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PFI2019-00098 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT a COMMUNITY DEVELOPMENT Permit#: PF12019-00098 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/27/2019 TIGARD Parcel: 2S103DC05000 Jurisdiction: Tigard Site address: 13900 SW 115TH AVE Subdivision: VIEWMOUNT Lot: 38 Project: Walker Sidewalk Repair Project Description: 13900 SW 115th Ave/Repair sidewalk on 115th Ave and Viewmount Lane. Owner: FEES Description Date Amount PFI Permit Fee 03/27/2019 $300.00 PHONE: Contractor: ROBERT W RANSOM JR 15258 SW OREGON STREET SHERWOOD, OR 97140 PHONE: 503-380-1990 FAX: Applicant: GORDON WALKER 13900 SW 115TH AVE TIGARD, OR 97223 PHONE: 503-475-8108 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 a;CF ,/Ce,�` -(,Grp Issued By: _ ill\, (2re.A.... Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00098 Type: Condition Name: Status: Severity: PFI_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 08-TRAFFIC CONTROL ADVANCE WARNING Applied 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 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_Sidewalk/[ 10-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_Sidewalk/[ 11 -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_Sidewalk/[ 12-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_Sidewalk/[ 13-DRAINAGE CONTROL Applied 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 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_Sidewalk/[ 15-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_Sidewalk/[ 16-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_Sidewalk/[ 17-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_Sidewalk/[ 18-SEWER SYSTEM TEST Applied 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 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_Sidewalk/[ 20-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_Sidewalk/[ 21 -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_Sidewalk/[ 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector. PFI_Sidewalk/[ 23-MONUMENT PROTECTION Applied 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 Applied 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 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_Sidewalk/[ 26-RIGHT OF ENTRY/EASEMENTS Applied 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 Applied 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 Applied 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 Applied Notice Other RECEIVED City of Tigard MAR 2 5 Z019 PFI#: l ' 0o001 • '1 ENGINEERING DEPARTMENTITY OF TIGARD • PLATmprovement 1NGlENGNEERING Public Facilities (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: rKS._.R-. F b �C ❑ TYPE 1-Franchise Utility Work Brief description of project: .1 buJ j}� 5 performed by NWN,PGE and/or utility agency 1„ 't, TYPE 2-ROW l,l Sidewalk/Driveway/Sewer Work a performed for the purpose of: 1-- • Sidewalk installation or repair. SITE INFORMATION • Driveway approach installation and repair Location (address if available): I O 1)54-11- 4-tre-) • Sanitary sewer lateral installation and main 167 g �j line tap CL �1 ❑ TYPE 3-Full scale Development Work performed with Land use APPLICANT INFORMATION approval which includes any of <e the following. Name: 6-r--Ae.hciNi • Subdivisions or Partitions "> Mailing address: COi 1 i I"514-0.E. • Street widening Z • Mainline installation for Sanitary aCity/State:—!T6-442J, CZip: ‘i7;2‘,") sewer,Storm sewer,Tigard water and [i Tigard Water Service Area a Phone: Sly—4 ®, c— ? ( 't r 0 TYPE 4-Small Cell Technology p_ Email: W IJOY C Ake rPhone:6'03-- 7c-?/0 0 TYPE 5-Tigard Triangle Contact name: g+ _ A-5 -` -F Phone: Email: CONTRACTO INFORMATION 0 Same as applicant Name: 1v1/4CCB Number: I I`. a Mailing address: City/State: Zip: Phone:6°3 3 J-1 1 clO( L Email: ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes XNo Case number: Is work related to a BUILDING PERMIT? 0 Yes KNo Building permit number: City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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 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, I,THE APPLICANT, 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,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. • To the best of my knowledge,all the information provided within this application package is complete and accurate. • I have read the entire contents of the application,including the policies and criteria,and understand the requirements for approving or denying the application. fite tAWLAR..., Asp 'cant or authorized agent signature Print name ate 4.43-7\ YIkke162___ G14__ roperty owner's signature (if required) Print name Do Case No:F12� '- � Permit fe 30o�° Received by: Date: Approved by: 65 Date: 3. 2 5. 1 1 Inspector Name: City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REQUIREMENTS INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee. TYPE 1 AND TYPE 2-Must include a See below for calculations. $300 is the minimum. sketch showing: NET PFI PERMIT FEE ❑ Dimensions Part 2: All non-water system improvements CISeet Name y p ❑ SitAddress Address Engineer's estimate X 7% (less the initial PH Permit Fee) TYPE 3—Must provide 4 sets of plans (sized 24 x 36 or 22 x 34)that include: WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements ❑ Cover—Site,Vicinity,Abbreviation,Legend Engineer's estimate X 12% ❑ General Notes(City,Water,Sewer,etc.) ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) FOR STAFF USE ONLY ❑ Water Quality Facilities CITYPE 4—SMALL WIRELESS FACILITY Grading Landscaping/Tree Plan CHECKLIST ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc.) Does applicant have a right-of-way license? ❑Yes 0 No [I] Details ❑ Traffic Sight Distance Under the wireless facilities standards,is the proposal considered? ❑ Signing and Striping (check all that apply): 0 Small Cell ❑Macro ❑ Street Light Plan and Photometric ❑ Engineers seal/signature How many install sites are proposed as part of this permit application? ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate The proposed equipment is located on which of the following: ❑Public Right-of-Way ❑Private Property Additional Submittals If equipment is to be located on private property,describe the type&use: (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of4 6 9 SW "Y " , 1 Edge of Pavement 0 i *"b5111 '— Ditch treetlyh�1 _.i.—.—.— .-.-r — —. it #7 ."L". 7 -4=!..-, ......,.... 3 I I I AlI CO i EYist:riq Ht�use �. r yN I Existing I „� v>iI • Driveway 1 '1 I 01 1 a+I o di ' 1. ?, it I N-1 gsal 1 ai 1 i cg I Existing Sho I I Powerpole • I Ij\\ 95' 1 I -T-rapert�L n�e- I I 1 p. ....„ I ! Fire Hydrant(FH) 1 I Scale: "I"=.30' • I I • I• I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer,storm,water) Street&street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of4 I Vicinity Maplarlf __ 115th Ave & Ba ''errc�r Viewmount Ln , Tt g a t d City of Tigard, Oregon • • -..,,A, - / '► g:i 1 Pi , 4 i 4 P AI, ill • x 1 P I siailipli ._..,,A ilk 0 . oft. ., - • it '' .110... .. ' Aril:111 - r • IIli . Ar di Data is derived from multiple sources.The City of Tigard makes no warranty,representation,or guerentee as to the content,accuracy,timeliness or completeness of any .. of the data provided herein.The City of Tigard shall assume no liability for any errors.omissions.or ,Y inaccuracies in the information provided regardless o' _�� � j�lisii11 � um� now cause . 4 li,..- t. • Scale: 0.01 Miles .. 9 City of Tigard 111 lilt Iliglir • 13125 SW Hall Blvd1111 * iiiTigard, OR 97223 e 1, Map Created: (503) 639-4171 03/21/2019 www.tigard-or.gov TIGARD