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Permit
CITY TIGARD SITE WORK PERMIT Aj 01/07/ DEVELOPMENT SERVICES PERMIT # : 9 -00076 4 DATE ISSUED : 01/07/2000 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11834 SW PACIFIC HY PARCEL : 2S101 BB -00301 W SUBDIVISION: TIGARD ROAD GARDENS ZONING : C -G BLOCK: LOT: 001 JURISDICTION : TIG CLASS OF WORK: ACS PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: $30,000.00 EXCV VOLUME: cy LANDSCAPING ?: Y FILL VOLUME: cy SITE PREP ?: Y ENG FILL ?: STORM DRAINS ?: Y SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: All AC removed and replace with new - New parking plan. Owner: FEES EQUIVA SERIVCES/TEXACO 3800 ST HELENS RD Type By Date Amount Receipt PORTLAND, OR 97296 FIRE GEO 12/20/1999 $118.60 99- 320262 5PCT BON 01/07/2000 $23.72 00- 320999 PRMT BON 01/07/2000 $296.50 00- 320999 Phone: 503 - 225 -4223 EROS BON 01/07/2000 $80.00 00- 320999 Contractor: ERPU BON 01/07/2000 $26.00 00- 320999 PACIFIC NORTHERN ENVIRONMENTAL ERPC BON 01/07/2000 $26.00 00- 320999 1081 COLUMBIA BLVD. PLCK BON 12/08/1999 $192.73 99- 320262 LONGVIEW, WA 98632 Total $763.55 Phone: 360 - 423 -2245 Reg #: LIC 00078140 Required Inspections Erosion Control lnsp 844 -8444 Paving Insp Strm Drain Insp Culvert/Catch Basin ` a ' fl San Sewer lnsp .. Domestic water line inspect. Landscaping Insp Final Inspection 0 R • " This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules as :: -. • • I •regon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thro = • • ' • �.:_-0 ou m bt 'n copies of these rules or direct questions to OUNC by calling (503) 24. 1987. Permittee ; • atur: WNW 11 Issued By: r �--- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day .1 CITY OF TIGARD Site Permit Application Plan Checly#t 2 13125 SW HALL BLVD. Commercial and Multi -Famil : Com lete ENTIRE form Recd By f1f/� [1 G1 y P Date Rec'd (2— r'1 TIGARD, OR 97223 Residence: Complete SHADED areas Date to P.E. /g - 26/ - 44 (603) 639 -4171 x304 Date to DST /Alt / Permit # S 7 ` / ff 9 6 oO74 Related SWR # Print or Type Called 12- Z1 - `I`' Incomplete or illegible applications will not be accepted Project Name Utilities (Complete all that apply) Job Texaco Address Address Storm Sewer 11834 SW Pacific Hwy 106 Linear Ft. Name Sanitary Sewer Equiva Services/Texaco 0 Linear Ft. Owner Mailing Address Fresh Water 3800 St. Helens Road 147 Linear Ft. City/State Zip Phone Catch Basins Portland, OR 97296 225 -4223 # 1 General Name II �l,' --..,, r Clean Outs Contractor ?a_p c, P J � .i iIA 1' UVt llmA t # 0 Prior to permit Mailing Address Describe work to be done: issuance a New❑ Addition❑ Alteration Repair❑ copy of all licenses are City/State Zip Phone Additional Description of Work - required d expired in COT State Const Cont. Board Lic. # Exp. Date All AC removed and replaced with new - New database parking plan attached. Name Project The Rummel Architectural LLC Valuation $ 30,000 Architect Mailing Address Plans Required See Matrix on back 1200 NW Front , Suite 550 The following, must accompany this application. City/State Zip Phone Site plan with Vicinity Map Parking (including Portland, OR 97209 227 -5844 X Showing ADA compliance X ADA) & Lighting Plan Name Grading Plan and details Landscaping Plan WRG Design, Inc. X X Engineer Mailing Address Erosion Control Plan and Retaining Structures 10450 SW Nimbus Avenue, Suite RA X details X including calculations City/State Zip Phone Site Utility Plan and details Soils Report (showing connection to (if required) Portland, OR 97223 603 -9933 X approved system) X Excavation Volume I hereby acknowledge that I have read this application, that the (Soils report required for >5,000 cu. Yards) information given is correct, that I am the owner or authorized 0 cu. yds. agent of the owner, and that plans submitted are in compliance with Oregon State laws Fill Volume Signatu of O gent Date (Soils report required for >5,000 Cu. Yds.) 0 dpiddj2.14olqci cu. yds. Will the fill support a structure ntact P Phone (Engineer required if answer is yes) YES❑ NO❑ �a�annl pAI -SNaSa, me Dev. Coordinator 603 -9933 Retaining structure? (check one) :pock FOR OFFICE USE ONLY i ❑ CMU Notes: ❑Concr e ❑Oltt�r Total new impervious area including all Land Use Ca Map/TL# buildings, sidewalks, and paving 0 Sq. Ft. —J" r 1I 17 — 10/30/98 1i1 tii 0 41 I6 (90 1.T3 16 u3 A2.1 1 5 A Vb11 -11) � t 16144 -oo©7b 7r or " 0 N APPLICATIO AND PERMIT TO OCCUPY OR PERMIT NUMBER PERFORM OPERATIONS UPON A STATE HIGHWAY 2 ER M 3 6 9 • See Oregon Administrative Rule, Chapter 734, Division 55 5 0 GENERAL LOCATION PURPOSE OF APPLICATION (TO CONSTRUCT /OPERATE /MAINTAIN) HIGHWAY NAME AND ROUTE NUMBER POLE TYPE MIN. VERT. CLEARANCE SW Pacific Highway II LINE HIGHWAY NUMBER COUNTY ,BURIED TYPE 1W 34 = WASHINGTON CABLE BETWEEN OR NEAR LANDMARKS PIPE TYPE W SW Garden P /ace and HWY 217 II