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PFI2018-00185 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00185 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/19/2018 Parcel: 2S 111 BA01700 Jurisdiction: Tigard Site address: 14341 SW 97TH AVE Subdivision: ADAMAMY TERRACE Lot: Project: Adamamy Terrace Subdivision Project Description: Adamamy Terrace/Mitchell PFI, New lateral-sewer. Moving to utility easement. 14341 SW 97th Ave. Owner: FEES Description Date Amount PFI Permit Fee 08/28/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: MICHAEL MITCHELL 14325 SW 97TH AVE TIGARD, OR 97224 PHONE: 971-777-4043 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 PF12018-00185 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, <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@tiard-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 RECEIVED City of Tigard PUBLIC WORKS — ENGINEERING JUL 18 2018 1yo Improvement Public Fadhty t1.G1�EfL_LFJ='1,1G TIGARD TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1-Franchise Utility Work Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE Detailed description: ItIta/LW_1�xe� 4 and/or utility agency. %G 7-4 V TYPE 2-Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. �,� • Driveway approach installation Proper address/location(s): and/or repair • Sanitary sewer lateral installation and/or main line tap ��(C��"f�L G i�/ r l�C l'7�� El TYPE 3-Full scale Development Applicant: Work performed with Land use Address: S s ` 7 .- approval which includes any of City/state: l ! �/ , Zip: the following: Phone: X17/ 77 Y6�7Email: r C e f��7 Li�.,�[,S'�14 Subdivisions or Partitions �� - Street widening Contact name: , /CH^24 y_ ,, � 96Kne: �47/2 ,z • Mainline installation for Sanitary Contractor: sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: Expiration: Address: ? SUBMIT COMPLETED APPLICATION TO: City/state: Mn/�l�,a D2 Zip: ci7e3S City of Tigard Planning/Engtneeting Phone: ,(Email: :�tyi rsr4 �J ww44((.A. �ji r 13125 SW Hall Blvd. Contact name: f iLC, tuff LW Phone: ' 3 90 3 /,.O Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: "� ��''1n (,� only may be emailed to: romTermits ,tigard-or.gov Address: ' FOR STAFF USE ONLY City/state: Zip: (j (� 1 Q� Phone: Email: Case No.: I F1 20,b `�00tH`? Contact name: Application submittal fee(.007%of Engineer's Estimate) $ ?40. Estimated opo Estimated value of work is required(if over$5,000):$ Additional fees: $ (within the public right-of-way) Application accepted: i Q^��) Q Is work related to a LAND-USE DECISION? El Yes El No By: �L Date: �-t(, If so,please specify (MLP, SDR, SUB, etc.) case #: Application reviewed: By: 14.652 4 Date: �ZV-10 Is work related to a BUILDING PERMIT? ❑ Yes ❑ No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date: %Julio. I:\ENG\PermitApplications\pfi—application Rev.10/16/2017 ,. BCP G1y(w City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 Page 1 of4 APPLI CANT S 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. hranchised Utilities are not required to obtain the owner's signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subiect 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,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. Applicant/Aut�cSrized Agent's signature Print name Date SIGNATURES of each owner of the s bject property, if required. wner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigaid-or.gov 503-718-2421 • Page 2 of -1 4.1 0 I 11 5 14135 p CL v s 141969577 t 1-4140fi 1412 i ,T 14145 -- n " ! 9687 9 641 9593 ,.;. 14150 .f4 0100 14153 `. 1 14235 -y- kit. 04 Mourlt.ain View Ln • -, t .r J I �, 953 14270 14285 4% .,� J 1 428 i t' v ? 9567 �l 779 9749 14341 � � - -- -- 9582 Jubilee Ct 'igard '143-5 G 9558 !. All 1 t 9794 97 74 9744 14379 9519 9335 ' - g j.00kI n`jLn- _ Ir 9755 `►- 9541 0s x 953 Inez St L\ �zu/ S1.dGat-�rN� v ar L'H�L C1, ly �y I DEVELOPMENT ENGINEERING FEES FOR s'rAFF ITSE' ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL APPLICATION FEE Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/ DRIVEWAY AND UTILITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5% (less$300.00 minimum submittal fee) Sketch Engineer's estimate X 2%Plan Review (including information below) ❑ Dimensions WATER SYSTEM FEE ❑ Street Name Part 3: All public water system improvements ❑ Site Address Engineer's estimate X 12% FULL SCALE DEVELOPMENT PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements) There will be no permit fee charged,or assurance required for the following types of work: Design Plans • Sidewalk repair(less than 20 lineal feet) (4 sets,24x36 or 2204) • Relocate or replace mailbox ❑ Cover—Site,Vicinity,Abbreviation,Legend • Ditch cleaning that does not involve regrading. ❑ General Notes(City,Water,Sewer,etc.) • Weep hole repair ❑ Street(Plan,Profile) • Curb repair or replacement (less than 20 lineal feet) ❑ Water,Storm and Sanitary(Plan Profile) • Lawn sprinkler system installation or repair ❑ Water Quality Facilities • Street tree pruning or planting ❑ Grading • Planter strip landscape maintenance ❑ Landscaping/Tree Plan • Test wells ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc) ❑ Details Note: A cash/bond assurance may be ❑ Traffic Sight Distance required per TMC 15.04.140. ❑ Signing and Striping (customer deposit) ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate 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 Provider Approval PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of VV/Ab lNCUTON COUNTY COURT 330.41 ' CASE NO. C13-0227CV 110.00, I ` I I I )2°12'05"W S68°4 1 6.55' 40, 244E 8.00 I 8.001iU-), 2y LOT 1 P.U.E. I J I N Ln c\j M r 8,000 S.F. 0 + L *' 8.00' 0 =T Lam+ .= O as I c� 0 �'— N = 00 I = t tQ i .L ° x 0 I z 1 °' 33-001 by - co UTILITY EASEMENT ��, oo I 25.00' 3C L T 2 00 0 0 FOR THE BENEFIT I o 5, i 0 OF LOT 2 i �, 7 S. 3 23 v - - - - - - - - - - - - - - I .� � Ln EXISTIN POWER > t � N o co L&i � � OrdEW LATERAL M T- RAL N x Ira ° I as cn TRACT "All0 c\j (D) I ' 00 o 2,796 S.F. - - - - - _ _ _ _ _ _ 49' 49 42,47 - - - - - - -52.16 - - - - -L,3 Cl ' `2 � (E) cy) ;1 Q SW VIEW TERRACE IN Z.26' N88015'25"W 114.27' 00 122.27' 25.00' C8 C7 L-31 -58' -7 2011 Edition Page 81 Shoulder Work w/Minor Road Encroachment Diag. 300 ROAD WORK AHEAD 1 Initial Warning A • Sign (Optional) I • • 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