PFI2019-00078 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
a ' COMMUNITY DEVELOPMENT Permit#: PF12019-00078
Date Issued: 03/14/2019
T 1(_;A It 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: 2S104DA15500
Jurisdiction:
Site address:
Subdivision: QUAIL HOLLOW-WEST Lot: J
Project: Quail Hollow West HOA Sidewalk
Project Description: Replace 19.5 feet x 6 feet of sidewalk on the north side of SW Gaarde Street, across from SW
Princeton Lane.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
JAY JACOB MILLER
8152 SW HALL BLVD#240
BEAVERTON, OR 97008
PHONE: 503-707-4725
FAX:
Applicant:
JAY MILLER
8152 SW HALL BLVD#240
BEAVERTON, OR 97008
PHONE: 503-707-4725
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2019-00078
Type: Condition Name: Status: Severity:
PFI_Sidewalk/[ 01 -WORK SITE REQUIREMENTS 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_Sidewalk/[ 02-WORK SITE AREA 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_Sidewalk/[ 03-WORK SITE EROSION CONTROL 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_Sidewalk/[ 04-WORK SITE REPAIRS 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_Sidewalk/[ 05-TRAFFIC CONTROL SPECIFICATIONS 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_Sidewalk/[ 06-TRAFFIC CONTROL PLAN 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_Sidewalk/[ 07-TRAFFIC CONTROL ROAD CLOSURE 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_Sidewalk/[ 08-TRAFFIC CONTROL ADVANCE WARNING Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours (min.)before initiation of construction work.
PFI_Sidewalk/[ 09-TRAFFIC CONTROL PROPERTY ACCESS 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_Sidewalk/[ 10-TRAFFIC CONTROL WORK HOURS 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_Sidewalk/[ 11 -TRAFFIC CONTROL LIMITED WORK HOURS 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_Sidewalk/[ 12-TRAFFIC CONTROL MODIFICATION 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_Sidewalk/[ 13-DRAINAGE CONTROL Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Sidewalk/[ 14-UTILITY NOTIFICATION 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_Sidewalk/[ 15-UTILITY LOCATION CONFLICT 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_Sidewalk/[ 16-TEMPORARY PATCH 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_Sidewalk/[ 17-REPAIR OF EXISTING FACILITIES 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_Sidewalk/[ 18-SEWER SYSTEM TEST Notice
A sewer system air-test and/or DVD T.V. test report and one set of"As-Builts"shall be provided for review and approval.
PFI_Sidewalk/[ 19-PRECONSTRUCTION MEETING 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_Sidewalk/[ 20-NOTICE TO COMMENCE WORK 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_Sidewalk/[ 21 -PERMIT/PLAN ON SITE 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_Sidewalk/[ 22-DAILY INSPECTION REPORTS Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI_Sidewalk/[ 23-MONUMENT PROTECTION Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Sidewalk/[ 24-VALIDATION OF MATERIAL/CONSTRUCTION Notice
The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Sidewalk/[ 25-EMERGENCY CONTACTS 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_Sidewalk/[ 26-RIGHT OF ENTRY/EASEMENTS Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI_Sidewalk/[ 27-PRIVATE PROPERTY AGREEMENTS Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI_Sidewalk/[ 28-AS-BUILT DRAWING Notice
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
PFI_Sidewalk/[ 31 -OTHER Notice
Other
11111111 City of Tigard
RECEIVE
PUBLIC WORKS — ENGINEERING '. •.)
MAR 1 1 2019
1 7.7
-2.=-..-:„ .,-.- ..•_----i----7 Public Facility Improvement (PFI) Pet
„...: DF TIGARL' •
rb-MG/ENGINEE
. _.
DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK
Check one: 0 Utility Conncction
D TYPE 1 -Franchise Utility Work
>e,Sidcwalk/drivo.vay approach Work performed by NWN,PGE
0 Street improvements and/or utility agency.
Detailed description: Si l ter/ tetifiait"6
Cktlida `F11._TYPE 2-Sidewalk/Driveway/Sewer
(q,(011 xb , - Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
and/or repair
Property address/locati.on(s): (9 I d t., f
/Agee fit/0 P rine,t+trl 11/11 1 ig . • Sanitary sewer lateral installation
and/or main line tap
tii4C70/Alitnek-- OVA
)i47/11 SS(OL p i.V iS.' 0 0 TYPE 3-Full scale Development
Work performed with Land use
Applicant:
rv.--V4:-; . , "v . approval which includes any of.
Address: \OK/\ .= w,SJ-. _. the following-.
t ...,,,,,,A, -
City/state: :11741 r i ,, . , Zip: • Subdhisions or Partitions
Phone: -_ Email: • Street widening
Contact name: Phone: • Mainline installation for Sanitary
- , - . sewer,Storm sewer,Tigard water
Contractor-40 C.14 gal t.• ----" I,Pk,sta,i/V2t- , and/or Tigard Water Service Area
--'4 '')V -';',1,.,
CCB#: I:/- t,.4L3_______+______, Expirar,ion: ior41.:',.-AZ-,: i SUBMIT COMPLETED APPLICATION TO:
•• i , i '
Address: ' L'
^ .(1. ' 4' I*. , P.1- ;...•2-at
'.. City of Tigard
11. ' ' . : • - il L;.) Planning/Engineering
City/state:, '.6.V '1ii\,-, I,' fc - Zip: '-
/10 , •
Phonetr)153- i&W_IgVM* ' ildi'LL2t1i4Ji16.44-Iiii. t&griltall*C-ei' , 13125 SW Hall Blvd.
