PFI2014-00028 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00028
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/14/2014
Parcel: SEG1039
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Adjacent to SW Walnut Street and SW Pathfinder Court. Temporarily cutting 30'of 4"(W)main.After
box culvert installed,we will replace this with 30'of 4"(P)main. SEG 1039
Owner: FEES
Description Date Amount
PFI Permit Fee 07/14/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MICHAEL MARTIN
220 NW 2ND AVE
PORTLAND 97209
PHONE: 503-226-4211
Total $300.00
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: \J 0.. . ryl
Issued By: l_�1 (if - l�(.�(i✓(�,�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00028
Type: Condition Name: Status: Severity:
ROW 21-REPAIRS REQ-INSPTR OPINION Continuing Notice
Work provided for under the permit shall include repair of existing facilities(roads,ditches,etc.)as may be necessary, in the
City Inspectors opinion,to overcome deterioration or damage which occurred in conjunction with the work authorized by the
permit.Walnut Street is an arterial requiring a blanket inlay to repair the street. Corrective work shall be done at the permit
holders expense.
ROW 09-TRAF/NOISE CTRL-WORK HRS Continuing Notice
No work will be permitted during the hours of darkness,nor between 9:00 p.m. to 7:00 a.m. Monday through Friday, nor
between 9:00 p.m.to 8:00 a.m. Saturday, nor between 9:00 p.m.to 9:00 a.m. Sunday.
ROW 11-TRAF CTRL-CITY CAN MODIFY Continuing Notice
The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic
and to assure public safety.
ROW 22-AS-BUILT/ENGR CERTIF REQ Continuing Notice
At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public
right-of-way shall submit complete"as-built'drawings 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 engineers certification of installation
compliance(form attached).
ROW 24-TESTS/REPTS TO VALIDT CLMS Continuing Notice
The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's
engineer or contractor to validate claims of material or construction adequacy/compliance. Such tests/reports shall be
provided at the permit holder's expense.
ROW 03-TRAF CTRL-SPECIF(CITY) Continuing Notice
The City's standard specification for traffic control is"Manual on Uniform Traffic Control Devices for Streets and Highways",
U.S. Dept.of Transportation, F.H.A., 1988 Ed.
ROW 18-UTILITIES PRELOCATION REQ Continuing Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0010 through OAR 952-001-0080. Copies of the rules may be obtained from the Center by calling(503)232-1987.
If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders
expense.
ROW 27-PROB SOLVING-RESPON PARTY Continuing Notice
The permit holder shall 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 an
emergency. The permit holder shall notify the City Inspector, in writing, of any/all assignment changes.
ROW 19-UTILITY LOCATIONAL CONFLICT Continuing Notice
Contractor 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 permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall
coordinate the work with affected utility agencies.
ROW 04-TRAF CTRL-CONTR RESPON FOR Continuing Notice
Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in
accordance with a City(job specific)approved traffic control plan.Walnut Street is an arterial so lanes may not be closed
from 6:30 to 9:00 a.m. and 3:30 to 6:00 p.m.A copy of the approved traffic control plan shall be available at the work area.
ROW 05-TRAF CTRL-ROAD CLOSURE Continuing Notice
Public roadway shall not be closed to traffic, at any time,without having first obtained written approval from the City
Engineer.The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide
Emergency Services(Tigard Police Dept., Tualatin Fire&Rescue)and to Tri-Met and Tigard School District.
ROW 10-TRAF CTRL-MIN LANE WIDTH Continuing Notice
Minimum travel lane width shall be eleven(11)feet; pedestrian travel shall also be provided for.
ROW 12-INSP 24 HR NOTICE REQUIRED Continuing Notice
The permit holder or his contractor shall notify the City's inspector Kenny Fisher at 503-816-6146 or email at
kenny@tigard-or.gov,twenty-four(24)hours prior to commencing work,twenty-four(24)hours prior to any staged
inspection, and after completing work covered by the permit.
ROW 14-DEBRIS-MATERIALS Continuing Notice
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
cleanup and stoppage of work to accomplish cleanup.
ROW 16-REPAIRS-LIKE MATERIALS REQ Continuing Notice
Property disturbed by construction activity shall be seeded with a standard grass mix; shrubs,flowers, barkdust, existing
signs, pavement markings, mailboxes,etc., shall be reestablished, reinstalled or replaced,with like kind and material.
ROW 20-TRENCH-PATCH/SAFETY/LBILITY Continuing Notice
A temporary hard-surface patch(Cold mix A.C.or Hot mix A.C. base paving) shall be placed on trenches within roadways
at the end of each day's work. No trench, on site or off site, shall be left at any time in an unsafe condition.The permit
holder is responsible for and is liable for hazards or damage resulting from the work.
ROW 26-MONUMENT PROTECTION REQ Continuing Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders
expense.
