COMMERCIAL-USE CHECKLIST

Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application.

Valuation

Existing building area: square feet

New building area: square feet

Number of stories:

Type of construction:

Occupancy groups:

Existing:

New:

NOTICE

All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons apply:

BUILDING PERMIT FEES*

Please refer to fee schedule

Fees due upon application

Amount received

Date received:

This permit application expires if a permit is not obtained

Authorized within 180 days after it has been accepted as complete

signature:

Print name: Date: * Fee methodology set by Tri-County Building

Industry Service Board

Form B70-1001 REV 11/19

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Electrical Permit Application Community Development Department, Building Division City of Beaverton 12725 SW Millikan Way / PO Box 4755 Beaverton, OR 97076 BuildingPlanSubmit@BeavertonOregon.gov Phone: (503) 526-2403; Fax: (503) 526-2550 www.BeavertonOregon.gov/bib

OFFICE USE ONLY Date Received: Permit No.:

Date Issued: By:

Payment Type:

TYPE OF WORK New construction Addition/alteration/replacement

Other: CATEGORY OF CONSTRUCTION

1- and 2-family dwelling Commercial/industrial Accessory building

Multi-family Master builder Other:

JOB SITE INFORMATION AND LOCATION

Job no.: Job address:

City/State/ZIP:

Suite/bldg./apt. no.: Project name:

Cross street/directions to job site:

Subdivision: Lot no.:

Tax map/parcel no.:

DESCRIPTION OF WORK

PROPERTY OWNER TENANT

Name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

Owner installation: This installation is being made on property that I own, which is not intended for sale, lease, rent, or exchange.

Owner signature: _______________________________________________ Date: _________________

APPLICANT CONTACT PERSON

Business name:

Contact name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

CONTRACTOR

Business name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail: CCB lic. no.:

Electrical lic. no.: City or metro lic.:

Supervising electrician signature, required:

Print name: Date:

Authorized signature:

Print name: Date:

PLAN REVIEW Please check all that apply:

A service or feeder beginning at 400 Amps where the available fault current exceeds 10,000 Amps at 150 Volts or less to ground or exceeds 14,000 Amps for all other Fire pumps Emergency systems Addition of new motor load of 100 HP or more Six or more residential units in one structure Health-care facilities

Hazardous locations A service or feeder rated at 600 Amps or more Buildings more than three stories Marinas and boatyards Floating buildings Commercial-use agricultural buildings Installation of 150 KVA or larger separately derived system “A,” “E,” “I-2,” or “I-3” occupancy Recreational vehicle parks Supply voltage for more than 600 supply volts nominal

FEE SCHEDULE Description Qty. Fee Total *

Residential single- or multi-family dwelling unit Includes attached garage 1,000 sq. ft. or less 194.64 4

Ea. add’l 500 sq. ft. or portion 34.77

Limited energy, residential (with above sq. ft.) 46.42 2

Limited energy, multi-family residential (with above sq. ft.) 91.72 2

Services or feeders installation, alteration, and/or relocation 200 amps or less 115.83 2

201 amps to 400 amps 137.89 2

401 amps to 600 amps 229.34 2

601 amps to 1,000 amps 299.93 2

Over 1,000 amps or volts 690.22 2

Utility reconnect 91.72 1

Temporary services or feeders installation, alteration, and/orrelocation 200 amps or less 91.72 2

201 amps to 400 amps 127.41 2

401 amps to 600 amps 184.11 2

601 amps to 1,000 amps 225.29 2

Branch circuits – new, alteration, or extension, per panel A. Fee for branch circuits with

above service or feeder fee, each branch circuit

4.26 2

B. Fee for branch circuitswithout service or feeder fee, first branch circuit

81.14 2

Each add’l branch circuit 4.26

Miscellaneous (service or feeder not included) Each manufactured or modular dwelling, service, and/or feeder 98.35 2

Pump or irrigation circle 91.72 2

Sign or outline lighting 91.72 2

Signal circuit(s) or limited-energy panel, alteration, or extension. Describe: 91.72 2

Each additional inspection over allowable in any of the above Per inspection 81.14

Investigation fee

Other: Electrical permit fees

SUBTOTAL

Plan review (25% of permit fee)

State surcharge (12% of permit fee)

TOTAL PERMIT FEE This permit application expires if a permit is not obtained within

