PFI2020-00013 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12020-00013
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/22/2020
Parcel: SEG1394
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: On SW Wall Street. Install 47'of 2"(p)main to stub in for future Fields Apartments prior to road
improvements/open trench/see sketch/R00025302.
Class of Work: FEES
Description Date Amount
Type 1 -Utilities(gas, electric,data) PFI Permit Fee 01/22/2020 $300.00
Owner:
Total $300.00
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tigard-or.gov to schedule inspections online.
Contractor:
PHONE:
Applicant:
LORENE NICHOLS
PHONE: 5032264211
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: /t, F PLXA IU,1}J/
J /"� �"li
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12020-00013
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 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 19-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Trent Brickey>at
<971-228-9269>, to establish a preconstruction meeting.
PFI_Utilities 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_Utilities 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_Utilities 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector.
PFI_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 28-AS-BUILT DRAWING Applied Notice
1,2,3,4,5 28-AS-BUILT DRAWING
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).
1,2,3,4,5 28-AS-BUILT DRAWING
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).
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_Utilities 31 -OTHER Applied Notice
Other
RECEIVED
JAN 14 2020
MV!
City Of Tigard CITY OF TIGARD
ENGINEERING DEPARTME��`NNING/ENGINEERING.,
Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project name: Wall Street 2"(p)main Stub In
r TYPE 1—Franchise Utility Work
Brief description of project: Install 47'of 2"(p)main to stub in for future performed by NWN,PGE, or utility
agency
Feld Apartments Subdivision prior to road improvements/open trench/see sketch/R00025302 r TYPE 2—ROW Sidewalk/Driveway/Sever
Work performed for the purpose of
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
(address if available): SW Wall St .9F � -- main line tap
Location
F TYPE 3—Full Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
NW Natural Gas • Mainline installation for sanitary sewer,
Name: storm sewer, Tigard water, and Tigard
Mailing address: 220 NW 2nd Ave water service area
City/State: Portland OR Zip: 97209 r TYPE 4—Small Celt Technology
Phone:
503-2264211 x4372 r TYPE 5—Tigard Triangle
Email: eln@nwnatural.eom Phone: 503-226-4211 (VOTE: Type 1 and 2 applications may be
Contact name:
Lorene Nichols emailed to ro ermitsnalfieard„ -or.gov.
Phone: 503-2264211 x4372 Email: eln@nwnatural.com
CONTRACTOR INFORMATION E Same as applicant
Name: Loy Clark-Jade Leedy CCB Number: 52281
Mailing address: PO Box 1369 City/State: Tualatin OR Zip: 97062
Phone: 971-806-2841 Email: jade.leedy@loyclark.com
ENGINEER INFORMATION
Name: NW Natural-same as above
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? `Yes =No Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 1 of 4
.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 15.04.140.
* With the exception of a utility operating pursuant to a valid franchise or license with die 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 must sign this application in the space provided or submit a written authorization with this
application. Franchised or Licensed Utilities are not required to obtain die owner's signature on the application.
1,the applicant,certify that:
• To the best of my knowledge,all the information provided within this application package is complete and
accurate.
• 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.
