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PFI2014-00079 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT ' rl COMMUNITY DEVELOPMENT Permitil: PF12014-00079 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/232014 Parcel: SEG2724 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: NW Natural Project Description: Adjacent to SW 118th Court. Install 8'o(2"(p)main to lie-in to existing 2"(p)main.Main is on the short side of SW Gaarde Street,street cut,hole hag.SEG 2724, 1614 Owner: FEES Description Date Amount PHONE: Contractor. PHONE' FAX: Applicant: LORENE NICHOLS 220 NW 2ND AVE PORTLAND,OR 87209 PHONE: 503-226-4211 Total $0.00 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. s Permittee/Applicant Signature: It A) A 14' Issued By: 'geviL Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12014-00079 Type: Condition Name: Status: Severity: 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 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 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 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 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 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.A copy of the approved traffic control plan shall be available at the work area. 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 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). 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 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 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 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 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 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 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 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.Corrective work shall be done at the permit holders expense. ROW 12-INSP 24 HR NOTICE REQUIRED Continuing Notice The permit holder or his contractor shall notify the City's inspector<name>,at<phone#>or email at<email address>, 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 01-CUSTOM CONDITION Continuing Notice <Custom Condition goes here> 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 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 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 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 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 25-RELEASE-WAIVER REQ Continuing Notice The permit holder shall provide a copy of a properly executed Release&Waiver document to the City for each ownership disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction. 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. City of Tigard RECEIVED Public Facility Improvement SEP 2 2 2014 (PFI) Permit CITY OF TIGARD pLANNINGIENGINEERING i GA K4_l!_d General Information: I-OR STAFF USE ONLY Property Address/Location(s):SW 118th Ct Engineerin S�G 2_1 2_4 �(��y Case No. _�I��'—C0079t Fee: 0- Receipt No.: f1 0�- *Applicant's Name:NW Natural/00003228 Date:9`L 3• Address:220 NW 2nd Av Application Accepted:9 1*2-2—_liy:_JN < City/State:Portland OR /;p_97209 Primary Contact:Lorene Nichols REQUIRED SUBMITTAL Phone: 503-226-4211 X 4372 I':►x:503-273-4822 IF INFORMATION E-Mail: nwnpermits@nwnatural.com Professional Engineered Plans are required for: Loy Clark/Wanda Taylor StreetWidcning Contractor's Name: Subdivision Infrastructure CCB#52281 Expiration: \Iain utility line extension: Address:PO Box 1369 0 Storm Drain,Sanitary—TigArd 0 Water—Tigard Water Service Area Ciry/State:Tualatin OR 97062 (includes Durham,King City and a 503-783-1171 portion of unincorporated Washington Phone: Fax: County) "*Note:See Engineered Plan Plans By:NWN (same as above) Submittal Checklist attached. Address: For all other work:Submit scaled sketch of the City/State: Zip: work to be done.