PFI2018-00337 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
li
s COMMUNITY DEVELOPMENT Permit#: PF12018-00337
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/12/2018
Parcel: SEG1851
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: NW Natural-WO#3561242
Project Description: SEG1851 and SEG 1879, intersection of SW 79th Ave and SW Bonita Rd. Repair leak on gas valve at
the intersection of SW 79th Ave and SW Bonita Rd. Main on the 4' in ROW in the sidewalk.Will need to
remove one flag for repairs. See attached.
Owner: FEES
Description Date Amount
PFI Permit Fee 12/12/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
SHELLY KIRSCHENMAN
220 NW 2ND AVE
PORTLAND, OR 97209
PHONE: 503-226-4211
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: See application
Issued By: ----
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00337
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
aintained.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. Brady Bullinger is the inspector assigned to this permit(503)
718-2611
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 DEC 1 1 2018
I'[IBLY: \\'0RKS — ENGINF.F"RING CITY F TIGARD
e I-AsNIIIf'U,-;!E ,9GINEERING
Public Facile T Im rovement PFI
pl:'
ermit
4c
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-Avay)
0 TYPE 1 - Franchise titilin•\\Fork
Check one: 0 Utilitic,, ❑,Sidewalk/dn%,c\vay approach Q Street improvements performed by NW'N, PGIi
I)ctailed descriptit m: Repair leak on gas valve at the intersection of and/or utility agency.
SW 79th Ave & SW Bonita Rd, Main on the 4' in ROW in the sidewalk. 0 TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpc>se of
Will need to remove one flag for repairs. See attached. - Sidewalk installation or repair.
Property address/1()cat1011 s
SW 79th Ave & SW Bonita Rd - Driveway approach installation
and/or repair
WO#: 3561242 lSE5194 - Sanitary sewer lateral installation
and/or main line tap
Applicant: NW Natural/Shelly Kirsehenman ❑ TYPE 3—I ull scale Development
Work performed u��ith land use
Address: 220 NW 2nd Ave approval which includes any of
City/state: Portland OR Zip: 97209 the following.
Phone: 503-226-4211x4347 l,mail: smk@nwnatural.com - Subdivisions or Partitions
Contact name: Shelly Kirschenman Phone: - Street widening
- Mainline installation for Sanitary
Contractor. Loy Clark/Jade Leedy sewer, Storm sewer, "Tigard water
and/or Tigard 1K/ater�n�ice Area
CCIi#: 52281 I•.xpiration:
Address: PO Box 1369 SUBMIT COMPLETED APPLICATION TO:
City/state: Troutdale OR dip: 97062 City of Tigard
Phone: 971-806-2841 1ade.leedyto clark.com PlanninglEngineerngImail
13125 SW Hall Blvd.
Contact name: Jade Leedy Plu nic: Tigard,OR 97223
\pplications for"minor work in rigln-of-way"
)-?nginccr:
Richard Girard only inar be entailed to:
romzerm i is(ajgard-or.gov
Address: Same
City/state: zip: mmii�
Phone: 360-921-0314 l,mail: r2g@nwnatural.com Case No.: r FI-/ol,3"0b 33
1-
Contact name: Application submittal fee(.007%of
l;ngineer s Estimate) $
l:stimatc:d value of work is required(if over$5,000):0):$ Additional fees: $ 4��
(within the public right-4-way) Application accepted:
� t
Is work related to a LAND-USI? DE ISR)N? ❑ Yeas ❑ No By: E(-- -Date:
If so,please specify, (N111),SDR,SUB, etc.) case #: Application reviewed:
Bv: a Date: /I /
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No Applicant notified:
If so,please specIR7(BUILDING PI RMI'l)case#: By: �_C. Date:
I.\ENG\PermitApplications\pfi—application Rev.10/16/2017
City ofTigard - 13125 SW Hall Blvd. - 'Tigard,Oregon 97223 9 www.tigard-or.gov - 503-7111-2421 Page 1 of4
APPLICANTS
NOTE: Person specified as"Applicant" shall be designated "Permittee"and shall provide financial assurance for work,if
required by the cite pursuant to TNTC, 15.041.1401.
With the exception of a utilit\ operating pursuant to a valid franchise with the Cite ofT'Ig aid,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 owners)must sign this application in the space:provided or submit a written authorization with this application. Franchisee/
I Itiltties are not rcyuireel to obtain the owner's signature on the application
BY SIGNING BELOW,TI IE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded decd restrictions that mai,be attached to or imposed upon the subject
rc1Nr •.
• 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.
