PFI2020-00505 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2020-00505
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12l31l2020
Parcel: 2S110DD07800
Jurisdiction: Tigard
Site address:
Subdivision: SUMMERFIELD NO.6 Lot: K
Project: Summerfield Sidewalk
Project Description: Replace 3 panels of damaged sidewalk on SW Durham Road across from 108th Ave, near Summerfield
golf course.
Class of Work: FEES
Type 2-Sidewalk/Driveway Approach Description Date Amount
PFI Permit Fee 12/31/2020 $300.00
Total S300.00
Owner:
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tiaard-or.00v to schedule inspections online.
Contractor:
BEST LAID CONCRETE CONSTRUCTION INC
2206 NE KELLY AVE
GRESHAM, OR 97030
PHONE: 5032848220
Applicant:
CART LINDSEY
10650 SW SUMMERFIELD DR
TIGARD, OR 97224
PHONE: 5036200131
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 PF12020-00505
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_Sidewalk/[ 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/[ 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[OUCH].
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_Sidewalk/[ 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/[ 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/[ 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 MATERIAUCONSTRUCTION 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 applicants 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
INIy City of Tigard PI I #: 2020-00505
a . , I:\(.I\II lil\(i Di It110 \Ilf\'I
TIGARD Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
\ TYPE OF WORK
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Contact name: __ � � ___ _.__.__.
Phone: (L1' X- I.mail: •&
CONTRACTOR INFORMATION [ ' '-.unc as applicant
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Phone: __ 503.[Zb4 it) I ,n.Id: ac cd @_8 l.c. 4.-
ENGINEER INFORMATION
Name: V4 Cl.
%liling atidres': ______ - ( I!- "',III /.ip: ._
Phone: _ __ I nt:n!
ADDITIONAL INFORMATION
I':crintaterl\aloe of wi ll iS is rryu in.(l "i f I cr S,Inn :- (within the public righr-of-\\av)
Is work related to a 1..1\1) I SI Ill .( ISI( >\ ❑ lcs II t .tat nunthcr:
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APPLICANTS
NOTE: Perstm spertictl as 'WI, ile:uh '' shall he designated '•Pe•rmittec''and shall provide financed assurance for
�ttrrk,if required ht the citt pursuant bt l \lC I..114.I411.
' With the e.rrptv,n of.r obits l ,tr'tiny punt tin r, i..titd li onrinv ,,r hunt .r ul,iht t'n, nt hg..ir 1,wlirn the rnancr and lilt apphem,
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I, the applicant, certik Mar
• To the best of mt knowledge, all the information pro\ided this application package is complete and
accurate.
• The alum c rcyucsl dt re. n'II t inlut :Ink i'cc t,rrlul deed restriction• that inn he attached to or imposed upon the
subµ•ct propern
• If the application is granted, I will exercise the righis granted in acctird: ncc with the terms and subject to all the
conditions and limitations'it the approval.
Ca_r► l�i� __-- ia1Z3/2.oZ0
Applit's orauth t�d aicnl'. Print n,mlt Date
owe _ n4C1c C' n use, la(Z3Jz10
Property uwner's Signal ni retlu Print Hanle (t
STAFF LSE ONL7'
Case No: PFI2020-00505 Permit Lee: 5.OG Received bv: AL I)ate: 12/23/2020
Approved by:1_►^ f 1)atc: /2/2 7/Zed 2o Notified by: kL Date: I2I bq (-2610
City of Tigard • I 3 I 25 S\\ I fall kiln]. 'rig:1111,l 4e;eui119'223 • wwwtigartl I • 510.'I8 2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement (PFI)Permit:
INITIAL PH PERMIT FEE
Part 1: Required suhnutrat tee is ItI".,of the Net PI'I Permit I..cc.Sec bell nv for calculations. Minimum of S3(111.
NET PH PERMIT FEE
Part 2: All non•watcr sysrem intioventtnrs tog ncer's tstimatt X ' (less the initial PH Permit Pcci.
WATER LINE CONSTRUCTION FEE
Part 3: All public a aver%%sum unto)venxnts engineer's estimate X 122
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4: SMALL WIRELESS FACILITY TYPE 1-3: DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Dues applicant have a right of wn license? r.7 Yes fJ Nu TYPE 1 AND TYPE 2- Must include a sketch
showing:
Under the wireless facilities standards,is the proposal
❑ Dinknsinns
considered?(check all rear apply): 0 Small Cell 0 Macro (] Street N:uue
How manyinstall sites arc imposed as pan 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
0 Cover-Site,Vicinity,Abbreviation,Legend
If equipment is to be heated on private properly,describe the ❑ General Mules((gin,Water,Sewer,etc.)
type&use: 0 Street (flan,I rnfile
---__. _-- —_---.-- ❑ Water,Storm and Sanitary(Plan Profile)
❑ Wirer Qualm.Facilities
O Grading
O 1»mdscapingfTree Plan
O Composite Utility Plan(Electrical,Phone,Gas, Storm,
Sanitry,Water,Signate,Street I.ights,etc.)
❑ Detail.
❑ Tr.tfik Sight Distance
❑ Signing and Striping
❑ Street taught Plan and Phu ometnc
❑ Engineers
❑ Sheet label(project land use name,revision and plan
log block,dates and sheet numbers.)
O Engineer's Construction Estimate
Additional Submittals
(per land use modinonc,if applicable)
❑ •fratlic Report
O Sturm water Drainage Calculations
❑ Geuu•chmr.d)(Ton
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
O Pathway Design
❑ Valet Provider•Approval
•
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