PFI2017-00083 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
s COMMUNITY DEVELOPMENT Permit#: PF12017-00083
13125 SW SEG1
Parcel: EG1043 Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued:
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: ODOT detour PFI
Project Description: Detours on City of Tigard street for work within ODOT 1-5 sign replacement
Owner: FEES
Description Date Amount
PHONE
Contractor:
PHONE
FAX
Applicant:
MATT FREITAG
123 NW FLANDERS
PORTLAND, OR 97209
PHONE: 503-731-3197
Total $0.00
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00083
Type: Condition Name: Status: Severity:
PFI—Sidewalk/1 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_Sidewalk/[ 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—Sidewalk/1 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—Sidewalk/1 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_Sidewalk/[ 05-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_Sidewalk/[ 06-NOTICE TO COMMENCE WORK Applied 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. call Ken Fisher 503-816-6146 or Kenny@tigard-or.gov
PFI_Sidewalk/[ 07-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—Sidewalk/1 08-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_Sidewalk/[ 09-OTHER Applied Notice
RECEIVED
City of Tigard MAY 0 4 2017
n PUBLIC WORKS — ENGINEERING CITY OF TIGARD
PLANNING/ENGINEERING
a , Public Facility Improvement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
detour ❑ TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑X Street' performed by NWN, PGE
Detailed description: and/or utility agency.
Detours on City of Tigard streets for work within ODOT ROW on ❑ TYPE 2—Sidewalk/Driveway/Sewer
the 2016 Signs Replacement Project Work performed for the purpose of-
- Sidewalk installation or repair.
SEC, I N9 - Driveway approach installation
Property address/location(s): and/or repair
See attached Vicinity Map and Detour Plan - Sanitary sewer lateral installation
and/or main line tap
Applicant: Oregon Department of Transportation (Matt Freitag) ❑ TYPE 3—Full scale Development
PP Work performed with Land use
Address: 123 NW Flanders approval which includes any of
City/state: Portland, OR Zip: 97209 the following-
Phone:
ollowingPhone: 503-731-4851 Email: Matthew.D.FREITAG@odot.state.or.us - Subdivisions or Partitions
Contact name: Chris Aguon, P.E. Phone: 503-731-3197 - Street widening
- Mainline installation for Sanitary
Contractor: Unknown at this time sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: Nate Shroeder, P.E., PTOE only may be emailed to:
Address: 720 SW Washington Street, Suite 500 rowpermits t ard-or.gov
City/state: Portland, OR Zip: 97205
Phone: 503-972-1238 Email: nns@dksassociates.com Case No.: T p
F-T ?A)11 "000 83
Contact name: Nate Schroeder Application submittal fee: $
Additional fees: $
Estimated value of work is required(if over$5,000):$ N/A Application accepted:
(within the public right-of-way) (not in City ROW) By: M 0 Date: S J 9 1-7
Is work related to a LAND-USE DECISION? ❑ Yes ❑x No Application reviewed:
If so,please specify (MLP, SDR,SUB, etc.) case #: ByJGs1�— Date: 5/-Y/17
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes ® No By: �—S Date:
If so,please specify(BUILDING PERMIT)case#: I:\ENG\PermitApplirations\pfi_applintlon Re 12/16/2016
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.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,if
required by the city pursuant to TMC 15.041.140.
" \Reith the exception of a utility operating pursuant to a valid franchise with the City of'11%ard 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. 'llhe owner(s)must sign this application in the space provided or submit a written authorization with this application. franchised
Utilities arc not required to obtain the owners signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any ecorded deed restrictions that may be attached to or imposed upon the subject
proper .
• 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 any 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.
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
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 Ifall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
APPLICATION FEE
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.
Engineer's estimate X 5% (less$300.00 submittal fee) (work in the right of way)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system improvements ❑ Street Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (G sets,24x36 or 22x34)
• Weep hole 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 ❑ 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
SAMPLE SKETCH:
Edge of Pavement
Ditch
Streetlight I -- ----------- —t---
Rain Dren
1 1 � • --T.-are � :
1 ' a
1 6
' i!-Propos d�5e11werTi1-1 e'-
U31 . Existing House
I Existing 1
ad, Driveway
v�
ciI
CI � I ' :h•
vl � rl
do' I 1
01
a, I 1
o
Existing Shop �
1
Powerpole 1 I A=
o
951 - -
y�-------7roper -Line----- --
II Fire Hydrant(FH)
� I I
Scale: 1"=30'
� � I
� I I
' I I
� � I
MINIMUM SKETCH REQUIREMENTS (Put'IN/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
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4
Overall Site Map for 1-5 Signs
Replacement Locations
5/3/17
7 : Portland Goll Club t 14 21- i
19 24 40 25
to a se t
E t r. _
t3
22
23 20
11 17��.
