PFI2018-00202 s
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00202
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/06/2018
Parcel: SEG405
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: TCA/AT&T
Project Description: SEG 405. on Greenburg Road between Cascade Ave and Shady Lane. Raise existing manhole to grade
for AT&T.
Owner: FEES
Description Date Amount
PFI Permit Fee 08/03/2018 $300.00
PHONE:
Contractor:
STANDARD UTILITY
12094 EHLEN RD
AURORA, OR 97002
PHONE: 503-849-4828
FAX: 503-678-2721
Applicant:
SHAWN DALBEC
PHONE: 503-329-2172
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 I/,
Signature: t' '�--
T,
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00202
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
RECEIVED
City of Tigard UL 3 0 201
PUBLIC WORKS --- ENGINEERING
C1 OF TIGARD
Public Facility Improvement Ppoit-N10,1NEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility\Vork
Cheek one: Utilities ❑ Sidelz-alk/dtil-e«-ay approach ❑ Streetimprovements performed by NTW'?\', PGE
Detailed description: 4y (_WS4 P.XJSA--"S andJorutilin-agenc}-.
❑ TYPE 2—Sidewalk/Driveway/Sever
`p r r(,J e f�r A-T4- 1�
\fork performed for the purpose of
- Side-walk installation or repair.
- Driveway approach installation
Property_- address/location's'): SW 6i uAb404-( and/or repair
[ a5e�� S _ � anitarZ seta er lateral installation
and/or main line trap
�C A / .r��
EJ TYPE 3—Full scale Development
Applicant: 1 \York pe.r.for.med,,v1th Land use
Address: approval wl-iich includes any of
City,/state: zip: the following:
Phone:5�>3-3 24—Z!7 Z Email: Subdivisions or Partitions
S�ac�n • Street widening
Contact name. �atbe,L Phone: ng
• Mainline installation for Sanitary,
Contractor: S+A/\.C�aC4 U- 11,1,t sewer, Storm seiner, Tigard water
�r.�r�-��`S
J_ ���/ and/or Tigard\\later 5ei- icc Area
CCB#: LY QQ b Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City,/state: u� '^ 0(. zip: Q 9 g" Ci 1 of Tigard
Phone:,5,>7-3&4-tot I I Email: !a S+anAard v f 61-1 Q Planning/Engineering
13125 SW Hall Bhrd.
Contact name: alrLe S�ckw Phone: Sv 3 tGJ-o7 23 Tigard,OR 97223
Applications for"minor work in right-of-wa}."
Engineer: only.may.he emailed to:
roy�permits[aAigard-or.g_o�=
Address:
FOR STAFF USEON LY
City/state: zip: _
Phone: Email: Case No.:
'
I
Contact name: application submittal fee(.0 7 fro of
Engineer's Estimate) $
Estimated value of work is required(if over S5,000):S additional fees: `
(Nkithin the public right-of-,vay) application accepted:
By: Date: `
Is work related to a LAND-USE DECISIONr ❑ Yes No
- -
If so,please. specify (1Application regieied:
\4LP,SDR, SUB, etc.) case #: J r
T3\-: Dace:
Is work related to a BUILDING PER.��MH? ❑ Yes (� No Applicant n
ot
ified: �
If so,P leasesP ecif,(BUILDING PER ,1I1�case#: By: Date:
1:\ENG\PermitApplicatlons\p`i_appli--ation Effective 10/16/2017
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City of Tigard • 13123 S\N%Hall Blvd. Tigard,Oregon 97223 «-wwtigard-or.gov - 333-71$-2=121 • Page 1 of 4
.4 XX AI\�TS
NOTE: Person specified as`-Applicant" shall be designated "Permittee" and shall provide financial assurance for work,if
required by the cit}- pursuant to TRIC 15.041.1.10.