(see attached minimum sketcb Phone: pax: requirements and provided sketch area). Updated 6124/2-013 1:1(:[NPIIQihtacicn\Inial Use Applinwms\Pu66c Facility Description of work:install 8'of 2" (p)main to tie-in to existing Impnncmem.d xx 2" (p) main/main is on the short side of SW Gaarde Rd/street cut/hole hog/see sketch Estimated value of work(within the public right-of-way): $2.50 x 8'= 20.00 Is work related to a LAND-USE DECISION? YES ❑ NO Q If so,please specify(MLP,SDR,SUB,etc.)case#: Is the work related to a BUILDING PERMIT? YES F—] NOFE—] If so,please specify(BUILDING PERMIT)case#: City of Tigard 13125 SNx1 Fall Blvd.,Tigard,OR 97223 1 503-718-2464 1 ,v-%"v.tignd-or.gov I Page 1 of 5 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 be 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 Submittal 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 attached to or imposed upon the subject gror&rn • 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 of each owner of the subject property. DATED this / day of ��o��'`��✓ 20� r pplicant/Authorized Agent's Signature Owner's Signature Owner's Signature Owner's Signature Cityof Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-715-2464 1 www.6gard-or.gov k Page 2 of S CROSS SECTIONS GENERAL NOTES N 1.Call the followmp Unlit w Notification Center FUSE& 8' 50� 8' 48 hours poor to any excavation INSTALL: Oregon: 811 or 1-800.332-2344 Washington: 811 or I-800-424-5555 ❑ LW CUT& CAP rJE .5' 14' 14'=EC ' ' 2 ATTENTION:Oregon law requires you to follow ❑ 1#Anode J J rules adopted by the Oregon Utility Notification S'F'L C (L Center.Those rules are set forth in OAR 952-001-O . L O LLI 0090.You may obtain copies ofthe rules by callingC E W B B ' the center.(Note:the telephone number for the Oregon j j Utility Notification Center is(503)232-1987 or 811) a D_ 3.Fill out construction sketch as-built supplied with I>. job packet and return with work order. Only one I I I rc ^ n r(P)'03/JT/CPW " "2' 2' as-built is required. LW 4.All distribution mains must have a minimum depth of TH 24"and services must have a minimum depth of 18" T 2-(P)'03/ABN SW 116 CT unless there is anapprovedvariance, 2-(P)'03/JT/CPW 2"(P)'03/JT/CP W- t 1"(W)'03/ABN .S W. GggRDE o R S All transmission lines must have a minimum depth of INSTALL:- D 30"in Class'l'locations and 36"in Class'2,3,&4' locations,unless there is an approved variance. ❑ LW + H e n 6.Written dimensionsthis construction sketch ; U - INSTALL: have precedence overr scaled dimensions. {, " •C ie e a 7 Pressure test shall be tested in accordance with VARIANCE (S) �'- ,•,•, ,,,,,,• I, ❑ LW a VARS standards in CFM and Engineering Standard practice 23 ,2"(P)JT �y + V_t*1" : 8.Test medium for class"B"main shall be air,unless = �• 1 otherwise noted. Test medium for class"C-F"main 4 • a Ra�m(sT shall be water,unless otherwise noted. + 26 A.For Class C or higher tests,see Design Document and •tr r-00 : r 25 F 2' INSTALL: Mouit—t k— (4arif,t Hydrostatic Report- 22 24 r—'t F 2 ❑ LW INSTALL: s s /ygwd N— sp,.,.. I Or. ❑ LW ��[••• . ..�.z"�P1ur �I.+ .. .. .... {.0 52'+: N + it 127' 3 CIMSS"B" PRESSURE TEST INFORMATION (cirde &label test area on as -built drawing) 4wiI p•�• ,tP? • 21 Test by NNG —Other .11+95 TM �• �•/. ti• Tit eN O.F I... IVYf Mw"n1YM1Y i 4 A,. sr M EMS. war. Dr• la,r or. r TM 2"P/JT , A .. . ...... ............54 —; INSTALL: 21 20 19 .1 .O OSI:•4t•CAS. ❑ LW B INSTALL: r; C5 LW U :?1+ 5 D INSTALL: ;a E ❑ LW 1817 16 CALL SEVEN DAYS PRIOR TO START OF DRY UTILITY TRENCH F CALL FOUR DAYS PRIOR TO SHADING TO SET INSPECTION DATE 14 _ CONTACT:DAN SIMONSCT 503-706-0159 ALL DEPTHS MEASURED FROM FINAL GRADEROAD 24" FIELD a WELDS SIDE MIR I SIDE %X- CERT. OPER. PM PM FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY# ORDER# •• + \ INSTALL 8' 2" P B P24 .216 60 57 45 710 03420795 5v` 8 MEASURED INSTALL 1988' 2" P B P24 .216 60 57 45 710 03420793 FROM INSTALL: THE 30- .... PROPOSED ❑ LW FINAL 4�) N W Natural 0 50 100 GRADE CO4T Out . ❑ 1#Anode a Feet 12'REC. � BAC1ffILL Engineering Department 1 in= 100 It 0-MIN•) , ( voRROCK-,; ADDRESS CRY COUNTY STATE DEEMED BMK DATE 0911112014 GAu AyATavE 12 11 10 SW 118TH CT TIGARD WASHINGTON OR DRAWN KDC DATE 091171201 T J BETWEEN AND A"RovEoLC DATE 09118/201 MIN . . Order Street Description Plat number Costing Pipe Size,Type Order Type NAMEW GAARDE ST CREW DATE ,CATV PHONE O 3408032 1554 SE Tacoma St Customer adding on to the west side of h 1-038-032 Z316 P-0080 SM05 MEDALLION MEADOWS PLATTED DATE ',Cf 00 3410210 1554 SE Tacoma St Abandon XX'of 1/2"(P)seruce 1-038-032 2316 P-0050 SM10 PUT TWN RND SEC PIPELINE ID- JOB TYPE: TRENCH REQUIREMENTS NEW CONSTRUCTION MAINS 12" 3420796 SW 118th Ct Abandon 1"(w)main 1-045-017 Z116 S-0100 SM10 -045-017 T02S R01W NW 10 PM a: PROJECTIREVIaWNa FOR JOINT UTILITY USE 03420793 00003228 1 MAIN EXTENSION 3420797 11754 SW Gaarde St reline and relocate 1/2"(p)sw, 1-045-017 IZ316 P-0050 I SM05