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PFI2015-00068 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT q COMMUNITY DEVELOPMENT Permit#: PF12015-00068 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/01/2015 Parcel: SEG297 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Cable Project Description: Adjacent to 11392 Ironwood Loop. Bore from Comcast ped near 11392 under Ironwood Loop(56'in ROW)to 11389. One 3/4"conduit at 30"depth. Owner: FEES Description Date Amount PFI Permit Fee 05/28/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 11308 68TH PKWY TIGARD,OR 97223 PHONE: 888-824-8264 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. PermitteelApplicant Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00068 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 503.816.6146(cell), 503.718.2602(office), or 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 21 -OTHER Applied Notice RECEIVED City of Tigard MAY 2 6 2015 ° PUBLIC WORKS—ENGINEERING CITY OF TIGARD = PLANNING/ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one:;)(Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description:. Vr-orh G rvt 0_1b* 2�_& near Minor work in right-of-way �l'39Z ta.t AeA- ,�t-� � _ (1, ,�\A\ ,� (sidewalk repair,curb cut,street J o g,etc.)requires: h4 Vie- 3/ 1. C�rtCkta.i�t�� • Application form,completed ,,,*nd signed Submit one(1)copy of scaled sketch Property address/location(s): the proposed work to be done Lpp _+;a2) Submit one(l)copy of traffic // control plan —OR— Applicant's name: + "p e, ❑ Substantial project work requires �� IQ� above items and professional � Address: - - jQ9—�D 'PKO11, engineered plans for: City/state: d 01,�— Zi (� }ZZ� .Street widening p' -Subdivision infrastructure Phone:$Z'I LVEa2( e4 Email:Ro. Qk-36 iC},dS®C461f•CirsCaryf. wi Main utility fine extension: Jj Storm Drain,Sanitary-Tigard L- Water-Tigard Water Service Contractor's name: l--t✓12. �-Q e L_I.-e- . Area(includes Durham,King City CCB#: _ 14040S Expiration: kilt(. and a portion of unincorporated Address: l c�WD S W 61St Pt W—. Washington County) City/state: 711,.96A.A rl Ute. Zip: °1�(QZ DELIVER APPLICATION TO: �,�(Z,� 1`� ^^ City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Engineers name: Q-C' Og A-Kk\Q,r- Tigard,OR 97223 Address: 11 O O S 5 0- A of Applications for"minor wYttk in right-of-way" only may be catailed to: City/state: TLA-aAA4n-,r\ VF,_ "Lip: 9-' - )(o 2 Phone: 9_+1•_A13. 1-{1$3 Email: Cq a �t�f►QSC1tDQ.1(G.Cor►'l Estimated value of work (within the public right-of-way): $ Case Na: Application submittal fm Is work related to a LAND-USE DECISION? ❑ Yes jNo Application Accepted.- If so,please specify (MLP,SDR,SUB,etc.) case #: By .� Date r Is work related to a BUILDING PERMIT? ❑ Yes X No Application reviewed- If so,please specify,(BUILDING PERMI`1)case#: By: � 4` 9 Date` A5_ Applicant n tified: By.— Dace V2:d I cleueruA►.t.woW nd w.App0aft s aft 07n6lm14 City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 0 www.tigard-or.gov - 503-718-2421 9 Page]of APPLICANTS NOTE: Person specified as `:Applicant" shall be designated`Permittee"and shall provide financial assurance for work. When the owner and the applicant art different pcoplt%the applicant muat be the purchaser of record or a k-wee in possession with written authocuatiom from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written 2uth0r=1ion with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above rengest does not notate nn.y deed rectn�rione t_h t rrLe be attached to or im�noce d nnnn the subject • If the application is granted,the applicant Mill exercise die 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 staterncnts in rbc 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,inckuhng the policies and criteria,and understands the requirements for approving or denying the application. SIGNATURES of each owner of the subjcct property required. B,117 C -e- ; 3 1 j Applicant Au o>azed Agent's signature Print name Date oe •ture Print name Date Owner's nMe Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERAUT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.thgard-OLgOV 1 503-718-2421 • Page 2 of 4 RECEIVED MAY 2 6 201 '6 5 CITY OF TIGARD , 3 oo- PLANNING/ENGINEERING r a -off IL e UJ ----- cs U) � M DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part L• Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee =Part 2+ Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.6gard-or.gov 503-718-2421 Page 3 of 4 4.320 Lane Closure with Flagging p iagrarn 320 Lane Closure with Flagging Diagram No.321 covers total closure of one lane of a 2-lane,2-way roadway. The right-hand drawing illustrates Ih e use of two flaggers. une fcx 1A/e i each approach. The left-hand drawing illustrates the arse of a sinGl�flogger woax to c 0nkr l both lanes of traffic on low vokxne(less than 400 average dally traffic)mads with good Sight distances as discussed below. ,, C 1. Use truck-mounted high-intensity roWtrr„ flashing•oscillating,or strobe ,A warning lights with 360' MM visibility on all work vehides. For added a visibility, truck mounted arrow panels or PCMS in the caution mode may _ � ♦ be used. '� - I s,ere., 2. F!aggers at each approach are required if arty of the following onditions i 4A ' a orb +oo rod t0 , extst -� n-40 3so uo 360 rsa Night Operations or ''M t z'°° 3°0 s°° b• Work space;,s over 2W feet In length or. _ c. Sight distance is less than 750 feat from each approaen trough the f lane closure or. /� I\ \ ` •� / I ! \1 'aProtetlion Vehicle d. Traffic volumes are greater than 4rx;ADT, \ • vry TMA 3. The length t < (BMh Ophonan ng between the ifagger signs shall not exceed one mile �' %... 4. Cones should be used to outline the,vork space when curves or other ' roadway aGgnmerls prevent clear direrhon for the motorists to pass the f i' •• ` work zone sad �+ t • ely. Cones along side the work space are recommended when posted speeds are 45 or greater.when workingunder r • or when travel lanes are narrovrr heav�traf is 'I i than 11 feet. T � � •• �_ _ 5 Eytended queue signing(aI3 Shown on Di:ar)rain No W 1)should to used >/ ��' , when traffic queues extend beyond the initial advance warning sign 1 F When flagging near an intersecber., the Flagger symbol sl(l t Tt 1 f r visible to traffic entering from any side road.Additionn advance wambng I 7 rr r - and Flogger symboi signs may be placed on the stile road(s). f t n' It r -iHPNtlp 7. Sign seat- agfl P 1J J ��/ �e-T >� i9 up and fi er place shown In Drawin No. 320 may be used for intermittent full mad ri�cures or 20 minutes or Icss. i e x 8 The ONE LANE ROAD AHt=,40 sign is optional ono should be �` J- 1 [3 ''w rnnsicered on high volume or high speed roads, or when extended \ �, • PCAC �% �;rs may be exp�ted. -1 (Optrono C Low Volume Single Flagger Option MAC WOW M"n Diagram No. 320 Two Flagger Operation 62 0110 63