PFI2022-00056 MP-q City of Tigard PFI#:
ENGINEERING DEPARTMENT 2022-00056
— .P1 .
TIGARD Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project name: 3670997
F—, TYPE 1—Franchise Utility Work
Brief description of project: Reline 63' of 3/4"(w) with 1/2"(p) and performed byWN,PGF, or utility
agency
install 1 800 efv at main and 1 800 efv 33' from EFV at main F TYPE 2—ROW Sidewalk/Driveway/Sewer
due to leakage. 1 4x5 and 1 2x3 hard surface cut required. Work Performed for the purpose of:
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION Sanitary sewer lateral installation and
Tigard OR 97223 mainline tap
12490 SW Main St, Ti
Location (address if available): 9
F TYPE 3—Full Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Name:
NW Natural • Mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tigard
Mailing address: 250 SW Taylor St water service area
City/State: Portland, OR Zip: 97204 F TYPE 4—Small Cell Technology
Phone:
971-979-6460 F TYPE 5—Tigard Triangle
Email: nwnpermits@nwnatural.com Phone: 800-882-3377 NOTE: Type 1 and 2 applications may be
Contact name:
Christine Barton emailed to rowpermitsg igard-or.gov.
Phone: Same Email: Same
CONTRACTOR INFORMATION CEJ Same as applicant
Name: CCB Number:
Mailing address: City/State: 97062
Phone: Email:
ENGINEER INFORMATION
Name: Rich Girard
Mailing address: Same City/State: Zip:
Phone: 360-921-0314 Email: r2g@nwnatural.com
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000):$ (within the public right-of-way)
Is work related to a LAND USE DECISION? —Yes —No Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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
are 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 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.
• 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.
Ch>y'%W"iR13a*-t&n Christine Barton 1/28/2022
Applicant's or authorized agent's signature Print name Data.
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: Permit fee: Received by: Date:
Approved by: Date: Notified by: 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).
WATERLINE CONSTRUCTION FEE
Part 3: All public water system improvements engineer's estimate X 12%.
FOR STAFF USE ONLY • ' STAFF USE ONLY
TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Does applicant have a right-of-way license? I 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): I Small Cell Macro
F_ Street Name
How many install sites are proposed as part of this permit
C 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 I Private Property
L, Cover—Site,Vicinity,Abbreviation,Legend
If equipment is to be located on private property,describe the L General Notes(City,Water,Sewer,etc.)
type&use: L. Street(Plan,Profile)
L Water,Storm and Sanitary(Plan Profile)
L Water Quality Facilities
L. Grading
L. Landscaping/Tree Plan
L Composite Utility Plan(Electrical,Phone,Gas, Storm,
Sanitary,Water,Signage,Street Lights,etc.)
L Details
Traffic Sight Distance
L Signing and Striping
E Street Light Plan and Photometric
Engineers seal/signature
F_ 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
C Storm water Drainage Calculations
L Geotechnical Report
L Preliminary Access Report(Sight Distance)
L Proposed Plat
Pathway Design
L Water Provider Approval
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4
Edge of Pavement
-44— Ditch op
Streetlight I ------------- —r---
� I
' T��i'o'p'os [f'Se1�werTife"� I
I ;i Existing House
I I v� I Existing
�r driveway
C1 r 1i
ELI '
0, 1
a IEL
IJ Existing Shop I
Powerpole 1 I = 1 4
I� I
I 7roper-E Line-------- --
i
I I Fire Hydrant(F H)
� � I
Scale: I"=30'
� I I
TYPE 1 AND TYPE 2:
MINIUM SKETCH REQUIREMENTS (Put N/A if not
� I I
� I I
� � I
pp
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 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4
Re-line 314"(W)service and WO#3670997/PLAT 1-043-020
Install 1 800EFV at main �� 12490 SW Main ST, Tigard
# and 1 800EFV 33'after EFV Reline 63' of 3/4"(W) service Due to
as \ at main in side walk leakage and install 1 1300EFV at main and
1 at 33' from efv at main in side walk.
This service feeds 2 customers that
share a building with a double meter
at building.Add#12490 and#12492
Current service is under pond
1 with large rocks at front of
building
rs
_11b '41Z
r,Q
.
Ft4 r P0. )0 h
•' STP. S$J R
r" '� a11P
i NW Natural
CROSS SECTION DETAILS
Comments: Number of cuts: 1 AC cut 1 Concrete cut
NLB/FS2 WO#3670997 1-4x5 AC cut over main and 1- Size of cuts: 4x5
4x5 Cut in concrete walk Over main: Y
Over other utilities:
Street name: SW Main ST
Direction Facing: West
All dimensions are in feet unless otherwise stated.
Line depth is not known or specified on figure.
