PFI2015-00174 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: P1712015-00174
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/25/2015Parcel: SEG1579
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Adjacent to 9605 SW Hillview Court. Install short side 1/2"poly svc; main is on the 13'in ROW. Possible
cut for tie-in/WR#3454161.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/25/2015 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
AISHA PRESTON
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
Total $300.00
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: - Not Present
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00174
TVVe: Condition Name: Status: Severity:
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Not Met 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 12-UTILITY NOTIFICATION Not Met 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 17-NOTICE TO COMMENCE WORK Not Met 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 04-WORK SITE REPAIRS Not Met 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 09-TRAFFIC CONTROL WORK HOURS Not Met 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 MODIFICATION Not Met 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 18-PERMIT/PLAN ON SITE Not Met 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 Not Met 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 Not Met 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 01 -WORK SITE REQUIREMENTS Not Met 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 Not Met 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 05-TRAFFIC CONTROL SPECIFICATIONS Not Met 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 Not Met 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 08-TRAFFIC CONTROL PROPERTY ACCESS Not Met 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 03-WORK SITE EROSION CONTROL Not Met
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 10-TRAFFIC CONTROL LIMITED WORK HOURS Not Met 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 13-UTILITY LOCATION CONFLICT Not Met 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 Not Met 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 Not Met 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 Not Met 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 21 -OTHER Not Met Notice
RECEIVED
City of Tigard NOV 18 2015
r PUBLIC `FORKS — ENGINEERING Y OF TIGARD
Public Facility Improvement (r1ffffl I"N"�I
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: El Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: Install short side 1/2" poly svc; main is on the ❑ Minor work in right-of-way
(sidewalk repair,curb cut,street
13' in ROW. Possible cut for tie-in/MIR#3454161 opening,etc.)requires:
•Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/locadon(s): 9605 SW Hillview Ct of the proposed work to be done
•Submit one(1)copy of traffic
control plan
—OR—
Applicant's name: NW Natural/Aisha Preston ❑ Substantial project work requires
PP above items and professional
Address: 220 NW 2nd Ave engineered plans for:
•Street widening
Ci /state: Portland, OR Zip: 97209 •Subdivision infrastructure
Phone: 503-226-4211 x4428 Email: nwnpermits@nwnatural.com •Main utility line extension:
- Storm Drain,Sanitary—Tigard
- Water—Tigard Water Service
Contractor's name: Loy Clark/Heather Wyckoff _-lrea(includes Durham,King City
52281 and a portion of unincorporated
CCB#: Expiration: Washington County)
Address: PO Box 1369
City/state: Tualatin, OR Lip: 97062 DELIVER APPLICATION TO:
503-783-1188 heather. ckoff to clark.com City of Tigard
Phone: Email: wy @ Y Planning/Engineering
13125 SW Hall Blvd.
Andrew Young Engineer's name: 9 Tigard,OR 97223
220 NW 2nd Ave Applications for"minor work in right-of-wap"
Address: only may be tmailed to:
City/state: Portland, OR Zip: 97209 mmMermitsgitigard-or.gov
Phone: 360-281-6169 Email: afy@nwnatural.com
Case No.: lJ — �,yl�
Estimated value of work (within the public right-of-way): 1�C�.J
Application submittal fee:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application accepted:
If so,please specify- (MLP,SDR, SUB, etc.) case #: By: L-2 Date: S
Is work related to a BUILDING PERMIT? ElYes ElNo Application reviewed:
If so,please specify(BUILDING PERMIT) case#: By:/dR Date: (l2'f- tS—
Applicant notified: _
By:_ LS Date: RSd/S
1:\CURPLN\Masten\Land Use Applications Rev.07/16/2014
City of Tigard • 13125 S%X`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.
*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(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANTS) 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 therights granted in 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 entire 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.
Digitally signed by Aisha Preston
Aisha Preston t° ap@nwAisha atura.om,c=Ut °°. Aisha Preston 11/18/15
email=aap@nwnatural.com,c=US
Date.2015.11.10 12:37:24-08'00'
Applicant/Authorized Agent's signature Print name Date
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 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part 1: Required submittal fee 5300.00
Part 2: Allnon-water system improvements
Engineer's estimate X 5% (less $300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2 + Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged, or assurance required for the following types of-,york:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 Sys'Hall Blvd. • Tigard,Oregon 97223 • w-w-wtigard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
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Edge of Pavement
I 4— Ditch —�
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MINIMUM SKETCH REQUIREMENTS (Put"N/A" if Not Applicable):
North arrow Property lines & dimension Slope of property
Street& street name(s) Existing building, structures Utility& street light poles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water, storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard - 13123 SW Hall Blvd. - Tigard,Oregon 97223 - wzvw.tigard-or.gov - 503-718-2121 - Page 4 of 4
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NW Natural PLAT: 1-044-019 COUNTY: WASHINGTON 11/10115 12:32
(603)226-4211 TOWNSHIP: T02S RANGE: R01W SECTION: 2SW SCALE: 1 IN = 100 FT �J USER ID:aap
www.invarion.com
Lane Width 12
N WNatural Notes: Posted Speed 25 Notify FireIEMS,EPD Place No Parking signs KBD as the preparer of this traffic control plan makes no representation
CONTACT:Richard Patterson 1. Maintain ped.access to and Merge Taper NA and LTD 48hrs before 48 hours before work begins as to its general adequacy or being approved for implementation.
503-019.2484 through crosswalks Shift Taper NA beginning Work Approval must result from the Traffic Engineer or other public official
2. Maintain Min.12'lanes Buffer NA g g LEA SC DULE having statutory enforcement authority in the jurisdiction.
3. Maintain local access I Sign Spacing 100 H DIS ATCH Utilization and implementation of this plan shall be as a result
4. Notify Transit authority at least Cone Spacing: 503=523-7287 of that approval. Ref.MUTCD 2009 6A-01(10).
LOCATION: 9605 48 hrs.of bus slop closure Tangent 25 HO S IN ADVANCE
SW Hillview Ct. 5. Traffic control plan and all Taper 20 D PROVIDE A
devices shall comply with -
MUTCO,ATSSA and OTTCH CO OF THE APPROVED
DATE: JOIB#3454161 6.Adjust to field conditions AFFIC CONTROL PLAN
11116115
Manifest
11x road work ahead RECEIVED
1 x shoulder work CW21-5 NOV 18 2015
.t CITY OF TIGARD
m� PLANNING/ENGINEERING
o�
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SW Hillview Ct :1
•
Legend "' Ww W
Illl` Sign Stand k
DW Driveway
CW20-1 CW21-5
Work Area
cones
road work ahead
shoulder work CW21-5
a Jnm^M• OT TO SCALE
KS 0 SERVICES OF OREGON,INC PHONE:503-723-7287 FAX:503-723-8750 DRAWN BY ALAN WARD 04456