PFI2016-00024 v CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00024
i 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/24/2016
Parcel: SEG2466
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Adjacent to 9237 SW Martha St. Bored one 3/4"conduit for cable from ped at 9232 under SW Martha
St. at min. depth of 30",then through ROW W and to D mark on 9237.
Owner: FEES
Description Date Amount
PFI Permit Fee 02/23/2016 $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: t NotPresent
Issued By: ��
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00024
Ty pe: 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 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
FEB 17 2016
City Of Tigard CITY OF TIGARD
PUBLIC WORKS— ENGINEERING p ING/ENGLNEERING
Im rovement (Pdlermit
Public Facility
DESCRIPTION OF WORK(in the right-of-way)
TYPE OF WOGS
Check one: utility Connection TYPE f-f=ranchise Utility Work
Sidewalk/driveway approach Work performed by NWN,PGE
Q Street improvements and/or unlit,agency.
eE. mrte.�'�u� �e n•t ❑ TYPE 2-Sidewalk/Driveway/�*cr
Detailed description: `�— Work performed for the purpose of:
t�l.k q 132 ta.�n dt,c SW N�aa'�'l��-�-• a vwtn . �lek'1
• Sidewalk installation or repair.
�, tVLIlf' o
l Q • Driveway approach installation
ST i � and/or repair
Property address/location(s): a3} W • Sanitary sewer lateral installation
7 and/or main line tap
❑ TYPE 3-Full beak Development
n L / Work performed with I.atxl usr
1 ,�
Applicant: _ CDt�f approval which includes any of
Address- the following:
City/strut: ` p: • Subdivisions or Partitions
Phone:
ZyU64 Email: . S S MGaSt• • Strc t-Arcingation for Sanitary
• mainline install
Contact name' hone: N
scwcr,Storm sewer,Tigard water
t ` and/or'ftltard Water Service Area
Contractor: LLC
CCB#: 14D 4D� Expiration: I�I � l�- susstlT courlBTen wrrucanoiv 7%)-.
19100 SU.I X516+' � - • City or Tigard
Address:
PLturisg/E+giwe�a3
City/state: Yuma-�'�� Zip: _ q �GZ 13125 SW HaD Blvd.
PhG5ner jl Z-�g fir' Email' C• CD/1ii Tigard,OR 97223
_�p11.,�C,l� Phone: � '1" - Applications for"minor wrk in right-of-way"
Contact name' 1 ordy may be emailed u>:
Engineer:
Address:
City/state: lip:
Case Na:
Phone: Email:
Application submittal foe:
Connect dame:
Additional feet.
Application accepted:
Estimated value of work is required(if over$5,000):$ B LS Date:
(within the public right-of-way)
Appy'• rc
Is work related to a LAND-USE DECISION? ❑ Yes }$�No By. Date-
If
ate
P specify (MLP,SDR,SUB,etc case #:
1 f so,please s ) Applicant�oa�Fi�: ---�
DaoG a a
15 work related m e BUILDING P1:RMIT? ❑ Yes No Br.r�a,wwv USEAn'c"'°- AM
If so,please specify(BUIL-DING PERM11)case#: _
City of Tigard • 13125 SVC Hall Bh•d. • Tigard.Orcgon 97223 • www•tigard-or.gov • 543-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Persona specified as"Applicant"shall be designated"Nrmittee"and shall Provide financial aasumace for work
must be d= of maW or s bessoe in posey With aronen
•Wbeo the owns and the�°i arc diEfacct parplq the t�ppltcant P �P1°"'�or submit a z�
nwhoamdon f m m the own=or=samt of the owner. 7U owners)must op dais appiscwon is the
with due apphaaw
3Y SIGNING BELOW.THE"PL ICAM(S)SHALL CERTIFY THAT:
31C AM
• If tate application is granted,the applicant will 0='Ciw the tights granted in accordance with tie trans and subject to all the
conditions and limitations of the approval.
and the statements in the plot plan.atxad mcnts,and exhibits transmitted hcwwvi ,are nut;and
• All of flit above statements aPPlitati y if it is found that an suet
the is so acl uo�atiedge that any pcmut issued,based on this on,tan be rr:vofs+ed Y
stawnents are false.
tso int dw and tawan,and understands the
• 'The applicant line toad the eatirc conocnrs of the apptica n, udi� p��
for appeoving or denying the application.
gZCAAATLMM of gmgh owner of the euhK-ct property K9uircd•
Date
Agents signature Ptdnt name
Ptinc Warne Date
PIIAt nameownee
8 Print t]amc Date
i
I
pUDUC PACILIIY""ROVEME TT PUM Tl<'
C T%pwd 13125 SW HaA Blvd. • "rigavd.Ckcgon 97223 wwart>gaad-or goo 50 718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement (PFI)Permit:
APPLICATION FEE
part 1: Required submirW fee$300.00 FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTU'-rY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improv-micnts (work in the tight of way)
Engineer's estimate X 5% (less$3U0.Cal submittal fee) Sketcb
Engineer's estimate X 2%,Plan Revicw (including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system improvements ❑ Street Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL,SCALE DEVELOPMENT
There will be no permit fee charged,or assumnec required (Subdivisions/partitions and Street Improvements)
for the following types of work:
• Sidewalk repair(less than 20 Lineal feet) Design pians
• Relocate or replace mailbox (6 sets,24x36 or 22x34)
• Ditch cleaning that dues not invulvc regrading.
