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PFI2016-00031 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00031 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/01/2016 Parcel: 2S110DC00500 Jurisdiction: Tigard Site address: 11455 SW SUMMERFIELD DR Subdivision: WILLOW-BROOK-FARM Lot: 17 Project: Kona Kids Dentistry Project Description: Adjacent to 11455 SW Summerfield Dr., replace sidewalk along Durham Rd. frontage and portion of Summerfield Dr.frontage. Owner: FEES Description Date Amount PFI Permit Fee 03/01/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: BRANDON SCHWINDT 11455 SW SUMMERFIELD DR. TIGARD, OR 97224 PHONE: 503-620-2777 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: Not Present Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00031 Type: 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/1 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/1 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/[ 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. Kenny Fisher at 503-816-6146 PFI—Sidewalk/1 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 PFI_Utilities 10-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. RECEIVED City of Tigard FEB 2 3 2016 PUBLIC WORKS — ENGINEERING CITY OF TIGARD Public Facility Improvement (PF1)pP&ffi*INEERING DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK Check one: ❑ Utility Connection ❑ TYPE 1—Franchise UtilityWork IPbidewalk/driveway approach Work performed by NWN,PGE ❑ Street improvements and/or utility agency. Detailed description: ?`e�t)Vg c,`n(A CoCP S� '� '(TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: Up \A O • Sidewalk installation or repair. 5 CG Z_ .S S Ip2 ts4(4« • Driveway approach installation and/or repair Property address/location(s): • Sanitary sewer lateral installation and/or main line tap ❑ TYPE 3—Full scale Development Applicant: 77 Work performed with Land use Address: approval which includes any of the following: City/state: Zip: Z.Z • Subdivisions or Partitions Phone: ��-QM 27mail: b ,(C�y� • Street widening Contact name: h Rwll Phone: ao 3"�Z '2111 • Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: . C.0. C��t1 C and/or Tigard Water Service Area —e CCB#: \!��q� Expiration: SUBMIT COMPLETED APPLICATION TO: Y Address: 27zo\ City of Tigard City/state: WQ Zip; u�Z Planning/Engineering Phone.%O -W�l Z-QMl Z mail: L�Ot - !AZ CC 13125 SW Hall Blvd. Tigard,OR 97223 Contact name: e Phone: CrApplications for"minor work in right-of-way" only may be emailed to: _ Engineer: roo ermits .tigard-or gov Address: FOR STAFF USE ONLY _1z' p City/state: Zip: Phone: Email: Case No.: I i�I r<� ''0�_SS_i' Contact name: Application submittal fee: 3Q0 Additional fees: Estimated value of work is required(if over$5,000):$ 25 App accepted: (within the public right-of-way) By: Date: �� 3 n revi e Is work related to a LAND-USE DECISION? El Yes d: Yes [�No By: Date: If so, please specify (MLP, SDR, SUB, etc.) case#: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes I!V_No By: Z_S Date: z 1 ht,,2 If so,please specify(BUILDING PERMIT)case#: I:\CURPLN\Masten\Land U"AppllWlons Rev.07/09/2015 Cityof Tigard 13125 SDL'Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2.121 • 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 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. • 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. �� A t orized Agent's s at re Print name I R ' r Date 1 J- rA—� 2 Z / /to Own s signature rant name Date w]n (3oc,,kvt a 3 6 Owner's sign ure Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLIY '-, Public Facility Improvement (PFI) Permit: DETAILED REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 FRANCHISE UTILIT.Y AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY. CONNECTIONS,ETC. Part 2: All non-water system 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 unensions . Part 3: All public water system improvements j Stre'ef Name . Engineer's estimate X 12% i SiteAddress ) 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) i - • Relocate or replace mailbox f DesignkPlans • Ditch cleaning that does not involve regrading. r (6 sets;24x3G,or 2204) ; • Weephole repair ElCovet -Site,`�Uicinity Abliievranon Legend, • Curb repair or replacement (less than 20 lineal feet) ❑ G'erieral Notes(City Water;Sewer etc) • Lawn sprinkler system installation or repair ❑�Sfseet(flan.Profile) �`" • Street tree pruning or planting i a p g p g ❑` Water,5£orm and Sanitary(PIanProfile) r_v tr • Planter strip landscape maintenance � ❑ Water; uali`",Faeilities� .w. Q ry � . • Test wells �❑ Grading° ❑'Landscaping/TreePlan ❑ Composife Utility Plan(Electfical;'Phone,Gas, Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,-Street Lights,'-etc) TMC 15.04.140.