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PFI2015-00055 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00055 s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/30/2015 Parcel: SEG1441 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Project Description: Adjacent to 10605 and 10645 SW Fairhaven St., place new 45C4 pole 18'east of existing pole, abandoned 45C4 pole due to large tree has grown around pole making it unable to be removed. SEG1441 Owner: FEES Description Date Amount PFI Permit Fee 04/30/2015 $300.00 PHONE: Contractor: WILSON CONSTRUCTION 1190 NW THIRD AVE. CANBY, OR 97075 PHONE: 503-720-0016 FAX Applicant: ROSALIE SIMS 4155 SW CEDAR HILLS BLVD. BEAVERTON, OR 97760 PHONE: 503-319-7787 Total $300.00 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 Not Present Signature: Issued By: --~— Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00055 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 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 09-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 10-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 11 -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 12-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 13-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 14-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 15-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 16-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>, to establish a preconstruction meeting. PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector Kenny Fisher at 503-816-6146 or email at kenny@tigard-or.gov twenty-four (24) hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI_Utilities 18-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 19-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 20-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 hanges.PFIUtilities 21 -OTHER Applied Notice RECEIVED city of Tigard APR 2 8 2015 C PUBLIC \FORKS — ENGINEERING RD Public Facility Improvement (RuplivF T'�Ai NG TIGARD DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one:Fxl Public Utilities(gas line,electric,data cable) ELEMENTS Minor work in right-of-way ElSidewalk/driveway approach (sidewalk repair,curb cut, ❑ Street Improvements(subdivision/partition) street opening,etc.) Detailed description: PLACE NEW 4504 POLE 18TT EAST OF EXISTING POLE,ABANDONED 4504 POLE DUE TO LARGE TREE HAS GROWN AROUND POLE MAKING IT For detailed submittal UNABLE TO BE REMOVED. elements see checklist page 3 Property address/location(s): -POLE WEST OF DRIVEWAY TO 10605 SW FAIRHAVEN ST — - OR- E] R-❑ Substantial project work Applicant's name: FRONTIER COMMUNICATION (Subdivision/Partition) • Street widening Address: 4155 SW CEDAR HILLS BLVD Subdivision infrastructure BEAVERTOK OR 97760 City/state: 'Lip: _ , Utility main line extension: Phone: 503-319-7787 Email: rosalie.h.sims@ftr.com Storm Drain,Sanitary-Tigard and Contactperson: ROSALIE SIMS Ph#: 503-319-7787 Water-Tigard Water Service Contractor's name: WILSON CONSTRUCTION CCB#: 68553 Expiration Date: 8-29-2016 DELIVER APPLICATION TO: Address: 1190 NW THIRD AVE City of Tigard Planning/Engineering City/state: CANBY, OR Zip: 97075 13125 SW Hall Blvd. 503-720-0016 Phone: Email: khorrax@wilsonconst.com Tigard,OR 97223 t ROSALIE SIMS \pplications for"minor work in right-of-way" Engineers name: only may be emailed to: Address: 4155 SW CEDAR HILLS BLVD rowpermits(2tigard-or.gov Citv/state: BEAVERTON, OR Zip: 97075 Phone: 503-319-7787 Email: rosalie.h.sims@ftr.com r ,.0 Case No.: Pr L '7-O (1S -y(Do SD� Application submittal fee: $itao Estimated value of work is required (if over$5,000): $ Additional fees: (within the public right-of-way) Appli a accepted: I Is work related to a LAND-USE DECISION? El Yes x] No By: Date: If so, please specify (MLP, SDR,SUB,etc.) case #: Application reviewed: Is work related to a BUILDING PERMIT? ❑ Yes xH No By:,-- Date: t s • �i If so,please specify(BUILDING PERMIT)case#: Applicant notified: By: I—S Date: Ldaql"�- I:\CURPLN\Masters\land Use Applications Rev.07;1(/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. *When the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authoriiatirm from the owner or an agent of the owner. The owner(s)must silm this applicaricm in the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: 10- • The above request does not violate any deed restrictions that may-be attached to or imposed upn the subject propertT. • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are false. • The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for approving or denying the application. SIGNATURES of =h owner of