PFI2020-00339 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
I COMMUNITY DEVELOPMENT Permit#: PFI2020-00339
Date Issued: 09/23/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: SEG515
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: SEG515/11180 SW 119th Ave. Bore one 2" HDPE from ped across from 11185 North through RO then
east under ROW and then SE to meter on house at 11180. Min 36"depth.
Class of Work: FEES
Description Date Amount
Type 1 -Utilities(gas, electric, data) PFI Permit Fee 09/22/2020 $300.00
Total $300.00
Owner:
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tioard-or.aov to schedule inspections online.
Contractor:
LINESCAPE LLC
19100 SW 51ST AVE
TAULATIN, OR 97062
PHONE: 5039694409
Applicant:
RANDY SHIELDS
11308 SW 68TH PARKWAY
TIGARD, OR 97223
PHONE:
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.
ttuelApplicant O f 1
Signature: ..��jj��
00
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2020-00339
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 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector.
PFI_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 28-AS-BUILT DRAWING Applied Notice
1.2,3,4,5 28-AS-BUILT DRAWING
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).
1,2,3,4,5 28-AS-BUILT DRAWING
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).
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 Utilities 31 -OTHER
_ Applied Notice
Other
City of Tigard pFl;r: 2020-00339
• LNGINI.LRING L)EP:\ItT\II'.ti'1
t I,.niti) Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION TYPE OF WORK
Project name: I t t RO iki\I \i rl*I'A'A- en Pa."' tld TYPE:I-rtanclow t•tltt Wu&
fist) GYtP .'N V PC e' /1 pew perf•.tmnl MKT%P(iL. of abet.
Brief dcscripdon of project:
Clt t-ciS i'fetA It I%t.,...) NI +1,ne �(i Yid £ L"'C)J' R i 1 TYPE 27 lit RC SdoolL..7rice•.a‘;Nom
L tJli P I. H•vk P..wmnd G•r,ha MnP•n••u'
\ CY.1 1I\In1 )L `e• Ilti-ker G.1 '1C'41.IIISO (4'Glt\'1kn t�a(.:e7UC�th.•Suh aS ulrallm,m.4n7n
•t)n•a«v.appn•ach uturllata•n and Irma
SITE INFORMATION • wot:.rt"..•-r tamnhnrtaaAran Anil
11}� S .""lime rap
IueatiunGRltlre+stl ar:ulable 111 )• ;Y� ilV t1 - } •� U TPE1-I..LS IIetk.uLiinnrtnU.nl:
SEG 515 I.:tnutur.l unh Inane af(tno al Much
Admit,ann of the following:
•Sultan-morn or i anwott•
APPLICANT INFORMATION •Butt YYtt'Nnl:
• 1Lttthnc tmtalleth•n nn .autan +ca'rt.
Name: Al CA-VT sat.'Nara Wain. an.I T:xu:l
w.un+enne trey
Mailing address: II'a�� �iVti: �f:�� P vs;L1
Cin'/State: -[t At!� CV-- zip:��3oa' L T
l PEa-StWlCellTnhcnl•r:p
Phone: 6c..q. r)
Email: '-'12.alNK4-- Phone: ea5Ae- NOTE: lire I grid 2 Amen-Atom nut be
-i atuiled to p nrr cane!it neatal,n.w,tt.
