PFI2017-00223 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00223
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/10/2017
Parcel: SEG1396
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Bettinelli PFI
Project Description: Install power, gas, utilities, LIDA at 9795 SW Frewing
Owner: FEES
Description Date Amount
PFI Permit Fee 10/10/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
JEFF BETTINELLI
15685 SW 116TH AVE SUITE 290
TIGARD, OR 97224
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 parti s before beginning work.
Permittee/Applicant
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00223
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 Jonny Gish 971-713-0281 or Jonny@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 OCT 10 2017
�a PUBLIC WORKS —ENGINEERING
CITY OF TIWD
Public Facilityimprove, ment (PFI) F6P�fffNGINEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
1 ] TYPE 1—Franchise Utility Wk
one: x UtilitiesKSidewalk/driveway approach El Street improvements \ performed by NWN, PGE
Detailed description: IA157PLURhmr� 6-A5, I and/or utility-agency,.
t�/�_ X TYPE 2—Side«alk/Driveway/Sewer
Work performed for the purpose of
• Sidewalk installation or repair.
5 / y S� � ,` r Driveway approach installation
Property address location(s)• `� p� [T and/or repair
Sanitary sewer lateral installation
and/or main line tap
`� '� ❑ TYPE 3—Full scale Development
Applicant: T Work-performed with rand use
Address: C* v`t��� Q approval which includes any of
City/state: 1 6 Zip: �-�- the following
_ ��'' y,� .� �` r • Subdivisions or Partitions
Phone: � 41 J—U;-` Email:-.1 V Vl\,a�•y^r
- - Street widening
Contact name: �i!�% Phone: 5 v�V�
• Mainline installation for Sanitary
A al
sewer, Storm sewer, Tigard water
Contractor: ������ �ii�i�C�!) ����� � 1��.r g� -
and/or Tigard Water Sen-ice Area
CCB#: Q `7y1Z– Expiration:
1�� J \�►\t_- '�.i,l 1 C, [ SUBMIT COMPLETED APPLICATION TO:
Address:
Cit<•/state: `ti TQ Zip: 1.
City of Tigard
Planning/Engineering
Phone:51*
---z t -k,�3 `Email: N. Nti +
13125 SW Hall Blvd.
Contact name: ! Rj ash–_-_ Ai % -Phone: , Tigard,OR 97223
5�� 2,,0 G 04 applications for"minor work in r1ght-of-\x7ay"
�/ only max•be emailed to:
Engineer: �°k
ro"ermits(a_),,tigard-or goy
Address:
OR STAFF ITSE ONLY
City/state: Zip: P J7y T'
Phone: Email: Case No.: t-7 ��Z Z�
Contact name: Application submittal fee: 5
\ddidonal fees:
Estimated value of work is required(if over$05,000):S Application accepted:
(within the public right-of-wa),) Bir: Date: "0� I
Application reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes K No
Er. �;,5 �a� )ate: �� 1 7
.�
If so,please specify (I\II..P, SDR, SUB, etc.) case #:
Applicant no,�ified: IO
M Av
in
/� 6
Is work related to a BUILDING PERMIT? )c Yes ❑ No Bv: Date:
IL so,please specify(BUILDING PERMIT)case#:,1N&S"T 2.Cs1 1 r 0o Z- 1:\ENG\PermitApplications\pfi_application Rev.12/16/2016
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 w wtigard-or.am, 503-718-2421 Page 1 of 4
i
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TZZC 15.041.140.
* With the exception of a utilityoperating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different
rd or a lessee in possession with written authorization from the owner or an agent of the
people,the applicant must be the purchaser of reco
owner. The owner(s)must sign this application in the space pro-6ded or submit a urritten authorization v6th this application. Franchised
i
Utilities are not requircd to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• IThe above request does not violate any recorded deed restrictions that mai•be attached to or imposed upon the subject
ro erty.
• 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.
ppli*Ithorized Agent's signature Print name Date
SIGNA S of each o ner of the subject property, if required.
00,
l2
wner's e Print name Date
-wrier signature Print name Date
Owner's signature Print name Date
f
PUBLIC FACILITY IMPROVEMENT PERMIT
i
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-ongov 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STNFF USE ONLY
Public Facility Improvement(PFI)Permit: SUBMITTALDETAILED
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE 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 Rcview 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-, ill 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
(G sets,2406 or 22.134)
• Ditch cleaning that does not involve regrading.
F-1 Cover—Site,Vicinity,Abbreviation,Legend
• Weep hole repair
• 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 Quah",Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
ote: 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 seat/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 Dcsign(if applicable)
❑ Water Department Approval
.... -- --
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-ongov - 503-718-2421 Page-3 of 4
SAMPLE SKETCH:
I Edge of Pavement
'-- Ditch
Streetlight I .—.—.-----------C_ --
I Rin
' T" F-1-01)'os' cf�Se1rrei'Ltne"
N' '
Existing House
Existing '
(Lii I1
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IL I a�
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a .ti
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°' cam'
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0
• I Existing Shop 1
J i
. �
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-------- - 7 ------_---
.
