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PFI2016-00018 o CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT o COMMUNITY DEVELOPMENT Permit#: PF12016-00018 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/16/2016 Parcel: SEG1118 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Mountain View Tree Service Project Description: Line clearance pruning on select street trees Owner: FEES Description Date Amount PFI Permit Fee 02/16/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: MARVIN KLOPTENSTEIN PO BOX 80805 PORTLAND, OR 97280 PHONE: 503-363-0991 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: C Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00018 Type: Condition Name: Status: Severity: PFI—Street Imp 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—Street Imp 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—Street Imp 03-WORK SITE EROSION CONTROL Not Met 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—Street Imp 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—Street Imp 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 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—Street Imp 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—Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Not Met 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—Street Imp 09-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—Street Imp 10-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—Street Imp 11 -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—Street Imp 19-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—Street Imp 20-NOTICE TO COMMENCE WORK Not Met 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—Street Imp 12-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 Street Imp 13-DRAINAGE CONTROL Not Met 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—Street Imp 14-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—Street Imp 15-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—Street Imp 16-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—Street Imp 17-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—Street Imp 18-SEWER SYSTEM TEST Not Met Notice A sewer system air-test and/or DVD T.V.test report and one set of"As-Builts"shall be provided for review and approval. PFI—Street Imp 21 -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—Street Imp 22-DAILY INSPECTION REPORTS Not Met Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI—Street Imp 23-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—Street Imp 24-VALIDATION OF MATERIAUCONSTRUCTION Not Met 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—Street Imp 27-PRIVATE PROPERTY AGREEMENTS Not Met Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI—Street Imp 28-AS-BUILT DRAWING Not Met Notice 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). PFI—Street Imp 30-PUBLIC WATER QUALITY FACILITY Not Met Notice The Developer shall create and provide to the City a schedule for periodic(quarterly)maintenance of the water quality facility. The Developer shall maintain said facility for a period of three(3)years from the date of City Conditional Acceptance of the public improvements. On October 1st of each year during this three(3)years period,the Developer shall report, in writing,maintenance activities to the Director of Public Works. City crews should monitor proper removal and disposal of silt and debris. Prior to City final acceptance of the facility,the Developer shall provide a written evaluation of the operation and maintenance needs of the facility and correct any deficiencies identified in the evaluation. PFI—Street Imp 25-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—Street Imp 26-RIGHT OF ENTRY/EASEMENTS Not Met 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—Street Imp 31 -No traffic restrictions 6:30 a.m.to 9 a.m.and 3:30 p.m.to 6 p.m. Not Met Notice 31 -No traffic restrictions 6:30 a.m.to 9 a.m. and 3:30 p.m.to 6 p.m. City of Tigard PUBLIC WORKS — ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK Check one: ❑ Utility Connection TYPE 1–Franchise L'tilin•Work ❑ Sidewalk/driveway approach Work performed by N-V7N, PGE 2 Street improvements and/or utility agency. Detailed description: /_i(se- r -Qn i ( yu D t5 y1 ❑ TYPE 2–Sidewalk/Drivewat/Sewer ae ,Q a St ATS \X-ork performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): ���1 �TG��j and/or repair (�' i T— • Sanitary sewer lateral installation and/or main line tap ❑ TYPE 3–Full scale Development Applicant: /t �n1�Y�.