PFI2018-00064 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00064
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/14/2018
Parcel: SEG3880
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: SEG3880, SEG3881, SEG3882. Segment of Bull Mountain between Roy Rogers and 164th. Installing
1232' of 6"poly, 102'of 4"poly and 77'of 2"poly main. Our work is due to the Bull mountain
Roundabout project. Work order project#201742.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
JENNIFER WOOD
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
Tota 1 $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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00064
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.
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
City of Tigard RECEIVED
PUBLIC WORKS — ENGINE17MING MAR 12 2018
ZI AIGARD
Public FacilityImprovement (PFI) V&t"GINEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-sway) ❑ TYPE 1–Franchise Utility Work
Check one: 0 Utilities ❑Sidewalk/driveway approach ® Strectunprovements performed by N%VN, PGE
Detailed description: installing 1232'of 6"poly, 102'of 4"poly and 77'of 2" and/or utility agency.
poly main. Our work is due to the Bull Mountain Roundabout project. ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
Work order project#201742.
- Sidewalk installation or repair.
• Driveway approach installation
Property address/locations : SW Bull Mountain Rd
I t}' ( ) and/or repair
Between Roy Rogers Rd and SW 164th Ave • Sanitary sewer lateral installation
3& and/or main line tap
NW Natural ❑ TYPE 3—Full scale Development
Applicant: Work performed with Land use
Address: 220 NW 2nd Ave approval which includes any of
City/state: Portland OR %ip: 97209 the following:
Phone: 503-226-4211 email: Jaw@nwnaturai.com - Subdivisions or Partitions
Contact name: Jennifer Wood Phone: 503-226-4211 - Street widening
• Nfainhine installation for Sanitary
Contractor:
NW Natural sewer, Storm sewer, Tigard water
and/or Tigard Water Service:area
CCB#: Expiration:
Address: 220 NW 2nd Ave SUBMIT COMPLETED APPLICATION TO:
City/state: Portland OR Lip: 97209 City of Tigard
503-226-4211 jaw@nwnatural.com Planning/Engineering
Phone: Email: 1 @ 13125 SW Hall Blvd.
Contact name: Jennifer Wood Phone: 503-226-4211 Tigard,OR 97223
Applications for"minor work in right-of-way"
only nlay lac emailed to:
Engineer: ro3NTerinits u,tigard-or.gov
Address:
FOR STAFF USE ONLY
City/state: Zip:
Phone: Email: Case No.:
f
m -oo06q
Contact name: Application submittal fee(.007%of
Engineer's Estimate)
Estimated value of work is requited(if over$5,000):5 4,000 ,Additional fees: $
(within the public right-of-way) Application accepted: .� p
�`�� _
Is work related to a LAND-
USE DECISION.? ❑ Yes ❑ No By: Date:
If so, please specify (MLP,SDR, SUB, etc.) case #: Application reviewed:
By: V _Date:
Is work related to a BUILDING PERMIT? ❑ Yes 0 No Applicant notified:
If so,please specify(BUII.,DING PERMI"l)case#: By: S C Date:
1:\ENGVennitApplicatlons\pfi application Rev.10/16/2017
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City ofTigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwxv 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 lessee 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
ro er
• 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 ani,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 theap lication.
Jennifer Wood 319/18
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
CityofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page Z of4
ROAD Legend K8�D as the preparer of this CUSTOMER: .invarion.com
w°RK -I r
AREA traffic control plan makes no NW Natural
representation as to its general CONTACT:
500' 1 Cone adequacy or being approved Kirk 4211Bentxhl
Spacing + for implementation.