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Home-WMtlord 16 �— l2
--- ` ' CUtl INS VIEW
Washington Square 77 lS
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Tigard
1
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onto. o •1
Temple•The
l ake.osweo
DETOUR MAPS
DETOUR PLAN 50V-066
HAINES ST TO 1-5 SOUTHBOUND GENERAL NOr£5,
1. Adjustments t0 temporory rroffiC Control devices moy
be required to accommodate existing field conditions.
L"i"on of olitemporory traffic ponrroldeviCSS
PALATINE shall te approved in the field by the Engineer.
2 ST -
N
3
i
2 ¢ 3 n p
OETOUR N4-8 24"x12" DEf0U9 N4-8 24"x12" pETOUR Y4-B 24"x12" OETOIIR Y4-8 24"x12"
$OATH N3-3 24"x12" SOUTH Al'_' 24"x12" $OQIII Y3-3 24"x12" $OUIH N3-3 24"x12"
Iz END
S P C� DETOl1R N1-1 24"x24" NI-1 24"x24" NI-1 24"x24" NI-I 24"x24"
`a + Q' =------- CG20-5
30"x24" N6-2R 21"x15" y Alb-IR 2f"x15" �"'► Y5-IR 21"x15" 06-3 21"x15"
P W
O O O O O
LESSER.-_%"
a
a0
N4-8 24"472"
DETDF614-8 24412"
RAMP SOUTH MJ-3 24
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>,
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u 4 CT.,, p a 4-- N6-rL 21"x15" OR22-18 Y5-1L 21-x15"
> 350't `D -
a _._ 48"x30" 48"x48"
_-__--. ATLANTA ST HAINES ST. O OT OB O
BAYLOR `L ST w; GUNTHER L E G E N 0
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6 SOUTHVfEW SS�9 a /� Flogger Station
-- -
CLINTOIV ST, D ST.:
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x Temporary sign on TSS
-
p S 2-ET1110 `T' pPL 7 6'Type(fill LR or LR Dorriaode
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w EDPACIFIC 6 COLUMBIA RIVER HIGHWAYS
-- !bines Sr to 1-5 SB romp ctosed CLACKAMAS,MULTNOMAH.A •ASNINGTON COUNTIES
OREGON
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ExP1RE5:JUN.30.2018 ft
DETOUR PLAN 2C-6
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a6rmxr 5OV-066
-- DETOUR PLAN
1-5 SOUTHBOUND TO KRUSE WAY/HWY 217 L £ G E N D
--—- - ——-w-Oetaur route
7 6'Type Ull)CR.or LR barricade
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Pcriabfe c wvwbb-$$me sir(PLUS)
A
OX Sign detail,we derails this sMM
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= A 217KRUSE EXIT
CLOSED HAINES
PORTABLE CHANGEABLE MESSAGE SIGN
(Suggested Message)
(Locate As Directed)
i
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4
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- ExwREsduN w.zola DETOUR PLAN 2�_7
X:\Projects\2016\P16102-000 (ODOT 2016 Interstate Signs Replacement)\MICROSTATION\19201_TR.TP07 ::Default 4/24/2017 11:19:53 AM ryon.Derger Rotation:0° Scale:l"=100'
SOV-066
DETOUR PLAN
HAINES ST TO 1-5 NORTHBOUND L E G E N D
—41-Amur muro
11 Tow4wary sign on TSS
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NORTH M3-3 24"XJ NORTH MJ-3 24"x12" NORTH M3-J 24"x12" NORTH 43-3 24"x12"
Q a' DE70UR 5 Ml-1 24"x24" Ml-1 24"x21" 5 MI-1 24"x24" 5 MI-7 2,"x24"
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NORTH M3-3 24"x12" RAMP NORTH M3-3 24"x12"
3 _ 4 ; 6 MI-I 24-x24" CLOSED MI-124"x24"
