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PFI2017-00021 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2017-00021 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/10/2017 Parcel: SEG366 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: NW Natural Project Description: Install short side service; main is on the 4'in ROW. Possible cut for tie-in. Owner: FEES Description Date Amount PFI Permit Fee 02/10/2017 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: AISHA PRESTON 220 NW 2ND AVE PORTLAND, OR 97209 PHONE: 503-226-4211 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 See application Signature: Issued By: � Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00021 Tvae: 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 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_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 twenty-four(24)hours prior to commencing work,prior to any staged inspection, and after completing work covered by the permit. call Ken Fisher at 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 RECEIVE® City of Tigard FEB 0 g 2017 PUBLIC WORKS —ENGINEERING G RD Public FacilitY Imp rovement ( f4 G r` fG TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ 'TYPE 1—Franchise Utility Work Check one: El Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE Detailed description: Install short side svc; main is on the 4'in ROW. and/or utility agency. Possible cut for tie-in//WR#3497035 ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. / 10659 SW 127th Ct �� !�� • Driveway approach installation Property address location(s): and/or repair • Sanitary sewer lateral installation and/or main line tap Applicant: NW Natural ❑ TYPE 3—Full scale Development PP Work performed with Land use Address: 220 NW 2nd Ave approval which includes any of City/state: Portland,OR Zip: 97209 the following- Phone: ollowingPhone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com • Subdivisions or Partitions Contact name: Aisha Preston Phone: • Street widening • Mainline installation for Sanitary Contractor: Loy Clark sewer, Storm sewer, Tigard water 52281 and/or Tigard Water Service Area CCB#: Expiration: Address: PO Box 1369 SUBMIT COMPLETED APPLICATION TO: City/state: Tualatin,OR Zip: 97062 City of Tigard Phone: 503-644-2137 Email: Jim.fitzgibbon@loyclark.com Planning/Engineering 13125 SW Hall Blvd. Contact name: Jim Fitzgibbon l'hTigard,OR 97223 \pphcations for"minor work in right-of-way" Engineer: NW NaturaUPeter Cathcart only may be emailed to: rowpermits@tiQard-or.gov Address: 220 NW 2nd Ave Portland,OR 97209 FOR STAFF USE ONLY City/state: Zip:Phone: 503-715-7441 1.�11ai1: P1 c@nwnatural.com Case No.: 006 Contact name: Application submittal fee: $ AVIO a Additional fees: $ Estimated value of work is required(if over$5,000):$ Application accepted: (within the public right-of-way) By: L—S Date: C—QAab Is work related to a LAND-USE DECISION? [3Yes [3 No reviewed:No 2l1 �7 If so,please specify (MLP,SDR,SUB,etc.) case#: By: G--SL Date: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By: G-- S Date: 02 37 If so,please specify(BUILDING PERMIT)case#: I:\ENG\PermitApplications\pfi_appliration Rev.12/16/2016 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.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,if required by the city pursuant to TMC 15.041.140. * With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,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. franchised Utilities are not required to obtain the owners signature on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject ro e • 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 any 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. Optreo'wela" -.- N5 .,� -Preston, Aisha , .e Aisha Preston 2/8/17 OWe.2017.02.0813:10.55-08'07 Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Owne?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 FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL APPLICATION FEE REQUIREMENTS Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water system improvements CONNECTIONS,ETC. Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: All public water system improvements ❑ Street Name Engineer's estimate X 12% ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required (Subdivisions/Partitions and Street Improvements) for the following types of work: • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. {6 sets,24x36 or 22x34) • Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,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) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4 SAMPLE SKETCH: Edge of Pavement I 't— Ditch op Streetlight I -------------- —C--- Rain Drain /• Fir Tree ,e-" . A � 6 I I . ' T--Fr'67;— Sewer TinF— � I Q.} I N� I Existing House Existing �. I �i Driveway �I co I 3 I . o� a. I i .0' �� I i O Existing Shop � = I Powerpole I I d �� o • o I I a 95' 1 I -----7ror -Line pe —-—-—-—-—- I I -- Fire Hydrant(FH) I � I Scale'. -1-=30' � I I I 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 Trees 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 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4 cis 1 q NEW C L 1 16 z-�a•(�fa.z5ov41 � p 15 13 14 12.314'(W1�4.250`An - -1 y Rp• 165 t °� FERRY 62 163 164 > 68, 161 N 160 .p SEW C 13 L ` s } 0' p.' CL °�92 _ - ) 1110600 ` �\ $ (95)#12744 1.(P) No N iv 45 218 219 26� a$ 1^Ip) 217 (Wl _ °i —; 1.5 216 s � a x 1.5 ✓ ii----=--k10620 �i /Aj �°�' �� a1d 31' � 215 204 SW 127th Ct$#3497035 204 a 2} •tp 111064 jrZ = 11127 0 N Q 1 u: --- - 30 (90) 2 i ❑ a 19s) 0 263 C : O• 203 7yP) ?i°Ocz 7 #10674 (92) 212 212 #10673 fp) 313' LU (03) 312 202 G C('OR fr '_$ 329 CURB UNE ' Q 213 O 1(P) 010700 mope ' 13T 357 I 7'(PP p) S - --- 7f 201 -- - (P) F- #12658 yo #10720 214 N 117' (p) AIM J� 200 207 (w) 124' 215 (p) #10704 IS 206 138' (p3J 17 170' fpl #10740 (pJ (88) 7s , 205 (p) I0775 57' - p #10760 216 ^ e 199 fi 5 4 5g (85) ex �s 201 204 I&M ♦• ,�1 195 .� lyora 1gg \ �p1I1 7$� 7C /l 7 75. ' d ^ � co, pJ 197 Se ,,ti -- // j 10 ,—� 1.5' #11329°i ! s SW Springwood Dr �` *o,, 196 men ~ (P) ^�y1\ ✓ /�. #'1p�5 w 7f g 128' (91J 344, #11307 (88) (P) 1.5 2y * N � S,oR � 1• a (IS) 152 �/V �JBe 1.5 P NW Natural PLAT: 1-041-016 COUNTY: WASHINGTON 02/08/17 12:15 (503)226-4211 TOWNSHIP: T01S RANGE: R01W SECTION: 33NE SCALE: 1 IN = 100 FT I�I USER ID:aap 2011 Edition Page 81 Shoulder Work w/ Minor Road Encroachment Diag. 300 ROAD WORK to AHEAD • Initial Warning A • Sign • • • (Optional) • • Protection Vehicle w/TMA(both Optional) See Chapter 4 • Buffer 10' minimum • L./3 • I i i A ROAD NARROWS (Optional) B ROAD M � WORK • AHEAD Initial Warning Sign 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 Spacin 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