PFI2015-00145 94CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00145
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/12/2015
Parcel: SEG265
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Adjacent to 11435 SW 115th Ave. Bore one 3/4"conduit from ped at 11436 under SW 115th Ave @
min.depth of 30"to power meter on 11435.
Owner: FEES
Description Date Amount
PFI Permit Fee 10/09/2015 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RANDY SHIELDS
11308 SW 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.
Permittee/Applicant Not Present
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00145
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 21 -OTHER Applied Notice
RECEIVED
OCT 07 2015
CITY OF TIGARD
City Of Tigard PLANNING/ENGINEERING
PUBLIC: WURhS -- LNGINhERIM;
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK (in the right-of-way) FREQUIRED SUBMITTAL
ELEMENTS
(ttcck tmc: Utilttics
tiulew�lic/duv�-�ar .ppctxu:h LJSucet u��ivvenw"1s
pea inor v✓�u1c m rigit+�of via}'
DttttiltKl deafriPUot): - � Or1Q. 3/y 1�1.4w _- -C�J� (si k-walk[chit.[utb utt,suet
a_e opening,etc.)requires:
. Appycstion form,colleted
-A-435 -- - -- and meed
•Submit ooc(i)copy of rcakd sketch
__t � cSy�I �_ of the propcxod vbck to be dose
Property address/localion(s): •Subaut tau(1)copy of traffic
control plan
� ^ ❑ Sub.tautial ptvi«t .retic t�u�a
Applicant's name: —� �C- -- above ittxrta„nd prvEuaxxs.l
cngineercd plana for
Address: L 30 _S_V11_�o$�K - -Stmt
City/state: _ r-ip: q-+aa•?S •4Subdhvu2cx3 izfimstrtx:ture
cnMs.�Cowttit.S 'Main utilit7 h�e: �:
Phone: I;r6%- o`i F.trail. '�-t - Storm Dt—,Sanitary Tw—rd
Water---rgrard DVater Service
Contractor's nnrrx: -+.rIQSCAfi� ISL -- - 'urs(u loch=Dud--x.K-g Uty
and a portion of unwcugxxawd
CC:B#: � ��� Expiration: -- 011 — VAshitWon Conoty)
Address: 191007 V4 SI s"- A ff ------ ntruvsx APPLICATION'Do.
city/:tate: �t�-oeZ — City of Tigwd
5�- to-��� tail: � ne_s_ � comet, p,.""�s`E"�'a"»L
Phone: 13123 SSV Hra1 blvd.
-rWrd,OR 97223
hagmccj�6 nLrac1 — --- ,htsu.w,+f.x"nuaur s•Arlt n rot lit wad"
--or--— rr,tj may be cam"w:
Address: -
City/static: L.tp
Phone: F..tnail: -
��'1
f=,etimated value of work (within the public right-of-way): f
Is work related to a LAND-USE DECISION? ❑ 1'u 191-NO
SDR,SUB,etc) case
If so, plaac specify (MI-I', R, .
r
is wvtit related to a BUILDING PERM 'P O Yes �t`o �If so, lc"c s UILDING PERMII)case#: `
s '
Cky q'Ti&asd • 13125 S'W HaU Blvd • Tigard orcgoo`»223 w ww.ugard-or-gov Pear 1 of4
APPLICAN'T'S
NOTE: Pe:san op cified as"Applicant"shall be desipnaced—Permitted"and shall provide fimurial asses«for vAwL
•Wbou do =d rhe eppb=t arse ddf=c t poapsc,dac epphamt must be dx prmbom of oomai as a brace m pancsaiaa tde6 arime�
Cott fiam the own"or ao Vomit of the own= The owoe(s)must W tib appbwagm in the space pra Med etr se book a adtted
td*ehm q9 aoanm.
BY SIGNING BELOW,THE APPLICANT(S) SHALL.CERTIFY THAT:
• 11C ohm_wmr doter not vto&'.-anv -- yawirms thin Ma be Artaco-A to cx imposed am=&C> •
• if the apphcatmn is granted,the applicant will escrrise the tight+gonted w accotdaacc with the terms and subject to all the
conditions and lemirations of the approwl.
- 1W of the above stateaxmts and the statements in Else plot plan,attadu=uts,and Exhibits transmitted heaewisk ate true;and
the applicants so acktnowkdge that any permit issued,based on this application,may be revoW if it is 6,— that any such
stat meats are false.
The apphce-,has read the entire ccmtms of the spph=uon.ancludiog the polities and-m�ocria,and unclerstmWe tate
tegttirmeamma hoe nppacovmg or denying cher application.
SdCx,?"7 JRR8 of smah oe xme of tht ambit"property required.
