PFI2022-00206 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12022-00206
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/19/2022Parcel: SEG1869
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Portland&Western Railroad Crossing Rehabilitation
Project Description: SEG 1869/Rehabilitate Bonita Rd Railroad Crossing
Class of Work: FEES
Type 1 -Utilities(gas, electric,data) Description Date Amount
PFI Permit Fee 05/17/2022 $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.tiqard-or.qov to schedule inspections online.
Contractor:
PHONE:
Applicant:
JASON SIMS
1200 HOWARD AVE
ALBANY, OR 97321
PHONE:5039307721
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: HPollard
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12022-00206
Type: Condition Name: Status: Severi :
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.
PFI_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-TEMPORARYPATCH 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, <Trent Brickey>at
<971-228-9269>,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 -PERMITIPLAN 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 corners, 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
City of Tigard PFI#: PF12022-00206
ENGINEERING DEPARTMENT
• , Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORN
Project name: Portland &Western Railroad Crossing Rehabilitation
I ❑ TYPE i—Franchise Utility Wadc
Brief description of project: Rehabilitate Bonita Rd Railroad Crossing performed byNWN,PGE, or utility
agency
❑ TYPE 2—ROW Sidewalk/Din ewzy/Sewer
Work performed for the purpose of.
• Sidewalk installation or repair
• Dm-eway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
Location (address if available): Bonita Rd - Tigard OR main line tap
❑ TY3—Full Scale Development
Portland&Western /TriMet Railroad Tracks PE
performed with laud use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Streetwidening
Name: Portland &Werstern Railroad • mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tignd
Dimling address: 1200 Howard Ave water service area
City/State: Albany, OR Zip: 97321 O TYPE 4—Small Cell Technology
Phone:
503-930-7721 ❑ TYPE 5—Tigard Triangle
Email: jsims@gwrr.com Phone: 503-930-7721
NOTE: Type 1 and 2 applications may be
Contact name:
Jason Sims emailed to rowpermits t ard-oneov.
Phone: 503-930-7721 Ems: jsims@gwrr.com
CONTRACTOR INFORMATION ❑ Same as applicant
Name: Portland &Werstem Railroad CCB Number:
1200 Howard Ave 97321
1\Iailitzg address: City/State: Albany, OR Zip:
Phone: 503-930-7721 Email. jsims@gwrr.com
ENGINEER INFORMATION
Name: Jason Sims
1200 Howard Ave Albany, OR 97321
Mailing address: City/State: Zip:
Phone: 503-930-7721 Email: jsims@gwrr.com
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000):$ N/A (within the public tight-of-way)
Is work related to a LAND USE DECISION? ❑Yes ❑No Case number. N/A
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 501-718-2421 • 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 Tn1C 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 die applicant
are different people,the applicant must be the purchase of record or a lessee in possession with written authorization from the owns
or an agent of the owner. The owner must sign this application in the space provided or submit a written authorization Hath this
application. Franchised or Licensed Utilities are not required to obtain the owmei s signature on the application.
I,the applicant,certify that:
• To the best of my knowledge,all die 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.
gadq,/Z, Jason Slms 5-13-22
Applicat s or authorized agent's signature Print name Date
N/A NIA 5-13-22
Property owner's signature (if required) Print name Date
ra
Case No: PFI2022-00206 Permit fee: 'r,300, Oa Received by: NT Date: _-�YV
.approved by: 7-~ Date: 51r7 I&Z7— Notified bv:�_Date:
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 PFI 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 ONLY • ' STAFF USE ONLY
TYPE 4: SMALL WIRE LESS FACILITY TYPE 1-3:DETAILED SUBMITTAL
REQUIREMENTS
CHECKLIST
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 ❑ Dimensions
considered?(check all that apply): ❑Small Cell ❑Dlacro ❑ Street Name
El Site Address
Hoag many install sites are proposed as part of this permit
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 ❑Private Property .
❑ Cover—Site, %ri rcnnity,Abbreviation,Legend
If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sew",etc.)
type&use: ❑ Street(Plan,Profile)
❑ Crater,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
❑ 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 mater Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design
❑ Water Provider Approval
Cityof Tigard 13125 S\C'Hall Blvd. Tigard,Oregon 97223 www.fgard-or.gov • 503--18-2421 • Page 3 of 4
I
MINIUM SKEWH REQUIREMEWFS (Put N/A if not .pp
North arrow Property lines&dimensions Existing utilities locations
(sewer,storm,water)
Street&street names ?.11 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
Cite of Tigard • 13123 SW Hill Bh-d. Tigard,Oregon 97223 • wvw.tigard-or.gov • 503-718-24-11 • Page 4 of 4
D&H Flagging, Inc.
1621 SE Pardee St Portland,OR 97202 OhM
Phone: (503) 232-2488 Fax: (503)234-4572
www.d-hllagging.com
MWESB -DBE-WBE Certified in OR&WA
DBE OR-478 DBE WA-D2F5011213
CCB#216371
May 3, 2022
Portland & Western Railroad
Attn: Rick Southerland
Job Location: SW Bonita Rd& SW 74th Ave-Tigard
TSS Pre-Warning(1 Week)
(48"X36") Custon Pre-Warning Sign 2 @ $172.00 ea $344.00
Metal TSS Stand 2 @ $22.00 per week $44.00
Delivery/Setup 1 @ $165.00 per trip $165.00
Estimated Pre-Warning Costs**: $553.00
Weekly Closure Rental:
Item Qty Rate Term Total
48"x48" Sign 14 @ $32.00 Per Week $448.00
28" Cones 15 @ $5.00 Per Week $75.00
Type II Barricade w/sign 7 @ $28.00 Per Week $196.00
Type H Barricade w/sign& custom rider 15 @ $54.00 Per Week $810.00
Type III Barricade 6 @ $24.00 Per Week $144.00
Type Ill Barricade w/sign 3 @ $47.80 Per Week $143.40
Delivery/Setup i @ $330.00 Per Trip $330.00
Pickup 1 @ $330.00 Per Trip $330.00
Estimated Weekly Rental Cost**: 2.476.40
TCP Costs:
Traffic Control Plans 1 @ $250.00 Per Site $250.00
TCP Additional Pages 3 @ $100.00 ea(up to 5) $300.00
Estimated TCP Costs**: $550.00
Estimated Project Total**:
i(Pre-Warning+Weekly Rental+TCP Costs)
"This job estimate is based on above estimated hours and equipment. Final job cost billed will be based on actual
hours worked and equipment used.
