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PFI2015-00031 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00031 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/22/2015 Parcel: 1 S136CD02200 Jurisdiction: Tigard Site address: 7850 SW DARTMOUTH ST Subdivision: PALMER ACRES Lot: 3 Project: Costco Wholesale street improvements Project Description: Construct a new Southbound right turn lane at the intersection of SW Dartmouth St and Hwy 99. Costco wholesale: 7850 SW Dartmouth St. Pacific Crossroads shopping center; 11701 Pacific Hwy Owner: FEES Description Date Amount PFI Permit Fee 03/19/2015 $300.00 PHONE: Contractor: PHONE FAX: Applicant: DAVID ROGERS 999 LAKE DRIVE ISSAQUAH, WA 98027 PHONE: 425-313-8100 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 beginnin work. Permittee/Applicant r Signature: 41 Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00031 Type: Condition Name: Status: Severity: PFI—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Applied 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 11 -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—Street Imp 12-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—Street Imp 13-DRAINAGE CONTROL Applied 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 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—Street Imp 15-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—Street Imp 16-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—Street Imp 17-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—Street Imp 18-SEWER SYSTEM TEST Applied 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 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—Street Imp 20-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—Street Imp 21 -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—Street Imp 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector. PFI—Street Imp 23-MONUMENT PROTECTION Applied 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 MATERIAL/CONSTRUCTION Applied 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 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—Street Imp 26-RIGHT OF ENTRY/EASEMENTS Applied 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 Applied 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 Applied 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 Applied 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 Applied 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 1 st 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 Applied Notice CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00131 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/17/2015 Parcel: 2S102CA00205 Jurisdiction: Site address: 13285 SW ASH DR Subdivision: VIEWCREST TERRACE Lot: 3 Project: Richey Sidewalk PFI Project Description: Replacing 18 feet of the driveway 24 feet of approach Owner: FEES Description Date Amount PHONEPFI Permit Fee 09/17/2015 $300.00 Contractor: a PHONE FAX L Applicant: SHELLY RICHEY 13285 SW ASH DR TIGARD, OR PHONE 503-476-6629 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: i Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00131 " !XR2.L Condition Name: Status: Severity: PFI_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 05-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—Sidewalk/1 06-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_Sidewalk/[ 07-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—Sidewalk/1 08-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—Sidewalk/1 09-OTHER Applied Notice I • City of Tigard RECEIVED 16 2015 s PUBLIC WORKS— ENGINEERING CITY OF TIGARD Public Facility Improvement (PFI) Peff YyirGINEERING DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK Check-one: ❑ Utility Connection ❑ TYPE 1-Franchise Utility Work Sidewalk/driveway approach Work performed by NWN,PGE ❑ Street improvements and/or utility agency. Detailed description: ' I 0� 4JqTYPE 2-Sidewalk/Driveway/Sewer J2 12--Q a Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): rt 11 and/or repair • Sanitary sewer lateral installation and/or main line tap `_ , El TYPE 3-Full scale Development Applicant: `\Li�U II���/1L�1 Work performed with Iand use approval which includes any of Address: 1 2 9'V7 uw IAS the following: City/state: T-%Q 41^'A Fitt Zip: Q'x a, 3 • Subdivisions or Partitions Phone:_'3 3-4-ho- Ue- Email: Sh(A\tA t!D frc,,�-ie-r•, Cep • Streetwidening Contact name: Sal O LA Phone: S�� �F7(o -CS�.Z eJ • Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: 9 aYI )l qO /7 I-&TG Lz C, and/or Tigard\ll,ater Service Area CCB#: i707 Expiration: SUBMIT COMPIETED A"UCATtoN TO: Address: 40/0 u-/ ve City of Tigard City/state: OR Zip: JOU Pianning/EngineeHng Phone(231 /41-70 2 Email:S1r .Cow�le®.y vv oC0W7 13M SW Hall Blvd. / Tigard,OR 97223 Contact name: -rO r-�✓'�cho Phones 9/�1 -70 9'9 Applications for"mi,ior work in right-of-way" oiilt,may be emailed to: Engineer: rQi}ermit8a1i .d-or goy Address: / City/state: Zip: ✓ Phone: Email: Case No.: ff T 20 IS Contact name: Application submittal fee: Additional fees: Estimated value of work is required(if over$5,000): 1 U ' Application accepted: (within the public right-of-way) By_m 6 Date: C1/14 /1'( I_Opn reviewed: Is work related to a LAND-USE DECISION? ❑ Yes ❑ App No ' Date: If so, please specify (MLP, SDR, SUB,etc.) case #: B} Applicant notified: 1 Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By: ,ice- F. Date: If so,please specify(BUILDING PERMIT)case#: 1ACURPU1\M•stersWwdUse Appikatiom a*v.07/09/201S City of Tigard • 13125 SW Hall Bbd. • Tigard,Oregon 97223 • uwwtigard-or.gov • 503-718-2421 • Page I of 4 DEVELOPMENT ENGINEERING FEES FOR STAIT USE' ONLY Public Facility Improvement (PFI) Permit: _ APPLICATION FEE REQUIREEMENTS Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water s}stem CONNECTIONS,ETC.improvements (work in the right of way) Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE Q Dimensions Part 3: All public water system improvements Engineer's estimate X 12% Q Site Street Q Name te Address PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required FULL SCALE DEVELOPMENT for the following types of work: (Subdivisions/Partitions and Street Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans (6 • Ditch cleaning that does not involve regrading. sets,24x36 or 22x-'A.) • Weephole repair Q; Cover—Site,Vicinity;Abbreviation,Legend • Curb repair or replacement (less than 20 lineal feet) D General Notes(City,Water,Sewer,etc) • Lawn sprinkler system installation or repair. Q! Street(Plan,Profile) • Street tree pruning or planting D Water,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance Q Water Quality-Facilities Test wells QI Grading Qi Landscaping/Tree Plan Q, Composite.U61it}Plan(Electrical,Phone,Gas, Note: A cash assurance may be required per Storm,Sanitar);eater,Signage,Street Lights,etc) TMC 15.04.140.(customer deposit) Q' Details. D Traffic Sight.Distance. Q, Signing and Striping El Street Light.Plan and Photometric 0 Engineers seal/signature Q Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) 0 Traffic Report. Q Storm water Drainage Calculations Q Geotechnical Report Q Preliminary Access Report(Sight Distance) Q Proposed Plat Q Pathway,Design (if applicable) Q Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • -%mox.tigard-or.gov • 503-718-2421 • Page 3 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 oumer. 'nie owner(s)must sign this application in die 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 ny deed restrictions that may be attached to or imputed tgon the subject Va=LW. • 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. Ll Applicant/Autho ' ed Agent's signature Print name ,d Date Owners fi4gnature Print name Date Owners signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www,6gafd-or.gov 503-718-2421 • Page 2 of 4 ... .,. 4� ir- a gra :h is 4% 1 �b It o . N r - Feet 1y+• # _ —f ► 21 i�r , ;