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PFI2019-00159 11,4 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT 2 COMMUNITY DEVELOPMENT Permit#: PFI2019-00159 n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/21/2019 T t "fit'" g Parcel: 2S102AA04100 Jurisdiction: Tigard Site address: 12230 SW MAIN ST 100 Subdivision: None Lot: None Project: Spot Repair Project Description: Exterior 5 foot spot repair in front of curb in ROW. Owner: FEES Description Date Amount PFI Permit Fee 05/21/2019 $300.00 PHONE: Contractor: JACK HOWK PLUMBING/RESCUE ROOTER PO BOX 2830 CLACKAMAS, OR 97015 PHONE: 503-850-3100 FAX: 503-491-2932 Applicant: DAVIX PO BOX 2830 CLACKAMAS, OR 97015 PHONE: 503-850-3100 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: SLI6CVJ Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00159 Type: Condition Name: Status: Severity: PFI_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 09-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_Sidewalk/[ 10-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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector. PFI_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 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_Sidewalk/[ 31 -OTHER Applied Notice Other RECEIVED MAY 2 0 2019 CI of Tigard CITY OF TIGARD 11111 8 PLANNING/ENGINEERING • K PUBLIC WORKS — ENGINEERING TIGARD Public Facility Improvement (PFI) Permit a TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) *OA 0 TYPE 1-Franchise Utility Work*4 Check one: *'SIdcwalk/dnye av approach ifiligriernaffilai' + performed by N11'N, PGE Detailed • scription: J Pr ge: and/or utility agency. /r/l - A <y��i[t- ar+ L�!�/i/7dt/�io )4 TYPE 2-Sidewalk/Dnv-csvay/Sewer f V ,ltr�9.44 y� (/t- �(I`L./ Work performed for the purpose of: i I I// • Sidewalk installation or repair. / �// 6tj� Si- Driveway approach installation Property address/location(s): /V V '�•�/ • and/or repair • Sanitary sewer lateral installation and/or main line tap I r 4i�729,,,.0 f`�7� y ii ` ��� Work� o ❑ TYPE 3--Full scale Development e� Work performed with Land use Address: !/ 04 i -I,. /�.�/� approval which includes any of City/state: 4 i 'S Zip: vl Tl/ the following: Ph /� /e, 4. Email: /•/ .K+[`�/ gyp/ . aYV - Subdivisions or Partitions IP'/ ,c • Street widening Contact name . ,1. , ,><[- Phone: /:4 .�� rj' ,v i + h • Mainline installation for Sanitary „-K,/ w sewer, Storm sewer, Tigard water Contractor: r and/or Tigard Water Service Arca CCB#: ,Ae AA) �f�+ QE piratiot : Address: " . Li % O 4 '''' P SUBMIT COMPLETED APPLICATION TO: Cit}'/state: Zip: City of Tigard Planning/Engineering Phone: Email: 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" only may he emailed to: Engineer: _ rowpermitaitigard-or,gov Address: I ooIc :oar •I t til. t,\I \• City/state: `Zip: • Phone: ....„./...**- Email: Case No.: i•iri a d/q -0 O/1 Contact name: Application submittal fee(.07%of ��yyyy)) Engineer's Estimate) S Estimated value of work is required(if over 55,000):S •"�0r Additional fees:S 300 (within the public right of way Application accepted: C Is work related to a LAND-USE DECISION? 0 Yes KNo By: Date. J/�D/�q If so,please specify (MLP,SDR,SUB,etc.) case#: Application reviewed: ` By: VA) Date: 11` �°� Is work related to a BUILDING PERMIT? 0 Yes k No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: SL Date: c'El-lit lattrayrearmosiitasoanproansciiion Ettative raW2orr City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ww wttgard-or.gov • 503-718-2421 • Page I 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 15.0.41.140. \1 jilt the exception of a utiiit}operating pursti t tt ol a valid franchise with the City nt i p;,trd,when the miner and the applicant are different people,the applicant mum he the purchaser of record or a lessee in possession with written authorioatinn from the owner or an agent of the owner. Th,o,yner:5i Mit Sign this applicati'.n in thy space provi,led or submit a written ai.ttlosrizatiiiin lwrh this application. Franchised Utilities are not required to obtain the owners si,naturr on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded Aced restrictions that may be attached to or imposed upon the subject pa Iperiy. • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the condition;and limitations of the approval. • Al!of the above statements and the statements in any plot plan,attachments,and exhibits transmitted herewith,arc true;and the applicants so acknowledge that am permit issued,based on this application,mat 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. / Ce" a."2/* oC7r410 /9 Applicant/:\ toriecl A=gent's signature Print nam Date. SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Owners signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 S\\ Hall Blvd. • Tigard,Oregon 97223 • wwwtigard•or.gos • 503 718 2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI) Permit: 17t. I`1ILLll SUBMITTAL It 1;QUI RLM ENTS APPLICATION FEE Part 1: Required submittal f s .S I O.I)1 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY CONNECTIONS,ETC. Part 2: All non-wan t system impo)ve tents (work in rht ght of ) Engineer's estimate X 3°'0(less S300,00 submittal tee) Engineer's estimate X 2'1b Plan Review. Sketch (includin'-.information 1>e';ert-) WATER SYSTEM FEE ❑ Dimensions Part 3: .\ll public waters'stem improvements ❑ Strtet`temc kneinccr',,estimate X 1240 0 Site Address I'FI Permit Fee Exemptions: FULL SCALE DEVELOPMENT 'there will be no permit tee charged,or assurance required (Subdivision Partitions and Street Improvements) for the following types of work: • Sidewalk repair(less than 21)lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 22x3 ) • Weep hole repair 0 Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) 0 General Notes(City,\Vater,Sewer,etc.) • Lawn sprinkler system installation or repair 0 Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Pian Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Note: A cash assurance may he 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 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 O Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) O Water Department Approval ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 S\\ Hall Blvd. • Tigard,Oregon 97223 • uww..tigard-or.gov • 303-718-2421 • Page 3 of 4 lorzala SKETCH AREA: DATE: X72t2/20/ PROJECT ADDRESS: LC-Pl/ nig/2725-A/ 71764e12____ 11/0611 V°.19 OVIA11) 414 \\: boiet7 PROVIDED BY: ARS dba Jack Howk/Rescue Rooter, P.O. BOX 2830, Clackamas, OR 97015, Phone: 503-850-310o Fax: 503-491-2932 SKETCH AREA: DATE: .-7ZWg0/_/ PROJECT ADDRESS: / 0-7Q c,�,�hi 'a4 ,$ 7/- l"e - f Ndiert 4 . ___. ,..„.. ...... . ...... ,i _....,l9 *9 9 ...„ 1. 31)a , fie 611\1,,,,,,„/4\ox ', .....--- r---; • • \ 7- 14\N. `O ' . \\%! vt-t 0A lQQ \/+ SOS Nt 'ic SOP0. \ .}1�,ypO r P .,, 0 Irl ,zir.-6-71- \ PROVIDED BY: ARS dba Jack Howk/Rescue Rooter, P.O. BOX 2830, Clackamas, OR 97015, Phone: 503-850-3100 Fan: 503.491-2931