PFI2020-00448 hrl (].?—�— aptl�g
NOV 1 8 A a City of Tigard
hNGINkERINr DliPut•CMLNT
I.f.� r Ti T,::,,lil) Public Facilities Improvement (PFI) Permit
R NING(ENGINEERI
PROJECT INFORMATION
? L / TYPE OF WORK
PrgCCI name; t� �"J �5 �y Y7 T11'1:I-l,,nd,nc Cabty Wick
Brief description ill pr.,irrl: t Fit 611C. I4�1"I rrVt fj c.,, V I+'*Nnmr•i I+,\1T1.(Y:I:. eq milk;
1 14 t{lroif' Vv.'', 6./i,h-1 W 1,"\^-te f%/14.e 1315{ Poet- O TYPE 2_1411WSidru2IWIMr-cyari.Swo
¢i�{lb1 it, IN ,,1 c•' 1 I.l.c�' l'n A•} �r� ?�' A;;ILp o+i,.nndh,r+irin+riori.a
. 'a 1- il•1•I i c,
• Ihi.-nag aptm uch natallati,.n mid mpb
;: SITE INFORMATION •tiamias,WV cr 4ncrd.nua4au..n wm
tale. jadiltif 11'.'y bli,':: 130`l8 Vs C
t'y .riZtl'Sne ut�dgR.S1. '^^oluuup
(�I7,/7j { -1 ❑ TYPE 3-I ull St m Stair Ih.elcnml N"otk
'Vitt.‘"ji.(rLt.- Iyi6.7c� Ir.I..rme,l anh farad Wee:1111WW al Which
•1 ,fAwir,un,of tlu Wllurtir;.
J • Snkhri.ion..n 1'aniu++n.
)1 AAPPLICANT�T INFORMATION •S,terI W,h.,,i„'
Nan1C: l \f _'.,i' ' 3lnftdi U u n liu r+mun Arum
. , `� .vam, 'art,•n,tani Wan. anj
i�i 1Iprd
Mailingaddresc: 1171 It\1 lit'" Pr'�I1/IL.A 11':ntr Kn'iu:lru
1 _ __44 1
City/Stale: I I 0. l7 t?1.a4 � 13 TYPI3.1.Small l:eA Tnfln<d<p,•r
Phone: JL_e1, n 'Ito—3`'1 e1 C ❑ TYPE S-7'rtall7i,anrk•
I= limaii: TF.rsl@. PI onr: A•c.+t.�
sf 1� 4 DOTE: •Li!r I :And?alydpiue.n OliW hi.
t.
Contact name:
1"7lkn A Sr11 T.��.;1 c+nLh.11::Ir.4J,rrnun,il•nl•:rirlin In.y.
Phone: S:'-nv.. s Email: 1R' o,1),1 4k`2.�L�.S6�.L'ts'I(s4SI',L01'1/_
i .
CONTRACTOR INFORMATION CI Same as applicant
Name: J-..;014-SCC.1)e.. LL- . CCIiNumber: l`I-11L'S
a 1 CC170 D-
\Itiliny; ddrers: 111C C> >yL 'l 1�l �1� . Lire/Slate:Stare: �{:�Q1.1171 � Zip:
Phone: .'1.g1—V-1-k-l'{-tl Email: Tl+.rthai-.S(t: leillecaee,ilc • e cv,(
ENGINEER INFORMATION
Name:
Mailing address: Ciic.'4;ur: Zip:
Plum: I.mail:
ADDITIONAL INFORMATION
Estimated value of work IS required iit.uycrS5,IahI):S i within the public right-of-Nay)
is work ra•1.1icd t ,a LAND t'Sr DrcimoNil ❑ler. XNn Case number:
City of Tigard • I.il24sv. Italillkd. • 'Iiiul,tltr•F,n1'1'22 3 • .4WWIIgard•.+r.g,.r • SU.3.710/.24?1 • Par Iof4
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il
APPLICANTS
1' NOTE: Pei son specified as'Applicant"shall be designated"Permmce"and shall pro wide financial assurance fur
work.if requited by the cis pursuant to nit:: 13.14.141i.
