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PFI2015-00170 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00170 13125 SW Hall Blvd ,Tigard OR 97223 503.718 2421 Date Issued: 11/18/2015Parcel: SEG2320 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: NW Natural Project Description: Adjacent to 15745 SW Serena Ct Install short side 1/2"poly svc, main is on the 2' in ROW. Possible cut for tie-in/WR#3453859. Owner: FEES Description Date Amount PFI Permit Fee 11/18/2015 $1 00 PHONE PFI Permit Fee 11/18/2015 $299.00 Contractor: PHONE FAX Applicant: AISHA PRESTON 220 NW 2ND AVE PORTLAND, OR 97209 PHONE 503-226-4211 Total $30000 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 Not Present Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00170 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 fob 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 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 09-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 10-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 11 -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 12-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 13-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 14-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 15-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 16-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 17-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector Kenny Fisher at 503-816-6146 or email at kenny@tigard-or gov twenty-four (24)hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI—Utilities 18-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 19-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 20-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 21 -OTHER Applied Notice RECEIVED City of Tigard NOV 0 9 2015 ®® PUBLIC WORKS — ENGINEERING CITY OF TIGARD Public Facility Improvement TNermit to DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: 0 Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Install short side 1/2" of svc; main is on the ❑ ilmorworkin right-of-way Detailed description: poly (sidewalk repair,curb cut,street 2' in ROW. Possible cut for tie-in//WR#3453859 opening,etc.)requires: •Application form,completed and signed • Submit one(1) copy of scaled sketch Property address/location(s): 15745 SW Serena Ct ` (� of the proposed work to be done •Submit one(1)copy of traffic control plan –OR– A OR– Applicant's NW Natural/Aisha Preston ❑ Substantial project work requires PP s name: above items and professional Address: 220 NW 2nd Ave engineered plans for: •Street widening Portland, OR Zip: 97209 •Subdivision infrastructure Phone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com • \hum utility line extension: - Storm Dram,Sanitary—Tigard LO Clark/HeathWyckoff - eater—Tigard WWater Service Contractor's name: Y Clark/Heather Y Area(includes Durham,King City 52281 and a portion of unincorporated CCB#: Expiration: ��-ashington County) Address- PO Box 1369 City./state: Tualatin, OR Zip: 97062 DELIVER APPLICATION TO: City of Tigard Phone: 503-783-1188 Email: heather.wyekoff@loyclark.com Planning/Engineering 13125 SW Hall Blvd. Andrew Young Tigard,OR 97223 Engineer's name: 9 :Applications for"minor work Lit right-of-way" Address: 220 NW 2nd Ave only may be entailed to: City/state: Portland, OR Zip: 97209 ro=ermitsatigaard-or.gov Phone: 360-281-6169 Entail: afy@nwnatural.eom 0 0 Case. Estimated value of work (within the public right-of-way): S APi atiori:submittal-fee:�.���3� �,i"" Is work related to a LAND-USE DECISIONS ❑ Yes ❑ No Applicauon'a'ccep�tedi ;`;' 3° �;; ;•" -�, ' If so, please specify (MLP SDR SUB etc.) case #: Bv: �=' �I�at'e�'�`�'� "Application"revicwe`d:'''�'•'��''_ Is work related to a BUILDING PERMIT% ❑ Yes ❑ No If so pleasespecify UILDING PERMIT)case#: ., 1pp'ca tified: t ;. By: g a t Date: Vi$ : � 1:\CLJ LN\Masters\Lan Use Applications`Re '02/16/2014 " City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 ,tlyw.