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PFI2018-00270 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT • COMMUNITY DEVELOPMENT Permit#: PF12018-00270 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/08/2018 Parcel: SEG820 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: SEG820, associated with 12065 SW Morning Hill Dr. Directional Drill from the existing ped at a depth of 36"37' in ROW to provide CATV service to 12065 SW Morning Hill Dr. Owner: FEES Description Date Amount PFI Permit Fee 10/08/2018 $300.00 PHONE: Contractor: PHONE.- FAX- Applicant: HONE:FAX:Applicant: RANDY SHIELDS 11308 SW 68TH PKWY 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: ,��cc'�__��-- Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00270 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. 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 OCT 0 4 2013 r . . CITY'OFi-G'A#�D • PUBLIC ��ORDS — ENGINEERING PLAN NING,'EfiJGNEERIN Public Facility Improvement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1—l7r:anchise Utility Work Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑ Streetimprovements performed by NWN, 13GI Detailed description: Directional drill from the existing ped at a depth of 36" and/or unlit}•aagencv. 37' in ROW to provide CATV service to 12065 5W Morning Hill Dr, 97223 ❑ TYPE 2—Sidewalk/Draw%%%iy/Scxvcr \ ork performed for the purpose ot: • Sidewalk installation or repair. 12065 SW Morning Hill Dr, 97223 • Driveway approach installation Pryoperty address/locadon(ss): 9 and/or repair JOb#_947063 • Sanitary sewer"lateral installation and/or matin lint:tap Rand Shields for COMCAST CABLE ❑ TYPE 3—l-ull scale Dcvclopmenr .•�l�l�licatlt: Y \�%ork performed with Land use lddress: 11308 SW 68th Pkwy :approval which includes any of City/state: Tigard, OR Zip: 97223 the following: Phone: 360-301-1962 Email: Randy_Shields@cable.comcast.com • SubdivisurnsorPartitions Contact t,anle: Randy Shields I'l�crtZe: 360-301-1962 • Street widening • 1lainlinc installation for Sanitary' Csewer, Storms sewer, 'l'igard waterontractor; Fisk Communications Contracting Inc . and/orTigard Water Se1-��1ce Area ORCCB#185632 L•'xpiration: 02/24/2019 �ddre:ss: 2705 NE 65th Ave SUBMIT COMPLETED APPL1CA*rr0N TO: (_:itv/state: Vancouver, WA Zip: 98661 City of Tigard ig Phone: 360-3'14-4454 Email: fccambern@gmail.com Plarrrrirrg/Errgirrecv 131.25 SW Hall Blvd. Contact name: Amber Nantz Ial,t,tle: 360-314-4454 Tigatrd,OR 97223 Applicatims For"minor wot-k in n'ght-of-\%,,i " l Aigineer: ortly may be em ailed to: rowpermits a,tigard-or.gov :address: :R STAFF USE ONLY City/state: Zip: Phone: Email: Case No.: 1'/�F 1 Z019— 004?.70 Contact name: Application submittal fee(.07%of Engineer's Estimate) $ Esdmated value of work is required(if over$5,000):$ Additional fees: $ 300 (withinthe public right.-of-way) .Application accepted: u B)-:— Sc- Date: 10—1-1 Is work related to a L:1ND-L.3S1: DI:=�:CISION? ❑ Yes ❑x. No Application reviewed: If so, please specify (IVILP, SDR, SUIS, ct.c.) case #: By: 135 Date: 10 Is work related to a BUILDING PI. RMI"l? Cl Yes, M No :\pplicant norified: If so,please specify(BUILDING PERNMI'l)case#: By: Al, Date: —L0 Eel 10. I:\FNG\PermitApplications\pri application Effective 10/16/2017 Cityof Tigard 13125 SW 1 lall Blvd. • Tigard,Oregon 97223 ww\vr1gard-or.gov • 503-718-2421 Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant" shall be desitniated "Permittee" and shall provide financial assurance for work,if rcclui.red by the city pursuant to -FIMC 15.041.140. ' \ ith the exception of a utility operating pursuant to a valid franchise with the City of Tig,*ard,when the owner Incl the applicant arc different people,the applicant must be the