PFI2017-00096 u CITY OF TIGARD RIGHT OF WAY PERMIT
= COMMUNITY DEVELOPMENT Permit#: PF12017-00096
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/25/2017
Parcel: SEG1852
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: ODOT
Project Description: Detour for construction paving on State Highway 141 (Hall Blvd)at Bonita
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
STACY STUBBLEFIELD
9200 SE LAWNFIELD RD
CLACKAMAS, OR 97015
PHONE: 971-673-6200
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 f 0A-"
Signature: M 000 !
Issued By: / ! /10
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00096
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 any time 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 3:00 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 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 twenty-four(24) hours prior to commencing work, prior to any staged
inspection,and after completing work covered by the permit. call Ken fisher at 503-816-6146 or Kenny@tigard-or.gov
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
RECEIVE®
MAY 2 4 2017
City of Tigard
PUBLIC WORKS — ENGINEERING
CITY OF TIGARD
= Pl:4NN1Nr!r-NGiNFERING
Public Facility Improvement (PFI) Permit
5%tK� TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way�T
M. ❑ TYPE 1-Franchise L'rilih,Work
Check one: ❑ Utilities ❑Sidewalk/driveway approach ❑Stre tunprovements performed by NAXNi\, PGE:
]!«O� C.2MS l.•�� and/or utility agent}.
Detailed description: �7 1
❑ TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): and/or repair
• Sanitary sewer lateral installation
and/or main line tap
Applicant: ❑ TYPE 3-Full scale Development
PP Work performed with Land use
Address: qwx) sc L&L&nn A-eid, ed approval which includes any of
City/state: tAI&l_kL1Y64_j2.O (A^ Zip: �"701 !Z— the following:
Phone.'"F( -424 Email: .S .SIS •Y.LA�ybdivisions or Partitions
• Street widening
Contact name:SVUik S4a�h6 'J P��h��one: a'•1( "te-B-13,4 3 a Street widening
installation for Sanitary
Contractor: GyAk .LWL Cowts \1'IAGJ uyl- Co sewer,Storm sewer,Tigard water
-1 Idt and/or'1'igard Water Service Area
CCB#: 10 k NCIS Expiration:
Address: 1% 1W�-At SQ 1s't 5& SUBMIT COMPLETED"PLICATION TO:
City/state:\1Aj0LdZAAXr LAA Zip: City of Tigard
Phone'-LM-14 Email: •�.OM Planning/Engineering
13125 SW Hall Blvd.
Contact namel�&IA_A&A beiA A} hone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: N JA only may be emailed to:
row rmits .tigard-or.Qov
Address:
City/state: Zip: Mimi
Phone: Email: Case No.: �� T
Contact name: Application submittal fee: $ T
Additional fees: $
Estimated value of work is required(if over$5,000):$_> Application accepted:
(within the public right-of-way) By: Date:
Is work related to a LAND-USE DECISION? ❑ Yes �, No Application reviewed:
If
If so,please specify (NILP,SDR,SUB,etc.) case#: By:�6-aI,— Date:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes Vtio By: F"r) Date. `S��'I�E�
If so,please specify(BUILDING PERMIT)case#: 1:\ENG\PermitApplkatbns\pfl application Rev.12/16/2016
City of Tigard • 13125 SXX'I fall Blvd. • 'Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page I 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.
With the exception of a utility operating pursuant to a valid franchise with die City of"I igard,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 sigh this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owners signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate ann!recorded deed restrictions that tnay be attached to or imposed upon die subject
ro
• 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.
S�atGy Si'�68L�^Flb� qZ AA-7
pplicant/ thorized Agen signature Print name fate
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name Datc
Owner's signature Print name fate
Owners signature Print name fate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR 5FAFF USF* ONLY
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water system improvements (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
❑ 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 24x3G or 2
• Ditch cleaning that does not involve regrading. (G sets, x34)
• 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 S\V I Iall Blvd. • 'Tigard,Oregon 97223 • .vwwtigard-or.gov • 503-718-2121 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I G' Ditch —4
Streetlight I _•—•—•—•—•—•— —C—•—
• ° Pak,DraaL
' T—IMropos d1sewerMne
N
I � I � I I
41 Existing House
I �� I Existing
>i Driveway
�I
vi I
al
3 I
a•
CLcla
y
0� I 1
I J � Existing Shop �
= i
Power ole I
I
I a 95'
I I —-—
-----7roper 'Line'----------
' I
! I Fire Hydrant(FH)
I i I
Scale: 1"=30'
I I I
I I I
i I I
i � I
MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow Property lines&dimension Slope of property
Street &street name(s) Existing building,structures L'tility &street light poles
Proposed work Existing curb or edge "frees
Existing S/W or of pavement Existing utility locations
D/u'apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 S\G I Tall R)hd. • 'Tigard,Orcgon 9?223 • www.tigard-or.gor 503-718-2421 • Page 4 of 4
`� Tigardo �
SW Vams St
D&H Greg LeA4ieu SW Parke�. Q 94 Fenno Park A.Fanno Park
SW Flagging Inc.
