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PFI2017-00231 l �� CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12017-00231 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/30/2017 Parcel: SEG954 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Directional drill from SW Bell Ct going west 28 feet across road placing 2 inch pipe under road with CATV to service 12545 SW Bell Ct. Owner: FEES Description Date Amount PFI Permit Fee 10/26/2017 $300.00 PHONE: PFI Permit Fee 10/27/2017 $300.00 Contractor: FISK COMMUNICATIONS CONTRACTING 6307 NE ST. JOHNS RD., STE B VANCOUVER, WA 98661 1 PHONE: 360-314-4454 FAX: 360-314-4456 �j w A •�/ Applicant: RANDY SHIELDS 11308 SW 68TH PKWY TIGARD, OR 97223 PHONE: 888-824-8264 Total $600.00 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 PF12017-00231 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 Ken Fisher at 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 Lina Smith From: Margarita Vega <fccmargarita@gmail.com> Sent: Friday, October 27, 2017 11:33 AM To: ROW Permits Cc: fccmaegan (fccmaegan@gmail.com) Subject: Re: ROW Permit Application:12545 SW Bell Ct, 97223 Categories: Misc. Correspondence Yes, I can do that. This has been paid! Thank you, Margarita Vega FISK Communications Contracting Inc. 2705 NE 65th Ave Vancouver, WA 98661 Office: 360-314-4454 fccmar ag rita((�,gmail.com This email and anv tiles transmitted with it are confidential and intended solely for the use of the individual or entity to which they are addressed.If you have received this email in error please notiA,the system manager.Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the Company.Finally_the recipient should check this email and any attachments for the presence of viruses.The Company accepts no liability for any damage caused by any virus transmitted by this email. On Thu, Oct 265 2017 at 4:50 PM, ROW Permits <rowpermitsa tigard-or.gov> wrote: Hi Margarita, .Another customer accidentally paid for your permit, and.we're working to issue her a refund. In the meantime, can you go to the website main to pay for this permit? I re--invoiced the $300, and I can issue the permit as soon as you finish paying. Thank you! City of Tigard Public Facility Improvement (PFI) Permits Phone: (503) 718-2421 E-mail: rowperinitsati arm d or.gov i RECEIVED City o f and OCT 17 2017 fTit g a PUBLIC \\ ()RISS — L-'NGINEERING CITY Oil:TIGARD :..� ING/y NGINEERING Public (An--47Permit 'I'YPE OF WORK DESCRIPTION OF WORK(in the right-of-way) TYPE 1—Franchise Utility\\urk (.heck one: ❑ Utilities ❑ Sidewalk./driveway approach ❑ Street improvements X performed by N\\,'N, 13Gf-. Detailed description: Directional drill from the ped, on the west and/or utility agency. side of SW Bell Ct going west 28'across road placing 2" ❑ TYPE 2-Sidewalk/Driveway, Work performed for rhe purhuse�,t: pipe under the road with CATV to service 12545 SW Bell Ct ___ - Sidewalk installation or repair. Ptopern12545 SVV Bell Ct, 97223 - Driveway approach installation address/locaac�n(s): _ and/or repair - Sanitary sewer lateral installation and/or main line tap Applicant: Randy Shields for COMCAST CABLE ❑ TYPE 3—Full scale Development Work performed with Land use Address: 11308 SW 68th Pkwy approval which includes any of Cite/state: Tigard, OR /ij,. 97223 the following: 360-301-1962 Rand Shields cable.comcast.com - Subdivisions or Partitions Phone- Email: Y_ @ Contact name: Y Phone: Rand Shields 360-301-1962 - Street widening - Mainline installation for Sanitan• Fisk Communications Contracting Inc. sewer, Storm sc-,%?cr, 'Tigard water ( r)ntraetclr: 9 ORCCB# 185632 and/or Tigard Water Scrvicc Area C(.:13#- Eaplraticm: 2/24/2019 Address: 2705 NE 65th Ave SUBMITCOMPLETEDAPPLICATIONTO: City/state: Vancouver, WA /il,: 98661 City of Tigard 360-314-4454 fccmar arita mail.com Planning/E�rgincering 1 hone:: _ Inlall: _ g @9 - 13125 SW Hall Blvd. {`()rltact n:tnlc: Margarita Vega photic: 360-314-4454 Tigard,OR 07223 pplic:uio»1s for"minter work in right-of--.%,;n" only may.be emailed to: :lciciress: l:ndress:: rowperinits a egad-or.gov FOR STAFF USE ONLY City/state: Zip: Phone: I�maiL Case No.:��/�Q l'7, O 61 Contact name: Application submittal fee: $—401p, Qe5 Additional fees: Estimated value of work is required(if over S5,000):S Application accepted: (M•ithin the public night-of-way) By: '5-W Dare: Application reviewed: Is work related to a LAND-USE DL''CISION? ❑ Yes Ll No 13y: Date: 1 p-2Ar-1 I If so , please speciR (It11.P,SI R,SUB, etc.) case #: • Applicant notified: Is work related to a BUILDING PERM117? ❑ Yes D No By: LZ Datc: ca If so,please spcclf),(13UIL13ING case#: I:\ENG1PermitAppticitions\pfl application Rev.12/16/2016 Cityof Tigard - 1312;SWI hall lilvd. - Tigard,Oregon 97223 - wvvwtigard-orgov - 503-718-2421 - Page 1 of 4 APPLICANTS NOTE: Person specified as`.-Applicant" shall be designated"Pertnittee"and shall provide linancial assurance ti)r work, 1►' rctluIred by Ilie city I)ursuant to TMC 15.04 1.1411. 111111 the exception of a ulilitn•()[.)Ll-ating pursuant to a valid franchise%,.itlt the City of'I'igard,'when the owncr and the applicant arc different "11Ic,the applicant must he the purchaser of record or a Iessce in posscssmtl With myrittcn authorization from the o,tncr or an agent of the (rUrler. '111c rnrner,$)must siy11 this application in the spare pnivided or suhmit a wittcn authorization with this application. I-ranchised I tilities.arc lith 1-c'itIln11 to 1-1It.1111 the i-atu•r's>i�n:uun 4It1 the applicatVm M* SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • IJhc above requcIt doers not violate am rcatrdcd decd restrictions that may be attached to()r imposed upon the,lrbicct I1ro lcrn. • It' Ilie application is granted,the applic;all \t Ill c-ze-rrl<c• 111c ritiltts granted in accordance wt111 Ill(' It•rnls and subject to all tic c"nditions and limitations o1 the ahprcn al. • .111 of Iic abox,e statements and the statetllcnts in ;Illy blot plan,attachments,altd exhibits transmitted hcrewith,are true;and tic applicants so acknowlcclgc that any permit issilud,based on this application,may be revoked if it is found that ally slrch tatcnlents arc fare. • I is applicant has read the entire contents of the application,including the policies and criteria,and understands the 1,c(luire111ct1ts for:tpprol'tllg or deliving the application. NAck If 0 S;R,V-A' �-CL- \j G Irl d 1-11 .Applic: :Authorized:Agent's t`nature Print nattrt� Date SIGNATURES of catch owner of the subject property, if required. )WneC s stgllal urc h-int name Date f hviler's signature 1,1"I11t I1;1111C Dare C )wlicr's sig aturc 1)1'111t 11a111c late PU,BLIC FACILITY IMPROVEMENT PERMIT (.It\- Of Ti-ard • 1 ,l 2; 11:111 i;lvd. • Tigard,Oregon 9722; • -,v\\•kt•.ilgard-or.goy 1 ti 2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI) Permit: DETAILED SUBMITTAL APPLICATION FEE REQUIREMENTS Part 1: Required subtnittal fee S300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: x111 non-water system imCONNECTIONS,ETC.provements (work in the right of way) Engineer's estimate X 5%(less S300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: All public water system llllpt'ul•ements ❑ Street Name Engineer's estimate X 12'ln ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no pc:rnlit fee charged,or assurance required (Subdivisions/Partitions and Street lmprc�verncnts) for the following types of work: • Sidewalk repair(less thin 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (G sets,2406 or?2x34) • \Veep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement (less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler s}stem installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary=(Plan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • 'fest wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Note: A casb 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(if applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 1312:1 SW Hall Blvd. • T1gard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 basic Communications Contracting Inc. � ��, (360) 314-4454verwa- Li ►�-- �� if 2p M, fL4 0° § a� t 2011 Edition Page 77 Short Duration Road Work Diagram 200 1 t Work Vehicle (Optional) * 3 or more cones �--- _ ROADS , may be placed • — - '' WORK behind vehicle • * AHEAD for added visibility \ Vehicle mounted (Optional) I 1 mile maximum r` ROAD --— ---- WORK AHEAD Initial Warning Sign (Optional- See Note 6) September 2016 Chanter 5 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff Check(✓)one REFUND OR Name: Heidi Sellick INVOICE TO: (Business or Individual) Linescape,LLC Mailing Address: 19100 SW 51St Avenue City/State/Zip: Tualatin, OR 97062 Phone No.: (971) 804-1496 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. ® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: PFI2017-00231 Site Address or Parcel #: SEG954 Project Name: Comcast Subdivision Name: N/A Lot #: N/A EXPLANATION: Customer accidentally paid for another customer's permit. Please issue 100% refund. Thank you! Date: 10/26/17 Signature: C Print Name: Lina Smith Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date Refund Processed: Date L A Invoice Processed: Date B Permit Canceled: Date AJIj B Parcel Tag ridded: Date B I:\Building\Forms\RegPcrrnitAction_092314.doc q City of Tigard November 20, 2017 Linescape,LLC Attn: Heidi Sellick 19100 SW 51"Ave. Tualatin, OR 97062 Re: Permit No. PFI2017-00231 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: SEG954 Project Name: Comcast Job No.: N/A Refund: ® Check#226761 in the amount of$300.00. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund application fees paid in error on the wrong permit number. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Bui1d1ng\Refun&,3Un }ice ,*p3yigaMi gon 97223 • 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard-or.gov _ City of Tigard Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Linescape, LLC DATE: 11/6/2017 Attn: Heidi Sellick 19100 SW 51't Ave. REQUESTED BY: Dianna Howse Tualatin, OR 97062 LS TRANSACTION INFORMATION: Receipt#: 413553 Case#: PFI2017-00231 Date: 10/26/2017 Address/Parcel: SEG954 Pay Method: CreditCard Project Name: Comcast EXPLANATION: Refund 100% of application fee as customer paid for another customer's permit fees on the wrong permit number in error. REFUND INF". 1 N. Fee Description From Receipt RevenueAccount No: Refund = j3qjldipg Permit Fee Exam le: ,2300000-43104 $Amount PFI Permit Fee 100-0000-43114 $300.00 TOTAL REFUND: $300.00 APPROVALS: SIGN U ES DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under $50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 12 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Comcast Site Address: Receipt Number: 416581 - 04/06/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12017-00231 $-300.00 Tota I: $-300.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 226761 DROWSE 04/06/2018 $-300.00 Payor: Linescape LLC Total Payments: $-300.00 Balance Due: $300.00 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Comcast Site Address: e��1'67/Alit-t-- Receipt Receipt Number: 413553 - 10/26/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12017-00231 PFI Permit Fee 100-0000-43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 07960G PUBLICUSERO 10/26/2017 $300.00 Payor: HEIDI E. SELLICK Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1