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PFI2015-00154 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00154 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/02/2015 Parcel: SEG1532 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 13630 SW 114th Ave. Bore one 3/4"conduit for Comcast Cable from ped at 13675 under 114th Ave. at min depth of 30"to power meter on 13630. Owner: FEES Description Date Amount PFI Permit Fee 10/30/2015 $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 Signature: Not Present Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00154 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 2 2 2015 CITY OF TIGARD City of Tigard PLANNING/ENGINEERING PUBLIC WOIU<_S — LNG1N1✓I RING - >a Public Facility Improvement (PFI) Pernut --- REQUIRED SUBMITTAL DESCRIPTION OIF WORK 0-n the right-ol-way) ELEMENTS Check oar Utilitica Sid,.,Wl,/drivrway approach ❑ btr�t unPrtmu�utts ; auric in tight-of-e+sy walk Detailed description: fi rye 3V � t c:�+►��s'?"'�� fico,�(siderrpau,curb cut,baeet lcoy, e� ' opening,cm)requires: Pr • .Application form,cpmpletcd 61 ty�.h �J� 'lb 1n�carer tti2 -r-C2✓1-�`3�O � and signed • k,innit cme(1)copy of scaledsEuh VJ V'Q.. . of the pcvposod work to be done propcsry address/location(s); _ � . Submit uac(1)copy of uufl'ic control plan -OR- 0 Sube.Un l pmt aodr-qu" above iteam and profcasiox Applicant's norm: UD mg,,=cd Plans for. Address: 113� � �` _��t`' - ;" =S lip: a 3 -Subdivision iynimstruc-m City/state a -Main U ary lint caacnsiozi= Phone: -D�-©��D4 Email:�l" �-C� Con�CaS�• titorm Drnia.Sani=y- iag_d Watcc-Ttgwd Water Service L--1 of-S Ca-iP �- ; sea(ux-ludrs Dtdum,l—g CitY Contractors name: and a portion of uninc-pomwd CCB#: 14 0 Lht� Expiration: O������ Washington County) SISt A Dgl 1°►l0� �vJ Address: ,[�.�Pl<.acaaiOrl�: gwd city/state: ��R z,�,. �—_�— P�• Phone: ��✓'�la E.,zail: 13tzs SW Hafl Blvd - Phone. OR W= tKtr'S carne: APPb,,6em.fen-mk"_--k m�t-of--y- vBrIgi =ty asap tx mV=j d to: Address: City/state: -- Zip: Phone: E natl: Estimrtced value of work (within the public right-of-Amy): U-USE DECISION? O �'� No � Ls work related t o a I.AN If so, please spedfy (MI.I',SDR, SUB,etc.) case #: P)=.RA�I1 I? ❑ 1s woA related to a BUILDING If so,plesse specify(BUILDING PERMI"I)cast ;'i: (� aY.. �City �• yr d• ..y•+e-J'i of T,gara 13125 SW Hall Blvd 'I cgard,Orcgvz' 503-7111.2421 Page 1 of 6 APPLICANTS NOTE: Person apccified as Applicant" shall be d=4paced "Permittee"end shall pwvuk fiaanciai asau nstcc for work. •Wben aha am==and dao t ore Get poopk,die oppB must be the puntw=of ncnafld ar a I. a P in pwsoam aah writtaa Lsm tide owner w as awwr of the owmm Thc Owna(e)awn SWI&M apphcomm in the gKwc prwof submit a vaiRs suchazicuiaa lith thaw apOcaftm. BY SIGNING BELOW,THF. APPLICANTS) SHALL CERTIFY THAT: • '1'h��mramr dam=. rum Vm str Jaw gV-%rri;rimia tint may b�ttyrlt rl to ur jmVaWZd Lea the and a a to • if the applicutoo is granted,the applicant wall exercise the ngbts granted in accordance with the terms and subject no all the conditions and litWtmdons of the approval • All of the above statements and the smtements in the plot p6n,attachment-,and eichihits transmitted herewith.nae true;and the opp}iceats so athnoovkdgc that any pewit issued,based.tit*'I-t applicp !i tea}be revoked if it is found that any such 3�t i sCattil�.ent8 wit false. .. �P , • "Ihc applrmat has read the entire contesstss of the appltcauou,racl mhug the poh6ca wad cxu= a,and uLWk=stnada the r+et*cmecm Eat approving or dcnvmg the application. SIGNATURES of rash owner of the erabirct qty treyoaited. Ba b Appiican oAzed Agent's signature Print name Date Print name Date OwQzr's _ Print nameDate Owner a fiwwrure Print name Dane PUBLIC FACILrrY IMPROVEMENT PER UT CGty of Tig�ad 13125 SW Fta11 Bid. • ligard.U=goa')7223 • .vw ugord-or{Sov • $03.718-2421 • Pctga 2 of4 e of Pavement. 