PFI2020-00443 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12020-00443
13125 SW Hat Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/03/2020
TIGARD Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Subdivision: None Lot: None
Project: CWS Sidewalk
Project Description: 16060 SW 85th Ave. Saw cutting trip hazards in 4 location at the corner of SW 85th and Durham Road.
Class of Work: FEES
Type 2 - Sidewalk/Driveway Approach Description Date Amount
PFI Permit Fee 12/03/2020 $300.00
Total $300.00
Owner:
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tigard-or.gov to schedule inspections online.
Contractor:
SAFE SIDEWALKS LLC
PO BOX 697
FAIRVIEW, OR 97024
PHONE: 5033056271
Applicant:
DENNIS KRAMER
2550 SW HILLSBORO HIGHWAY
HILLSBORO, OR 97123
PHONE: 5036813600
•
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
Signature: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2020-00443
Type: Condition Name: Status: Severity:
PFI_Sidewalk![ 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Sidewalkl[ 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. 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 clean-up
and suspension of work to accomplish clean-up.
PFI_Sidewalk/[ 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Sidewalk/C 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI_Sidewalk/[ 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services
Association [ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Sidewalk/[ 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area. Traffic control devices,flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Sidewalk/[ 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic,at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire&Rescue) and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District) and other service providers impacted by such closure.
PFI_Sidewalkl[ 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours(min.)before initiation of construction work.
PFI_Sidewalk/[ 09-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Sidewalk/[ 10-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI_Sidewalk/[ 11 -TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Sidewalk/[ 12-TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Sidewalk/[ 13-DRAINAGE CONTROL Applied Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Sidewalk/[ 14-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE:Damage to utilities shall be corrected at the permit
holder's expense
PFI_Sidewalk/1 15- UTILITY LOCATION CONFLICT Applied Notice
Applicant 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 applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI_Sidewalk/[ 16-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI_Sidewalk/[ 17-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads,ditches, etc.)as may be necessary, as determined by
the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Sidewalk/[ 18-SEWER SYSTEM TEST Applied Notice
A sewer system air-test and/or DVD T.V.test report and one set of"As-Builts" shall be provided for review and approval.
PFI_Sidewalk/1 19- PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Trent Brickey>at
<971-228-9269>,to establish a preconstruction meeting.
Please call 503-639-4175 to schedule inspection, use code 735
PFI_Sidewalk/[ 20-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24) hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit.
PFI_Sidewalk/[ 21 -PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance,and all attachments, and a copy of the approved construction plan
and all amendments shall be readily 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 these must be approved by the City, in advance of work
performance.
PFI_Sidewalk/[ 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI_Sidewalk/[ 23-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Sidewalk/[ 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice
The City's Inspector may,at his discretion, require tests and or reports.from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Sidewalk/[ 25-EMERGENCY CONTACTS Applied Notice
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 any emergency. The
applicant shall notify the City Inspector, in writing,of any/all assignment changes.
PFI_Sidewalk/[ 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain 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 applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI_Sidewalk/[ 27- PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI_Sidewalk/[ 28-AS-BUILT DRAWING Applied Notice
One as-built drawing 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 engineer's certification of installation compliance(Certificate of
Compliance).
PFI_Sidewalk/[ 31 -OTHER Applied Notice
Other
se City of Tigard pH #: 2020-00443
_ ENGINEERING DEPARTMENT
T I G A R I) Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project name: sidewalk trip hazard removal ❑ TYPE 1-Franchise Utility Work
Brief description of project: performed by NWN,PGE, or utility
agency
saw cutting trip hazards in 4 locations at the corner of SW X TYPE 2-ROW Sidewalk/Driveway/Sewer
85th Ave and SW Durham Road. (#6-9 on attached map) Work performed for the purpose of
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
OR main line tap
16060 SW 85th Ave,
Location (address if available): Tigard,
❑ TYPE 3—Full Scale Development Work
97224 performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Clean Water Services • Mainline installation for sanitary sewer,
Name: storm sewer, Tigard water, and Tigard
Mailing address: 2550 SW Hillsboro Highway water service arca
City/State: Hillsboro, OR Zip: 97123 ❑ TYPE 4-Small Cell Technology
Phone:
503 681 3600 ❑ TYPE 5-Tigard Triangle
Email: kramerd@cleanwalerservices.org Phone: 503 547-8086 NOTE: Type I and 2 applications may be
Contact name:
Dennis Kramer cmailed to rowpermtrs(riesrd-or tam.
Phone: 503 547-8065 Email: kramerd@cleanwalerservices.org
CONTRACTOR INFORMATION 0 Same as applicant
Name: Safe Sidewalks, LLC. CCB Number: 178181
Mailing address: PO BOX 697 City/State: Fairview, OR Zip: 97024
Phone: 503 305-6271 Email: sidewalk trip hazard removal
ENGINEER INFORMATION
Name: None
Mailing address: City/State: Zip:
Phone: Email:
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000):$ 212.69 (within the public right-of-way)
Is work related to a LAND USE DECISION? 0 Yes XNo Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4
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 15.04.140.
' With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,when the owner and the applicant
arc 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 must sign this application in the space provided or submit a written authorization with this
application. Franchised or Licensed Utilities arc not required to obtain the owner's signature on the application.
I, the applicant, certify that:
• To the best of my knowledge,all the information provided within this application package is complete and
accurate.
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the
subject property.
• If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
i641i r✓l i - /61-?010
Ap li nt's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No:PFI2020-00443 Permit fee: 300.0 Received by: AL Date: 11/16/2020
Approved by: T sic-tf • Date: tt/l7/ZOtd Notified by: / / Date: ll` (1:170
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
INITIAL PFI PERMIT FEE
Part 1: Required submittal fee is 10%of the Net PH Permit Fee.See below for calculations.Minimum of$300.