LINE HWY. REFERENCE MAP DESIGNATED FREEWAY IN U.S. FOREST 5B -24 -2 n YES IXI NO fl YES [X[ NO Ti NON- COMMERCIAL SIGN APPLICANT NAME AND ADDRESS MISCELLANEOUS OPERATIONS AND /OR Equiva Services (XI FACILITIES AS DESCRIBED BELOW 3800 NW St. Helens Rd. BOND REQUIRED REFERENCE: AMOUNT OF BOND Portland OR 97296 IXI YES n NO OAR 035/21 734 -55 cost of project INSURANCE REFERENCE: SPECIFIED COMP. DATE 503 - 225 -4223 ® YES ❑ NO OAR 734 -55 035/11 4.30.00 DETAIL LOCATION OF FACILITY(For more space attach additional sheets) MILE MILE ENGINEERS ENGINEERS SIDE OF HWY OR DISTANCE FROM BURIED CABLE OR PIPE SPAN POINT TO POINT STATION TO STATION ANGLE OFCROSSING CENTER OF PVMT R/W LINE DEPTHNERT. SIZE AND KIND LENGTH 8.70 8.74 57 +77.2 59 +88.4 East DESCRIPTION AND LOCATION OF NON - COMMERCIAL SIGNS OR MISCELLANEOUS OPERATIONS FACILITIES This permit is for curb and sidewalk improvements. Also for closure of access at MP. 18.73 SPECIAL PROVISIONS (FOR MORE SPACE ATTACH ADDITIONAL SHEETS) TRAFFIC CONTROL REQUIRED - OPEN CUTTING OF PAVED OR SURFACED AREAS ALLOWED? 1 IXI YES (OAR 734 -55- 025(6)1 n NO • 2 [X] YES (OAR 734 -55- 100(21 n NO (OAR 734 -55- 100(1) 3 AT LEAST 48 HOURS BEFORE BEGINNING WORK, THE APPLICANT OR HIS CONTRACTOR SHALL NOTIFY THE DISTRICT REPRESENTATIVE AT TELEPHONE NUMBER: 503 - 229 -6542 OR FAX A COPY OF THIS PAGE TO THE DISTRICT OFFICE AT: 503 - 297 -6058 SPECIFY TIME AND DATE IN THE SPACE BELOW 4 WITHIN 30 DAYS OF COMPLETION OF THE PROJECT THE ATTACHED NOTICE OF COMPLETION POSTCARD SHALL BE SIGNED AND RETURNED TO THE DISTRICT OFFICE. 5 A COPY OF THIS PERMIT AND ALL ATTACHMENTS SHALL BE AVAILABLE AT THE WORK AREA DURING CONSTRUCTION. 6 ORS 757.54 TO 757.571 REQUIRES EXCAVATORS TO LOCATE AND PROTECT ALL EXISTING UNDERGROUND UTILITIES. YOU MAY BE HELD LIABLE FOR DAMAGES. CALL FOR UTILITY LOCATES. CALL BEFORE YOU DIG. 1- 800 - 332 -2344 COMMENTS 7. All work shall comply with this permit and the attached 3 pages of provisions, and approved plans to the satisfaction of the District Manager or his representative. 8. Any work not in compliance shall be removed, repaired to meet the approval of the District manager or his representative. 9. Refer to permit # (r n A A 3 5 5 4 O for access improvements. IF THE PROPOSED APPLICATION t WIILL AFFECT THE LOCAL GOVERNMENT, THE APPLICANT SHALL ACQUIRE THE LOCAL GOVERNMENT OFFICIAL'S SIGNATURE BEFORE ACQUIRING THE DISTRICT MANAGER'S SIGNATURE. LOCAL GOVER , , NT a /AL SIGNATURE TITLE DAN 1 � X _ r 1;e-- Ge►7<ea -cr IL� /tC�hJ E- , V. lCe � 410.0 ..i. TELEPHONE NO. APP ,;.r'v � r� J 4 /Jl// DAT T /TL ; ' - subject REPRES NTATIV '!'^ When this ion Is approved by the Departme the a pp /cant is APPROVAL DATE I ect to, accepts a • 'DISTRICT MA GE 0 R E approves the terms and provisions contained and attached: and the terms of Oregon Rules, Chapter 730, Division 55, which is by this reference made a part of this permit. v / n A L y -7t Mina 734- 3457(9 -96) •.• GENERAL PROVISIONS FOR POLELINE, 2 A M 3 6 9 5 0 . PIPELINE, AND BURIED CABLE PERMITS APPLICANT Equiva Services HIGHWAY 1W MP 8.70 -8.74 0 • WO ITE 1. Applicant must call for utility locates before digging (1- 800 -332- 2344). You may be held liable for damages. Pre - marking of excavation areas is required. 2. F Applicant shall have a copy of this permit and all attachments at the work site. They shall be available to the District Maintenance manager or representative at their request. 3. Contractor to acknowledge receipt of and review of, by letter, the Oregon Administrative Rules (Chapter 734 -55) governing miscellaneous facilities and operations on the highway right of way as the governing provisions of this permit or agreement. 0 4. Access control fence must be maintained during construction and restored to its original or better condition after construction is complete. �• in rmittee shall not use the right of way to display advertising signs or merchandise of any kind. 1 I�� . The stopping and parking of vehicles upon State Highway right of way for the maintenance of adjoining property or in furtherance of any business transaction or commercial establishment is strictly prohibited. �f 1 . All grass and small brush within the work area shall be rotary or flail mowed to ground level prior to the beginning of work to facilitate clean up. I Disturbed areas shall be reseeded with grass native to the area in an appropriate seeding time. . The spreading of mud or debris upon any State Highway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. Clean up shall be at the applicant's expense. The highway shall be cleaned of all dirt and debris at the end of each work day, or more frequently if so determined by the District Manager or representative. c Permittee shall replace any landscape vegetation or fences that are destroyed. Any damage that is not fully recovered within 30 days (weather permitting) shall be replaced by ODOT at the expense of the permittee. A "plant establishment" shall be understood to be part of the planting work to assure satisfactory growth of planted materials. The plant establishment period will begin when the original planting and all landscape construction has been completed and approved. The length of the establishment period will be one calendar year or as defined in the Special Provisions. 