180 days after it has been accepted as complete* Number of inspections allowed per permit.Form B70-1002 REV 02/21

Plumbing Permit Application 12725 SW Millikan Way / PO Box 4755

Beaverton, OR 97076 Phone: (503) 526-2493 Fax: (503) 526-2550

General Information (503) 526-2222 BeavertonOregon.gov

TYPE OF WORK

New construction Demolition

Addition/alteration/replacement Other:

CATEGORY OF CONSTRUCTION

1- and 2-family dwelling Commercial/industrial

Accessory building Multi-family

Master builder Other:

JOB SITE INFORMATION AND LOCATION

Job site address:

City/State/ZIP:

Suite/bldg./apt. no.: Project name:

Cross street/directions to job site:

Subdivision: Lot no.:

Tax map/parcel no.:

DESCRIPTION OF WORK

PROPERTY OWNER TENANT

Name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

APPLICANT CONTACT PERSON

Business name:

Contact name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail:

CONTRACTOR

Business name:

Address:

City/State/ZIP:

Phone: Fax:

E-mail: Plumbing. lic.:

CCB lic.: City or metro lic. no.:

Authorized signature:

Print name: Date:

FEE SCHEDULE

For special information, use checklist.

Description Qty. Ea. Total

New 1- 2-family dwellings (includes 100 ft. for each utility connection)

SFR (1) bath 389.74

SFR (2) bath 448.20

SFR (3) bath 506.67

Each additional bath/kitchen 46.81

Fire sprinkler ( sq ft.) *

Site utilities

Catch basin/ area drain/manhole 20.31

Drywell, leach line, or trench drain 20.31

Footing drain 20.31

Manufactured home utilities 20.31

Rain drain connector 20.31

Sanitary sewer (no. linear ft.: ) *

Storm sewer (no. linear ft.: ) *

Water service (no. linear ft.: ) *

Fixture or item Absorption valve (water hammer) 20.31

Backflow preventer 43.68

Backwater valve 20.31

Clothes washer 20.31

Dishwasher 20.31

Drinking fountain 20.31

Ejectors/sump 20.31

Fixture/sewer cap 20.31

Floor drain/floor sink/hub/ primer 20.31

Garbage disposal 20.31

Hose bib 20.31

Ice maker 20.31

Interceptor/grease trap 20.31

Medical gas (value: $ ) *

Roof drain (commercial) 20.31

Sink/basin/lavatory 20.31

Tub/shower/shower pan 20.31

Urinal 20.31

Water closet 20.31

Water heater/expansion tank 20.31

Water meter pvt 20.31

1&2 family dwelling re-pipe 144.95

Multi-family/commercial re-pipe (first 20 fixtures)

144.95

Multi-family/commercial re-pipe ea. fixture over 20

9.67

Other: 20.31

Subtotal

Minimum permit fee 96.64

Plan review ( 25% of permit fee)

State surcharge (12% of permit fee)

TOTAL PERMIT FEE

This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete.

* See Fee Schedule

Payment Type:

By: Date Issued:

Permit No.: Date Received:

OFFICE USE ONLY

FORM B70-1004 REV 10/17

Page 1

Date: Project Name: Is this project associated with a current CIP or SD project? Project number: General Location: (Example: landscape strip, roadway between X and Y)

Description of Work: Site Address: Applicant Information:* Primary Contact: Name: Address: City: State: Zip: Cell Phone: Email: *Must be signed by the property owner(s) or by someone authorized by the property owner(s) to act as an agent on their behalf.

Contractor Information: Primary Contact: Name: Organization Name: Address: City: State: Zip: Phone #: Email: CCB #:

Work Start Date: End Date: # of construction days: Sidewalk or Street Closure? Yes No *If proposing street or sidewalk closure, a Traffic Control Plan (TCP) is required.

This application is for: Check all that apply.

