PFI2021-00292 City of Tigard PFI#:_PFI2021-00292
ENGINEERING DEPARTMENT
Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project name: SW Ash Ave and SW Hill St Main Lowering due to City Project
) F, TYPE 1—Franchise Utility Work
Brief description of project: Lower 19'of 1"(w)main and replace to lower 2 services performed by NWN,PGE, or utility
agency
open trench/see sketch/R00027673 F TYPE 2—ROW Sidewalk/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): 13120 SW Ash Ave main line tap
7 TYPE 3—Full Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
NW Natural-Lorene Nichols • Mainline installation for sanitary sewer,
Name: storm sewer, Tigard water, and Tigard
Mailing address: 250 SW Taylor St water service area
Portland OR . 97204 F_ TYPE 4—Small Cell Technology
City/State: Zip.
7 TYPE 5—Tigard Triangle
Phone: 971-979-6464
Email: eln@natural.com Phone: NOTE: Type 1 and 2 applications may be
Contact name:
Lorene Nichols emailed to rowperxnitsngxieard-or.gov.
Phone: Email:
CONTRACTOR INFORMATION C Same as applicant
Name: Loy Clark Construction Jade Leedy CCB Number: 52281
Mailing address: PO Box 1369 City/State: Tualatin OR Zip: 97062
Phone: 971-806-2841 Email: jade.leedy@loyclark construction.corn
ENGINEER INFORMATION
Name:
Mailing address: City/State: Zip:
Phone: 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.
Lorene Nichols 07/12/2021
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: I 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 Pemn t 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
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
E Traffic Sight Distance
L Signing and Striping
E 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
Edge of Pavement
! -'*— Ditch
Streetl'sght '—•—•—•—.—•—•— —r—•—
,. °
RIM Drikin
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TYPE 1 AND TYPE 2:
MINIUM SKETCH
� I �
� I !
REQUIREMENTSp• -
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
CROSS SECTIONS GENERAL NOTES N
1.Call the following Utilities Notification Center
48 hours prior to any excavation:
Oregon: 811 or 1-800-332-2344 W E
J J Washington: 811 or 1-800-424-5555
CL 2.ATTENTION:Oregon law requires you to follow
O 0) 0) O rules adopted by the Oregon Utility Notification
W �' W Center.Those rules are set forth in OAR 952-001-
0090.You may obtain copies of the rules by calling
the center.(Note:the telephone number for the Oregon
Utility Notification Center is(503)232-1987 or 811).
O *__ 3.Fill out construction sketch as-built supplied with
job packet and return with work order. Only one
as-built is required.
4.All distribution mains must have a minimum depth of
24"and services must have a minimum depth of 18"
unless there is an approved variance.
J J 5.All transmission lines must have a minimum depth of
C 30"in Class'1'locations and 36"in Class'2,3,&4'
p -a N -a N O locations,unless there is an approved variance.
0 0 O 6.Written dimensions on this construction sketch ❑ WELD NOTE:
W W lY W have precedence over scaled dimensions. MAIN NEEDS
7.Pressure test shall be tested in accordance with TO BE 4'DEEP
standards in FOM and Engineering Standard Practice.
_40.0 4-- 8.Test medium for class"B"main shall be air,unless
otherwise noted. Test medium for class"C-F"main
shall be water,unless otherwise noted.
9.For Class C or higher tests,see Design Document and 0�
Hydrostatic Report. x 1.
