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PFI2020-00454
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. Please call 503-639-4175 to schedule inspection, use code 738 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. Alt 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 MATERIAUCONSTRUCTION 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 cltpq 11 Wd PFI#: ��0"" 0i t/s4 ;: . ENGINEERING DEPARTMENT / • TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: WO#: 3633252 17 TYPE 1-Franchise Utility Work Brief description of project: Install service to: 9895 SW Kimberly Dr. Main performed by NWN,PGE, or utility agency is on the 2'in ROW in sidewalk. One flag of sidewalk to be removed for tie-in r TYPE 2-ROW Sidewalk/Driveway/Sewer Work performed for the purpose of: See attached for details. • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 9895 SW KimberlyDr main line tap Location (address if available): K n� r 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/Shelly Kirschenman • Mainline installation for sanitary sewer, Name: storm sewer, Tigard water, and Tigard Mailing address: 250 SW Taylor St water service area City/State: Portland OR zip: 97204 T TYPE 4-Small Cell Technology r TYPE 5-Tigard Triangle Phone: 971-979-6054 Email: smk@nwnatural.com Phone: NOTE: Type 1 and 2 applications may be ShellyKirschenman emailed to rowpermits@tigard-or.gov. Contact name: Phone: Email: CONTRACTOR INFORMATION C 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: Richard Girard Mailing address: 220 NW 2nd Ave City/State: Portland, OR Zip: 97209 Phone: 360-921-0314 Email: r2g©nwnatural.com ADDITIONAL INFORMATION Estimated value of workis required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? E 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 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. IpYIWYAM _ «'r" Shelly Kirschenman for NW Natural 11/20/2020 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Dacc ��yy.�... STAFF USE ONLY ,, ^^ Case No: T7�/`2�C/—OO'ermit fee: YQJ4 Received by: /�Y Date: /1 Approved by: Tnw,t ,t7n?,kty Date: tt/t3lzoz. Notified by: Date: // " 22) 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 PFI 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 PFI 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? I Yes I No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal L Dimensions considered?(check all that apply): I Small Cell Macro C Street Name How many install sites are proposed as part of this permit L Site ddress 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: Public Right-of-Way Private Property L Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the L General Notes(City,Water,Sewer,etc.) type&use: L Street(Plan,Profile) L Water,Storm and Sanitary(Plan Profile) L Water Quality Facilities L Grading L Landscaping/Tree Plan L Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) L Details C Traffic Sight Distance L Signing and Striping C Street Light Plan and Photometric F Engineers seal/signature Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) C Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) C Traffic Report C Storm water Drainage Calculations L Geotechnical Report L Preliminary Access Report(Sight Distance) L Proposed Plat Pathway Design L Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 4 sw '• I Edge of Pavement Streetlight / Ditch —t" i 1 _ t ® 1 r 1 - o.. Lieo� i 7--raproos IrSoj�wn—LITIe— 1 c.• 1 j ,i Existing House 1 _� Existing j v� • Driveway r vi n 1 a1 1 `-1 or I I Vs9°' 1 iiU1 m® j i 1 1 c c Existing Shop j 1 Powerpole I I I • L • o • 0 1 I 1— ---- 95' 1 I 1 Fire Hydrant(FH) I 1 i1 Scale: 1"=30' I 1 I ! I 1 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 of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 CC 09980 N 16 9 (78) �l/ / (�f�(C (410030) (W)240 ,"' w..��/!/ / O y �1� `\ 015775 New service to: M98� — 8' --• 4-- Q6) 6109895 SW Kimberly Dr 09840 1 . N100DD g 312 e<) v) (WO#: 3633252 (78) o d o 'mo MI b 1 17 20 329' 27 aAr 855 O 28 N10020 815785(78) ) 310• Ps) 9 0 VI) tsr — 111' V\ 8\ O >- (78) O t71' W (W)223' _ 015755 (,'�') Q 8 d$ _ Q• 09885 L I Co _(P) X1t70x8 0 '� •\ (78) M 09870 ) 015775 —'--'!I{Yj x15795 i. \\ 1116!ii J W (78) } (93) pz• _ 7) /a• 1 z3s• . 