Paving Symbols:AC-Asphalt, E-Earth, C- Concrete, G- Gravel
Section Symbols: PUE-Public Utility Easement, ROW-Right of Way, EOP-Edge of Pavement
SW Main ST
0 0 0 0
LU w 0-1
70
C u asphalt asphalt r C E C
SOUTH 14' 2' curb 15' 17' curb 2' 6' 1 7' 1 6.5' NORTH
EXISTIN 24.5'
4"(W)
Page 118 2011 Edition
Lane Closure at Intersection with Flagging Diagram 620
Diagram 620 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging, traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance (see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. There should be one flagger for each approach. One flagger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections (fewer than 400
entering vehicles per day), one flagger may be used.
4. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues may be expected.
Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs Buffer
Speed A B C Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 119
Lane Closure at Intersection with Flagging Diagram 620
ROAD
%VW
AHEAD
ONE LANE C l t
(ppSiWTe�l ROAD
ANEW
BE B
PAEPAREO
TO STOP
CB
A (pptional}
E IANE
ROAD
100 R Mac PREPARED ROAD
TO STOP MRK
AHEAD
A S B C
Buffer
IDO2 rwa:,�
C B B A
ROAD BE
WORK PREPARED
AHEAD TO STOP I OO IL MU.
WLM
RaAn 1111■11{
ANBW
(°°°°nary A
B
PREP
70 STOP
B {ppuw.ry
ONE WW
ROAD
WORN
AHEAD
December 2011 Chapter 5
K&D Services,as the preparer of this traffic , / ROAD tr/,. ROAD ..
control plan makes no representation as to its' , WORK �f��, WORK 1. Maintain Ped.access to
general adequacy or being approved for implementation. / AHEAAHEAD and through crosswalks
Approval must result from the Traffic Engineer or / / , ql� , and or sidewalks.
other Public Official having statutory enforcement authority / / 100 100 2. Maintain Min. 10'lane
in the jurisdiction.Utilization and implementation of this / / trlr BE 3. Maintain Local access
plan shall be a result of that approval. PREPARED
Ref.MUTCD 2009 6A-01 10 / BE ro sroP 4.Traffic Control Plan and all
' PTO STOP D R 9y devices shall comply with the
CUSTOMER: / '
2009 MUTCD and OTTCH 2011
NW Natural ' 100' 1 Q' standards.
5. Device spacing:
CONTACT: Nate Burke , ' • Flag taper 20'
503-476-2670 / All other tapers equal to the
posted speed.20'min.for tangent
LOCATION: ' , tS/w � 6.28"cones
/ Iv�� 36" barrels
48"signs w/
12490 SW Main St / ' O06. 7.Cover stop siglns ags and/or disable
Tigard, OR Monitors To Assist S't' 100' 5 lights when at a controlled intersection
8. Place No Parking signs 48 hrs in advance.
DATE: W/O# Pedestrians Around 9.Adjust to field conditions.
2/16/22 3670997 QaG��� Work Area
Designed By: Rene Solis Gjv_ ' Gj� SPEED
OR TCS#05936 Main:503-723-7287 Ext 1014 / LIMIT
Direct:503-465-498 Cover Stop Signs 20
ORTCP KNDSERVICES.NET / to Flag Intersection <
K & D SERVICES , .� Inventory
TRAFFIC MANAGEMENT /
PLEASE SCHEDULE WITH DISPATCH 4 DAYS IN ADVANCE �!
AND PROVIDE A COPY OF THE APPROVED TRAFFIC < ill 4 x ROAD WORK AHEAD
CONTROLPLAN
503-723-7287 1 1 x RIGHT TURN LANE CLOSED AHEAD
Monitor � � SC-'\111
F 4 x BE PREPARED TO STOP
/ ' R
` 1
100' 3 x FLAGGER AHEAD
' 5 x FLAGGER
12490 s� '� 1 x MONITOR
�4 1 30 x Cone
' SLIMTD . 5 x No Parking
30 100'
BE
LLQ 100' PREPARED
Legend TO STOP
SPEED ROAD WORK AHEAD
LIMIT
11 20 11 5� RIGHT TURN LANE CLOSED AHEAD 100'
BE PREPARED TO STOP
100' FLAGGER AHEAD TUCRIGLANE
HT
RCLOSED
AHEAD
FLAGGER
BE
PREPARED MONITOR
TO STOP
Cone
� 100'
100'
No Parking
ROAD
WORK
Bike Route AHEAD
ROAD Driveway N
WORK
AHEAD y§ Crew Truck
W"JE
Dump Truck s
NOT TO SCALE
NOTIFY EMS,FIRE
.ski� Excavator AND POLICE
72 HOURS IN ADVANCE