PFI2016-00081 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00081
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/02/2016
Parcel: SEG2254
Jurisdiction: TIGARD
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Adjacent to 15630 SW 88th Ave., bore one 3/4"conduit from ped at 8960 under Hamlet St. at depth of
30",then through ROW of 8955 and 15630 to power meter on house. SEG2254
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: 888-824-8264
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: Not Present
Issued By: ---�-
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00081
Type: Condition Name: Status: Seven :
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
RECEIVED
City of Tigard APR 2 5 2016
PUBLIC WORKS — ENGINEERING CITY OF TIGARD
PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK (in the right-of-way) TITE OF WORK
Check one: Nitilin•Connection TYPE 1—Franchise Utility\Cork
❑ Sidewall:/drivruat approach
Work performed by NWN,PGE
❑ Street improvements and/or utility agency.
Detailed description: `�e� ❑ TYPE 2—Sidcualk/Driveway/Sewer
a_kP t p Ah Q 1� p G '�'L n Work performed for the purpose of:
-��ou.�' ��J $455 g IS b� '��W�t-.....{C oY,� • Sidewalk installation or repair.
• Driveway approach installation
Propert}, address/location(s): 1569p SW !W-hAv,, and/or repair
• Sanitary sewer lateral installation
and/or main line tap
ElTYPE 3—Full scale Development
Applicant: Co MLP- Work performed with Iand use
Address: 11 approval which includes any of
the following:
City/state: Tip: Subdivisions or Partitions
Phone -$2- �-:mail: _S Street widening
Contact na[nc: �bL,�SQL Xk&s Phcmc: _614 _ Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
Contractor: _ ��1�S CA.`�2. �.�-•��, / and/or Tigard\Vater Service Area
CCB#: I`xp'ration: �` I f�_ SUBMIT COMPLETED APPLICATION TO:
Address: 5W S k S+AqP_• City of Tigard
Citi•/state: C I , Zip: q O(D Planning/Engineering
Phone: 503-- (z.=19 I} 1:nt.►il: �Q,{Yy���t S�L�,,n ;�Lp�p�((C •CDOA 13125 SW Hall Blvd.
1
Contact na � '+1";04- ��Q Tigard,OR 97223
[t�c: -}fC�(�� ,� Phone: for"minor uork in right-of-way"
only clay he ctnailed to:
Engineer: to c iitsnsgA.a_ -. y
Address:
City/state: Til,:
Phone: I-:mail: Case No.:?FIIQ1tj-00M
Contact name: _ Application submittal fee: _
Additional fees:
Estimated value of work is required(if over$5,000):S App G 1ti accepted:
(within the public right-of-way) By: Date: y ZS
Applird:
catir rcy •yvDate:
Is work related to a LAND-USE DECISION? El1'es �Nr,
If so, please specifi• (�fI,P, SDR, SUB,etc.) case #: By:
Ap ca t �-�titird:
Is work related to a BUILDING PI R>till7'? ❑ }'es No By: Date: Z�6
If so,please specif}'(BUILDING PERMIT)case#: 1ACURPLN\MastenkLanC Use Applications Rea 07/09/2015
City of Tigard • 13125 SV'Hall Blvd. • Tigard,Oregon 97223 • ,i,•u-v,:tigard-or.gt,v • 5(j.1-71h-2421 • Page 1 oro
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
Puchaw of authorization from the owner or an agent of the owner. 'The oainer(s)must anger thu �n in�as a leasee is possession with vvattea
authorizadoa with this application �Provided or submit a wsittea
BY SIGNING BELOW,THE APpLICANT(S) SHALT.CERTIFY THAT.
• The above ren .. _
.��' -anv deed stri ti nn at a � .
• If the application is granted,the applicant will exercise the rights granted in accordance with the
perms 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 Mumnitted herewith,
the applicants so acknowledgethat an are sari
y permit issued,based on this application,may be revoked if it
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 g,ach owner of the subject property required.
lo
PPli� orized Agent's signature Print name
Date
Own rice Ut h
Print name Date
signature Print�name Date
Owner's signature Print name
Date
PUBLIC FACILXrV IWR0VF2*1 ENT PERMIT
City of Tigard 13125 SW Han Blvd. • Tigard,Oregon 97223 • www tigard-or goes 503-718-2421 • Page 2 of 4
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ATTENTION:Oregon law requires you to follow rules adopted by the Oregon UOity tlficetlon Carder.Those Nies re se forth In OAR 9b2-001 0010
through 2-001-0090.You may obtain Copies of the Ntaa by calling the inter.(Note: a num r r 0 Utility Notification Center
is(b09)2532-1887).
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Page 84 2011 Edition I 2011 Edition Page 85
Sfationary?Lane'Glosu�e,with•F•I'agging Diagram 320 Stationary';Carie Clozureyithflagging' Diagram-320
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if sing a single flagger to control
ntrol
ffiADT)
S I o
both directions of traffic on low volume roads less than 400 ADTwith good w� o
sight distance as discussed below. CL
i
1. Use truck-mounted flashing warning lights on work and protection 0
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. o
toa
2. For added visibility,a truck-mounted arrow board or PCMS in caution
mode may be used.
wg o
3. Flaggers at each approach are required if any of the following m a A -7
I ~
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach �_________________ I m
through the lane closure._ i � 3 i .• �o D
d. Traffic volumes are greater than 400 ADT. I I c s
4. The length between the Flagger Ahead signs shall not exceed one 1 ° 1 1 I m a
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one /
mile. I I i
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass I 0
the work space safely.
I nE 7� I
6. Cones along the work space are recommended when posted speeds I a I • ^/� I • .�
are 45 mph or greater,when working under heavy traffic or when travel •
lanes are narrower than 11 feel. I Ce
I �J Y a e Ia
7. Extended queue signing(see Diagram 5-4)should be used when I m o I 'j'— .A
traffic queues extend beyond the initial advance warning sign. 1 I t Yocc
8. When flagging near an Intersection,the'Flagger Ahead"(CW23-2) !__________v
sign should be visible to traffic entering from any side road. Additional _
advance warning and Flagger Ahead symbol signs may be placed on I stop Spacing and o•rcaL•,gu,.trees) 1 t
the side road(s). EPRATA: PostedFA
twan na sun•r
5 8 G speca9. Sign set-up and flagger placement shown may be used for intermittent s PPrenunt'rewe sozs too too rs
full road closures of 20 minutes or less. w 100
3s,0 3sa ]so10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should W-ea" � +s 100
be considered on high volume or high speed roads,or when extended '""°' s0 soo so0 210
ss 250
queues are expected. sI n s act,z and Buffer t o th (fact) u l e it
Posted- . 5 tido eotwoen Signs ,
Chapter 5 December 2071 Dacemtxtr 2011 "Buffer" Chapter
Speed.. A •.B'. ., C Space
60 285
65 700 700 700 325
70 365