PFI2018-00014 gI CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00014
Date Issued: 02/26/2018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: SEG1396
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NWN PFI
Project Description: Install 2 short side SVCS main is on the 8' in ROW under asphalt.
@ 9795&9799 SW Frewing
Owner: FEES
Description Date Amount
PFI Permit Fee 02/05/2018 $300.00
PHONE:
Contractor:
LOY CLARK
PO BOX 1369
TUALATIN, OR 97062
PHONE:
FAX:
Applicant:
AISHA RIVERS
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 r n C,�,/V�/„�L_A
Signature: vl
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00014
Type: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS Not Met 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 Not Met 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 04-WORK SITE REPAIRS Not Met 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 17- NOTICE TO COMMENCE WORK Not Met 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.
PFI_Utilities 06-TRAFFIC CONTROL PLAN Not Met 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 Not Met 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 09-TRAFFIC CONTROL WORK HOURS Not Met 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 20- EMERGENCY CONTACTS Not Met 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 03-WORK SITE EROSION CONTROL Not Met 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 05-TRAFFIC CONTROL SPECIFICATIONS Not Met 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 12- UTILITY NOTIFICATION Not Met 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 18- PERMIT/PLAN ON SITE Not Met 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 11 -TRAFFIC CONTROL MODIFICATION Not Met 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 13- UTILITY LOCATION CONFLICT Not Met 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 Not Met 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 Not Met 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 19-MONUMENT PROTECTION Not Met Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI—Utilities 16- PRECONSTRUCTION MEETING Not Met 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 08-TRAFFIC CONTROL PROPERTY ACCESS Not Met 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 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 JAN 2 5 2018
PUBLIC WORKS — ENGINEERING 't CITY CF'i IGARD
' r, iffifNGINEERING
Public FacilityImprovement (PFI) Pe
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: El Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: Install (2)short side svcs; main is on the Fin ROW ❑ 'Minor work in right-of-way
halt//V11R#3530436 & 3530439 (sidewalk repair,curb cut,street
under as
p opening,etc.)requires:
•application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): 9795 & 9799 SW Frewing St of the proposed work to be done
�C-1 0 0 •Submit one(1)copy of traffic
"' control plan
–OR–
Applicant's name: NW Natural/Aisha Rivers El Substantial project work requires
PP above items and professional
Address: 220 NW 2nd Ave engineered plans for:
•Street widening
City/state: Portland, OR Zip. 97209 •Subdivision infrastructure
Phone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com •Main utility line extension:
- Storm Drain,Sanitary–Tigard
LO Clark - Water–Tigard Water Service
Contractor's name: Y area(includes Durham,King City
CCB#: 52281 Expiration: and a portion of unincorporated
Address:
PO Box 1369 Washington County)
City/state: , Zip:
TualatinOr97062 DELIVER APPLICATION TO:
City of Tigard
Phone: 971-806-2841 Email: Jade.leedy@loyclark.com Planning/Engineer
ing
13125 SW Hall Blvd.
Engineer's name:
NW Natural/Rich Girard 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 LQmermits&tigard-orr go_v
Phone: 360-921-0314 Email: r2g@nwnatural.com
Case No.: POU 11 — 0000
Estimated value of work (within the public right-of-way): $ application submittal fee: $soy ,od
Is work related to a LAND-USE DECISION? ❑ les ❑ No Application accepted:
If so, please specify (MLP, SDR, SUB, etc.) case #: By: Date: 15
Is work related to a BUILDING PERI HT? ❑ Yes ❑ No Application reviewed:
If so,please specify(BUILDING PERMBy: 64 Date:IT) case#: .
Applicant notified:
�1'L�t�1.1►.�Cc� )S A J-00 Cj T s-rtzct–T, -r-e* j cv+t es By: AL" Date: 2
t�
�t l` .. 1 fe t 4 +& ,eg C f�} •TN �,�l N 1 �f I:\CURPLN\Masters\Land Use Applications Rev.07/16/2014
l�f �
City of Tigard • 13125 SW Hall Blvd. 0 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.
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 imtiosed ution the subject tirotierty.
• 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.
Digitally signed by Aisha Preston
DN: aha Preston,o=N,c Natural,ou,Aisha Prestonemail=ap@nwnatural.com,c=US AI s h a Preston 2/24/16
Date:2016.02.23 10:33:57-08'00'
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 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
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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 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 95
Self-Regulating Lane Closure Diagram 350
ROAD\' — A
WORK B
7JA •
Initial AHEAD
Warning •
Sign •
•
,
ONE LANE ® \ ,,,�
ROAD
AHEAD •
Protection Vehicle • TO YIELD
W/TMA(both Optional) ONCOMING OR TO
See Chapter 4 • TRAFFIC ONCOMING
TRAFFIC
• Buffer
••
50'-100'
a
I5�
ORV A 1E,
ONE LANE\
B ROAD
AHEAD
ROAD
C � WORK
AHEAD
Warning 1 / Initial
Warning
Sign
December 2011 Chapter 5
Machine Mill The Sand And Seal
Paving Joints With
12 � � Area For A 1-1/2" Hot Paving Grade
Exsting 12„ Min Blanket Inlay Oil (pg 64-22 Or
Asphaltic Min See Notes Below Equivalent)
COnCrete
Exsting �a.�' �'Y Jr.,1 ��.,.{ •• � ,,,..'' %s.' ��
Road 1, �;' >�� - ..• . �; ��
Base �'��.�`-�1.`.,_J C����' ..�r,. . . • ' �..�.�`--�1-�`�''-.�.�r� v�
Non—Compressible
Backfill Cement Slurry '
(for Mojor Roads Or As• J i 1=
Asphaltic Concrete Pavement Specified) i ' Undisturbed
Ground
"7" Patch, 6 Thick Or. Match I Ground
Existing Pavement (whichever Is
Greater) Up To The Level Of ;
Original Pavement.
{�— Crushed Aggregate _I
Or Granular Pipe
Zone Backfill
I —{ d Material { f
III lil ! I III-- I { 11
.ail { ! fl fl1 -lll . ,II ! i { {
R
0 o Trench Width
�; ------ Per Plan or
hAs Specified
*
o Notes:
$ Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, P9-64-22
o Hmoc In Dry Pavement Conditions, Where Existing Pavement Is At Least 60• F
And Rising.
Tock All Pavement To 8e Inlaid With Emulsified Asphalt.
�s The City Engineer Shall Determine the Final Width and Length of the Inlay Patch
to Best Fit Travel Pottems.
3
to
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CAPITAL CONSTRUCTION AND
�� TRANSPORTATION DIVISION City of Tigard FIG_URE
-0�� �- 13125 SA ,� BLVD.
Blanket I n I�y
!. •. nav caRo, oRrc97223
.z VOICE: 503-639-4171
W. 503-624-0752 Detail FILE NO
a I www.RWD�-oR.cov n�a