ROW 28-CONSTR SAFETY-RESPON PARTY Continuing Notice
The permit holder shall cause his contractor to provide to the City Inspector, in writing, the name and 24 hr emergency
telephone number of a designated"Competent Person"responsible for construction safety as per OR-OSHA, Chap. 437,
Div. 3 Construction, Subdivision P-Excavations.The contractor shall notify the City Inspector of any/all assignment
changes.
ROW 02-PERMIT&PLAN REQ ON SITE Continuing Notice
A copy of the permit and all attachments,and a copy of the approved construction plan and all amendments shall be
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 the aforesaid must be approved by the City, in advance of work performance.
ROW 08-TRAF CTRL-DEVICES IN PLACE Continuing Notice
Traffic control devices,flagpersons,etc., shall be in place prior to initiation of construction work and shall be effectively
maintained.
ROW 29-ESMT/RT OF ENTRY-RESPON Continuing Notice
It is the sole responsibility of the permit holder to provide for 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 permit holder's failure to obtain or provide for proof of right-of-entry or easements.
ROW 07-TRAF CTRL-PRIV PROP ACCESS Continuing Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not,
shall be cause for work stoppage until effective access is established.
ROW 06-TRAF CTRL-ADVANCE WARNING Continuing Notice
Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance
notification sign at each end of the construction area 72 hours(min.)before initiation of construction work.
ROW 13-HAZARDS-CERT OF INS Continuing Notice
Maintenance of the work area and approach roads is the responsibility of the permit holder.The work area and approach
roads shall be maintained in a clean condition,free from obstructions and hazards.A copy of the permit holders Certificate
of Insurance shall be available at the work area.
ROW 15-EROSION CTRL REQ Continuing Notice
Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q.
requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion
control.
ROW 17-DRAINAGE CONTROL REQ Continuing Notice
Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent
private property, public property and the receiving system is not adversely impacted. The City may, at any time,order
corrective action and stoppage of work to accomplish effective drainage control.
ROW 23-DAILY INSP REPORTS REQ Continuing Notice
The permit holders Engineer/Inspector shall submit daily inspection reports, on a weekly basis, to the City's Inspector. (see
Developer-Engineer Agreement note#5).
RECEIVED
City of Tigard
Public Facility Improvement JUL 0 S 2014
Permit PLANIN/TY ENOF N(PFI) EE,RING
General Information: FOR STAFF USE ONLY
Property Address/Location(s):P-201216 Engineering,,-1 �14r�2g
Case No.:
SW Walnut St& SW Pathfinder Ct S� 10�1 j a o
Fee: , 30
Receipt No.: 15(,p 7 R 7
*Applicant's Name:NW Natural Date: 7-/q -// _,q.�
Address:220 NW 2nd Ave Application Accepted:-716114
II__'' ••,,'' By:lam=
City/State:Portland OR Zip:97209 Y, MyTtry-a
Primary Contacr.Michat3l Martin REQUIRED SUBMITTAL
Phone:
503-226=421:1; .Ext 4331 • ,Fa.�;� 503-273-4822 INFORMATION
E-Mail: mom@nwnatural.corn Professional Engineered Plans are required
fm
• Street��dming
Contractor's Name: • Subdivision Infrastructure,
CCS# Expiration: • Main utility fine extension:
0 Storm Drain,Sanitary-Tigard
Address: 0 Water-Tigard Water Service Area
City/State: ' - Zip: (includes Durham,King City and a
portion of unincorporated Washington
Phone: Fax: Count))
**Note:See Engineered Plan
Plans By: Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
City/State: Zip: work to be done. (see attached minimum sketeb
Phone: Fax: requirements and provided sketch area).
Ulxlated:G/2a/�c113
I:\CURPLN\Mastcn\Iand Usc Apphcatmns\Public Fa6ity
Temporarily cutting 30'of 4" W Main '"'""°°"°`"t.docx
Description of work: p Y 9 ( )
After box culvert installed, we will replace this with 30'of 4" (P) Main
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES r-] NO
If so,please specify(MLP,SDR,SUB,etc.) case#:
Is the work related to a BUILDING PERMIT? YES F-1 NO
If so,please specify(BUILDING PERMIT) case#:
City of Tigard ( 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov Page 1 of S
APPLICANTS:
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on
the front of this application in the"Required Submittal Elements"box.
NOTE: Person specified as"Applicant"shall lie designated"Permittee"and shall provide financial assurance for work.
*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(s)must sign this application in the space provided on the
back of this form or submit a written authorization with this application
(Detailed Submitral Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.)
BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT:
♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subicct propgty,
♦ If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions
and limitations of the approval.
♦ All of the above statements and the statements in the plot plan, attachments, and exhibits transmitted herewith, are true; and the
applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are
false.
♦ The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for
approving or denying the application.
SIGNATURES ofd owner of the subject property.
DATED this 7th day.of July 2014
Applicant/Authorized Agent's Signature Owner's Signature
Owner's Signature Owner's Signature
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.dgard-or.gov I Page 2 of 5
Machine Mill The Sand And Seal
Exst n Vn
Area For A 1-1/2' Pay ng Joints With
E t i c 12Blanket Inlay Hot Paving Grade
Asphaltic ' See Notes Below 0# (p9 64-22 Or
Concrete l Min Equivalent)
Ersting
Road
Base
Non-Compressible
Backfill-Cement Slurry .• i•--_..
