PFI2014-00120 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00120
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/04/2014
Parcel: SEG2279
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: At the intersection of SW 98th Ave&SW Summerfield DR-Replacing a district regulator and installing
4"(W)Class B main.
Owner: FEES
Description Date Amount
PFI Permit Fee 12/04/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
SHELLY KIRSCHENMAN
220 NW 2ND AVE
PORTLAND, OR 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 J
Signature: _T r(��Q - e LZY t l I ( �H o'
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00120
Tope: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Utilities 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. 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 clean-up
and suspension of work to accomplish clean-up.
PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work,effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Utilities 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes,etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept.of Transportation, FHWA,current edition,American Traffic Safety Services
Association[ATSSA],and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area.Traffic control devices,flag persons,etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic,at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services 503-629-0111 (Tigard Police Dept.,Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080.Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice
Applicant 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 applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI_Utilities 14-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads,ditches,etc.)as may be necessary, as determined by
the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert
Phone#>, to establish a preconstruction meeting.
PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit.
PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance,and all attachments, and a copy of the approved construction plan
and all amendments shall be readily 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 these must be approved by the City, in advance of work
performance.
PFI_Utilities 19-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice
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 any emergency. The
applicant shall notify the City Inspector, in writing,of any/all assignment changes.
PFI_Utilities 21 -OTHER Applied Notice
RECEIVED
City of Tigard NOV 19 2014
PUBLIC WORKS —ENGINEERING CITY OF TIGARD
Public Facility Improvement (PFI ; Permit IEERING
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: Replacing a district regulator and installing ❑ Minor work in right-of-way
(sidewalk repair,curb cut,street
4" (W) Class B main. opening,etc.)requires:
/ 2� � /� •Application form,completed
`1 and signed
•Submit one (1)copy of scaled sketch
Property address/location(s): SW 98th Ave & SW Summerfield Dr of the proposed work to be done
•Submit one(1)copy of traffic
control plan
-OR-
NW Natural/Shell Kirschenman 8 Substantial project work requires
Applicant's name: y Z- 3 ��t above items and professional
Address: 220 NW 2nd Ave engineered plans for:
•Street widening
City/state: Portland OR zip: 97209 • Subdivision infrastructure
Phone: 503-226-4211x4347Email: smk@nwnatural.eom •Main utility line extension:
Storm Drain,Sanitary—Tigard
Water—Tigard Water Service
Contractors name: Same Area(includes Durham,King Cin
CCB#: Expiration: and a portion of unincorporated
Washington County)
Address:
DELIVER APPLICATION TO:
City/state: Zip:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Engineer's name:
Andrew Young Tigard,OR 97223
220 NW 2nd Ave Applications for"minor work in right-of-way"
Address: only may be emailed to:
City/state: Portland OR Zip: 97209 romperrnits tigar�d-or.goov
Phone: 360-281-6169 Email: afy@nwnatural.eom
FOR STAFF USE ONLY
Case No.: "' Z�
Estimated value of work (within the public right-of--way): $ Application submittal fee:
Is work related to a LAND-USE DECISION? ❑ Yes No Application accepted:
If so,please specify (MLP, SDR, SUB, etc.) case #: By: lb'rCl- - Date: 1-26-
Is work related to a BUILDING PERMIT? C1Yes [INo Application reviewed;
If so,please specify(BUILDING PERMIT)case#: By-A& Date, 12 -3 - '
Applicant notified:-
By-
otified:By: Date: ✓c� y I
1:\CUIIPIN\1AnAwm\Land Use Applications Rm 07/16/2014
City of Tigard L• 13125 SVG'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.
*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 or submit a written
authorization with this application.
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 subject prop..
• 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 required.
incMnrryn.SMe/
Shelly Ki rsch e n m a n 11/19/2014
mu.n.w iou:n sena
Applicant/Authorized Agent's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
Owners signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4
CROSS SECTIONS GENERAL NOTES N
I.Crll the I'ollmvtng U41m.N-11—Im.Gema
48 hours prier a auv—mu,.