Sidewalk New Repair Curb & Gutter New Repair

Driveway New Repair Is this Code Enforcement related? Yes No

If Yes, please reference the file # from the Code Enforcement letter, along with the comply by date: Code # ______________________ Date: _________

Landscape

Street T-Cut Saw Cut Trench Road Bore Pothole Closure Core

Utility Water New Connection Repair

Sewer-Sanitary New Connection Repair

Storm New Connection Repair

Non-Potable New Connection Repair

Franchise Provider

Electrical Fiber Other Provider Name: _________________________________

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021Engineering Application for Small Wireless Facility Only

Site Development Division sitedevelopmentplansubmit@beavertonoregon.gov

Page 2

Submittal Requirements (see City of Beaverton’s detailed Right-of-Way Submittal Requirements)

Please allow (3) business days to process this application unless an emergency By my signature, I certify that I have read this application and agree that the supplied information above is correct. I agree to comply with all applicable City ordinances and State laws pertaining to the proposed construction and hereby authorize City representatives to enter upon the above property for inspection purposes. I understand and agree to pay all costs to repair or replace any property damaged while work is being performed under this permit and acknowledge that failure to pay these costs when due will constitute a violation of the terms of the permit and the City may avail itself to any and all legal remedies. Authorized Signature: ____________________________________________ Date: _______________

Form Revised 09/2021

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Approved By:

Drawn By:

Reviewed By:

COMMUNITY DEVELOPMENT DEPARTMENT

Site Development

SA

NP

RIGHT OF WAY PERMIT

UTILITY TAP EXAMPLE

ON AERIAL IMAGE (EITHER GOOGLE MAPS AERIAL OR STREET VIEW), CLEARLY

SHOW APPROXIMATE LOCATION OF PROPOSED WORK WITHIN CITY ROW AND

LABEL DISTURBANCE WITH DIMENSIONS AND AREAS

NOTES: LABELING IMAGE WITH PEN WILL SUFFICE

PAVEMENT CUT

FOR SEWER TAP

EXAMPLE: STREET VIEW IMAGE WORK DESCRIPTION.

(ACCEPTABLE FOR UTILITY TAP)

5

'

4

'

STREET VIEW IMAGE

COURTESY OF GOOGLE

LEGEND:

CONSTRUCTION LIMITS

EXAM

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Approved By:

Drawn By:

Reviewed By:

COMMUNITY DEVELOPMENT DEPARTMENT

Site Development

SA

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RIGHT OF WAY PERMIT

CURB & GUTTER / APPROACH

SIDEWALK SUBMITTAL EXAMPLE

CURB CUT

ON AERIAL IMAGE CLEARLY SHOW PROPOSED WORK

WITHIN CITY ROW WITH DIMENSIONS AND AREAS

NOTE: LABELING IMAGE WITH PEN WILL SUFFICE

NEW 6" THICK APPROACH

EXAMPLE: STREET VIEW IMAGE WORK DESCRIPTION.

(ACCEPTABLE FOR SIDEWALK, CURB CUT, AND/OR

APPROACH WORK)

3

'

1

5

'

STREET VIEW IMAGE

COURTESY OF GOOGLE

23'

5

'

LEGEND:

CONSTRUCTION LIMITS

EXAM

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Approved By:

Drawn By:

Reviewed By:

COMMUNITY DEVELOPMENT DEPARTMENT

Site Development

SA

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60'

RIGHT OF WAY PERMIT

SINGLE FAMILY RESIDENTIAL EXAMPLE

NEW OR

EXISTING HOME

PROPERTY LINE

12'

18'

5'

16

'

CITY RIGHT OF WAY LINE

PUBLIC SIDEWALK

24" CURB

AND GUTTER

PROVIDE LOCATIONS, LENGTHS, AND AREAS OF HARD

SURFACE DISTURBANCES (CURBING, SIDEWALK,

PAVEMENT) AT CONSTRUCTION LIMITS.

NOTE: HAND-DRAWN AND TO SCALE IS ACCEPTABLE.

EXAMPLE: SITE PLAN FOR SIDEWALK WITH

PLANTER STRIP.

(ACCEPTABLE FOR ALL ROW APPLICATIONS

EXCEPT COMMERCIAL/UTILITY WORK)

WEEPHOLE CORE

(NO CUT)

TRANSITION PANEL

FULL WIDTH (TYP.)

