PFI2020-00162 IIIII CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
o COMMUNITY DEVELOPMENT Permit#: PF12020-00162
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/06/2020
TtGAg.D g Parcel: SEG2113
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Alderbook Ct& PI Watermain Replacement
Project Description: SEG 2113/2114. Replacing 4-inch water mains in Alderbrook Place and Alderbrook Court that are at
high risk of breakage due to poor laying conditions.
Class of Work: FEES
Description Date Amount
Type 1 -Utilities(gas, electric, data)
Owner: Total
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:
SHAST BILLINGS-BECK
13125 SW HALL BLVD
TIGARD, OR 97223
PHONE: 5037182698
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 ppOccd'.,
Q
Issued By: r rp Y1---a 6 2 Z--�.
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2020-00162
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.
PFIUtilities 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, <Insert Name>at<Insert
Phone#>, 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
lir
iliicity of Tigard RECEIVED PFI#: 2DZD'�1��
s ENGINEERING DEPARTMENT MAY 5 2020
TIGARD Public Facilities I N �tnt (PFI) Permit
PROJECT INFORMATION TYPE OF WORK
Project name:Alderbrook P1 and Ct Water Main Replacement • TYPE 1—Franchise Utility Work
Brief description of project: Replacing 4-inch water mains in performed byNWN,PGF., or utility
agency
Alderbrook PI and Ct that are at high risk of breakage due to poor • TYPE 2—ROW Sidewalk/Driveway/Utility
Work performed for the purpose of
laying conditions. • Sidewalk/Curb installation or repair
• Driveway approach installation and repair
SITE INFORMATION • Sanitary/Storm/Water lateral service
Location (address if available):Alderbrook PI and Alderbrook Ct installation and main line tap
� • TYPE 3—Work performed with/without
`'�`"�(
north of SW Alderbrook Dr /�+ 2'i 3 ,2-1 14 land use approval which includes any of the
following.
• Subdivisions and Partitions
APPLICANT INFORMATION • Water Infrastructure
Name: City of Tigard • Street Widening
• Sanitary o r Storm Sewer Infrastructure
Mailing address: 13125 SW Hall Blvd
• TYPE 4-Small Cell Technology
City/State:Tigard,OR Zip: 97223
• TYPE 5—Tigard Triangle
Phone: 503.718.2698
Email: shastabna,tigard-or.gov Phone: Same as above NOTE: Type 1 and 2 applications may be
cmailcd to rowpermitski)tieard-or.eov.
Contact name: Shasta Billings-Beck
Phone: Same as above Email: Same as above
CONTRACTOR INFORMATION ® Same as applicant
Name: City of Tigard PW Water Operations Crew CCB Number: N/A
Mailing address: Same as above City/State: Zip:
Phone: Email:
ENGINEER INFORMATION
Name: City of Tigard PW Engineering
Mailing address: Same as above 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 ® No Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-otgov • 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 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 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 the owner's signature on the application.
I, 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.
Digitally signed by Shasta
Billings-Beek
Date:2020-05-05 11:38:14
Foxit PhantomPDF Version:9.1.0 Shasta Billings-Beck 5/5/2020
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No:? 2(nO"Od O2- Permit fee: — i Received by: it Date: 515 20
Approved by: �n.Y1J(6 Date: - /S7c 02O Notified by: A-1— Date: 514112o
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
INITIAL PFI PERMIT FEE
Part 1: Required submittal fee is 10%of the Net PH Permit Fee.See below for calculations.Minimum of$300.
NET PFI PERMIT FEE
Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PH Permit Fee).
WATER LINE CONSTRUCTION FEE
Part 3: All public water system improvements engineer's estimate X 12%.
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Does applicant have a right-of-way license? ❑Yes ❑No TYPE 1 AND TYPE 2-Must include a sketch
showing:
Under the wireless facilities standards,is the proposal
❑ Dimensions
considered?(check all that apply): ❑Small Cell 0 Macro ❑ Street Name
How many install sites are proposed as part of this permit ❑ Site Address
application?