0 i- a �� N,008p #15855 ,4,5�' • q5 \ I d 29 5 U Q) (78) 0 _ 7 1'(W778INN P . _ �e,6 �� , 30 (eBJ j‘ - 7.96, 9 6 #75795 gm 13' 0. (/) • � (W)33' R O 313' r,5,� m � A h o EA m /� `0125865 O 7 N158050 M7 7 ago ) 33 32 .,� 29T 015875 31 (91 34 35 5 4 O ♦ 36 (W) 3 A 015690 015890 N15900 415885 (78) 0 (79) (78) )14. (78) = Q Z1 W ---------- '"4'78 (� �' ifi1' I-7 j 144' rr=c ors. § ----------------------------------t' R N15920 40 • #15910 37 015925 32 36 (78) 8`~+ ui (78) 0--• `O E (78) 09835 0 (P) ' 58' WELDBAPO71 <1— 887.11-71 '`t 2 015930 (97) 98 53_• o 0 (78) 10'UTIL.PAS. 13' ^`i 1 (W(81' --. ,TWLD l 015935 ) • 0 (78) 2 \ /x SW DURHAM RD d 1111 50 RZ(P790 II I II II 11- 1 11 2'(W)'78 2"(W)130 1 11 11 d 111 1 r(P)n 11 11Sli 2"(P)'97 1 / 14 I 4. rM1 NW Natural PLAT: 1-046-019 COUNTY:WASHINGTON 11/20/20 08:15 (503)226-4211 TOWNSHIP: TO2S RANGE: RO1W SECTION: 11SW SCALE: 1 IN = 100 FT N I USER ID:slt,k r ry. s„ Vk ,,;. . J , ' �ryy-Elf, ale _ � a e - r • , Y " a _ 'yam 9895 SW Kimberly Dr ;w` �— ti _ r, JJ L T. �1111T 4 �vi ` �,�i" Tty°. ' ' ' _ 4! ' 4.,46/041p, r . t r • z r --� Main in 2' in sidewalk Y= - CO %, + ,. , Google iiit _.___-_.. ._...__ I capture May 2019 02020 Gocgle United^uxs Tams Raportapr94hn (,) NW Natural CROSS SECTION DETAILS Comments: Number of cuts: 9895 SW Kimberly Dr Size of cuts: Over main: Over other utilities: Street name: SW Kimberly Dr Direction Facing: West Ai, Oi/7E171-00f:5 clre Line depth is not known or specified on figure. Paving Symbols:AC-Asphalt, E-Earth, C-Concrete, G-Gravel Section Symbols:PUE-Public Utility Easement, ROW-Right of Way, EOP-Edge of Pavement SW Kimberly Dr 3- 0 0 0 0 0 w w cc 50 asphalt as.halt ' TE SOUTH 5 19 19 1 5 NORTH xisting ( . I f m 1 In NJ o g 8 N s a g g g N 8 N s A 4 '^ Single Flagger Operation , rt N w a s for Low Volumes 11.? (Optional) o (ADT<400) 7 O9 g g 0 8 'd ' BE E n rn c w RAMER c ' PREPARED ONE LANE b t• t• P TO STOP ROADO I— g 8 R 8 I ,g H I 1+ I F SD 7 •. A �/ OWORK N a S o S ^5 ' K K K K r• ••ti NN e ' 00 � , r � oo $ oIX8 � 8i ii . scwr. ` / mew ! AB B'f C z- 4 7 a, 77 max 1 y • • • • S—• • • —• tQ co • • •• �• 5• • 0 K K K *2 Al.ft I_C B B I _ ' 1' Buffer Protection Vehicle w/TMA(both Optional) , OA� �� See Chapter 4 CI 111. WORK PREPARED y Ai o To STOP Two Flagger Operation iv w o 0, (Optional) C ReM-Z'eta l-Z l Page 84 2011 Edition Stationary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of one lane of a two-lane, two-way roadway. See the detail inset for the layout if using a single flagger to control both directions of traffic on low volume roads (less than 400 ADT)with good sight distance as discussed below. 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. Flaggers at each approach are required if any of the following conditions exist: a. Night Operations. b. Work space is over 200 feet in length. c. Sight distance is less than 750 feet from each approach through the lane closure. d. Traffic volumes are greater than 400 ADT. 4. The length between the Flagger Ahead signs shall not exceed one mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one mile. 5. Cones should be used to outline the work space when curves or other roadway alignments prevent clear direction for the motorists to pass the work space safely. 6. Cones along the work space are recommended when posted speeds are 45 mph or greater, when working under heavy traffic or when travel lanes are narrower than 11 feet. 7. Extended queue signing (see Diagram 5-4) should be used when traffic queues extend beyond the initial advance warning sign. 8. When flagging near an intersection, the"Flagger Ahead" (CW23-2) sign should be visible to traffic entering from any side road. Additional advance warning and Flagger Ahead symbol signs may be placed on the side road(s). 9. Sign set-up and flagger placement shown may be used for intermittent full road closures of 20 minutes or less. 10. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should be considered on high volume or high speed roads, or when extended queues are expected. Chapter 5 September 2016