PFI2021-00449 City of Tigard PFI#:
ENGINEERING DEPARTMENT 2021-00449
. Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
ec
Pro t name: 00028164
� F—, TYPE 1—Franchise Utility Work
performed by NWN,PGE, or utility
Brief description of project: Cutting gas services to both locations below. agency
Gas main is 16'west of center line. Two 4'X 5' hard surface cuts. F— TYPE 2—ROW Sidewalk/Driveway/Sewer
We hope to complete work ASAP. Work performed for the purpose o£
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
9640 SW Greenbur #Hse &#Church, Tigard main line tap
Location (address if available): 9 9
F TYPE 3—Full Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Streetwidening
NW Natural • Mainline installation for sanitary sewer,
Name: storm sewer, Tigard water, and Tigard
Mailing address: 250 SW Taylor St water service area
City/State: Portland, OR Zip. 97204 I— TYPE 4—Small Cell Technology
Phone:
971-979-9615 F— TYPE 5—Tigard Triangle
Email: law@nwnatural.com Phone: 971-979-6047 NOTE: Type 1 and 2 applications may be
Contact name:
Jennifer Wood emailed to rowpermitsp_dgard-or.gov.
Phone: Email:
CONTRACTOR INFORMATION 0 Same as applicant
Name: CCB Number:
Mailing address: City/State: Zip:
Phone: Email:
ENGINEER INFORMATION
Name: Richard Girard
Mailing address: Same City/State: Zip:
Phone: 360-921-0314 Email:
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.
J:!" r`''B"''"'0,-'s Jennifer Wood 12/17/21
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: Permit fee: Received by: Date:
Approved by: Date: Notified by:---j-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 Pen-nit Fee).
WATER LINE 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 I No TYPE 1 AND TYPE 2-Must include a sketch
showing:
Under the wireless facilities standards,is the proposal
L Dimensions
considered? (check all that apply): Small Cell Macro
F Street Name
How many install sites are proposed as part of this permit E 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 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
L Street Light Plan and Photometric
F 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)
L 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
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REQUIREMENTSTYPE 1 AND TYPE 2:
MINIUM SKETCH 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
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2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs "Buffer" \ Z CQ C
Speed A B C Space V C W O
20 SO ZOOCQ O
25 100 100 100 75 O ...
30 100
35 40 350 350 350 125
150 p Y
45 180 O O
50 500 500 500 210 Q
55 250
60 285
65 700 700 700 325
70 365
September 2016 Chapter 5
Page 84 2011 Edition
Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a two-lane, two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT)with good
sight distance as discussed below.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3— Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340— Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4) should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the "Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. 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 are expected.
Chapter 5 September 2016