PFI2017-00162 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00162
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/15/2017
Parcel: SEG931
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Bore one 2"conduit from ped at 12300 W through ROW and under 128th Ave at min of 30"then S
through ROW approx 21'then W through ROW to power meter on house
Owner: FEES
Description Date Amount
PFI Permit Fee 08/15/2017 $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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00162
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, Ken Fisher at
503-816-6146 or Kenny@tigard-or.gov 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
RECEIVE®
City of Tigard AUG 0 9 2011
Pl,1iI.IC \VORKS — EN( INEERING CITY OF TIGARD
Public Facility Improvement (PFI) Pe &GINEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
Qt] TYRE 1-Franchise Utility Work
Check one: N Utilities ❑ Sidewalk/driveway approach ❑Strectimprovements performed by N\XN, PGE
Detailed description: Bore one 2"conduit from ped at 12300 W through and/or utility agency.
ROW and under 128th Ave. at a min. of 30"then S through ROW aprx. ❑ TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of:
21'then W through ROW to power meter on house. • Sidewalk installation or repair.
Property- address/location(s): 12305 SW 128TH AVE. TIGARD, OR 97223 • and/or ry apppproach installation
3l P
-r
• Sanitary sewer lateral installation
and/or main line tap
A hcant: COMCAST El TYPE 3—Full scale Development
PP 11308 SW 68TH PRKWY Work performed with land use
Address: approval which includes any of
City/state: TIGARD, OR Zip: 97223 the Mowing:
888-824-8264 Rand Shields Ilnesca ellc.com • Subdivisions or Partitions
Phone: I:mail: Y_ @� P
Contact name: Randy Shields Phone: nla
• Street widening
• Mainline installation for Sanitan'
Contractor: LINESCAPE LLC. sewer, Storm sewer,Tigard water
and/or Tigard Water Service area
CCB#: 140408 Expiration: 2-1-18
Address: 19100 SW 51ST AVE. SUBMIT COMPLETED APPLICATION TO:
City/stair. TUALATIN, OR Zip: 97062 City of Tigard
Phone: 503-612-7917 1:mail: Permits@lineseapellc.com Planning/Engincering
13125 SW Hall Blvd.
Contact name: Heidi Sellick 971-804-1496 Tigard,OR 97223
1pplicatiow fur"muior work in right-of-way"
only may be emailed to:
Address: �A� g�
ro ermits -g -or.eov
Address:
City/state: Zip:
Phone: I:mail: Case No.:
Contact name: Application subn-&tal fee: $ 3�m•o0
.Additional fees:$
l-.stimated value of work is required(if over$5,000):S Application accepted:
(within the public right-of-way) By: LQ Date:
Application reviewed:
Is work related to a ].AND-USI: DECISION? ❑ Yes ® No Application
. Nt�Y�ewee: - �'�
If so,please specify (MI-P,SDR,SUB,etc.) case #: Bv:
.Applicant notified:
Is work related to a BUILDING IIHUNIIT1 ❑ Yes, ® No Bv:—VAL-- Date:
13
If so,please specify(BUI].DING PF.RNII'I)case#: '.\Ertc\r.m.tAppl"tionr\,r.oaKation Rev.IV16nor6
City of Tigard • 13125 S\\'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-3421 • Page I of 4
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated'Termittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
" With the acception of a utility operating pursuant to a valid f-anchise with the City of'l'igard,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 owncr(s)must sign this application in the space provided or submit a written authorization with this application. franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
12ro- .
• 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 any 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.
AJ� G
plicant Authorized Agent's signature Print narrig Date
SIGNATURES of each owner of the subject property,if required.
Owners 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
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit: K11111111113mulmill
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way)
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% ❑ Site Address
PFI Permit Fee Exemptions:
FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
Ditch cleaning that does not involve regrading. (6 setts,24x36 or 22x34)
• Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Seaver,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ 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) Q Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ 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 Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.dgud-or.gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I - *— Ditch
n Streetlight I —•—•—•—•—•-----r---
r / I l � °• Ram Drain
�l I c rT•m .a
C—alp a 1
o
I I ,
' T—�'ro'pos d'�elw'erTiri�"
a.� I
I i rn� ! Existing House !
