PFI2021-00293 111 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2021-00293
Date Issued: 08/12/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S103DB02500
Jurisdiction: Tigard
Site address: 13490 SW GENESIS LOOP
Subdivision: GENESIS Lot: 1
Project: Burdett Move to Texas from Tigard
Project Description: 13490 SW Genesis Loop,Tigard, OR 97223. These 5 pods were placed to have the doors open facing the
hours to alleviate bringing items around on the busy street. The pods were placed on the right of way on
115th since I cannot place them in-front of my house because of a man-made barrier.
The Time Frame is from Tuesday August 3rd to Friday August 6th. The contractor or business used for
moving is U Pack. Picture is attached to the email along with this completed form
Class of Work: FEES
Type 1 -Utilities(gas, electric, data) Description Date Amount
Encroachment Permit 08/10/2021 $25.00
Owner: Total $25.00
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tiqard-or.qov to schedule inspections online.
Contractor:
PHONE:
Applicant:
BRIAN BURDETT
13490 SW GENESIS LOOP
TIGARD, OR 97223
PHONE: 9712261547
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.
PermitteelApplicant
Signature: See applicationAriA ! /VtQ�O,C(,/
Issued By: l� n^"
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2021-00293
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 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 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).
. City ofTigard Permit#: PFI2021-00293
~ ENGINEERING I PUBI.IC WORKS
Return to City of Tigard After
TIGARD Encroachment Permit Recording(For Permanent Only)
0
PROJECT INFORMATION
Project Name:Burdett Move to Texas from Tigard
This Encroachment is for: ® Furnishing ❑ Underground System ❑ Privately owned Structure 0 Hardscape
*(See TMC 15.16 for definitions)
SITE INFORMATION (Include:Site address,proposed use of right-of-way,proposed time frame, contractor information, and
scale draining of encroachment and its relationship to adjoining properties):
13490 SW Genesis Loop,Tigard,OR 97223.These 5 pods were placed to have the doors open lacing the hours to alleviate bringing items around on the busy street.The pods were placed on the right of
way on 115th since I cannot place them lo-front of my house because of a man-made barrier.
The Time Frame is from Tuesday August 3rd to Friday August 6th.The contractor or business used for moving is U Pace.Picture is attached to the email along with this completed form
APPLICANT / PROPERTY OWNER INFORMATION I Is Applicant Same as Property Owner? B Yes ❑ No
Applicant Name: Brian Burdett Property Owner: Brian Burdett
Applicant Address: 13490 SW Genesis Loop Property Address: 13490 SW Genesis Loop
City: Tigard State: OR zip: 97223 City: Tigard State: OR Zip: 97223
Phone:971-226-1547 Email: burdett_brianl5_hotmail.com phone: 971-226-1547 Email: burdett_brian15@hotmail.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 have read, and I agree to be bound by Tigard Municipal Code Chapter 15.16.
Applicant Signature: Print Name of Applicant: Brian Burdett
Property Owner Signature: Print Name of Property Owner: Brian Burdett
IF INSURANCE IS REQUIRED BY CITY OF TIGARD:
Insurance Policy No. Policy Expiration Date:
I Ai II '4'^ 4:1 " 2P2 — 1i
STAFF USE ONLY
Received by: HPollard Received Date: 8/4/2021 Permit fee:r oz S-.4221
Approved by: i rhf Approved date: 4S ilS`/ o2./ Add. Fees:
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
stable and self-supporting under a wind load of at
transportation system or the provision of public
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 Furnishings:
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.
(1)::<I SW Genesis Loop
ill This is where I placed 5 UPack pods. They Arrived on Tues. and will be
picked up on Friday 8/6.
. :7„.
0
, .„....
._,
_„
0-1
„.„+. ...
1 11/4.
t
, only
, -
RI
4 ,
t . ,
,,,r
- i
'..wi
folt.
4: 1 0
.
... ..
0 laite))17.ga rd.,SG3 972,2,
. N.
i .
f
0.
vefttli 11 ' ,
so ,
4 WNW
lal 4,,,7Firo 7-""$4 at
„410*
—....
..„ ,
4ir
r ar
It evitoug ie.& i
Ns
l= two.*