PFI2017-00218 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00218
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/12/2017
Parcel: SEG2278
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Summerfield Tree Removal PFI
Project Description: Removal of street trees, temp lane closures 10/18-10/19 8am-4pm
Owner: FEES
Description Date Amount
PFI Permit Fee 10/12/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
ANNEMARIE CHRISMAN
6795 SW 111 TH AVE
BEAVERTON, OR 97008
PHONE: 503-701-9231
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
Signature: [ ��
Issued By:
VT
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00218
Type: Condition Name: Status: Severity:
PFI—Street Imp 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—Street Imp 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_Street Imp 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_Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours(min.)before initiation of construction work.
PFI—Street Imp 11 -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_Street Imp 12-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—Street Imp 13-DRAINAGE CONTROL Applied Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI—Street Imp 14-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—Street Imp 15- 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_Street Imp 16-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—Street Imp 17-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_Street Imp 18-SEWER SYSTEM TEST Applied Notice
A sewer system air-test and/or DVD T.V. test report and one set of"As-Builts"shall be provided for review and approval.
PFI_Street Imp 19-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_Street Imp 20-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.
PFI_Street Imp 21 -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_Street Imp 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI_Street Imp 23-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Street Imp 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice
The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Street Imp 25-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—Street
hanges.PFI_Street Imp 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI_Street Imp 27-PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI—Street Imp 28-AS-BUILT DRAWING Applied Notice
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
PFI_Street Imp 29-PRIVATE WATER QUALITY FACILITY Applied Notice
The Developer shall maintain the water quality facility and correct any defective work, and shall perform all scheduled
maintenance to assure proper functioning of the facility.
PFI_Street Imp 30-PUBLIC WATER QUALITY FACILITY Applied Notice
The Developer shall create and provide to the City a schedule for periodic(quarterly)maintenance of the water quality
facility. The Developer shall maintain said facility for a period of three(3)years from the date of City Conditional
Acceptance of the public improvements. On October 1 st of each year during this three(3)years period, the Developer shall
report, in writing, maintenance activities to the Director of Public Works. City crews should monitor proper removal and
disposal of silt and debris. Prior to City final acceptance of the facility, the Developer shall provide a written evaluation of the
operation and maintenance needs of the facility and correct any deficiencies identified in the evaluation.
PFI—Street Imp 31 -OTHER Applied Notice
RECEIVED
City of Tigard OCT 0 4 2017
PUBLIC WORKS — ENGINEERING
� CITY OF TIGARD
. . 1mprovement
'°'"6 ` "NGINEERING
Pubhc Facility (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑Sidewalk/driveway approach Ntreetimprovementsperformed by NWN, PGE
Detailed description:S t g&A 14 ekgA +rfA.S
and/or utility agency.
f STYPE 2—Sidewalk/Driveway/Sewer
+ L AYE Work performed for the purpose of:
• Sidewalk installation or repair.
Property address/location(s): I �j4t;' �'rN rr�L:� •C � • Driveway approach installation
<<,, _ and/or repair
r 1 0 1 v4 � �' , nwl OC c� •o Sanitary sewer lateral installation
L2'1 and/or main line tap
Applicant: �� -��'�'� lvrec �5ezr'`,`C ❑ TYPE 3—Full scale Development
/, Work performed with Land use
Address: (JQ!� SVJ th V,�• approval which includes any of
City/state: "�3 0—Ck-VC(-k 0A D R Zip: 9 100i5 the following:
Phone: 0 101`q l-:3! Email: Cal Cir\f' -.e • Subdivisions or Partitions
• Street widening
Contact name: NU&Af;e v\ Phone: 503__7 Gni 2 31
• Mainline installation for Sanitary
Contractor: G&�k-(-f-<< 1-re e y;( sewer, Storm sewer,Tigard water
CCB#: 3("C qand/or Tigard Water Service Area
Expiration: 11 6
Address: j q-5 —15w, M t ti Au e. SUBMU COMPLETM APPLICATION TO:
City/state: O VN Zip: 01 joos� City of Tigard
Phone:15;03'" O i-G 231 Email: 01. C k�-;5VVUA✓1 �eV1� Planning/Engineering
13125 SW Hall Blvd.
Contact name: L C. r15wttivl Phone:��- 10 i'Ci
731 Tigard,OR 97223
Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: im��
an_.ris�ard- gQg
Address:
City/state: Zip: mmm� i
Phone: Email: Case No.: � FJ?ZI I — 0 0219
Contact name: Application submittal fee: $
Additional fees:S
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By: �Y' 6 Date: 1011
e
;rZrff...-.