Contact namr: �'a r1 1 ')11:f 1 c'' S
r 5{v,t1cf564144CaS�I tuc�(
Plxmr. Can\2 t'.n>.rol: l�A/\LZ^•,—A
CONTRACTOR INFORaiIATION 0 Same as applicant
Name: L:rlt YA LI-C CC II Number.. 140gok
Mailingaddrtss: i1ILr-. 1› AI>
\\l ' t ii-ve tit,;'Srate:lt't'•X l-'hY\,R Zip: eii9"0
Phan i1I-ILIA- INc1(; lanai': Per m,}6€ i LSCnQ-e_ «C.Cori4
ENGINEER INFORMATION `
Name:
Stalling address:_ kite/State: Zip:
Phone: I mail:
ADDITIONAL INFORMATION
Estimated value of work is regairt d,if r wer Si,t*a):S (within the public nghr-of-way)
Is work related to a LANE)l'SI'1)[I:ISI(iN% 0 Yes 0 NO Casa numlser:
Ciry of Tigard • 15125 SW I laa Niel. • T,I;anl,t)rcpol 9-213 • a-smugatd.n.4ror • St(3.-18.2421 • Page 1 of 4
APPLICANTS
NOTE: Person sputter)as".lpphc.tnt"shall:e Jc.i ii.aeJ"Pcrnuii c and shall pnn'ale financial assurance tor
ao.rk.if required hn the cis.pursuant to'I:\It 15.114.1411.
• Wish dw notrpr>.n.daetdn•pa-neep:pwwun or i41A h n.iaw t haci.....ith II.ell..iIr{an1,When the uw'tetaald)e apq•h...r.-.
ate dd(rn•a pop.4,die.ppheanr nut.)ter do putttiin. .t.cc•4.1,n a los.r..r•p..,ot..un with wirtrn audprtvaum 41111.111(..;,1.•
ut an apnr r.f rho•wtci. tiu.w net mist.ipr it s alpd+:a:n.a in rho space porn-Mod.a sulnl'.n a,bins it..'.,-.rs.n..1.1
app4carhm. I rant least no[Armed Cdr...ttc.un n.puta,l I..d.nm rhr wand.••amvrc•.n 44 arphoorn
I.the applicant,ccruh-that:
• To the best of my knowledge.all the infumtaam provides)within this application package is complete and
aCCuralt.
• The aborr request does not vodatr any recorded deed restncuons that may be attached to or imposed upon the
subject property.
• If the application is granted.I vial es.ercisc the rights granted in accordance with the terms and subject to all the
conditions and litnitations•if the approval.
at'\ 'the 12/149
Applicants or authorized agent's sjgmamrc Print name Date
Property owner's silmature(if required) Print name Date
STAFF USE ONLY
Case No: PFI202020-00 39 Penns fe 3C242 *y Received b}:AL Date: 9 16 20
Approved b):<I/• � Date:___ Notified by:_ Date: ,Z7i 7
City of Tigard • I;I..SW 1 tall Blvd. • Tigard,uug.n V722 3 wvx.tiy;ath-•.ryhrs • ii yi-'Iti•_4_1 • l'.tgr 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Imptavemenr(PFI)Permit:
INITIAL PFI PERMIT FEE
Pan I: Required submittal far i.lu:,.of the Net PI-I Permit Ver.See!white for calculations.Minimum of S3UU.
NET PFI PERMIT FEE
Pan 2: All non-water system improvements engineer:citimatc X 7'in(kss dtc initial PFI Petra Fee).
WATER LINE CONSTRUCTION FEE
Part 3: All public water s»rem itnpruvements engineer's estimate X I?'*a.
FORSTAFPUSIL ONLY Dolt STAFF USE ONLY
TYPE 4:SMALL WIRELESS FACILITY T5'PE I—3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
TYPE 1 AN1)TYPE 2-Must include a sketch
Does appGt.nr havea rihxnluav l!cn:ec� rj\,• L\" showing:
Under the wireless fa¢Gdrs s!utdards,is the pnsi*n.J ❑ Dimensions
considered,(check all that apply): O Stall Cell ❑Macro ❑ S1nYt Name
❑ Site Address
Lion many instil sites arc ripened as part of this pemtu
sppLcauunr TYPE 3-Must provide 4 acts of plane(sized 24 x 36
or 22 x 34)and an ciecrronic version of all submittal
The proposed equipment is located on which of the idluwieg: items. The plans must that include:
0 Lambdas Right+sf-tat 0 PnntePruptttr 0 t_inrr-5itt,\'Kin;n,Abbrematum,lriwnd
❑ General Notes(Cite'A atcr,Sewn,etc./
If equipment is to be lotted on private pntpcng,describe the 0 Street(Plan,Prr,Slcj
typeuse: ❑ Water,Storm and Sanitary(Plan Profile)
❑ Mate,Quality Facilities
❑ Grading
❑ landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Ga.s,Sturm.