TYPE 3-Must provide 4 sets of plans (sized 24 x 36
or 22 x 34) and an electronic version of all submittal
The proposed equipment is located on which of the following: items. The plans must that include:
0 Public Right-of-Way 0 Private Property
❑ Cover—Site,Vicinity,Abbreviation,Legend
If equipment is to be located on private property,describe the ❑ General City Utility Notes/Tigard Conditions of Approval
type&use: ❑ Street(Plan,Profile)
❑ Water,Storm and Sanitary(Plan Profile)
❑ Water Quality Facilities
❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,
Sanitary,Water,Signage,Street Lights,etc.)
❑ Derails
❑ Traffic Sight Distance
❑ Signing and Striping
❑ 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,if applicable)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design
❑ Water Provider Approval
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4
illir
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TYPE 1 AND TYPE 2:
MI NI I .1.1 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 of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 303-718-2421 • Page 4 of 4
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_. _--. .—isgiaD 12 DIP------
11D0016 11D0417 -- --- smrmwmr91a,1•M
> ' 15205 15200 13103 13200 15207 15202 alarm Water
$ - •rw.ra.....a
t' 9165 9733 9105 9 ,water Catch Rev)
fr"p` 6 as sSI1n01n ss110013 tg Ssii D015 • „r. •,13273 a k•ie
�l • • •9dT WdtH OlMllek[
7 15220 15223 7 Approximately 28O tt,a 15222 9195 9Wmwater ll0es
15225 l of new 4-inch Watc1 "— w.e
-1,nr , y sS11Dn06 •:�
r•1 - _f.. --main to be installed _ ul t awe,,,.,g:e1R r.T st,.mwater ow.11
$ lo- f about 1.5 feet west or - 4 DIw' , '—
, �-� 15235 15240 15243 1 existing main in both 15244
Storm water maM
vrz - Alderbrook Cl and w,
-_Alderbrook P1. _.....co.......“.
< Isolation valves will ht.
v n 9190 -Awrt rChannel
Detention Ma
15255 - _ valves used for hot taut.
- 9't 60 9130 9100 Wm e,
15280 15265 - a - 15266
s _* '-m Alderbrook Dr. `. - Storm..•••• Swale
`'� �' - f x Portland style dead-tond 1
grs f 15265 - blow-offs will be "°"""'^"
r,•,s'4'.. t
?—"- installed at the northl.-., sc«mwM9raMIn.,90
F • 15260 15265 ends of each new tnaln. 15266 ■•w.,. ^,
M 15275
Water Hydrants
f
0
13315 Wm,v.hes
15345 15335
15283 Itu11 a IC s�. •.w..an
' of RS 15390 15297 15292 ^11 I •^• v+^«
} 11D1`9b1 1'1 15293 IDn0S' 110 L'IDOt:SC lit •Ma.M•a
w,p 551100�6. ] t. 11 tat ,T D r '
Dr ."
La..•IWe D{7 Finings
". . 51100t4 5110016 '
•dosed wane Valves
worce
•-w ^^L 5511001 0' Weer Main
«--^--.B DIP- 1 Dsn,y, �F-.. II � s;" •' D. 11D0041
>� 'f' " Lek - I11TUfhs 1 11170051 11D0044� 11 23c1, 0041 w"«`e
\\� •.�!' f' l3D]3f •. Dm46 8 DIP 1
'�� I ` lik i1D 9 ', EEDla'-10e •4' ___... War mw
..,t w. ws6110012 ---` 11[Itn 3i___.. Q .. -.,.. .,..,. .........,
IS'.iml flange or pin•" f '+e 0 ...
.. 110n056 le o m Alderbrook 15349 , y
I .. 15350 15335 �n "
9450 9dd0 9430 9420 9410 1141* I 4130057 I)/ I'.xl,,ting valve o
1 cans to be removed � • Kssv 0019 $ - '
i 49' -- and valves to bei II
---- -
15365 0
buried.Old main n, 6•M: 0.02 M•
7, he abandoned in I �' 13370 15355
- w
r]:tc C. 15373.. y- Cn orn ere
IF] ; --,,,•,j,:_ " 1'1D191¢ 13126 SW Nall Blvd
Tigard.OR 63223
15385 t Mar craim 1509)009-4121
1 1 5390 15375 059252920 99W.109rd-or.9ev
•
i nluei DI uulc
Vicinity Map I 15130{ ;,..