LEGEND:

CONSTRUCTION LIMITS

TREE

VEGETATION

UTILITY POLE

PEDESTAL

INLET

VAULT

EXAM

PLE

Site Development Permit Application Detailed Cost Estimate Format and Breakdown

Required for Fee and Performance Security See Cost Estimate Template on Applications & Forms site. The information below presents the minimum cost estimate breakdown of items covered under a Site Development, Right-of-Way, and Franchise permits. This list is not exhaustive; additional items particular to a project may need to be added to account for the full cost of construction. The estimate shall be considered as all costs to install/construct “in-place” considering the location, type, and scope of work for each line item. Administration, overhead, profit, incidentals, testing, surveying, and construction staking costs shall be considered to be included with mobilization and a part of each line item. The quantity units shown shall be used unless given prior approval by the City Engineer or designee. Items in parentheses are to be broken out as individual lines for the estimate. The list is loosely ordered to reference the City Standard Drawings and Clean Water Services Standard Drawings. Items In Place Units Mobilization LS City-Maintained Streets (See Grading and Aggregate Below) Centerline Monument (boxes at intersections, AL caps) EA Standard Monolithic Curb and Gutter LF Type A Curb (vertical, special application) LF Commercial Driveway - 4000 PSI concrete SY Residential Driveway - 4000 PSI concrete SY Subgrade Treatments, Special Compaction, Soft Spot Fix SY Pavement (PCC or AC, thickness, class, base & wear lifts) SY Paving Treatments (fabric, grinding to match existing, seals) SY Traffic Markings (thermoplastic, width, color; buttons) LF Standard Sidewalk - 4000 PSI concrete SY Sidewalk Ramps (each type) EA Traffic Calming (circles, tables, and humps) EA Street Barricade – Type III EA/LF Street Sign Assembly (typical, w/stop, others) EA Traffic Signal Installation and Modifications LS Street Lights and Poles EA Street Light Controllers, Meters, Power Connects LS Street Light Junction Boxes EA Street Light Conduit and Wiring LF

Items In Place Units Site Grading Erosion Control Measures, Tree-Protection Fencing LS Mass Grading Activities (clearing, stripping, grubbing

excavation, fill, earth import, stockpiling, undesirable soil removal, all haul-off and disposal costs) CY

Special Grading Activities (site demolition, blasting, well abandonment, septic tank and drain field removal) LS

Retaining Walls (> 4 feet tall and/or any in right of way) LF Aggregate Placement & Soil Reinforcement (Type with specified uniform placement thickness) SY Utility Trenching (in right of way and/or public utilities, type) CY Overhead-Utility Undergrounding (vaults, conduit types and lengths, service conversions) EA Privately Maintained Streets and Parking Lots Curbs (subdivisions only, common drives) LF Paving (fire access, common drives, parking in floodplain) SY Paving (parking lots outside floodplain) SY Sidewalks (subdivisions only, common use) SY Private street lights (subdivisions only) LS City Water System Taps, special fittings, and couplings EA Pipe (size, class, restraint type) LF Valves (size, type - includes CARV & post-indicator) EA Hydrants EA Pressure-Regulating Stations LS Service line installation and meter boxes EA City Sanitary and Storm Sewer System Taps, special fittings, and collars EA Pipe (size, material, class, anchor blocks) LF Structures (manholes, clean-outs, inlets: type, size) EA Headwalls and other special construction EA Private sewer laterals (subdivisions only, stubs to each lot in streets or common areas, with markers) EA Storm Water Management Facilities (public and private) LS (Include plants and border plantings. For subdivisions, include fencing lengths, gates, and other amenities.)

Other Non-City Public Improvements* (Washington County, Oregon Department of Transportation, Clean Water Services District, Tualatin Valley Water District, West Slope Water District, and the Raleigh Water District) *In the case of subdivisions, per State Law, the City must hold a performance security for these costs if the applicable service provider does not require one. (NOTE: Abbreviations –LS=lump sum, EA=each, LF=lineal feet, SY=square yard, CY=cubic yard)

Form Revised 09/2020

SITE DEVELOPMENT DIVISION APPLICATION, REVIEW & INSPECTION FEES City Staff will inform you of the application & permit fee

Updated November 4, 2021

Research Fee $ 75.00 FEMA Floodplain Elevation Determination Fee (per tax lot) $ 50.00 Floodplain, Floodway and Wetland Modification Fee $ 750.00 per permit House Move Permit Fee $ 200.00 per section Re-Inspection Fee (mandatory for stop work order removal) $ 100.00 Right-of-Way (ROW) and Facilities (FC) Permit Application Fee $ 100.00 Individual tree cut (street tree); sidewalk repair, replacement, or installation; street cut

Site Development Review of Building Permit Plans Fee Legal Documents-Easement, Release, Private Stormwater Agreement Includes review of standard submittals and recording

