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PFI2016-00078 a CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00078 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/02/2016 Parcel: SEG1019 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Integra Project Description: Adjacent to 12455 SW 68th Ave. Directional bore and place 154'-2" HDPE conduit and fiber optic cable in ROW. Owner: FEES Description Date Amount PFI Permit Fee 05/02/2016 $300.00 PHONE: Contractor: PHONE: FAX Applicant: BRIAN DAVIDSON 18110 SE 34TH ST BLDG ONE, SUITE 100 VANCOUVER, WA 98683 PHONE: 360-558-4215 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. ttlicant Signature: ignPermittee/Applicant Signature:ure: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00078 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 at 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® APR 18 2016 CITY OF TIGARD Cary of Tigard PLANNING/ENGINEERING _ PUBLIC WORKS —ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION 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,PGE ❑ Street improvements and/or utility agency. Detailed description: J01&77DAf,*L 802E 4 OOLAct /SSSS r — ❑ TYPE 2—Sidewalk/Driveway/Sewer 2" MOPE CMD07- i '996X aenc, C4f366 /1V RDA1. Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(,): 1285-5 SW &F'4V67. and/or repair • Sanitary sewer lateral installation J /T— and/or main line tap ' ❑ TYPE 3—Full scale Development Applicant: 15445 •ZIedCr UGHrAA116 UZ Work performed with Land use Address: /SO 0 SSE 3V rN Sr, WCr ANE , S'TE, /00 approval which includes any of the following: City/state: V4AICDU✓E72 k* Zip: W33 • Subdivisions or Partitions Phone: (360)5S8-5121 S Em' ail: bpi&n. d-e ri al5mgf in/Urah?leam.s om • Street widening Contact name:SP-I,#n/ DhOD.Sen/ Phone: 660)5558-4215 • Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: S7'*Atj V-b &J ?Urfi CGY1/)70C4—AkS XAIC. and/or Tigard Water Service Area CCB#: 616,749 Expiration: SUBMIT COMPLETED APPLICATION TO: Address: 12-0941 F4V"Al 4. N/E City of Tigard City/state: A94&" 1 /�OR Zip: 7 74902— Planning/Engineering Phone:63y3)S'rf9-$828 Email: �Ln"C r®r SRndala>�i�><y.�o+rr 13125 SW Hall Blvd. Tigard,OR 97223 Contact name:QAr2Q6L !4/!.G/ImS Phone: (So3) 9-V'828 Applications for"minor work in right-of-way" only may be emailed to: Engineer: M141N AW/10 bowl roapermits4tigard-or.nov Address: .SAM-1 /4'.S f}PPUCA+JT City/state: Zip: FOR STAFF USE ONLN_ Phone: Email: No..- Contact � Case No.• Contact name: Application submittal fee: d Additional fees: Estimated value of work is required(if over$5,000):$ /�✓�86� Application accepted: (within the public right-of-way) By: �S Date: ' ed: Is work related to a LAND-USE DECISION? ❑ Yes Q'No Applicatio re By: Date: If so,please specify (ML13,SDR,SUB, etc.) case#: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes eNo By: L—�7 Date: If so,please specify(BUILDING PERMIT)case#:— _ 1ACURaunM•.t—\L"dU.AWicaft", Rev 07109l201s City of Tigard 13125 SW I fall Blvd. • 'rigard,Oregon 97223 www.tigard-or.gov 503-718-2421 Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. *When the owner and the applicant arc different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agoit of the owner. The owner(s)must sign this application in the space provided or submit a written authoeration with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request docs not violate any deed restrictions that may be attached to Or imposed upon the subject propel. • 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. SIGNATURES of each owner of the subject property required. Lj� /✓ SR 1,'91V A4VZ6 Son/ 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 City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4 f DEVELOPMENT ENGINEERING FEES FOR STAFF' IJSEI ONLY Public Facility Improvement(PFI)Permit: DETAILED stmmrrml, APPLICATION FEE REQIJIREMENTS Part 1: Required submittal fee$300.00 � FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water system improvements CONNECTIONS,ETC. in.the right of way} Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (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: There will be no permit fee charged,or assurance required FULL SCALE DEVELOPMENT for the following types of work: (Subdivisions/,Partitions and Street Impiovementti) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 22x34) • Weephole repair ❑ Covet—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City;Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas; Note: A cash assurance may be required per Storm,.Sanitary,Water,Signage;Street Lights,etc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers'seal/signature ❑ Sheet label(project land use name,revision and plan log block,.dates and sheetnumbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(f applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 iI I I I CONSTRUCTION NOTES: Facilities shown on this plan were obtained from records, visual surface inspection,and/or information obtained from I other utilities.Some facilities may be omitted,or shown at an I EXISTING ELI 2'X3'HANDHOLE incorrect location.Facilities shown are in assumed locations I I I -BACK OF SIDEWALK- based on all information received,but exact locations must be verified prior to start of construction. I I I REMOVE/REPLACE EXISTING ELI 2'HDPE WITH F.O.CABLE I I I I SIDEWALK PANEL,AS READ. Aerial facilifies are to be bonded&grounded al all accessable locations,with cable tags placed at each attachment i I " — " 1 EXISTING ELI 2"HDPE WITH F.O.CABLE All aerial attachments are to be street-side unless otherwise noted.(FS)indicates"Feld side". ao 42' —— 6' All materials,methods of placement,and restoration must meet the requirements of the City of Tigard,OR. Place cable tags at each pullbox,slack loop,aerial jI SID-- — _ _ _ _ attachment or accessable location. NEW 2"HDPE WITH F.O. SW FRANKLIN CABLE-PLACED BY I 24' Contractor to contact Utility Notification Center prior to start of 3' S 1T DIRECTIONAL BORING- I any excavation work.l-800-0245555 or 811. 6, __— —4 —— 36"MIN.DEPTH _ NEW2"HDPE WITH F.O.CABLE-PLACED BY •I •---•—"—•—•—•—•—•—•—^-- DIRECTIONAL BORING-36"MIN.DEPTH REMOVE 1 REPLACE I I —� ———_ SIDEWALK PANEL,AS REOD. j SCOPE OF WORK: SIDEWALK—•— — •—" •—•—.—. I _ _I 2"HDPE COND.W/FIBER OPTIC °w Ew"Y — _ — —"—" — — —•—.—.—.—,_ _ _ _ CABLE=154'IN RIGHT OF WAY. 13 ———'j'— `I — -- • _ _ _— —_—_— —_ _ _ COND.TO BE 36"MIN.DEPTH i \ � " i I i /^��—----yew—__ •—'—�— —•_— i NEW ELI 17x30 HANDHOLE- I > I I NORTH PRIV.PROP. McGee Wealth Mgmt. I I CITY ITUlT PIAN Ii (0 - U) 1 12455 SW 68th Ave. I I (0 j j I j I ® �Integrd LIGHTWAVE I I I I 1 I I I 18110 K 3 & (W,5566800 CORP UFU Vs,mw".WA V 0,WA 100 88681 o, McGee Wealth Mgml.-12455 SW 68th Ave,Tigard,OR srt6l xo. 1 1 Brian Davidson , (360)5584215 wre 4115/15 n (360)55BA700 C27538.OSP.I6.ND.12HP.SUC rah R4E scut r. 20'