ZD
Fire
Line
f 1
I
Fire Hydrant(FH)
1 i I
Scale: -1
� I
I I
I ( I I
MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable):
North arrow L`Property lines & dimension V Slope of property
Street &street name(s) Existing building, structures �`Utility &street light poles
Proposed Nvork Existing or edge e Trees
g
Existing S/W or Ll of pavement Existing utility-locations
D/W a ron
n
p t�/L. L-)z�X `�tui (sewe ,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
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QCs ht — Jeff@blackdiamondhomesinc.com ackdia fax
• �p�,�,r �a �^=�-�- Tigard OR 97224 Jeff@blackdiamondhomesinc.com Jeff@blackdiamondhomesinc.com �V
/� Address:9799 SW Frewing St.Tigard,Oregon 97223 Address:9795 SW Frewin St.Tigard,Oregon 97223 North
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HIGH DENSITY JUTE OR
6" MIN COCONUT MATTING
FREEBOARD
OVERFLOW TO 3:1 (H:V) MAXIMUM SLOPE
CONVEYANCE. MAINTAIN
MAXIMUM LINEAR
SEPARATION FROM ALL
STORM INFLOW POINTS ,
q _ _
=1i1iil- li—lil--
_ _ <c - 11=!I El 11-1 1=1 I I 1 MIN
=1 11=1 I -III-1 l 1-
M i Ifi
1=1 I I-1 11=1 I I-1 I I i 1 i__ -!i i-!►!-iTl-!I!=tom
-III=1 I El 11=11 I-)i 1_1 I I-111- 111- I I i-I I I-I i 1=111-I I I 18" MIN GROWING MEDIUM
I=1I11=1 11=111=1 I=111 I I 1=1 11=1 I- _I 11 111-III-III-III-I I I-111=1 11=1 1 751
;I I I i I I IF,:j 111=111=1 11=III-1 i i-1 11=1 i 1=1 11-I 11�11111=1 11=III= 3„ DEEP 3
-1 l I=1 I I-III_111 =111=111=l I El 11- -111- ( /4' - 1/4")
/\j CLEAN CRUSHED DRAIN ROCK
DEEP (1-1/2" — 3/4")
Vf CRUSHED DRAIN ROCK
Z,IOVERFLOW TO
\ \ \ \ \ \
CONVEYANCE
NATIVE
SUBGRADE
NON—WOVEN GEOTEXTILE
FILTER FABRIC
NOTES:
1. PUBLIC WATER QUALITY AND/OR QUANTITY SYSTEM
2. PROVIDE OVERFLOW CONVEYANCE SYSTEM, OVERFLOW CONVEYANCE HEIGHT TO ALLOW 6" MAXIMUM
PONDING, PIPING TO A MINIMUM OF THE PLUMBING CODE OR CONVEY THE 25 YEAR STORM.
3. IF USING THE NATIVE SOIL INFILTRATION FOR SIZING, THE RATE SHALL BE DETERMINED BY ASTM
STANDARD TESTING METHODS.
4. FLOW DISSIPATORS SHOULD BE USED IF ENTRY SLOPE TO THE BASIN IS GREATER THAN 3:1, FLOW
DISSIPATORS SHALL BE CONSTRUCTED OUT OF ROCK OR GRAVEL PER DESIGN FLOW VELOCITY AT
ENTRY OF THE FACILITY.
5. TREATMENT AREA SHALL HAVE HIGH DENSITY JUTE OR COCONUT MATTING OVER 18" MINIMUM OF
GROWING MEDIUM OR BASE STABILIZATION METHOD AS APPROVED BY THE DISTRICT.
6. VEGETATION TO BE USED IN WET AREAS OF THE BASIN IS PER APPENDIX "A" OF R&0 07-20 FOR
THE WET MOISTURE CONDITIONS.
7. VEGETATION TO BE USED IN OTHER AREAS OF BASIN CONFORMS TO PLANT LIST OF THIS HANDBOOK
AS APPROVED BY DISTRICT.
NON—STRUCTURAL LI D A
PLANTER/RAIN GARDEN HANDBOOK CleanWater Services
DRAWING N0. 797 REVISED 05-16
cleanwater'� Services Low Impact Development Approaches Handbook
EXISTING DRIVEWAY —
MATCH WIDTH & GRADE
A
R/W LINE
6„ SEE NOTE 3
SEE NOTE 4
5' MIN 2% SIDEWALK
SEE
LANDSCAPE SEE NOTE 2 NOTE 3 LANDSCAPE
STRIP STRIP
A
30' MAX
3, 3,
10' MIN
PLAN RAW
3/4" PROJECTED TOP
OF CURB 2% MAX
tla
e
STREET
o .
t i r
° r, o`�� SEE NOTE N0. 4
I-_IIIT
2" OF AGGREGATE
SECTION A—A (3/4"-0") COMPACTED
NOTES:
1. CONCRETE COMPRESSIVE STRENGTH SHALL BE A MINUMUM OF 3000 PSI AFTER 28 DAYS.
2. CURB JOINT SHALL BE TROWELED WITH A MIN 1/2" RADIUS ALONG BACK OF CURB.
3. EXPANSION & CONTRACTION JOINTS SHALL BE 1/2" PREMQLDED ASPHALT IMPREGNATED
MATERIAL OR EQUAL EXTENDING FROM SUBGRADE TO FINISH GRADE.
4. DEFORMED #3 REBAR AT 12" EACH WAY. PLACE 3" CLEAR OF AGGREGATE. TIE ALL BARS.
(FOR COMMERCIAL DIRVEWAYS ONLY)
APPROVED BY:
CITY()F TIG:11tll NO SCALE
ORFt;()N' LORE FAHA, P.E. COMMERCIAL
W4 ENGINEERING DIVISION
PUBLIC WORKS DEPARTMENT' CITY ENGINEER DwG. NO.
HG .HALT.BUM.BUM. 143
'1'1ARDRD,OItI:GON97223 FEBRUARY 2016 DRIVEWAY
fi VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE