PFI2016-00114 v
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00114
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/01/2016
Parcel: SEG 1164
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast PFI @10820 SW Pathfinder
Project Description: Bore one 3/4"conduit from ped at 10835 under SW Pathfinder way then West through ROW to power
meter on 10820
Owner: FEES
Description Date Amount
PFI Permit Fee 06/01/2016 $300.00
PHONE:
Contractor:
LINESCAPE LLC
19100 SW 51 ST AVE
PHONE: 971-804-1496
FAX:
Applicant:
RANDY SHIELDS
11308 SW 68TH
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 Not Present
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00114
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 or Kenny@tigard-or.gov
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
■ MAY 31 2016
e PUBLIC WORKS — ENGINEERING
A
Public Facility Improvement (PFI) � G�NERING
DESCRIPTION OF WORK (in the tight-of-way) TYPE OF WORK
Cheek one: 15J�Utilin,Connection
(TYPE 1-Franchise Utility Work
❑ Sidea-allt/drivcw•ay apprnach Work performed by MC•N,PGE
El Street improvements r' and/or utility agency.
Detailed description: �ofe_ 0 Y,e 3l4-t. Cvn�-LJ-� r.-\
❑ TYPE 2-Sidewalk/Drivrw•a}•/Sewer
Te-6- -� 10 5r S W P"-�I f'N1d(ar -}{�q� \fink performed for the purpose cit.
R-Uy O pots ftuAe-r o0 In� Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): 10 S a_�)SY4 `PgA� t'Aj'zr SIAM and/or repair
• \r �r D p a� -.1 Sanitary sewer lateral installation
and/or main line tap
rr _ ❑ TYPE 3—l=ull scale Developmern
Applicant: l_1JYWork performed with Land use
Address: I 1 ?s D� US 1/� g�h + l<W approval which includes am of
City/state: T 1 0 dzip: 011:aa3 the following:
• Subdivisions or Partitions
Phone: q-6201 Email: _$1,,,�1�5 (� l2_[on1 •tory Strcct widening
Contact name: ,��. k s'"Iks Phone: NIA ?Mainline installation for Sanitarv
I sewer,Storm sewer,Tigard water
C'.ontractor: C and/or Tigard Watcr Service Area
0
l'
CCB ss: I j I l•D�LO
Address: D Expiration: °Iz 1 /I SUBMIT COMPLETED"PIICATION TO:
�1/\f �j� S� �.� ,
City of Tigard
City/state: _Y1 O R Zip: Planning/Engineering
Phone: 503-612_411} 1;mail: P?�W�i}5�,(.1r�e5Ca, �Le CO&V 13125 SW Hall Blvd.
Contact name: t
,A, Sal 'GK- Phone:
p _�oy `1 q 9(_0 Tigard,OR 97223
1
Applications for"minor work in right-(jf-way"
only may be cnuilcd to:
Frigineer: d
row�crrrit_■_C�;.gar=or g=
Address:
City/state: Zip:
Phone: Email: Case No.: PFSZ01 - 0 a-/)!1
Contact name S z� „-
Application submittal fcc: �v 0,&
Additional fees:
Estimated value of work is required(if over$5,000):$ Application sy,� SI-3111 (.,cptcd:
(within the public right-of
!�--way) By:
Is work related to a LAND-USE DECISIONS ❑ )'cs No Application reviewed:
If so, please specify (MI.P,SDR,SUB, etc.) case #: By: Datc: - S"
Applicant norificd:
Is work related to a BUILDING PERI\1171= ❑ Yes Kf No By �S_ Date: S
If so,please specify(BU11-DING PERMIT)case#: tWUPtP1N\LU&WWL"u,e A,pk-r „ A�07/09r"15
Cityof Tigard • 13125 SVi'Hall Bh•d. • Tigard,Oregon 97223 • w-a•w:ti9ard-ocgov 1 503-718-2421 • Page 1 of 4
APPLICANT'S
FNE: rson specified as"Applicant!'shall be desigated'Ttrrn1uxe,,andshallprovidefinancialassurance for vwork.