1621 SE Pardee St SW Hall Blvd and SW Bonita Rd Flagging/Detour Detail
Portland,OR 97202 ,
� + OJJ.(503)232-2488 11
Fax:(503)134-4571 _ - SW arnara"
flagging.com '• Pcats
greg@d-hChefry. �r 'co
♦ _� h
FRA.NF.1 FRAME 2''
D ..• on a7�� E- g6W00d-St- --�� Cn BONITA USE
Contractor.Granite Constmetion '- 'I CLOSED DURBAN PLAN NOT TO SCALE 929
p' l /' TiaH-Time�. T072ND V..��.�Q ..
Contact Person:Grant Youngren i Y I L
�r Phone:(360)831-5519 a� __ _
SA Email.grantyoungren[((iigcinc.com -
Job Location:Hwy 141 MP 5.56 to MP 5.73 A MP 6.32 to MP - { �,�
6.26 'y�
Tigard �• �1 'n _ F
Type of Work:Grind/Pave I• - A ,., I 92A
m Duration:Pending
Revised
Time Pending BOtlda
�,
Date:Pending —_"�— - ''
rte>� -t�►.SW �; *See p.6 for closure details `•..�SW B0 a Rd i -�� L" vita Rd
May Mautltam ►�"` �, a SW R}nebrno �� Ro coxa 1 I
M 9�20L1�7 D&H PLAN#A
5966-5, 4 _I t
� 72 SW-Murdock 5tONLY
'11
Burma
SW Bonita Rd and SW 72nd Ave Soft Closure Rro � !L
r� r— f 29 1
ROAD L_!_J
PCaLS �' d I 'tiIFRAME I �
WORa AME 2
LA 06 ¢
K�c y
_ r l
•Place PCMS board in advance SW Ashford
�� �� �■+ d HaRlrl(f
of RWA signs on SW Bonita
Rd. _- r
®� I�
M>
•PCMS to be In place 1 weekaowD ' �+ Q
it ocN.Accaa 1 Dsro�R .\ -
.� w ONLY ARCD prior to starting work. , CO6® ___.-J r�
3-
a—
sa An An SW Bonita Rd
A A /� /� A /'
CJ �J V V V e DRlYl1:R
.mates AveV I.- PRANE 1 FRAME
r y,_ y
? Q CLOSED qeDURBAN tROIR.-■ �................I
q v, � Timc-Time T072ND
LEGEND '
+i
I Type II Barricade 6
Type 111 Barrlade "' C 290 m
w� r_ --
•
l l 1 lARhtlll Parlt (D 0t
s� fisc
1CO. ar Dxhporn t
II t - _ d..t _ •. _ __..
Equipment List Granite Construction-
Dn5%6-1
NanD 6 Road Work Ahead
as 3 Be Prepared to Stop
3 Flagger Ahead
e 2 Lane Closed
1 1 Road Closed Ahead
Bas }i 1 Type 11 Barricades w/No Left
Tum
1 Type If Barricade w/Detour PLAN NOT TO SCALE
(Straight Arrow)
2 Type III Barricades
1 Type III Barricades w/Road
ero Closed
N
55 28"Cones
2 Flaggers
2 Lighting Stations
+t 3 PCMS Boards
—NOTES—
'Traffic c control devices shall not encroach Into the adjaceut lane.
Maintain 10'minimum lane width at all times.
Cone spadog-20'an(for speed[India less than 45aph).
SW Gree and Lo
Adjust to field conditions.
100'± AD traffic control shall adhere to current MUTCD guidelines.
aow Notify Tri-Met at least 48hn In advance W(503)9624949.
wawc
/*Adjust
ers to maintain high levels of visibility at Flaggen to maintain high levels of visibaity at all dace.
es.
}I Flagging nations to be I t when work is taking place at night.
9 actor to have traffic signals turned off whens are present(notify city in advance). covtnnor to have enmc ngons turned otrwhen mggen arc
resent(notify city/nate/county in advance)•
............... A flagging set up as needed. Notify residents in advance.
• noon
•• cLosm
t CLOSED
350'± �1
P SW Bonita Rd S
r �y
l�q O LeFr
?a)<7rLR
+1
t 8►a L' <
� . 50-100'T r a34 g � aN4
D61Or
a coo LEGEND
SW Pi•ebrook M
100'± 100'±4. '± Y Ja"a 38"Signa w/Flags
}i 28"Cones
sono
coli
� � Flogger
o s— l- Lighting Station
ono
100'4
SW rdocIsSt D&H Greg LeMieux
Flagging Inc.
1611 SE Pardee St
B•r Portland,OR 97201
e t
Off.(503)231-1488
an Fax:(503)234-4571
soli
3 aro greg@d-hJlagging.com
H ��Q�fOC)OZ1
D{C7 n Q(n T Contractor:Granite Construction
Bas M D—-n D Z T Contact Person:Grant Youngren
t }ei Cn n Z I-<n n Phone:(360)831-5529
M (7 r Q t:7 Email.granLyoungre�gcinacom
4 =Z{QC Z Job Location:Hay 141 MP 5.56 to MP 5.73&MP 6.32 to MP
- �� 6.16
Q = Tigard
ROn� T Q 1 Type ofWork:Grind/Pave
xKnD Duration:Pending
Time:Pending
Date:Pending
Revised
May 15,1017 D&H PLAN#5966-6