PFI2020-00441 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
'E11 I COMMUNITY DEVELOPMENT Permit#: PFI2020-00441
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 1 112 312 0 2 0
Parcel: 2S 102 DC00512
Jurisdiction: Tigard
Site address: 9050 SW OMARA ST
Subdivision: EDGEWOOD Lot: 12
Project: McLoughin Sewer
Project Description: 9050 SW Omara St. Decommission septic and connect to city sewer.
Class of Work: FEES
Type 2-Sidewalk/Driveway Approach Description Date Amount
PFI Permit Fee 11/22/2020 $300.00
Total $300.00
Owner:
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:
SEWER RENEWAL SPECIALISTS LLC
PO BOX 230147
TIGARD, OR 97281
PHONE: 9718032042
Applicant:
DAVID HEFLEY
PO BOX 230147
TIGARD, OR 97281
PHONE: 9718032042
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 PFl2020-00441
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, <Trent Brickey>at
<971-228-9269>, to establish a preconstruction meeting.
Please call 503-639-4175 to schedule inspection, use code 738
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_Sidewalkl[ 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_Sidewalkl[ 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
City of Tigard PH 2020-00441
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TIGnk Public h'acilities Improvement (PF'I) Permit-
PROJECT INFORMATIO` —
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CONTRACTOR INFORMATION • 1,^.nle IN applicant
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APPLICANTS
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I. the applicant,certify that:
• 'to the best of mt knna ledge.,all the tnfr,miatu,n pun tded within this application package it,complete and
accurate.
• 'the above request does not violate any recorded deed restncttnne that mat be attached to or unposed upon the
subject proper .
• If the application is granted, I will exercise the rights granted in accordance with the terms and subject to all the
ins and limitations of the appro al.
ppltcant's or authorized agsnl'+srpn;nure name liA5r
Date
I'rnpem ttwin •Ignature (if required) Print name
Date
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a,e \n PF12020-00441 Permu fcc: 3�•QD Ro Nuuecentd b1:AL Date: 11/16 2020
\ppnn ed hr:TI^QYtf a- Uatc h l!?�202ficd hr Al— Date: it leo
Ci,•of Tigard • I112'i\\. IlallRhd • It titIII 1't _i • a.o.•tllr1nl Ir: • :n{ I1• 'L'! • page 2ofa
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DEVELOPMENT ENGINEERING FEES
Public I acilitc Improvement(I'PI)Permit:
INITIAL PIA PERM!I FI,G
Part 1: Requital.ul,tnin.ii Ice I. Iu .a di, ' i t 1'I I I't nmt I cti 'i t bt I+icl tor,alcnlare ni- +luimi.aii ,I >inn.
NET PEt PERMrl•FEE
Part 2: All in nn w au r,c.tcni unpruccnu uIN cii uteu -c-tt11t1it A- �. ..:,t..r I1 I I', I
WATER LINE CONSTRUCTION FEF
Part 3: \ll puhhc „ a. tem impn.'cut,ui. uw it t r
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4:SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
I).it .gq,ue.uu h.,,a otht of w at It.unc ❑Ss.. ❑ \o TYPE 1 AND TYPE 2-Must include a sketch
showing:
lender the wireless fauhoes standards,is the proposal
0 Dimensions
considered?(check all that apply): 0 Small Cell ❑ Macro ❑ tinter V Arne
I low mans. install sites arc proposed as pan 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
llic proposed equipment is located on which of the following: items. The plans must that include:
❑Public Right of\\ay ❑Private I'ropem ❑ Cnc-s-Sue,\icuun-, \bhreriannn,Legend
I f equipment is to be located on private property,describe the ❑ General Notes(City.\\'aver,Sewer,etc
ripe&use: ❑ Street(Ilan,Profile!
___ ❑ \\Ater.Storm and Simian (Plan Profile)
❑ \A tt r I ivahn Paulines
Fl Graduig
Cl I.,mdw aping%1 rce Plan
I_l (;onipo.ue l tilin Plan QFlectncal.Phone,Gas, Storm,
<Arutan•\\aver,Srgnage,Street Iaglus,etc.
❑ Details
❑ traffc Sight Distance
❑ Signing and Striping
❑ Street I Ight Plan and Phommeinc
❑ Engineers seal/signature
O Sheet label(protect land use name.revision and plan
log block,dares and sheet numbers.)
D F.ninncer s Constmehon IFstumuc
Additional Submittals
(per land use condition.,it applicable)
r❑ Traffic Report
u storm w41:i Dram u a(.ak nlations
O C m-chnual Report
❑ 1'i chmmu, \ceco.Report(Sight Distance)
Pn,lnscd Plat
❑ Patltw'.n l)t'nen
I J Water Pros.wler \pproval
(att of l igard • I\12S S\\ I tall Blvd • I i'ai.l.(in Ron tr t • ot;ard iu got • it11 -18.2 I'_I • Page3 of 4
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EJ^c of Pavement
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TYPE I AND TYPE 2:
MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable)
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A._ Pro,Iv,.cd work I st;nug curb or cdgt III pat moll L'ubtt & .treci light pick.
_ I xusruu1 Si •,r I)/\\ apn•n __.. SI,T v of pr.•ptIll I rec.
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City of Tigard • 111',s\\ I lall IL( • lipid,()rtgro tt'221 • MO&ttgard-oug.n • in i -I K-L-121 • Page 4 of 4
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g.
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Figure 6H-11. Lane Closure on a Two-Lane Road
with Low Traffic Volumes (TA-11)
4 t . JA. ,,
Akti
C (ophon eq•
(optional)NM
•
{ T
(optional)
50 to 100 h
(optional)
• Butter space(
i
J.101111°) A.
�J�r�
0
Butter,space(optional)
50to110011 . V •
Note See Tables 6H-2 and 6H•3 1
for the meaning of the je 115 fl
1 symbols and/or letter i I To
nodes used in this figure. 'ONCOMING
A TRAFFIC i
(optional) .1. I
(see Section 3B 16) \I
B p(optional)
J.
(optional)
T l t c
i
(optional)
](optional)
\\.,
Typical Application 11
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