purchaser of record or a lessee in possession with written authorisation from the owner or an agent of the owner. The owner(s) must signs this application in the space provided or submit a written authorization %%7th this application. franchised Ctilttics are not required to obtain the owners signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions tluat may be attached to or imposed upon the subject pro crt • 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. • f111 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 st,municnts are false. • Tlic applicant has read the entire contents of the application,including the policies and criteria,and understands the regttiretnents fora roving or denying the application. :applicant/iluthorizcd Agent's s Tnaturc Print name Datc SIGNATURES of each owner of the subject property, if required. ()xvner's signature Print name Date U%vner's signature Print name Date Owner's signature Print name Date PUBLIC FACILI'T'Y IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Orcgon 97223 • w%vwtigard-or.t;ov 503-718-2421 Page 2 of 4 SAMPLE SKETCH: Edge of Pavement /// [+ (� /n Ditch Streetlig I I ••YWW.!iDD�• 7' ■Y�rllllll•!i• ■i■ � • .. Rtt l •ii L 4 � ' T`_7M_Pas cf Sewer'�iiie" Q j • I j �l Existing House v 11 j Existing _�:I Driveway . L. a j �t a j v V 1 I �, I �I a 0' Existing Shop I C� ' • Powerpole j I ! �..._...,.._. —.—._.'.___ .. j 7operty Line Fire Hydrant(FH) I � I j Scale: 1"=30' � j I j 1 a MINIMUM SKETCH REQUIREMENTS (Put"N/A" if Not Applicable): North arrow Property lines & dimension Slope of property Street & street name(s) Existing building, structures Utility & street light poles Proposed work L-xisting curb or edge Trees Existing S/%V or of pavement Existing utility locations I)/W apron (sewer,water, storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SSV Hall Blvd. • 1"1gard,Oregon 97223 • wvunvrigard-or.gov • 503-718-2421 • Page 4 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI) Permit: DETAILED . REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (in cluding in formation belo%v) WATER SYSTEM FEE ❑ Dimensions Part 3: AH public water s}'stern Irnprovements ❑ 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/P;trtitions and Street Improvements)the following types of work: • Sidewalk repair(less than 20 lineal feet) Design Plans • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. (G sets,24x36 or 22134) • Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes (City,Water,Sewer,etc.) • L,awn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting El `dater,Storm and Sanitary(Plan Profile) ❑ • Planter strip landscape maintenance ater Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(I lectrical,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 Rcporr.(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval ❑ Engineer's Construction Estimate HS a.S'=.li'iSMifi:1F3Y3XGk :ffi :&i#tigF.CAS:pfiA:6S'2::'w..N 9 k:KcSSR@S:' 87FF@'W+tET1EYY41f4h�''S,AYE""..+7.T.0°k'B11Z':F�i4'3t€ui1{i8'fYL'KE?Vit:€>cx.`:Rr'Y..1H?S.k5:2 R&Xk7Xl�lffikC4 ^`.fil�lrw:k74".3£3t�'(fizaYtlG`*5I317?lk?:e pl.'A `ITSL`S5Mt1.t51+4KC1,'1T. ...Fa.&..._.::5 x.�,.a r z is:Zvl .:. PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW I-Iall Blvd. • 'Tigard, Oregon 97223 • vrw«ttigard-ongov • 503-718-2421 0 Page 3 of 4 &A r�C,'G ST 21r 1 45 r�tom- NL tC�s ST Fisk Communcafio� _v Contracting Inc. (360) 314-4454 2011 Edition Page 77 Siht ar_t Duration Road V1 ark D 1`a gra+rn 2 0'0 t Work Vehicle (Optional) ROA( * 3 or more cones "�" `�— WORK may be placed •• * AHEAD behind vehicle for added visibility Vehicle mounted (Optional) 1 mile Maximum ROAD WORK AHEAD Initial Warning Sign (Optional - See Note 6) September 2016 Chapter 5