PFI2021-00312 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
14s COMMUNITY DEVELOPMENT Permit#: PFI2021-00312
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/25/2021
Parcel: SEG2681
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural WO#:3656163
Project Description: SEG 2681 /Install 42'of 2"poly to tie-in to our existing main to service new subdivision
Class of Work: FEES
Type 1 -Utilities(gas, electric, data) Description Date Amount
Total
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:
PHONE:
Applicant:
ROSE SENDA
250 SW TAYLOR ST
PORTLAND, OR 97204
PHONE: 5036107914
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: ATVZ �/V✓ �,00V
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2021-00312
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 applicants 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 applicants 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).
City of TigardIII PFI#: PFI2021-00312
_ ENGINEERING DEPARTMENT
TlGA'RD Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project name: Ashbrook Villas
I- TYPE 1-Franchise Utility Work
Brief description of project: Install 42'of 2"poly to tie-in to our existing main to performed by NWN,PGE, or utility
agency
service new subdivision.WO#3656163//R00027622 I— TYPE 2-ROW Sidewalk/Driveway/Sewer
Work performed for the purpose of:
SEG 2681 • Sidewalk installation or repair
- • Driveway approach installation and repair
SITE INFORMATION • Sanitary sewer lateral installation and
Location (address if available):
SW 95th Ave main line tap
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
Name: NW Natural • Mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tigard
Mailing address: 250 SW Taylor St. water service area
r
City/State: Portland,OR Zip: 97204 TYPE 4-Small Cell Technology
I— TYPE 5-Tigard Triangle
Phone: 503-610-7914
Email: ris@nwnatural.com Phone: same NOTE: Type 1 and 2 applications may be
Contact name:
Rose Senda emailed to rowpermitsCu,tigard-or.gov.
Phone: Email:
CONTRACTOR INFORMATION — Same as applicant
Name: Loy Clark/Jade Leedy CCB Number: 52281
Mailing address: P.O.Box 1369 City/State: Tualatin,OR Zip: 97062
Phone: 971-806-2841 Email: jade.leedy@loyclark.com
ENGINEER INFORMATION
Name:
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 DECISKON? -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.
Rosie Senda 08/20/2021
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: PFI2021-0031 Permit fee: 2/2
Received by: NT Date: 8/23/21
Approved by: Date: 2 Sf2/ Notified by: Date: b IRE 7Jz1
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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°/0 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
L Dimensions
considered?(check all that apply): Small Cell Macro 7 Street Name
How many install sites are proposed as part of this permit
C 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:
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
Traffic Sight Distance
L Signing and Striping
E Street Light Plan and Photometric
— Engineers seal/signature
Sheet label(project land use name,revision and plan
log block,dates and sheet numbers.)
L Engineer's Construction Estimate
Additional Submittals
(per land use conditions,if applicable)
C Traffic Report
L Storm water Drainage Calculations
L Geotechnical Report
L Preliminary Access Report(Sight Distance)
C Proposed Plat
L 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
9 sw '•l- " St
Edge of Pavement
I 'Al— Ditch —1
Streetlight
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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 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4
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
cc N o
`1 8 N S 8 8 N S N 5 N 81 a ` Single Flagger Operation •.,, » m
N w for Low Volumes I R ' (Optional) n
(ADT<400) c �, 3
o 8 8 0 8 'a ' \_ ' / BE ID O
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CROSS SECTIONS GENERAL NOTES
8' 47 I.Call the following Utilities Notification Center N
4 tis I. 48 hours prior to any excavation
6' S 5.6 13' 13' • S Oregon'.All or l-800.33=-2J44 W E
e F-►•�►4 I. 4 e 4 ►4 14[L Washington:Ell or 1.A004245555
ui i5 rn C t IS 2.ATTENTION:Oregon law requires you to follow
1�
D 3 E CJ E..VI B L B relt�+l — cola eloped M1Y esth eantfUtility Notification
a E Center.Those rides are set forth in OAR 952LOI- `S
0090.You rosy obtain copies of the roles by cal Ong
the center.(Note:the telephone number for the Oregon
—►O 4—Z PEW Utility Notification Center is(503)232-19R1 or RI I).