,..,�arrtl ,. E.' J
e a M,r9r, ! �, ,5,2a .,.. Water Main
1 Rlmd Ilanec or plug 1
?rlrarna.
," >' icc.mSattlerSt. 1 or { to 0- 15025 ; Plan
❑ --_ -. n l i City of Tigard.Oregon
- - h:xnnng valve cans , 4 — Naa er,«.
ss o •' 9su sass to be removed and a _ 15015 „
valves to be buried. - :- rr ; s. rM. k
t8150 _�.., .. .
?(„ ,rt� 75152 tl1J3 blrz011 004 0—
j
_i r10295r' i'N258 jj !•ak.
0 t'^.1 4' m w.w:.a
b 4
110. ,C� 010/1D000B .� v4D 1102t0N r- '4 0ow•raews
C30R97N{[t..... O110296oM „u . �;— _ _ '� - ... -.
40x98[D,a 17 u 102a7GiFa i2y110 ''
- sstt nisi.n,., _2 7.410294 .r, �u920.1'
ss 1 i65 . 55119"I? Dta.-12" 0* / u9144 D,a•t>
Eli •., W w A WV! 99
samary main
'1000 2i 11D0011 j� f 13000 ficion 1100018 11130027
S !11'60095 12 DIP r,m 011 -' 12 DIP _ 11Dt70 12 DIP w.a
4 r 1D0016 'IDH+17 storm water Manure
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15xo5 I 15200 15205 15Il0. 11207 15202 Storynwiter vault
4E 9165 9133 9105 k..cweanom
_` Henn Water Catch ka4n
•
15215 c5130n10 53110013 td • tincammatrw.I'nm "-`-4^t
.,'• ! •
;:. = - • Storm Wmr MO Inlet
15220 15225 A roxsmakl_ .{I aid 15222 ✓ 9195 Storm water Modes
pp
15225 } . of new 4inch„-.Ito ..a
- 1m0 sstloon6 .W,e
_'.-...I 2 w --main to be mtt llen + ... „ts,$ell,4 t stam Water WWI
9457 l about 1.5 feet west ci ,." • ak.ca„m,�
15235 15240 15245 ,.,.existing main In both 15244 -- Storm water Mam
-1a4 < .__Aldcrbrook PI ;;
D' ..{} isolation v�hr 'v ii hr -storm Water Detention Ppe
15255 0 �t valves used to hol I I,P 9190 -Storm Waw0,awml
_,,1,„� i < 13290 15285 - 3 15266 9160 9130 9100
•9453 y r _ in Alderbro 1.1lr 1 Storm Water Swale
nt r - Portlandslyk ti ur sd J - s��n.,w.
15265 m blow-offs will ha 4 w ONew..
Storm Water Quaky Pond
installed at the nrn'hrm ° ■MM„Ir,
15273 13290 15285 15289 ••m.c..m aw
ends of each,�r 1c main
- wmrMapm,6
9449 _.. , ♦...rm.
15345 15335 15315 wacervakea
15285 - w grwvwm
Ke no i1t4
{ `O. t 15390 15297 15292 ' emMmrvws
eY i 11C,.,. , 15295 t
s.. ssu0n1} i no.7i
•
3 - �l 1 _ .n . - _ Water . ,
l •
• gm�"'.am
L-besl "" 0Ea�.. 5110014 h11001a f o
55110017I •water
6 , .'".d'1�111080 ,".. ew Dr 11D0n5a tS . 11p�p�� 11D0044 11�0041 .., .
• 9 DIP - _11013(afy..- noo4e 9 DIP 133C, wn �
31101112 e
Mind flange or plug .�
i it noose Ices in Alderbrook 13345 , usso is»51 .r, °'a °
9420 9410 9400 {I i,(op,7 I)r.Existing valve 1 . f
9450 9440 8430 . 1 e 551.10019
• cans to be removed It?' ; o
and valves to be 15365 0
hurled.Old main to ` Scab
he abandoned in '` 15370 1569a
j,laec. 1J 15375 ".i P-' pry g,"tnrd
,�J M...` ..�.� �,._yw-- 1101.91 13125 SW Hill ehdM
"5�^ 001 I-gold ON 9/223
15395 MW Cream, (503)639-4111
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