With the e\ception of a utility-operatin g pursualtt to a t-alid franclhi�e wltli the Cin-of'171,Ttrd,v ien the owoer and the applicant are different
people,the applicant must be the purchaser of n•cord or a lessee in possession with written authorization from the oxviler or an agnt of the
owncr. The owlier(s) must Sl,;Tl this applicaticrrn in the space provided or submit a writtern autl(niiation With this application. Franclhised
utilities arc lot required to obtain the owner's signature on the applicariot7
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• T1ie above request does not yiolate ane recorded deed restrictions that JJJaN7 be attached to or izni2osed upon the subject
�rc�}erty.
• If the application is granted,the applicant will exercise the rights granted in accordance NvIth the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the stateinents in an),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.
Grp /E-7
%applicant/Autho.zed Agent's signature Print name Date
SIGNATURES of each uwner of the subject property, if required.
Owner's signature Print name Date
Owner's signature Prinr naive Date
Owner's signature Print name Date
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125-W Hall Blvd. • Tigard,Oregon 9/223 • \s1«N:tigard-or.go-,- 503-718-?421 9 Paige 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility,Improvement(PFI) Permit:
APPLICATION FEE
Part 1: Required submittal fee S-100.00
FRANCI4ISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water st-stein improvements
(tvork in the right of ,vay)
F_ngineer's estimate 15%(less$3100.00 submittal fee)
Engineer's estimate X 2%Plan Revie'VV Sketcb
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system,improvements ❑ Street Name
Enguieer's estimate X 12°j0' Sire Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(Subdil,71sicuis/Panm
rtitic, s and Street Improveents)
for the following types of work:
• Sidewalk repair. (Less than 20 lineal feet)
Design Plans
• Relocate or replace mailbox
(G sets,2406 or 22x34}
• Ditch cleaning that does not involve regrading.
• Weep hole repair ❑ Cover—Site,Vicinity,:abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes (City,Water,Se,,-ver,etc.)
• Lawn sprinkler si srem installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary-(Plan Profile)
• Planter strip landscape maintenance El 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) ❑ Derails
❑ 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,dares and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water.Drainage Calculations
❑ Geotechnical Report
❑ Preliminary-:-access Report(Sight Distance)
❑ Proposed Plat
❑ Pathways Design(if applicable)
❑ Water Department:-approval
❑ Engineer's Construction Estimate
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PUBLIC FACILITY IMPROVEMENT PERMIT
Citi-of Tigard 13123 SW Hall Blvd. • Tigard,Oregon 97223 • N-vw 6gard-or.gov • 303-715-2421 Page 3 of 4
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77
Page 104 2011 Edition
Work in a Continuous Left Turn Lane Diagram 420
Diagram 420 shows work in the continuous two-way left turn lane of a two-
way road with three or more lanes.
1. Use truck-mounted flashing warning lights on work and protection
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 be used.
3. For operations of more than one hour, cones and signs are required as
shown. Protection vehicles are optional.
4. For operations between 15 minutes and one hour, including work that
will relocate intermittently, cones are required and signs may be
replaced by protection vehicles with flashing lights.
5. For operations of 15 minutes or less, signs and cones may be replaced
by one or more protection vehicles with flashing lights.
6. When only one protection vehicle is used, the use of a spotter(s) is
recommended to warn workers of approaching traffic.
Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs °'Buffer"
Speed A B C Space
20 so
25 loo 100 100 75
30 loo
�� 350 350 350 ���
45 180
50 Soo Soo Soo 210
55 250
60 285
65 700 700 700 325
70 365
Chapter 5 September 2016
2011 Edition Page 105
Work in a Continuous Left Turn Lane Diagram 420
1
ROAD
WORK
AHEAD
BCENTER
i
lyt
LANE .
CLOSED
AHEAD
A '
Q2 •
.
Buffer
Protection Vehicles
w,rrMA(both Optional)
See Chapter 4 <1
Buffer
• U2
J A
CENTER
LANE
CLOSED
AHEAO
ly B
ROAD
' WORK
AHEAD
September 2016 Chapter 5