PFI2015-00169 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00169
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/18/2015
Parcel: SEG620
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Adjacent to 11450 SW Winterlake Drive. Bore one 3/4"Comcast conduit from ped out 12932 under SW
Winterlake Drive at 30"depth to shop 11450 SW Winterlake Drive.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/18/2015 $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 PF12015-00169
Ty pe: Condition Name: Status: Severity:
PFI_Utilities 03-WORK SITE EROSION CONTROL Not Met 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 08-TRAFFIC CONTROL PROPERTY ACCESS Not Met 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 10-TRAFFIC CONTROL LIMITED WORK HOURS Not Met 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 Not Met 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 07-TRAFFIC CONTROL ROAD CLOSURE Not Met 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 12-UTILITY NOTIFICATION Not Met 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 Not Met 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 Not Met 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 18-PERMIT/PLAN ON SITE Not Met 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 20-EMERGENCY CONTACTS Not Met 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 17-NOTICE TO COMMENCE WORK Not Met 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 21 -OTHER Not Met Notice
PFI_Utilities 02-WORK SITE AREA Not Met 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 04-WORK SITE REPAIRS Not Met 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 Not Met 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 Not Met 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 09-TRAFFIC CONTROL WORK HOURS Not Met 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 01 -WORK SITE REQUIREMENTS Not Met 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 15-REPAIR OF EXISTING FACILITIES Not Met 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 19-MONUMENT PROTECTION Not Met Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 16-PRECONSTRUCTION MEETING Not Met 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.
City of "Tigard RECEIVED
PUBLIC WORKS —ENGINEERING NOV 0 9 Z015
CTQF TIGARDPubl c Facility Improvement (PFJ�A
VEERING
7,
ESCIIPTION OF WORK(in the right-of-way)
Check one:�Urility Connection
TYPE 1—Franchise Utilitj'%fork
❑ Sidewalk/driveway approach %Rork performed by NI M! i,PGE
❑ Street improvements and/or utility agency.
Derailed description: (fin{+ 31t1 Cpr„L�yrte} C* cLu;.}. ❑ TYPE2-Sidcwalk/Driveway/Sewer
m 'p2r� t 19 3a- LA I d e4- S W Mn•1-e_r-L••g YQ b a-. Wark performed for the purpose of.� `GAO" !�?���t J= Skgp� 1 4 y.rjo s'W V�,�� � � Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s}: i l y Sc� ��( �� f L-�-�d �r_ and/or repair
a'}aa'3 7 � � • Sanitary sewer lateral instaLation
and/or main line tap
❑ TYPE 3-Full scale Development
Applicant: ri�CR�� Work performed with Land use
Address: �C,V� �a -- approval which includes any of
the following—
City/state: zip: °1�-2-a��
�— Subdivisions or Petitions
Phone: `b`bg-194- a(et-{ Email: _ In, L2.Crant��tc+• vy Street widening
Contact name: RNA&_Y� _ one: _ NA�_ Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
Contractor: and/or Tigard Water Service Arca
CCB#:
-140 Stip /N..
iration: !Z I -
5+ "a„ 'igTErr: r}? ziiro=F`$
Address: S-A
City/state:
City tat'Tigard
�U�-A�-t'y-� ('�}� Zip: �`�-(�(ov�.- Plurarxin,�lEngzneering
Phone: 50_23-(012111Email: P2rrti,;tS (cel �+}neSCszc tlL (yy,vt 13125 SWHaHBlvd.
Contact name:
Tigard,OR 97223
_ �2iC�-+. �C'sQ�-�e,�' Phone:_ N/�
Applications for"minor work in right-o€-way"
only may be emailed to:
Engineer: xow�errr sLrcfcLtigardov
Address;
Ciry/stare: Zip: '
Email: Case l<:o
Contact name:
ilpplacataoa�subt�s:a1 Ecce:. 9 vee ?�.�: '.
?Iddatotialtees �. - ; ,
Estimated value of work is required(if over S5 04Q): ed
Apphcataanccep °s
lig
pub
within the c right-of-way) -B i ,��.:.
is
PP
Is anontire" W. +;:
ark related to a
Is w late LAND-USE DECISION? ❑ Yes �I No •x - �
If so, X33 = :.:�.
cify t 3
: y Vii:a
please spe (MLP, SDR, SUB, etc.) case#: R.,
Is work related to a BUI LDI F.M v<<` ='<� ''l=(}„ �.,'
NG PERlMIT.a ❑ Yes \o V'73:w�.` �. yl�a e:.: ��... .�.,
:= :.