�a-,�� i ;PQM �p {�)�C P Work performed with Land use Address: P-U approval which includes any of the following: City/state: �O-CA V OJty Zip: I!t-4 Z%U • Subdivisions or Partitions Phone:503--3(o3x-CYi41 Email: y�1 �t;(1(cJy�1��)�fP2. ;y� • Street widening Contact name: A,x'U,n \ 1pASLA Phone: i 0-2r S lulaK • :Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: /\ U CW Tim �Q4 V and/or Tigard Water Service Area CCB#: -- I�-q` 71S Expiration: 1Z i Z$I R SUBMIT COMPLETED APPLICATION TO: Address: 0. 61z-,?, City of Tigard City/state: r�(� D►�Q� t_-_ Zip: eZSkO Planneng/Engineeriag Phone:503-3(e3-0qq I Email: 13125 SW Hall Blvd. Tigard,OR 97223 Contact name: _��t.rui n K<<n�2n -�:'!\ Phone: Sb3-253CU +�(fig' Applications for"minor work in tight-of-way' only may be emailed to. Engineer: Address: City/state: Zip: J Q Phone: Email: Case Na: Contact name: Application submittal fee: Additional fees: Estimated value of work is required(if over$5,000):S Application accepted: (within the public right-of-way) By: Ls Date: / Is work related to a LAND-USE DECISION? ❑ Zes No Application re ed: By: Date: 2/N /lit If so,please specify (MLP, SDR, SUB,etc.) case#: / Applican/t notified: Is work related to a BUILDING PERMIT? El Yes p No By:LS Date: If so,please specify(BUILDING PERMIT)case#: uupw+\M,.anwna U"Anak.fwns p. 07/09/2015 City of•Tigard 13125 SW'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 A�k: we r�r,� G:,3oa..�- y,,,K, " w - 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 silnt this application in the space prordded or submit a written authorization with this application. BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate am,deed restrictions that mai-be attaclied to or imposed upon the subject property. • If the application is granted, the applicant will exercise the rights 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,mai-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. SIGNAT�yURRES of each owner of the subject property required. A�e, ,�' N�Applicant/Authorizesignature 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 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • u%%rkc tigard-or.gov 303-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement (PFI) Permit: DETAILED SUBMITTAL APPLICATION FEE REQUIRENIENTS Part 1: Required submittal fee 5300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water system improvements CONNECTIONS,ETC. Engineer's estimate X 5% (less S300.00 submittal fee) (work in the right of way) Engineer's estimate X 2%Plan Review Sketch WATER SYSTEM FEE (including information below) Part 3: All public water system improvements ❑ Dimensions Engineer's estimate X 12% ❑ Street Name ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT mi There will be no pert fee charged,or assurance i equired for the following types of work: (Subdivisions/Partitions and Street Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 2204) • Weephole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary*(Plan Profile) • Planter strip landscape maintenance ❑ \eater Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility-Plan(Electrical,Phone,Gas, Note: A cash assurance maybe required per Storm,Sanitary,Water,Signage,Street Lights,etc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(pro)ect land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ,in%..ti:tigard-or.gov • 303-718-2421 • Page 3 of 4 ■MINE■ ■■■■■EE INE I■ ■EME■■■INE■■■■■■ IN m 0 EMS 0 No ■■E ■■FINN■ ■■EEMEME■■■■NOE INEE ■■ ■■■■■E ■■■■Immommmommm m mom pion MmmatA AN EMSEN ME mompaq ME mom No ONE Ki w ■EINE■■■■moi mom mom ■ - -_ _...: , ■■■■�■■■■r;_; ■■ SOMEONE ■■■ ■E■■■M■ uIN■■■■■■■■■ EM0 ■EIN■■■ ■■M■■■!E■■■■INE■■■ 00 ■ EEE■■■■[i�����;:11r'�I 0■E■M■t►. EEE■ 7■■�l��w1iE, �mmumm■■■■■■■■ 0000Er0■■■■■�I■■■Y�■■■■IN■M ININ■■■■ ■■0■■■■■■■■■■■■E■div ■tE0 M■■■■■■ E■ 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 December 2011 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 c 0 CL o C-7) CM td Wd sL ,�, LL m�� m 3 a� Or o r----------------- ° v I f • .. I x 1 •° > m t I m ° <tm I • I 'E '� I I I • ° ? 1 _o m I nE1 02g Z� I Rik k [-9 Y` rhe I I • o LU a I m� I �` w°do �� I t IF 1 m ho I �� I •� ff OR I-----------------I I rm Sign Spacing and Buffer Lengths(feet) W Posted S acinBetween-Sl ns Buffer 7S Speed A B 1 C Space o o O 20 50 25 100 100 100 75 30 1 100 35 350 350 350 OH 40 45 ;g0 Q 50 500 500 500 2t0 55 250 December 2011 Chapter 5