0 10. Applicant will install and maintain landscaped area as shown on the attached drawings. Planting shall be limited to low growing shrubs, grass or flowers that do not attain sufficient height to obstruct clear vision in any direction. The Commission or Engineer shall have the right to remove said landscaping at any time such removal may appear to the Commission to be in the public interest, without liability or loss, injury, or damage or any nature whatsoever. . TRAF 11 . The work area during construction or maintenance performed under the permit provisions shall be protected in accordance with the current Manual on Uniform Traffic Control Devices for Streets and Highways, US Department of Transportation, and the Oregon Department of Transportation supplements thereto. Flaggers must have a card or certificate indicating their completion of an approved work zone traffic control course. All traffic control devices shall be maintained according to the ATTSSA Quality Standards for Work Zone Traffic Control Devices handbook. 12. Contractor to provide a detailed traffic control plan for each phase of the work, showing signs and cones. Plans to be submitted for approval by the Distri t Manager or representative in advance of construction or maintenance. FA 13 . All damaged or removed highways signs shall be replaced by the applicant. Installation shall be according to MUTCD standards or District Manager's s ification, and shall be completed as soon as possible no later than the end of the work shift. 4. No lane restrictions will be permitted on the roadway during the hours of darkness, on weekends, nor between 6:00 AM and 9:00 AM, or 3:00 PM and 6:00 PM (Monday thru Friday) without prior authorization of the District Manager or representative. 0 15. Hours of work shall be: / /C / /r 2--W APPLICANT " /' � -F_ T REP DATE A , • �/ �` a;l--#.-. D AGE 2AM36950 16 . On site storm drainage shall be controlled within the applicant's property. No blind connections to existing state facilities. 0 17. Excavation shall not be done on the ditch slopes. Trench excavation shall either be at ditch bottom or outside the ditch area. (Minimum depth at bottom of ditch -36 ", minimum depth at the outside of ditch -42 ".) 18. Only earth or rock shall be used as fill material and shall slope so as not to change or adversely affect existing drainage. Fine grade and seed the finished fill with native grasses to prevent erosion. n 19. A storm drainage study will be required by a registered engineer meeting the standards of the National Pollution Discharge Elimination Systems (NPDES) when any of the following conditions apply: Whenever a 4" pipe is inadequate to serve the developed area, development site is 1 acre or larger in size and directly or indirectly affects state facilities, or as directed by the District Manager or representative. 0 20. An advance deposit of $ (Order to Render Service) is required for ODOT Hydraulics Engineer (Bridge Section) to review and approve storm study calculations. 17 21. You will be required to provide "on site" retainage for storm water run off that exceeds that of undeveloped site. 0 22 Storm drainage study shall be a 10 year, 25 year, 50 year, 100 year, other. 0 23. All water discharged to an ODOT drainage system will be treated prior to discharge. All requests for connection to an ODOT storm sewer will meet any requirements of the National Pollutant Discharge Elimination System that could include: local jurisdiction approval of on site water quality treatment facilities, development of an operation and maintenance plan for any on site water quality treatment facility as determined by local jurisdiction. EXCA ION /CONSTRUCTION 4. Open cutting of pavement shall only be allowed in areas specifically approved by District Manager or representative. n 25. Trench backfill shall be according to the attached typical drawing, marked as Exhibit A . 0 26. Open cutting of the highway will be allowed with construction in accordance with OAR 734 -55 -100. All excavation in paved areas shall be backfilled and the roadway surface patched before the end of each shift. In special cases where steel plates are allowed, said plates shall be pinned and a temporary cold patch applied to the edges. The permittee shall be fully responsible for monitoring and maintenance of temporary patching and steel plating. 