If so, lease #: AF
p specify(BUILDING ERi��1I ca a:ueR9Lr+�=u�it�n�t��
Citv of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 ww w.tigard-ongov 503-718-2121 Page I 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 peoplt,the applicant must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owacr(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does notviolate anv deed restrictions that m b
` yam att ties L 1 or impose upon the cub.i t property.
• 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 each owner of the subject property required.
Zpphcand Agent's signature Print name Date
Print name Date
"�—C ( SP /7 aN/CG1 ` SX17
Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-orgov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI) Permit:
APPLICATION FEE
Part 1: Re
gutted submittal cec�34U.4U °`�'�'��`"��""�a��� ��«t .'�' .,'��.=�_°�`�"`� •• ��`,au ��'
'rFFtAICHISEITIZ<h
; " �ANU�SZDE 'AL3
PES . ..
Rt�IIT FEE Y��U:'I
Part 2: AR non-water :C±DhTh3E
system improvements �
estimate 1 $300.00
Engineer's e ri �% °(ivoriti-iii.t3�esri Vie:
$ 00.44 submit x iif i �..°'_�_ �.:,x ,, El
Engineer's estimate X 2% plan Review
�( eCuctin 'n#orm3tirn,,61iiw, 'i'•t
WATER SYSTEM FEE � � '
-
Part 3: AU public water system improvements A� ° �s
`�. 3 K^'r Sdt ,.ss�'g�'"*, °ryr•`fy*x N, `
nee s ate ` :S,treet1ame; a';;
Engi r estimate X 121 , :;
CD dress:°
r
PFI
Permit Fee Exemptions: MZ
X
,�°
There ii ill
be no permit fee charged,or assurance A]r.E'�I?E'6' LCl�PiLE1'�1T ';�' ;
!' required
i .ry�c '>.c`,,��$.,i::;."�'•,�,�- ..�+.:.l:.i` "2`�T3
for the following tVpCS of work:
{Subd� nszvk6fid- and Street'Frzapra�ments
Sidewalk repair(less than 20 lineal feet) h
� 4�
• 11
Relocate or replace mailbox Uszgn I'Iaias,�,,. s
pin that do '(6 -a `2. ., •,
• Ditch Clea r - r^°
� es not involve regradin J :(.�:;�-;�,��ar'�
�,- 'fit "N
Weephole re a
:,SiteVicini Ab
• 'ri, _: t"��' '�...Y,._�r" i.:rC'Gtl�.ir
tif-?rl,I:.L',��CSl*',e
Curb repair or replacement(less than 24 lin t u' r ' fW
=°
lineal feet)
;.Q RGai`dcces
• Lawn sprinkler system installation or repair
l ❑ Srrea:t"{elan;Praii1c�� � a \. 4
• Street tree pruning or planting
❑ hater Starn�and S
y
uutr (PIan;PraSle
° Planter suip landscape maintenance �� �
• Test wells
❑�atit'�ter{ ualitv:Fatses' r�
❑ riding �° # ,
'LandscaptnglTree Pltn
❑ �om �tery�P1 ( leecnrat,Phony,Gas,
Note: f1 crash assurance may be required per
ThIC 75.04140.(customer deposit) w:=.�'r°Svc�c'i-i":.!i.nr' S°a�,n::,,t,G:a. tt`-�fi;°`.,�:ater;^S,z. ?'•a..,,::.eS�,t`.t,,e,ret`Ligh�ts:'"'";er cc�.�"`.':,'`„
”.
NKII
w4 �4y'•v_��' [� 3 p:.e};xk
Tx •�i ,d`>.1. niN;.;ai_ �,i:.s-4= cla r•`" \::e
I}tstan` is
It a
QvSrrci.Li %Pland.`Potsizi�etii '>::
illi t'�7�.`L `.ani -< .yy..,,•,:,"°" .�`• <^�
l��
Cl Sheer�l project 14hu"se nam`C,��as�on anti
` pk log block,-dates iixrl sheet n�inn6er ay
°'�;.
;•;t::; �` .ted', ,:' -:_„
tC�1tZOtttt J�ttll7�Yttt1S z �� 4'
(per C.��snd bse costdattans} �� ':,� �
;•- :'.
„l Stcizi i-Vaicr�Drain Fg e
taaris
llaeclsgucal=;
❑ PreGtrx ria cress Report is nee) s.
❑�1'riaposedrPlar...
lPatlsa} Dessgrf aPpf�caile)` }
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tiggard 13123 SW HA Blvd. • Tigard,Oregon 97223 • w%"-.tigard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
'S t
Edge of Pavement
-4*— Ditch
Streetlight ----------------
Roin Drain
vu Mew
-r--FfqP AW I
Existing
Driveway
Qi I
01
CL
(L
4"A
-E CFA
110-7 1
Powerpole
E:2
ca
CL.