�xN�N ❑ WELD
CLASS"B" PRESSURE TEST INFORMATION(circle&label test area on asbuilt drawing) �x
TEST BY NNG --OTHER
ON OFF
A
B 0 REPLACE IN RM/XD
0 475 EFV
C
Q RELINE INSIDE PROPERTY
D
E
F
REPLACE IN RM/
3'NORTH AT 0+63&3'DEEP
Q 475 EFV
0 RELINE INSIDE PROPERTY
WELDS
X- CERT. OPER. PM PM
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY# ORDER# `
INSTALL 19' 1" W B API 5L B .133 60 57 45 114 03657535
OOS 19' 1" W B N
00
00
NW Natural
Engineering Department
ADDRESS CITY COUNTY STATE DESIGNED KDB DATE 07/01/2021
SWASH AVE& SW HILL ST TIGARD WASHINGTON OR DRAWN KDC DATE 07/06/2021
BETWEEN AND
SWASH DR SW HILL ST APPROVED R2G DATE07/09/2021 VARIANCE (S)
NAME CREW LDR. DATE
SWASH AVE TIGARD PLATTED DATE
PLAT TWN RNG SEC PIPELINE ID- JOB TYPE:
PUBLIC WORK MAINS
1-044-020 T02S R01 W SE 2 PM#: PROJECT/REVISION#
03657535 00027673
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
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
pC C
Speed A B C Space
20 50 z�Q
25 100 100 100 75 0 O
30 100
35 40 350 350 350 125
150 p Y
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45 180 QOO=
50 500 500 500 210 Q
55 250
60 285
65 700 700 700 325
70 365
September 2016 Chapter 5
Page 90 2011 Edition
Lane Closure with Pilot Car Diagram 340
Use this detail when closing a long section of one lane on a two-lane,two-way road and using a
pilot car to guide traffic through the closure past the work space.
1. Consider using a pilot car when approaching traffic cannot see from one flagger station
to the other;or,conducting work at night.
2. A pilot car operation should be limited to 3-5 miles,depending on volume and roadway
geometry.
3. Operation of the pilot car shall be coordinated with flagging operations at each end of
the one lane section.
4. Radios or other reliable communications shall be used between flaggers,the pilot car
and the work superintendent,or designated worker,at all times.
5. Instead of flaggers,the"WAIT FOR PILOT CAR"(CR4-20)sign may be posted on side
roads or accesses intersection state highways when pilot cars are being used to control
traffic on the mainline through the work zone,provided:
a. Accesses or side road traffic is being stopped for no more than 20 minutes
(per Section 00220 of the Oregon Standard Specifications for Construction,
and Chapter 3 of the Oregon Temporary Traffic Control Handbook).
b. Access or side road is a dead-end facility or has no immediate alternate
access,has an ADT of 100 vehicles per day or less,and does not access
public service facilities(e.g.parks,rest stops,waysides,ranger stations,
landfills,utility hubs,treatment plants,etc.).
For private residential driveways,see sign CR4-20a.
Intersections or accesses using the WAIT FOR PILOT CAR sign should be checked
regularly to ensure safe and effective traffic operations.
For a facility with an ADT greater than 100 vpd, but not exceeding 400 vpd,the sign may
be used only if closely monitored and frequently checked for traffic compliance,operation
and safety. If operational issues are observed at these or any other location using the
WAIT FOR PILOT CAR sign,the sign should be replace by Flagging or other traffic
control measures as quickly as practical.
6. Mount the"PILOT CAR FOLLOW ME"(G20-4)sign in a conspicuous location on the rear
of the pilot car. A truck-mounted PCMS may be substituted for the PILOT CAR
FOLLOW ME sign.
7. The last vehicle in the pilot car queue can be identified by communication between
flaggers. Alternately,the last vehicle may be identified by handing off a flag between the
driver and flaggers.
8. No vehicles should be allowed to pass the pilot car.
9. Cones along the work space are optional.
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.
11. For oiling and chip seal operation details,see Diagram 345.
Chapter 5 September 2016
2011 Edition Page 91
12.Lane Closure with Pilot Car Diagram 340
\ Sign Spacing and Buffer Lengths(feet)
ROAD Posted Spacing Between Signs "Buffer"
WORK
AHEAD \ \ Speed A B C Space
(Optionaq C' 20 50
ONE UNE 25 100 100 100 75
ROAD
AHEAD 30 100
8
PREPARED BE 40 350 350 350 125
150
TO STOP
B 45 180
\ 50 500 Soo 500 210
55 250
P 60 285
65 700 700 700 325
``ot Car 70 365
opfor P nd
turn arou \ (Optional)
• ONE LANE
ROAD
50�-1p0 • BE AHEAD
. PREPARED ROAD
TO STOP WORK
AHEAD
t A B B C
I
PILOT CAR
100' FOLLOW ME
• 100'for pilot car
to turn around
A
B
BE
PREPARED
TO STOP
B (Optlonaq
ONE UNE
ROAD
AHEAD
1 t C ROAD
WORK
AHEAD
September 2016 Chapter 5