PFI2020-00404 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12020-00404
Date Issued: 10/27/2020
T t G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: SEG1828
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast PFI
Project Description: Bore one 2" from ped at 9260 NW through ROW
Class of Work: FEES
Description Date Amount
Type 1 -Utilities (gas, electric, data) PFI Permit Fee 10/27/2020 $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.tigard-or.aov to schedule inspections online.
Contractor:
PHONE:
Applicant:
RANDY SHIELDS
11308 SW 68TH PRKWY
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.
PermitteelApplicant See application
Signature:
Issued By: oet
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2020-00404
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,Trent Brickey at
971-228-9269,to establish a preconstruction meeting.
please call 503-639-4175 to schedule inspection, use code 738
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 1'I'1 4: 2020-00404
i ENGINEERING I)EPr1R;:.\IkNT
TIGARD Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
L �-.))"i 14E TYPE OF WORK
Projeel namc: 1 L 7' L' 'i' 11 i'TYPE I-Pun.It:.e I \C,a•I,
Brief dtscription of pnrivet: Dose..nnE.1,2 i*T on F.6L t.T PtY7i.rmni:lt M.X.N.IKIrr. :o out,
t -�r t � c
`lath(/ I' ''\r Tt\.fL 41 ftt1i •J 12 - 4 (t.et'Act
I/Lt/ G TYPE 2-InVa sul,,4L nntnrayr nova
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• ..In,ali ai•,.:a:,m,rt r
111•.,„N1 t..•Y'1 .r -It i h [4- !S•/r • ln,M n ann sa 1.m.,ali s,tJ trims
SITE INFORMATION • ,.....ar.curt lateral rtu:alLti.m arxl
:)�'Ct AVE, a 1.1'lief
I. canon (address if a,.aiL>hlt': i . 7\!i > iC I ) E,
SEG 1828 ei I1 PES-Lna\clle t>e,e'.gmm:11.+1:
1'�'il, l.� C R -I I'::i.miurl t 141.1 we,Eq,nnee%huh
( — .ot loci..an.,- lilt ti,IL..rr;
• •.I.Inca n,.•n Pan:non.
APPLICANT INFORMATION • -::,,,.,.kimp
Name: C*011(e-,'ti • 1laumint ,rtoalLtnv, Grt •antlar, .curt.
^7 a.' r>�� ` •o.rn, .tvtr.Takata filter. and Tµarc
flailing address: t I f,ice't -7i'v { 1 IL \ AACT•ants.,tea
' ®' Zip:
t,3.;)4` Ll i1PEa-Small call Tmlumit
1'CPI.s-I t..tl'fnan¢k
Ph; �
I:m:111, IZA 11.1L iIL.it `iCL 1.'1Y1i P ji t----4 C Yl'-`
—j 1�rtlrK -' NOT8: lip. 1 and 2 aiq,livamn mat lm
Contactnamcc '{�1\i.,,,A1) ',It/frIikS nnulr.122,p.rirmv.jt22•2222.lt.Lk.G
Phone: (-CAl".ft., t I mail: .Xcitil(-
CONTRACTOR INFORMATION 0 Same as applicant
Name: I..,ttNe 3l It,C- I.-LC. (:t:li Numhcr: Li a L{G
Mailing address: Ic11IL'(- c-,,A 'ZI /tv.'-• t-ire,Sratr. 1;,irt.&&titt Lj zip: 11 (,.•,_
Phone- C11 -; :.t4 - l( 1i. _ I--mail: rf t itl.A 16, I1I1f..S Ca.F. ((( (ow(
ENGINEER INFORMATION
Name:
flailing address: tiny,State: Lip:
Phrrnc: hi mtl:
ADDITIONAL INFORMATION
Estimated salucof WWII'Isrcgmrcd;iI,I\crS5.t ll)):j (w,chin the public right-of-way)
15work related to I.ANI)PSI'.Ill (.ISI(INr 01es OtNil Lase number.
