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PFI2015-00135 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2015-00135 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/22/2015 Parcel: SEG760 Jurisdiction: Site address: 13110 SW FALCON RISE DR Subdivision: MORNING HILL NO.1 Lot: 32 Project: Comcast Cable PFI Project Description: Bore one 3/4 inch conduit from ped under Falcon Rise Drive South through ROW at 30 inch depth to power meter on 13110 Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 11308 SW 68TH TIGARD, OR PHONE: Total $0.00 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 Signature: 0/11 AADD/I(,c-1iLT n Issued By: 13 4:::� Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00135 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 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 SEP 17 2915 City Of Tigard CI-Y OF TIGARD a PUBLIC WORKS -- L•;NGINEE.R1NG PLA,NNINGIENGINEER►NG Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check oncAUtilitics OkSide.-A/driveway approach ❑ street improvements ELEMENTS Detailed description: �o Pl: dtr1E, 3�4' �Y�_� ;MM �_(sjdewRlk jrk a curbtb cutt,street repair, 7aA un y, 1;k1ConRF s'E_'Dt- S �1�rb�a/1A Row eu- opening,etc.)requires: p -NN-lpplication forni,completed 24 [�P��n �WP.r YkQjce� OYN 13110 _ and signed Submit one(1)copy of scaled sketch Property address/llocation(s': 1 11 of the proposed work to be done d 0\1 ��'�-3 \tiubmic one(])cop}'of traffic 'Ci 0.!` _ control plan SLC^ -OR- Substantial project work requires Applicant's name: Coyn S!L above items and professional Address: 1130(K cbW LDV'- TY1� engineered plans for: •street widening City/state: R Zip: q`}a-`a-`� •Subdivision infrastructure Phone:�g ��b-S"16 mail:�bry r ��el_�.SI�QC e..Cow+[�S •Ntain utility line extension: n: Storm Drain,Sanitary-Tigard Water-Tigard Water Service Contractors name: ;.rapes' C etbo,LLC. :gym(includes Duchun.Kang Cry CCB#: 1 t MD 4 V Expiration: 011 011 to and a portion of unincorporated Washington County) Address: ,�°1 lCb �yJ �1 Si-�• ' 1 DELIVER APPLICATION TO: City/state: Ttila-1Ak' [ Jtt Lip: �� City of Tigard Phone: -COOL PioxxisislEniseering 13M SW Haa Blvd. Tigard,OR 97223 )✓ngineer's name: s� Appticadwns for"minor work in tight-of-way" Address: only may be emaikd to: city/state: ;T�J►-Nr+_ bR Zip: 934-0(o� Phone: c1'K-313-43 E-mail: 5N a I_�ntt. L1L��► 't Estimated value of work (within the public right-of-way): $ "'' • i ' `' Is work related to a LAND-USE DECISION? ❑ Yes IKNo H If so,please specify (NILP,SDR,SUB,etc.) case #: Is work related to a BUILDING PERMIT? D Yes No If so,please specify(BUILDING PERMIT)case#: ' App City of Tigard • 13125 SW Hall Blvd. • Tigard,Otegoo 97223 www.6g=d-or.gov 503-718-2421 Page 1 of 4 APPIJ CANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. Whm the owav Rad tke appbm t are different pwplo_the appLvapt mint be the p—dbaso of cccord or a tcs•ee in poxwesnon vnb w.it tom the owner or an agent of dx owner. '11c owner(s)must aga titin upplicuion in the spat c provided or arbmir a wrimm witb this tion. BY SIGNING BELOW,THE APPLICANT(S) SHALL,CERTIFY THAT: -1-hr-ah"Ir remi-cr.arm not violate anti decd resmrruins that may be ar aehtd to etr impiQ5nd UUan tate c..fW=P� 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 appro%al. • All of the above statements and the statements in the plot plan,artaduncnts,and rxhihits transmuted 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 fake The appiicsut has read the entire contents of the appltcation,tnchmhng the policies and enter*and understands the rcquurments for approving or denying Elie application. SIGNATURES of each owner of the subject property required- Be b ✓�� c�f�t � !! ' � s Applicant AU orized Agent's signature Print name