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. When the ownet and the applicant are different people,the apphcant mint be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner The ownet(s)must sign this application in the space provided or submit a written authonzanon with this apphcation BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate anv deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted, the applicant will exercise the rights granted ul accordance with the terms and subject to all the conditions and limitations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith, are true;and the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are false. • The applicant has read the enure contents of the application,including the policies and criteria, and understands the requirements for approving or denying the application. SIGNATURES of each owner of the subject property required. 11g7rt211V s,nld dy 1i1ha Preston Preston 11/5/15 DN f�,=Baha�f.s,t n,o., Natural,ou, Aisha 1 restos A i s h a Preston e raJ=as?Crvniatural com,-US Date•2015'105090125-08'00' Applicant/Authorized Agent's-signature Print name Dare Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 S\\'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 I 4�66�0 146' #15690 (92) 8' a 3 6' 1119 1 14 23 24 2 26 15745 SW Serena lN) Ct, #3453859 175' g9#15pzu) Z_r C, WW1 49gZ0 N 2 15 / q oQ`oGG `mac J �� 415160 22 #9960 �Wly43 J (74) #5755 2' °- q 306 1.,(w) 1 DR. 260' 216' - A 10 16 21 P8) #9830 #9980ql 80 (#10030) (W)240' (�g)S, (1'V) #9840 #15775 306' (78) (78) 3 8' > 3' #10000 3 #15790 (w) - +- (78) (W)298 329' m 312' (74) U W 3 {W�_ CT7 159' 17 2 28 #9855 310-(W) --� C78) 15785(78) L- ( >- #9860 A (7q °35 #10020 9 A a) J (78) �f 157' (75) -til' of 171' 18 19 (W)223' W m 6 #15755 (W) #9885 '15 F- 7p0q° �' (78) Y #9870 N (P) 91? ) W g3, ry (w 15795 (78) -- #10060 " w 5} #,5775 472' 23s _(J #10060 66p,6 `W` 29 U #15 55 '�` 15 d U #15795 �tgpoes 37• 8 15 3 = 30 '#100 194' c��—" �— 1n' �� o /s�8'� L (W) 13' �S (06) S..JI_V BJ --363' #15805 i> 'g 415865 / 7 A � 2s 96�, (02) ,9 297= Vo33 1 32 31 NW Natural PLAT: 1-046-019 COUNTY:WASHINGTON 11/05/15 08:2 (503)226-4211 TOWNSHIP: T02S RANGE: R01 W SECTION: 11 SW SCALE: 1 IN = 100 FT USER ID:aap Page 78 2011 Edition -� - o , �;°� � ..... : =;�,;: tea,_;_,. _� • _ WoFE k, Shoulder,, -_ y , Dia ram 210. ..,,_ ., t Diagram 210 covers stationary work with work or parked equipment on the shoulder. This diagram does not cover work on a freeway shoulder. See Diagram 710 for Freeway Shoulder work. 1. Vehicles should be parked as far off the roadway as practical. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 3. For added visibility, truck-mounted arrow boards or PCMS in caution mode may be used. 4. Arrow panels in caution mode are recommended for work on roads with posted speeds of 45 mph or greater and high traffic volumes, greater than 2000 average daily traffic (ADT). 5. Requirements for signing and devices are shown in Table 5-2, below. Table 5-2: Device and Signage Guidelines Yry 3 -P'roxtmitto•Ed vele e•of.Trad"VVa ?° , Mdre'jhan 1.5 feet " '� . �-?:ice°;°, �< �:: behind Barrier°or ; L`essahan�'.1'5 feet ' � .... �_� ;.:. One advance warning sign is sem`_... .::,z;•. " :. Advance warning q 9 required and two signs are recommended. 1N,ork-in Place signs, devices, and More-than 1>`Hour = flashing warning Cone taper is required. Cones li optional.lights are along the edge of traveled way a' are optional. Work>in Advance warning signs and devices are optional. ;Less than 1°:Wour. Sign Spacing and Buffer Lengths(feet) Posted ;°S" aein- Betweeri;Si nBiiffen.;, S eed 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 79 HD'a„ ram:°21.05 iNork::on'Sio"ulcler - _ ; . • • • (Optional) • ® Protection Vehicle w/TMA(both Optional) S0ee Chapter 4 • • Buffer I s • • ® U3* • A ROAD SHOULDER WORK OR WORK AHEAD AHEAD Initial Warning Sign *Use as appropriate-see Table 5-2 December 2011 Chapter 5 i 1 1