PFI2020-00508 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
,r COMMUNITY DEVELOPMENT Permit#: PFI2020-00508
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/30/2020
Parcel: SEG1826
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast#348984
Project Description: Bore one HDPE 2"from ped at 9490 W 7'then N under S/W and road to meter on house 9425 at min
depth of 36"
Class of Work: FEES
Type 1 -Utilities(gas, electric,data) Description Date Amount
Total
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: 3603011962
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: 161111,0 14/1 `1`n0^`�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12020-00508
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
r City of Tigard PFI#1 2020-00508
■ t NGINI.t.l(ING I)1•P 1ITI MI N I
17111
TICARD. Public Facilities lmprovernent (PFI) Permit
PROJECT INFORMATION TYPE OF WORK
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SITE INFORMATION
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SEG 1826
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APPLICANT INFORMATION a .,n ::" a' 0
Name: - 1 '
Mailing addrets: v.,, 4'0j" f K I'.,Ll
I\I'!.4-.N*-Al'.c t Tmhn,iq`S
Y
(itl'-Statc: , • ' I' -Zip: } i --- _ I t i'P:S-'I:uul'(rcnfz
Ph..nr: - • ' ' '
PIUmr: ' -` .•_ NI II I mi 2 alry•iK.mmu m., ix
Cc ntact name: `•'.t`, `j '; .._--.
mail.
CONTRACTOR INFORMATION 0 Saint'as applicant
Nan c L_if v _L.;I t_i-l. . I-X.1k Numh.r.
1.: . cd • ,, Ft`4r. (arc St ii; i , i• 1
�laJitll;ulkln �: I
Phone: 111 �%'i t'}`S1, _— I.n)atl: i • , . ;
ENGINEER INFORMATION
Nang::
Mailing address:
l.in Simi:: /.ip:
Phone: Enrol:
ADDITIONAL INFORMATION
�41A nn•
(a shin the public right .t=Wa))
Ectirtarrd caluc t.i u..rk is rcgalnli it ",�....
Is ni.rk rrlatcd to a I.1NI)I•til' I)1.I:I:-It 1\r 0 1"c' ,1.\o t'alc numix.
Ciny ofTiganl • I:I?;Sty (IaII l53tl • 1 cant.(ing.,n'1'?J:. • uu 4 tlran1.n.);.it • Hat^1++.74'I • Page!of4
APPLICANTS •
NOTE: Person specified a` \ppbr:rr.•..,hail >.'i.•t,mami"Pcrmntee'and shall pn n nit Iinan:iaLnar.r tic f,r
work,if required In the an purslant Its I Ait- 5.414.1 JU.
• Pith tic curets to.d i.actin•.atsnr:¢F.a• .u`..,. ...!rt i s!tr. itt. r:a to!h era 4 tr. .»tat anal.i..
arc tif&tunt p•,pr.lit- pr'nmt It'u.? 1. ... ,:d 14•a.rtY •:.a:aul at a., nuia,r r',c rn01r6.t.•i_7
.,t an sIcnt ni du,++nil. flu I.0 KI nail!.t¢r ri:•apply n.un m do.p..pn•a+,L,I•a.nAvnn•arsmn mrfam.am.r.a'I
appLuu..1 ftmJu+aJ•a ixen.al du•»awn'•.iniz u..m the.pplutam.
I,the applicant,certify that;
• To the best of me knuwlcdg.,all the inn win won pruvnkd within this application package is complete and
accunite.
• The above request dates not sudatc am rya sided deed restncta.ns that ins• Ix attached it t.r unpi•sed upon the
subieet pn Tent.
• If Ihu applicanun is granted,1 will exetrn:the rights sramc.I in:aa.idancc with the terms and subject a.all the
cunditiuns and limn ations.of the approval.
M— ! Irv"` I V ottzt Am 1217eef o
.\pplieant•s'Sr authuriz.d agent's,it•naturc Print narne Date
proper uwncr's signature cif requircrb Print clam: Date
_\u 12/2
SFAF I.USE ONLY
Disc
Pcnrit feu: --Cr Received bt: I S Dare: 9/20
Approved by: Ye"+ B Daic tit(ZA(—LcNoriftcd by: At D2te:1 '2I240
(:1n. of li�anl • 13125 SVI. fall Phai. • 11.arji t kce.m':-. I I • ;Ii••Ih2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Fadliry Improvement(PFI)Permit:
INITIAL PF1 PERMIT FEE
Part 1: Required submittal fee is Rt..of the\ea 1)1.1 Permit Fee.See below Ira calculations.Minimum of S3IXI.
NET PFI PERMIT FEE
Part 2: All nun•aater system iniprowemente ettl;incers estimate 5'%+i(less the initial PH Perna:Fee).