7. Compaction test will be required for each open cut per ODOT Standard specification for Highway Construction. Tests shall be conducted every .5C) LF per £9 Lift of a continuous trench by standard AASHTO T99 method. At the discretion of the District Manager or representative, results of such test shall be provided to District Manager or representative at applicants' expense. n 28. Control Density Fill (CDF) shall be used as surface back fill material in place of crushed rock in open trenches that affect the travel portions of the highway. A '4 "-0 rock will be used for the aggregate. The amount of concrete used shall not exceed 3% of the total mixture's weight. Maximum compressed strengths must not exceed 100 -150 psi. 9. Surface restoration shall be a minimum of 6" of hot AC, or match existing AC depth, compacted in 2" lifts, whichever is greater. 0. All rock shall be from an ODOT Certified material source. 1. Any area of cut or damaged asphalt shall be restored in accordance with the attached "T" type drawing. For a period of 2 years following the patched paved surface, the applicant shall be responsible for the condition of said pavement patches, and during that time shall repair to the District Manager or representative satisfaction any of the patches which become settled, cracked, broken, or o e ise faulty. c � /l'' Z —Cys APPLICANT /5/_„ �� /-' ODOT REP DATE dLT' ! D"iq�s�'' 2AM3f$95 H 32. An overlay to seal an open cut area shall be completed prior to the end of the construction season, or when minimum temperature allows per ODOT Standard specification for Highway Construction. Typical overlay shall be 1 'fe" deep and cover the affected area from edge of pavement to edge of pavement, and taper longitudinally 50' : 1 ". Taper may be adjusted by the District Manager as required. For a period of two years following this patching of the surface, the applicant shall be responsible for the condition of said pavement patches, and during that time shall repair to the District Manager or representative's satisfaction any of the patches which become settled, cracked, broken or otherwise faulty. 1 - 133. Highway crossing shall be bored or jacked. Bore pits shall be located behind ditch line or in areas satisfactory to the District Office. Unattended pits shall be protected by a 6 -foot fence or shall be backfilled or steel plated and pinned. 0 34. Applicant shall install a "tracer wire" or other similar conductive marking tape or device, if installing any non - conductive, unlocatable underground facility, to comply with the Oregon Utility Notification Center, One Call System (per OAR 952 -01 -0070 (6). n 35. Trench backfill outside of ditch line or in approved areas can be native soil compacted at optimum moisture in 12" layers to 90% or greater of the maxim ensity. 36. Native material found to be unsatisfactory for compaction shall be disposed of off the project, and granular backfill used. 0 37. Trench backfill in rock slope or shoulder shall be crushed 1 " -0 or 34"-0 size rock compacted at optimum moisture in 12" layers to 95% of maximum density by standard AASHTO T99 method. 0 38. Where excavation is on fill slope steeper than 2:1 slope protection shall be used with 4" size rock laid evenly to a minimum depth of 12" 0 39. No more than 300' of trench longitudinally along the highway shall be LEFT open at any one time and no trench shall be left in an open condition overnight. 0 40. Areas of disturbed cut and fill slopes shall be restored to a condition suitable to the District Manager or representative. Areas of erosion to be inlaid with an acceptable rip rap material. 111 41. All underground utilities shall be installed with a 3' or more clearance from existing or contract plans guardrail post and attachments. All non- metallic water, sanitary and storm sewer pipe shall have an electrically conductive insulated 12 -guage copper tracer wire the full length of the installed pipe using blue w' for water and green for storm and sanitary sewer piping. 42. Any area of cut or damaged concrete shall be restored in accordance with the attached Typical Section -Pipe Section under sidewalk. 111 43. Signs and pedestals shall be placed as near the highway right -of -way line as practical. In no case shall pedestals and line markers be located within the highway maintenance area. n 44. No cable plowing is allowed within the lateral support of the highway asphalt (i.e. at 6' lower than the edge of the asphalt, no plowing with 9' of the edge of the asphalt). 