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PFI2016-00080 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT ® COMMUNITY DEVELOPMENT Permit#: PF12016-00080 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/02/2016 Parcel: SEG760 Jurisdiction: TIGARD Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 13090 SW Falcon Rise Dr., bore one 3/4"conduit from ped at 13165 under Falcon Rise Dr. at mon. 30"to ROW through 13170 to power meter on 13090. SEG760 Owner: FEES Description Date Amount PFI Permit Fee 04/29/2016 $300.00 PHONE: Contractor: LINESCAPE LLC 19100 SW 51 ST AVE. TUALATIN, OR 97062 PHONE: 503-612-7917 FAX: Applicant: RANDY SHIELDS 11308 SW 68TH PKWY. TIGARD, OR 97223 PHONE: 888-824-8246 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: --- — �A�. Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00080 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 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 RECEIVE® City of Tigard APR 2 5 2016 PUBLIC WORKS — ENGINEERING CITY OF TIGARD Public Facility Improvement (PPty'VeEr"VING DESCRIPTION OF WORK (in the right-of-way) KTVork TYPE OF WORK Cheek one: kUtiliry Connection ypE l-Franchise Utility Work❑ Sidewalk/driveway approach performed by NVCN,PGE ❑ Street improvements o and/or utility agenc}: Detailed description: '&rC. Crn& 3�� U17� � ❑ TYPE 2-Sidewalk/Driveway/Sewer "D _ Fia Coa m-1)r_ 0* Ivry. 3t)"-f<-o R o W \X ork performed for the purpose of-. o I W +o KAr N14-e,r pn Sidewalk installation or repair. • Drivcway approach installation Property. address/location(s): jeZ0!C0 (SW F-C1.-Cfl(I and/or repair • Sanitary sewer lateral installation - and/or main line tap ❑ TYPE 3-Full scale Development Applicant: \fork perforated with land use Address: approval which includes anyof �� - the following: City/state: Gip: Subdivisions or Partitions Phone•. OZ4 Email: _ CA ,r. �(A�� • Street widening Contact name: 1 toric: ` Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: _ �..b�R�,epi rAVt, LLL, and/or Tigard Cater Service Area f CCB#: 14*`�V(� Expiration: 7 / 1 /I� _ SUBMIT COMPLETED APPLICATION To: Address: 1011 SW City of Tigard City/state: /ip: Q16(6D Planning/Engineering 503'�M-' +JIB 1:�nail: Mi 13125 SW Hall Blvd. Phone: �-�S�a'�, ltnPS�u AP u. •�>N� � ` ,p r Tigard OR 97223 Contact name: �� szel�,GIZ. Phorlc: IL% Applications for"n inor u•t�rk in right-of-ma) only may he emailed to: Engineer: to nermitsatigard�crov Address: _ City/stateIMMUNE Gip: Phone: _ Email: Case No.- W-1 2.014- MAO Contact name: Application submittal fee: Additional fees: Estimated value of work is required(if over$5,000):$ App L � accepted: (-within the public right-of-way) By: Date: 14125114 Ap licatio rc cd: Is work related to a LAND-USE DECISION? ❑ Yes [ Nts By: Date:j�g �G If so, please specify (MIT, SDR, SUB, etc.) case #: - Appli a tiFied: Is work related to a BUILDING PER IYF? ❑ Yes No By. Date: If so,please speciti (BUIMING PF-:RMI'I�case#: 1:WUR0'1N\M*ste,\ontl Used Mn Chr&om Rev 07/0912015 Cityof Tigard 13125 SW Hall Blvd. • Tigard,()regon 97223 • w•ww.tigard-or.gov • 503-718-242.1 • Page 1 of 4l APPLICANTS NOTE: Person specified as"Applicant"shall be designated'Permittee"and shall provide financial assurance for work 'When the owner and the applicaac arc different peopk the applicant must be the suthomadoa from the owner or an agent of the owner. The a must of rea�rd or s lcgaee in poasasion�� authotimtion with this application. owner() '`l"s application in the apace provided or submic a wtitcm BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: to any deed restriccinil rhar May he artachr.,to or ur. ■ the subbed Nop=ty. • If the application is granted,the applicant will exercise the tights 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 phu4 attachments,and exhibits ttansmitced herewith, the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found diet any s such d 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 ggch owner of the subject property required PPli� orized Agent's signature Pnrtt name Owny� -12,/4 tore Print name Date er � Print name Date Owner's signature Print name Dace PUBLIC FACILITY D"ROVEKBNT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www dgard-oL$°v 543-718-2421 Page 2 of 4 �pIZOVG�i STREET.S worm PF-OrEaTY Lime SIDSWAL1<5 • l 3 t l�5 � WALK Tilivil MAAtT� t C�rr+vw► yr IP tic Nk f r (007 - l6Ht'-OPr-WA- i -- t FOC pl�J arrtcp --- -J---- - - -_ t^/ -- - ►3 - 2�+ - GrrtU Rlkf ►NAc K ' € /7,/ ) 1: 't $ . J t�, ! ( 3 t 13 15Q 3 1 �Q 13010 � ! r � F3610 ATTENTION:Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.Those rules are set forth in OAR 952-001-0010 through 952-001-0090.You may obtain copies of the rules by calling the center.(Note:the telephone number for the Oregon Utility Notification Center is(503)232-1987). i Page 80 2011 Edition 2011 Edition Page 81 'g4dolEadfo `c m n, L.gWeJW��&-__W_4yi f Cd iFd s; u erm or, 3y/Minos R Dia 300 SI brkw1;M_LrEo�,_R_ ai—,Ericroyc Ch.( 0M Row woluc Use this detail for non-freeway work which extends into a travel lane and < raEno X maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane • can not be maintained,or when traffic can not safely pass by in both lanes Initial simultaneously,use the appropriate lane closure diagrams—for example, I Warning A • Diagrams 310 through 350. Sign • A lane closure may be appropriate for conditions such as high traffic • VA volumes,high speeds,and inadequate approach sight distance to the work space,or heavy equipment adjacent to the travel lane. • 1. Use truck-mounted flashing warning lights on work and protection (Optional) • vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. • 2. For added visibility,a truck-mounted arrow board or PCIVIS in caution mode may be used. • 3. Cones shall be placed along the entire length of the work space. If a Protection Vehicle protection vehicle is used and work is in place one hour or less,the w!TMA(both OptionA taper and tangent devices may be omitted. See Chapter 4 — • Butler 4, If the speed is 45 mph or higher,volumes exceed 2000 ADT,or there • is limited sight distance,consider placing cones or tubular markers on 10, centerline. minimum sL13 5. An arrow board in caution mode or truck-mounted PCIVIS with 'SHOULDER WORK'or other appropriate message may be used for • higher visibility. 4 Sign Spacing and Buffer Lengths(feet) I .-P—" "-�Is..-.-, A - t6d,I it _iBdtwbie—n'.SIons,- T_BiiK1r,_ P6s ROAD ;,Speed;!. _x B, C 50010,01 I I NARROWS 20 50 ERRATA: 25 100 100 100 75 30 100 SupplementToble I (Optionao 35 50 350 350 1 46 3 15250 UpdA,d:1ehV12, B 45 180 2016 50 500 500 500 210 `o�or vary 1 55 250 Sign Spacing and Buffer Lengths(feet)Sunolement ,Posted Spaclng%Eletwe Sign-1. Psuffer-"- WInitial Warning Speed A 8 C SOCC1, Sign 60 285 Chapter 5 December 2011 December 2011 Chapter 5 65 700 700 700 325 70 365