1,- I 1 ti ,
Contact name: : i 44.4 i hid/L/1.i Phonet)(/2)--r7il-L1-1;2(L-5Tigard,OR 97223
Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: lowpermiteritigard-or.gov
Address:
r()I: - 1-;!.;- t--I. iiN.1 •,-
Citv/state: Zip:
Phone: Email: Case No.:PF12-0 ic1-C)0016
Contact name: Application submittal fee: 4r"
Additional fees:
i /11
Estimated value of work is required(if over$5,000):$ fUl ii Application accepted:
(within the public right-of-way) By: Al--- Date: 1 1 I 1 rt
Application reviewed:
Is wot k related to a LAND-USE DECISION? n Yes a-No
By: 14.i151,4*- Date: 3 f)41/1 1
If so, please specify NTT, SDR, SUB, etc.) case #:
Applicant notified:
'•......g.
Is work related to a BUILDING PERMIT? 0 Yes a No By: • Dare:
If so,please specify(BUILDING PERMIT) case#: i7CUlkf.l.ti\MastersVhnct Use Apptications Rev 07/0912DIS
P. e
Go•444t„.*77._.__ ,, ,-(. .V.
City of Tigard • 13125 SW Hall Blvd. • Tigard.,Oregon 97223 • wwuttigard-or_gov • 503-718-2421 • Page 1 of 4
etticyt_. TO trAt4Z--- 4.1t, 164.L- Aftimic,
APPLICANTS
NOTE: Person specified as "Applicant" shall be designated "Permittee"and shall provide financial assurance for work.
*When the owner and the applicant arc different people,the applicant must lx 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
as•thcnrization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL GER'Il1i1 ?1kT':
• • ç •• •• •• . ' ._ • • - • •► t. • •• }• ' • 4* _ •e• • ► SI • • • I I ' • M t ••yII
• 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.
3/0 `
Applica �1trtbori2ed er1t's signature Print name •
Date
•
Owner's sign r Pri t game Date
td ...
r ADL
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 • 501:718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement (PFI) Permit: DETAILED SUBMITTAI.
•
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee $300.00
FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All nem-water system Improvements P (work in the right of marl
Engineer's estimate \ S'%, Mess S300.00 submittal tee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: 111 public water system improvements 0 Street Name
Engineer's estimate X 12
❑ Site Address
PFI Permit Fee Exemptions:
There will be no permit tee charged,or assurance required FULL SCALE DEVELOPMENT
t,Subdivisions/Partitions and Street Improvements)
for the followingapes of work:
• Sidewalk repair (less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. 1,6 sets•24x36 or 22x34)
• \''cephoIe repair 0 Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement (less than 2U lineal feet) 0 General Notes (City,Water,Sewer,etc.)
• Lawn sprinkler system installation or repair 0 Street (Plan,Profile)
• Street tree pruning or planting 0 Water,Storm and Sanitan (Plan Profile)
• Planter step landscape maintenance 0 Water Quality Facilities
• Test wells 0 Grading
❑ Landscaping/Tree Plan
• Composite Utility Plan (Electrical,Phone,Gas,
Note: A cash assurance may he required per Storm,Sanitary,Water,Signage,Street Lights,etc)
?VC 15.04.140. (customer deposit) ❑ Derails
• Traffic Sight Distance
❑❑ Signing and Striping
D Street Light Plan and Photometric
❑ Engineers seal/signature
O Sheet label (project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per land U<< c0ntliu(1ns)
Traffic Report
O Storm water Drainage Calculations
❑
Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
E Proposed Plat
❑ Pathway Design (if applicable)
water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW 1 fall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503--718-2421 • Page 3 of 4
SAMPLE SKETCH:
? SW " Y ' SI
{ Edge of Pavement
r St
I
reetlight . �', E,„,,,, ..._,....
-.. • GPM•�•_•_aMai • +,...r— • ...
f 7 ,. i I 4,4E1. Drwri N•L' 4111
itiik....ra , 4•0
1 I
1-77617•C egeWIr it g—
I .
d
. � Existing House
,I 1 Existing 1
! >1 1 Driveway
'' I 1
CI r I ' It �z?•
a i f.
f . '
ofi \
LiUa m 1 1
PL, I Existing Shop II
I c79
.= ':Fowerpofe l { - I 1
'',.......„6.4 „...."'" Icl- 95' I
. iJ
opertyLine-
I
(5 . IN
I Fire Hydrant(FH)
I I
I I Scale: 1"=30'
I
I I
I
I
i
I
MINIMUM SKETCH REQUIREMENTS (Put"N/A" if Not Applicable):
North arrow Property lines & dimension Slope of property
____. Street & street names) Existing building, structures _ Utility& street light poles
Proposed work 1'.xisting curb or edge Trees
I.xisting S/W or of pavement Existing utility locations
D/V'apron (sewer,water, storm)
_-r-. .'. .-+)faG,r":^.tiY:ova:\'s'�'�..�.LF"4S'iG�.VdM.fin �. -, .. ..-. _ . .. . - -•.V1Yr. .. '.4ry®. .dl+l-�-1Y?.1Y.JPfTlAI�!.}iS G3:G if:: '.