0 45. All pipe and bridge attachment hardware shall be submitted to the ODOT Operations Structural Coatings Coordinator for approval. n 46. Expansion joints of an ODOT approved type to be located in the closed proximity with the expansion joints of the structure. ODOT Bridge Office Practice Manual attached. n 47. Adhesive anchors only are acceptable for support brackets. For a list of acceptable adhesive anchors or more information, see the ODOT Bridge Office Practice Manual. n 48. Field drilled holes in the stiffeners and areas damaged by drill shall be painted with two coats of zinc -rich primer prior to assembly. Methods shall be approved by ODOT Operations Structural Coatings Coordinator. n 49. Neoprene gaskets to be placed between the mounting plates and stiffeners. ODOT Bridge Office Practice Manual attached. 0. Plans are approved in general only and does not relieve the applicant from completing the construction improvements satisfactory to ODOT. Field changes may be required by the District Manager or representative. When revisions are made in the f Id a built drawings will be submitted to the District Office. . .... ...- .:V___it,_,A.— !/ /r7/' yf APPLICANT %� Aiv i_ i % T REP DATE �� 5 tril99- X74, ° Transportation APPLICATION AND PERMIT TO CONSTRUCT APPROACH ROAD PERMIT NUMBER 2 AA3 5 540 • HIGHWAY NAME MILE POINT ENGINEERS STATION SW Pacific Highway 8.71 58 +30 HIGHWAY NUMBER COUNTY SIDE OF HIGHWAY APPROACH TO SERVE 1 W Washington n souTH n WEST Service Station BETWEEN OR NEAR REFERENCE MAP NUMBERS TAX LOT NUMBER . SW garden P /ace and HWY 217 58 -24 -2 301 APPLICANT NAME AND ADDRESS BOND REQUIRED REFERENCE AMOUNT OF BOND RI YES❑ NO OAR 734 -50. 025/61 cost of project Equiva Services INSURANCE REQUIRED REFERENCE RI ADMINISTRATIVE FEE 3800 NW St. Helens Rd. IW YES❑ NO OAR 734 - 50-025(31 ❑ TEMPORARY DEPOSIT Port /and OR 97296 AMOUNT CHECK NUMBER 50.00 1390 DISTRICT 6,L4f0alli PRESENTATIVE DATE APPLICATION APPROVED TELEPHONE N • BER: 503 - 225 -422 1 V � . (�(• / 2 �J C // APPLICANT CAT /ON DATE APPROACH ROAD COMPL TO / �/ I REFPr.ENCE o1a�3asc� pSLre 4-30-00 / T e applicant declares thaThe/sh - s the owner or lessee of the real property adjoining the above described h nd has tie iawyv/ aafnorlty to apply for this permit. When this application Is approved by the Department of Transportation, the applicant is subject to the terms and provisions contained herein and attached hereto; and the terms of Oregon Administrative Rule, Chapter 734, Division 50, which is by this reference made a part of this permit. Copies of the Rule may be obtained from the District Manager's office. Issuing of permits under these regulations is not a finding of compliance with the statewide planning goals or the acknowledged comprehensive plan for the area. Permits are issued subject to the approval of city, county or other governmental agencies having either joint supervision over the section of highway or authority to regulate land use by means of zoning and/or building regulations. It shall be the applicant's responsibility to obtain any such approval Including, where applicable, local government determination of compliance with the statewide planning goals. (OAR 734 - 50-0551 SPECIAL PROVISIONS 1 - -- If the proposed application requires traffic control devices and /or special road construction, the applicant shall provide a copy of this application to the affected local government. The original application must be signed by the local government official. LOCAL - OVER ' T al IAL SIGNATURE E ,- OAT X �� _ �afPµ61.r��tx� 12 low( 2--- Within 48 ho s before beginning work and after completing the permit work, the applicant or his contractor shall notify the District Repres •ntative at telephone number: 503 - 229 -6542 Or FAX number: 503 - 297 -6058 3. All work shall comply with this permit and the attached 3 pages of provisions, and approved plans to the satisfaction of the District Manager or his representative. 4. Any work not in compliance shall be removed, repaired to meet the approval of the District Manager or his representative. 5. This permit will close access at STA.59 +.30 and supercede permit #14590 6. Refer to permit # 2 A M 0 6 9 5 0 for sidewalk improvements. • TYPE 4 APPROACH ROAD - CURBED HIGHWAY NOTE: All material and workmanship shall be in accordance with the current State of Oregon Standard Specifications for Highway Construction I D r w y. I W= 9.2m W 10.8m x= 1.2m K = 1.8m I I ANGLE OF SKEW APPROACH TYPE CURB TYPE R/W Llne--‘ I __ I 1 ._ 1.5r A C �/ r A • \\ W _ \ - \ - NOTES: W= WIDTH OF DRIVEWAY c , AB \ ( / ► 5 +2 e < _ K= DISTANCE FROM FACE OF CURB TO BACK Q W \ \ / PRESENT OR FUTURE WALK OR 10 FEET, P / I WHICHEVER IS LESS 04 Conc Curb *C W t SEE TABLE A ON REVERSE • PLAN X= SEE TABLE A ON REVERSE 734-3307E18-961 SEE PAGE 2 OF APPLICATION GENERAL PROVISIONS FOR POLELINE, 2 A A 3 5 5 4 PIPELINE, AND BURIED CABLE PERMITS APPLICANT Equiva Services HIGHWAY 1W MP 8.71 0 WO TE 1. Applicant must call for utility locates before digging (1- 800 -332- 2344). You may be held liable for damages. Pre - marking of excavation areas is required. 2. Applicant shall have a copy of this permit and all attachments at the work site. They shall be available to the District Maintenance manager or r representative at their request. 