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PFI2016-00143 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00143 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/12/2016 Parcel: SEG387 Jurisdiction: Tigard Site address: 12658 SW North Dakota Subdivision: Lot: Project: Comcast PFI Project Description: Bore one 3/4"conduit from ped under north Dakota st. north through ROW and then west to D Mark Owner: FEES Description Date Amount PFI Permit Fee 07/07/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHEILDS 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 Not Present Signature: 01, Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00143 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 JUL 06 2016 City Of Tigard CITy Op TIGARD PUBLIC WORDS — 1 NGINEI RING PLANNING/ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK (in the right-of-way) TYPE OF WORK Check one: ,f Uriliry Connection ZTYPE 1—Franchise Utility\Y'ork ❑ Sidewalk/driveway approach \Fork performed by NVi'N,PGI. ❑ Street improvements and/or utility agency. t� Detailed description: �iLc�'f.., @3n8, �4 t,pr�.t-.� "^`L C7 TYPE 2—Sidewalk/Drivewat•/Sewer fV'O �L o- -I �.r-a 'h Work performed for the purpose of: � p K��-f-c� S-F- t'V -� Sidewalk installation or repair. I Driveway approach installation z�� 0 S IV W }„(jc �, p a�10, and/or repair Property address/location(s}: `'1 • Sanitary sewer lateral installation S�• Tf per OF, �� a a3 and/or main line tap 'E C-1 3 t ❑ TYPE 3—Full scale Development Applicant: m�� _ Work performed with Land use + a roval which includes any of Address: 3 S kh p�W_1 thefollowing. Cite/state: ��°\�`�d`r D� _ "Lip: a��— Subdivisions or Partitions Phone: '&6�Zy'S26qEmail: dt1—Sk',euSLa,Chblf, ,( tern- Street widening Contact name: 7-�4Xnkh L )ieJ-Jc Phone: N/At Mainline installation for Sanitary t sewer,Storm sewer,Tigard water Contractor: and/or Tigard Water Service Arca CCB#: I`{r,) 40 Expiration: d- 1111_+ SUBMIT COMPLETED APPLICATION TO. Address: MOD S V� 5 i S-1 /�V Q, City of Tigard Cit'/state: Zip: -I Planning/Engineering Fjo5-( IZ_}TTEmail: �� tv�°+S /�i�,�\QSCG��I�L,t.o�' 1Tgard,O3125 SW 97223. Phone: _ _ Q / Tigard,OR 97223 Contact name: � �d .eAU`� Phone: `��!-O�Lf`��I to Applications for"minor work in right-of-way" unly may he emailed to: Engineer: rowperr ts(g tigard-or.gov Address: Cit•/state: Lip: f rl -, D V l4 Phone: Email: Case IVo.: Contact name: Application submittal fee: 3 0y• cc Additional fees: Estimated value of stork is required(if over S5,000):S Application accepted: (within the public right-of-way) By: �' IDate: Application reviewed: is work related to a LAND-USE DECISION? ❑ Yes No 7--1- By: �1'h4+'ta:l2 Date: If so,please specify (MIT,SDR,SUB,etc.) case #: Applicant notified: Is work related to a BUILDING PERMIT? ❑ .Yes � No B`` � Date If so,please specify(BUILDING PERMIT # }case : 1ANRPtK\Ma1t 1%\hndUse Apo"nO s of noes Cite of Tigard • 13125 SDi'Hall Blvd. • Tigard,Oregon 97223 • ww-a- Bard-or.gov • 503-718-2421 • Page I of 4 D,414-p- A 1'S tjIq 0✓�,� l,A,� E d �l o c.n s t - �1ut,t 1&17 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work •Whea the owner and the applicant arc diffe=t people,the applicant must be the purchaser of record or a knee in possession with written authorisation from the owner or an agent of the owner. The owner(s)must sip this application in the space providcd or submit a asiw= authorization with this application BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT: • The above=quest does not violate any deed restrictions LbW may he attached to or imposed loon the suhjgt pu �� • If tate 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 hcrewith,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 ggch owner of the subject property required. pplican A orized Agent's signature Print name Date Own tare Print name Date • .