Is work related to a LAND-USE DECISION? [IApplid:
Yes No By:
If so,please specify (MLP,SDR,SUB,etc.) case#: Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes j 7 No By: -S Date: l v
If so,please specify(BUILDING PERMIT)case#: I:\ENG\PerrMAppiutions\pfi_ipplicgion Rev.12/16/2016
r
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.
* With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different
people,the applicant must be the purchaser of record or a Icssce in possession with written authorization from the owner 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 obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
propemT.
• 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.
VLAQ-k >a L 311�r;S1 �1 vt G
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 Sht'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 2 of 4
Lane closure areas for tree removals at Summerfield Civic Association 10650 SW Summerfield Dr.
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Sam-4pm
Lane Closure Areas 10/19
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Lane Closure Areas 10/18
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Lane Closure Areas 10/19
Eauitsment List
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Flagging Inc.
1621 JE Pandee Si
Portland.OR 97202
Off:(503)232-2488
Fax (503)234-4572
greg�i d-ttllagging.com
Contractor:General Tree Service
Contact Pen.on:Anne-Marie Chrisman
Phone:(503)701-9231 -tYOTtiS—
Email:a.chri.ananrgenerallree.conr nMc control devices shall not encroach into the adjacent lane.
Joh Location:SW Summerfield Dr and Sµ'Alderhmok-
Highland Dr Maintain 10'mlaimum lane width at all titles.
Tigard
Type o i{oak:Tire Wort Cone spavin;-20'max(for speed limits less that ISmph).
"1e LEGEND
Duration:2 Days Adjust a field rn11Ai1iots.
Time:Sam-4pm
Date:Oct 18-19 PATI tralf c control shelf adhere to current Mt1TCD tuidelites
� 4X-%JA-$I=lls w/Fixes
�NellQ residems in advatce.
Oete)her 2.201' D&H PLAN#6453-1 Dr Cotes
Eauiament List
7 Road Work Ahead
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Flagging Inc.
1621 SE Pardee St 6
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Portland.OR 97202 •
Off.(303)132-2488
Fax:(5031234-4572
greg@d-hpagging.com
Contractor.General Tree Sendce
Cantaet Pervon:.4nne-Marie Chrivman
Phone:(303)701-9231 r— - —NOTES—
Email.a.chrismanCa eneraltree.eom
Joh Location:SWSummerfield Dr and SIV AIderhrook- i'frrfiic control deices shall all encroach info the adjacent lane.
Highland Dr �Nfairlain fY'minim at lane width at all flmes.
Tigard
Type of Work:Tree Work Come spacirr-211'ms(W speed Iimih Irss than JSlrphl.
Duration:2 Dgvv LEGEND
Time:Sam-4pm Adjrsr to Gem cordkioas.
Date:Ou 18-19 *All fraffk'control shall adhereto curreal NIUTCD leridelines
M"%411'Signs w/Flaks
October 2.2017 D&H PLAN#6453-2 ,'Nodfv resicknts In advance' 2N^Conn.
Eaniament List
4 Road Work Ahead
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Flagging Inc. .yJ
"""'"'•'�'"""� M2 SF.Pardee St
Portland.OR 97202 •
0 (503)13:-:488
Fax:0113)234-457:
greg_Rd-hJlagging.com
Contractor.General Trer Senvre
Omiuct Person:Anna-Alarie Chrivmun
Phone:(503)T01-9231 —NOTF-S—
Email:a.chrisman(ageneruhree.cam
Jolt Lowation:SW Summrtfirld Or and SIV AIderhroek_ TraDie restr•l devices shall not encroach int•the adjacent lace.
Highland Dr hlalnlaln 111'minimum Use width at all times.
Tigard
Typr of lf'ork:Tree Werk Cane spaatina-20'moa(tor speed limits less than 45mph).
Durarinn:2 Days
Time:Sam-4pm Adjust to ReW e•ndni•as LEGEND
Dare.Oct 18-19 A9 traffic control shall adhere to surreal kl"CD Caiddines 1x"\J6-Siena w/Flays
Ocreher Z 201' Ddb 11 PLAN#6453-3 N•db•residents in advance.
• 2l1-cont,
—NOTFS—
Traffic control devices shall not encroach into the adjacent lane.