$ 75.00 per permit $ 300.00 per document

Small Wireless Facility Application Deposit* $ 3548.00 *Pursuant to ORS 227.175(10), if a land use decision has not previously been heard in a public hearing format, the fee for an appeal of that decision cannot be adopted by Resolution No. ___ Modification of Standard Forms Fee $ 500.00 per page Technical and legal review for modification request Design Exception Request (single item)

$ 500.00 per request

Site Development Application Fee For sites less than 1 acre and/or 3 residential units or less $1,150 For site greater than 1 acre and/or 4 residential units or more $3,150 plus (partial acre is increased to next whole acre, e.g. 1.1 acres = 2 acres) $300 per whole acre

SITE DEVELOPMENT PERMIT FEES

Site Development, ROW, and FC Permit Fee (payment prior to permit issuance):

The applicant shall pay a permit fee based on the final construction cost estimate prior to permit issuance as determined below.

Construction Cost Estimate Fee $0 - $10,000 7.5 percent of value $10,000 - $100,000 $750.00 plus 10 percent of value over $10,000 $100,000 - $500,000 $9,750.00 plus 8 percent of value over $100,000 Over $500,000 $41,750.00 plus 5.5 percent of value over $500,000

EROSION CONTROL FEES A. Erosion control with a building permit: Fee $0 to $25,000 $75 $25,001 to $50,000 $100 $50,001 to $100,000 $150 $100,001 and above $150 plus $125 per $100,000 of the fraction thereof exceeding the first $100,000 B. Erosion Control with no building permit 0 to 0.99 acre $350 1 acre and greater $350 plus $200/acre or fraction thereof (continued below)

OPEN AIR BEAVERTON

Application Fee $100 Renewal Fee $100 Moving Fee At cost Appeals $500 TECHNOLOGY FEE Fee Assessed on all applications and permits 3.5 percent of total Site Development fee(s)

Page 1

The Oregon Department of Transportation (ODOT) ADA Curb Ramp Design Checklist needs to be filled out for EACH ADA ramp that will be present.

Access the checklist at the following link and include completed checklist(s) with the application.

https://www.oregon.gov/ODOT/Forms/2ODOT/7345184.pdf

Form Revised 05/2020

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021

ODOT ADA Checklist

Site Development Division sitedevelopmentplansubmit@beavertonoregon.gov

Page 1

This checklist is a tool to assist applicants and to help the City expedite permit applications. Please submit all applicable documents in the order below via Box (See Electronic Document Submittal document on the City’s website) as a set of PDF files.

Refer to City of Beaverton Engineering Design Manual (EDM), chapter 1, section 120 – Submittal Requirements for Site Development, ROW, & Facilities Permits for additional information.

_____ Plan sets of 11 x 17-inch, in PDF format (see EDM chapter 1, section 120.2 for requirements) (required)

See EDM section 120.3.1 through 120.3.16 for requirements regarding the below:

_____ Title Sheet (required)

_____ Existing Conditions and Demolition (required)

_____ Street Tree Removal

_____ Typical Sections

_____ Details

_____ Traffic Control

_____ Utility Plan and Profiles, with easements and structures shown (PGE, NWNG, VERIZON, QWEST, COMCAST)

_____ Site Grading and Erosion Control, with wetlands and floodplains identified

_____ Landscaping

_____ Structural - Retaining Walls, Bridges, etc.

_____ Illumination / Street Lighting

_____ Traffic Signals

(cont. below)

_____ Intersection Sight Distance Certification (if meeting public roadway)

_____ ODOT ADA Curb Ramp Design Checklist for EACH ADA ramp

_____ Reports (as applicable):

_____ Storm Water Management _____ Traffic _____ Structural

_____ Geotechnical _____ Floodplain _____ Misc.

Form Revised 08/2021

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021 Engineering Application for Small Wireless Facility Only

Project Checklist Site Development Division

sitedevelopmentplansubmit@beavertonoregon.gov

Page 1

Project Location Address:

Owner Name or Name of Business Mailing Address Phone Email

Arborist Name Mailing Address Phone Email License Number

Contractor Name Mailing Address Phone Email License Number

Tree Information Type of tree (species) Height of tree Diameter of tree trunk (DBH measured at 4 feet above ground) Is this tree at a single-family residence? Reason the tree is to be removed Date tree cut is to take place Is tree within 50 feet of a wetland? Is work to be performed in the public right-of-way or other property?