�osPe�i l��n i cA ) � -S ��o er' signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMBNT PERMIT City of Tigard 13125 SW Hall Blvd. - Tigard,Oregon 97223 • wwwtigard-orgov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement (PFI) Permit: DETAILED REQUIREMENTS APPLICATION FEE Part 1: Required submirtal fee $300.00 FRANCHI5E UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY CONNECTIONS,ETC. Part 2: 1111 non-water sv stem improvements (work in the right of way) Engineer's estimate:\ 5%(less$300.00 submittal fee) Engineer's estimate 1 2"/6 Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: 111]public water s�lstem improvements ❑ Street Dame Engineer's estimate 1 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 Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (G sets,24x36 or 22x34) • Weephole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Mater,Sea•er,etc) • lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ \Vatcr,Storm and Sanitary,(Plan Profile) • Punter strip landscape maintenance ❑ Winter Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Note: A cash assurance maybe 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/slgnamre ❑ Sheet 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 Acccss Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ \Xfnter Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-ongov • 503-118-2421 Page 3 of 4 T—MKOVGH STREET r WtTW �A 4 Lime SIOLFWALK � DnwK� - 51V4 a PIANTE'k 1 , acvl+a� WALK 1. 60' 34' S W ri.rn Lang F" VYA t K G' PLANTER ' ro ATTENTION:On Vm bw nsgt m you 10 foNow ndes adopMd by the Oregon LOW Mo55catlon Center.Those rutty om ed tbrth In OAR 0524014ot o Through 052401.0000.You may obtain Oopiss of the Pres by caft Bre O wrier.(NoM:OW WWOWne number for the Onsgoo Ul ty No11 kxft C@nW Ie(503)232-1017). Pago 84 2011 Edition 2011 Edition Page 85 Stationary,Lane_Closute with Flagging Diagyam 320; Stationary`Lan_e•Closurewith?Flagging___-___, Diagr 32am 0 Diagram 320 covers total closure of one lane of a twoaane,two-way roadway. See the detail inset for the layout if using a single flagger to control both directions of traffic on low volume roads(less than 400 ADT)with good I o sight distance as discussed below. •0 1. Use truck-mounted flashing warning lights on work and protectiong 'LQ. vehicles. See Section 4.3–Lights and Lighted Signs for exceptions. o " I rn 2. For added visibility,a truck-mounted arrow board or PCMS in caution o m mode may be used. a A 1 11 w 3 3. Flaggers at each approach are required if any of the following conditions exist: ; a. Night Operations. •}C b. Work space is over 200 feet in length. �— c. Sight distance is less than 750 feet from each approach -------- through the lane closure,_ d. Traffic volumes are greater than 400 ADT. t D� A t •• >0 t uI t ® 4. The length between the Flagger Ahead signs shall not exceed one I ' g j 1 t m� mile. Use Diagram 340–Lane Closure with Pilot Car if exceeding one / mile. /- I E I O 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 o the work space safely. a� 73 G. Cones along the work space are recommended when posted speeds � I O?�' �•. O I � are 45 mph or greater,when working under heavy traffic or when travel -0 V lanes are narrower than 11 feel tmg s I LL J s 7. Extended queue signing(see Diagram 5-4)should be used when I a,o r traffic queues extend beyond the initial advance warning sign. a I 1 I t Yu d� I ut h 8. When flagging near an intersection,the"Flagger Ahead"(CW23-2) I ' sign should be visible to traffic entering from any side road. Additional ---- advance warning and Flagger Ahead symbol signs may be placed on I Sign Spacing and Butfar t.cngtha(fact) 1 the side road(s). tanATA: pauad .:. -1 twcan. na. Ifl.s�dB, c _ o 9. Sign set-up and flagger placement shown may be used for intermittent 5pplamantT.b1a 25 100 100 toofull road closures of 20 minutes or less. w tp+a.ar•an�tt, 75 xaso Sso 10. The"ONE LANE ROAD AHEAD'(W20-4)sign is optional and should + ^�• ,s301SSO ""°' be considered on high volume or high speed roads,or when extended 50 5c0 500 sac 210 � x5o queues are expected. SI n S taci a d Bu far len i s fa t Su yHemr, t December 2011 'd9st"ad :-s, ache 11 ,•66twaen 51'ns '"Bu_Hor", chapter 5 December 2011 S cod . A 0. C Space Chaptor 5 60 285 65 700 700 700 325 70 365