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PFI2021-00133 o CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2021-00133 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Data Issued: 04/26/2021 Parcel: 2S111 DB07600 Jurisdiction: Tigard Site address: 15495 SW ALDERBROOK DR Subdivision: SUMMERFIELD NO.7 Lot: 370 Project: Crutchfield Pod Project Description: Encroachment permit for a pod container for 5/21-5/24 and 5/28-6/01. Class of Work: FEES Type 1 -Utilities(gas, electric,data) Description Date Amount Encroachment Permit 04/22/2021 $25.00 Total $25.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at LAtioard-or.aov to schedule inspections online. Contractor: PHONE: Applicant: EDNITA CRUTCHFIELD 15495 SW ALDERBROOK DRIVE TIGARD, OR 97224 PHONE: 5036849116 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: XA�L�— Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00133 Tvce: Condition Name: Status: Severity: PFI_Utilities 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_Utilities 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. PFl_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 19-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>,to establish a preconstruction meeting. PFI_Utilities 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_Utilities 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_Utilities 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector. PFI_Utilities 23-MONUMENT PROTECTION Applied Notice Existing monuments, property comers, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28-AS-BUILT DRAWING 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). 1,2,3,4,5 28-AS-BUILT DRAWING 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). 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_Utilities 31 -OTHER Applied Notice Other 1 City of Tigard Permit ts:E1Z=-00I33 i l;'i(ilti'I'.I .RI\( j 1'l�lil. l ( \V "IlK4 Temporary T;ncroachmcnt Permit for Furnishings dZ An lincroachmcnt Permit is requtrrd anytime a pmh;ur p:mwants ut put uxncthing to the City's right-of-way,such I as placing tables and chain on a 0". sidewalk. Prior at placing;the encroachment,a permit must be obtained from the city. Upon receiving;an application for tcmporaty cnct. ochnicnt, the city will issue a tentative temporaty J permit. The (Dilative etatus will allow the applicant Igo place the cnn e ,achmcntc in the ROW pending rcvieac by the (;itv. If the 0ty dctcnninc,, that the applicant lift, not c+rmplicd with,rNl(' 15.16,the City will contact the applicant Z„make changes,"11tc• applicant agrees to respond to requests b} the City fern ad<litional information and it, make any changes requested by the•City. Failure to respond to a follow-up request Is•the City within a timely manner will ascan denial of the application. '111c•City will contact UI.(,(. to inform the agency of any application denials.Tltc j I'm'will base its review on ensurint;the-safety of all users. BUSINESS NAME: REQUIRED INFORMATION f - Narrarivc regarding;propnscd use and encroachment into public right-of-way. Narrative must include ntrrttber and size of tables,chairs, benches,sux)is,etc. Also explain how ADA accessible route will be maintained thmugh rigbt-of ioviy.The ADA route Miall be a harrier free S wide area."chis area cannot be used j for fumishings or patron queuing/waiting areas. Site plan / sketch showing encroachment, ADA accessible route,patron queuing and waiting areas,and furnishings with dimensions. Site photos of J cig;ht-of-w•av showing arca of proposed encroachment. APPLICA-NI T / PROPERn' OWNER INFORMATION ' 11s Applicant Sarnc as Property Owner' 1'es 13 N Applicant Narnc._UN;IrA Givi V6 Proivrt� () vncrName: Appiictnt Address:�S`I� SW 1t)a s-uo Prolxrn• Address: Citt: 'r. t3lw._ __ S(atc: 0?Z Gip: 722 { Ctn: State: ,__.. Zip: Phont: O (� ,q , 1 Io Phone: ):mail: r 0 n- cel_ Qz� ticy;� <,o,,n Email: THIS ENCROACHMENT PERMIT IS SUBJECT TO THE PROVISIONS OF Tigard Municipal Code Chapter 15.16. I certify that the information provided in this application is true and correct to the list of my knowledge. 1 - h •e read, and I ee to be bound by Tigard Municipal Code Chapter 13.16. /llap',ic:tnt Si;;n.%tort int Name of Applicant: �r)t��` G\\N��h� Prt,lnm Uyvneri m:tt �. t Name of Propertn (hvncr. Received liv. 2 02l Pemlit lee: — I Reviewed by-, Additional Pees: t 1pptxn cd b1°: °�°°:� ,�� Permit FXpires- December �. . 411 ' 31,20?1 T�ttrtl,l got, 4) Wa11 Nled. _ Trent Brickey From: Ednita Crutchfield <ednita.crutchfield@gmail.com> Sent: Tuesday, April 20, 2021 5:17 PM To: Trent Brickey Subject: Pod permit F kL ? 4,41ZJ f O W W 1 w 4q IU r I V [ R IIA zt f Sent from my Whone 1