y6p� Aw-
Lorene Nichols 01/14/2020
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: `,.7 Permit fee: ZOO- M Received by: _� `� Date:
Approved by: Date: 11211ZO2d Notified by:_ Date:
Cityof Tigard`• 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wu>\vtigard-or.gov • 503-718-2421 • Page 2 of 4
CROSS SECTIONS GENERAL NOTES N CALL SEVEN DAYS PRIOR TO START OF DRY UTILITY TRENCH
1.Call the following Utilities Notification Center CALL PoUt DAYS PRIOR TO SHADING TO SET INSPECTION DATE
52' 8' 48 hours prior to any excavation: CONTACT:MARK FARLEY 9714084236
Oregon:811 or 1-800-332-2344 WE
Washington:811 or 1-800-424.5555 ALL DEPTHS MEASURED FRDMFIN4L GRADE
J 5.5' 17' 17' 5.5' T J 2.ATTENTION:Oregon law requiro you to follow ROAD 1I� 24- FIELD
d d rules adopted by the Oregon Utility Notification S SIDE I MIN.--�I SIDE
LU
Center.Those rules are set forth in OAR 952.001-
E O U g C/ L g 'a ° 0090.Y2 rosy obtain copies of the rules by calling
Of W W E C a the anter.(Note:the telephone number for the Oregon /
a. Q. Utility Notification Center is(503)232-1987 or 811). /
3.Fill out construction sketch as-built supplied with / T MEASURED
job packet and return with work order.Only one a°x/ / '� FROM
as-built is required. Mz3�p r/a / THE 30•
o t—5'EX.MAIN 2' 4.AlI distribution mains must have a minimum depth of s/ PROPOSED
24"and services must have a minimum depth of I8" r, FINAL
WIS SW WALL ST E/S unless there is an approved variance. �/% GRADE / CONTROPJ!ED Ir 5.All transmission lines must have a minimum depth of 1T REC. / BACKFILL /
30"in Class'I'locations and 36"in Class'2.3,&4' e,y 18"MIN.) // (SAND OR ROCK-//
locations,unless there is an approved variance. / ///F� /
6.Written dimensions on this construction sketch Q" GAS `
VARIANCE S
lel meas: have precedence over scal<ddimensums.
vMlMxa
7.Pressure test shall be Tested in accordance with 3 t2• //
standards in CFM and Engineering Standard Practice. r MIN. // /
Raasan(•):
S.
Test medium for class"B"main shall be air,Unless 3 J /CATV RiONE SEC
otherwise noted.Test medium for class"C-F"main / / O
xwitamon Urian(9"): shall be water,unless otherwise noted.
9.For Class C or higher tests,see Design Document and TRENCH REQUIREMENTS
Appevr Nm: siylmr.a ora: Hydrostatic Report. FOR JOINT UTILITY USE I~t2"—►
MAIN EXTENSION
Class"B"PRESSURE TEST INFORMATION(circle&label test area on as-built drawing)
Test by NNG–Other
Tar PY• rad- Pt» tsn ti
ab Part aatar• Dr. TM mom'
Ar
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B S�
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40, QJ
WELDS p1 d� " 4V
X- CERT. OPER. PM PM x Q'•. ti
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOPNOP ACTIVITY# ORDER#
INSTALL 143' 2' P B P24 .216 60 57 45 710 03600466 Rqg � '�'•� 6 �� e
r /
FUSE 8
INSTALL:
4NN W Natural 0 50 100 Feet ❑ 2"PE VALVE
Engineering Department 1 in=100 ft ❑
INSTALL:
ADDRESS CRY COUNTY STATE DESIGNED BMK DATE 0111012020 ❑ LW
SW WALL ST TIGARD WASHINGTON OR DRAWN KDC DATE 0111412020 ❑ 1#Anode
BETWEEN AND
SW VARNS ST SW CHERRYDR APPROVED L2C DATE 01dAa02
NAME CREW LDR. DATE
WALL ST 2-(P)MAIN STUB IN PLATTED DATE
PLAT TWN NNG SEC PIPELINE ID- JOB TYPE-
1-044-021 T02S R01W SW 1 NEW CONSTRUCTION MAINS
PMN: PROJECTIREVISION#
03600466 00025302
Page 82 2011 Edition
pT o-1n i�TrafBc _v�r orn U n Should_Diagi'a 3x101
Diagram 310 covers shifting traffic lanes on a two-lane,two-way roadway
around the work site with one lane partially or fully on the shoulder.
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. All travel lanes should have a minimum 10 foot lane width.
4. Shoulder shall be adequate in width and surfacing to cavy traffic.
5. Two advance warning signs are required.
6. Place cones as shown. Cones along the far edge of travel lane,
farthest from the work space, are optional and may be added to clearly
mark the travel path.
Sign Spacing and Buffer Lengths(feet)
p 71
20 50
25 100 100 100 75
30 100
35
40 350 350 1 350 1 25
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 83
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December 2011 Chapter 5