(hegnn:
811.1-900-132-2444 WE
Washmgrnn.511 or I-500424-5555
2 ATTEMION thegon law reyuuv you t"ILgow c
rules adopttk
ed b,the egm Utility Noufinutm S
Case,.Those ruler ae set foM in OAK 952-001-
talWt Yau mal o,s w,mif rth me AR 95 calling
the anter IN—the tekplm-numbere fhg
fm the
I luhty N-f—uan C-I ,(504)242-1987 or 511).
1 Fdl out cnox—wn sketch ua-b.h rupphcJ with
jnlpckel and velum with Mork order OnW one
as-twit u reyuueJ
4 All dwnbutim musm mum h—a minimum depth of
M'and smicea muxt Mre a mrmmum depth of 18'
srnleua there°ar approval va,u_
5.All IT--lines must here a mrrumum J Tth al'
30•in CI•ra'I'locamns wd 36'In Clax'2.1.d 4'
VAMPICE S _ I—m—.odes.there u un approved vaimme.
v a.e tN ars: 6.Wnuen dtmrnaanu m dna umArmum sk—h
love precedarce ma scrled dimensmtw
R.W"�at - 7.Pte. aext alwn ase teased In see«dan,:e wab INSTALL: LU
..ndardx m CFM..d Pngm—mg LS,.Jard Pract-
5 1'cm medium for clacx'H'mann xhall be air....less Q
kalPaaRlr..n..r _ aah—,,e-,t d ❑2"BALL VALVE
4.11 he water,Ind—nlnerwixe Mated. 300 ANSI WXW F
AFara••I Ns" sMsw °+• `I F\rz Clam Car lughes terns.see Design IN—mi and STOCK#101152 tD
IlydramaOc Repel BOND
Class"B" PRESSURE TEST INFORMATION (circle 8 label test area on as -0uih drawirg) ❑TR PER STD a
Test by NNG —Other DWG B-01-05-A
ABANDON REG R-02
e► rr 51'
A 'R INSTALL:— 511' (Wey74
B ❑DISTRICT REG SET R-03 0+St'' ITR-2 s•IWr74
PER DWG.1-046-019-R-03 4(w)
TL
C 4lf2•(WI'74TL n 41 (Wy76
D a S SUMMERFIELD DR
E —
F s O BOND
RELIEF 51' INSTALL:
Order sheet oes-ptlon Plat number Cost'mg Pipe Sze,Type Order Type g , I 4"LSF
3408953 SW 981n AW b SWSummerfield Dr 1.046-019-8-03 1-046-019 2013 N!A smog ❑REBUILD RELIEF PER--1'4
9413102 SW 98th Aae b SW SummeAeld Dr Dlp up mem and engoau 1-046-019 ZIPPO NIA Sm09 1-046-019-R-03-E-A
34207195 SW919Ih AW b SW Summerfield Dr 1.046-019.R-02 1-016019 2013 N/A SM10 ^o
Ci
WELDS e
X- CERT. OPER. PM PM
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOPNOP ACTIVITY# ORDER#
INSTALL 18' 41/2"W B API 5L X42 .237 60 57 45 116 03420141
INSTALL 10' 3/4" W D B 0.113 optional 225 225 225 116 03420144
INSTALL 40' 2' WD B 0.154 optional 225 225 225 116 03420143
t NW Natural 50 '°°
�Feet
Engineering Department 1 in=100 ft
ADDRESS CRY COtl11Ty STATE DEsIogo C4C DATE 08/18201
SW98THAVE TIGARD WASHINGTON OR IRAm KDC DATE 09_292_0.1
BETWEEN AIO
SW SUMMERRC
ELD DR REM IDD R �C DATE 10N3201
NAaE CREW DATE
REBUILD DISTRICT REG MATTED °ATE
FLAT TM RND SEC PIPELINE ID- JOB TYPE:
1-046-019 T02S R01 W S W 11 P71 F11 A OCATE/ABANDOmND MA-1NS-
03420141 00013020
Knowledgeable&Dedicated Service
Northwest Natural: Notes: K&D as the preparer of this traffic control plan makes no representation
1. Maintain ped.access to as to its general adequacy or being approved for implementation.
and through crosswalks Rono Approval must result from the Traffic Engineer or other public official
2. Maintain Min.10'lanes woRR having statutory enforcement authority in the jurisdiction.
3. Maintain local access E Utilization and implementation of this plan shall be as a result of that approval.
CONTACT:Richard Patterson 4. Notify Transit authority at Ref.MUTCD 2009 6A-01(10).
