PFI2017-00134 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
= COMMUNITY DEVELOPMENT Permit#: PF12017-00134
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/09/2017
Parcel: SEG1320
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Bore one 2"conduit from pole 3432 east through ROW 39'then north under Derry Dell Court and ROW
to power meter at a min. depth of 30"
Owner: FEES
Description Date Amount
PFI Permit Fee 08/09/2017 $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 �(�_ CA � n 1 1'OCA �U�
Signature: !/ (' I
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00134
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. call Jonny Gish 971-713-0281 or Jonny@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
RECEIVF
City of Tigard JUL 27 2017
PUBLIC WORKS— ENGINEERING CITY CF TIGARD
Pl_ANNI � E IiV�
tY mP rowmer ermit
Public Facih I
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
x [R TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑Sidewalk/driveway approach ❑Streerimprovemetlts performed by N\CTI, PGI:
Detailed description: Bore one 2"conduit from pole 3432 E through ROW and/or utility agency.
39'then N under Derry Dell Ct. and ROW to power meter at a min. depth ❑ TYPE 2—Sidewalk/Driveway/Sewer
of 30". Work performed for the purpose of:
- - -- • Sidewalk installation or repair.
Property address/location(s): 10725 SW DERRY DELL CT. 97223 - Driveway approach installation
and/or repair
- Sanitary sewer lateral installation
and/or main fine tap
Applicant: COMCAST ❑ TYPE 3—Full scale Development
PP Work performed with land use
Address: 11308 SW 68TH PRKWY approval which includes any of
City/state: TIGARD, OR Zip: 97223 the following:
Phone: 888-824-8264 l mail: RANDY_SHIELDS@COMCAST.COM - Subdivisions or Partitions
RANDY SHIELDS N/A • Streetwidening
Contact name: Phone:
• I1lainline installation for Sanitary
Contractor: LINESCAPE LLC. sewer, Storm sewer, Tigard water
and/or Tigard Water Service area
CCB#: 140408 Expiration: 211118
Address: 19100 SW 51ST AVE. SUBMITcoMPUETEDAPPLICATION TO:
City/state: TUALATIN,OR Zip: 97062 Cite of Tigard
503-612-7917 PERMITS LINESCAPELLC.COM Planning/F_nginerring
Phone: l.�mail: @ 13125 SW Half Blvd.
Contact name: HEIDI SELLICK 971-804-1496 Tigard,OR 97223
\pplicatitns for"minor work in right-of-way"
Engineer: only may be emailed to:
myvperrn i tsntipard-n r.Pov
Address:
FOR STAFF I'SF ONTLY
City/state: Ail):
Phone: Email: Case No.: P — QL611
r2o
Contact name: Application submittal fee. $
Additional fees:$
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By: 4, e2T2
Is work related to a LAND-USE DECISION? ❑ Yes0 No Application reviewed:
By:'TG�s1-- Date: S � 1
If so,please specify (MLP,SDR,SUB,etc.) case#:
Applicant notified:
Is work related to a BUILDING PERM 1'1';) ❑ Yes No By: M 9 Date: f 17
If so,please specify(BUILDING PERMI I)case#: 1.\rN6\P•rmltAPPIWAtioni\pfi—,colication PAW.12/16/2016
Cin-of Tigard - 13125 SW Flall Blvd. - Tigard,Oregon 97223 • www.tigard-or.gov - 503-718-2421 - Page 1 of 4
'�J
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
• With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,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 am not required to obtain the owners signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate an,;recorded deed restrictions that may be attached to or imposed upon the subject
pro
• 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.
pplicant uthonzed Agent's signature Print name 15aie
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.6gard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
Part l: 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 Sketcb
(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,Sewer,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/TreePlan
❑ 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) ❑ 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(f applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.dgard-or.gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
Ditch —�
Streetlight I -—•—-—-—-—-—-— —C---
I A
1 / T'_ A ,
T--FIop'os d"Se1w5`rTine"
�= Existing House 1
I Existing 1
>I Driveway
a� vi I 1
z.
al
7� I
►fir-
"
o
I 1
I J � Existing Shop 1
L •.� 1
Powerpole
I a _
I ------- —-—-—-—-—-
I � property Lme
II Fire Hydrant(FH)
I i I
Scale: 'I
I I I
I 1 I
i I I
I
MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow Property lines& c6mcnsion Slope of property
Street &street name(s) I?xisting building, structures Utility&street light poles
Proposed work Existing curb or edge 'frees
Existing S/\ 'or of pavement Fxisting utility locations
D/\V apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 S\\'I fall 13kd. • 'Tigard,Oregon 97223 • amAmtigard-ongov 503-718-2421 Petge 4 of 4
t
r
r
Rov4 SIS D/
EP
D e'r rrr
CIP
�•�ELr-
ROW —
iv o S l PQ- o
I o�-lop r
ATTENTION:Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules are set forth in OAR 952-001-0010 through 952-001-0090.You may obtain copies of the
rules by calling the center.(Note:the telephone number for the Oregon Utility Notification Center is
(503)232-1987).
r t
• r
t
Pagc 80 2011 Edition 2011 Edition Parlc a1
5.3 _ Two-Lane, Two-Way Roads Shoulder Work wl Minor Road Encroachment Diag.300
,Shoulder Work w/Minor Road Encroachmont Diag,300
T•
Use this detail fer non-freeway work which extends into a travel lane and
maintains a minimum 10 foot travel lane. If a minimum 10 fool travel lane i •
can not be maintained,or when traffic can not safely pass by in both lanes Initial
simultaneously,use the appropriate lane closure diagrams-for example. s Fn Warning A I •
Diagrams 310 through 350. I ( I •
A lane closure may be appropriate for conditions such as high traffic T •
volumes,high speeds,and inadequate approach sight distance to the work i
space,or heavy equipment adjacent to the travel lane. •
1. Use truck-mounted flashinq warning lights on work and protection (optionaq •
vehicles. See Section 4.3-Lights and Lighted Signs for exceptions. )
2. For added visibility,a truck-mounted arrow board or PCMS in caution
mode may he used.
•
• _
3. Cones shall be placed along VoNdong the entire length of the work space. If a
W1 Tr.IA(both OPlional)
protection vehicle is used and work is in place one hour or less,the See Chapker 4 —I— 4 Butter
taper and tangent devices may be omitted. h
4. If the speed is 45 mph or higher,volumes exceed 2000 ADT,or there
is limited sight distance,consider placing cones or tubular markers on �p _
centerline. minirmrm • L/3
5. An arrow board in caution mode or Iruck-mounted PCMS with I •1
'SHOULDER WORK'or other appropriate message may be used for • _- _
higher visibility.
I
Sign Spacing and Duffer Lengths(feet)
nl1/1D
Posted S acin q between Signs puffer
Speed A D C Space -. _.i
20 50 ERRATAc
25 IN 100 100 75 �`-
30 100 Surr��^eneT�bl. I toptronaq
35 350 350 350 125 y.l,l.a:r.ntiwlz. D
40 150
45 18U teu
q-oum rVa..�.r...r I {
50 500 500 500 210
55 250 I ♦ NIUD
SI in S acin,and Duffer tan the(feeti Surmlement
Initial
Posted Spacing Between Signs "Buffer" %Vam`n0
Speed A D C Space Sign
60 285 December 2011 Chapter 5
Ch pars 65 700 700 700 325 Decomtx r tot t
70 365