Sant t ry.\Pater,Signage,Sttect Lights,etc:
❑ Derails
❑ lraflic Sight Distance
❑ Sii(uwg and Striping
❑ Sheet Light Plan and Phtstonscoic
(3 Engincasscal/signature
❑ Sheet label invoice-eland tent saute,revision and plan
log likrck,dates and sheet numbers.)
1':rypneds Comtntctinn Estimate
Additional Submittals
(per land use conditions,if applicable)
:3 Traffic Report
❑ St. water Drainage Calculations
U Gcotcchnical Repeat
❑^ Preliminary Access Rrpon(Sight Distance)
`J Pr posed Plat
❑ Pathway Design
0 Ater Prosidn Approval
•
City of Tigard • 13125 SW!hall ithd. • -11s;:nd. negon 47227i • wau tiganinu ge.v • 503 718•2421 • Page 3 of 4
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Page 04 2011 Edition 2011 Edition Page 85
Stationary,Lane Closure with Flagging- ' :.,ygifireriii151372.0 Statioftery -.Diagram'320
Diagram 320 covers total closure of ono lane of a two-lane.two-way
roadway. See the detail inset for the layout if using a single flogger to control
both directions of traffic on low volume roads(less than 400 ADT)with good I . I a
sigh)distance as discussed below. I '`
1. Use Wck mounlod flashing warning fights on work and protection •
— a
$$$ 0
a
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
I a
a
2. For added visibility,a truck-mounted arrow board or PCMS In caution twi
mode may be used. m • -' 1 0
3. Floggors at each approach are required if any of the following i a o v
— 1-
conditions exist: I
a. Night Operations. G
'Ai
b. Work space is over 200 feet in length.
c. Sight distance Is less than 750 feet from each approach I
through the lane closure. ••
d. Traffic volumes are greater than 400 ADT. 1 ,�/ y
4. The Length between the Flogger Ahead signs shall not exceed one _ tit 1 • •a•
mile. Use Diagram 340-Lane Closure with Pilot Car if exceeding ono I E 1 /b ''- w
mle. .I1 Y
5. Cones should be used to outline the work space when curves or other �•'' j_tt • 'I
roadway alignments prevent dear direction for the motorists to pass '� iN •
the work space solely. ! ig f(1 /j� •.
II
6. Cones along the work space are recommended when posted speeds •
i-,
are 45 mph or greater,when working under heavy traffic or when navel F
le
lanes are narrower than 11 feet. 3k I ,4
I • -
•
-.7. Extended queue signing(see Diagram 5-1)should be used when S b `I -
traffic queues extend beyond the initial advance warning sign. top j t r *I .. >S<a
8. When flagging near an intersection,the-Flogger Ahead-(CW23-2) ~
sign should be visible to traffic entering from any side road. Additional 1 I t 7
advance warning and Flogger Ahead symbol signs may be placed on I SW Se•••ro•as meet Lugo.clap `i' I
the side road(s). miiA --- P•+d'r._•Wrt'9 Canna"sqn. evnor Sg3 .2
9. Sign set-up and nagger placement shown may be used for intermittent ruer4ne•m144. 2• son m a ro I Ff
a, so
so
fug road closures of 20 minutes or loss. 30 140
WA..,.....SI. u US napp
an .0 ]'.9 130 .ria IN
10.The'ONE LANE ROAD AHEAD'(W20-4)sign is optional and should ,••—•'' ' .s lac
w Sea sea 573 ro
he considered on high volume or high speed roads,or when extended _ so no
queues ore expeGed. sle sp,[fox and Muter tenons tfna)supplement
Pound _Sparing 0atwnen Signs 'oul1 r
7iwpter 5 nnru+M M nr 2011 tincnu+r 2011 Ct+nnt+r 5
Spell A e f Space
60 265
65 700 700 700 325
70 365