Bees� l,lh � y z� Cs
ApplicanAut�dAgents signature Print name Date
e 14, fes_
Print name m Dsa
Ownces Print name Date
Owzmmes agnattice Print name Date
PUBLIC FACILITY IMPROVE ZYorT PERMIT
City of-rte - 13125 ti'W HnD Blvd. • -rW.,d Ch gam 97223 wwaRegaed tie rsov 503-718-2421 - P*grc 2 oro
J .
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DEVELOPMENT ENGINEERING FEES
L Pods Pecilky Improvement(PFI)Perera:
Past L• Requited submittal fee$300.00
Pact 2: All non-wanes system impmvemesus
Feces eaeimaee X 51/6(leas M-00 submittal fee)
EA&CU%estiamte X 2%Plan Review
Past 3: All public water system improvements
Fngiocces estiaoaoe X 12%
Total Permit Fee =Part 2+ Part 3
PFI Permit Fes Exemptions:
These will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(kss than 20 hacal feet)
• Relacm or replace mailbox
• Ditch cleaning that does not involve regrading,
• Wacp},ole repair
• Curb repair or replacement(less than 20 bacal feet)
• Lawn sprinkler system installation or repair
• Sum tree pruning as planting
• Planter stop landscape aoaintrnartcc
• Test wells
PUBLIC PACILITY U"ROVSb48NNT PERMiT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 WV1Wdga1d-or gov 503-718-7421 PAV 3 of 4
t
SAMPLE SIMCH
Sw
Edge of Pavement
I
-GO— Ditch --�►
SlreetUBht I — .•—•.•......��..�
I 4 � sar r.o,
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f i �t 1 9 1
�. I 2t Driveway
CL + = 1
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CL10
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Pinrerpo�e . 1 C5i
ti i
I d 95' i
--•----�ropet �litv'------�.—.
! I Fire Hydrant(FH)
I
I
I
i I Scale: 1 X30'
1 i
I !
' i I
I � i
/ MIIVIMUM SKI 'TCHiREQUIREMEN'TS(Put"N/A"if Not Applicable):
North arrow '/ Property lines &dimension ✓ Slope of property
-""Street&street narne(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)
i
PIJBIAC FACILJrrY IMPROVEMENT PERMIT
City ofTigatd 13125 SW Hall Bl-.,d • Tigard,Ozcgou 97223 • vmwiigard-otgov 503-718-2421 Page 4°f4
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HROV644 STREETS
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Lane Closure with Flagging
4.320 lane Closure with Flagging Dlagranj Sao
Diagram No.320 covers total closure of one lane of a 2-1w,2•mey
roadway. The rfgttt•hand drawling AIU mise the use of two flags,one for
each,approach. The left--hand drawing iitusaates lila use of a single bggw , Jt
to control bath lanes of trafftc on low volume(loss than 400 average daily C
truft)roams with good sight distsincts as di=Ased below. so A
1. Use tn,c k4nounted h#gh-intensity rotating, flashing.osallatirig,of stmt) ip B
warning rights Frith 380'vlWbitlty on ell work vehicles. For>ndded a
vis►b�ty,truck mourded array panels or PCMS in the caution mho may 0 0
B
be used. JAL rao rco too
00 93so.
no too W eco
2. Flaggers at each approach are requires!it arty of the following condil►ons � to I � 0-58 am Sao sen aa
exist 1
a. Ntghl Operations car 4W
Work space,q over 200 fact in langlh or. 400 x
c. Sight distance is less than 750 feet from each appamn through the / •' Protadtpr•+Vehide
lane closure or, / 1 \ • lvW TWA
d. Traffic volumes are greater than 400 ADT. / ' A 'C
3. The length between the Ragger signs shag not exceed one mile. � ` ' �- I a� �
Xauftr
4. Cones shor dd tm used to outline the work space when curves or other .
noatdway alignments prevenif dear direction for the motonsts to pass the
work zone safety. Cones along side the work space are rsc=019nded
when posted speeds are 45 or greater, when working under heavy traffic
or when travel Itines are narrower than 11 feet. 1 • ,
Extended quave stgning(as shown on Diagram No. Opt)should be used !
.Yher traffic yuraues extend beyond the initial' advance warning sign. BE
` I•• f f ' �
f
6 When flagging nue► an intersection, the Flogger symbol sign should be `, i A�l
visible to traffic entering from any side road.Additional advance warning f rosrov
and Flaggar symbol a"may be placed on the side road(s). I A / g
7. Sign set-up and ger placement shown in Drawing No. 320 may be � \ � / V LAW
used for intormittnnt full road closures of 20 minutes or less. � \ ` s r B IMM
B. The ONE LANE ROAD AHEAD sign is optional and should be \' y _I f� � 1 � copoonm �
cxtslttered on high volume or high speed roads,or when extended C
ryeues may be expected. Low Volume ��� PAW
Single Ragger Option 1 ,
i AMW
f� Diagram No. 320 Two Flagger Operation