Date ture ---7— �� I� —x-4 Print name Date vlf\ i cdL 0A..1�- I - .11 Ownesrs turc Print name ��— Date Owners signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SCID full Blvd. • l igard,Oregon 97223 - wwzv.ug"-ocgov • 503-718-2421 - Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI) Permit: Part L• Required submittal fee$300.00 Part 2: All non-water system improvements Engaineces estimate X 5%(less$300.00 submittal fec) Engineees estimate X 2%Plan Review Part 3: All public water system improvement-s 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 true pruning or planting • Planter strip landscape maintenance • 'rest wells PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 972M • www.tigani-or.gov 503-718-2421 Page 3 of 4 SA=LJE.SKETCH• W LdAe of Pavement Ditch Streetlight I — ..........�..�.��.� I r• �►r� 1 1 G—Low- I I b basting :t 21 Driveway . m� I cit I t CO c. I • o i. �• £I t 1 Powerpole �� o --- 95, � I iI Flra Hydrant(Ft- � ITT i II Scale: 1 X30 � I I � I � � I I � � I MINIMUM SKETCH 7QUIREMENTS(Put"N/A"if Not Applicable): --V)Nor-th arrow Property lines &dimension Slope of property Street&street name(s) Existing building,structures Utility& street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Miall Blvd. - Tipzdt Oregon 97223 - wwwdgard-ocgov • 503-718-2421 - Page 4 of 4 6 4 TNKOVf,H STRE6r . WIT'W LrN6 SIDEWALK 41, SW Moc-n��, 131 3 \n5 SVI F ' loW plorMt� • Wy Foe 8„W pl a.►�u s��. s+mss 'O' rat) Slopes Lane Closure with Flagging 4.320 Lan Closure with RMIng Dlegrarr) 320 Diagram No.320 covers total closure of one tans of a 244*,2-way medway. The Vt-hand drawing Mu*sdes the use of two fleggim,one for w each approach. The left-hand di awing iNutlksb"the use of a single f{agger ARM to coi 0 both lanes of traffic on low vdww(bas then 400 average dallyG traffic)meds with good fight distances;as diecussed below. RW A 1 1. Use truck-rnounted high-intensky rotating,flashing.ostillat ng,or strobe (optioneq C waTAV lights with 3t30•vlsibl)lty on all work vehicles. For added54.Z N vWbft.truckmounted arrow pends or PCMS in the caution mode may .wK jt c be used. roa+ts t3 0 thou sop r'm 2. Flaggers at each appmac:h are required if any of the foil(NAng conditions41� q Tt �o deo tosac sn u ' +s�ti saa soo s�o a�n exist .L� a Night Operations or 41110 , t). Work space-s over 200 feet in length or. c. Sight distance is less than 750 feet from each approacn through the ••• 1 lane closure or. I \ : Prabotbn vet+ide YW TMA d. Traffic volumes are greater than 400 ADT. % A \ goei 3 The lergth between the ftepger sign shall not exceed one mile �- 4. Cones should be used to outline the work space when carves or other it I••• �r*0r roadway allgmnents prevent dear direction for the motorists to pass the }{+ .® , • worts zone safely. Cones WoW side the work space we recommended t n ` • when posted speeds ane 45 or greeter,when working under heavytraffic •• or when travel Innes are narrower than 11 feet. i 1 I T Extended queue signing(as shown on Diagram No 001)shouid be used 1 I A when traffic quieusit extend beyond the initial advance warning sign. � i i•• it ' ' • 6 When flagging near an inlersection, the Flagger symbol sign should be A� visible to traflk entering from any side road. Additional advance waming �* 1 (1 r ,oma and Flogger symbol signs may be placed on the skle road(s). 7. Sign set-up and saggar placement shown in Drawkhg No.320 may be �. / V LAWLAWused for intermAtent full roast censures of 20 minutes of leas. ! a e FROM 8. The ONE LANE ROAD AHEAD skin is optional and should be .l _L 1 1 �- p considered on high volume or high speed roads,or when extended C :Zueues may be expelled. low Volume 'r—! Single Flagger Option i " wawat 0 Diagram No. 320 Two Plugger Operation 62 63 i