PFI2014-00074 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
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COMMUNITY DEVELOPMENT Permit#: PF12014-00074
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/15/2015
Parcel: 2S115AB00300
Jurisdiction: WASCO
Site address: 16280 SW 113TH AVE
Subdivision: WILLOW-BROOK-FARM Lot: 24
Project: 1113th Avenue Apartments
Project Description: New water connection for anew apartment building located at 16280 SW 113th Avenue
Owner: FEES
Description Date Amount
PFI Permit Fee 09/10/2014 $300.00
PHONE: Engineering-Water 12/29/2014 $348.75
Public Works-Water 12/29/2014 $548.25
Fire Service Reimbursement 12/29/2014 $1,400.00
Contractor:
JTSC LLC
5285 MEADOWS RD, SUITE 171
LAKE OSWEGO, OR 97035
PHONE: 503-308-7324
FAX: 503-684-0102
Applicant:
JESSE NEMEC
5285 MEADOWS ROAD, SUITE 171
LAKE OSWEGO, OR 97035
PHONE: 503-730-8620
Total $2,597.00
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.
Perm ittee/Applicantn ' (�y
Signature: V(II / G� � '�
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00074
Type: Condition Name: Status: Severity:
PFI_Street Imp 01 -WORK SITE REQUIREMENTS Not Met 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_Street Imp 02-WORK SITE AREA Not Met 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_Street Imp 03-WORK SITE EROSION CONTROL Not Met 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_Street Imp 04-WORK SITE REPAIRS Not Met 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_Street Imp 05-TRAFFIC CONTROL SPECIFICATIONS Not Met 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_Street Imp 07-TRAFFIC CONTROL ROAD CLOSURE Not Met 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_Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Not Met Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours(min.)before initiation of construction work.
PFI_Street Imp 06-TRAFFIC CONTROL PLAN Not Met 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_Street Imp 09-TRAFFIC CONTROL PROPERTY ACCESS Not Met 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_Street Imp 10-TRAFFIC CONTROL WORK HOURS Not Met 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_Street Imp 11 -TRAFFIC CONTROL LIMITED WORK HOURS Not Met 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_Street Imp 12-TRAFFIC CONTROL MODIFICATION Not Met 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_Street Imp 13-DRAINAGE CONTROL Not Met Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Street Imp 14-UTILITY NOTIFICATION Not Met 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_Street Imp 15-UTILITY LOCATION CONFLICT Not Met 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_Street Imp 16-TEMPORARY PATCH Not Met 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_Street Imp 17-REPAIR OF EXISTING FACILITIES Not Met 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_Street Imp 18-SEWER SYSTEM TEST Not Met Notice
A sewer system air-test and/or DVD T.V.test report and one set of"As-Builts"shall be provided for review and approval.
PFI_Street Imp 19-PRECONSTRUCTION MEETING Not Met Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, Kenny Fisher at
503-718-2602 to establish a preconstruction meeting.
PFI_Street Imp 20-NOTICE TO COMMENCE WORK Not Met 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_Street Imp 21 -PERMIT/PLAN ON SITE Not Met 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_Street Imp 22-DAILY INSPECTION REPORTS Not Met Notice
Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector.
PFI_Street Imp 23-MONUMENT PROTECTION Not Met Notice
Existing monuments, property corners,and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Street Imp 24-VALIDATION OF MATERIAUCONSTRUCTION Not Met Notice
The City's Inspector may, at his discretion,require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Street Imp 25-EMERGENCY CONTACTS Not Met 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_Street Imp 26-RIGHT OF ENTRY/EASEMENTS Not Met Notice
Applicant to obtain 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 applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI_Street Imp 27-PRIVATE PROPERTY AGREEMENTS Not Met Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI_Street Imp 28-AS-BUILT DRAWING Not Met Notice
One as-built drawing 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 engineer's certification of installation compliance(Certificate of
Compliance).
PFI_Street Imp 29-PRIVATE WATER QUALITY FACILITY Not Met Notice
The Developer shall maintain the water quality facility and correct any defective work, and shall perform all scheduled
maintenance to assure proper functioning of the facility.
PFI—Street Imp 30-PUBLIC WATER QUALITY FACILITY Not Met Notice
The Developer shall create and provide to the City a schedule for periodic(quarterly)maintenance of the water quality
facility. The Developer shall maintain said facility for a period of three(3)years from the date of City Conditional
Acceptance of the public improvements. On October 1st of each year during this three(3)years period,the Developer shall
report, in writing, maintenance activities to the Director of Public Works. City crews should monitor proper removal and
disposal of silt and debris. Prior to City final acceptance of the facility,the Developer shall provide a written evaluation of the
operation and maintenance needs of the facility and correct any deficiencies identified in the evaluation.