5 P T.
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snarpe oppraee in the tela by the Erg;neer. 2C-8
E%PIRES:JUN. 30.201 B
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50V-0"
DETOUR PLAN
1-5 NORTHBOUND TO HAINES ST
w EXIT 293% USE
HAINES ALT
F ^I CLOSED ROUTE N�, all LnwHAINES ST _6"C
ai w xx<
EXIT 293 USE
t PAOIPTC' _-91 !„ CG20-6 Oe HAINES EXIT 294
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II
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6 i x
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+8"x+8"
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o�; CLOSED
t ,$ CG20-6 Mod., 112 MIL
T; 9 � 4 30-,36-' END
J
� DETOUR
8 HAINES ST _6'•C HAINES ST _6"c
pETOUp HAINES ST
6"C HAINES ST _6"C �Tt7l�i
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GENERAL NOTES, ] 8'Type(111)LR.or LR barricade Z OREGON et
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shallbe approved in tee field by the Engineer. /f� N, SCS
OX Sign detail.see details this sheet DETOUR PLAN
ExPINEs:�uN.50,tole 2�'9
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50V-066
DETOUR PLAN GENERAL WE&
1-5 SOUTHBOUND TO HAINES ST 1.Adjustments to temporary traffic controfderfces may
be reprired to accommodate existing field Conditions.
Locations of all temporary traffic control devices slat be
j _- 8'6YllI1R approved in the field by the Engineer.
v� A
N
v\ O HA N2E8 EXIT 294
4� CLOSED HWY 99W
- :v PORTABLE CHANGEABLE MESSAGE SIGN
(Suggested Message)
- - --_ S -- aoaafe As Oirectedl
36"xlZ- HAINES ST 36"xtr'
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.� , DETOUR OETOVR DETOUR
2 �f, .4\,,�IJ�, - C620-6 �CO20-6 fwodJ D�O� M4-9L
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/ 30"x24"
L E G E N 0
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Exit 293 (Hoines St) - -
/� Flogger 9fofian
- romp closes -
8'Type(III)L.R.or LR barricade
4
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- ® Portable changeable message sign(ACMS)
OSign detail,see details this sheet
1-111MW;
OREGON DEPARTMENT OF TRANSPORTATION
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EXPIRES:JUN.30.2018 DETOUR PLAN 2C-I0
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L E G E N D
50V-066
——-1110-Secondary detour route DETOUR PLAN
1-5 NORTHBOUND TO BARBUR BLVD/HWY 99W
------llm� Primary detour route W20-3(Mad.)
18„X18„
7 8'Type fIIULR.or LR barricade
RAMP 1BARBURBLVD1_6"C BARBUR BLVD _6"C
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® Porto"dfmyeobk massage sign(PCMS) S — _ CG20-6(Mod.)
O -- AHEAD LG20-6• �"► N
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BARBUR BLVD
DETOUR BARBUR BLVD _6"C BARBUR BLVD _6"C
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9
GENERAL MOTES.
2 ).Aa%u5tme05 to Temporary tralfk confrdabV)Ws may
8
be required to oarommodate existing fWd uond77ans.
Locafionry fr0/r
s or on temporaio comrd dWoes"I be
opprweo;n me f(eto oy the
Engineer.
i
7
r OREGON DEPARTMENT OF TRANSPORTATION
J
2 BARBUR USE ��Ep PROFFf "� ' ma
S
1 wvx 0��f50f:31e3.CCm
O BLVD EXIT
DETOUR 295 7s.eo0 ° 2013 INTERSTATE SIGN REPLACEMENT PROJECT
r PACIFIC 6 COLUMBIA RIVER HIGHWAYS
EXIT 294 USE CLACXAMAS.MULTNOMAN,A eASNINCTDN COUNTIES
OBARBUR EXIT 293 z DREcoN 4 a �,,, - A sw..a.
CLOSED 'i a o ft w—e,-AAM 1.C—
PORTABLE CHANGEABLE MESSAGE SIGN y4 GNf 2.20 04' o.w+w eX-ods cm
s tsugge w Message) NEC N. 5��� STET
ILooVe As Dfreded) DETOUR PLAN
87111)R0 20-11
EXPIRES:JUN. 30, 2018
X:\Projects\2016\P16102-000 MDOT 2016 Interstate Signs Replacement)\MICROSTATION\19201-TR.TPII::Default 4/24/2017 11:21:32 AM ryon.berger Rotation:0' Scole:l”=100'
L E G E N D 50V-066
_ DETOUR PLAN
D~route 1-5 SOUTHBOUND TO BARBUR BLVDIHWY 99W A
3 B'Type UIDL,R.or LR Dorrkode
i Teinwory sign on Ie9wory supper/ ..-
® Portays dangeaft messop sign fPC115)
Ox Sign derokme defans this aaeet
yup
Flapper Stot)on
/ N
1-9
GENERAL NOTEA U
1.Adjustments to temporary traffic controlaeviees may
to required to OCCO—Wote ex)SRnp field conoilions,
Locof)ons of all temporory traffic Control devices stroll be
approved in fte field ay the£n¢'neer. _I -
Exit 294 fBordv Blvdl
ramp closed
__ HWY 99W 36"x12" HWY 99W 36"x12" HWY 99W 36"x12"
a LG20_6(mod.) CG20_6 CG20_6(,Mod.)