Maintain le'mininnnl lane IS idth al all times.
1
'Cone spacing=20'ms%(for speed limits less than 4.,raph)•
'A'ust to field eondilions.
All traffic control shall adhere to current A1tiT'['D Usidetines. ;
PLAN,W'1 f.1ti('.iLF. ngFTaers to maintain high levels of vlsdsllity at all times.
Flagging stations to he lit N►en work is taking place at night.
ui NA Notify residents in advance.
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Flagging Inc. Nf1kN
No....w,a Frrnw 1621 SE Paul ce St wr:.us
Portland.OR 97202
Off:(503)232-2488
Fax:(503)234-4572
gregC d-hAagging.com
Contractor:General Tree Service
Contac!Person:Anne-Alarie Chrisman
Phone:(503)701-9231
Email.•a.chrismortt"agenerultr're.com
!oh Location:SK'Summerfteld Dr and SIV Alderbrook-
Highland Dr
Tigard LEGEND
Type of Work:Tree Work
Duration:2 Days
Y 4a"\ltt Signs Nl Flays
Time:8am-4pm
Date:Oct.18-19 . 2N»Cones
•
October 2.2017 D&If PLAN#64534 Flagger
LEGEND
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�— - - _NOTES— `
• Traffic control derkes shag not encroach into the adjacent lane.'.
•
t• hlalmaia 10'mininun Lane w idth at all tlmn.
•
• S Co•e spaeine=211'mas(for speed limits less than 45mph)
• S adjust to field conditions.
•
• All traffic control shall adhere to current NIUTCD guidelines.
3— • �Se-11N►'TM r Flaggers to maintain high It%els of sisiltill)at so times.
SU Summerfield Un • '
b Olilagtilng stations to he lit%hen nark is takio
@4
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� Summerfield Ln and SW Alderbrook Notify residents in adrance.
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D&Il Greg LeMieua'
Y woaF Flagging Inc.
\tlMl.\D "IN•n�w.M 6w1..+: 1621 SF.Pardee St
Portland.OR 97202
Off:(503)232-1088
Fax,(503).134-4572
greg a d•hflaggrrig.com
Contractor:General Tree Service
Contact Person:Anne-Marle Chrisman
Phone:(503)701-9331
Email:a.chrismaWn-generahree.com
F(Juiotnent List Joh Location:.SIV Summerfield Dr and SIV Alderhrook-
Highland Dr
6 Road Work Ahead Tigard
4 Be Prepared to Stop Type of WorA:Tree Work
5 Flagger Ahead Duration:2 Days
Time:8am4pm
20 28"Cones Date:Oct.18-19
2 Flaggers
Octaber 2.2017 D&H PLAN#6453-5
NOTES—
"Traffic control devices shall am encroach into the adjacent lane.;
111.1alatain Is miaimmus lane width at all times.
y Cone spaei.r-20'max f for speed limits leas than 44mphl.
i
1 Adjust to field conditions.
i I
All traffic control shall adhere N current Mt`TCD guidelines.
Mu.W W I.\n
woar: N\lml( FlalLws to maintain high levels of visiMlih at all times.
utt:\ Nur st I
FLAN NOT TO SCALE v FlagonIt stations to he lit when work is taking place at might.
wtut
tea, 4 +1 Notify residents in advance.
a�4 � asp
+1 a 3 S s
IT v •Flagger to control traffic at SW Alderbrook p
��I 111111 111 PI and SW Alderbrook Dr. b 6
+I +1 nF: ro.ut
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D&H Greg LeMierux
Flogging Inc.
rfl crtl •N•""�'"iiiid li•t•"• 1621 SE Pardee St
Portland.OR 972112
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Off.(503)232-2188
¢ ut nn a Fax:15031 234-4572
SW Summerfield Ln
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Contractor.General Tree Service
a Contact Person:Rinne-Marie Chricman
g Phune.(503)701-9231
Email:a.chrisman(ageneraltree.com
Joh Location:SIVSummerfield Dr and.SW Alderhruok-
F:gulpment List Highland Dr
h LEGEND TiRard
7 Road Work Ahead Type of Work.Tree Rork
4 Be Prepared to Stop Y Duration:2 Days
6 Flagger Ahead Time:Rom-Jpm
Ti
ebaes Date:Oct.18-19
20 28"Cones
3 Flm Flaggcr
ggers October 2.2017 D&H PLAN#6053-6