DM i=sm*nwr%sura1cn .c-UWN11.°a` Shelly Kirschenman 12/11 /18wnsKi=sm�,�nw�awal cam.c=115
D46e:2018.02.1108:31:8-08'00'
Applicant/Authorized Agent's signature i'rit�t tl;�t�ie 1)a(e'
SIGNATURES of each owner of the subject property, if required.
Owner's signature Print name Date
Owners signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City ot'Tiwtrd • 1'125S\\' 1 lall lilvd. I iii.rel,e )rc�l►n '�?'''� wwwtigard-ongov 503-718-2421 Pad;e 2 uf4
DEVELOPMENT ENGINEERING FEES FOR
STAFF USE ONLY
Public Facility Improvement (PFI) Permit: DETAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
[ ngineer's estimate X 5%,(less$3(X1.00 minimum
submittal fee) Sketch
(including information below)
E ngrineer's estimate X 2%►Plan Review
❑ Dimensions
WATER SYSTEM FEE ❑ Street Name
Part 3: Ml public water system improvements ❑ Site Address
Engineer's estimate X 12'%►
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements)
There will be no permit fee charged,or assurance required
for the following;types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (G sets,2406 or 2204)
• Relocate or replace mailbox ❑ Cover—Site,Vicinity,Abbreviation,Legend
• hitch cleaning;that does not involve regrading. ❑ General Notes(City,Water,Sewer,etc.)
• V'c:cp hole repair ❑ Street(Plan,Profile)
• Curb repair or replacement(less than 20 lineal feet) ❑ Water,Storm and Sanitary(Plan Profile)
• Lawn sprinkler system installation or repair ❑ Water Quality Facilities
• Street tree pruning or planting ❑ Grading
• Planter strip landscape maintenance ❑ Landscaping/Tree Plan
• Test wells ❑ Composite Utility Plan(Electrical,Phone,Gas,
Storm,Sanitary,Water,Signage,Street Lights,etc)
❑ Details
Note: A cash/bond assurance maybe ❑ Traffic Sight Distance
required per TMC 15.04.140. ❑ Signing and Striping
(customer deposit) ❑ Street Light Plan and Photometric
❑ Engineers seal/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 Design(if applicable)
❑ Water Department Approval
❑ Engineers Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City ufTig;ard 13125 SW flail lilvd. • •Tigard,Oregon 97223 503-795-2421 • Page.3 of
SAMPLE SKETCH:
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D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW 1 lall lflW. • 'Tigard,()Ngon 977-223 • wwxN-.t1gard-or.g0\, 9 503-718-2421 • Page4of4
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ONE LANE CLOSURE RIGHT LANE CLOSURE, NEAR SIDE
GENERAL NOTES FOR ALL DETAILS:
• Additional Traffic Control Measures(TCM)may be required for all legs of the intersection.
• The'BE PREPARED TO STOP'sign shall be used only in conjunction with the FLAGGER symbol sign.
• To determine Taper Length("L')and Buffer Length("B'),use the"MINIMUM LENGTHS TABLE"on Drg.No.TM800
• For left lane or shoulder work,place TCD to close left lane or shoulder. Use"LEFT LANE CLOSED AHEAD"sign,
'LEFT LANE ENDS'(W4-2L)symbol sign,or'LEFT SHOULDER CLOSED"sign,where applicable.
• To determine sign spacing A,B.and C,use'TRAFFIC CONTROL DEVICES(TCD)SPACING TABLE'on Drg.TM800.
• When a through road intersects within the work zone,place a"ROAD WORK AHEAD'sign in advance of the intersection at sign spacing A-
• Use plastic drums in lane closure tapers when the posted speed is 45 mph or greater.
• Where shoulder width is limited,Sequential Arrow may be placed within the lane closure taper.
• • 28'Tubular Markers cam.BOOK No. ____ N/A_____ BASEUNE gEPM DATE 01-JUL-2011
---------------
See TCD Spacing Table on NOTE: All material and workmanship shall be in accordance with
TM800 for max.spacings. the current Oregon Standard Specifications
• 28"Tubular Markers OREGON STANDARD DRAWINGS
See TCD Spacing Table on The selection and use of this
TM800 for max.spacings. Standard Drawing, while designed
O UNDER TRAFFIC in accordance with generally INTERSECTION WORK ZONE DETAILS
® UNDER CONSTRUCTION accepted engineering principles
and practices,is the sole respon-
To be accompanied by Drg.Nos.TM820, sibility of the user and should not 2008
TM821 &TM840 be used without consulting a DATE REVISION DESCRIPTION
Registered Professional Engineer. 07-0'•m" Rt VlSFD°R""""G AND NOTES
Effective Date: June 1, 2012 - November 30, 2012 TM841