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PFI2022-00165 P-q City of Tigard PFI#: ENGINEERING DEPARTMENT 2022-00165 TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: 3659066 F—, TYPE 1—Franchise Utility Work Brief description of project: Install new 1" poly gas service and EFV at performed byNWN,PGF, or utility agency 9925 SW Greenburg Rd. Main on the 18' in ROW. One 4'x5' hard surface F TYPE 2-ROW Sidewalk/Driveway/Sewer cut needed over main. See attached. Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 9925 SW Greenbur Location (address if available): g Rd mainline tap F YPE 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 City/State: Portland, OR Zip: 97204 F TYPE 4—Small Cell Technology Phone: 971-979-6460 F TYPE 5—Tigard Triangle Email: lulia.meged@nwnatural.com Phone: 800-882-3377 NOTE: Type 1 and 2 applications may be g Contact name: Julia Me ed emailed to rowpermits9 igard-or.gov. Phone: Same Email: Same CONTRACTOR INFORMATION 0 Same as applicant Name: CCB Number: 23035 Mailing address: City/State: Zip: Phone: Email: ENGINEER INFORMATION Name: Rich Girard Mailing address: Same City/State: Zip: Phone: 360-921-0314 Email: r2g@nwnatural.com 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 DECISION? —Yes No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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. Julia Meged 4/25/22 Applic s or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: Permit fee: Received by: Date: Approved by: Date: Notified by: Date: 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). WATERLINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY • ' 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 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal Dimensions considered?(check all that apply): I Small Cell Macro F_ 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 I 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 F_ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) 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 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4 Edge of Pavement -44— Ditch op Streetlight I ------------- —r--- � I ' T��i'o'p'os [f'Se1�werTife"� I I ;i Existing House I I v� I Existing �r driveway C1 r 1i ELI ' 0, 1 a IEL IJ Existing Shop I Powerpole 1 I = 1 4 I� I I 7roper-E Line-------- -- i I I Fire Hydrant(F H) � � I Scale: I"=30' � I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not � I I � I I � � I pp 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 �.Y Pik ( {' #�+...;kr -�!! "S I .�.. { Flo- ........... .j J Y, A 0 0 e { r r r f r t1kb — �. • - ODA r S a R m �x,� .. � 100 -, Map data©2022 Imagery @2022,Maxar Technologies,Metro,Portland Oregon,State of Oregon,U.S.Geological Survey,USDA/FPAC/GEO 9925 SW Greenburg Rd NW Natural 1-040-019, REGION BEAVERTON/TIGARD/PORTLAND, WASHINGTON COUNTY ietary &Confidential n T01 S R01 W 26SW Proprietary 8 CorrFder�tPa� This document may not be reproduced Submitted by el 1000088 Mon Apr 25 2022 09:01:27 AM or distributed without prior written permission from NW Natural. WO#3659066 z PLAT 1-040-019 Install APPROX 1172'Of 1'(P)with 12COEFV. Meter location 8' to the north of ti left back corner r PrWaftOR t-(P) - - - - -- -r S Lehman'ST ,w Riser will be Contractor to install 2"conduit 1+5d in concrete. from new meter location to Riser will greenburg rd.contractor not eed Poiyken 100%sure if ditch is going to tiL---` •�o wrapped be dug an north side of private {� I } F sS DR or the south side of the a o AT t private OR. ' ---•---- 3 Ftv sw r 9 ------------------------------------- _ RA L +f y IOW Natural CROSS SECTION DETAILS Comments: Number of cuts: 1 AC CUT FS2 NLB WO#3659066 Size of cuts: 4x5 Over main: Y Over other utilities: Street name: SW Greenburg RD Direction Facing: North All dimensions are in feet unless otherwise stated. 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 Greenburg RD 0 00 0 w w 60 E urL asphalt asphalt AC 10' 2' curb 19' 19' 10' WEST EAST 18' z �W� XISTING Page 118 2011 Edition Lane Closure at Intersection with Flagging Diagram 620 Diagram 620 covers work within an intersection when normal traffic control must be interrupted. Work vehicles may or may not be in the work space. 1. During flagging, traffic signals shall be turned off. Contact the road jurisdiction for approval and assistance (see Chapter 3). 2. For multi-lane facilities, traffic approaching the intersection shall be reduced to a single lane on each approach. See Chapter 3 for information on flagging through intersections. 3. There should be one flagger for each approach. One flagger may control two adjacent approaches if sight distance, low volumes on side roads, and flagger position allows for safe operation and clear direction to motorists. For low traffic volume intersections (fewer than 400 entering vehicles per day), one flagger may be used. 4. 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 may be expected. Sign Spacing and Buffer Lengths(feet) Posted Spacing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 100 35 40 350 350 350 125 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 119 Lane Closure at Intersection with Flagging Diagram 620 ROAD %VW AHEAD ONE LANE C l t (ppSiWTe�l ROAD ANEW BE B PAEPAREO TO STOP CB A (pptional} E IANE ROAD 100 R Mac PREPARED ROAD TO STOP MRK AHEAD A S B C Buffer IDO2 rwa:,� C B B A ROAD BE WORK PREPARED AHEAD TO STOP I OO IL MU. WLM RaAn 1111■11{ ANBW (°°°°nary A B PREP 70 STOP B {ppuw.ry ONE WW ROAD WORN AHEAD December 2011 Chapter 5