PFI2018-00208 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00208
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/07/2018
Parcel: SEG1703
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural
Project Description: Install 7' of 1"(p)service prior to new driveway being installed for future 2 home development. One(1)
4'x5'street cut. R00022226.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
LORENE NICHOLS
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
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.
PermitteelApplicant (fin ? n ,
Signature: �� �u i LL( � U IV
Issued By: �.IG
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00208
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
RECEIVED
City ofTigard AUG 0 6 2018
PL.'BI:,1 C.: \ 't.)I�I — :Iw NCil:i�ll ; "s;f;�.
IT f
, RD
,E �.
�
�L blip Facffity Improvement (PFPI-)��'�`���q�.� t.��;1N G
iA
TYPE OF NVORK
DESCRIPTION OF WORK (in the right-of-xvay)
� TYPE 1—f'rctncllise L.'cilitA- \C-ork
C;l,cc 1.cn1c: 0 t. tilit.ies El5idc° ,tll:;"clri�c��.t� :tpprc>ttc:h tree t iml7rc;)t-cme_nts c rtortned be NWN, 1'C:;I:i:
Dctailcd description: install 7' of 1"(p) service prior to new and%or ut111n .t cticl.
driveway being installed for future 2 home development ❑ TYPE 2- idett,llk I7rivcut�lSc�scr
\Vork perforrnc:d for the purpc:)sc of:
1 4x5 street cut/R00022226
° '.idcwalk ins-,allat1011 or repair.
14135 SW 93rd Ave Tigard OR • Dnk.-c"G-ay approach Inst illation
l�tc�I7t.z'tt' ciclt'es %lc>catiiatt(s}. 9 and/or repair
Sanitary sewer latcral Installation
and/car main Linc Lip
NW Natural
EJ TYPE 3-Full sc.ile Dcvc1opment
!AI�plicartt: Work performed%vith Land List•
220 NW 2nd Ave apl�rrw.a which irtclttdes:a-nv r.,,l
C; Ct','sttte: Portland OR Zip: 97209 the following:
plat�rlL: 503-226-4211 .x4372 I^;n�altl: eln@nwnatural.Com Subdivisions or 1'arritii.ms
Lorene Nichols Street
x4372 �Eicic:s�i�,
C:cxltact tzsaa�at; I Ittlrae:
° iM.titilinc snstallal'oll for San,
rff t Loy Clark seiner, '�rortn •cwc.r, ligttd water
.111d/or Tig.mi 11.arer"-"ci:vicc ��rc a
� C;13 52281 I,�pir,ation:
_Address: PO Box 1369 SUBMITCOMPLETED APPLICATIONTO:
City/sidle. Tualatin OR zip. 97062 City of Tigard
Phone: 971-806-2841 13de.ieed Cl0 clark.com 1'Ltrrrrir���/Lq!irrecrirr
1312:5 SW Hall Bled.
C c_lntact name: Jade Leedy Phone: 971-806-2841 Tigard,OR 97223
Applications I,-()r minCn-work in rit;Etr .it'wa�
rmly tnas,be csnailcxi to:
L:t�tTit7eer: nla
rt11$7 zerrnitsov.,
,tirrard-or7
1-----. -�. -
e
C itv/ taCc': zip:
Hione:
Email: Case No.- a =e_"`�
C_.CJntaCC naam
_A0
plicatlota_-stt1.1n11tt<tl [ce.(Q071.
En,ineer x.I:stiplate)
Usti-n-iate:d v,aluc:of Nvork is reclt irccl(if over$7,000): Additional fees: S
"'Within [lie publicrit Iat-cif-�v; '} :111pl car on accepred:
By: � Dare: waf
I:s \vork related Lo a LAN C. S1-- DECISION? ❑ Yes (] No
Applic.}tion reviewed:
It sopic."Is Specti:z' (�I:I.I', I_)IZ, SL.'13 c'_tc.; c-aasc f"5: Q
Bv: • �otilr� _late:
Is work related to <a I3t'11:.17i\'<, I'I ,IZ�I.I'I ❑ Z'cs ❑ No 'sppl.ic:atirnorified:
If spe:cit-y(Ii tI:I:,I)ING 1)1:,'R1MIT) C"Ise rt: B,: .��- DaGe:
I:�:flG'PermFtlp•icatior,:�pf applic�ti7n"'Rev.10j.16J2017
M ...
City of Tigard • 1312 S I fall 1:11vd. I'i .Lief Oregon 972-23 ° \v,,v'wt1gard-or.gc3t, 503-7/18-2421 .P.tg e 1 of d
APPLICANTS
NO'T'E: 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 arc 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 APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate an),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 any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements f approving or denying the application.
Lorene Nichols 8/6/18
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
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 2 of4
DEVELOPMENT ENGINEERING PEES
Public Facility Improvement (PFI:) Perrtiit:
s o
:APPLICATION FEE
Part 1: Required submittal fee$300-00 (nlini.nxum) FRA.NCI-IISE UTILITY AND SIDENVALK/
DRIVEXV,A.YAND UTILITY
PERMI'T' I`EE CONNECTIONS;ETC.
Part 2: AH non-water system improvcment:s (work ill illi' light,of ivay)
f::nt�ineer's estinxate X , (less$300J.)0 mininit.tm
•' Skctc•/i
sLlbnitttal lc'i;)
(inc.licltn�,ltaf•c�rmatioil llelowv)
".n«incer s estimate X 2!P,, Plan Itevicw
❑,'I�in�cilslcills
WATER SYSTEM FEF ❑ `ikrc c.r iti:tille
Part 3: _:U1 pL1b1ic water sv:tenz improvements ❑ �itc ..lcliiiGss
Enjonc:er's estimate X 120)
FULL SCALE DEVELOPMENT
PFI Permit Fee Exeriiptions: Strect Impicnvc_i1lCnes)
I`here°Will be no pe.rnlit CCC char Cd,car.tssurance rquiretl
Cor elle loll(:nvil�t7 t�-pes c:f work: Pb
• Sidewall: repair(Less than 20 lineal lee:t) `(G 5c,is,2 a;tiaG or:22.N34) . .