NET PFI PERMIT FEE
Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Permit Fee).
WATER LINE CONSTRUCTION FEE
Part 3: All public water system improvements engineer's estimate X 12%.
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4: SMALL WIRELESS FACILITY TYPE 1-3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Does applicant have a right-of-way license? ❑Yes ❑No TYPE 1 AND TYPE 2-Must include a sketch
showing:
Under the wireless facilities standards,is the proposal
D Dimensions
considered?(check all that apply): 0 Small Cell ❑Macro ❑ Street Name
How many install sites arc proposed as part of this permit
❑ Site Address
application?
TYPE 3-Must provide 4 sets of plans(sized 24 x 36
or 22 x 34) and an electronic version of all submittal
The proposed equipment is located on which of the following: items. The plans must that include:
❑ Public Right-of-Way 0 Private Property
❑ Cover-Site,Vicinity,Abbreviation,Legend
If equipment is to be located on private property,describe the El General Notes(City,Water,Sewer,etc.)
type&use: ❑ Street(Plan,Profile)
0 Water,Storm and Sanitary(Plan Profile)
❑ Water Quality Facilities
❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,
Sanitary,Water,Signage,Street Lights,etc.)
❑ Details
❑ Traffic Sight Distance
O Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and plan
log block,dates and sheet numbers.)
❑ Engineer's Construction Estimate
Additional Submittals
(per land use conditions,if applicable)
❑ 'Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
O Pathway Design
❑ Water Provider Approval
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4
9 sw '•v '• sl
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TYPE 1 AND TYPE 2:
MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable)
North arrow Property lines&dimensions _Existing utilities locations
(sewer,storm,water)
Street&street names All existing structures
Proposed work Existing curb or edge of pavement Utility& street light poles
Existing S/W or D/W apron Slope of property Trees
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4
Trip Hazard Removal Bid
Durham Facility
Job ID#: 20-P43 �.+, P.O. Box 697
Date 3-Nov-20 , Fairview, OR 97024
r Durham Facility
�'Tl.-1f'61 rrc (503) 305-6271
Attention: Dennis Kramer Trip Hazard (503) 659-2034 (Fax)
Removal Specialists
16060 SW 85' Avenue Federal ID#: 26-0452999
Tigard, OR 97224 Safe Sidewalks CCB#178181
Total Linear Ft. AvefLinear Ft #of Trip Hazards AvefTrin Hazard Total Cutting Cost
125.00 $13.28 23 $72.20 $1,660.50
Work to he Completed:
1. All trip hazards marked for saw cutting will be done in accordance with The Americans With Disabilities
Act requirements. Each offset will be tapered at a 1:12 slope and shall all have smooth uniform appearance
and texture,
2. All saw cutting shall be taken to the zero point of differential settlement and to both edges of the sidewalk
to eliminate trip hazards for the full width of the sidewalk.
3. Debris and concrete dust shall be cleaned from the sidewalk surface as well as surrounding rails,sidewalks,
driveways, landscaping or other objects in the vicinity of work.
Terms of Work: Our Method
If bid is accepted:
1. Owner agrees to pay the bid amount of $1,660.50
no later than 30 days after completion of work and receipt of invoice.
2. All amounts not paid within 30 days shall bear interest at the rate of 2%
per month.
3. Owner further agrees to make the work area accessible to Contractor
and to cooperate in preventing interference with the performance of 111016.1
Contractor's duties.
4. In the event legal action is necessary to enforce this agreement, jjjRD BEFORE REPAIR
the prevailing party in such action shall be entitled to recover its
reasonable attorney fees therein incurred.
5. The person executing this document on behalf of Owner warrants
authority to enter into this agreement and to bind the owner and TRIP HAZARD AFTER SAW CUT REPAIR
guarentees payment of all amounts due hereunder.
Bid Valid for 60 Days
Accepted by: Date:
Printed Name: PO Number:
No. High Low Linear Feet Location Cost
1 1 7/8 5 Mangate $192.19
2 3/8 0 7 Shaffer near east light $53.81
3 1/2 0 4 Shaffer near west light $41.00
4 `other method needed 85th between north power poles openings
5 "other method needed 85th north power pole spelling
6 1/2 0 3 85th north near guy wires $30.75
7 3/8 1/4 5.5 85th north at curve $70.47
8 3/8 0 4.5 Durham west access circle $34.59
9 3/8 1/4 6 Durham east of 2nd sewer drain $76.88
10 *other method needed Durham east of 2nd sewer drain spalling
11 1/2 0 7.5 85th south clean water sign $76.88
12 3/8 0 7 85th south 1st tree $53.81
13 1/2 0 5 85th south 5th tree $51.25
14 1/2 0 7.5 85th south 7th tree $76.88
15 1/2 1/4 7.5 85th south 8th tree $115.31
16 1/2 1/2 7.5 85th south 9th tree sewer $153.75
17 1 1/4 1/4 7.5 85th south 15th tree $230.63
18 1/2 0 5 85th south 16th tree $51.25
19 5/8 0 4 85th south path east $51.25
20 1/2 0 7.5 85th south at path east $76.88
21 1/2 0 2 85th south 22nd tree $20.50
22 3/8 1/8 5 85th south 26th tree $51.25
23 3/8 0 4 85th south ar east path $30.75
24 3/8 0 5 85th south near hydrant $38.44
25 1/2 0 3 85th south hydrant $30.75
26 1/2 0 5 85th east south of 2nd driveway $51.25
*Data for these three hazards (4, 5, & 10)provided for informational purposes only. 1
'These three hazards are not included in the scope of work.
*THESE THREE HAZARDS CANNOT BE REPAIRED USING OUR PROCESS.
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