Loading...
PFI2016-00135 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT $ COMMUNITY DEVELOPMENT Permit#: PF12016-00135 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/23/2016 Parcel: SEG446 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Directional drill from the ped, on the north side of Thorn St going south 21'across road placing 3/4"pipe with CATV to service 8820 SW Thorn St. Owner: FEES Description Date Amount PFI Permit Fee 06/23/2016 $300.00 PHONE: Contractor: PHONE: 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 PF12016-00135 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 5030816-6146 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 JUN 21 2016 City of Tigard g PUBLIC WORDS— ENGINEERING CITY OF TIGARD PLANNING/ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: Utilities ELEMENTS ❑ ❑ Sidewalk/driveway approach ❑ StrerK improvements Detailed description: Directional drill from the ped, on the NORTH ❑ Minor work in right-of-way side of SW THORN ST going SOUTH 21' across road placing 3/4" (sidewalk repair,curb cut,street�ing, ) qu o etc requires: pipe with CATV to service 8820 SW THORN ST. •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 8820 SW THORN ST, 97223 of the proposed work to be done •Submit one(1)copy of traffic control plan —OR— COMCAST CABLE ❑ Substantial project work requires Applicant's name' above items and professional Address: 11308 SW 68TH PKWY engineered plans for: TIGARD, OR 97223 •Street widening Cir•/state: Zip: •Subdivision infrastructure Phone. Email:Ematl: Randy_Shields®cable.comcast.com •Main utility Eric extension: - Storm Drain,Sinitan'—Tigard . Fisk Communications Contracting, INC. - Water—Tigard\�faterService Contractors name: .1rea(includes Durham,King City C(-B#: ORCCBa 185632 Expiration: and a portion of unincorporated Address: 2705 NE 65th AVE V-ashington County) Cir'/State' Vancouver, WA Zip: 98661 DELIVER APPLICATION TO: City of Tigard Phone:360.314.4454 Email:fcclocates@comcaet.ne[ PJanning/Engineering 13125 SW Hall Blvd. Engineer s name: Tigard,OR 97223 Applications for'rninoz work iu right-of-way" Address: only may be emailed to: City/state: Zip: rownermitsi•strd-or.9eov Phone: Email: Estimated value of work (within the public right-of-way): g600.o0 Case No.: } 1Q07(0- 0013S" Application submittal fee: 3149 w Is work related to a LAND-USE DECISION? ❑ Yes ® No Application accepted: /� If so, please specify (MLP,SDR,SUB,etc.) case#: B}- _.� Date:�'C Is work related to a BUILDING PERMIT? ❑ Yes ® No ApplicaUun reviewed: If so,please specify(BUILDING PERMIT)case#: Applicant o rJ. By: Diitc: I\CURPINVASUa \l4nd Um Ap{Jr A, Rev 07/16/2014 Cityof Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 xvw wtigard-or.gov 503-718-2421 • Page l of 4 APPLICANTS NOTE: Person specified as"Applicant" shall be designated`Permittee"and shall provide financial assurance for work. %viten the owner and the applicant are different people,the applic:utt most be tlo pmchasct of record or n lessee in possession with written autltorizaoon from the oaaner or an agent of the owner. The owner(s)must sibm this application un Elie space provided or submit a written authotizatioo with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be artached to or imposedoon the subject Apert;. • If die application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and linutations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmirted 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 die requirements for approving or denying the application. t SIGNATURES of each owner of the subject property required. J f—, Margarita Vega 6/21/16 ApphcantRAuthorizcd Agent's ignarure Print name Date Owners signature Print mune Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERAIIT City of Tigard • 1312.5 SW Hall Blvd. • "Tigard,Oregon 97223 • tvw%utigard-or.gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part 1: Required submittal fee 8300.00 Part 2: All non-water system improvements Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee=Part 2+Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-of.gov 503-718-2421 Page 3 of 4 -�ff 13eaga s-W-Rxt- -a► ' ��, � 3�,� r-e. Y\G L ��r J 1ST Communications Contracting Inco (360) 314-4454 Li I pw N 5 8�zo �S o