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PFI2016-00041 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2016-00041 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/04/2016 Parcel: SEG 3604 Jurisdiction: Tigard Site address: 11300 SW 81 Subdivision: Lot: Project: Frontier Communication PFI Project Description: a 50"bore across SW 81 st between 11287 SW 81 st and customer at 11300 SW 81 st ave. This will place 1.5"conduit and a flower pole. Owner: FEES Description Date Amount PHONE: Contractor: SONICOM 1275 S KODIAK CIRCLE 97113 PHONE: 503-710-2972 FAX: Applicant: JOHN COUSINEAU 4155 SW CEDAR HILLS BLVD BEAVERTON 97005 PHONE: Tota 1 $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: �— Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00041 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. Kenny Fisher @ 503-816-6146 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 " City of Tigard Memorandum To: PFI2016-00041 Case File From: Lina Smith, Assistant Planner Re: PFI2016-00037 and PFI2016-00041 Date: March 16, 2016 This Public Facility Improvement permit was mistakenly duplicated (Case Nos. PFI2016-00037 and PFI2016-00041). Both case numbers cover work adjacent to 11300 SW 81St Avenue. I erroneously issued PFI2016-00041, instead of PFI2016-00037, and did not invoice the $300.00 permit fee. I will submit a "Request For Permit Action" form to void PFI2016-00037. I apologize for the misunderstanding. Thank you, Lina Smith, Assistant Planner DECEIVED City of Tigard MAR 012016 PUBLIC WORKS —ENGINEERING CITY OF TIGARD ING Public Facility Improvement (1V1)'Pe'rn-nt DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: A 50' bore across SW 81 st Ave. between 11287 ❑ Minor work in right-of-way (sidewalk repair,curb cut,street SW $1 st and the customer at 11300 SW 81st Ave is requested. This opening,etc.)requires: will place 1.5" conruit and a flower pole. •application form,completedand signed •Submit one(1)copy of scaled sketch Property address/location(s): 11300 SW 81 st Ave n/o SW Pfaffl . St. of the proposed work to be done Lr �� •Submit one(1)copy of traffic / 304 control plan –OR- 0 Substantial project work requires Applicant's name: Frontier Communications/Cousineau above items and professional Address: 4155 SW Cedar Hills Blvd. engineered plans for: City/state: Beaverton Zi 97005 •Street widening P' •Subdivision infrastructure Phone: 503-643-0371 Email:jchn.cousineaunftr corn •Main utility line extension: Storm Drain,Sanitary—Tigard Crater--Tigard Water Service Contractors name: Sonicom Area(includes Durham,King City CCB#: 188116 Expiration: 3/24/201(3 and a portion of unincorporated Address: 1275 S Kodiak Circle Washington County) City/state: Cornelius Zip: 97113 DELIVER APPLICATION TO: City of Tigard Phone: 503-710-2972 Email: mattshore(cbsonicom.eom Planning/Engineering 13125 SW Hall Blvd. Engineers name: John Cousineau Tigard,OR 97223 Applications for"minor work in right-of-way" Address: 4155 SW Cedar Hills Blvd. only may be emailed to: City/state: Beaverton Zip: 97005 roLvpermitsntigard-ongov Phone: 503-643-0371 Email: john.cousjneau.ftr.com • ONLY � 2,01 k' � �� Estimated value of work (within the public rip Case No.: 1 tight-of-way): 2,000 o(�v Application submittal fee: U �P Is work related to a LAND-USE DECISION? ❑ Yes ® No Application accepted: If so, please specify (MLP,SDR,SUB,etc.) case #: By: m Date: Is work related to a BUILDING PERMIT? ❑ Yes ® No Applieado revi d: Zo J G If so,please specify(BUILDING PERMIT)case#: By Date: L Applicant notified: 74�� Gt �'-'y �l/�S a//' (',/r UC2/Z sGt�IytlFI A— By Date:�T 0r / I;\LURPIN\Marten\lard Use Appu atfons Rev.07/16/2011 City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 s-tZ� U.a�"a( 1�jeMo . LS 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 people,the applicant must be the purchaser of record or a lessee in possession with written authorisation from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANTS) SHALT.CERTIFY THAT: • The above request does not violate Any deed restrictions that may be attached to or imposed upon the subject proF,e. • 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. SIGN _ URES of each owner of the subject property required. John Cousineau 02/26/16 Applicant/Authorized Agent'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 Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part L• Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee=Part 2+Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: 4 S W "}� " S t Edge of Pavement Q Ditch Pk Streetlight I +—' -- If ry Tlm qa. T—morp'os d"S�werT'ne�' 1 I _ 1 ;t I & . Existing House � v11 I Existing 1 �I I 3� Driveway �I I of zrx v� v� a Existing Shop 1 J , Powerpole I I ice_ -- ---—-TopertyLine-—-—-—-—-—- I II Fire Hydrant(FH) � I I i iI Scale: '1"=30' I I � I I MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable): North arrow Property lines&dimension Slope of property Street&street name(s) Existing building,structures Utility&street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (server,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - -'VW vtigard-or gov - 503-718-2421 - Page 4 of 4 i I I I I 5, / cQ� / 11287 SW 81 St. Ave 11287 SW 81St. > BORE FROM EXISTING HAND HOLD Q Ave ACROSS SW 81 ST AVE 60' WITH 0 EXISTING COVER OF 36" AND PLACE 1.25" Z HAND HOLD C w CONDUIT. I 6845 6844 Q U) 1315 11300 SW 81 St. Ave SW 81 St. Ave SW PFAFFLE ST - - I I I I �s 11287 SW 81 St. Ave 11287 Li SW 81st. BORE FROM EXISTING HAND HOLD Q Ave ACROSS SW 81ST AVE 60' WITH C) EXISTING COVER OF 36" AND PLACE 1.25" N HAND HOLD I CONDUIT. 00 LiJ 6845 6844 1315 I cis 11300 SW 81 St. 00 SW 81st. Ave :�:: Ave X>• I c� — --- — — --- — SW PFAFFLE ST — — —