wer and the neer or a arc dit of t c gown the"fimat mux be the purchaser of record or a 1com in possession with writoen
authoaxatioa from the owner or an meat uE the owner The owner(s)mux wgnthis
suthoiMadan with this appliaadAM II t°the" c providedor aabmit a wsitcea
BY SIGNING BELOW,THE APPUC.ANI'(S)SHALT.CERTIFY THAT:
If the application is granted,the applicant will exercise the tights
granted
conditions and limitations of the approval. in accordance with the terms and subject to all the
• All of the above statements and the statements in the plot plan,attachments,
the licants so and exhibits trap d itted herewith,arc true;and
statements are that any permit issued,based on this application,may be revokod if it is found that any such
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 AAGh owner of the subject Property required.
orized Agent's signature Print name Date
S X1.7—4
VIA rVk
Print name Date
Print name
Date
Owner's s4plature Print name
Dace
PUBLIC FACILITY DIPROVEMKNT PERKM
CkY OfTIVrd 13125 SW Hall D". - Tigard,Oregon 97223 • wwwcigaad.ar m 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement (PFI) Permit:
SUBMITTALDETAMED
APPLICATION FEE •
Part 1: Required submirtal fee $300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
Engineer's estimate X 5% (less $300.00 submittal fee) (work in the right of way)
Engineer's estimate X 2%]:']an Review Skeicb
WATER SYSTEM FEE (inclucling information below)
Part 3: All public water system improvements ❑ Dimensions
Engineer's estimate X 12% ❑ Street Name
❑ Site Address
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required FULL SCALE DEVELOPh4IENT
for the following types of work: (Subdivisions/Partitions and Streer Improvements)
Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,2406 or 2204)
Weephole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement (less than 20 lineal fent) ❑ General!dotes(Cit};\Vater,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 ❑ \Fater Quality facilities
• Test wells ❑ Grading
❑ Iandscaping/Tree Plan
❑ Composite Utility Pian (Electrical,Phoac,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 sheet numbers)
Additional Submittals
(per land Use conditions)
❑ Traffic Rcport
❑ Storm Water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight.Distance)
❑ Proposed Plat
❑ Pathw,ay Design(if applicable)
❑ WInter Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cit} of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wuw.tigard-or.gov • 51.1.3-715-2421 Page 3 of 4
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Page 114 2011 Edition 2011 Edition Page 85
Stati ono ry Lane Closure with Flagging ___ Diagram 320 [StationaryL-ane Closure-With+lagging Diag7am 320•
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control l
c
both directions of traMc on low volume roads(less than 400 ADT)with good & S
sight distance as discussed below.
.*. CL
1. Use truck-mounted flashing warning lights on work and protection a O
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
m
2. For added visibility,a truck-mounted arrow board or PCMS in cautionLL
`0
mode may be used. L l 1 4 3
iE
3. Flaggers at each approach are required if any of the following 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 °
through the lane closure, 1I .••• p o
d. Traffic volumes are greater than 400 ADT.
= � i m
4. The length between the Flagger Ahead signs shall not exceed one I ke 1 1 el
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one I /- "-I
j a~
mile.
5. Cones should be used to outline the work space when curves or otherto
roadway alignments prevent clear direction for the motorists to pass I — d I I '•
the work space safely. j nE ttt i .
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater,when working under heavy traffic or when travel j ° I
lanes are narrower than 11 feet. tm
7. Extended queue signing(see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign. I c 1 t * D) /
B. When flagging near an intersection,the"Flagger Ahead"(CW23-2) V.
I / a
sign should be visible to traffic entering from any side road. Addiflonal
advance warning and Flagger Ahead symbol signs may be placed on I R30
snadCIMng d4t•iriSiGer a_ ir•W
the side road(s). F3L7grq: Potted tw•tn �•- auno
' "A- e. C,
50
9. Sign set-up and Flagger placement shown may be used for intermittent wPd°m"rt,T�l• too ao °° r5
full road closures of 20 minutes or less. foouemd:,"t.uvr,, 115rots150 JSO 35010. The"ONE LANE ROAD AHEAD'(W20-4)sign is optional and shouldtd°`�'°'be considered on high volume or high speed roads,or when extended Soo sao sro z,o
750
queues are expected. stn Spacin and Hu rot Lonnj tht feet supitlement
Potted ', 5 adn Detwoan5l nt ; "Buffer':
Chapter 5 December 2011 December ZOtt mew_ A d e space
_ Chapter 5
60 285
65 700 700 700 325
70 365