the subject property required. ROSALIE SIMS 04-28-15 Applicant/Authorized Agent's signature Print name Date Owners signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 CONSTRUCTION NOTE ABANDONED DEFECTIVE POLE FTR 30820 45C4.LARGE DAh TREE HAS GROWN AROUND T�0 POLE,PLACE NEW 45C4 POLE LoNornAE I 18'FT EAST OF EXISTING FIR NOA POLE.TREE TRIMMING MAY BE REQUIRED. EM HDAv� �' CONTRACT POWER CREW TO ^au I a PLACE NEW POLE DUE TO ti z PRIMARY POWER. PLACE NEW POLE M001 N• pp p�Q ry� p�ryh n`� I3 AND TRANSFER < z pQ IQ ASAP, SAFETY ISSUE mQa a� o �� I� SEE SHEET 2 FOR POLE Az p p� 10645 S F IRHAVEN ST i3l,-: DETAIL 10605 SW IRHAVE T I 000 5115233 2 1.001 SEE SHEET 3 FOR TGRDORX 2 TGRD RxA 20) TGRDORXA 2 VICINITY MAP. 45-4 (01.1980) - --------------- —-—-— -------------_—_---- _ PERMIR REQUIRED PER -SW FXRRAVEN -(sw CITY OF TI IGARD TGRDOR)A 2S2 3 I TGRDOR)A 1 WORK WITH PT 1847336 17 ' Z A f ¢ TC 00 X O BBGTD 4,2101100116 < I ?249 �O t 40 AKF XD,1 + y 00 I 100 26 S0 BBGTD 14,2101-2111+ XD,23+ Lo O XD,12+ BGTD 14,212 -2200 a 106' BBGTD 14,2113-2122+ AE XD,23+ 25 24 BBGTD 14,2124-2200 BBGTD 4,2126-2150 ------___ 386 05.2006 ------- � YJD ere TGRDORXA H502 ,1-125+ XD,126-180+ TGRD REPLACE DEFECTIVE POLE 181-216 1 1645 SW FAIRHAVEN ST,SAFETY ISSL E RTWNSHP C.O.AREA TGRO 5115233 E%CH.CODE:51351 ATE: ENGR: ROSALIE SI NT'y WASHINGTON PHONE 503-3137787 FILE:2014 RHS 51 t52" -100 TAX DIS TRIC T: DWG hill 1 OF 3 7S RNG:'117-[C SEC:3D0 PROPERTY OWNER OF TREE 10605 SW FAIRHAVEN 10645 SW FAIRHAVEN TREE R/VII _ R/W 11' - ------ - ---- - ---- E/P -- ------E/P 92' 18' --\ S W 28' 50. FAIRHAVEN ST -----------E/P- --------------------- E/P 11' R/W I R/W [FAIRHAVEN 0650 SW 10600 SW FAIRHAVEN 50'FT R/W CONSTRUCTION NOTE PLAT - FAIRHAVEN COURT ABANDONED POLE VZ #38820, TREE GROWN AROUND POLE (45C4) SW ('1960) CAN'T BE REMOVED UNLESS TREE IS REMOVED, PLACE WITH NEW 45C4 187T TO THE EAST. POLE LOCATION IS STAKED, WORK FAIRHAVEN WITH PT 1847336 FOR PGE, COMCAST TO TRANSFER. ` WAY CONTRACT POWER CREW TO PLACE NEW 45'FT POLE DUE TO PRIMARY POWER. PGE TO APPROVE OF NEW LOCATION BEFORE PLACEMENT. 51351-5115233 WP2 OF 3 CITY OF TIGARD PERMIT REQUIRED 2S1 W3DD 5460-TIGARD ROSALIE SIMS 503-319-7787 N Lane Closure with Flagging 4.320' Lane Closure with F'laggirig, Diagram 3 4 } Diagram No. 320 covers total closure of one lane of a 2-lane, 2-way roadway. The right-hand drawing illustrates the use of two flaggers,one for ROAD each approach. The left-hand drawing illustrates the use of a single flagger AHEAD to control both lanes of traffic on low volume (less than 400 average daily traffic) roads with good sight distances as discussed below. ONE LANE ROAD 1. Use truck-mounted high-intensity rotating,flashing, oscillating, or strobe AHEAD w (Optional) 8 warning lights with 360°visibility on all work vehicles. For added Posted Sign BE -+- I t Seed S do R Marvisibility, truck mounted arrow panels or PCMS in the caution mode may PREPAFIED (mph) A B c ttt) be used. TO STOP B 0. or3lese 100 t00 100 100 2. Flaggers at each approach are required if any of the following conditions • A 35-40 350 350 350 250 exist; 45-55 500 500 500 350 a. Night Operations or, • b. Work space is over 200 feet in length or, / 'r • . \ C. Sight distance is less than 750 feet from each approach through the / B 06 lane closure or, \ ` Protection Vehicle / •® w/TMA d. Traffic volumes are greater than 400 ADT. A \ (Both Optional) 3. The length between the flagger signs shall not exceed one mile. • 4. Cones should be used to outline the work space when curves or other •14 Buffer roadway alignments prevent clear direction for the motorists to pass the } '' •® '� • work zone safely. Cones along side the work space are recommended when posted speeds are 45 or greater,when working under heavy traffic I '• or when travel lanes are narrower than 11 feet. Tt I 5. Extended queue signing(as shown on Diagram No. 001)should be used �. when traffic queues extend beyond the initial advance warning sign. ` • i 6. When flagging near an intersection, the flagger symbol sign should be Tt � BE visible to traffic entering from any side road.Additional advance warning \ A PREPARED and Flagger symbol signs may be placed on the side road(s). TO STOP I A / �B 7. Sign set-up and flagger placement shown in Drawing No. 320 may be \ �, used for intermittent full road closures of 20 minutes or less. \ B ` B ONE UNE ROAD 8. The ONE LANE ROAD AHEAD sign is optional and should be {� V (options►) A"EAD considered on high volume or high speed roads, or when extended queues may be expected. Low Volume Single Flagger Option I WROAD ORK .-. AHEAD Diagram No. 320 Two Flagger Operation 62 °" 63