Existing
Driveway
I
I I rl
°'
-E C
o .
Existing Shop i
L � 1
Powerpole I I = I a (I
I Imo .—.—.—..PoP95ine--.----?---
I
I l J I Fire Hydrant(FH)
Scale: 1"=30'
I I I
I �
� I I
I I I
MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow Property lines&dimension Slope of property
Street &street name(s) I'.xisting b[o]ding,structures Utility&street light poles
Proposed work I'Aisting curb or edge 'frees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard - 13125 SWI Iall Blvd. - 'Tigard,Oregon 97223 - %t,%tiwtigard-or.gov - 503-718-2421 - Page 4 of 4
4P,0v&cj STREETS
1KttN PRo�E.RT
r Lime Y �$
' ! iz3OL
D/Vn
AM WALK Lt'
RAHM l3'
STRIP
4E I
fob
21�
60` 31¢' S Vf 2 'H^Ave-.
(O, Rtcmr—tw—WAY
Foc
Row sr n pia I r+t p•tQ- c ow„1 ,,
K
�o SLoe-e,
D 1 vJ po t•+tr-
ATTENTION:Oregon law requires you to follow rules edoptOd by the Oregon UtEty Notification Center.Those rules are set forth in OAR 952-001-OD10
through 952-001-0090.You may obtain ooples of the rules by calling the center.(Note:the telephone number for the Oregon Utility No58cat!on Center
Is(603)232-198T).
Page 84 7.0 11 Edition 2011 Edition Page.(15
Stationary Lane Closure with Flagging Diagram 320 Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a tyro-lane,two-way
roadway. See the detail inset for the layout if using a single(tagger to control x q
Coth directions of traffic on low volume roads(less than 400 ADT)with good I o
sight distance as discussed below. M
1. Use truck-mounted flashing warning lights on work and protection A.
vehicles. See Secllorl 4.3-Lights and Lighted Signs for exceptions. o _t I O
rn
2. For added visibility,a Irick-mounted arrow board or PCMS In caution M
t 1 1
mode may be used. e
o
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feel from each approach
through the lane closure,, •� A
d. Traffic volumes are greater than 400 ADT. o
4. The length between the Flagger Ahead signs shall not exceed one I ` r 1 1 I o i 3
mile. Use Diagram 340-Lane Closure with Pilot Car if exceeding one
mile. 1 O I
5. Cones should be used to outline the work space when curves or other I ��' I • _�.m
roadway alignments prevent clear direction for the motorists to pass o
the work space safely. t f9 ^ ; fft /! I ••
aE
6. Cones along the work space are recommended when posted speeds I O o t•, t
are 45 mph or greater,when working under heavy traffic or when travel i a�
lanes are narrower than 11 fee;.
I LLJ _ Y' a a I / '9.7. Extended queue signing(see Diagram 5-4)should be used when rn�
traffic queues extend beyond the initial advance warning sign. I i(
i 1 Y- Q ,' 10
8. When flagging near an intersection,the-Flagger Ahead-(CW23-2) _________________ I
I Y I •�•__
sign should be visible to traffic entering from any side road. Additional 1
advance waming and Flagger Ahead symbol signs cony be placed on Sa Sp-e,g.rd n.n.,L—tsih.1,.•11 ♦ �-��
th116.10e side road(s). cad�u:---
a.lw n. j ul s
Sp.W AK n w C w¢� ly
O 0
9. Sign set-up and nagger placement shown may be used for intermittent S prl• .,Tdd. n 100 100 leo s \
full road closures of 20 minutes or less. 10100 ` qq
►...,. �,,,. 35 s a M750 In o �1
10. The"ONE LANE ROAD AHEAD'(W20-1)sign is optional and should °�^•' .e ,ro o
be considered on high volume or high speed roads,or when extended
gUCUCS are expected.
Si!n Spacitur and Buffer lenrtths(fret] upolemrnl
Posted 5 adn Between Signs 'Buffer"
:hiptm 5 nerrmtsrr 2011 Dncnmtu+r 2011 Speed A B C Space Chnplor S
60 285
65 700 700 700 32S
70 36S