Loading...
PFI2016-00011 v CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00011 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/29/2016 Parcel: SEG885 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Replace damaged section of 2"schedule 40 pipe with CATV mainline Owner: FEES Description Date Amount PFI Permit Fee 01/29/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: IVAN CHANDLER 11308 SW 68TH PKWY TIGARD, OR 97223 PHONE: 503-596-3754 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 PF12016-00011 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 RECEIVED City of Tigard JAN 26 2016 PUBLIC WORKS—ENGINEERING F TIGARD Public Facility Improvement (Pdrj�4VI € itHNG DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK Check one: X Utility Connection TYPE 1—Franchise Utility WorkSidewalk/driveway approach Work performed by 1`-W-NT,PGE E Street improvements and/or utilityagency. Detailed description: -Replace damaged section of 2"schedule 40 pipe with CATV £ TYPE 2—Sidewalk/Driveway/Sewer Mainline. Work performed for tte purpose of: • Sidewalk installation or repair. • Driveway approach installation and/or repair Property address/location(s): w t 4 p S • Sanitary sewer lateral installation ST and/or main line tap £ TYPE 3—Full scale Dcvelopment Applicant: Comcast Cable Work performed with Land use approval which includes any of Address: 11308 SW 68th Parkway the following: City/state: Tigard OR Lip: 97223 • Subdivisions or Partitions Phone: 503 596-3754 Email: ivan_chandier@cable.comcast.com • Street widening Contact name: Ivan Chandler Phone: 971 777-0908 • Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: Fisk Communication Contracting INC. and/or Tigard Water Service Area CCB#: 185632 Expiration: 2/24/2017 SUBMIT COMPLETED APPLICATION TO: Address: 2705 NE 65th ave City of Tigard City/State: Vancouver WA zip: 98661 Plaaxinglagiseeriag Phone: 360 984-6567 Email: fcckris@gmail.com 13125 SW Hall Blvd- Tigard,OR 97223 Contact name: Kris Raimer Phone: 360 989-7285 Applications for"minor work in right-of-war" only may be emailed to: Ennnneer: ronTermits�`�t rd-or ggv_ Address: FOR STAFF USE ONLY City/state: Zip: �y�� Phone: Email: Case No..• �62 J) - 0-0—// Contact name: Application submittal fee: /0 0 Additional fees: Estimated value of work is required(f over$5,000): Application accepted: (within the public right-of-way) By- G-s Date: I a Application.rev ewed: Is work related to a LAND-USE DECISION? £ Yes £ No B`' � Date: If so,pleases ecify (NILP, SDR, SUB, etc.) case#: p Applicant„notif ed: Is work related to a BUILDING PERMIT? £ les £ No By- !S Date: d4VA0 If so,please specify(BUILDING PERMIT)case#: 1-.\cvftPU4\ "te«s\car.dUseAppliCAOM Re.071Wn015 wwwwwww�imwnw•nwwwwiwwr�rwwn�nwmniwwww��wwisia>.mwo�wwww�.ww�w�smnnwwwewww�w�ww City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-orgov • 503-718-2421 • Page 1 of 4 • — A APPLICANTS NOTE: Person specified as._"'\pplicant"shall be designated"PerLnittee"and shall provide financial assurance for work. \`hen the oumer and the applicant are different people,the applicant mint he the punch,}ser(if record or a lessee in possession x6th written authorization from the sumer nr an went of rhe ownev. The ocvmcr(s)must sign this applicarion in the space provided or submit a written authorization ccith this applicarion. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or its op sed upon the stibiect propert<. • If the application is grantee{, the applicant.will exercise the rights granted in accordance«gith the testas 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 herewida,are true:and the applicants so acknowledge that my permit issued,based on this application,may be revoked if it is found that an,,,-such statements are false. • The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements Cot appro-ving or denying the application. SIGNATURES of each owner of the subject property required. --- \pplicatht/1 titlx,rized r'egent's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13123 tilt-Hitll Blvd. • Tigard,Oregon 472^3 • wuwrigard-ringov 303-718-24'_1 • Page 2 of 4 DRIVEWAY �'0 12115 rfi � t2y$3 � 15 SI DE WALK 4 SW KATHERINF ST 6 BORE I NORTH CURB To CURS POSSIBLE: ?.-Clc >s S, WATEP, MAIN VALVE f j PI_MT-CM STRIP iZ BORE UNLER SIDEWAL-K - t ALONG 5AcK of '4, I 3, Fl . Communications Contracting Inc cKry Construction Division Q>ra b TOTAL R_ W = 153 (360)984-6567 METHOD= 'DI REC.T DRILL P[PE= p„POLY DEPTH= 36'r CORES= a POSSIBLE- ON HZO i SIF-ViCk MAINS