PFI2022-00002 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12022-00002
Date Issued: 01/20/2022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S103BD00400
Jurisdiction: Tigard
Site address: 11850 SW WALNUT ST
Subdivision: None Lot: None
Project: AKS PFI for 11850 SW Walnut St.
Project Description: Storm and sanitary laterals for replacement home
Class of Work: FEES
Description Date Amount
Type 2-Sidewalk/Driveway Approach
PFI Permit Fee 01/14/2022 $350.00
Total $350.00
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.00v to schedule inspections online.
Contractor:
PHONE:
Applicant:
BILL WAGONER
12700 SW CORNELL RD
PORTLAND, OR 97229
PHONE: 5039801708
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 44LL
applicIssued By: &4^L
� U
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2022-00002
Tvue: Condition Name: Status: Severity:
PFI—Sidewalk/1 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/1 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/1 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/f 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/1 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/1 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/1 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/1 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/1 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/1 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/1 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
holders 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/f 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/1 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 an inspection, use code 738
PFI_Sidewalk/f 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/1 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/f 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector.
PFI—Sidewalk/1 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/t 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/1 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/t 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/f 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
City of Tigard p 4 �xw :. �..
s ENGINEERING DEPARTMENT
Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TXPE OF WORK
Project name: 11850 SW Walnut Street p TYPE I—Franchise Utility Work
Brief description of project: Storm and sanitary laterals for performedbyNWN,PGE, orutility
�y
replacement home E2—ROWSidewalk/Driveway/Sewer
Work performed for the purpose of
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
Location (address if available); 2SI03BDO0400 main line tap
❑ TYPE 3—Pull Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widerung
Name: Westwood Homes, LLC •Mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tigard
Mailing address: 12700 NW Comet) Road water service are'
City/State: Portland/Oregon zip. 97229 o TYPE 4-StnaUCell Technology
Phone:
(503) 980-1708 ❑ TYPE5—Tigard Trtarq4e
Email:$illCei westwoodhomeslle.00m phone:(503)980-1708 NOTE: Type 1 sad 2 appHcadons may be
Contact name: Bill Wagoner emailed to mLjts ' *d-or.gov,
Phone: Please contact AKS Email: Please contact AKS
CONTRACTOR INFORMATION ❑ Same as applicant
Name; TBD CCB Number-
Mailing address: City/State: Zip:
Phone: Email:
ENGINEER INFORMATION
Name: Paul Sellke, PE, GE - AKS Engineedng&Forestry, LLC
Mailing address: 12965 SW Herman Rd Unk#100 City/State: Tualatin/OR Zip:97062
Phone: (503)563-6151 Email: pauls(a]aks-eng.COm
ADDITIONAL INFORMATION
Estimated value of work is required(if over 55,000):$ $5,000 (within the public right-of-way)
Is work related to a LAND USE DECISION? 0 Yes Vlo�o Case number: i
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page I of 4 E
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.
* U ith the exception of a utility operating pursuant to a valid franchise or license with the City of 7gard,when the owner and the applicant
are different people,the applicant must be the purchaser of record or a lessor 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 f icrnsed Utilities are 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.
• I£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.
31zz z r
Applicant's or authGWzed agent's signature Print name Dat
Property owner's signature(if requited) Print name Date
E
STAFF USE
ONLY
Case No: PF12022-00002 Permit fee `�c • : Received by: SPU Date, 11412022
Approved ate:by: 7' t �� > Dy j
k�� !/t , !_[�1_1__ Notified b -�_� Date=_
s
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www.ugard-or.gov • 503-718-2421 • Page 2 of 4
11850 SW WALNUT ST UTILITY IMPROVEMENTS
PUBLIC UTILITY IMPROVEMENT PLANS �� 7
DEVELOPERIOWNERV
WWAMMW} __-- WE9WOOD HOMES.LLC
CONTACT:BILL WAGONEReg F
-� 12700 HM CORNELL RD
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CIVIL ENGINEERINGISURVEYINGIARBORIST y p
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"= r CONTACT.PAUL SELLNE,PE,OE Z IL
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PRD.IKTWMIE 12965 SW HERMAN ROAD,SHIITE TOO Lu 2
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EMAIL PAULs4MN5-ENG.0011 .J >
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ARAGE 13125 SW HALL BOULEVARD Q.
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CONTACT.
PROPOSLG CONTACT:SMI MOMASOM
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VICINITY MAP P1 A 65e Mt Brum,a 97223 r F ¢�
CONTACT ROB BLOCK `s
PH:503639.4171 H?
PROJECT LOCATION
LEGEND 11850 SW WALNUT ST,TIGARD.OREGON
TAX LOT 301
D25DtIF E P?1MBSEIII TAX LOT 602 TAX W MI.M
pmwe O Q avp 50.,50 ar�x wr TM WAP ainro EXISTING LAND USE
p•wp.s se spd p.W Gip e a • YAW LOT
spa ptW.Wn opN . W
rN�xw••n • sm AW V•19L p • W
mr r = Gs•o o e PROJECT PURPOSE _
rrzx•IN Gx vnn • PUBIC UTILITY IMPROOEMEMI TO SERVE REPLACEMENT HOME
uip wtiv[ w a.R ra» r— — ON TAY LOT 40D N
p]BL LIWI•lW • . unnr wr a • ��'.