1 .- 3. Contractor to acknowledge receipt of and review of, by letter, the Oregon Administrative Rules (Chapter 734 -55) governing miscellaneous facilities and operations on the highway right of way as the governing provisions of this permit or agreement. n 4. Access control fence must be maintained during construction and restored to its original or better condition after construction is complete. 5. The permittee shall not use the right of way to display advertising signs or merchandise of any kind. .The stopping and parking of vehicles upon State Highway right of way for the maintenance of adjoining property or in furtherance of any business transaction or commercial establishment is strictly prohibited. 7. All grass and small brush within the work area shall be rotary or flail mowed to ground level prior to the beginning of work to facilitate clean up. Disturbed areas shall be reseeded with grass native to the area in an appropriate seeding time. T he spreading of mud or debris upon any State Highway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. Clean up shall be at the applicant's expense. The highway shall be cleaned of all dirt and debris at the end of each work day, or more frequently if so determined by the District Manager or representative. la 9 . Permittee shall replace any landscape vegetation or fences that are destroyed. Any damage that is not fully recovered within 30 days (weather permitting) shall be replaced by ODOT at the expense of the permittee. A "plant establishment" shall be understood to be part of the planting work to assure satisfactory growth of planted materials. The plant establishment period will begin when the original planting and all landscape construction has been completed and approved. The length of the establishment period will be one calendar year or as defined in the Special Provisions. 0 10. Applicant will install and maintain landscaped area as shown on the attached drawings. Planting shall be limited to low growing shrubs, grass or flowers that do not attain sufficient height to obstruct clear vision in any direction. The Commission or Engineer shall have the right to remove said landscaping at any time such removal may appear to the Commission to be in the public interest, without liability or loss, injury, or damage or any nature whatsoever. TRAFF 1. The work area during construction or maintenance performed under the permit provisions shall be protected in accordance with the current Manual on Uniform Traffic Control Devices for Streets and Highways, US Department of Transportation, and the Oregon Department of Transportation supplements thereto. Flaggers must have a card or certificate indicating their completion of an approved work zone traffic control course. All traffic control devices s I be maintained according to the ATTSSA Quality Standards for Work Zone Traffic Control Devices handbook. 12. Contractor to provide a detailed traffic control plan for each phase of the work, showing signs and cones. Plans to be submitted for approval by the District anager or representative in advance of construction or maintenance. 13. All damaged or removed highways signs shall be replaced by the applicant. Installation shall be according to MUTCD standards or District Manager's cification, and shall be completed as soon as possible no later than the end of the work shift. 14. No lane restrictions will be permitted on the roadway during the hours of darkness, on weekends, nor between 6:00 AM and 9:00 AM, or 3:00 PM and 6:00 PM (Monday thru Friday) without prior authorization of the District Manager or representative. 015. Hours of work shall be: det% lC- APPLICANT // , 1 e T REP DATE /2- 2f-1 9 nGE 2AA3 54 16. On site storm drainage shall be controlled within the applicant's property. No blind connections to existing state facilities. 0 17. Excavation shall not be done on the ditch slopes. Trench excavation shall either be at ditch bottom or outside the ditch area. (Minimum depth at bottom of ditch -36 ", minimum depth at the outside of ditch -42 ".) 0 18. Only earth or rock shall be used as fill material and shall slope so as not to change or adversely affect existing drainage. Fine grade and seed the finished fill with native grasses to prevent erosion. 