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PFI2016-00113 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00113 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/01/2016 Parcel: SEG2092 Jurisdiction: Site address: Subdivision: Lot: Project: Comcast PFI Project Description: Bore one 3/4"conduit from pole 2038 under SW Naeve St at the min of 30"and NE to D Mark on 11321 Owner: FEES Description Date Amount PFI Permit Fee 06/01/2016 $300.00 PHONE: Contractor: LINESPACE LLC 18100 SE 51 ST AVE PHONE: 503-612-7917 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 Signature: Not Present Issued By: ---.- C Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00113 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. Ken 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 iri 1 . PUBLIC WORKS — ENGINEERING CITY OF TIGARD Public Facility Improvement (PFIy1Wffffff EERING DESCRIPTION OF WORK (in the right-of-way) TYPE OF WORK Check one: KUtilit•Connection ( TYPE 1—Franchise Utility Work ❑ SideA*-Ak/driveway approach f `Work performed by NWN,PGE ❑ Street improvements and/or utility agency. Detailed description: Arlt? 3/4" ;-y Nl O TYPE 2—Sidewalk/Driveway/Sev.•cr _:j?o W- 2-C Ab u, &W Note.ve- S1 .cu - Moll Work performed for the purpose of: CJXnd -�O PACU L-- 01`l l 3Z( Sidewalk installation or repair. • Driveway approach installation Property address/location(s): 1 l'�2 1 Naeyf- SA. `j any and/or repair loCL Sanitary sewer lateral installation and/or main line tap ❑ TYPE 3—Full scale Development Applicant: Cn J)n(LSA I Work performed with Land use Address: 1130`6 SW b� approval which includes any of the following: City/state: t �t�G0 GIp: �� I�01�> Subdivisions or Partitions Phone: %-&L� Z� Email: Ra��-S�kk&S(cCa�a�P. Co�1[uS} Coni Streeturidening Contact name: Phone: N lR Mainline installation for Sanitary c II sewer,Storm sewer,Tigard water Contractor: 1 vie's e L-LL �- / �-T and/or Tigard Water Service area I CCB#: D qy& Z!` Expiration: 1 /I _ SUBMIT COMPLETED APPLICATION TO: Address: ll 00 �,yj r) � �'� �sye- • City of Tigard City/state: +V�A)�. ()k2 Zip: g-jU(0 Planning/Engineering T— 13125 SW Hall Blvd. Phone: ESO ��IZ"�`�J�Email: Tl?.t n�i�S[I,`neSCat�e.t(c .Cot✓1 r' p t I[ ILO I / Tigard,OR 97221 m Contact nae: -(3-t Se,[�lC� Phone: `l� i pU L ' IL lq(p Applications for"minor work in right-of-wavy only may be emailed to: Engineer: row er ite iligard-or.gov Address: City/state: 'Lip: Phone: Email: Case No.: ZO I IO - '00 f 13 Contact name: Application submitrtl fee: 30 0•ee Additional fees: Estimated value of work is required(if over S5,(N)1)):$ Application accepted: (within the public right-of-wa%) By- � �l Dafe: s�3/ b Is work related to a LAND-USE DECISION? ❑ Yes tgcNo Application rc\icwed: B%: K•1( Datc: If so, please specif, (MI.P,SDR, SUB,etc.) case #: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes No K> S Date. S 3�h� P\CURCLN\M•strrs\tlnd Use Opp"Tions RN 07/09f101S If so,please specify(BUILDING PERl�il'l')case#: Cityof Tigard • 13125 SAX'hall Blvd. Tigard,Oregon 97223 • wwwtigard-or.gov • 54-13-718-2421 • 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 differcat people,the applicant must be the purchaser of record or a Icseee in possession with written authoaization from the owner or an agent of the owner. Tbc owncr(s)must sign this application in the space provided or submit a watrcu authorization with this application. BY SIGNING BELOW,THE APPLICANTS)SHALL CERTIFY THAT; The above not violateany deed restricdong that he attaches to or impQsed uWa h Q,{„ect pm�.__Y- • 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 plan,attachments,and exhibits transmitted herewith,arc true;and the applicants so acknowledge that any permit issued,bash 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 sg�owner of the subject property required. &i 5��-� 1 6 PPli orized Agent's signature Print name Date o n Z % wti rA 4.n. _5',27--4r ;A, tore Print name Date 150�ff�- ///— .� SSP®� a /– -4� signature Print name bate Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwdgard-oz gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement (PFI) Permit: DETAILED SUBMITTAl- • ' APPLICATION FEE Part 1: Required submittal frac $300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY CONNECTIONS,ETC. Parr 2: All non-water s��srcm improvements (work in the right of way) Engineer's estimate X 5% (less S300.00 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°/t. ❑ 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 Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 2204) • Weephole repair. ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Dotes(Cin;VVater,Sewer,etc) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ \Vater,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ \Vater Quality Paciliries • 'rest wells ❑ Grading ❑ Landscaping/Tree Plan Cl 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 ❑ Sheer label(project land use name,revision and plan log block,dates and sheet numbers.) 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) ❑ \Vater Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 S\V Hall Blvd. • Tigard,Oregon 97223 • rvw,.v.dgard-or.gnv 503-718-2421 Page 3 of 4 I 0l 3 4povGN 4^ IrH PRo r r. Y ihcE 51 DEYyALICS -4 i <� WALK t3 Q 60' 34' s (D0, Rt`KT-Of-WA1' FOC ftAUT" ROW STRIP 13f 0 ON?- 2U � �K 35 1,73 J 3 .J d ATTENTION:Otepon law requires you to follow rules adopted try the Oregon USM NOtiflCfatfpl Center ThOee rules ars tet fDrtfl m OAR 952-001.0010 through 952-987). 0.You may Obtain copes of the rules by ca ling the center.(Note.the telephone nurrAw for the Oregon tltlNty NMkgtfon Center _ is(503)2J2.198�. Page 80 2011 Edition 2011 Edition Page 81 (5 3 Two-lane,Two-Way-Roads - LSFioulder, r_•k 410ORoad _ Diag.300 !Shoulder Workrw/MMinor Road,Encroachment _Dia Og 33 0 Use this detail for non-freeway work which extends into a travel lane and nNEao Tr`I 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 ,use the g p Initial simultaneously, appropriate lane closure diagrams-for example. wamging A Diagrams 310 through 350. Sign A lane closure may be appropriate for conditions such as high traffic i 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 vehicles. See Section 4.3-Lights and Lighted Signs for exceptions. (opllonaq • ® `I 2. For added visibility,a truck-mounted arrow board or PCMS In caution -I •7 i 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 yr/TMA(both Optional) �� — - taper and tangent devices may be omitted. See Chapter 4 I • �i Buffer �� 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 centerline. 10, minimum • L/3 5. An arrow board in caution mode or truck-mounted PCMS with I • -SHOULDER WORK'or other appropriate message may be used for higher visibility. Sign Spacing and Buffer Lengths(fool) I i Posted S acinyBelween Buffer I I i Bono Zee A B. Space I NARROWS 20 so ERRATA: t 25 100 75 i30100 SupplementTable -J~35 I (Option) 350 125 40150 2016Lkdr.bw y1:. B45180 :oie50 500 210 sccuantM55250 s woPoc a+Eao SI_n 5acin and Buffer Lon the feat upplement Posted S acin Between SiEns "Buller" Initial Speed A Warning +8 C S ace Sign 60 285 Chapter December2011 December 2011 65 700 700 700 325 Chapter 70 365 I I