503-226-4211 x.2964
CW20-1 road work ahead Approval must result from the LOCATION: Bull Mountain Rd
LEFT Traffic Engineer or other public TURRLANE L55y O CW20-7b be prepared to stop g p and Roy rogers Rd
CLOSE❑
500' t
official having statutory Bull Mountain OR
Spacing I Flagger enforcement authority in the NOT TO SCALE DATE: W/O#
jurisdiction.Utilization and
cn Left Turn Lane Closed Ahead implementation of this plan 1/10118 201742
RF shall be as a result of DRAWN BY:
PREPARE°
o 0 Right Turn Lane Closed Ahead that approval. ALAN WARD
500' Ref.MUTC D 2009 6A-01(10). -�
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WA 010434
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PHONE503-72-8750 87
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♦ Cover Stop Signs �'
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4 Bull Mountain Rd 11.■ �-- - - - - - ------- -- so.on—}
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AND PROVIDE A COPY OF THE APPROVED
Spacing TRAFFIC CONTROL PLAN
(n ••T, Notes:
n Inventory 1. Maintain ped.access to and
X through crosswalks
'` 500' 5 Road Work Ahead 2. Maintain Min.10'lanes
om Spacing 1 Left Turn Lane Closed Ahead 3. Maintain local access
° ° 4. Notify Transit authority at least 48 hrs.of
TO STOP 1 Right Turn Lane Closed Ahead bus stop closure
CL M500' S BePrepared To Stop 5. Traffic control plan and all devices shall
e pp
Spacing comply with MUTCD, ATSSA and OTTCH
6 Flagger Ahead 6. Notify Fire/EMS,EPD and LTD
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48 hrs before beginning work
7 F I a a rs
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Spacing 40 Cones work begins
ROAD 8. Adjust to field conditions
WORK 2 Stop Sign Covers
AREA
CUSTOMER: KSD as the preparer of this www.invarion.com
NW Natural Legend traffic control plan makes no
CONTACT: representation as to its general
Kirk Bentdahl , Cone adequacy or being approved
503-226-4211 x.2964 for implementation.
CW20-1 road work ahead
LOCATION: Bull Mountain Rd Approval must result from the
and Roy rogers Rd O CW20-7b be prepared to stop Traffic Engineer or other public
Bull Mountain OR official having statutory
Flagger enforcement authority in the NOT TO SCALE
DATE: W/O# jurisdiction.Utilization and
1/10/18 201742 Left Turn Lane Closed Ahead implementation of this plan
DRAWN BY: shall be as a result of
ALAN WARD Right Turn Lane Closed Ahead that approval.
Ref.MUTCD 2009 6A-01(10).
KAD ecwvioc■ OR 05377 W20-7a --
TwA rno MANA NzmT
PHONE.503723-7287 WA 010434
FAX 5037238750 ORTCP@kndservices.net ®Work Area
Page 2
ROAD
WORK >
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350'
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@ 503-723-7287 72 HOURS IN ADVANCE
AND PROVIDE A COPY OF THE APPROVED
TRAFFIC CONTROL PLAN CO
Notes:
Inventory Maintain ped.access to and
through crosswalks
5 Road Work Ahead 2. Maintain Min.10'lanes
3. Maintain local access
1 Left Turn Lane Closed Ahead 4. Notify Transit authority at least 48hrs.of
1 Right Turn Lane Closed Ahead bus stop closure
5. Traffic control plan and all devices shall
5 Be Prepared To Stop comply with MUTCD, ATSSA and OTTCH
6 Fla er Ahead 6. Notify Fire/EMS,EPD and LTD
gg 48 hrs before beginning work
7 Flaggers 7. Place No Parking signs 48 hours before
4work begins
0 Cones
8. Adjust to field conditions
2 Stop Sign Covers �'-
Samuel Copelan
From: Wood, Jennifer <Jennifer.Wood@nwnatural.com>
Sent: Monday, March 12, 2018 8:54 AM
To: ROW Permits
Subject: RE: Permit Request - SW Bull Mountain Rd, Tigard - WO # 201742
Attachments: Public Facility Improvement Permit Application.pdf; Sketch 201742.pdf; TCP - 2
pages.pdf
Hello,
I wanted to include our method of construction since I finally received word on it. This job will be joint
trench and open path most of the way. We will dig for tie ins.
Thanks,
Jennifer Wood Technical Coordinator
Engineering Department
NW Natural
503-226-4211, Ext. 4317
Fax: 503-273-4822
jaw(EDnwnatural.com
From: Wood, Jennifer
Sent: Friday, March 09, 2018 3:25 PM
To: ROWpermits@tigard-or.gov
Subject: Permit Request - SW Bull Mountain Rd, Tigard - WO # 201742
Hello,
am applying for a right of way permit. Please let me know if you have any questions.
