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PFI2018-00162 ®� IT PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00162 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: SEG11718 Parcel: EG1171 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: NW Natural Project Description: SEG 1171. Relocating 2"(W)vent stack 25'south out of the footprint of sidewalk and new ADA sidewalk approach.Vent has been damaged by vehicle. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: JAMISON FORGE 220 NW 2ND AVE PORTLAND, OR 97209 PHONE: 503-224-4211 Total $0.00 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:Issue41wj� d By:By: 4AA d v Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00162 Type: 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,Andrew Newbury at 503-718-2472, 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. 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 RECENED w. City of Tigard JUN S 5 2018 PUBLIC WORDS —ENGINEERING CITY OF TICARD public Facility Improvement IFI) PMhW'INEERING C c'�'.4��,��'" �TJJ A}'/x'''11 r FK�..�'S�5" �'�i Yn� .•r DESCRIPTION 4 WORK(in the right-of-way) El TYPE 1—Franchise Utility Work Check one: 0 Utilities ❑Sidewalk,/driveway approach ®Streetimprovements performed by NWN, PGE P Relocating 2" W Vent stack 25'South out of the and/or utility agency. Detailed description: g; � } footprint of sidewalk and new ADA sidewalk aproach.Vent has been damaged ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of. by vehicle. • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): SE corner of SW Hunziker St and Wall St and/or repair • Sanitary sever lateral installation j and/or main line tap ❑ TYPE 3—Full scale Development Applicant: NW Natural-Jamison Forge WO#3544127 Work performed with Land use. Address: 220 NW 2nd Ave approval which includes any of City/state: Portland,OR Zip: 97209 the following: Phone: 503-2264211x4542 Email: Jamison.Forge@NWNatural.com • Subdivisions or Partitions Contact name: Jamison Forge. Phone: 503-226-4211x4542 • Streetwidening • Mainline installation for Sanitary Contractor: sewer, Storm sewer,Tigard water and/or Tigard Water Service area CCB#: Expiration: Address: SUBMIT CUMPEETEIDTM NLICATIDN'TO City/state: Zip: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" only may be emailed to: Engineer: rowpermits(7a.tigard-or.gov Address: Ci /state: Zip• . Phone: Email: -'CasGNo3 $� ��` Contact name: Y - - pplicatton,Stu-uttal fee(007/o�of r . ZL y` � � � A pit � �? E gi leer's Estsrriate)� Estimated value of work is required(if over$5,000):$ 'rddia feesEN Al £� . (within thepublic ri lit-of-wa � `=° P g Y) _ pplicatson accelited � f" C S� BYTE Date ' Is work related to a LAND-USE DECISION? ❑ Yes 0 No - r1pltc aon'�rW. ev ed , If so,please specify (MLP,SDR,SUB,etc.) case#: r��Fh � � � _ s ` y 9.M 0174te: Is work related to a BUILDING PERMIT. ❑ dies ❑ No �u pp n ? � � i�A lica�nt nonfied:� I f so,please specify(BUILDING PERMIT)case#: �By� 1.10)ate��$ .Q, nt, G i tionsRt iia ion Rev QJ16 2017 C fi i i City o£Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 %vwwtigard-or.gov 503-718-2421 Page 1 of4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if required by the cit3,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(q)must sign tlus application in the space provided or submit a written authorization with this application. Franchised Utilities are not required to obtain the owner's 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 unposed upon the subject ro er • 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,attaclunents,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. Applicant/Authorized r'ent's kignature Print name Date SIGNATURES of each owner of the subject property,if required. Owners signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT CityofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ww%utigard-or.gov 503-718-2421 • Page 2 of4 OB.IVELOPMENT ENGINEERING FEES ...