• Weephole repair ❑ Cover–Site,Vicinity,Abbreviation,Legend
❑ Gencral Notes(City,Water,Sever,ctc.)
• Curb repair or replacement (less than 20 lineal feet) ❑ Street(per Profile)
• Lawn sprinkler system installation or repair ❑ Water,Storm and Smeary(Plan Profile)
• Street tree pruning or planting ❑ Watcr Quality Facilities
• Planter strip landscape maintenance ❑ Grading
• Test wells ❑ Landscaping/Trec Plan
❑ Composite utility Plan(Electrical,Phone,Gas,
Note: A casb assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(cuuomer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
0 &tgineers seal/signature
❑ Sheet label(project land use name,rer ibivn and
plan log bk>ck,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm router Drainage Calculations
❑
Geotechnical Rept
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if appli-'le)
❑ WG Rtzr Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97"3 • w-ww.tigard-or.gov • 543-718-2421 • Page 3 of 4
cantPL Ste=
j 1 Edge of Peveme11t
Ditch
Streetlight � �uni,
1IS
W a iia
1 �e • DrWewa
Powerpole 95, -
`+ 1 -------Hope YUne'— -�
• I jT
' 1 Fire Hydrant(FH)
I1 Scale: 1"=30'
� I �
1
• I �
i
IVIINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not slope of pr
Property lines &dimension Slope of property
North arrow
structures Utility& street light poles
tre
Street& set nameExisting budding,s) VV// Trees
Existing curb or edge
Proposed work
Of pavement Existing utility locations
Existing S/W or (sewer,water, storm)
D/W apron
PUBLIC FACILITY IMPROVEMENT'PERMIT 3 715-2421 • Page 4 of 4
City of?igsrd
• 13125 SW Hll Blvd. • Tigard,Oregon 97223 • w�rvgdgaTd-or.gvv 50
�FiAUtIbN STREETS
WtcM �tO TY Lima 51CWWALI<S
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30' o-
ftw Joe
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WALK
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00
4.320 Lane Cl6sure with FlaggingDFagrenj 320' Lane Closure with Flagging
Diagram No.320 covers total closure of one lane of a 2-lane,2-way t�
roadway. The rtgtr 4mnd drawing Ulustrstes the use of two fleggera,one for f I
each approach. The left-hand drawing RIDS etas the use of a single gagger r
to cortrW both tarsen of trafftc on low vohrrne(less than 400 average daily uMM
ftuft)r0adS with good sight distances as discussed below,
LAW C
1. Use truck-mounted high-intensity rotating,flashing,oscillaling,or Strobe FCM C
warning rights vrith 380•visibility on all work vehicles. For added (opannceg 8
visibility,truck mounted arrow panels or PCMS in the caution mode may x AO"ad
be used.
TO STM e
2_ Flaggers al each approach are required it any of the following cenCitions { 07 t00 '40 too
exist: ,r A t-.40 aso sso sea 00
d ( +s_sd sao Sao neo
2. Night Operations or ego
� ^' --
b. work space is over 200 feet in length or.
IT
C. Sight distance is less than 750 feat from each approach through the { •
s
Ione closure or, •
Profttbn vehicle
d. Traffic volumes are greater than 400 ADT. I \ ' p�
vW TMA
3. The length between the flegger f A ( \ C1G
signs shah not exceed one mile. � f 1 I!
4. Cones should be used to outline the work space when curvras or other ` h
roadway or prevent clear direction for the motorists to pass the , 1 `
work zone safety. Cones along side the work space are recomrnt3nded + I A •� I •
MW Posted speeds are 45 or greater,when working under heavytraflic •
or when travel lanes are narrower than 11 feet.
5 Extended queue signing °.
Q (as shown on Diagram No. OU 1)should be used i
when traffic yueuer;extend beyond the Initial advance warning Sign. •
o When flagging near an intersection, the Flagger symbol sign should be } •' I R
visible to traffic entering from any side road.Additional advance warning � �•� i R ! ( A!
and Flogger symbol signs may Placed on the side road(s). f ^ •
�• T 'M STOP
7. Sign seri-up and flogger placement shown in Drawing No.320 may be
used for intermftent full road closures of 20 minutes or less. �
E. The ONE LANE ROAD AHEAD sign is optional and should be e { �8 Lon
considered on high volume or high speed mads, or when extended > ,• 1 V
queues may be expected. �_ C (oFntonaq man
Low Volume
Single Flagger Option { MAD
Diagram No. 320 Two!=tagger Operation
62
63