PFI—Street Imp 31 -OTHER Not Met Notice
City of Tigard
Public Facility Improvement
(PFI) Permit
General Information: FOR STAFF USE ONLY
Property Address/Location(s): 16280 SW 113th Ave,Tigard,OR 97224 Engineering
Case No.:T15S 14 ' O 7Y
The site is 650'south of Durham Road on the east side of 113th Avenue.
Fee:
Receipt No.:
*Applicant's Name: Jesse Nemec-J.T.Smith Companies Date:
Address: 5285 Meadows Road,Suite 171 Application Accepted: By-
City/State: Lake Oswego/OR Zip:97035
Primary Contact: Jesse Nemec REQUIRED SUBMITTAL
INFORMATION
Phone: 503-730-8620 Fax:
E-Mail: jnemec@jtsmithco.com Professional Engineered Plans are required
for:
Contractor's Name: )TSC, LLC • Street Widening
• Subdivision Infrastructure
CCB# 200237 Expiration:6/18/2015 • TNlain utility line extension:
5285 Meadows Rd, Suite 171 0 Storm Drain,Sanitary—Tigard
Address: 0 Water—Tigard Water Service Area
City/State: Lake Oswego,OR Zip: 97035 (includes Durham,King City and a
Phone: 503-730-8620Fax: portion of unincorporated Washington
County)
*Note:See Engineered Plan
Plans By: Brian Feeney,PE-31 Consulting,Inc
Submittal Checklist attached.
Address: 5075 SW Griffith Drive,Suite 150
For all other work:Submit scaled sketch of the
City/State: Beaverton/OR Zip: 97tH)5 work to be done. (see attached minimum sketch
503-946-9365 requirements and provided sketch area).
Phone: Fax:
Updated:6/24/2013
IACURPIN\Masters\land Use Applicatmns\Public I-acility
I
Description of work: mprocemmt.docx
Construction of a 24-unit apartment complex consisting of two,three-story buildings.
Estimated value of work(within the public right-of-way): $ $15,250
Is work related to a LAND-USE DECISION? YES a NO
D(R)/[lRV].and Development L1400136
If so,please specify (MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES[_X] NO
Casefile 14-136-D
If so,please specify (BUILDING PERMIT)case#:
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of S
APPLICANTS:CANTS:
To consider an application complete,you will need to submit ALL of the RFOUIRED 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 appiicatiou
(Detailed Submittal Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.)
BY SIGNING BELOW,THE APPLICANTS)SHALL.CERTIFY THAT:
♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property.
♦ 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.
♦ fhe 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 120 '
!pplica /AuthorizedAgent's Signature s Signature
Owner's Signature Owner's Signature
City of'Tigard us1 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov I Page 2 of 5
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DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI)Permit:
Part 1: All non-water system improvements
Engineer's estimate X 5%(less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 2: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 1+Part 2
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
2. Addressing Fee: The fee for this service is$50.00 per address.
SAMPLE
Minimum Sketch Requirements
1� North Arrow Property Lines&Dimension Slope of Property
1� Street&Street Name(s) Existing Building,Structures Utility& Street Light Poles .
Proposed Work Existing Curb or Edge of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations(sewer,water,storm)
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-7111-2464 1 www.tigard-or.gov I Page 3 of 5
SAMPLE SKETCH:
Edge of Pavement
I �--'— Ditch 10
n
Streetlight I -----------•— —r---
• Raaf Drwn
' T–'tsi ojaos cf'�5ejirvet'Cine'–
�
� I
L,i Existing House
Existing
I
(5 I g
�. I �: Driveway
3�
a; V I I
CI h I Loi
O
W I i0
I i
O
Existing Shop
Powerpole I
o • o
I--------7roP95ne------- -—-
I
1 •
II Fire Hydrant(FH)
� � I
Scale: -1"=30'
� I I
� I I
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Minimum Sketch Requirements (Put"n/a"if Not Applicable):
North Arrow Property Lines &Dimension Slope of Property
Street&Street Name(s) Existing Building,Structures Utility&Street Light Poles
Proposed Work Existing Curb or Edge of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations(sewer,water,storm)
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 4 of S
I�
SKETCH AREA:
Cityof Tigard ( 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.dgard-or.gov I Page 5 o f S