PFI2019-00065 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
I COMMUNITY DEVELOPMENT Permit#: PFI2019-00065
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/05/2019
Parcel: SEG301
Jurisdiction:
Site address:
Subdivision: Lot:
Project: NW Natural WR#3563841 and 3563839
Project Description: SEG301, associated with 8910#B and 9010#A SW Oak Street. Install(2)long side svc; main is on the
8'in ROW under asphalt. (2)-4'x5'hard surface cut//WR#3563841 and 3563839
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
AISHA RIVERS
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
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 ( Ap P��1iV
(�j]--u_6 1 l
Signature: {/
Issued By: 4114°14/4 _
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2019-00065
Type: Condition Name: Status: Severi :
RECEIVED
City of Tigard
a PUBLIC WORKS — ENGINEERING
FEB 2 5 2019
GITY OF TIGARD
Public FacilityIm rovement PFI) 1GINEERING
TIGARD•
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
2/TYPE 1-Franchise Utility Work
Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Streetimprovements performed by NWN, PGE
Detailed description: Install (2) long side svc; main is on the 8' in and/or utility agency.
ROW under asphalt. (2)-4'x5' hard suface cut//WR#3563841 & 3563839 ❑ TYPE 2-Sidewall:/Driveway/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
8910 #B & 9010 #A SW Oak St
Property address/location(s): `` and/or repair
SL s�S L) • Sanitary sewer lateral installation
and/or main line tap
NW Natural
❑ TYPE 3-Full scale Development
Applicant: Work performed with Land use
Address: 220 NW 2nd Ave approval which includes any of
City/state: Portland, OR Zip: 97209 the following:
Phone:503-226-4211 Email: nwnpermits@nwnatural.com • Subdivisions or Partitions
Ai Rivers 503-226-4211 x4428 • Street widening
Contact name: Phone:
• Mainline installation for Sanitary
Contractor: Loy Clark sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: 52281 Expiration:
Address: PO Box 1369 SUBMIT COMPLETED APPLICATION TO:
City/state: Tualatin, OR Zip: 97062 City of Tigard
9 71-8 0 6-2 8 41 Planning/Engineering
Phone: Emalade.leedy@loyclark.com ade.leedy@loyclark.com 13125 SW Hall Blvd.
Contact name: Jade Leedy Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Rich Girard only may be emailed to:
Engineer: rowpermits@tigard-or.gov
Address: 220 NW 2nd Ave
City/state: Portland, Or Zip: 97209
Phone:36-921-0314 Email: r2g@nwnatural.cora Case No.: PE-1-2-0II-0006&
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ Additional fees: $
(within the public right-of-way) Application accepted:
By: L. Date: 2.-21-11 G
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No
If so,please specify (MLP,SDR,SUB, etc.) case #: Applicati11on reviewed: 4 a
By: h.1'ef1} Date: 3` " i
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: -k Date: 3-S`-1 1
I:\ENG\PermitApplications\pfi_application Rev.10/16/2017
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City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov •1503-718-2421 • Page 1 of4
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APPLICANTS
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. 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 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 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.
as nwnatural.com
P@
044[30190QK1S�ISI d^' 14111t'00 NW Natural/Aisha Rivers 2/25/19
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property,if required.
Owner'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.tigard-or.gov • 503-718-2421 • Page 2 of
DEVELOPMENT ENGINEERING FEES FOR STAFF t;S 1 O N Ll
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
REQUIREMENTS
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
(including information below)
Engineer's estimate X 2%Plan Review
❑ 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) (6 sets,24x36 or 22x34)
• 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
LI Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
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 Department Approval
❑ Engineer's Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of
SAMPLE SKETCH:
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Edge of Pavement
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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 ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of
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CROSS SECTION DETAILS Paving Symbols: AC-Asphalt E-Earth C-Concrete G-Gravel
RUE-Public Utility Easement.ROW-Right-of-Way.EOP-Edge of Pavement,CIL-Centerline
Comrwrses
(N, WO#3563839 2 $ 40'ROW $ i ` s
CURB'Y I N CURB,Y I N
SOUTH C 1 NORTH
1
Number of cuts. MAIN IS ON 8'
Size of cut(s):: 4'X5'
0 OweisinfINNIIIINNIS
0 Over mar
C Over other oblides 3' !' 15' 15' 1'
Street Name: SW OAK
Direction Facing 0 North "(west E CU AC AC E
Page 84 2011 Edition
N Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a two-lane,two-way
N roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT)with good
sight distance as discussed below.
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. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the"Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
2011 Edition Page 85
N
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Stationary
Stationary Lane Closure with Flagging Diagram 320
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December 2011 Chapter 5
Machine Mill The Sand And Seal
Paving Joints With
_ 12" Area For A 1-1/2�' Hot Paving Grade
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(for Major Roads Or As . •`-
Asphaltic Concrete Pavement _ •.Specified) a
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"T" Patch, 6" Thick Or Match l , 1 1_ Ground
Existing Pavement (whichever Is _� 1 `�= I 1__1
Greater) Up To The Level Of i •
Original Pavement. . ' I f-
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o Hmoc In Dry Pavement Conditions, Where Existing Pavement Is At Least 60' F
And Rising.
1-8
• Tack All Pavement To Be Inlaid With Emulsified Asphalt.
• The City Engineer Shall Determine the Final Width and Length of the Inlay Patch
b to Best Fit Travel Patterns.
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`" CAPITAL CONSTRUCTION AND
b -. :' TRANSPORTATION DIVISION City of Tigard FIGURE
a 13125 S.W. BLVD.
C
F •:� nGARO, Of2£GON 97223 Blanket Inlay
,_„1 VOICE 503-639-4171
- ;FAX 503-624-0752 FiLE NO
Q`` i I;J1.3A.IZD,'www.ncvRw-oR.Gov Detail
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