PFI2015-00186 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
a COMMUNITY DEVELOPMENT Permit#: PFI2015-00186
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/16/2015
Parcel: SEG469
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Adjacent to 10855 SW 83rd Place. Boring 82'from 10855 SW 83rd Place to 10825 SW 83rd Place.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
WARREN SWENSON
1910 SE 8TH AVE
CAMAS,WA 98607
PHONE: 503-856-2393
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: Not Present
Issued By: ---�- -C
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00186
Type: Condition Name: Status: Severity:
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
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.
RECEIVED
DEC 14 2015
City of Tigard CITY OF TIGARD
MTNPUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPT N OF WORK(in the right-of-way) TYPE OF WORK
Check one. Utility Connection TYPE 1_Franchise Utility Work
❑ Sidewalk/driveway approach Work performed by NWN,PGI:
❑ Street improvements and/or utility agency.
Detailed description: i"J!� 4-0 (--"tv\ ❑ TYPE 2-Sidewalk/Driveway/Sewer
sw 834 PL To lOSZS Sw03`9 -9L-, Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): tDa57 Syt-/ � "� F'L'. and/or repair
• Sanitary sewer lateral installation
T % and/or main line tap
❑ TYPE 3-Full scale Development
Applicant: GbWI CAST-- Work performed with Land use.
Address: 11'-200 �- 0+—K (9A(r1.Y-WAa approval which includes any of
the following-
City/state: Zip: —[ 1 DZ Subdivisions or Partitions
PhonegV-177•MOB Street.widening
Contact name: 1\IW C 11 ARpL01- Phone: • Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
Contractor: `f ( and/or Tigard Dater Service Area
CC:B#: -ZQC? e& Ex iration:' ZO
p SUBMIT COI+IPLFTED APPLICATION TO:
Address: 1 Q 1 D `J � '&"\j6 City of Tigard
City/state: r.*VAA A zip:jiky�_ PLrnning/Engineering
Phone:' :mail:f�ttSu�GiI-J/J 4A " f1L/T!�`Jt CU,NJ 13125 SW Hall Blvd.
Tigard,OR 97223
Contact name:\9a'N2"5ul6il.1. OIJ Phone: Applications for"minor work to right-of-way"
only may be emailed to:
Engineer:
rows„err its(&riQa�rrd-or.vov
Address:
Pitt;/state: Zip: PF/t,-Z)/
�)l S �/
Phone: Ismail: Case No.:
Contact name: Application submittal fee: 0
Additional fees:
Estimated value of work is required(if over$5,000):S Applicatio}3 accepted:
(within the public right-of-way) By: Date: �
Applicari naewed:
1s work related to a L�Nll-L'Sl: DECISION' ❑ Yes: `o ����—f Date:
�
If so,please specify By:(MIT,SDR,SUB,etc.) case#:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes No By: /—S Date: �/ K
If so,please specify(BUII., )ING PERN11-I)case##: I:\CURPLN\Mssten\twnd use Applcations Raw 07/09/2035
City of Tigard 13125 SW Hall Blvd. • "Tigard,Oregon 9?223 • www.tigard-or.gov • 503-718-2421 • Page 1 of4
V 3/' ' wo SI AL1 / G'c
APPLICANTS
NOTE: Person specified as":applicant"shall he designated"Permittee"and shall provide financial assurance for.work-
Wheal rt7r(","ficr and rhe apphatnt aria differcw people,Clic applicant must lac the purchaser of recoal or a le-ce in possv:sion with written
awhorizat+on from th(:.neu(:r or an a}sent of the owner, The owl)w")rnu,t�ifrn ehi< application in the,pace.provided or summit a written
m,du,nzati�m with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• 'f`l.�air ao e rc(lue�t clow riot violate any deed restrictions that may be attached to or imposed upon the sul2W LPMP-li
• 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 nbcwe statements and the.statements in the plot phin, attacluncnts,and exhibits transmitted herewith,are true;and
the.applicants so acknowledge that ant-permit issued,based on this application,may be revoked if it is found that any such
statement_<are false.
• The applicant has read the entire contents of the application,including the policies and criteria;and understands the
reLjLuretnents for approving or deriving,the application.
SIGNATURE5 o wa h owner of the subject property required.
A4�" W
Tas-���''S ��t`.mac-f�-t..�C- t Z 1
Ap cant,Aurhoriztd r\gent's signature. Prinr name Daic.