Thanks,
Jennifer Wood Technical Coordinator
Engineering Department
NW Natural
503-226-4211, Ext. 4317
Fax: 503-273-4822
iaw@nwnatural.com
i
CROSS SECTIONS GENERAL NOTES N
50, 1.Call the following Utilities Notification Center
48 hours prior to any excavation:
Oregon:811 or 1-800-332-2334 W E
15' 10, 0.0, 10, 15' Washington:811 or 1-800423-5555
_JJ 2.ATTENTION:Oregon law requires}'ou to follow
d -o N C vt d rules adopted by the Oregon Utility Notification S
W L B 0 v 0 Center.Those rules are set forth in OAR 952-00 1-
B
E IX W tY LIJ E 0090.You maN obtain copies of the rules by calling
the center.(Note:the telephone number for the Oregon
of Utilitt Notification Center is(503)232-1987 or 811)
--*0 .
20' 0 3.Fill out construction sketch as-built supplied with
job packet and return with"ork order.On1N one
as-built is required.
SIS SW BULL MOUNTAIN RD N/S 4 All distribution mains must ha%e a minimum depth of
24"and sen ices must have a minimum depth of 18"
unless there is an approved variance.
5.All transmission lines must have a minimum depth of
30"in Class'1'locations and 36"in Class'2.3,&4'
locations,unless there is an approved variance.
VARIANCE S 6.Written dimensions on this construction sketch
vadaoc.(s)mad. hate precedence over scaled dimensions.
7.Pressure test shall be tested in accordance"ith
Rwson(s)_
standards in CFM and Engineering Standard Practice. x
8.Test medium for class"B"main shall be air,unless I INSTALL:
Milipe<ian<ak.n(Beryl. otherwise noted.Test medium for class"C-F"main w I i y- I l 0 LW
shall be water,unless otherwise noted.
9 For Class C or higher tests,see Design Document and x O I� 10EAS. INSTALL:
App—t Name SV,*_. art
u: Hvdrostatic Repo . I '
2 ROCKHAMPTON LN O LW
Class"B"PRESSURE TEST INFORMATION(circle&label test area on as-built drawing) x } I i°os4' r�")00 (� ADELAIDEN A
Test by NNG—Other N I 7s o z I 232 231
Ar.a St. ►.N Feolap. haws. Dat.
ON T11.. Dal. OFF TMr" YIN Gable a ntnt N""ealW IHY I I I 6"(W)'00 1 INSTALL:
XI
48' R LIEF
2 178 0 TF W/LW&TL
A I U) 4Z #R2 V8 242 241 236
NN I TRACT
aC.TT
S—
P` N
0 1#Anode
B 4-(P)'oo +02
23 �t��24Q 9 238 237 235 4
234 233 I 185 183 182R/ GE
C 13' 181 180 179
D =wnsgx,*� " It 8(P
6.T) .
— — TI
ED
—1 �1rz.(WrsEF SW BULL MOUNTAIN RD.
tr I I" r P'o i T
WELDS 0 FUSE TO NEW 6"(P) 1+00 0+75 _
,
%X- CERT. OPER. PM PM r
FOOTAGE SIZE M P GRADE W.T- RAYED MAOP MAOP NDP ACTIVITY# ORDER# INSTALL.
INSTALL 77' 2" P B P24 .216 60 57 45 114 03529496 J41 0 LW INSTALL:�
F O LW
INSTALL 102' 4" P B P24 .391 60 57 45 114 03529495 s �' e, 1#Anode
INSTALL 1232' 6" P B P24 .576 60 57 45 114 03529467
ABAN 134' 4" P B
ABAN 1096'4 1/2" W B
6� NW Natural ° 50 '°°
Feet
Engineering Department 1 in=100 ft
ADDRESS CtrY COUNTY STATE DESIGNED KDB DATE 01/11/2018
SW BULL MOUNTAIN RD TIGARD WASHINGTON OR DRAwN KDC DATE 01/16/201
BETWEEN AND
APPROVED R2G DATE 03/06/201
SW ROY ROGERS RD SW 164TH AVE
NAME CREW LDR. DATE
BULL MOUNTAIN RD ROUNDABOUT PLATTED DATE
PUT TWN RNG SEC PIPELINE ID- JOB TYPE:
1-045-012 T02S R01W NE 7 PUBLIC WORK MAINS
PM M: PROJECTIREVISIONN
1-045-013 T02S R01 W NW B 103529467 201742