- • r.� y.; qy q.-.. .... Public Facility Improvement(PFI)Permit: • APPLICATION FEE 011 Part 1: Required submittal fee$300.00 (riununum) F�RAN �HISEUTYLITYbTD SIDEWALK`% k,Ji a + DR$I�EWAYS'ANDiSTILI'TY r� " PERMIT]FEE � f� ,�c,��-',�s-�. ��,r C+ON;NE�GTIONS K ETCt` � ' r , £G`-° raj YF f RZ s ai ��t' "�'ai A-'ei� .�.,'. c • `,� Part 2: All non-water system improvements (worl�in thcrightof2 way) ,y� �F Engineer's estimate X 5%(less$300.00 minimum 4RM, s s SICC Ich w a �_ x T Y u L+n submittal fee ca* , X-includin�YinformArion:belo�F Engineer s estimate�i.2%Plan Review G � ��3 r� ��; >Y �K Rh e l ws H € ti� Dunenstons � �� ; i �r� G;r y F. WATER SYSTEMFEE � *: street VutR Part 3: All public,,vater system im roveclientsC1Srte � � Engineer's estimate X 12% A aFLTsLL;S"CALEDEEIIOPMENT� y 7 "I'.. FY PFI Permit Fee Exemptions:tions: and�tHt 'Impro.re:nc nts} There will be no permit fee charged,or assurance requiredSUN. for the following tyi es of work: 1 4cs �� P (1 �(Gscts=24x3G'or2�a34) f � � � • Sidewalk re air e's than 201ineal Feet Y - ' � r � 4 r p a 'Y- rn¢. � z x C k V, • Relocate or replace mailbox zCover' ;Site;�icuuty,E'�bbreyiaao�lgend � E • Ditch cleaning that does not involve regrading. ® Gener-a1ftN10 Cai7r 5,W?ar Sewer�etc�)� � s 3;,a'�r �gs ' a' '�a� • Weep hole repairmy� - • Curb repair or.replacement(less than 20 lineal feet) -h Q' WaterStorznaand,San�tary(I IanProfile) • T r' repair , at uality�FaCItifl. gels os�' Lawn sprinkler s stem installation or � � �re�� X P � w • Street tree runin 'or planting , P g P g ��. • Planter strip landscape maintenanced�sca�p":iini�gTree r� � �a'4s t^Sif i • Test wellsrl] ComliosireUutity Plan(ElcctucalPhone,Gas; h- I "` ary, r gn g ��rreet`�Lightsetc) �' Sacut `X.ater Ski tae ; TU Note: A cash bond assurance May be ltDistance required per TMC 13.04.140. �`' g and:�triping x �srt r customer de osit t:aCiCett � � R p ,) � - S ght4Plan and Photomecncl �g � IM � ^�" s70 ?. � ' 'g+ x^� s'rte hkv a y tCn eers seal/si ature ." 5 �y � 1 Shee[label�(proaectlanduse name,r sion�'�and� ' plan�iog block dares,awp nd sheet�numers b )=�� Xc - � . 14, 15 da ,` d�tlo i ate 33 MAR (pc r Land-0Usenconclttian • ,,< �raffic�Re 10. ,�� a watery Drainage f 621alcvlations •� Geote c n At ic"alReportr � � s �'. .� .,+ ..,.,,.rte-"� is c r i �MPrelitnina ;lccess�Report�(Sight�Distance),, E; � ' s ( ®`Piop�osed Pl1R.Al i O Pathway lD.esi ` ifa livable) s praSVX _ . oi WrDPan s❑�Engineers�ConstructionEstur�ate ' �w�....`..�,k._..•�' ��w.�.��a��'+t.��r��' � .�j��„so- i i i i PUBLIC FACILITY IMPROVEMENT PERMIT City ot'Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of4 SAh2LE SKETCH: st , �teet9ight;' �. .wr d'aoa®oma a ir NMI o' Gbmt�RdOae SW _ '"• _ �� =...Tail.::'�''� J':�•1.�`�'/�! S . I.. dr EXiSfingi 77 'J"'ire._...;4a�' =`--C�'• ;:�•i.C = '::•r,'.:. Y. Powerpo!"e.�. g . I �, w �a®m•s s,��a•�wm�o s, • t-�yarit,(FH -o. = , . •1. -. MINIMUM SKETCH REQUIREMENTS(taut"N/A"if Not Applicable).- North pplicable):North arrow Property lines&dimension Slope of property Street &street narne(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 ofTigard • 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.dgard-orgov • 503-718-2421 • Page 4 of4 NW Natural—Site Information Form (SIF) Service Address Service WO# S.W. Hunziker Rd. and S.W. Wall St. Plat# City and County Main WO# Revision# 1-043-021 Tigard, Wash. #3544127 #21952 LOCATE INSTRUCTIONS: Locate 50'x 55'work zone mark in white at S.E. corner of S.W. Hunziker Rd. and S.W. Wall St. White Paint Down? 0 YES ❑ NO How many Headers? Delivery Pressure Total Therm Load ❑Single❑Double ❑Other#: ❑Standard 02 PSI ❑Other: ❑Residential ❑Commercial ❑Industrial ❑Conversion ❑Riser Relocate ❑Cutoff ❑ New Const ❑Open Pathway(open) ❑Conduit ❑RUSH ❑PRESOLD ❑Bore w/crew ❑ Bore-N-Go ❑GNS ❑Double Off ❑Keyhole ❑Job Agreement ❑ Easement Required PERMIT REQUIRED ❑NONE 0 City ❑Sticker ❑Verbal ❑Notify Only ❑Blanket ❑Standard ❑County ❑Sticker ❑Verbal ❑Notify Only ❑Blanket ❑Standard ❑ODOT/WSDOT ❑Railroad excay. area is on edge of traffic Ln. and may require some flagging. ❑Other(specialty permits,easements): 0 Flagging required 0 Traffic Control Plan Needed rid Standard ODOT template attached ❑Vendor-provided plan INSTALLATION REQUIREMENTS ❑See Separate Attachment Service Size&Type Service Footage Main Size&Type Main Footage 2'(W) 25'of Vent to Stack Service to Main Location 1;6 Short ❑Long Hard surface cuts required? ❑YES 0 NO Street Moratorium? ❑YES 0 NO Guard Post Required? ❑YES lZ NO Fiber Optics? 0 Unknown ❑YES ❑NO Oil Tank? ❑Unknown ❑YES 0 NO Septic Systems? ❑Unknown ❑YES 91 NO Sprinklers? ❑Unknown ❑YES p1 NO Other(list): 0 Unknown ❑YES ❑NO Houseline Installed: ❑YES ❑NO ❑Green Tagged Meter Loc: Working within open water area? ❑YES 0 NO Erosion Sensitive Area? ❑YES W1 NO Working within proposed or existing planter strip/swale? ❑YES 0 NO Working in a Tree Critical Root Zone? ❑YES NO CROSS SECTION DETAILS Paving Symbols: AC—Asphalt E—Earth C—Concrete G—Gravel PUE—Public Utility Easement,ROW—Right-of-Way,EOP—Edge of Pavement,C/L—Centerline Commentsa p w w 0 a CURB? YINF- CURB? YIN C€L Number of cuts: Size of cut(s):: ❑Over main ❑Over other utilities Street Name: Direction Facing ❑North ❑West F-8039 (6/30/10) NW Natural—Site Information Form (SIF) Description SERVICE MAIN WO#: VVO#:3544127 Crew comp Construction 4(DCL) x Construction 3(MCL) Construction 2 (PJ) Construction 1 (PF) Equipment Crew Truck x Poly Trailer Pickup Truck Kubota, 3 Yarder&Trailer John Deere, 3 Yarder&Trailer Mini-Excavator, 3 Yarder&Trailer x Mid-Bore/Mini-Bore Hole Hog Keyhole Truck Contract Hoe& Dump Truck Contract Dump Truck 10 Yarder Other Labor/Equipment Vac-X Truck& Crew Mechanic Welder&Truck Contract Bore Crew Flagger—how many? 2 Plate Truck Backfuii & Resurfacing Sand (yd) Gravel (yd) x CDF Paving Depth: Concrete Depth: �(�]{J(�7� }'{�/� n IIV isce ��1'ue/®ll s y Sx^5.....`.tb-..,.9.t�A r`av-£ a✓;. i a `G'/ F - ' F r0..}r *... 7 bf �P 3+' 4 9 Contract Sawcut Standard 1/" Service Kit+ Meter Standard I" Service Kit+ Meter Company Material Other: NOTES: (Construction details,flagging requirements,ground conditions,etc.) Crew will need to excavate and remove damaged vent stack on edge of traffic lane, then excavate 25'south to white staked location. 2"Vent and the four#6 Test Lead wires will need to be extended , Corrosion tech. (Phil Toth) has already extended these Wires some to reach behind new curb line, but they need to be extended to reach behind new ADA sidewalk ramp to be installed soon. White staked location should place Vent Stack between P/L and back of proposed new sidewalk per project Eng. James Parker(971-269-4111). work is next to Road Flaggers may be needed Name Orville Geelan Cell#503-806-1034 Cate 6/22/2018 F-8039 (6/30/10) \\ ., Plat 1-043-021 52' �.,, - -�_ ` �''�.� d *NOTE*Replace danmged 2"Vent Stack and relocate Vent Stack and#6 Test Lead wires 25'to South at staked location behind'/J tU"nOa�. -t4 nen ADA sidewalk mntp to be installedi` J, f T, 4(T I J /4f \o °'~ v2 pry', N jkPR its, v� rw�?3 RTS Page 80 2011 Edition , 'Shoulcle kWoMR"A, V onor Road�ncroachVI-15E t Di " 300 xnrdi�.au$., :u. .:xx..,l3,. - y Hr. =�m .o.",3a .ka ..::.a:c.:.•;,:n ...z .u.,.,2 d _ w�` �.n:-"� ,.-a�,.„m 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# Spacm 'Betv�ke"enS' ns � B3uffer 9. 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 81 `Sho`ulder Workr�/ Lf�I®6.\Oa�d k� �J i L p }' TS „R'-� Elr>lcroachment �„ Dia " "^a..m..&�saL....es,�.a.�r sr -k.�'.'�,d.�..�A� ,.�__ �=w.. ras -k � $:�wt3. a+.....+�.u�c�k.,xi�W's_: ROAD WORK to AHEAD 1 Initial Warning A . Sign • s • (Optional) • • Protection Vehicle • w/TMA(both Optional) See Chapter 4 • Buffer 10' • minimum ® U3 • A ROAD NARROWS (Optional) B ROAD WORK AHEAD Initial Warning Sign December 2011 Chapter 5