Cily a/Tigard • mil':t•W llall IthJ. • 71r.,nl.(>rc,•.m 9-223 • * as.!i:Lnl ii n1;.'i • 5t it^Id•?42! • Pig(I of4
APPLICANTS
NOTE Person specified as•:-lpplicant"shah he designated"Perm ui r.'and shall pnn•ide financial assurance for
work.if n.gmrrd In the an pursuant to TAB. 1504.141).
• 1i;ttit ils.-xmpn.m..i a loin:.xrejac lwr.aun:a a tttlul tiataLnc t tt Lcnsa s.im thy C,p Alk ud wtun nu ammo ntd d•r applicant
Arc dtirann po.rde.thy.pphcanr mutt Iw the patiumr or.mutt'or a knit m p.crtratx,te.d,unman .rurtv.n.anon(tom day twrra,
.:an a,trrr to yin uamcy. Thy oumyt malt,sign die appbraa.in in no;,par pe.tidcd.x xalxtut a%Milan auth,naafit to stub rho-
apphuex.0 I..u:.bu,nl•1 I ttrn.ui Fnbtic,sirfir wsittnn{v..a,tam,ht..uun'..tw.mura t xt the applioretn
1,the applicant,certify that:
• To the best of my knuwkdge,,all the information provided within this application package is complete and
accurate.
• lbe alrapee request dues not violate any rem•rded deed restrictions that may be attached It.or imposed upon the
subject pngmm.
• 11 the applicauon is granu.d,I will cacmse the rights granted in ago whinge with the terns and subject to all the
conditions and limiuuonssoor the approval.
rA„_. Vr' `' AGv PMJL`�"GwU �Q1 ZE/L�?fJ
Applicant's or authorized agent's signature Print mama Date
Property owners signature(if required) Print name Date
STAFF USE ONLY
Case No: PF12020-00404 Permit fee: l' Received be: NIB Data 10/26/20
Approved by: 7?w'1 t aPJ... Date: /0/27/IC/0 Notified by: Date:
City ofTigard • I ll!S SW Ilan 8MJ. • TtgarJ.tlregtxt7"?• • nu-a t.:,r.! .,_ir. -Ih 242: • Page 2 of
DEVELOPMENT ENGINEERING FEES
Public Facility improvement(PFI)Permit:
INITIAL PFI PERMIT FEE
Pan 1: Re jutectl submittal Ice is 111^ of dsr Net PI7 Penut Pee.Sec hcltrw for calculations,minimum of 5.31)(h
NET PFI PERMIT FEE
Pan 2: All non-water system improecntnts cahnnect's axumatc X%'Ye Ilcss the initial Pal Permit Fcc).
WATER LINE CONSTRUCTION FEE
Pan 3: All public water system impnovcmcnts m(area\estimate X
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4:SMALL WIRELESS FACII 1TY TYPE 1-3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
Does applicwn:have a right-of way license? CI Yrs 0 No TYPE I AND TYPE 2-Must include a ttketcIs
Showing:
Under the warless lacIlties swm4ttis,is the proposal
❑ Dimensions
evntidere P(check all that apply): 0 Small Cell 0.Iseo• •e] Siren Name
Haw many install site,are proposed as lime p of this ennit ❑ Site Address
applicariom"r
TYPE 3-Must provide 4 sets of plans(sleet]24 s 36
or 22 x 34)and an electronic version of all submittal
The proposed equipment is located on which of de ioJowing: items. The plans must that include:
C Public Eight-of-Way 0 Private Property
❑ Cirri—Site,\-triton,Abbres:anon,I.egad
If ceraipmam is to he located tan petals pnspenv,describe the 0 General tarn(Cn•,Water,Sewer,ew.)
tape tle usc: 0 Stine:(PLa,Pn,tde)
❑ \\'arc„Sturm and Sanitary(Plan Pro Fie
❑ \\.arc Quality FariGticn
❑ Grading
❑ landscaping/Tree Plan
❑ Composite Utility Plan(WeenieJ,Phone,Gas,Stone,,
Sanitary,Witty.SigtLW:.Street Lights,etc.)
