The URL can be used to link to this page

PFI2018-00207 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00207 Date Issued: 08/07/2018 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG1789 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: SEG 1789.Adjacent to 14080 SW 100th Ave. Directional drill from the pole, on the north side of SW 100th Ave going south 175'across the road placing 2"pipe under the road with CATV to service 14080 SW 100th Ave. Owner: FEES Description Date Amount PFI Permit Fee 08/07/2018 $300.00 PHONE: Contractor: FISK COMMUNICATIONS CONTRACTING 6307 NE ST. JOHNS RD., STE B VANCOUVER,WA 98661 PHONE: 360-314-4454 FAX: 360-314-4456 Applicant: RANDY SHIELDS 11308 SW 68TH PARKWAY TIGARD, OR 97223 PHONE: 360-301-1962 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: ----- r Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00207 Type: Condition Name: Status: SeverityL 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 Y E f��E �. City of Tigard AUG 0 6 2018 e� PL."IBLIC WORKS PublicFaCjlit�T Improvement (PFI)'` PV�"tNEIERING TYPE;UF WQ.RK DESCRIPTION OF WORK(iii the right-of-way) ❑ TYPE 1—Franchise Clriliry\C'ork Cheek cine: El Ut.ilitic< ❑ �ide��alk/cjri�c� a� <lpproach ❑ Street improvements performed by NWN, PC t:: Directional drill from the ole, on the north side ;inn/or utility.llgenc\. f]et;�iled dcscripti�an: p of SW 100th Ave going south 175' across the road placing 2" pipe under ❑ TYPE 2—Sidewalk/Driveway,% <.�, r the road with CATV to service 14080 SW 100th Ave,97224 i1'cirk performed for the purpose of: • Sidewalk installation or rep lr. •1 ( ) 14080 SW 100th Ave I�ri��vsty,approach insrall.tri�.7n Pro perty address/locadon s : ;tnd c>r repair. Z)�� ° Sanintry sewer lateral Install:ttion and/or main line tap Rand Shields for COMCAST CABLE ❑ TYPE 3—FL11l scalIe Development :�ppllCat�r: Y Work(�erformcd u�ith L.:tncl ttsc: _ldclress: 11308 SW 68th Pkwy slpprov;tl vhich includes-.111VOI CitA/state: Tigard, OR /ip: 97223 the following: 360-301-1962 Rand Shields cable.comcast.com ° Subdivisions or Part tions 1 boric: Email: Y_ @ C(:)tltact name: Randy Shields Phone': 360-301-1962 ° Strcct widening \Mainline installation for SaniturV Fisk Communications Contracting Inc sewer, Storm sewer, 'I'ignrd water Contractor: g and/or`Tigard tVater Service;'trc:a CCB#: ORCCB#185632 E piration: 02/24/2019 .\ddress: 2705 NE 65th Ave SUBMIT COMPLETE DAPPLICATIONT0. Vancouver, WA l 98661 Cin'of Tigard PlanCir\/gate: Zt p: ng PEn -mil:360-314-4454 Eail: fccmargarita@gmail.com 12rring/Engrnecv 133125 SW Hall Blvd. Contact nat�ie: Margarita Vega Phc�nc: 360-314-4454 Tigard,OR 97223 :Applications four"minor wnrk in right-ctf-w:t\" Wily ting lac(:anailed n).. Engineer: ro�vpcnnits Ntigard-or.gov Address: o ' 'bNLY Cinr/stale: %ip: - Phone: Email: C,tsc No �7f! 0 _ Contact name: Ajiblic ttion 5>tbmitt;tl fee t(i 7p ref • l n�ttlCLIS''l sUtn3tc) � �t9® ��` Esrin-ated Value of work is required(i f c:ver S 5,(7(.)t.l):$ ldd,66'6>f lfces $' (tVithin HIC public right-of-way) Apphc ttion ac.epted: B Lis Is work rc:lat.ed to a 1:,:-1ND-LASE DECISION? ❑ Yes I] No r�pplil.lttot-re�ncci ed If sc�, please specify-- (MIJ) SDR, S1.1B, etc.) case #: Is work related to a BUILDING PER:IV1I1'? ❑ Ycs D No �lpplic tpr i�oafi�c If so,please sperify(BLIILDING I-'El�.1\I1'a)case#: l3y � -- D,ttc, LUNG\t'etmit4piic6tions\pfi application Effective I0/]G/?017 City of Tigard 13123 Std%Hall Blvd, ° I ig;;rci,Oregon 97223 «-%,nvugard-ongov ° _503-718-2421 ° Page 1 of=f APPLICANTS NOTE: Person speclfled as ":Applicant"shall be designated "Permittee" and shall provide: financial assurance: for\vork, if required hl'the Citl'purstiant to'•T'INIC 15.0 11.140. \X1111 the cxccption of a lstlhl}'/�peratinp;pursu:utt u�a valid franchise with 111C City of''l'Tai•�thcn tile.