19. A storm drainage study will be required by a registered engineer meeting the standards of the National Pollution Discharge Elimination Systems (NPDES) when any of the following conditions apply: Whenever a 4" pipe is inadequate to serve the developed area, development site is 1 acre or larger in size and directly or indirectly affects state facilities, or as directed by the District Manager or representative. F1 20 . An advance deposit of $ (Order to Render Service) is required for ODOT Hydraulics Engineer (Bridge Section) to review and approve storm study calculations. n 21. You will be required to provide "on site" retainage for storm water run off that exceeds that of undeveloped site. 0 22 Storm drainage study shall be a 10 year, 25 year, 50 year, 100 year, other. F1 23. All water discharged to an ODOT drainage system will be treated prior to discharge. All requests for connection to an ODOT storm sewer will meet any requirements of the National Pollutant Discharge Elimination System that could include: local jurisdiction approval of on site water quality treatment facilities, development of an operation and maintenance plan for any on site water quality treatment facility as determined by local jurisdiction. EXC. . TION /CONSTRUCTION C 24. Open cutting of pavement shall only be allowed in areas specifically approved by District Manager or representative. F1 25. Trench backfill shall be according to the attached typical drawing, marked as Exhibit A . 0 26. Open cutting of the highway will be allowed with construction in accordance with OAR 734 -55 -100. All excavation in paved areas shall be backfilled and the roadway surface patched before the end of each shift. In special cases where steel plates are allowed, said plates shall be pinned and a temporary cold patch applied to the edges. The permittee shall be fully responsible for monitoring and maintenance of temporary patching and steel plating. 27. Compaction test will be required for each open cut per ODOT Standard specification for Highway Construction. Tests shall be conducted every 5V LF per CM LI Lift of a continuous trench by standard AASHTO T99 method. At the discretion of the District Manager or representative, results of such test shall be provided to District Manager or representative at applicants' expense. 0 28. Control Density Fill (CDF) shall be used as surface back fill material in place of crushed rock in open trenches that affect the travel portions of the highway. A'4 " -0 rock will be used for the aggregate. The amount of concrete used shall not exceed 3% of the total mixture's weight. Maximum compressed strengths must not exceed 100 -150 psi. r / 29. Surface restoration shall be a minimum of 6" of hot AC, or match existing AC depth, compacted in 2" lifts, whichever is greater. 0. All rock shall be from an ODOT Certified material source. 31. Any area of cut or damaged asphalt shall be restored in accordance with the attached "T" type drawing. For a period of 2 years following the 31. patched paved surface, the applicant shall be responsible for the condition of said pavement patches, and during that time shall repair to the District Manager or representative satisfaction any of the patches which become settled, cracked, bro n, o therwise faulty. I 2. 2 4 , 9 7 APPLICANT.,410 ,, ODOT REP eyl DATE �r -, ,� ■ i r 2A A35 5 0 32. . overlay to seal an open cut area shall be completed prior to the end of the construction season, or when minimum temperature allows per ODOT Standard specification for Highway Construction. Typical overlay shall be 1 1/2" deep and cover the affected area from edge of pavement to edge of pavement, and taper longitudinally 50' : 1 ". Taper may be adjusted by the District Manager as required. For a period of two years following this patching of the surface, the applicant shall be responsible for the condition of said pavement patches, and during that time shall repair to the District Manager or representative's satisfaction any of the patches which become settled, cracked, broken or otherwise faulty. 0 33. Highway crossing shall be bored or jacked. Bore pits shall be located behind ditch line or in areas satisfactory to the District Office. Unattended pits shall be protected by a 6 -foot fence or shall be backfilled or steel plated and pinned. n 34. Applicant shall install a "tracer wire" or other similar conductive marking tape or device, if installing any non - conductive, unlocatable underground facility, to comply with the Oregon Utility Notification Center, One Call System (per OAR 952 -01 -0070 (6). F1 35. Trench backfill outside of ditch line or in approved areas can be native soil compacted at optimum moisture in 12" layers to 90% or greater of the maxi density. 36. Native material found to be unsatisfactory for compaction shall be disposed of off the project, and granular backfill used. 0 37. Trench backfill in rock slope or shoulder shall be crushed 1 " -0 or 34 " -0 size rock compacted at optimum moisture in 12" layers to 95% of maximum density by standard AASHTO T99 method. 0 38. Where excavation is on fill slope steeper than 2:1 slope protection shall be used with 4" size rock laid evenly to a minimum depth of 12" 0 39. No more than 300' of trench longitudinally along the highway shall be LEFT open at any one time and no trench shall be left in an open condition overnight. 