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PFI2021-00209 q CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit*: PF12021-00209 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/10/2021 Parcel: 2S109AB12400 Jurisdiction: Tigard Site address: 14230 SW ALPINE CREST WAY Subdivision: ALPINE VIEW Lot: 5 Project: Vardhana Encroachment Permit Project Description: Encroachment permit to place a moving POD on street in front of the house at 14230 SW Alpine Crest Way. Duration from 6/18/2021 to 6/21/2021 Class of Work: FEES Description Date Amount Type 2-Sidewalk/Driveway Approach Encroachment Permit 06!1012021 $25.00 Total $25.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE, Tigard website at www.tioard-ocaov to schedule inspections online. Contractor: PHONE: Applicant: CHAITANYA VARDHANA 14230 SW ALPINE CREST WAY TIGARD, OR 97224 PHONE: 5122960715 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 See application Signature: Issued By: �lA� , Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00209 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/1 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/1 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/1 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/1 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/1 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/1 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 preoonstruction 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 holders expense. PFI—Sidewalk/1 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/1 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/1 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 Permit#: PF 12021-00209 s ~ ENGINEERING I PUBLIC WORKS Encroachment Permit Return to City Tigard After Recording PROJECT INFORMATION Project Name:POD on street for moving Is This Encroachment: A"Furnishing?" ❑ Underground System? ❑ Privately Owned Structure?Vf Hardscape? ❑ *(See TMC 15.16 for definitions) SITE INFORMATION (Include.Site address,proposed use of right-of-may,proposed timeframe, contractor information, and scale draping of encroachment and its relationship to adjoining properties): Permit to place a moving POD on street in front of the house at 14230 SW Alpine Crest Way, 97224 Duration: 6/18/2021 through 6/21/2021 APPLICANT / PROPERTY OWNER INFORMATION I Is Applicant Same as Property Owner?VfYes ❑ No Applicant Name:Chaitanya Vardhana Property Owner Name: Chaitanya Vardhana Applicant Address: 14230 SW Alpine Crest Way Property Address: 14230 SW Alpine Crest Way City:Tigard State: OR Zip: 97224 Cin,:Tigard State: OR Zip: 97224 Phone:512-296-0715 I mail:c.vardhana@gmail.com Phone: 512-296-0715 Email:o.vardhana@gmail.com THIS ENCROACHMENT PERMIT IS SUBJECT TO THE PROVISIONS OF Tigard Municipal Code Chapter 15.16. I certify that the information provided in this application is true and correct to the best of my knowledge. I hAa-ve�read,and I agree to be bound by Tigard Municipal Code Chapter 15.16. Applicant Signature: —� Print Name of Applicant: Chaitanya Vardhana Property Owner Signature: �""°—� Print Name of Property Owner: Chaitanya Vardhana IF INSURANCE IS REQUIRED BY CITY OF TIGARD: Insurance Policy No. Policy Expiration Date: STAFF USE ONLY Rcccived by: N I Date: 6/9/21 Permit Fee: Reviewed by: _ 7& Date: 46/910024 Additional Fees: euvh4� cus , 6 l 9 �2l " City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www..tigard-or.gov 503-718-2421 TIGARD MUNICIPAL CODE 15.16 ENCROACHMENT PERMITS Standards for Approval: 1.The proposed encroachment is 2.Furnishings must identify the name expressly authorized by the Tigard Community and address of the owner on the exterior of the Development Code or is otherwise in the public object,as well as an emergency contact number. interest and consistent with the City's Public Improvement Design Standards. 3. Furnishings must maintain a weather proof or weather resistant quality. 2.The proposed encroachment does not interfere with the existing or future 4.Furnishings must be designed to be transportation system or the provision of public stable and self-supporting under a wind load of at utilities. least 20 pounds without attachment to the pavement or other object. 3.The proposed encroachment does not impede vision clearance or sight distance, pursuant to Tigard Community Development Code Chapter 18.920 or the current AASHTO publication,"A Geometric Design of Highways and Streets,"whichever is more restrictive. 4.The proposed encroachment does not prevent access to,cover,or block the flow of water to or into catch basins,ditches,or swales, and does not otherwise alter the natural drainage patterns in a manner that adversely affects other property. 5.The proposed encroachment maintains minimum applicable vertical clearance for encroachments within the right-of-way,as provided in the Tigard Community Development Code or Manual on Uniform Traffic Control Devices. 6.The proposed encroachment must meet minimum horizontal clearance from public facilities,such as manholes and fire hydrants,as set by the relevant service provider. B. Standards of Approval for Fumishings: In addition to the standards provided in Section 15.16.050.A,approval of furnishings as encroachments must meet the following additional standards: 1. Furnishings may not be chained, bolted,or otherwise attached to any fixture,tree, or item located in the right-of-way,nor attached to the surface of any right-of-way.