The URL can be used to link to this page

PFI2017-00033 n CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12017-00033 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/06/2017 Parcel: SEG1396 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: NW Natural Project Description: Install short side svc: main is on the 8' in ROW. Possible cut for tie-in to main//WR#34999303. Owner: FEES Description Date Amount PFI Permit Fee 03/06/2017 $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. Signature: Permittee/Applicant ---�d`"� Signature: �/ odI r'.�,(/VL Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00033 Ty pe: 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. IF PAVEMENT IS CUT: GRIND AND INLAY ASPHALT STANDARD DESIGN(ATTACHED)SHALL BE FOLLOWED 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 MAR 0 2 2017 PUBLIC WORKS ENGINEERING CITY OF TIGARD Public Facility Improvement J"IPP81�ING DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: [j] Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Install short side svc; main is on the 8' in ROW. ❑ Minor work in right-of-way (sidewalk repair,curb cut,street Possible cut for tie-in to main//WR#3499303 opening,etc.)requires: •application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 9685 SW Frewing St �� J'�-I of the proposed work to be done •Submit one(1)copy of traffic control plan -OR- NW Natural/Aisha Preston E] Substantial project work requires Applicant's name: above items and professional Address: 220 NW 2nd Ave engineered plans for: Portland, OR 97209 •Street widening Ci /state: Zip: •Subdivision infrastructure Phone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com •Main utility line extension: Storm Drain,Sanitary-Tigard Water-Tigard Water Service Contractor's name: Loy Clark/Jim Fitzgibbon area(includes Durham,King City CCB#: 52281 Expiration: and a portion of unincorporated Address: PO Box 1369 Washington County) City/state: _ ''/.ii,: TualatinOR 97062 DELIVER APPLICATION TO: _ , City of Tigard Phone: 503-644-2137 i: ii: 1im.fitzgibbon@loyclark.com Planning/Engineering 13125 SW Hall Blvd. Engineer's name: Peter Cathcart Tigard,OR 97223 220 NW 2nd Ave Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Portland, OR Zip: 97209 ro=ermitsk Bard-o .gov Phone: 503-715-7441 Email: plc@nwnatural.com FOR ONLY 2 Case No.: � ��3/-COr7- Estimated value of work (within the public right-of-way): $ Ar3a0.— Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application accepted: If so,please specify (MLP,SDR,SUB,etc.) case #: By: La Date: Is work related to a BUILDING PERMIT? ❑ les ❑ No application reviewed: By:.16:sII`�— Date: 31 c.1 1-7 If so,please specify(BUILDING PERMIT)case#: Applicant notified: By:_ Date: lVURPLN\Masters\Land Use Applications Rev.07/16/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Pagel 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 mai-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. Dgitally signed by Asha Preston DN cn=Als. astUn,O= J Natural, OU,Aisha Preston mil=aap�nwnaturel.con,cUSAisha Preston 3/2/17 Date201507.22 _ 12:30:22-07'00' Applicant/Authorized Agent's signature Print name Date Owner's signature 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.tigard-or.gov 503-718-2421 0 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 • Street 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.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: SWIly " S t Edge of Pavement I -04— Ditch Streetlight I -------_------ —r--- f. Tr Rain Drain 1 I t ` --- FW Tra~ � a I �o a 1 ' T—propos d'SowerTine" ! I - 1 1 C.) I . , 21 ! Existing House 1 I I a� I Existing • Driveway L I �! �I 0, 1 a I ,� 1 i E� I i o Existing Shop � Power ole 1 p I oto I 1 a 951 I I -- -----�roperfyLine----------- II Fire Hydrant(FH) � � I ! Scale: -1"=30' � 1 I � I I I I i � 1 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 City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4 2011 Edition Page 95 Self-Regulating Lane Closure Diagram 350 ROAD v A WORK B 1 to AHEAD • Initial Warning • Sign I • A • - L • ONE LANE ® r ROAD \ ran AHEAD • Protection vehicle • TO YIELD' w/TMA(both Optional) - ONCOMING OR TO See Chapter 4 • TRAFFIC, ONCOMING TRAFFIC • �iifFer • 50'-100' • I5, �OORRV' A ONE LANE B ROAD AHEAD ROAD 1 WORK AHEAD AHEAD Initial Warning Sign December 2011 Chapter 5 Page 94 2011 Edition Self-Regulating Lane Closure Diagram 350 Use this detail for closures of one lane of a low-speed,two-lane, two-way road. 1. Use this diagram only if all of the following are true: a. Work space is less than 200 feet. b. The posted speed is 40 mph or less(unless not posted and speed governed by basic rule). c. Average Daily Traffic(ADT)is less than 400. d. Sight distance (in feet)is more than 750 at each end. 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, a truck-mounted arrow panel or PCMS in caution mode may be used. 4. A"Lane Ends(Right)" (W4-2R)symbol sign, or"RIGHT LANE ENDS" (W9-1 R)sign, may be placed inside the cone taper for more emphasis. Sign Spacing and Buffer Lengths(feet) Posted S acin 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 7.5' ��$P, ° 3 t r 611 5 ll $00 ek,Al /Its SW Frewing St �'� 00 11 9 A9�� 14,111, *alts a� O 10 9685 SW Frewing St, #3499303 sT s 94 3 ), � / ��• ,!y ? Pko �� O ,P1 �,2� `� � ENN DR• AQP '�� O ,'� a �• �� G1. + "3506 (� (8?) 50 e 4g ki 351, W (7 346 #13580 e, SW Ash Ave •13515 316 8 5 4 292 _ (P) #13570 #134 25t (96) 4, #13545 / p4) �vl .71 � 4, N fes. NW Natural PLAT: 1-044-019 COUNTY: WASHINGTON Q 03/02/17 14:09 (503)226-4211 TOWNSHIP: T02S RANGE: R01 W SECTION: 2SW SCALE: 1 IN = 100 FT USER ID:aap Machine Mill The Sand And Seal Paving Joints With kM12 Area For A 1-1/2" Hot Paving Grade Exsting 12„ Di! (pg 64-22 Or in Blanket Inlay Asphaltic Min * See Notes Below Equivalent) Concrete Exsting ? y r 11 2): Road - :� � ,<< Bose -.r -)�,��_, � �^Zi it 11-1 I I— � .• ; . . . , a �=1 �� I = Non-Compressible 1 Backfill-Cement Slurry -) I I. •(for Major Roads Or As. _III y Asphaltic Concrete Pavement Specified) Undisturbed dre '7" Patch, 6" Thick Or. Match Existing Pavement (whichever Is Greater) Up The Level Of 1-1 I • , I_ __I l Iy Original Pavement. =1 I I-= • '!ISI I-1 I Crushed Aggregate j,I -III— d Or Granular Pipe Zone Backfill Material � I-^-1 r E� 06 Trench Width ti2 Per Plan or e * As Specified b= Notes.- $ Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, Pg-64-22 o Hmac In Dry Pavement Conditions, Where Existing Pavement Is At Least 60' F And Rising. Tock All Pavement To Be Inlaid With Emulsified Asphalt. The City Engineer Shall Determine the Final Width and Length of the Inlay Patch a to Best Fit Travel Potterns. 3r t o o 2 a 0 CAPITAL CONSTRUCTION AND r TRANSPORTATION DIVISION City of Tigard FIGURE u �+ 13125 S. HALL BLVD. 77G4RD, OREGON 97223 Blanket Inlay i W. �I k710E• 503-559-4171 c FAX.- 503-624-0752 FILE NO WWW.77CARD-OR.GOV Detail n/o