Y ` With ilk cxtejrtrgt.d+WILT%..Vtanry:pau.hunt it.aX414 rrmaiur,SC haa:,n•With fir t:' �.i'ti•i.,l.wiwn IlK two
F '7 f �kt and the applicant
nt diffarnr pavp;v.lilt appLcarr mutt Ix the purtruu•.d rec.nd of a iencc cat p.nsnw.n a-tA V'narc +mhtv,mm from the tmnet
} or an+crrt ad she:sows,. the ,wnu must nj:dm app;tcra.n in Ilk.part p,..vtdtd nr•ulmut a Wnnen iuth•.rvau..n tad,this
applicam•n. Ia+nahtard.•r lktnwd Vatic"air tan rwwtnl:•.oCaw The..Watch agytarurt can the appheam.n
}}, 1,the applicant,certify than:
• To the beat of my knowledge,all the information provided within this application package is complete and
accurate.
• The above request dons not ewkne ally recorded deed restncuons that may be attached hi or imposed upon the
subject pn'petty.
• If the application is wanted.I will escrciSe the rights granted in ace•trdancc with the terms and subject ttr all the
conditions and limitations cat the approval.
ti
Y _
Applicant's or authorivcd agent's signature Print name Date
property owner's aignaturc(if rer1tiircd) Print name Date
i'.
6i
, � ,/�,�� STAF1 USU.ONLY /-may
Casc Nu: •1KdL" �r Y*it ice: Slav Received by: Date: ' 1/i'17
Approved by: !YY/tf toe;_ `///1/20e4:2 Notified by: AS= Date: i s
City ofI'igu«I i?1 \\ ILilllthti • i1,:aiJ.(71, .1722i • u-trt ui. Id, , ,sr • O3- 11.2421 • Page of
sl
DEVELOPMENT ENGINEERING FEES
Public Facility Imprnrrmrnt(PFI)Permit:
INITIAL PFI PERMIT FEE
Part 1: 14Na:red submittal fee is lU't.,of the Ntt Pit!Perron Fix.See below fur calculations.Minimum of S300.
NET PFI PERMIT FEE
Pan 2: All non-water system improvements engineer's cstimait X'%,less the initial PH Pcmdt Pre).
WATER LINE CONSTRUCTION FEE
Pan 3: All public Walt r v stcrn nnprt laments engineer's estimate X 13'si.
FOR STAFF USh ONLY FOR STAFF IISE ONLY
TYPE 4:SMALL WIRELESS FACII fly TYPE I—3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Does applicant have a right,of-way license? ❑Veit 0 No `TYPE I AND TYPE 2-Must include a sketch
showing:
Under the wireless facilities standards,is the p:op,ls:d
considered? cheek ali that army): Dimensions
( 1, O Small Cell ❑,aavn. ❑ Strcct Name
Flow many inxtall sites ate pntpused at pan of this permit ❑ Site Address
application?
TYPE 3-Must provide 4 seta of plane(sized 24 x 36
or 22,t 34)and tut electronic version of all submittal
The proposed equipment is located on which of the fc;bwurx
r. items, The plans must that include:
C]Public Right-of-Way 0 PAratc Propcuy
•
❑ Cover—Sue,Vicinity,Abbrs.-tuition,Legend
if tytriimtrnt it mu be heated on[Mime property,desril,e the ❑ General Notes(City.Water.Sesser,e t
type ts•usc: 0 Street(Plan,Profile)
0 Water,Scum mt.i Sail:tart-tl'lao Profile)
•
0 W'ein Q:ui:rr faati tie.
❑ Grading
❑ 1.-tndstapinr/Tree Plan
❑ l_utnisrsuc Utility Plan(I true ea!,Phone,Gat,Stuns,
Sarvfn)•,Water,Si„Cage,Strcct Lights,etc.)
(1 1)cta.;.
❑ 'wane Sight Distance
❑ Signing and Sniping
O Smell—iglu Plan and Phnunstrs •
O Ettgincera acal/signature
❑ Sheet label(project laud use name,revision and plan
ti log blue6,dates and sheet nuasber d
0 Engines:es Construction Cadman
Additioraf Suhmiitals
(per land use conditions,if applicable)
❑ Traffic Report
0 Storm water Drainage Calculations
❑ Ccoreelmical Report
❑ Prelimina •Access Report(Sight Dstancc.,
❑ Yu.ptncd Plat ..
