PFI2017-00139 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00139
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/03/2017
Parcel: SEG1883
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Geo Pacific Engineering, Inc.
Project Description: Evaluation of existing roadway section by extraction of three six-inch-diameter road cores from the
eastbound lane of SW Bull Mountain Road
Owner: FEES
Description Date Amount
PFI Permit Fee 08/03/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MIKE BAKER
PHONE: 503-598-8445
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 See application
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00139
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. Contact Mike White at 503.804.0658 or mikew@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
RECEIVED
City of Tigard JUL 312017
_ a PUBLIC WORKS— ENGINEERING CITY OF TIGARD
. ,
Public Facility Improvemen"Vermit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
„ • '° TYPE 1-Franchise Utility Work
Check one: p. ilities .1 idewalk/driveway approach Lreet improvements perfonued by N WN, PGE
and/or utility dWMY.
Detailed description: vk f 44+h s^ of Gs
x� '3R#;2 1 /'oa01 ww,, „ TYPE 2-Sidewalk/Driveway/Sewer
`Zf�u» b �c11r.��ho:, 01� f+<j_�Ct �•.�ih �+yM�+ r
-�- ---- - Work performed for the purpose of:
/'ypJ 1v�t s t�ri.+. > _ _&sk b+�.�.( S L4/ /3+.0 M4 Midewallc installation or repair.
Property address/location(s): _ J-_1.11.3& __ Qh y,
SW M 11_� ,h { riveway approach installation
and/or repair
/Zara T tir i� Q2 l+ itary setter lateral installation
and/or main lune tap
G1 1 T YPE 3-Full scale Development
Applicant: &eo PR t-i'15.L r 'r Work perfonned with Land use
Address: /`7 SS S S W A n d( A.r e- approval which inchides any of
City/state: Po r f/•..•4 D 2 Zip: the following:
Phos e S`1K `I`I S _ Email: b a (S cr ��t—o 4 r ' t-� c bdivisions or Partitions
Mtreet
Contact name: /A4 �� r33>~ k e!”. Phone: -15 L d-f - -Y'0&'0 �+ inlinne n&'o widen
in ung
stallation for Sanitary
Contractor: .is sewer, Storm sewer,Tigard water
and/or Tigard Water Service Area
CCB# : Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: — Tigard,OR 97223
Applications for"rotor work hi right-0f-way"
Engineer: only maybe emailed to:
Address: 1X965 �J 1� A Q Ok.A S�+ rotvpcnnitss-ktjuaid- r.got
S �� k
City/state: - F,4 k I k fi:. O t'k Zip: 9)o&
Phone: 5-111 $7.1 6157 Email: A e,. Q C,,k S ~e-v coati Caw No.:
Contact name: A le, /'f141-ft V Application submittal fee:
Additional fees:$
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By:—,-,S—Date: 3/
Is work related to a LAND-USE DECISION? Ms
Application reviewed: is/Z -
If
L) Date: 17f K C-so,please specify(MLP, SDR,SUB,etc.)case#: BY: �(
Applicant notified:
Is work related to a BUILDING PERMIT? t3 3 By:—/::�, --Date: I
If so,please specify(BUILDING PEFAUT)case#:
El City of Tigard `° 13125 SW Hall Blvd. M. igard,Oregon 97223 l8 vwwtigard-or.gov 9603-718-2421 h age 1 of 4
i
APPLICANTS
N OTE: 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 operatutg pursuant to a valid franchise with the City of Tigard,wfien the owner and the applicant are different
people,the applicant must be the purchaser of record or a lessee in possession with mitten authorization from the owarer or an agent of the
owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtavn the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY"THAT:
E he above rgquest does not violate any recorded deed restrictions that ma),be attached to or imposed upon the subjggl
propp .
Elf 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.
Dll of the above statements mud the statements in any plot plan,attachments,and exhibits transmitted herewith,arc 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.
^y he applicant has read the entire contents of the application,including the policies and criteria,mid understands the
requirements for approving or denying the application.
U-0
#64d 7 /L I, ti 4.c T 13
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 19113125 SW Hall Blvd. ETigard,Oregon 97223 ty vwrvtigard-or.gov w 3-718-2421 image 2 of 4
14835 SW 72nd Avenue SITE AERIAL AND PROPOSED
[G-6-0YP40%-Ct1IC Portland,Oregon 97224
Tel: (503) 598-8445 Fax: (503)941-9281 ROAD CORE LOCATIONS
RC-2 RC-3
\N Bull Mountain
-...
to
1 SVV Bull Mountain ' • . •
.40
144s
99
North
Legend Date: 7.26.2017
RC-1 Road Core Designation 0 300' Drawn by: MTB
and Approiamate Location Site Boundary
APPROXIMATE SCALE 1"=300-
Project:
—300'Project: Bull Mountain Heights Phase 3 Project No. 17-4666 FIGURE 1
Tigard, Oregon
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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September 2016 Chapter 5