Prior to issuance by the City, Urban Forestry will inspect the tree for possible removal and submit any conditions to be placed on the permit, such as a replacement requirement. Contact the City landscape section at (503) 526-2237 for an inspection.

By my signature, I certify that I have read this application and agree that the supplied information above is correct. I agree to comply with all applicable City ordinances and State laws pertaining to the proposed construction and hereby authorize City representatives to enter upon the above property for inspection purposes. I understand and agree to pay all costs to repair or replace any property damaged while work is being performed under this permit and acknowledge that failure to pay these costs when due will constitute a violation of the terms of the permit and the City may avail itself to any and all legal remedies.

Signature: ____________________________________________ Date: ____________________

Form Revised 08/2020

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021

Street Tree Removal Application Site Development Division

sitedevelopmentplansubmit@beavertonoregon.gov

Page 1

To: PRINCIPAL and/or SURETY

Re: PRIVATE WORK IN PUBLIC RIGHT-OF-WAY STREET OPENING BOND CITY ATTORNEY STANDARD FORM

Attached is a Private Work in Public Right-of-Way Street Opening Bond, standardized by the City Attorney's office.

General Notes: • Must be on Surety’s own Letterhead• Must have live-ink original writing/typing and signatures, please do not submit a fax or

photocopy• Attach any signing authority documents, per individual company’s standard

requirements

Please fill in the appropriate blanks;

Bond number from the surety, Name of principal shall be the contractor performing the work as principal, Surety name of the bonding company, Surety home state of the bonding company, Term shall be in MM/DD/YYYY, Amount of security in dollar amount written out in text and numeric after the $ sign, Live Ink Principal Signature and contact information as noted Live Ink Surety Signature and contact information as noted

Please note that if you choose not to use the standard form provided, you should expect that the approval process may be delayed because of the additional time necessary to review non- standard documents.

Form Revised 09/2021

City of Beaverton 12725 SW Millikan Way, 4th Floor, PO Box 4755, Beaverton, OR 97076

(503) 350-4021Site Development

sitedevelopmentplansubmit@beavertonoregon.gov

City Approved: ___________________________

STREET OPENING BOND

Bond No.: _______________

PRINCIPAL: _________________________ SURETY: _________________________ Address: ___________________________ State of Surety’s Incorporation: ________ ___________________________ Address: __________________________ Phone No: __________________________ __________________________ Phone No: _________________________ TERM: _____________to ________________

OBLIGATION PRINCIPAL and SURETY, as a corporation authorized to transact a surety business in the State of Oregon, are obligated to the CITY OF BEAVERTON, an Oregon municipal corporation (“City”), in the sum of ______________________________________________________dollars ($________). Principal and Surety (“the Parties”), their heirs, executors, administrators, successors and assigns, jointly and severally, are required to comply with the terms and conditions of this Street Opening Bond (“Bond”). THE PARTIES AGREE TO THE FOLLOWING TERMS AND CONDITIONS OF THIS BOND: 1. During the Term of this Bond the Principal must file applications with the City’s Site Development

Division to obtain permits to cut, break, dig up, excavate, disturb, dig under, or undermine public streets or alleyways, or to construct, repair, or reconstruct public sanitary sewers or storm drains (“Improvements”) in the City.

2. Principal must comply with the terms of the permit, the Beaverton Code, the Engineering Design Manual, and all other city policies regulating Principal’s work that are in effect at the time any permit is issued. In addition, Principal must immediately: a) remove all surplus sand, earth, rubbish and other material; b) immediately restore public utilities and the portion of the street or alleyway that was cut, broken, dug up, excavated, disturbed, or undermined to a condition satisfactory to the City Engineer; and c) restore all appurtenances, including landscaping, to the same or better condition than existed in the area prior to the work.

3. Principal must guarantee replacement and repair of the Improvements and keep the portion of the street or alleyway in good repair for a period of two years from the date of City’s final acceptance of the work.

4. If Principal complies with all the conditions of this Bond, then the obligation shall be void after the two-year maintenance period expires; otherwise it will remain in full force and effect.

THIS BOND is agreed to by the Parties and executed by the duly authorized signatures below. PRINCIPAL: SURETY: BY:____________________________________ BY:___________________________________ NAME:_________________________________ NAME:________________________________ TITLE:__________________________________ TITLE:_________________________________ ADDRESS:_______________________________ ADDRESS:______________________________ TELEPHONE:_____________________________ TELEPHONE:____________________________