PFI2018-00314 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00314
Date Issued: 11/21/2018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: SEG1344
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier
Project Description: SEG1344, adjacent to 13221 SW 68th Ave. Fiver Splicing in manhole at SW 66th Ave and SW 68th
Parkway. Frontier Work Order 51351-W0698156.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RUSSELL WELLS
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97005
PHONE: 503-643-1001
Total $0.00
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 PF12018-00314
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
REC�—,7AvL—D
City of Tigat-d NOV 2 0 2018
C
[7: ING
I'ubliC Facility Improvement (I-111) Pcrn-lit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) /-1-jrPE 1-Frailcliisc I Itilliv\Vorl,
Check otic: I'tilities El SI(lew,,ilk/(Irivcx%-ayil)l)ro.ICII El Street improvcnien ts performed bY N\VN, 11GF,
Mid/ot_LI till tv agency.
Det"111CCI Ascript"1011. Fififf— SAMAJIf AV &M/dC— Ll TYPE 2-S.idewalk./I)r1veN%.-av1/'Sc\A-Cr
AT SW L�TH Ale+ SW MT11 PAGUAV
DRI-87— 57T51- \Vnli,Perforilled for the P111pose of.
S'(1cwalk installation oi-repair.
Property address/locatic 5W k�M4 approach installation
and/or repair
A"A I �U� 31T Sanitar. sewer I-atcral installation
and/or nuill title tap
Applicant:ant: T ❑D 'FITE 3-Fullsuile Development
\Vork performed with Land use
Address: 4A5 5W CE04E HIMI MID approval Which Includc.,:lily of
City/state: AMW� zi r): 92005' the following-Subdivi,,lons or Partit.10111.;
I"`h()r1C:MT1w-j4M/ I"i-nall: ieuldl &&K+f_+r-001A
Contact narnc:&L'5� C ILW5 mmic: '23645—AMI - Street\videnitig
• Mainline installation for Swittary
Contractor: sewer, Stonn sewer, F
' igard xvater
•
aud hw'figW
ard "iter Service Area
C(AW: L:Xpir;iholl:
Address: Z st�iimrrcomvu;,r1-.*D APP1.ICA'11ONTO:
cit},/Stlltc: /Ap: City of Tigard
Mlofic: Pla n n biglbigi ii ecring
13125 SW Hall Blvd.
(.,'()Macf name: Tigard,OR 97223
\pplicafions for"ininor work in righ1o1'-N%;iy
()IIIv Inny be civailc(l to:
ruAvcrmitst<Wgard- rgov
Address:
City/state: /A I I: =31 M 0 ateiRl ME93 0 1 WA
Motic: 1 Ove No.: Lo I? O;)I I
Coritact name: Application submittal fcc
F,tig* ,
Fstimatcd N-Auc of work IS required (if over$510( 0):S_ IVIA (Mition'll fees: S
(XV11`11111 tIIC I)L1bIiC right-Of-Way) Application accepted:
B,:_ 1--Date:
Is work rclatcd to LAND-USE' DFUSION? R__ Ycw
Applicati,m revicwe&
If so, please speciFy (NIIA SDR, SUB,etc.) case #,:
Bv: L11 Date: Ll
Is work related to A BUILDING 11-ANIH? El Yes No Applicaut notified:
If SO,111CASC SI)L'CIf)'(Bt_"I I A)I N( 1)1:IZNI I T)c�isc BY:, "_Datc: 1142-
1:\ENG\Pei mitAp pitcat ions\pft—appl ic at on Effective 10/16/2017
City of'Tigard 13125 S\X,'l Jail Blvd. Tigard,(.)rcgon 97223 xvww.tigard-or.gov 5303-718--2421 Page 1 of 4
APPLICANTS
NOTE: I'crsoii specified as"Applicmit"shall be designated "I'ermitive".lid shall provide fiti:uu:i.il assurance for w(wk, if
rccluirc•ri ht• fixe city pursuant to'IAIC 15.041.14().
