PFI2016-00195 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
= COMMUNITY DEVELOPMENT Permit#: PF12016-00195
08/30/2016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: SEGO
Parcel: SEG444
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Adjacent to 8735 SW Spruce Street. NW Natural proposes to abandon 1/2"(P)service due to demo.
Main on the 16' ROW. Possible Street cut. SEG 444/WO#3480610
Owner: FEES
Description Date Amount
PFI Permit Fee 08/3012016 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
PETER CATHCART
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
Tota 1 $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: fs
Issued By: W+j
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
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96400-9WZI=1d JOI SUOMPUOO
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. Ken Fisher 503-816-6146 or Kenny@tigard-or.gov
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 AUG 2 9 2016
41 PUBLIC WORKS — ENGINEERING CITY OF TIGARD
tANNINGIENGINEERING
Improvement Public FacilityIrovement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: El Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Abandon 1/2" (P) service due to demo. Main O :Minor work in right-of-way
Detailed description: (sidewalk repair,curb cut,street
on the 16' in ROW. Possible street cut. opening,etc.)requires:
WO#: 3480610 •Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location (s): 8735 SW Spruce St of the proposed work to be done
✓_�� •Submit one(1)copy of traffic
��(71 control plan
–OR–
A OR–
Applicant's name:' NW Natural /Shelly Kirsehenman ❑ Substantial project work requires
pP above items and professional
Address: 220 NW 2nd Ave engineered plans for:
Portland OR 97209 •Street widening
Cit\/state: ftp •Subdivision infrastructure
Phone: 503-226-4211 x4347 Email: smk@nwnatural.eom • Hain utility line extension:
Storm Drain,Sanitary—Tigard
Same NWN Water—Tigard Water Service
Contractor's name: ) Area(includes Durham,King City
CCB#: Expiration:
and a portion of unincorporated
Washington County)
Address:
City/state: Zip: DELIVER APPLICATION TO:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Engineer's name:
Peter Cathcart Tigard,OR 97223
\pplications for"minor work in right-of-wat"
Address: Same only may be emailed to:
City/state: Zip: roermitsnti rg dor.gov
Phone: 503-715-7441 Email: plc@nwnatural.com
FOR STAFF USE ONLY
Case No.:W12-,DSU-04415
Estimated value of work (within the public right-of-way): $
Application submittal fee: 300.0
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application accepted:
If so, please specify (MLP, SDR, SUB, etc.) case #: By: Date: Z�
Is work related to a BUILDING PERMIT? ElYes ❑ Application reviewed:No B JG/•tS Date: g/3 C)/1 6
If so,please specify(BUILDING PERMIT)case#: y
Applic t notified:
By:_ Date: ?JJ
I:\CURPLN\Masters\Land Use Applications Rev. 7/16/2014
City of Tigard • 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 9 wwwtigard-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 APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject proper
• 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.
i KxzcNnvn S.W,
a_wm a,9..A.—NG 08/29/2016
_ ��� saN Shelly Kirschenman
e Is..aM Is o9B,imI �nwiin uiM mm
Z(I150Y.YI NY'09'S1 U]YIU'
Applicant/Authorized Agent's signature Print name Date
Owner's signature Print name Date
Owner's 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.tigard-or.gov • 503-718-2421 • Page 2 of'4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI)Permit:
Part 1: Required submittal fee$300.00
Part 2: All non-water system improvements
Engineer's estimate X 5%,(less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2 +Part 3
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
• Strect tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.dgard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I
-ad— Ditch —W`
�; Streetlight I — -----•----- —r—'—
1 ; Raaf Dnat
' � D
� 0 1
I I '
' T—'�r�j�as cf"Selw�r'1 tiil;'� 1
I ,1 Existing House 1
Existing
Driveway
CL
CL
c,
1
.:Fp
y I
y, L -
Existing Shop
Puv,/erpole I I 1
I I
,
i I Fire Hydrant(F H)
I � I
Scale: I"=30'
I I I
I 1 I
� I I
i � I
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 Trecs
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water, storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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Sign Spacing and Buffer Lengths(feet) 1 1 w
Posted S acin Between Si ns Buffer q
Speed A 6 I c Space i =d
20 50 I O
25 100 100 100 75
30 100 qq
4125
05 350 350 350 150 00
45 180 m 3
50 500 500 500 210
55-1 250
December 2011 Chapter 5
Page 84 2011 Edition
Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a two-lane, two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT)with good
sight distance as discussed below.
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. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the "Flagger Ahead"(CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
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