503-819-2484 least 48 hrs.of bus stop W70-1
closure Lane Width 12
5. Traffic control plan and all
LOCATION:SW 98th&Summerfiel devices shall comply with Posted Speed 25
Tigard OR MUTCD and ATSSA1 Merge Taper NA
6.Adjust to field conditions
DATE: JOB# BE Buffer NA
PREPARED
11/18114 320141 TO STOP Sign Spacing 100
K&D SERVICES
OF OREGON,INC W2
PHONE:503-723-7287
FAX:503-723-8750
DRAWN BY: W20-7
ALAN WARD
`• �-: `� TCS#04456
• BE ROAD
Notify Fire/EMS,EPD and LTD 48hrs �• PREPARED WORR
before beginning work T n■r TO STOP AME
Legend = =""- W20-
9 C O =� � NOT TO SCALE
® Work Area III
ROAD eE
Cone WNEA TOP9TORK PREAROPED •T�e
■ ��9P r flayyri
n Y
i Sign Stand w20-1 W20-7b w20-7a
0 road work ahead W20-1
O
� be prepared to stop W20-7b W20-7a
BEINVENTORY:
cairn
PREPARED
w20-7a w20-7a '°"°' 4-Road Work Ahead
flagger flagger w20-7b 1-Bikes On Roadway
ROAD 4-Be Prepared To Stop
Wii-i wit-1 WORK 4-FlaggerAhead
W20-1 4-Flaggers
20-Cones
Machine Mill The Sand And Seal
Vnr
Area For A 1-1/2' Paving Joints With
Exsting Hot Poving Grade
12' Blanket Inlay
Asphaltic • Oil 64-22 Or
Concrete � MSee Notes Below
in Equivalent)
`7,
�\
Eksting
Rood
L �..� \
Base o J C p��j` %' V V
_-__._ I Non-Compressible
_�
-"I E L' I- - ff! " Backfill-Cement Slurry -___I
III (for Mojor Roads Or As
___ I ,
Asphaltic Concrete Pavement � _° Specified) ; ��_._.`-� Undisturbed
'T' Patch, 6' Thick Or Match - r -.•..--I Ground
I
Existing Pavement (whichever Is
Greater) Up To The Level Of =11 i ........I
Original Pavement. -~-
-
--
I" I Crushed Aggregate --� .
Or Granular Pipe
Zone Backfill
Material
-III-
e
Trench Width
o Per Plan or
ti *Notes: As Specified
h
0 V
ry • Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, P9-64-22
o i Dry
And Rising. Pavement Conditions, Where Existing Pavement Is At Least 60' F
r� And
3 • Tock All Pavement To Be Inlaid With Emulsified Asphalt.
m • The City Engineer Shall Determine the Final Width and Length of the Inlay Patch
to Best Fit Travel Pottems.
CAPITAL CONSTRUCTION AND City of Tigard FIGURE
TRANSPORTATION DIVISION
13125 &W.. Mil BLVD. UT—BI
USM» a 97223 Utility Trench - Blanket Inlay
a 4 DICE 5W-63P-4171
rAK.* 503-624-0752 FILE NO
wwW.TrARD-0R•GOV Detail
n/a
1
15555 iL
S
N .
m SLC071
a
11CQL6F
11 Dc
/ d• i
SS11CO72 q 10ry
SS1 $�i _..
- -
k1 CDIA. 8� �S U M M E R E I E -D-DR—
LU
•D-D R---
W
1C073 12" DIP
SS11
Q i 11CM7
CO
1
b .
11CMUCAC0189
Fit
0
125 INN" 6" DIP��