.w m[n4 VlW 4 r/ Nnp war OU m —' TAX LOT 11900 VERTICAL DATUM L2.1
smTrrao Wnp ort o ^�uea ep IM s
WAIT Mall ELEVATIONS ARE BASED ON WASHINGTON COUNTY BENCHMARK
vr•rr.m vw[ O • rpa NAY. a NO.169,LOCATED AT THE SE COINER OF SW 115TH AVENUE O
ep r www�npn vMlT
MW m Uv AND SW TGARD DRII ELEVATION-IBORR FEET(NCVD 29).
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"°• .� SITE MAP SHEET INDEX
LEM PROPOSED _14I
CD DOVER SHEET
Cl CENTRAL CONSTRUCTION NOTES
C2 EXISTING CONDITIONS PLN
C3 POEM UTILITY IMPROVEMENTS PLAN
aw C1 PUBLIC UTILITY CONSINUCTOM OTNLS R
C5 STREET CONSTRUCTION DETAILS C•Ten
M IT..0 T ——— C6 EROSION CONTROL AND TREE PROTECTION AND REMOVAL PLAN
0i4p1 "---''"" C7 TREE PRESERVATION AND REMOVAL TABLE
CB EROSION CONTROL DETAILS
...................
____—___-- _ ATTENTION EXCAVATORS: meq.
as Mro a A
NOTE: THIS DESIGN COMPLIES W1N UPS 92.D44(7) OREGON LAW REOIRES YOU TO FOLLOW RALES ADOPTED BY THE
IN THAT NO UTILITY INFRASTRUCTURE IS DESIGNED OREGON UTILITY NOTFICATXIN CENTER THOSE RULES ME SET FORTH
____�___ T
rm up TO BE WITHIN I-FOOT OF A SURVEY MONUMENT IN OAR 952-001-0010 THROUGH OAR 952-ODI-0090.YOUWY
us up F ___ ___.•_ LOCATIONSHOWN ON A SUBDIVISION OR PARTITON OBTAIN COPIES G THESE RUGS FROM THE CENTER BY CALLING E
= Sip•Opp pM ________ _�— PAT.NO DESIGN MODIFlCATION OR FINAL FIELD 503-232-1987,IF YOUHAVE ANT JJEST NS ABOUT THE RULES. D6 WABFR
LOCATION CHAINS SHALL BE PERMITTED E IT YOU MAY CONTACT THE CENTER.YOU MIST MODIFY THE CENTER AT 9137
____•,____�_ _� �_ WOAD CAUSE ANY UTUTY INFRAMINICTUNE TO LEAST PMI BUSINESS DAYS BUT NOT MORE THAN TEN BUSINESS III wN,nbelOW.
•vm up BE PLACED WITHIN A PROHIBITED AREA. DAYS,BUM COMMENCING AN EXCAVATION.CALL 503-246-6699. Cd9 bMiore you tlg. 4m
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Submittal
Am Transmittal
AKS Engineering & Forestry LLC 1 12965 SW Herman Rd. Suite 100 Tualatin, OR 97062
FROM: Kathrine Lindsey
AKS Engineering & Forestry LLC TO: rowpermits@tigard-or.gov
12965 SW Herman Rd. rowpermits@tigard-or.gov
Suite 100
Tualatin, OR 97062
lindseyk@aks-eng.com
503-563-6151
PROJECT: 11850 SW Walnut St - Tigard DATE SENT: 1/4/2022
9137
SUBJECT: Public Facilities Improvement (PFI) ID: 00003
Permit
PURPOSE: As Requested VIA: Info Exchange
REMARKS: Hello,
Attached via link, please find the electronic submittal copy for 11850 SW
Walnut Street PFI permit. Please let me know if there is anything else
needed.
Thank you,
Kaathhrine Lindsey E
AKS ENGINEERING & FORESTRY, LLC
12965 SW Herman Road, Suite 100 1 Tualatin, OR 97062
P: 503.563.6151 Ext. 208 1 www.aks-ena.com I LindseyK@aks-ena.com
Offices in: Bend, OR 1 Keizer, OR I Tualatin, OR 1 Vancouver, WA
NOTICE: This communication may contain privileged or other confidential
information. If you have received it in error, please advise the sender by reply e-
mail and immediately delete the message and any attachments without copying or
disclosing the contents. AKS Engineering and Forestry shall not be liable for any
changes made to the electronic data transferred. Distribution of electronic data to
others is prohibited without the express written consent of AKS Engineering and
Forestry.
CONTENTS
QTY: DATED DESCRIPTION: ACTION:
1 12/29/2021 9137 20211228 CoT PFI App.pdf
QTY: DATED DESCRIPTION: ACTION:
1 12/30/2021 9137 20211228 Walnut St
Replacement Home, PFI Plans.pdf
Page 1 of 2
Submittal Transmittal
DATE: 1/4/2022
ID 00003
COPIES
Jeremy Tamargo (City of Tigard)
Paul Sellke (AKS Engineering & Forestry LLC)
Page 2 of 2