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PFI2016-00207 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00207 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/06/2016 Parcel: SEG2450 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Directional drill from the ped, on the south side of SW Martha St going north 35'across road placing 3/4" pip with CATV to service 9465 SW Martha St Owner: FEES Description Date Amount PFI Permit Fee 10/06/2016 $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 �B Signature: .�� Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00207 Type: Condition Name: Status: Severi : 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 SEP 2 0 2016 City of Tigard CITY OF TIGARD I'lUBLIC WORKS 1wNGINEEMXG PLANNING/ENGINEERING Public Facility Improvement (PFI) Permit All DESCRIPTION OF WORK(in the right-of-way) RE,QUIRE D SUBMITTAL Check one:S Utilities Street improvements ELEMENTS Detailed description:Directional drIll from the ped, on the south ❑ 'Minor work in right-of-%,.l t (sidewalk repair,curb Cut,Street side of SIN, M;LRTHA ST going NORTH 35'-across--road-placing 3/411 opciling,etc.)requires: pipe wl-,. CATI to set-vice 9465 SW MTI�V7`A ST, •Application form,completed and signed •Submit one(1)Copy of scaled sketch propertAl address/location(s): "I"5 SW MARTHA ST, 97224 of the proposed work to be done Submit one(1)copy of traffic control PIAII —OR— Randy Sl�,elds for COMCAST CABLL Substantial project work requires Applicatit's iiame: above items and professional Address: 11306 SW 68TH PrYlY engineered plans for: IGRiZti97223 -,Street wideri-in-9 city/mate: Zip: •Subdivision infrastructury 360.301.1962 Randy Shields',_�cable.conica�;t con'. Mnin utility fine extension:1*11101IC: — ],"mail: - Storm Drain,Sanitary-Tigard F;sk. Contracting, INC. - Vlater-'Itgard Water Service (,ontrActor's name: AreA(includes Dtirbam,King City (,(,B#: QRCCB# 135632 I.-Npiration: and n portion of unincorporated W*ashington County) Address: 2705 NE 65th AVE Zip: 98661 DEUVEM APPLICATION TO.- ,irt,/State__.Veneouver, WA - City of Tigard 360.314.4454 Emaihfccl ocates,,,,xomcast.net PlanninglEtighieerhig 13125 SW Hall Blvd. F,i-4ineer's name: Tigard,OR 97223 Applicaticxin foi"utinoi work iii sighl-4-wa4 Address: only einy lie cmailcd to; C,Ity/stpte: Zip: _V Y�suiiiated valtie of work (within the public right-of-way): S 600.00 Case No— hs1�v11a Application submittal fcc. Is work related to a I_JLND-USE D13CISION? n Yes, Q No Application:accepted: If so,please specify (AU-1),SDR,SUB,etc.)case#: Bv;_L9 Date: is work related to a BUILDING PEIRMIJ? 0 Yes F1 No Appliciition reviewed: If so,please specily� (BUILDING PERN1111)case 4: A- KOVIAAA�_ Date: Applicnsit nti6cd Br, Date: Citv of Ti,—.ird 13125SWI tall Blvd. Tigard,0regort97223 wwxv.tigard-or.gov - 503-718-2421 - Page lof4 APPLICANTS NOTE: Person specified as`:applicant"shall be designated"Permittee"and shall provide financial assurance for work. wlicn the owner and the applicant are different people,the appticatn must be the purclu.%er of record or a lessee in possession with written alitllorizattoll from the owtler or all agent of the ow[ter, nlc owacr(s)must sign this application ui the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE AI'PLICANT(S) SHALL CERTIFY THAT: • 'Me above reQuest does not vinlateC that may be attached to or imposed u,p.Qn the subiect propc • if the application is granted,rhe 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,attaehments,and cAubits txnnstnitted 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 polities and criteria,and understands the requirements for approving or denying the application. SIGNATURES ofeacti owner of the subject property required. AIL-,11j, v ' Margarita Vega 9/20/_6 rlppliTIt/Authorized Agent's ��natttre Print name Date 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 SVW Hall Blvd. • 'Tigard,Oregon 97223 • +vtvw.tigard-cingoe 503-718-2421 • Page 2 of 4 Fisk Communications Contracting Inco -� 5 DSPCt4 (360) 314-4454 - 191 I zl Th ter. 9 BEAV 0337 Beaverton 81 Issue Date Job p House p Address Pendi PAR Commercial Node Instructions 09/12/16 346981 9465 SW Martha St,97224 No Y No TG278 %�QRD Bore/2 SW Bores/150' Call 1st ph4 1 ph#2 Name Drawn by locate info/Thomas Guide Cross tree Distance Yes (971) 285-5952 - Hays, Robert Bore footage Drop status Drop lengh j `\ City/ Municipality Reason for call 1st: Tigard y ' , r� Extra notes: Use RGll/Sprinkler System : ,t', RBD RD2 RRB RDB » RSB CON i FMP Cutover Cutover, j N,.A a r Isf e E F F t www.invarion.com Owner Project/job Number Fisk Com. 346981 .. Project Name/Location 9465 SW Martha St Tigard, OR Prime Contractor Traffic Control Contractor UN(IIEl) {PAFi°!fir Fisk Comm. United Traffic Control CONTPOL SEPVICES Contact name/number E-mail Prepared By ORCert#05357 wACertx0=0057 Steven Hill EXP.6/27/2019 EXP.11/30/2019 E-mail Cell Phone Steveh@unitedtrafficcontrolservices.com 971-330-0343 N Legend Cone Work Area Manifest 20 x Cone + 2 xflagger nagger 3 x Road work ahead OW-134 2 x be prepared to stop CW20-7b ROAD PREPARED -WORK 2 x Signer D • 100' 100' 100' 100 Stopping / Sight Distance 'J Buffer Spacing t° Speed(MPH) Distance(ft)100' 25 75 ar 30 100 .' Merging tapers L 35 125 Shifting taper=1/2 L 40 150 Lane45 180 Width 10' 11' 12' 50 210 100 20 mph 70' 75' so' 55 250 25 mph 105' 115' 125' Posted 30 mph 150' 155' ISO' Sign Spacing(ft);f- 35 mph 205' 225' 245' speed. 40 mph 270' 285' 320' (MPH) A 0 C 45 mph 1 450' 1 495' 54.0' 50 mph 500° 551• 600' 30{or 1001 i00' 100' 55 mph 550' 605' 660' less) All signs and devices SHALL conform to the MUTCDIWAC. 35-40 359 350' 350' Signs SHALL be 48"x 48"retro reflective(Black on Orange) 45-55 500' 500' 500' will adjust to field conditions. Plan not to scale