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PFI2017-00232 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12017-00232 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/26/2017 Parcel: SEG796 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Bore one 3 inch conduit from ped at 13165 E through ROW approximately 20 feet then south under Katherine Street and east through ROW and south to power meter on 13146 at a minimum of 30 inches. SEG796 Owner: FEES Description Date Amount PFI Permit Fee 10/26/2017 $300.00 PHONE: Contractor: LINESCAPE LLC 19100 SW 51 ST AVE TAULATIN, OR 97062 PHONE: 503-969-4409 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: See application Issued By: --�— Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00232 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 RECEIVED City ofg Tigard 0 C T 17 201 y 1'LIBLIC WORKS — I_1NGINI:ERING CIN OF T IGARD (ENGINEERING PublicFtY pac' ' Im rovement (PFTTermit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1-Franchise Utility fork Check one: 8 Utilities [J Sidewalk/driveway approach ❑Street improvements x performed by NAX'N, PGE Detailed description: Bore one 2"conduit from ped at 13165 E through and/or utility agency. ROW apx 20'then Sunder Katherine St. and E through ROW and ❑ TYPE 2-Sidewalk/Driveway/Suver Work performed for the purpose of: S to power meter on 13146 at a min. of 30". • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): 13146 SW Katherine St. 97223 and/or repair ? - G • Sanitary sewer lateral installation and/or main line tap Applicant: COMCAST El TATE 3-I-'ull scale Development Pp Work performed with].and use Address: 11308 SW 68TH PARKWAY approval which includes any of Cite/state: TIGARD, OR Zip; 97223 the following: Phone: 888-824-82641:.mail: Randy_Shields@comcast.com Subdivisions or Partitions Contact name: Randy Shields phone: N/A • Street widening • Mainline installation for Sanitary Contractor: LINESCAPE LLC. sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: 14D408 Expiration: 2-1-18 Address: 19100 SW 51 TH AVE. SUBMIT COMPLETED APPLICATION TO: City/state: TUALATIN, OR Zip: 97062 City of Tigard Phone: 503-612-7917 1?mail: Permits@linescapeilc.com Planning/Engineering 13125 SW Hall Blvd. Contact name: Heidi Sellick Phone: 971-804-1496 Tigard,OR 97223 :\PPlications for"minor work in right-of-way" Engineer: only may be emailed to: tomMerinits@tigard-or.gov Address: INN City/state: Zip:Phone: 1�mail: Case No.: FXI QOL?-nn;a- Contact name: Application submittal fee: $ ot7•e-7 Additional fees:$ Estimated value of work is required(if over$5,000):$ Application accepted: (within the public right-of-way) By: Date: S Application reviewed: , Is work related to a LAND-USE DECISION? ❑ Yes ❑ No �v I 2L If so, leasespecify 'ILI?SDR,SUB,etc. case#: By:1�- T' 1-61-1 '<Date: Applicant notified: Is work related to a BUILDING PERNIM ❑ Yes ❑ No By: kS Date: If so,please specify(BUILDING PERMIT)case#: '.\ENG\PermitApplfcawns\Pti_appOcatlon Rev.12/16/2016 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wvwaigard-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,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 1`hard,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. Franchised Utilities are not required to obtain the owners signature on the application BY SIGNING BELOW,THE APPLICANTS) SHAD.CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon thr,subject 12ropm- • 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 fo approving or denying the application. lo 117/1 -7 A ph t/ thorized Agent's signature Print nAuke Date 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 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: APPLICATION FEE Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILI'T'Y Part 2: All non-watersy stem 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 0 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) Desi • Relocate or replace mailbox gn Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 2204) • 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/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) ❑ 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 ❑ PrehminM Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(f applicable) ❑ Water Department Approval PUBLIC FACILITY UAPROVEM ENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4 T�tRo�G� STRE�t v WkTN G 4 UNS 510(rWALK, I 131 l 31�� — � rjr /vJell WALIC Ax 601 3q# 4�r ("Of Rt"T'Glr-WAY RX WALK I or F ber D i V,� I � 31 No Slur, ATTENT M Oregon raw mgtdrea you b ldaw rubs pm A by the Oregon Uft lloffcetlon Carttar Thow nms ere sd rbrth to OAR 904) t-MIO trmoUP 00,M-MM.You may otrlslncopW of the nfsa by ca +e tlm oetmet.(NoW..the tale hone mRsbat for the Oregon Mty ftffgx lon Ctet is(608)mism. em Page 84 2011 Edition 2011 Edition Page 85 ,9,. __., ,,... _. ` _.. .99_. g._.... .,.g Stationary;. ne-Ciosure with Flagging`:', .r SID a' ra' 320, Stations Lane Closure vtrith Fla in Dia ram 320 Diagram 320 covers total closure of one lane of a two-lane,two-way roadway. See the detail inset for the layout if using a single flagger to control cc both directions of traffic on low volume roads(less than 400 ADT)with good a sight distance as discussed below. 1. Use truck-mounted flashing warning lights on work and protection •♦• a. O vehlcles. See Section 4.3—Lights and Lighted Signs for exceptions. $ ` a`, rn 2. For added visibility,a truck-mounted arrow board or PCMS In caution f• mode may be used. WM o 3. Flaggers at each approach are required if any of the following m P ** I H conditions exist a. Night Operations. • b. Work space Is over 200 feet in length. c. Sight distance is less than 750 feet from each approach t_ _ ________—____ I • ' o through the lane closure,. t ,• a" t d{ I >0 d. Traffic volumes are greater than 400 ADT. ��J/�� 6 I u I I •C/lL7 4. The length between the Flagger Ahead signs shall not exceed one I ' ,. — it1 1 I o m mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one /, I E /a mile. I O I • a 5. Cones should be used to outline the work space when curves or other I roadway alignments prevent clear direction for the motorists to pass I o •to {j I . the work space safely. ' j `�°ai f l l 'A j • I o.E �3 6. Cones along the work space are recommended when posted speeds i I O=)� I � I are 45 mph or greater,when working under heavy traffic or when travel a m lanes are narrower than 11 feet. t I mss_ 7. Extended queue signing(see Diagram 5-A)should be used when traffic queues extend beyond the initial advance warning sign. I c 1 I t „' {I{ d tcc / m W CL 8. When flagging near an intersection,the`Flagger Ahead"(CW23-2) I __ _____" —_——-- sign sign should be visible to traffic entering from any side road. Additional _ advance warning and Flagger Ahead symbol signs may be placed on sign spacing and B•n.,Leng1ha QW) 1 \ S NOW' K rw••n na Buffer \the side road(s). ERRATA: c • V__ g. o 9. Sign set-up and flagger placement shown may be used for intermittent SupiplemantT•M• tS too 100 too s full road closures of 20 minutes or less. J0 1O0 g 35 US x'1 150 150 158 2 u 10.The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should ^�• s ieWo be considered on high volume or high speed roads,or when extended so soo soo soo 2t0 queues are expected. — r� S n Sp3clnff and Buffer len the(fret)Su lenient n n :hipter 5 December 2011 DecemberPosted Spadn "wne51 s 'Buffer" 2011 Speed A B C Spare Ctutplrr 5 60 285 65 700 700 700 325 70 1 365