PFI2016-00055 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00055
p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/09/2016
Parcel: 2S109DA12400
Jurisdiction: Tigard
Site address: 12987 SW KOSTEL LN
Subdivision: SUMMIT RIDGE NO.2 Lot: 113
Project:
Project Description: Dig in sidewalk between curb and property to bypass utility.
Owner: FEES
Description Date Amount
PFI Permit Fee 03/09/2016 $300.00
PHONE. Erosion Control Fee 03/09/2016 $80.70
Contractor:
TEAM TITAN LLC
PO BOX 1803
CLACKAMAS, OR 97015
PHONE: 503-477-8117
FAX:
Applicant:
RICH EVETT
PO BOX 1803
CLACKAMAS, OR 97015
PHONE: 503-943-0955
Total $380.70
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: 7�� Q
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00055
Type: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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_Utilities 18-PERMIT/PLAN ON SITE 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 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 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 Notice
City of Tigard RECEIVED
092016
PUBLIC WORKS — ENGINEERING
Public Facility Improvement (PPI)l?N*NG
DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK
Check one: ❑ Utility Connection ❑ TYPE i-Franchise Utility Work
❑ Sidewalk/driveway approach Work performed by NWN,PGE
'% Street improvements and/or utility agency.
Detailed descri tion: 7✓S t1 �''c�u1�l!L �t
p � ❑ TYPE 2-Sidewalk/Driveway/Sewer
W L �• ?A-.0 PL 26 't) ;xis s V j}f J ti Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): 1 ZS,�,1 Sw ICvc'-f.c 1, J and/or repair
—7 Sanitary sewer lateral installation
i •'�� and/or main line tap
❑ TYPE 3-Full scale Development
Applicant: Work performed with Land use
approval which includes any of
Address: the following:
City/state: Zip: Subdivisions or Partitions
Phone: Email: Street widening
Contact name: Phone: -Mainline installation for Sanitary
^� sewer,Storm sewer,Tigard water
Contractor: 1%�'t, L_ and/or Tigard Water Service Area
CCB#: Zu ZZ- Expiration: SUBMIT COMPLETED APPLICATION TO:
Address: _ City of Tigard
City/state: Zip: 51 D 1 S Planning/Engineering
13125 SW Hall Bbd.
Phone S o� -Lt l'\.4110 Email: Tigard,OR 97223
Contact name: rZ,4A E,,e--7 Phone: Sul Applications for"minor work in right-of-way"
only may be emailed to:
Engineer:
ro rmits(Rgg ard-or.Qov
-�'ne .
Address:
City/state: Zip:
Phone: Email: Case No.: t F12014 -DDO55-
Contact name: .Application submittal fee:
Additional fees:
Estimated value of work is required(if over$5,000):$ .Application acc ed� L
(within the public right-of-way) B Date: ?-o/IV
�i
Application r ewed:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No 9
By:`Z7 Date:
If so, please specify (MLP, SDR, SUB, etc.) case #:
/2,0 k,
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ les ❑ No By: Date:
If so,please specify(BUILDING PERMIT)case#: e\euxPLN\MasWrsUanduse APPeot;ons R"07/09/2015
LM2011, - cc) z_-:v
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page I of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI) Permit:
DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS;ETC.(work in the right of way)
Engineer's estimate X 5% (less $300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE
Part 3: All public water system improvements El Dimensions
El Street Name
Engineer's estimate X 12%
❑ Site Address
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required FULL.SCALE DEVELOPMENT
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,2406 or 2204)
• Weephole repair ❑ Cover—Site,Vicinity=,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes (City,)X/ater,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 ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree.Plan
❑ Composite Utility Plan (Electrical,Phone,Gas,
Note: A cash assurance may be 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(project.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 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4
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