❑ Pathway Acsign .
❑ Water Ptnti4er Apptovs! .
City of Tigard • 1.31_2?SIC I tall lihal. • 'l aid,t trepan'77223 • wusc.tigan!-ucga.•; • 50.:•71 ti 3421 • Page of 4
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13098 SW CHIMNEY
RIDGE ST.97223 _alTrees N
♦ D/W /
ROW 12' ,— 01
►-4--►4—�
SSW I -- 35' 5' 7'
34'
w
SW CHIMNEY RIDGE ST. D 1
m D/W
• -• ,� 1 12184
SSW 16' (TrIel
ROW 6' 0D/W -0 ® e;-‘\•
,-? III
I
1.
13098 Bore'line 89'
o Trees N
N
m OT
Ito
3
vth
No Slope D/W i 'm v
N
12225 ? cNJ
oo
' I
1, — I
Iran:.S3 2011 P dram 2011 Edition Page 81
sj3 Two-Lane, Two-Way Roads ShouhteAWork W[Minorkoad OncroachlineOG r'�,D4tl.300
Sh-oulder Work w/Mino' toad Encroachment Ding, 3.00, I
Use this detail for non-freeway work which extends into a travel lane and •t ' I t.
maintains a minimum 10 fool travel lane. If a minimum 10 foot travel lane I
can not be maintained,or when traffic can not safely pass by in both lanes Inhlal I •
simultaneously,use the appropriate lane closure diagrams-for example, warning A •
Diagrams 310 through 350. Spn
A lane closure may be appropriate for conditions such as high traffic -1 - - I • •
volumes,high speeds,and inadequate approach sight distance to the work .
space,or heavy equipment adjacent In the travel lane.
•I
1. Use truck-mounted flashing warning fights on work and protection (O84lona0 •
vehicles. See Section 4.3-Lights and Lighted Signs for exceptions-
• • I
2. For added visibility,a truck-mounted arrow board or PCMS in caution • • - ��
mode may be used. • I
11
3. Cones shall be placed along the entire length of the work space. 11 a I n Protobn Vehicle .„.•
protection vehicle is used and work is in place one hour or less,the wl nAA(Dom optionan _..
taper and tangent devices may be omitted. See Chapter 4 •
I •
I Bullet
..�
4. If the speed is 45 mph or higher,volumes exceed 2000 ADT,or there • i -,-
is limited sight distance,consider placing cones or tubular markers on •
centerline. to' . • I
minimum •j
5. An arrow board in caution mode or truck-mounted PCMS with I • �I
'SHOULDER WORK-or other appropriate message may be used for
higher Visibiity. •
• -
Sign Spacing and Bettor Lengths(feet)
Posted 'Spacing Between Signs' Buffer, ' I i
Speed :.q-. B:. C Spaeo M-- _.._. I I �a I
20 50 CRTA: i
25 100 100 tOB 75 ♦' -
30 100 Supplement Table
40 350 350 350 35 1550 wa•.a:i.e I ' I IOptanm)
MISwwnh2, B
45 180
rrOVeri•yraYAry __
50 500 500 500 210 wry... I
55 250 I I 1 •4f• ----1-- -
Shtn Syacine and Buffer lengths(feet)Supplement W t
Posted .•.SpadnjBetween SIgni Buffer'' Initial
Warning
'Speed .'`A. - 8 -�.C, - -Spate
60 285
Chnpler5 emb
65 700 700 700 325 Docer2011 December 2011 Chapters
70 365
0 in
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13098 SW CHIMNEY
RIDGE ST. 97223 Trees N
♦ D/W ^ I
ROW 12' — (�Jl
S/W 1 ►4---►4-,
T —
f 35' 5' 7'
34' g
w
r
N
SW CHIMNEY RIDGE ST. D 1
m
D/W
12184
S/W z6'
• D/w
----".".•
ROW 6' IIIo� c Tree
C \‘1)
13098 • Bore line 89'
- -----
-10 rJ ----
-,° Trees ^'
a
N
(D Oa,
A
� i� 00
m
i
i
No Slope m o
D/W m' N
N
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