❑ Dcrds
❑ Traffic SightDivance
C Signing and Srnping
❑ Strccl light Plan and Phntrmtruic
❑ Engneers seal/signature
❑ Sheet label'.pnsiect land use rung,revision and plan
log block,dates and shret numbers.)
❑ ling rgcec Oonsu iccon Estimate
Additiouad Strbmittais
(per land use conditions,if applicable)
❑ 'rraftic Report
❑ Storm water Drainage Calculations
❑ (ieorcchniciRcp,at
❑ Preliminary,\cecss Report(Sight Distance)
❑ Prrprrsetl Plat
❑ Pathway❑nsig't
❑ Water Pon•ider Approval
City of Tigard • 13125 SW halt Bled. • 'Iin,trd.$)repon 9"22 • nw't,rr:u;.,,i,;,,v • 'so.;'Is• 2.121 • Pagr3 of
SW 93rd Ave.. Indicate North
SIDEWALK SIDEWALK
ROW ROW
34' 5' 7' v
4 w ►4 ►
Bore Line 90' t 444 A
d/W tree
V
O
9280 76'
Property Lines
Streetlight • o.6
PED
SLOPE
c/w
m
9260 -1
m
7J
70
D
C)
.. +
V
o v Work site address:
V
14370 SW 93RD
AVE, 97224.
Pane ho 2011[dikn 201t Edgbn Pagc Cl
5.3 Two-Lane,Two-Way Roads $houfdefWolhcw(•Mnor Road Encroaclunent f)iag.300
Shoulder Work wl Minor,Road Encroachment Dlag.-300
IUse this detail for non-freeway work which extends into a travel lane and 0 T' I 4 t•
maintains a minimum 10 foot travel lane. If a rninhnum 10 foal travel lane
can not be maintained,or when tralic can not safely
pass-o both lanes rin
Diagentso 10 use he appropriate lane closure diagrams-tor example, wring A
Diagrams through310 3511. S9,
A lane closure maybe appropriate for conditions such as high trafficI.
volumes,high speeds,and inadequate approach sight distance to the work
space.or heavy equipment adjacent to the travel lane.
1. Use Vick-mounted Bashing warning lights on work and protection (opiaid]vehicles. See Section 4.3-Lights and Lighted Signs for exceptions. • • - I
2. For added visibility,a truck-mounted meow board or PCMS in caution -A l
mode may be used. �h.•
3. Cones shall be placed along the entire length of the work space. II a
protection vehicle is used and work is in place one hour or loss,the vv aSc l ha Vehic r,1 • _le -'s
Sec Chapwd - 111dra
raper and tangent devices may 4 omitted.
4. If the speed Is 45 mph or higher,volumes exceed 2000 ADT,or them --
is limited sight distance,consider placing cones or tubular markers on
centerline. IC
MNae11 • M
5. An arrow board in caution mode or lruek+nounted PCMS with I • f
'SHOULDER WORK or other appropriate message nay be used for •i _higher visibibly.
Sign Spacing and Curler Lengths(feel]
Posted Spacing Between Skins But for I A
Speed. . A B.. ' C,. .,Space __.__ I Bono
'10 50 menu:
�•
NaAReirs
25 100 100 100 75 1
30 100 lapelaranl Uhl.
35
125 IDpt:m..p
40 350 350 350 1� a
11010*:r•wrd. I B
hin
45 1e0 •reunr•n+ry55
t
50 500 503 500 210250
1100 Iwo- j I ' x
51 n 5,aain, m
end Butlert, ;l I eel a• tennt -- 1
Pored Spada.Between SI•ns 'Butler Iw eWeal
e_t
Ste
5 red A B_ urn 5•aeo
60 285
casras Q 700 700 700 ®oxanber tall bnmmbnrml1 Gune,5
70 1E1E11
SW 93rd Ave.. Indicate North
SIDEWALK SIDEWALK
ROW ROW
34' 5' 7' o
B re Line 90' ♦ A L+
tree
d tree
i o
9280 76'
Property Lines
Streetlight • o ►
PED
cn
SLOPE
C
m
D/W
9260
_ m
C)
m
V •
•, . Work site address:
14370 SW 93RD •
AVE, 97224.