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4
---ft%... idewalkEST. NO.yr
sepair
filit un- PROPOSAL
' pecialist
.,.."
8152 SW Hall Blvd#240 sidewalkrepairs@gmait.com Phone:503-707-4725
CCB# 198613 Beaverton,OR 97008 http://www.siciewalkrepairs.net
Eliminate Trip Hazards
Property owners are responsible For the repair and maintenance of the sidewalks adjacent to their property..Avoid the costs,dangers
and hassles of being involved in a trip hazard lawsuit For personal injury. Your neighbors, children or, bicycles or skateboards, new
mothers with baby carriages,disabled people in wheelchairs Mnd everyone else have one common need:A smooth,safe sidewalk.
Let our experienced professionals grind out trip hazards or replace sidewalk sections as needed.
Customer Information all, To yn ot C EIS5 I-eY
Name: L,, �at L Rat1oLi 1.WecT No A �o - � �� fL•
Address: Y\ rG c e i vt �.��,0 n '= r 7 r a-r c �j7 ale� a�r� tEr7Pr
.z3 N/ ag 3 iN$
Phone: Email: rpo1
Personalized Estimate ? L.6
Q Grinding Subtotals ..‘ , L-------------__
____------/
1
Areas: j Est. L. Ft.:
ao ~`,.
Other: 1- Re - Let;e1-.. ____ - - # f IG_
. , ate. C
Grinding Total:.
0 Sidewalk Replacement
�`' y„d, .Le
Areas: I E L. Ft.:/ 71 Est.SQ. Ft.: t r.8 p&Q /76 K _ — - _
C. 7ieoo0 rt .
Other: � - ( &C►'V CuS � , z�------
-� �---'iciYil ' r I •d P C.; --- I/S1 a-LAI t 1 4 . ,.• M
Sidewalk Total: f
Final Total: ,- ,�._ ii o A
j,01... D. ...se,i. €, .. d,
Grinding M r ' w 11`0 c.. Los e CJ S 1 Kf
T -� _ � t... - - - z 9
�r,�; :GZa�-�-ESC�S Sipper•?�',•.vl.standar:.'c. �tL:des 2:..c__• 8yU'_ _ .-''+2�E•''T.s:�C� . �-.-?':rZr�C as OJ.!.•ems 3 �'Je.
Sidewalk Replacement - uC -a Ne r 'p1 e
f r c-' a. d F existing precare ►.nn 1 �.
tr1C�u:,ES al tabor mo P•"��a1',�eCiti:i✓'Tef1t c"e�'�•? nv Q15�oSE J: xis�'triC�„_ '�E e. j3re c�. su�'JSv '2Ce. "eT;,':e �y•S� :ger+-.,_..� 5..�'.lairC�� __..
rraximurr.arovide,insulia-w.`rrish su-"ac=of new corbc'e_e.aermits ant•nspect,ons ce-city or ca,.nt -ect-rernonts.
warranty
•
Contra:tor t':arants,raterial a '../e-+rnans i;;`ora Denoc of 1','ea'pts,Orpc07-,cm;struct'cn Contractors 5ca- 'e�”J,rerents
Disclaimer
-Newly ground concrete and newly replaced concrete mit have a d;c.e:er:aDpea'd'1Ce than yc.-existing cone:etc;see:',Ave/s.`eev.,u:.'<,'epcf,S.net Conrracto-
ca+nnot be responsible for future so -ovement Fran-tree roots or other co.r .ons b :cgid x;r cont'o ie.sprinklers.:rain:^ns.ray:r+:,nos:.
Acceptance of Proposal
The above pnces.spe.cations VIC Co.....tions re nereby acceotec.S dewaik Repel-Specialist:s ne7e5~;author zec to perform the:."orfs as ot;t':ir,eC above Pay"ent s
^'.ue:.soot+.tomo:ets3n unless ot1e-..:se note.:.' Buyer agrees:c Day ac.costs ro-: ..e:tons, -'ci;.g out costs and.egat fees.
Payment may be 7rade ty cheat.cash(ask about discount:, .'sa.Mastercarc Q sccve-Ca-C_
Buyer Signature: ic' P lr 'l �. Date: 3- 0 `L- i i _
Contractor Signature: VDate: J.-c e--
Ti i S:gr:er ac•.n::: ,
. :;es re.e.;n;Cc-,s:sme- c a �.-
ction s c= ;_`PrS- ciee. e d the int rrriaton Notce to.0:,rse INITIAL HERE:
aboutcOrSt-;,z_ e-s:e- ag�r‘ a-ei-e= 'ernents - - -
\.._.