(for Major Roads Or Ag.
Asphaltic Concrete Pavement _, Specified) Undisturbed
T Patch, 6' Thick Or Match - ;.•. r -._.__i i (; Ground
Existing Pavement (whichever Is i I ti
Greater) Up To The Level Of
Original Pavement. • , ' 't i w�I I i-
-Ii I1I VI
-111-7 --- I I
I ' '
T_. Crushed Aggregate
Or Granular Pipe I i
F °I Zone Backfill �-
Moteriol I —
d i— -I
�-
' il--
Trench Width
0
Per Plan or
*Notes: As Specified
U
b3
8 • Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, Pg-64-22
i Hmac In Dry Pavement Conditions, Where Existing Pavement /s At Least 60' F
a And Rising.
3 • Tack All Pavement To Be Inlaid W<th Emuls/rred Asphalt.
Jm • The City Engineer Shol! Determine the Fina/ Width and Length of the ln/oy Patch
to Best Fit Travel Patterns.
0
CAPITAL CONSTRUCTION AND
TRANSPORTATION DIVISION City of Tigard FIGURE
g 1a1T5 sw �„` �►�. Utility Trench - Blanket Inlay Ur-B�
z IAf.ARq OREGON 97T?3
V MICE. 5W-6M-4171
FAX 5a3-624-0752 FILE NO
10W.Y�O-OR.�' Detail
n/o
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 WE
Washington: 811 or 1-800-424-5555
2.ATTENTION:Oregon law requires you to follow
rules adopted by the Oregon Utility Notification .S
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).
3.Fill out construction sketch as-built supplied with ❑ CUT& CAP
job packet and return with work order. Only one
as-built is required_ INSTALL:
4.All distribution mains must have a minimum depth of
24"and services must have a minimum depth of 18" ❑ TF W/LW
unless there is an approved variance. ❑ TL & CP Wire
5.All transmission lines must have a minimum depth of
30"in Class'1'locations and 36"in Class'2,3,&4' (V ❑ 1#Anode
locations,unless there is an approved variance. , NOTE: TEMPORARILY CUT 4"(M MAIN
VARIANCE (S) 6.Written dimensions on this construction sketch Q AND INSTALL 4-(P) AFTER
Variance(s)made: have precedence over scaled dimensions.
7.Pressure test shall be tested in accordance with BOX CULVERT IS INSTALLED
standards in CFM and Engineering Standard Practice. 6.5.
Reasm(s} 8.Test medium for class"B"main shall be air,unless
otherwise noted. Test medium for class"C-F"main r54.
Mitigation taken (rt arry). shall be water,unless otherwise noted. #12440
9.For Class C or higher tests,see Design Document and (#11240) o
Hydrostatic R v
Apprw•al Name : Sigtatue: Dale: y Report.
tO \
Cl2SS"B" PRESSURE TEST INFORMATION (drde & label test area on as -built drawing )
Test by NNG —Other
rat Pro, 91.r- 1`4 O Tar ON OFF P_
A. 9120 Pay FootaW PYota. Do. Tarty oat. Tin. YM Pnra Nana W Yritw //� _(� \ \
A �` V ���N ` $ INSTALL:
CUT& CAP
B UT ,aP
C , x1� ❑ TF W/LW
D ply
❑ TL & CP Wire
E \
F a
CI
WELDS QP.�`Z`
%X- CERT. OPER. PM PM �A
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTMTY# ORDER# 10-
FOOTAGE
ABAN 30' 4" W B 114 03415793 INSTALL A #6 CP WIRE ALONGSIDE THE
INSTALL 30' 4 P B P24 .391 60 57 45 114 03415790 �� %� 4"(P) THE ENTIRE LENGTH OF JOB.
NOTIFY CORROSION TECH.
#12615 — _ "4' '�. ryQ� '$Ao ED LEVESQUE 503-701-7855
0 50 100 —42e �,� ��O• ��?•,A�9sj,?S09 PRIOR TO START OF JOB.
,) NW Natural moommor==Feet
Engineering Department 1 in = 100 ft -
ADDRESS CRY COUNTY STATE DESIGNED AFY DATE 07/03/201
SW WALNUT ST& SW PATHFINDER CT TIGARD WASHINGTON OR DRAWN KDC DATE 071031201
BETWEEN AND
APPROVED AFY DATE 071031201 10,,• ,
NSW FONNER ST SW WATK/NS AVE AME CREW LDR. DATE N /ye�s20
SW WALNUT ST& SW PATHFINDER CT P201216 WALNUT @ PATHFINDER PLATTED DATE
�1z
PLAT TWN RNG SEC JOB TYPE:
1-043-019 T02S R01W NW 2 PIPEI INE ID PUBLIC WORK MAINS i$��?o
PM#: PROJECT/REVISION#
03415790 201216