3.Fill out coettmchon sketch as-built supplied with NTo9E0 aWa50-A
job packet and ream with work order.Only one (93)
SIS SW LONG STAFF ST NIS aabuiltisrequired k INSTALL:
. W �r44 4.All distribution mains must have a minimum depth of ~m K 0 LW
24'and see ieea must have•minim depth of 18" 'TV e g7 0 1#ANODE
aJ 1 31' 1 1B ► :.5'R 45R 4.S 1 a. unless there is an approved variance_ sr- k- w
4 5.All hansmitcion lines must have a minimum depth of IWI p1. 711
a an
E & $I& I I w O'm Class'1'locations and 36"m Class'2.3,&4' or, -' dimes t SW LONGSTAFF ST,
?� W B L B tY W E C E locations,milers there is an approved variance. a,pass
a fi_ 6.Written dimensions on this eonstnteHan sketch /GGG•ttt""" 4-� [y rll'pTT 4•
f iJ u +i have precedence over sealed dimensions. E I a b..
M
'!.Pressure test shall be tested in accordance with witMONOw 0/-18'EX MAIN NEW 7--le 0 t 1 standards in FOM and Engineering Standard Practice. etc' -W r
A.Ten medium to Was"B"maim shall be air,cokes (W)
TH otherwise noted Tern medium for class'C-F"main
W/S SW 95 AVE F1S shall be water,unless otherwise noted. a lD „
9.For CWsC or higher tests,see Design Document and — _ 13 ISF'BAOOKV LA 1-041-020
Hydrostatic Report O TF t4 E v , , zz 1-042-020
CI maR"B" PRESSURE TEST INFORMATION(code&label tent area on asbuIt dra ai g) in
TEST BY NNG-OTTER oo,
TEST PIPE SIEEL- PIPE ON OFF PASS TEST NN035 x15' �-+•a-r
AREA SIZE POLY FOOT. DATE TIME DATE TIME Y(N MEDIUM GAIIGEa PRINT NAME B IN11AL rat '
A AIR 1 2
: q?
B AIR (%1 P) e, 6 t
toes
C AIR 3B5 3g INSTALL:
D AIR 1" ' • El2"PE VALVE
E AIR 0 LW
0 TL
F AIR
CALL SEVEN DAYS PROE TO START OF DRY UTILITYTRISICH
•. CALL FOUR DAYS OR TO SHADING TO SET INSPECTION DATE
WELDS CONTACT: MARK FARLEY WI -90S-623e
%X- CERT. OPER. PM PM ALL DEPTHS b£ASUaED FTOM MN-GRADE
FOOTAGE SIZE M P GRADE W.T. RAYED MAOP MAOP NOP ACTIVITY# ORDER ROAD I, 0C 'I FEiD
INSTALL 669' 2" P B P24 .216 60 57 45 710 03555163 SIDE MN SIDE
INSTALL 42' 2" P B P24 .216 60 57 45 710 02656164 ' 1 /\//'i �/k���//�//
,'
MEASURED ��/ �/,/
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50 100 PROPOSED
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Engineering Department 1 in=100 ft GRADE —4—AL I
ir ` "RO1O //%a•
ADDRESS CITY COUNTY STATE DESIGNED NOW mare 06/18/2021 (BMmG) e/ (SATE[SMOCK-0/
SW 95TH AVE TIGARD WASHINGTON OR [Num. KDC DATE 07/14/2021 + r)' r /F}�v,�y,,E,(// //
BETWEEN MO APPRm'® BMK DATE08/13/2021 )•,,./ "'Ai'<",7 r_/,
MSW LONGSTAFF ST SW DAKOTA ST AMEGREW LR. PATE vn.a.bt nude VARIANCE(SI ttz / /••/ //•/ /•�'
/
ASHBROOK VILLAS PUTTED DATE IMN //C';�TV'r�'YDIE{��C �.,
PUT two RNO sec PIPELINE ID- JOB TYPE' na�.APe // /y r-y�/OVVa
1-041-020 T01S ROIW NE 35 1-042-020 TOSS ROIW SE 35 NEW CONSTRUCTION MAINS
PM• PROERREYIMGNS ENylmtaM 01.0 TRENCH REQUIREMENTS
11
03656163 00027622 FOR JOINT UTILITY USE '—12"-N.
O WenS rim: Isprar: 1 no.. MAIN EXTENSION