PFI2017-00032 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00032
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/01/2017
Parcel: SEG660
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Rescue Rooter
Project Description: Sewer replacement from property to main sewer line in right of way, no sidewalk.
Owner: FEES
Description Date Amount
PFI Permit Fee 03/01/2017 $300.00
PHONE:
Contractor:
JACK HOWK PLUMBING/RESCUE ROOTER
PO BOX 2830
CLACKAMAS, OR 97015
PHONE: 503-850-3100
FAX: 503-491-2932
Applicant:
JOYCE DENNIS
PO BOX 2830
CLACKAMAS, OR 97015
PHONE: 503-850-3100
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00032
Tv 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 Jonny Gish 503-718-2467 or Jonny@tigard-or gov
TRAFFIC RESTRICTION: NO WORK ON SW GREENBURG RD BEFORE 9AM OR AFTER 3PM.
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
I
RECEIVE®
City of Tigard MAR 01 2017
PUBLIC WORKS— ENGINEERING CITY OF TIGARD
Public Facility Improvement (PFI) 1�bIffENGINEERING
TYPE OF WORD
DESCRIPTION OF WORK(in the right-of-way)
`,�
El TYPE 1 - Frtnc}usc L'tilin Work
Check one: ❑ Utilities ❑Sidewilk/d..A.cti�nya roach 66trcetimprovemcnts performed bt \��1, PGG
Detailed descriptir,n: and/oruulin agcnc}.
TYPE 2-Side%valk/Driveuac/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair.
ODrivcwa}'approach Installation
1 ropern' address�/��'ye�at�ion(s}: �P'� -' a
nd/ vr
G!/ 7//�— SP • wcr Lateral installation
Irne tap
.� TYPE 3-Full scale Development
:lpplieant: CSV��' Work performed with land use
:Address: approval which includes any of
Cit�•/state: ip: the follouing:
I'honc: 4 V10
• Subdivisions or Partitions
F190 Street wtdcnrng
Contact name: _ 'one t • Nl-.unhnc installation for Sanitan
Contractor: f sewer, Storm sewer,Tigard water
and/or Tigard Water Service Arca
CCB#: Expiration:
_address: SUBMIT COMPLET6O APPLICATION TO:
Cit}•/state: Zip: City of Tigard
Phone: ( mail: 1.3125
L3125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Application,Ior"minor work sit right-of
E'Itginccr: unit may tx cmatled to:
rowpermil5(5-tigard-or.Pov
Address:
City/state: zip: 7�
Phone. l;mail: Case No.: PF/ -207- 3i�z
Contact name: Application submittal fee: $ adt'•
Additional fees:$
F•' timated caluc of work is required(if overS5,000):S application accepted.
k,km in the public right-of-«•a}) Bv: L4�* Date:
Is work related to a LAND-USE D1-1CISION% 0 %-Ls ( No Application rmicticcd: j
7_
If so, please spcci(,• (�Q.1;SDR,SUB,etc.) case#: Br �Date:3
Applicant notified:
Is work- related to a BUILDING PEILMIT= Cl By: I—S Date: �f� /
If so,please specify(BUILDING PEIUNII'1)case#: t:\EN7iemJtAypGetticn�'pfl•aoxu000 Wv.12/16/x16
Cit}•of Tigard 13133 SW}-1311 Blvd. • Tigard,Ortgon 9-223 • w-%,.-w:tigard-or.go% • 503 713-3431 • Page 1 of 4
APPLICANTS
NOTE: Person specified as".-1pplicant"shall be do<ignnud"Permittee"and shall provide financial assurance for work,if
required by the cin•pursuant to TMC 15.0 41.1.10.
' 1\ith ilia c•sc'cpti4N,ui a utility•rlpcniin}�purs,las,c u,a wliJ fnnchiyc with the(:In of'I'iglyd,uhco tits ouncr,Ind(hc:,pphc.ln(arc dlficrcnt
people,flu applicant nn15t lx(hc 4xurhavr of ren>rJ 1rr a Irssce in prv:;e�.ion utth a nttcn authon�auun from(he oUncr ur an agc•nr of the
4smmr. 'i•hc ovaeri.)mint sign thin appheaion m the sp.tcc proeided or submit a untun authortiatton utth dw application 1 raneluved
Utilities arc 1141(required Ito obtain i1w ousters stt!tt.iure on the app60ti0n
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate am recorded deed_restrictions that mai•be attached to or imposed upon the subieet
ri' of a T•.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to 111 the
conditions and limitations of the approval.
• All of the above statements and the statements in any plot.plan,attachments.and exhibits transmitted•lierc%%itli,'ate tete;and
the applielnts so acknowledge that any permit issued,based'on'this nplilication may be revdkcd if it is Eound`that<an)• such
statements are false. '
• '11te applicant has read the entire contents b
It:appLeadon,inekiding\thc pohcirs and eritcri:t,and unr3crst.tnds the
requirements for approving or denting the application. L .
\pplieant/Authorize Agent's signature Print game 'Dafe
SIGNATURES of each owner of the subject property, if required.
(eOxvner's signature Print Warne Date
Owner's signature Print name Date
Owner's signature Print narne Datc
PUBLIC FACILITY IMPROVEMENT PERMIT
Cir of Tigard • 1 i 12i til\ 11x11 131ti•d. • l tgard,Oregon 9-223 • wm ugard orgo% 503 -182421 • Page?of=f
JACK HOWK / RESCUE ROOTER
4icPLUMBING & DRAIN Qom_ ' A
PO Box 2830 • Clackamas, OR 97015
Phone: 503-235-8784 • Fax: 503-491-2932
PROJECT: 11590 SW GREENBURG RD, TIGARD, OREGON
PLOT MAP ATTACHED
TRAFFIC CONTROL MAP ATTACHED
UTILITIES IN EXCAVATION AREA MARKED & LOCATED
SEWER REPLACEMENT METHOD DETAILS - We will be using the
burst method from cast iron cleanout in back yard to city lateral.
CONNECTION DETAILS AND TYPE OF PIPE — Connection will be by
furnco or sand collar, using 4" HDPE pipe
T-CUT DETAILS — street cut will be approximately 3.5'x5' and the
t-cut will be 1' on each cut side
BACKFILL/COMPACTION DETAILS — We will use 3.4" minus rock
for backfill, unless a compaction test is required and then we will
substitute CDF
STREET RESTORATION DETAILS — A steel plate will be used to
cover excavation. We will re-asphalt the street with hot asphalt up to
4" thick on main hole , rolled to smooth finish and sanded edges to
finish
SKETCH iVRE.A- -
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PROVIDED BY: ARS dba Jack I-Iovvl(/Rescue Rooter, P.O. BOX 2830,
Clackamas, OR 97015, Phone: 503-850-3100 Fax: 503-4.91-2932
SKETCH APNEA: --
DATE:
PROJECT ADDRESS: / �� %R �
PROVIDED BY: ARS dba Jack Howk/Rescue Rooter, P.O. BOX 28-30,
Clackamas, OR 97015, Phone: 503-850-33.00 Fax: 503-491-2937
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PROJECT ADDRESS: �Y D ��✓ C�; /��
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PROVIDED BY: ARS dba Jack Mowk/Rescue Rooter, P.G. BOX 2830,
Clackamas, OR 97015, Phone: 503-850-3100 Fax. 503-491-293%