WATER LINE CONSTRUCTION FEE
Part 3: Al!pulslic wetter ststem imps mt.-menus engineers estimate X
FOR STAFF USE ONLY FOR STAFF USE ONLY'
TYPE 4:SMALL WIRELESS FACt TY TYPE 1-3:DETAILED SUBMITTAL
CHECKLIST REQUIREMENTS
TYPE I ANDTYT•E 2•Slum in,!ids a scidb
Utss applicant harc a fight fit ass Lcuuc? C)VC!, 1- shooing:
I'nder the aimless facline.,stundanls,is the proposal Dimension•
considered?(check di that apply): D Small Call D Macro D Street Name
0 Site:\sdre,,
Huse many install sites are pu,poscd as pan of thit Neu:
appiiratiun? TYPE 3-Must prusidc 4 sets or plane(sized 24 x 36
or 22 x 34)and an electronic versiun of all submittal
The proposed equipment is located Oil Sihich of the following! isens_c. The plans must that include:
D Public Right•nf-\Cap 0 Private Pnspem ❑ Co;cc—Site.\:deity Abbresveon.legend
0 General Notes tLin.Witter.Sewer,etc.)
IC equipment is us be located on private pruprm',describe the Star(Plan,Profile)
tile)
n}x K use:
❑ Water,Sauna seas Saunas(Plan Profile)
❑ Water Quality Facilities
LI Grading
o t.:usdsetpung/Tree Plan
❑ Composite Utility Plan IKkcincal,Phone,Gm,Sturm,
Sabine:,\G'ater.Siimalyc,Street Lights.elc.j
(] Details
`'''1
L3 Traffic Si the Dtatance
u Sigiin1 anti Striping
D Sneer I ight Plan and Photon etric
❑ lasp•;necn seal/signature
❑ Sbecrlabel(proicee land use tuna.revision and plan
log block,dates anal sheet mambas.)
❑ Fnpra d.Coastmcnnn t suivte
Additional Submittals
(per land nee conditions.if applicable;
❑ Traffic Report
❑ Sunrn u•aur Drainage C.aieubtinm
❑ Gernechnical Report
❑ Preliminact Access lteport(Sight.Distance:
C3 Proposed Plat
❑ Pathway❑cugn
❑ Water Provider Apprr ral
Ciry of Tigard • 13123 Slit I Tall l Isd, • Tigard,Oregon 9'221 • u-' nuardoir.gua • Si tl"I n-2421 • Page 3 of 4
1'aye 04 2011 Ed lion
2011 Edition Page 05
Stationary Lane Closure.with.Flagging , Diagram,.320; -,„ -
Str;ijalary+L+ah �xl.4alroiwitli; 1 gigratni320
Diagram 320 covers Iola)closure of one lane of a fwo•Wna.two-way
roadway. See the detail Intel for the layout if using a single gagger to control
both direction of traffic on low volume roads(less than 400 ADT)with good • '
sight distance as discussed below.
. 0 I. Use lack-mounted flashing warning Miles on work and protection
j" g
vehicles. Soo Section 4.3-Lights and lighted Signs for exceptions.
2. For added visibility,a truck-mourned arrow board or PCMS In caution x a-,
made maybe used.
3. Fleggers at each approach are required it any of the following : S -
Condilbffis exist
NightO E' ®
A Night _I F-
Opumlions.
b. Work space Is over 200 feel in length, •ei
c. Sight distance Is less than 750 feet from each approach
through the lane closure,_ In
d. Traffic volumes are seater Than 400 ADT. x
'I. The length gger Ih between the FW .x Ahead signs shall not exceed one '® :x j 1 t •% / S
1 �
.
mile. Use Diagram 340-Lane Closure with Pilot Car it exceeding one
mile. x I ig i. 8.. u.w
- i
5. Cones should be used to outline the work space whom curves or other I. . --
roadway alignments prevent clear direction for the motorists to pass l _ -a tn the work space sorely.
w. r Ili Is 1e.
ii. Cones along the work space are recommended when posted speeds 0. It
are 45 mph or greater,when working under heavy traffic or when travel g t•.
lanes are narrower than 11 feet. g�k
> -
8
1-9Z t
4.
Extendedqueues queue extend
be(silo Diagram 5-4)should be usedi when
traffic queues axsond beyond the initial advance warning sign. a- ®t — 'r-
0. When flagging near an intersection.the-Flogger Ahead'(CW23-2) N �1 T 1
sign should be visible to trellis entering front any side road. Additional 4 •-
advance warning and Flogger Ahead symbol signs may be placed on s:n,Spacing U.5.li.w V..
the side road(,), IWM: e ...'egad, .us� , e ,.
sow., .. e n.
10
9. Sign set-up and Dagger placement shown may be used for inlonmttenl l.evb„•,nhsr, 36 w I - o
full road closures o120 minutes or leis. as '^+ Ire no isaston
. ..a•.."x N 3'. x0 ID re
10.The'ONE LANE ROAD AHEAD'(W20.t)sign is optional and shouldv.v '°
he considered on high volume or high speed roads,or when extended -.. .r KO son sum �w
queues are expected. x re
-linters 4 a5naein•..4• , en axe M1.1 't, lumen
OerAnce:r 2011 nelte4 t-ad
CerneLee 2011 -a.rwmM1 St..._-suffer-
tend A e• e. •s.are C1'-,nuni
mEns
m 700 700 700 NM
70 365
Work site address:
93rd AVE. 9425 SW INEZ ST. Indicate North
e
SIDEWALK
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12'
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9385 I co
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D/W I �'I =_
C. ,' , 9390
D/W
Property lin I 1
4-- — �, PED
Bore line 78' _-
7'
D/W @r
9425 ..
•f �_- 9430
r I D/W
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