0 40. Areas of disturbed cut and fill slopes shall be restored to a condition suitable to the District Manager or representative. Areas of erosion to be inlaid with an acceptable rip rap material. 0 41. All underground utilities shall be installed with a 3' or more clearance from existing or contract plans guardrail post and attachments. All non- metallic water, sanitary and storm sewer pipe shall have an electrically conductive insulated 12 -guage copper tracer wire the full length of the installed pipe using blue wire for water and green for storm and sanitary sewer piping. 42. Any area of cut or damaged concrete shall be restored in accordance with the attached Typical Section -Pipe Section under sidewalk. n 43. Signs and pedestals shall be placed as near the highway right -of -way line as practical. In no case shall pedestals and line markers be located within the highway maintenance area. 0 44. No cable plowing is allowed within the lateral support of the highway asphalt (i.e. at 6' lower than the edge of the asphalt, no plowing with 9' of the edge of the asphalt). [145. All pipe and bridge attachment hardware shall be submitted to the ODOT Operations Structural Coatings Coordinator for approval. 0 46. Expansion joints of an ODOT approved type to be located in the closed proximity with the expansion joints of the structure. ODOT Bridge Office Practice Manual attached. n 47. Adhesive anchors only are acceptable for support brackets. For a list of acceptable adhesive anchors or more information, see the ODOT Bridge Office Practice Manual. n 48. Field drilled holes in the stiffeners and areas damaged by drill shall be painted with two coats of zinc -rich primer prior to assembly. Methods shall be approved by ODOT Operations Structural Coatings Coordinator. 0 49. Neoprene gaskets to be placed between the mounting plates and stiffeners. ODOT Bridge Office Practice Manual attached. 50. Plans are approved in general only and does not relieve the applicant from completing the construction improvements satisfactory to ODOT. Field changes may be required by the District Manager or representative. When rev' ' • are mad 'nth tel • ilt drawings will be submitted to he District Office. r Z' 4" APPLIC • _ / 4 % • T REP DATE 04/07/2000 Activities for Case #: SIT1999 -00076 2:54:55 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes SITC005 Application received 12/08/1999 BON RECD No Hold GEO 12/20/1999 SITC008 Permit Created 12/20/1999 GEO DONE No Hold GEO 12/20/1999 SITC013 Plans Routed to Plans Examiner 12/10/1999 GEO SENT No Hold GEO 12/20/1999 • SITCO26 Plans approved by CPE 12/23/1999 12/23/1999 12/23/1999 RDP DONE No Hold RDP 12/23/1999 SITCO30 Reviewed plans routed to DSTS 12/23/1999 RDP DONE No Hold RDP 12/23/1999 SITC700 Erosion Control lnsp 844 -8444 12/23/1999 12/23/1999 No Hold RDP 12/23/1999 SITC730 Paving lnsp 12/23/1999 12/23/1999 No Hold RDP 12/23/1999 SITC740 Strm Drain lnsp 12/23/1999 12/23/1999 02/22/2000 TLP PASS No Hold AKJ 02/22/2000 1 catch basin and storm drain from canopy SITC744 Culvert/Catch Basin • No Hold RDP 12/23/1999 SITC750 San Sewer Insp 12/23/1999 12/23/1999 No Hold RDP 12/23/1999 SITC757 Domestic water line inspect. 12/23/1999 12/23/1999 No Hold RDP 12/23/1999 . SITC760 Landscaping Insp 12/23/1999 12/23/1999 No Hold RDP 12/23/1999 SITC799 Final Inspection 12/23/1999 12/23/1999 04/06/2000 TLP PASS No Hold AKJ 04/06/2000 SITA032 DST Post - Review Completed 12/27/1999 BON DONE No Hold BON 12/27/1999 SITA080 (F) Ready to issue 12/27/1999 BON DONE No Hold DEB 01/05/2000 Do not issue until applicant • brings in authorization from . ODOT approving working in the R -O -W as noted in MMD1999- 00008. SITA070 (F) Ready to issue 01/05/2000 BON DONE No Hold DEB 01/05/2000 Received ODOT permission to work in R -O -W.. Copy attached to site permit. SITC092 (F) Issue permit 01/07/2000 BON DONE No Hold BON 01/07/2000 SITC770 Misc. Inspection 03/10/2000 TLP PASS No Hold AKJ 03/12/2000 footing/slab insp for trash • enclosure SITC800 Case Finaled 04/06/2000 AKJ DONE No Hold AKJ 04/06/2000 Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171 9 ! g Date Requested CO oo AM PM �c BLD r Location tq � pa( Suite ME ?i) -- 0066 4 1 4 � Contact Person 7[7 Ph 3100 I 1 /31 ?& l Atli WOO-0 00 4 40 Contractor Ph SWR ` L Tenant/Owner ( GO ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: fe � p Slab y "�X SIT f ?4' - 00c.) Post & Beam Ext Sheath /Shear Int Sheath /Shear // , w , D + Framing , A V (�'r • � l� • �i7 ' ✓ ( I Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: PART FAIL • ' BING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL ECHANICAC) Post & Beam Rough In Gas Line Smoke Dampers __1 PART FAIL '` -" RICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date C / Other ' Inspector Ext CO) C) PART FAIL DO NOT REMOVE this inspection record from the job site.