• lWocatc or replace mailllc,>X ❑ Mc:r_:site,1005 bbredarion,I::.egund
• Ditch cle:Ltung that dc)es not:involve>_egrac'lillg- ❑ C:;,cner:ll'fore:: (C iir Wlatcr,~ewer,etc.j
• \1i`eep hale lcpa_ir ❑ s6xc.r(plan,I lotllc)
• (:urb repair or repl:lc.ement (less than 20 lineal feet.} ❑ \Vater,Storm:incl s " irar•i (I?Ian Pre1111e}
® Lawnsprinklrx sti stem installaticln or rep l.ir ❑ '\Varer t)ii:ah I�tc.Itttics
• SII:CCt ncc 111'L1Ilin,;{)i planting, ❑ t Ii idln
• Planter strip landscape:maintenance ❑ I.uxcl5c�ping/rl iC C 1'l ril
• Test"vTe.11s ❑ C.,llnpcisitc Utillt� P1<in(l c:ctric:�l;Pllcin'c,Gas;
_;rornl :S nit.lr',�' rer 5iI nStreeC 1-ights,etc)
❑ I7Qils
Note: A ur:3rice rm y he Q Traffic Sight Iaistance
required per TM(;fj,04..f40. El-Signing and Striping`
(i us tnr�ic r cic:pc�tiit}
ET Suter l..ight Flan and Photonletxic
❑ 1:::'.nlryilli:eLS SC.:d/S1t;natLlLe
❑ Shcet:libel(ja ojcct land use,lame,revision and
plan log WAC dares and sheer numbers)
Addition al Suhmi r;ily
(per l And Use.c6nciidons)
)�} Ill.tl•t.Ic'IZela�xrt.,
❑ Stossxz w;Lter Drainigt(::ilcillatiozis
:'❑ C7eotc:chnical"lZepbrk, `.
❑ I?reIii li i tib ..l c e ss Report (Siglxt.Pis-t,liicc)
❑ ]'rc>l1c>>ed l'l:li'.
❑`,I'arhwa}'Dc sign(it appllt.<i_t�l�) .
❑ Water I�ep;rsrilxinr.lplxrclt°:Ll
❑ t n.gineer's C.t nml ructxc)n I:stim ate
.... ....... ..........
PUBLIC FACILI'FY IMPROVEMENT PERMIT
City o/"Tigard 1 3125 SW I-fall i3lvd. Tigard,t:)tegon 97223 ° -,vwNvt.igai;cl-c1z:.l;ov 503-718-2421 P -e3of4
SAMPLE SKETCH:
S "Y ", St
Edge of Pavement
I
--� Ditch:-�--- -
Streetlight I w m.... .....M=W w .,.w:._r_.....
1 f FTr Tram U'
9 D.
aI I Existing
i Driveway
ii I ■ �aP �'w
-%
p
= I I (74
cr�
Powerpoie
® O
� I
II Fire Hydrant.(FH)
I ! Scale:"1-'=30'
� I I
t6
°
II � •
® I
I ■
6 I
MINIMUM SKETCH[REQUIREMENTS(Put"N/A"if Not Applicable):
X North arrow Property lines&dimension Slope of property
X Street &street name(s) Existing building,structures Utility&street light poles
X Proposed work Existing curb or edge Trees
X Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 0 Page 4 of
... ............. 'j
O ✓ -1 _
.....
.� - _ ..__..Me.,DONALD
.................
W
G
5.3 1 ;? i•
ii
s
I
>
ZN
14 0&0
I o0' n I
€
A
I
-----._-_....�_���3_,__.__
L
fi fr1N 3yJ
CT
SW-ELROSE
_
22'
f
#14 70
J- o
S' _ u _
l z
t
l-1 l f t 1 G'1'
t,5' j
M
S
ry
(p)
_ o
17'
t
LV cO � 3
j 1 v j ±
p
NW Natural PLAT: 1-045-020 COUNTY: WASHINGTONIry 08/03/18 17:0
(503)226-4211 TOWNSHIP: T02S RANGE: R01 W SECTION: 11 NE SCALE: 1 IN =90 FT USER ID:bmk
r f
Page 84 2011 Edition
S atianary Lane Closuire wi h`F(agging ®gag am .320
Diagram 320 covers total closure of one lane of a two-lane, two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT)with good
sight distance as discussed below.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet,
7. Extended queue signing (see Diagram 5-4) should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the"Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
t------------------------ J o
� Sin !e F!a er 0 oration I 1 m
Ln l 9 9 p I .
� �, I for Low Volumes I (optional) i j; m
ji,
m` BE
F1AO0E� PREPARED OI�E LAME
m I A�►®i► �►c!� I TO STOP W 1
5� a
c I —. . .r. ... I ROAD 'M!3
I '. ® I WORK
KO{9 6�A R I AHEAD a�a
O O O 1;[��7`` I • I ���I.
---- ---- Tt �i ..
1 mile
Max
Q 13
Buffer
Pic on VehIde
(bat ptlonaD
ROAD w TMA(both o
® See Chapter 4 �I
WORK 1
AHEAD
o" E BE
PREFAB®
0 Two Flagger Operation
�- AHEAD TO STOP ;
d
AN
0)
w (� no ;o Ln