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PFI2020-00470
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT ' s. COMMUNITY DEVELOPMENT Permit#: PFI2020-00470 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/08/2020 Parcel: SEG264 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast#239007 Project Description: Bore one 2" HDPE for Comcast from pole#4682 at 7134 N under road and ROW to dmarc on house 7113 unit B at min depth of 36" Class of Work: FEES Type 1 -Utilities(gas, electric, data) Description Date Amount PFI Permit Fee 12/08/2020 $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.gov to schedule inspections online. Contractor: PHONE: Applicant: RANDY SHIELDS PHONE: 5035963996 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: 16TO 0eAlt•telorb Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2020-00470 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 MATERIAUCONSTRUCTION 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 1 APPLICANTS NOTE: Person pecuied is—Ail! n -h,ll its k ign.oc i'•Pernuties".md•ball pit pride financt:4 assurance Inr uark.if required In the on pur._ ".II I;1 41411. With ita cur ca.<� rarr.-t.:, _.-_. " n n •_:.r•: I n•i t•,;u.l.irhn r•. ,a Cif.:wl.in.ptiucam a:c.Mitten.pnp4.•I c Ip•ht:c:i, I.ft c p 41 r 4 I. c.i a i i..I..p .n:.sl..,xaa .rutM.l.:,u,n io.•o flit.•trra:r o3 m cot.d:h.•iw:a I n. ,..:u ,a... ,p,: ,. u:tits •px, p., .134 .,,lam.uneta anria•ntation wait dux ai la:u.rnt btanwhwd Incin..i l .:I;:r.,u.c., •h.•ur•.a'.._G-ran.:t...,l. .p litav,p I,the.rppIieant,cen11t that • To the Lest of inn latuu'kd};c,.ill Ills mtonn.m.nl ht.rl!Ad tritium this Applicants)ptck:Igc It crnnpletc and accurate. • 'I'h.Bisset request d.•c•s nu ii t ululate in rev.•riled deed restnctn nis that ii i'lie.nt.lehed to or imposed upon the sulnect pn•pent. • If the appheattnn is granted.I uw41 exercise the rights cranlcd In accordance uith the terms and subject to all the cunt ' ins and hnut.Itiuns If the.Ipprur tl. \mow 12 Applicant's air .audlwin.d agent's signal ure Prim nitn a I).it i Prupem nonce s signature(if reyuircti Print name STAFF USE ONL\• Case No: 124 I—1 1 a 1 atit fee ,��.� Received by: Dart: , Approved hy:it `) G Data 12I3A D Notified by: pate:_2 Zt'�10 air o/Tigard • 1312.;i\l1 Ian nli.l. • II:.:d.I it,c••n'i?ri • n.tu.L!..n'.t • ',.:i-II,242: • Page 2o)4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PE])Permit:: INITIAL PH PERMIT FEE Part 1: kcyuirsd.uhtnitral rice is lit'..ujtl:c Ner I'I I Pcnnit I e are bchwc lisr calrulajnns.\]irimum u1$300. NET PFI PERMIT FEE Pan 2: .1.11 non water syvcm itopruscnianrc iniginece.cst:mutc X":.•(lass tht usual PR Pcmnt WATER LINE CONSTRUCTION FEE Pan 3: All public u-:nr:.l stem imprtltctnents en;:neei s cetj:nate X 12'•l,. FOR STAFF USE ONLY FOR STAFF USE ONI.1" TYPE 4:SMALL WIRELESS FACILITY TYPE]-3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS j'. Dort applicant havea tighonhway Geer.,% El1'c. ID No TYPE I AND?1'PE 2-blast Include a sketch showing: �., L'nde.the uncle's faahuc,standard:.u the prop lad all mns'ldetrsl.' check that a s rl ❑ Uimcnsuasr iIS >): 0 Small Cell 0,loan' ❑ Strs:ei Nance I IOW nun instal sites are n, ❑ Site.Adamsn ! p puscJ ai par.ui this pcnuu application> TYPE 3-Must provide 4 sees of plans(sized 24 a 36 or 22 x 34)and an electronic version of all submittal The pnposcd equip:ucrt is located nu which of the ioi a u:g: items. The plans must that include: ❑Plc Might-of-Was ❑Pusate Prnpeuy 0 t_rl\tr-Sue, traJl. .