Chuncr's signature Print tlaiTlcT_ Daw
Ov,=ner's signature Print name Date
C)wner's signature Print name, Date
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PUBLIC FACILI'T`Y IMPROVEMENT PERM rr
City of`rigatd • 1312 S\V 1-1all lih'd. • T1gard,Oregon 9 '33 • ww-a--.igard-or.gov 503-7118-2421 • Page 2 of 4
COMCAST
REPAIR CATV MAINLINE
10855 SW 83RD AVE
TIGARD, OR.
CONTACTS SHEET INDEX
IVAN CHANDLER 4 No. DESCRIPTION
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11308 SW 68th PARKWAY MaM� swows, w-
TIGARD, OR. 97223 3 GENERAL NOTES AND
CELL 971—777-0908 TYPICAL TRENCH DETAILS
!van—chandler@cable.comcast.com
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JOB�SITE
WARREN SWENSON "'dc
SN Sryuce St SM Sw.ae S: SN'lynce 5l
NX UTILITIES
FIELD SUPERVISOR
1910 SE 8th AVE
CAMAS WA. 98607
Ph: 503-856-2393
WSWENSON®nxutilities.com m
VICINITY MAP
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1947 CLAXTER RD NE RNG 1W 811
UTILITIESPH A LEM,OR01 REPAIR CATV MAINLINE CALL LOC SHT 2
ND FAX:971.275.186210855 SW 83RD AVE BEFORE YOU
SCALE NONE DRN. DET TIGARD, OR.
nxutilitiea.com DATE- 12/10/2015 DIG �F 4
REPLACE WITH . MIN. I.12
GENERAL NOTES: a
NATIVE TOPSOIL.
RESTORE TO EXISTING 6" MIN. DEPTH OF 1"
1. CALL UTILITY LOCATE AT 811 72 HOURS PRIOR To TRENCHING OR DIGGING. CONDITIONS OR BETTER. DIA. CRUSHED ROCK
2. THE EXISTENCE AND LOCATION OF ANY UNDERGROUND UTILITY PIPES OR STRUCTURES
SHOWN ON THESE PUNS WERE OBTAINED BY FIELD INSPECTION AND A SEARCH OF THE
AVAILABLE CITY OR COUNTY RECORDS.SINCE THE ACTUAL LOCATION AND NATURE OF THE
UNDERGROUND FACILITIES WAY BE SOMEWHAT DIFFERENT FROM T14AT SHOWN,THE (V MAINTAIN 95%
CONTRACTOR IS REWIRED TO VERIFY PRIOR TO EXCAVATION. MAINTAIN 95% ':'>",-:a COMPACTION OR
COMPACTION OR
3. THE RIGHT-0F-WAY SHOWN HAS NOT BEEN SURVEYED OR TIED.RIGHT-0F-WAY GREATER & BACKFILL GREATER & BACKFILL
LOCATION IS ASSUMED WITH REFERENCE TO ONLINE DATA SOURCE MATERIAL CONTACTOR PER JURISDICTIONAL
TO VERIFY ALL RIGHTS-OF-WAY AND/OR EASEMENTS PRIOR TO CONSTRUCTION. PER JURISDICTIONAL STANDARDS AND
STANDARDS AND n SPECIFICATIONS M
4. FOR UNDERGROUND ACTIVITY:TEST AND VENTILATE MMIHOLE/UnLITY VAULT PRIOR TO SPECIFICATIONS
ENTRY.PUCE WARNING DEVICES AND WORK AREA PROTECTION AS REWIRED,AND USE EYE
AND HEAD SAFETY PROTECTION PER FEDERAL,STATE,AND LOCAL REGULATIONS.
5. ALL EXCAVATION.TRENCHING,AND SHORING IS TO ADHERE TO THE CODE OF FEDf]TAL PROPOSED PROPOSED
RF .noec(FRT 1926.64n SURF FT P. SDR-11 SDR-11
PROVIDE ALL PITS WITH 1'x1'SLOPE AT ONE END OF EXCAVATION FOR TECHNICIAN
INGRESS/EGRESS.
C. Bb. BAARRMCAADE ALL
OPEN ARE ANTO ONTORENNCCHIINGFOR�Pueuc SA�n.�iULL�awaNaDES. 4" MIN. BEDDING 4" MIN. BEDDING
MUST BE EQUIPPED WITH FLASH DIG LIGHTS FOR NIGHT VISIBILITY.