(customer deposit) ; ❑; Details # ❑'Traffic Sight Distance " ❑ Signing and Striping ❑ Street,Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,,revision and plan log block,dates and sheet numbers) Additional Submittals (per Land Use conditions) -3 ❑ Traffic Report ❑,, Storm water Drainage„Calculations ❑,'Geotechnical Report: ' ❑ Preliminary Access Report(Sight Distance) ❑,Proposed Plat �: �, ❑ Pathway,D'estgn(if"applicable) ❑ Wa`tet Department approval r PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: S W sy 5' yS t Edge of Pavement I f— Ditch Streetlight I •— —•—•—•—•—•— it—.— Rain r� g I 10 0 1 `E" in Fi,o:use air Existing µ'' 1 ,• �� Driveway f•,.,_ (L� OL 0 i � `Existin. Sho � rn Wim.=, A k :. - � I Powerpole a`_ D]-------PrropertyLine----------- � I f Fire Hydrant(FH) � � I II Scale: 'I-=30' � I I � I � � I I � � I MINIMUM SKETCH REQUIREMENTS (Put"N/A" if Not Applicable): VNorth arrow Property lines & dimension N A Slope of property / Street& street name(s) ✓ Existing building, structures ✓ Utility & street light poles Proposed work Existing curb or edge Trees !J A Existing S/W or of pavement Existing utility locations D/W apron (sewer,water, storm) PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-or.gov - 503-718-2421 - Page 4 of 4 1 O9 �+ JP6 r 'S""10` Tree f��''� JJ 1 s-.ce t £ ( t � s � 5- d a 1 �L\ C�r JA y N � C4- I w o Is oi Page 78 2011 Edition Work on Shoulder Diagram 210 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 Proximity to Edge of Traveled Way More than 15 feet, or behind Barrier or Less than 15 feet Guardrail One advance warning sign is Advance warning required and two signs are Work in Place signs, devices, and recommended. More than 1 Hour flashing warning Cone taper is required. Cones lights are optional. along the edge of traveled way are optional. Work in Place Advance warning signs and devices are optional. Less than 1 Hour Sign Spacing and Buffer Lengths(feet) Posted Spacing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 100 40 350 350 350 125 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 79 Work on Shoulder Diagram 210 1t (Optional) • ` Protection Vehicle wf rMA(both Optional See Chapter 4 • • Buffer • • • • U3 • • A ROAD SHOULDER WORK ORWORK AHEAD AHEAD Initial Warning Sign t *Use as appropriate-see Table 5-2 December 2011 Chapter 5 Page 80 2011 Edition 5.3 Two-Lane, Two-Way Roads :Shoulder Work w/ Minor Road Encroachment Diag._300 Use this detail for non-freeway work which extends into a travel lane and maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane can not be maintained, or when traffic can not safely pass by in both lanes simultaneously, use the appropriate lane closure diagrams—for example, Diagrams 310 through 350. A lane closure may be appropriate for conditions such as high traffic volumes, high speeds, and inadequate approach sight distance to the work space, or heavy equipment adjacent to the travel lane. 1. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 2. For added visibility, a truck-mounted arrow board or PCMS in caution mode may be used. 3. Cones shall be placed along the entire length of the work space. If a protection vehicle is used and work is in place one hour or less, the taper and tangent devices may be omitted. 4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there is limited sight distance, consider placing cones or tubular markers on centerline. 5. An arrow board in caution mode or truck-mounted PCMS with "SHOULDER WORK"or other appropriate message may be used for higher visibility. Sign Spacing and Buffer Lengths(feet) Posted Spacing Between Signs Buffer Speed A B C Space- 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 81 Shoulder Work w/ Minor Road Encroachment Diag. 300 ROAD WORK to AHEAD • Initial Waming A • Sign • • • (OptionaQ • • Protection Vehicle • w/TMA(both Optional) See Chapter 4 • Buffer 10' • minimum • U3 • o A ROAD M NARROWS (Optional) B l ROAD WORK AHEAD Initial Warning Sign December 2011 Chapter 5 J,