%Girl l Inch.11.l.ertu'. If equipment is to be located ran private prslprru;deseabe die ❑ c;t-,wrJ Sums Ilicy,Wider,Neu ee,yte.) type R use: ❑ Strut(Plan,Prntile) • Water,Sturm and Sanitary',Tian Pn'ida) 0 Winer Quality Facilities ❑ (trading ❑ landscaping/Tyre Plan 0 Cana ate Unlit!Plan(llcratral,Phone.Gas.Stuns. Samar•,Water,Siyrlage,Street flyht>,esc.i 0 Orui!, ❑ Traffic.Sight Disunite ❑ Signing and Striping ❑ Street Light Plan and Phntnntenir iJ Engincen seal/signature ❑ Sheet label;limiter land use name,rrs Ginn and play; k,i;black,dates and%him numbers.) ❑ Eno:eel',Cnronnetinn listimatc . -9dJitirmairSul>mitwb (per land we a uruiiuuns,tf applierb!e} ❑ Traffic Kelton ❑ Sturm water Dnuagc Calculations ❑ Gnucchnical Report 0 Prelimrnary Access Report tSighr Distance, ❑ Proposed Plat ❑ Prima):I)csign ❑ Cater Pas-rider.lppnna City ofTiw.trd • 1112i NW Hull Klyd. • igarJ.t It ,.n t"s; • u•c',m:. at,,,4,,: • .1,0 -l..,-242 • rage of-4 1, I Work site address: SW 72"d Ave. 7113 SW MAPLELEAF ST Indicate North UNIT B, 97223 FOC EOP ROW a A T Proper*/ Lines Pole 46:2 Bore line 44' • -- r D/w 7134 D/W 7113 UNIT 7113 B 12' $' Road 25' 4 No s ope C ROW g 7)i frn D/W '1'I co SW 71 ST Ave. Pave 04 2011 Edition 2011 EdImn ,c BS ,Stationary Lane Closure.with Flagging, „Diagram_320 Stationary Lane Closure with Flagging...:. , Diagram 320 roadway. 72e covers total closure of ono lane of two-lane,two-way both dire See of detailf inset l fvr the a rout a(less using a single 400 flogger i control COIN distance of Imll"mse be volume roads(kss than 400 PDT)with good I sight distance as discussed below, m 1. Use truck-mounted S flashing worming fights envied$l and protection - 8jq; -`` •+• O vehicles. Sae Section 4.3-Lights and Lighted Signs for exceptions. E 2. For added vis4hlkly,a wnl ck- ounlad arrow boats caution PCMS In utienCO a mode may be used. g �� R o 3. Flaggers at each approach are required if any of the following e fl I F- conditions exist' a. NightWork space .- _ = b. Work s Is over 200 feel in length, a Sight distance is less than 750 tent fmm each approach 5 through the lane closure, -- -- . II d. TroEe volumes are gloater than 000 PDT. I l • • ; . ig 4. The length between Me Flogger Ahead signs shall rot exceed one �-:a j j gg m mile. Use Diagram 340-Lane Closure lh Pilot Car if exceeding one ,�/ r, t '�'� ` ///aP mt. V • 5. Cones should be used to outline the work space when curves or other is 6!• • _1 g roadway alignments prevent clear direction for the motorists to pass o -- a5 the work space safely. m w /i.qi� is I `m u )i 6. Cones along the work space me recwmnomed when posted speeds .n g •, • ar0 45 mph or greater.when working under heavy traffic or when travel o t. lanes are narrower than 11 fenti I .86g R - • 7- Extended queue signing(see Diagram 5-4)should be used when _ v' -I- • traffic queues extend beyond `o - ( j / q the initial advance warning sign. t 7! f7-' 8, When flogging newan intersection,the'Nagger Ahead'(CW23.2) m r V— sign should be visible to traffic entering irons any side road-Additional / advance warning and Flogger Mead symbol signs new be placed on I ale se.Aro.<sw.s..r..e•N 4 T Y \ the side road(s). ! i2---- IltiTAI �. �.,,_ 9. Sign set-up and gagger placer/mill shown may be Load for intermittent SYA...rrs+k © re ��® �- ILA road closures mnulcsaless. _ fir, 4•�e.•'�.r4 10.The'ONE LANE ROAD AHEAD'(W20-l)atgn Is optional end should ....r NE= mimm he consklcred on high volume or high speed roads.Illwhen extended `,, CIIICI� queues are expected. p 4* Ilea sw<Inr.rd Buffer teunn.1r0•1 Sir stemant :Mawr5 a•r+rnmer 2011 Owed spetl_ owwntlasi nt 'Behr. pncm4w:011 - GWH0t-5 Spam A -B e 5 rce 60 205 65 700 700 700 325 70 365