4. FOR PIIS GREATER THAN 4'IN DEPTH.USE APPROPRIATE SHORING FOR WALL
STABILITY. TYPICAL TRENCH DETAIL TYPICAL TRENCH DETAIL
8. TRENCH COVER IS TO BE 36'MINIMUM AND FREE OF ROCKS,DEBRIS.AND CLODS. UNIMPROVED AREAS GRAVEL STREETS
THE TRENCH IS TO BE A MINIMUM OF 36'COVER IN DEVELOPED AREAS AND A MINIMUM OF
48'OF COVER IN UNDEVELOPED AREAS(ANY VARIANCE FROM THESE STANDARDS WILL DE NTS NTS
SPECIFIED ON THE PIANS).
7. ALL ASPHALT/CONCRETE AND LANDSCAPING REMOVED,DISTURBED,DR DAMAGED AS A
RESULT OF CONSTRUCTION SHALL BE RESTORED TO ORIGINAL CONDITION OR BETTER IN
ACCORDANCE WITH JURISDICTIONAL AGENCY STANDARDS AND SPECIFICATIONS. SAWCUT EACH SIDE OF TRENCH
S. NORMAL/GUIDED-BORING METHOD RECOMMENDED WHEN BORING. WIDTH OF TRENCH — SAWCUT WIDTH
9. ADHERE TO AIRTIGHT GUIDELINES UNLESS OTHERWISE NOTED. REPLACE ASPHALT CONCRETE6UU 12° 6" 12" OR LESS 6" MIN.
PER JURISDICTIONAL GREATER THAN 12" 12" MIN.
10. BOND BURIED/AERIAL FACIIJf1E5 As REQUIRED BY JURISDICTIONAL ACENCY(s). STANDARDS AND
11. AERIAL FACILITIES ARE TO BE TESTED PRIOR TO BEGINNING WORK PER STATE AND SPECIFICATIONS. 3" MIN.
LOCAL REGULATIONS.
12. ALL WORK AREA PROTECTIONS FOR TRAFFIC CONTROL IS TO BE WITH APPROVED
WARNING DEVICES AND PLACED PER STATE DEPARTMENT OF TRANSPORTATION AND/OR MAINTAIN 95%
PUBLIC WORKS ENGINEERING DEPARTMENT STANDARDS AND SPECIFICATIONS.IF REWIRED,A
TRAFFIC CONTROL PLAN SHALL BE SUBMITTED TO THE REQUESTING PERMITTING AGENCY. COMPACTION OR
PRIOR TO BEGINNING WORK,PERMITTING AGENCIES MUST BE NOTIFIED 45 HOURS IN GREATER & BACKFILL
ADVANCE OF CONSTRUCTION ACTIVITIES. PER JURISDICTIONAL
13. EXISTING PEDESTRIAN CROSSWALKS AND WALKING AREAS SHALL BE MAINTAINED AT AL STANDARDS AND
TIMES.AS NECESSARY,TEMPORARY PEDESTRIAN CROSSWALKS AND WALKING AREAS SHALL SPECIFICATIONS ,+7
BE PROVIDED AND MAINTAINED PER STATE DEPARTMENT OF TRANSPORTATION AND/OR PUBLIC
WORKS ENGINEERING DEPARTMENT STANDARDS AND SPECIFICATIONS.
14. THE FOLLOWING FOOTAGES ARE ESTIMATES.FCOTAGES TO BE VERIFIED PRIOR TO PROPOSED
CONSTRUCTION' SDR-11
4" MIN. BEDDING
NO . TYPICAL TRENCH DETAIL
CONTRACTOR OR HIS AGENTS SHAT NOT ENTER OR ENCROACH UPON PRIVATE PROPERTY ASPHALT SURFACE
WITHOUT NOTIFYING THE PROPERTY OWNER A MINIMUM OF 72-HOURS IN ADVANCE OF
ENTRY.NOTICE SHALL BE IN PERSON OR BY DOOR RANGER IF OWNER IS NOT PRESENT AT
TIME OF PHYSICAL NSR.DOOR HANGER SHALL NOTIFY PROPERTY OWNER OF THE NTS
CONTRACTOR'S NAME,PHONE NUMBER,AND NATURE OF ENCROACHMENT AND WORK TO BE
PERFORMED
TWN: 1S DIALW.O.: 47231
SEC: 36
1947 CLAXTER RD NE RNG: 1 W COMCAST
UTILITIES SALEM,OR REPAIR CATV MAINLINE CALL81 SHT 3
N D PH: 971.900.0991
FAX:971.276.1992 DRN. DET 10855 SW 83RD BEFORE YOU
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DATE: 12/10/2015
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