We have a 4-hour minimum call out. If you need to cancel,please call at least 2 hours before start time to avoid the 4-hour
minimum call out fee.
D&H Flagging does not handle any permitting.It is the contractor's responsibility to obtain any and all permits
required by government regulatory agencies.
If you have any questions,please contact Matthew Eagar at(503)232-2488.
—Pricing Sheet Addendum—
Scheduling
All Scheduling is handled through our dispatch by telephone only C(503)232-2488.For after hours emergency scheduling press 2 then leave
a message with a call back number.Third party(including other D&H employees),fax,voice mail,text,mail&/or e-mail requests are not
accepted. Please have information ready(including specific D&H Flagging traffic control plan#if applicable).
Overtime
For Private.Highway,and Union Wage,overtime will be billed after eight(8)hours of work,at night(6PM-6AM),and on weekends.We
bill holiday rate for work on holidays listed below. For Prevailing Wage projects,overtime will be billed per the State's Prevailing Wage
regulations.
Per Diem
Per Diem for meals and lodging is billed on jobs any time it is sensible for D&H employees to stay away from Portland overnight. Per Diem
rates are based on GSA recommended rates for lodging,meals,and incidentals.
Mobilization
Mobilization is billed on jobs located(1)hour or more from our Portland location at 1612 SE Holgate.OR(per Google Maps).Mobilization is
calculated based on fuel plus employee drive time(at D&H private rate),and shop time when applicable.
Mileage
Mileage is applicable when flaggers must travel in their personal vehicles to several job sites for one contractor in the course of a workday.
Flaggers are reimbursed at the Federal mileage rate,and the contractor is billed at the same rate. Mileage is not billed when the contractor has
requested a truck for the job.
Four(4)hr Minimum
Four(4)hour minimum will be billed for all employees starting at the time of arrival on the job site unless the contractor cancels at least 2
hours before the scheduled job start time.For jobs cancelled upon arrival to the site,a charge may be assessed to recoup fuel charges for D&H
vehicles dispatched.
Traffic Control Plans
City,state.and county regulatory agencies frequently require computer generated traffic control plans to be submitted for approval before
commencement of work.D&H Flagging TCPs start C$250.00 minimum per location,plus S IDD per additional page(required for multiple
setups and/or extended work areas)up to(5)additional pages.D&H guar-antees approval of TCPs by regulatory agencies,however if revisions or
additional pages are required because of changes or lack of information/communication by the contractor,a SI00 revision fee may be charged.A
minimum of 3 business days notice is requested to guarantee TCP completion.We reserve the right to charge an emergency rush fee of up to
5250 in addition to the TCP charge to cover overtime if earlier turnaround is imperative.
Equipment Delivery/Setup/Pickup/Teardown or Checkup
A 5165(5230 during OT boors)minimum delivery,pickup,setup,teardowv,or checkup fee will be assessed in lieu of employee wages and
truck charge forjobs involving equipment rental only.Also for any request in addition to original scheduling that requires an additional employee
to drive to and from the work site.
Special Equipment
Items not included on the quote sheet will be provided at the market rate at the time of service.
Administration Fees
Requests that require excessive time and attention of office staff may be subject to an administration fee(Safety Management Plans.Journey
Management Plans.special billing requirements,etc.).This fee will be based on the nature of the request and time involved.
Site Visit Fee
If we are requested to attend on-site meetings there may be a S 100 fee per employee.Mobilization may also be added if the site is more than 1
how away.
Holiday
For Private and Highway Rates:Holiday Rate will be billed on following days:New Year's Day,Memorial Day,Independence Day,Labor
For Washington Prevailing Rates:Sunday and Holiday Rates will be billed per Washington Prevailing Regulations.
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t(� a Email: plan lk"fia,,ingcem
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Email: ricxard.sourlandWgNrr.mn
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„ HEAD FLAGGING Job L4eallan: SW%nila Rd 6 SW Tall,Ave
City.Sial.: Tigrd.OR
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Equipment List Notes
L Maintain R-minimum lone width M..to traffic gall limas
6 R.it Work Ahead 2_ Down spacing at 25 MPH I Toper•20'1 Tangent•20'1 Corner/Acces3/811tal•101
2 Rod Closed Ahead ltTNl 3. Adjust devices as met buslnHs•ntranem its am at affected
e
2 Read Closed
Ahead SN BONITA RD 4. All traffic control shell adhere to current MIITCD[ODOT The Drawing guidelines
2 Detour Ahead S. Adjust to Bald conditions
I Right Tum Leon Closed Ahead
1 flight Tum Len•Closed
5 Type ll-SW BONITA RD+Dufour(�)
4 Type ll-SW BONITA RD.Dal 6^I
2 Type ll-See BONITA RD-Detour(1)
4 Type ll-Set BONITA RD•End Detour
1 Type 11-No Rlghl Turn
4 Type ll-Sidewalk Closed NOTE InWl i nen,In
2 Type 11-Sidewalk Closed Ahead ad•ISna atm&
I Type ill-Road Closed a Detour()
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