JO"x36" 30"x36" 30"x36••
rgrin
i., HWY 99W 36"x72" ENO
r.a'� uEiOUR
arm oerow M4-9L CGi20-5 EXIT 294 UISE
�� ♦ 30"x24" 30"x24" OA HWY 99W EXIT 293
M1I O O CLOSED HAWES
PORTABLE CHANGEABLE MESSAGE SIGN
5 - --{---- - +,a (Locate As Directed)
1 t Ir OREGON DEPARTMENT OF TRANSPORTATION
\ 130 5N Yllgnx'gkxl S1.Suh 500
POnINp.Olcgon 97305
,���Ep PROF fff
' 7s,eoo 2018 INTERSTATE SIGN REPLACEMENT EVEN NR HIGAYS PROJECT
PACIFIC &CLACKAMAS.MILTNOMIM,d WASHINGTON COUNTIES
I(3) Z OREGON qc uoaer M.r.
' S 'y4 GNE 2.20,0 Opp o..lmw e1 ex�ms cw
— ExRREs:JUN.so.m1s DETOUR PLAN 2C-12
X:\Projects\2016\P16102-000 (ODOT 2016 Interstate Signs Replacement)\MICROSTATION\19201_TR.TP12::Default 4/25/2017 6:00:07 AM nns Rotation:00 Scale:1"=100'
DETOUR PLAN EXIT 295 USE EXIT 5 0 V-0 6 6
O
I-5 SOUCAPITOL 296ATHBOUND TO CAPITOL HWY A CLOSED BARBUR
st:
PORTABLE CHANGEABLE MESSAGE SIGN
!Suggested Message)
(Locate As Oirecteol
_ sr
-- <% CAPITOLHWY .6"C
_6"C nt
CG20-6
� YI-9L 30"x36"
JO"x21"
,rrrl�,
�. 3•. 5, � - " DErouR
!
Maar.!
48-x4d"
z =6"c RAMP
o20- CLOSED
CG20-6'Medd A
HEAD
d
30"x36- END
O
/ JQ
6 CAPITOL HWY _6'C CAPITOL HWY _6 C
4
-_, CAPITOL HWY .6"c DETOIR DETOUR
CG20-6!Mood CG20-6 Oladd
DETOUR _-9R 30"x36" 30"x36"
rS 3011x24"
l
5 O O O
-- r OREGON DEPARTMENT OF TRANSPORTATION
j
% ,���EO PROFFff, , ]?0 SW V�tm CI NIY S Xi
r�una.a �]zos
�,i x asasv ralescwn
/ L E G E N D is.eoo q 2016 INTERSTATE SIGN REPLACEMENT PROJECT
PACIFIC 6 COLUMBIA RIVER HIGHWAYS
•—— Detour route CLACKAMAS.MULTNOMAn•b eASMMCIOe COUNTIES
Ev720 fCW;ki Hwy) 3 8'Type(111)L.R•or LR barricade
ramp LYa.Aed GENERAL ROTES. = OREGON 4 D-• T—L-1- .e v.S-1-1
1.Adjustments t0 temporary traffic contra'devices my 0 Temporary sign on temporory Support GNf 200 �Q OeA�p�ea ey-Ed's E.[mocro
be repuirea ro oammmodale exislinp field GVndilions. 4 2' O o.°T•"'- c•0
Lowf;ons of WI temporary traffic cafrlrol devices shpt)be ® Portpble chongeobk message sipn lPCNS) Hof( N• S�a� o f
approved in rhe field by the Engineer. O sign detail.see derails th;s sheet DETOUR PLAN
EXPIRES:JUN.}0.2018 20-13
X:\Projects\2016\P16102-000 (OOOT 2016 Interstate Signs Replacement)\MICROSTATION\19201_TR.TP13 ::Default 4/24/2017 12:03:58 PM ryor.berge, Rotation:0• Scale:1"=100'