Property Line —-—-—-
Fire Hydrant(FH)
Scale:
1 i !
MINIMUM SKETCH REQUIREMENTS (Put "N/A"if Not Applicable):
V= North arrow
_,z Property Lines &dimension Slope of property
Street& street name(s) —,,/ I Existing building,structures Utility & street light poles
Proposed work --V/ Existing curb or edge Trees'
Existing S/W or of pavement Exisdng utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Ticyard - 1312i Sly Blvd. - Tigard,gard,Oregon 97223 - wv-a-.tiga,rd-or.gov - 503-718-2421 - Page 4 of 4
74P.OVC,-H STREETS
Wlrw PRo,16ATY LtmLr SIDEWALKS
a�5' ►,�50
Skimp
o ►vew Ped
fes! WALK -+
fOi PLANTS la' C3 C3
STRIP
TSS
4 J�.1C✓ I
? GO' R«tr-of-WA-r
Foc
Tom° r3' o s+me*u
Roar
OA- sw w
L Dom. OA- a- r.,A-n . beT+V\ os-
� � 30'' � shb� ��►��o.
s .
3 �
co
4�-10 Iwan o ClOsure Witti FlaggingDiaranj 320 Lane Closure with Flagging
g
rjr*,Im No,320 Covers total cfaiure,of one lane Of a a 2-tare,2-way
roadway. The right-hand drawing jjju$tj,at0f3 the use of tvo(,a r's �11
990a for
each 4)Prosch. The left-hand dravving Mustretes the use of a Sir,910 flagger Wftwc
to c'-1 01 both lanes of traffic on low vollurne(less than 400 average da I)y
tr3fITC)roads with 9000 Sight distanow as discussed�iejow.
wry' G
USO truck-mourned high-intevisity rotalinU, KOA3
Yearning lights with 360* 118shin[j.oscillating, or stfribe AJ9,*AV
visibility all Fill work vehicipa. For addetj H
VISiNuly, truck Mounted arrov"Panels Or PCM S in the caution Mode may lod
4C.4 Used, PRPPAf
TO IMP
I'lagget-i at�'�aclh C.ii�any ol Ow lfolloviff%'� I f0b
T
10" W
ev
76 e 'A
Sight ail3q,,nt- 'S It
Ihafi 750 iMta ffojjj e;jcl-,
lane closure or,
Traffic"ILIMeS We grPAIuIr than 400 ADT. WI TP
3. Tiara jengttj t)atvj" !A ophbnal)
thef 1, $11cill not r
orle mile,
4shqutd Ere IJSM 10 GlItlinf-I thev;orh rqjaice whef,cu� 1,of olilf,.f
.r dirfrhon for the motorists to p SS
aligninienis pievent clear 've a th
40M j
horses nio.Ig is ttlij
%Ajolk space
We recOmmoneed
W(leds are 115 or 9veatel'. willen working Under heav,,tira(fic
Of'001411 travol lanes are nafrovier than I I feet_
t-'XIC-Ided cluc-aie signing(nt3 VIIDVP-�oil Diaqratv shop?
: ,c"raffic qw'-(lef�ex c sad
waining,
"'Vh—n flaglillg floar an intomfictior, lfll-+FlPtWer SYMbol,-,i(jn S1ic, jicj 041
"Sit74le to trafllc wltallflg (shire ailY Sidt! Addifloiial �jv,,
and FluqUe a an rning t Tt I ew •
r Syrni),)l Sj((Is May[Ie Plam a"Old A
on O)o St
'ro mop
0:igrl aet-up and 1`11199er in Drawing No, 320 tray be AT a
Ua0d for inti rmftril full road rlosures of 20 minutes of lc3s. 'Ile
ONE LANE ROAD AHEAD sign is optional ana should ba "I a WIM
,,onSklered on high VOILPTIr,Or high SPIWJ toads, or mail e)rtende,
Imes rna'/be d 16ptkinaij
Low Vc4ume
Single Flagger 0ptj()?j
WORK
Ai"11
Diagram No. 320 Two Flag O
'
ger Peralicin
63
T
LocustI ��i - •' • 1 I 1 i
Tigard St
' Commercial Burnham St
Ash Ave
• �T� _T�,l' _ �_ �� -L� -- I �-
�I • I •• 4 lt, j_
Main St
Scoff ins St
Dartmouth `� T f i'�'+ I,� rt �1 _
_ r _ .��
---1 1
72nd Ave
68th Ave
•
,