PFI2015-00170 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00170
13125 SW Hall Blvd ,Tigard OR 97223 503.718 2421 Date Issued: 11/18/2015Parcel: SEG2320
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Adjacent to 15745 SW Serena Ct Install short side 1/2"poly svc, main is on the 2' in ROW. Possible cut
for tie-in/WR#3453859.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/18/2015 $1 00
PHONE PFI Permit Fee 11/18/2015 $299.00
Contractor:
PHONE
FAX
Applicant:
AISHA PRESTON
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE 503-226-4211
Total $30000
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 Not Present
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00170
Type: 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 fob 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 Kenny Fisher at 503-816-6146 or email at kenny@tigard-or gov 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 0 9 2015
®® PUBLIC WORKS — ENGINEERING CITY OF TIGARD
Public Facility Improvement TNermit
to
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: 0 Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Install short side 1/2" of svc; main is on the ❑ ilmorworkin right-of-way
Detailed description: poly
(sidewalk repair,curb cut,street
2' in ROW. Possible cut for tie-in//WR#3453859 opening,etc.)requires:
•Application form,completed
and signed
• Submit one(1) copy of scaled sketch
Property address/location(s): 15745 SW Serena Ct ` (� of the proposed work to be done
•Submit one(1)copy of traffic
control plan
–OR–
A OR–
Applicant's NW Natural/Aisha Preston ❑ Substantial project work requires
PP s name: above items and professional
Address: 220 NW 2nd Ave engineered plans for:
•Street widening
Portland, OR Zip: 97209 •Subdivision infrastructure
Phone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com • \hum utility line extension:
- Storm Dram,Sanitary—Tigard
LO Clark/HeathWyckoff - eater—Tigard WWater Service
Contractor's name: Y Clark/Heather Y Area(includes Durham,King City
52281 and a portion of unincorporated
CCB#: Expiration: ��-ashington County)
Address- PO Box 1369
City./state: Tualatin, OR Zip: 97062 DELIVER APPLICATION TO:
City of Tigard
Phone: 503-783-1188 Email: heather.wyekoff@loyclark.com Planning/Engineering
13125 SW Hall Blvd.
Andrew Young Tigard,OR 97223
Engineer's name: 9
:Applications for"minor work Lit right-of-way"
Address: 220 NW 2nd Ave only may be entailed to:
City/state: Portland, OR Zip: 97209 ro=ermitsatigaard-or.gov
Phone: 360-281-6169 Entail: afy@nwnatural.eom
0 0
Case.
Estimated value of work (within the public right-of-way): S
APi atiori:submittal-fee:�.���3� �,i""
Is work related to a LAND-USE DECISIONS ❑ Yes ❑ No Applicauon'a'ccep�tedi ;`;' 3° �;; ;•" -�, '
If so, please specify (MLP SDR SUB etc.) case #: Bv: �=' �I�at'e�'�`�'�
"Application"revicwe`d:'''�'•'��''_
Is work related to a BUILDING PERMIT% ❑ Yes ❑ No
If so pleasespecify UILDING PERMIT)case#: .,
1pp'ca tified: t
;.
By: g a t Date: Vi$ :
� 1:\CLJ LN\Masters\Lan Use Applications`Re '02/16/2014 "
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 ,tlyw.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 ownet and the applicant are different people,the apphcant mint be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner The ownet(s)must sign this application in the space provided or submit a written
authonzanon with this apphcation
BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate anv 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 ul 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 enure 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.
11g7rt211V s,nld dy 1i1ha Preston Preston
11/5/15
DN f�,=Baha�f.s,t n,o., Natural,ou, Aisha 1 restos
A i s h a Preston e raJ=as?Crvniatural com,-US
Date•2015'105090125-08'00'
Applicant/Authorized Agent's-signature Print name Dare
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 S\\'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
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NW Natural PLAT: 1-046-019 COUNTY:WASHINGTON 11/05/15 08:2
(503)226-4211 TOWNSHIP: T02S RANGE: R01 W SECTION: 11 SW SCALE: 1 IN = 100 FT USER ID:aap
Page 78 2011 Edition
-� - o
, �;°� � ..... : =;�,;: tea,_;_,. _� • _
WoFE k, Shoulder,, -_ y , Dia ram 210.
..,,_ ., t
Diagram 210 covers stationary work with work or parked equipment on the
shoulder. This diagram does not cover work on a freeway shoulder. See
Diagram 710 for Freeway Shoulder work.
1. Vehicles should be parked as far off the roadway as practical.
2. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
3. For added visibility, truck-mounted arrow boards or PCMS in caution
mode may be used.
4. Arrow panels in caution mode are recommended for work on roads
with posted speeds of 45 mph or greater and high traffic volumes,
greater than 2000 average daily traffic (ADT).
5. Requirements for signing and devices are shown in Table 5-2, below.
Table 5-2: Device and Signage Guidelines
Yry 3 -P'roxtmitto•Ed
vele
e•of.Trad"VVa ?°
, Mdre'jhan 1.5 feet "
'� . �-?:ice°;°, �< �::
behind Barrier°or ; L`essahan�'.1'5 feet
' � .... �_� ;.:.
One advance warning sign is
sem`_... .::,z;•. " :.
Advance warning q 9
required and two signs are
recommended.
1N,ork-in Place signs, devices, and
More-than 1>`Hour = flashing warning Cone taper is required. Cones
li optional.lights are
along the edge of traveled way
a' are optional.
Work>in Advance warning signs and devices are optional.
;Less than 1°:Wour.
Sign Spacing and Buffer Lengths(feet)
Posted ;°S" aein- Betweeri;Si nBiiffen.;,
S eed
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 79
HD'a„ ram:°21.05
iNork::on'Sio"ulcler - _ ; .
•
•
•
(Optional)
•
® Protection Vehicle
w/TMA(both Optional)
S0ee Chapter 4
•
• Buffer
I
s
•
•
® U3*
•
A
ROAD SHOULDER
WORK OR WORK
AHEAD AHEAD
Initial Warning Sign
*Use as appropriate-see Table 5-2
December 2011 Chapter 5
i
1 1