1 -d*— Ditch Streetlight — I �• Rain txsa WNW LIHO 7 r �m acs a I r 1_ it:�' 1 t Li Driveway a Q. A. 6 Powarpole ! 1 a I 1 Id \\ 95r 1 I ....— .— ---- --_--- • I ' pot •lrnv I ( I Firm Hydrmni(FI-0 o i Y I Scale: 1 =.30 1 0 1 I I I f I MIND4UM SKETCH,R/EQUHULNMNTS(Put"N/A"if Not A.pptac WC): North arrow ✓ Property lines &dirnension ✓ Slope of property V Street&street namc(s) Existing building,structures V Utility&street light poles 1/ Proposed work ✓ Existing curb or edge `� tees Existing S/W or of pavement Existing utility locations D/W apron . (scwrs,water,storm) PUBLICFACILITY IMPROVB.MEM4T PERMIT City of Tigwd • 13125 SW Hall Blvd. T'igasd,Oregon 97223 • wwwtigard-ot.gav . 503-718-2421 - Pagc 4 of 4 WIZOVG4-t STREET.s , WITH PP-Ol'f-&Ty- I i -3 AM PIAN M t3' -4 Fac i ' - --- - - - --- s ewe FOG PLAUT" _ ST;ZtP t3' DMJ II, D/ f' ' 0 13 3O N v S lnt�e I 4..320 Lane Closure with Flagging Diagranj 3213 Lane Closure with Flagging Diagram No.320 covers total closure of one lane of a 2-lane.2-"ay i roadway. The right-hand drawing ilhmtratos the use of two flaggere,ogre for FMAO i each aPp+oach. The left-hand drawing ffluMles the use of a single flagger to con�Ct Doth tares of trafl}c on tovx volume(lass than 400 average daily �. lraft)roads with good sight distances as cr=ussed below, WX C 1. Usra buck-mounted high-intensfty rotating,flashing,oscillating,or strobe RM S"L warning lights with 3ti0'visibility on alt work vehicles. For added t + a visibility. truck mounted arrow panels or pCMS in the caution mode may �' a � to uW. y per . TO 37W 0 2. Flaggers at each approach are required It any of the following,,oneibons �' a* s exist _ �e � iA $ <D a. Might Operations or 155 . SM SM• b. Work space is over 2M fee; it tength or, COOv G. Sight distance is less than 750 teat from each approach through the � � � I • lane closure or, /•�I�� • d. Traffic volumes are greater than 400 ADT. ProtaM II/nVAeNcle The length between the ftagger signs shall not exceed one mile. // f lA (tin t?ptlon 4. Cones should be used to outline the Work space when curves or other t roadway alignments Prevent clear direction for the motorists to pass thel °•• i • ger workzona safety. Cones along side the work space aro recommended 1 tl •® ,� ° when posted speeds are 45 or granter,when working under heavy traffic ° or when travel lanes are narro%ver than 11 feet, I ° . 5 Extended queue signing(as shown on Diagram No. 001)should be used • .vhen traffic queues extend beyond the Initial advance warning sign. t, I �I �' / t When flagging near an intersection, the Flagger s brI • , I 1 i %iioreativance wamgvisite to traffic entering from any side road.and Flagger symbol signs may be placed on the side road(s). A.? MM-AM 7. Sign Brat end pt � �°llrop 9 -� er agement shown in Drawing No. 320 may be used for intermittent full road closures of 20 minutes or less. �g j B� E. The ONE LANE ROAD AHEAD sign is optional and should be \� ( � LAM ROAD considered on high volume or high wend reds, or when extended �L � queues may be expected. 0 (0PrionO u+eno Low Volume Single Flagger Option l ,� tWORK ARZAn Diagram No. 320 Two Flagger Operation 62 63