<>wncr and rile aphlicant arc clitfcrcnt pcoplc,the applicant must be the purchaser of rCCO rd or a lessee in posse,,Ioll with wrlllcil :ulthorization from the owner or an agcw of the ��wner. The uwner(s)must J),tl this application in the space prmided or submit a written authorisation with this applit:ation. I ranchisell 1 tilitius are not required it)obtain the owncr's signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • "T•he above request does nor,,folate any recorded deed restrictions that may be attached to or imposed upon the Subject pro fern. • If' tile.application is granted,the.applicant will exercise the rights granted in accordance with the terms and subject to all tile. cclriditions and Ii.mitations of the approval. • 111 t-)f the above statements and tilc st.ttcincnts in any plot plan,attachments,and exhibits transmitted herewith,are true;and elle 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 requi.remcnts for approving or dem yitil;the application. Applicant/Authorized!Agent'. gnature Print name Date SIGNATURES of each owtier of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date e.:1>wtur's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 1 3125 SW I-lall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-715-2121 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES << _ a Public Facility Improvement(PFI)Permit: - f APPLICATION � $�q�p+�a { APPLICAYHON FEE Part 1: Required submittal fee$300.00 -FRANCHISE UT11 T- YATgD S11DEWALK/ PERMIT FEE DRIVEWAY. AND Y7'I II IT"K CONNECTIONS,ETC: Part 2: All non-water system improvements {vcoils sight of way) Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sk�tcb (including inforxn�tlon,below) WATER S'Y'STEM FEE Dimensions Part 3: All public water system improvements Engineer's estimate X 12% ® Stye Name ❑:Ste ddress PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required L SCA,LEEL®P _ for the following types of work: (Subdrvasi ins/Partitions ikid Street Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox DesYgn'Plans • (6 sets,.24x3G or 22.x34} Ditch cleaning that does not involve regrading. • Weep hole repair ❑ Coven--Site,'Vicinity.Abbreviation,Legend . • Curb repair or replacement(less than 20 lineal feet) ❑ Genesi Notes(Cstg,Water;Sewer,etc:) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile} • Street tree pruning or planting ❑ Water.Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ Water Quahty;Faalit es' • Test wells ❑ Grading ❑ Landscaping/Trec Play ❑ Composite Utility Plan(Electrical;Phone;:Gas, Note: A cash assurance may be required per Storm,Saiutary,Water,Signage,Streetlights,etc) TMC 15.04.140.(customer deposit) ❑ Detail§`, , ❑ T'raf&,Sight Distance ❑ Sigwng<and Stopsng ❑'Street Light Plan and Photometric. :TT:Epgtneemsafore ❑ Sheet label(protect land use name,xev�sion and log bock;datesfand$ietubs} Additional Submiitdls' (per Land Use conditiggs ::❑ TraFSc Report. Storm water Drunage Caiculatxons ❑ Geotechnical Report ❑ Preliminary AccessRhtDistance). . ❑ Proposed Plat t ❑.Pathway Design Vol ❑ Water Department Approval ❑ Engineer's'Constxvcponstunate PUBLIC FACILI'T'Y IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: SW 51 y S t I Edge of Pavement I Ditch StreetlightI •—•--...••--i.=. r—.— ] Rain Drain 1 f Fir Tree a s =e I Existing 91 a Driveway 1 41 ] ° 1 dl a i ] .E t£ lcn }Shop. 1 Powerpole ] 95, ' —.—.—.--74erWLni e------.�.—. I I . I I �. Fire Hydrant(FH' I I I Scale: 1"=30' I I 0 I I I I s MINIMUM SKETCH REQUIREMENTS(Put'IN/A"if Not ApOcable): North arrow Property lines &dimension Slope of property Street &street name(s) Existing building,structures Utility&street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 6 wwwtigard-or.gov - 503-718-2421 - Page 4 of 4 s � G �-s Core- /4G� �" f j gOTO t019 r � 110 100AVE Ali �� I Pow 9 5�� 1 S soa1fv tj Fisk Communications Contracting Inco (360) 314-4454 _._..rIOD -------- --_ _r a N r ' Single Ragger Operatiorn n ..c2p C. iCL mfor WVOUreS V0o IBELANE $Loa" ONE � r ROAD %II s•a�•B s.`t+ r TQ STOP AHEAD N w r r 1 r r jj WORK 0 o a a " 1 C K 6 1 a I a �--� S ANFAD Q '^� erw 1 } _ 1 � P+eM7�e�WwPed�o� r {.l A N O�M V Oo Rl.M C►'d d `� .A N N O Q wn.a A B t___--_-______________-__� • rO $ 9 A' Buffet Pro*.�oi:Vehide -- w/TMA(both ClpnsonaQ _ -- ROAD See Chapter 4 00 vim fla AHEAD67�L:4:NE BE T'�r® -lacgger®pesation TO SMPI `° (optima