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PFI2016-00027 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT a COMMUNITY DEVELOPMENT Permit#: PF12016-00027 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/22/2016 Parcel: Se93046 Jurisdiction: Tigard Site address: 10770 SW WALNUT ST Subdivision: ECHO HEIGHTS Lot: 2 Project: NWN PFI Project Description: Install long side svc; main is on the 18'in ROW. Possible cuts for tie-in and pot hole over utilities Owner: FEES Description Date Amount PFI Permit Fee 02/22/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: AISHA PRESTON 220 NW 2ND AVE PORTLAND, OR 97209 PHONE: 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 Not Present Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00027 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 anytime 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 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 3:30 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:30 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,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 FEB 18 2016 PUBLIC WORKS —ENGINEERING CITY OF TIGARD NINC�/ENGINEERING Public Facility Improvement (PFI) PLAN ermlt DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: R Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Install long side sve; main is on the 18' in ROW. Minor work in right-of-way (sidewalk repair,curb cut,street Possible cuts for tie-in and/or pot hole over other utilities opening,etc.)requires: WR#3463004 •.Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 10770 SW Walnut St of the proposed work to be done so n� r �f^ S •Submit one(1)copy of traffic `T o control plan OR– Applicant's NW Natural/Aisha Preston E] Substantial project work requires pP s name: 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 Finail: nwnpermits@nwnatural.com •Alain utility line extension: - Storm Drain,Sanitary—Tigard LO Clark/Robin Junor - Water—Tigard Water Service Contractor's name: Y \rea(includes Durham,King City CCB#: 52281 Expiration: and a portion of unincorporated Address: PO Box 1369 Washington County) City/state: Tualatin, OR Zip: 97062 DELIVER APPLICATION TO: City of Tigard Phone: 503-783-1177 Flmail: robin.junor@loyclark.com Planning/Engineering 13125 SW Hall Blvd. Engineer's name: NW Natural/Andrea Kuehnel Tigard,OR 97223 220 NW 2nd Ave Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Portland, OR Zip: 97209 rowpermitsntigard-or.gov Phone: 971-409-7594 Email: afk@nwnatural.eom R STAFF USE NLY •Dr_ • Case No.: i Rf 2A I OW 11 Estimated value of work (within the public right-of-way): $ Application submittal fee: 0_ Is work related to a LAND-USE DECISION? ❑ Yes ❑ No _Application accepted: /� If so,please specify (MLP,SDR,SUB,etc.) case#: By: rl7 Data t Is work related to na BITILD NG 3 4RMIV ❑ Yes ❑ No Application viewed: I ,p ease s ecify(BUILDING PERMIT)case : _ By. Dare:Z Zol4 Applicant notified: � )� By: Date: \� 1:\CURPU4\Masters\land Use Applications Rev.07/16/2014 City of Tiga 25 SAA'Hall Blvd. • Tigard,Oregon 97223 • www . ov • 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 arc different people,the applicant nwst be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. 'I'hc 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 any deed restrictions that may be attached to or imposed upon the subject proper4rt • 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,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. Q 1T Digitally signed by Aisha Preston a Preston AiSha Preston DN_cn=Ai@nwnaPreston,o=n,c=USNatural,ou, AiSha P1 esto1 1 2/18/16 email=aap@nwnatural corn,c=US Date:2016.02.18 10.13:40-08'00' Applicant/Authorized Agent's signature Print name Date Owner's signature Print narne Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW HallBlvd. • Tigard,Oregon 97223 • xvv wtigard-or.gov 503-718-2421 Page 2 of 4 Page 84 2011 Edition Stati'ona`ry Larie`Clbswre',with Flagging Diagram.LL320 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 0 N'9 ———— ————— � N n C N A ?W-N N'a O CD in o cn o cn o cn o N n a Single Flagger Operation, for Low Volumes I (Optional) !� a N W to N 1 (ADT<400) X; 0 0 0 m I BE 0. IF1ApCQ PREPARED P ONE LANE }� w a ^ 7�B I•B I�c I• TO STOROAD / E r 0 0 0 .2 CD r -i 4— / f m — —. — — ♦— ROAD iM . WORK o c"ii o n� KcKBKBKA-I a� I AHEAD O. O vNi�m NNo-cnin tumor IM1 1 (00-0 �F A B I B C I* i I------------- --I3' 1 mile -Ti max. '4T to B B A Buffer Protection Vehicle ROAD 0 w/TMA(both Optional) WORK �+ See Chapter 4 I AHEAD i n ONE LANE BE 0 PREPARED = ,,°, To STOP Two Flagger Operation 3 / v j CD 00 i (Optional) f a� Q z mom o o _w 912236 w 226• ~ 912237 -fl 129, fn J IPI (71) Hyl\ Cam (7.) 912244 M� �$ 912325 _ a `b .b Y (WI'62912320 bb53' b R j 912355 1.1/rC 1 SW Walnut St a �y �o IwI a 912350 € # � 169' 51 � 912365 �j O 910880R P 99 24 C (P) ' ---- ' =$ 10770 SW Walnut St, #3463004 _ 910615 7T 1389 28 910585 y 19t' d "^ 201' d 210' t. LWR.•'99 h �+ d 4 4479•11 300' g P s NW Natural PLAT: 1-043-018 COUNTY: WASHINGTON 02/17/1 1906 3 (503)226-4211 TOWNSHIP: T02S RANGE: R01W SECTION: 3NE SCALE: 1 IN= 100 FT LTJ USER ID:aap