PFI2016-00215 .. n
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00215
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/26/2016
Parcel: seg311
.Jurisdiction:
Site address:
Subdivision: Lot:
Project: ODOT
Project Description: Highway 217/SW Greenburg Road. ODOT is completing a demonstration SUE project.This is survey
work with 5 potholes. SEG 311
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
HEATHER HOWE
4040 FAIRVIEW IND DRIVE SE
SALEM, OR 97302
PHONE: 503-986-3658
Total $0.00
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: Rce,
Issued By: Anu
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00215
Ty pe: 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.
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 SEP 2 6 2016
PUBLIC WORKS —ENGINEERING
s CITY OF TIGARD
Public Facility Improvement (PFS''' EERING
DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK
Check one: ❑ Utility Connection 5(TYPE 1—Franchise Utility Work
❑ Sidewalk/driveway approach Work performed by NWN,PGE
❑ Street improvements and/or utility agency.
Detailed description: MOT is eQ!21Ple4.. A de~s+s' 4mn ❑ TYPE 2—Sidewalk/Driveway/Sewer
V _ '
)ioeiS i SS,•�1/t1N t�J0f1G �i th �, leq Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): 14w1 2-)'4 ai- &/-CAnbua IZd and/or repair
l • Sanitary sewer lateral installation
61 0 ' ` and/or main line tap
❑ TYPE 3—Full scale Development
Applicant: _ ('�t'e�on D t)7 Work performed with Land use
y0 6;rd eW Tn� 04 SE approval which includes any of
Address: � the following:
City/state: 54 leen 0912 'Lip: 14 362 • Subdivisions or Partitions
Phone: 5503 `1% 3 G 58Email: Hew'N1er. e. Powe p o&4. sf4c.or VS • Street widening
Contact name: Neai'mer NoW a Phone: • Mainline installation for Sanitary
//��
sewer,Storm sewer,Tigard water
Contractor: /A and/or Tigard Water Service Area
CCB#: Expiration: SUBMIT COMPLETED APPLICATION TO:
Address: City of Tigard
City/state: Zip: Planning/Engineering
13125 SW Hall Blvd.
Phone: Email: Tigard,OR 97223
Contact name: Phone: Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: 'eat2o ra=ermita tigard-or.gov
Address: 5915 SW Wes}rr4te •Dr SOrk 10b l
�04kind 02 Zi '4 221 _
City/state: p: 9 Q�--
Phone:$03 Zoe 3 7-13 Email: dwn. u-)e b CarAnp .CaM Case No.:l
Contact name: Application submittal fee:
Additional fees:
Estimated value of work is required(if over$5,000):$ Q Q 00o Application accepted:
(within the public right-of-way) By: ALI Date:0112.4114W
Application reviewed:
Is work related to a LAND-USE DECISION? ElYes 1� No
By: :a L Date: 24 6
If so,please specify(MLP,SDR,SUB,etc.) case#:
Applicant notified:
Is work related to a BUILDING PERMIT? [I Yes 31 No By: Dace: r
If so,please specify(BUILDING PERMIT)case#: ;:\CUIIPunMastem\LarWUnAPPIka&ns Rev.07/09/2015
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 wwwtigard-ongov 503-718-2421 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 are different people,the applicant must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that ma be attached to or imposed upon the subject propelu.
• If the 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 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 the
requirements for approving or denying the application.
SIGNATURES of each owner of the subject property required.
Applicant/Authorized Agent's signature Print name Date
g g A,,-- P pecAer Powe '2Cl6
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
Oregon Department of Transportation
Technical Leadership Center
Kale Brown,Governor Right of Way Section—MS 2
4040 Fairview Industrial Dr SE
Salem,OR 97302-1142
Phone: (503)986-3600
Fax: (503)986-3625
Utility Companies www.oregon.gov/odot/hwy/row
Subject: Project Notification
SW Greenburg Road overpass over Hwy 217 Demonstration Site
Attention: See Cover sheet
Project Description
The Oregon Department of Transportation (ODOT) demonstration project is located on Highway 217 at SW Greenburg
Rd. ODOT has hired Cardno as the Subsurface Utility Engineering(SUE)firm to complete a Level B SUE demonstration
site. ODOT is currently creating a SUE program and is using this demonstration project as a way to learn more about the
process and procedure for SUE activities.
As this is a demonstration site,there are no utility conflicts with your facilities. Because your system is within the limits
of the demonstration site,the SUE firm will be contacting you for information. We ask for your help by providing your
mapping information to Cardno or to me so we will have as much information as possible regarding this site.This site
will be used to demonstrate what information can be collected in a SUE project.There will be no potholes as part of this
demonstration.
If you are interested in watching this process please let me know.
Plan Review
The enclosed map shows the project limits of the demonstration site.
ODOT Project Resources
For questions regarding this notification and its requirements, please call me at: 503-986-3658. My work address is:
Heather Howe
4040 Fairview Industrial Dr SE MS#2
Salem OR 97303
Sincerely,
&
State Utility& Railroad Liaison
Attachment: Project Limits map
CC:Chris Pucci,Construction Automation Surveyor
,t
Uregon
Department of Transportation
Technical Leadership Center
Kate Brown,Governor Right of Way Section—MS 2
4040 Fairview Industrial Dr SE
Salem,OR 97302-1142
Phone: (503)986-3600
Fax: (503)986-3625
www.oregon.gov/odot/hwy/row
Comcast Cable-Margaret Porter
11308 SW 68th Parkway Portland General Electric- Mike Ansbergs
Tigard, OR 97223 3700 SE 17th Ave
Margaret porter@cable.comcast.com Portland, OR 97202
(503) 605-4997 (503) 736-5715
Michael.ansbergs@pgn.com
Frontier Communications-John Bielec
4155 SW Cedar Hills Blvd CTLQN-CENTURYLINK-Scott Miller
Beaverton, OR 97005 8021 SW Capitol Road, Rm 110
John.bielec@ftr.com Portland, OR 97219
(503) 367-5106 Scott.miller4@centurylink.com
(503) 242-4144
Level 3 Communications-Todd Hurd
520 SW 6th Ave, Suite 400 AT&T LNS-Shawn Dalbec
Portland, OR 97204 10340 SW Nimbus, Bldg N
Todd.hurd@level3.com Tigard, OR 97229
(503) 416-1522 Sd1461@att.com
(503) 495-0112
MCI/XO Communications/Verizon -Caleb Mazil
2550 NW Aloclek Drive City of Tigard Utilities- Mike Stone
Hillsboro, OR 97124 13125 SW Hall Blvd
Caleb.mazil@verizonbusiness.com Tigard, OR 97223
(503) 707-3416 mstone@tigard-or.gov
(503) 718-2759
ZAYO FNA ABOVENET -Joe Bangah
joe.bangah@360.net Tualatin Valley Water District-Kevin Schmeltzer
2101 Fourth Ave, Suite 2000 1850 SW 1701h Ave
Seattle, WA 98121 Beaverton, OR 97006
Kevin.schmeltzer@tvwd.org
NW NATURAL - Peter Cathcart (503) 848-3041
220 NW 2nd Ave
Portland, OR 97209
(503) 226-4211 x4429 Cleanwater Services - Marvin Spiering
Peter.canccart@nwnatural.com 2550 SW Hillsboro Hwy
Hillsboro, OR 97123
ODOT Electrical -Johnny Sapp spieringm@cleanwaterservices.org
9200 SE Lawnfield Rd (503) 681-5114
Clackamas, OR 97015
Johnny.r.sapp@odot.state.or.us
(971) 673-6202
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