1t illi tLc•t•xcrptieru of';j 1lfilily ope•ratilig pnl"tiant to a valid ti•andhise with Ill•(;ih'of*Fi)MIX],Wheu flue owilul-:mel file applicant are difTelv111
people,t11e applic:a111 11111FI be the pill'clia"' .of ix-cord ora le.sse c in posses,;iol1 with wlitlen aufholi7mion IIY)111 file owner or au aj c•u1 lel file
0\c n11% ill(,owner(s) lutist sign tllis applicimon ill file space provided or submit .1 Wlim-11 aulliolizatioll Willi dlis application. Fralidlised
t't ihiles arc•not required to obtain lilt•owlivi's S41,11aulix•on rhe•applicaf ion
BY SIGNING BELOW,THE APPI.,ICANT(S) SHALL CERTIFY`i'I-IAT:
• 'l•hc,Dove regtrcst docs ri()t vi(alare aril•I'QC()rdc(l deeci rest_ric:ti(.)Ils th.lt mak.be"Ittac:lux.i r()()I'inilx)se'd tlperl1 the'obiter
arc)x'rt1•.
• If the application is granted,the appliouir will exercise the r0irs,cr,mted in accordance with the terms atxl subject to all the
conditions,lid 11mitam ms Of tile.approval.
• All of rile ahOve st.ttenicnts;lid the statements in alto plot plan,attachrncnts,and eshihits transniittcci he rctvith,arc true;anti
rhe applica,its s()aclmowledge that-.my perriiit issucci,haseei on this application,mac he r(•v()kc•ci if it i, fc)urld that.111y such
statelients arc fake.
• 'I'he applicant has re;
DEVELOPMENT ENGINEERING FEES
1701Z STAFP USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED
SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Port I: Reyuircd submittal ficc$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water s}�stem itnprovcmelir` (work in rhe•right of way)
r?ny inc'er's estini,tte "5°•o(less 5300.00 submittal tee)
Fligineer's estim,tre l 2°"o flan Review Sketch
(includinginforin'16on below)
WATER SYSTEM FEE
❑ Ditncnsiotls
Part 3: All public water sVsrem improverlients ❑ Sttrct Manlr
I_�.ngiilcer's estitnae 1 120-'o ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee cliarged,or assurance' reyuirccl
(Subcli�Zsi��ns/partilicnls:tnd Street Illi�ro�•cnlcnt
s
for the f<�lit_�u�ing types of uvork: l )
• Sidewalk reptur(less than 20 lllie,tl feet)
• Relcx;atc car replace mailbox (6
Phots
• Ditch cleaning that(lees not in�•olve tegradirl1;. tG sets,3 Is3G or 3?.3 l)
• \X.,eep hole repair ❑ Cover—Site,Vicinity,Abbreviation,legend
• Curb repair or replacement(less than 20 lineal feet) ❑ Gcner.il dotes(C+ity,XVI'ter,Sewer,etc.)
• 1:WI1 Sprinkler system Ills tall,lrtc>n or repair ❑ Street(plan,profile)
• Street tree ptltning or phulting ❑ 1\':iter, toms.uicl Sauitanr(Plan Profile)
• I'anter strip landscape,nainten.tnce ❑ \\'iter c)u,,liry laacilitics
• -rest\veils ❑ Grading
❑ L.ttldscaping/Tree
❑ Composite Utility Plan(Iilcctrical,phone,Gas,
NULL: A CtISI?assurance fllll�f bei'PCjllll requiredper Stornl,S,init,irv,\Vnicr,Sippige,Street I..ghts,etc)
❑ Details
TMC 15.04.140.(custome)-deposit)
❑ Tniffic Sis ht Distance
❑ Sigiing.t id Striping
❑ Street 1,it ht Plan;tud Photoinetric
❑ 1-ingincers seal/sipmature
❑ Shcc(l;tl)cl(project land use nanlc,revision and
plan log block,dates and sheet number%-)
Additional Submitteds
(Per land Ise conditions)
❑ •I'ratfic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Prc)iniinary Access Report(S4,it Distance)
❑ PrI)Puscd PbIt
❑ Rithwar Desi m(if aPPlic.tblc)
❑ \\',iter Dep.trtment.1pprov it
❑ Cunstniction lstinlate
PUBLIC FACILITY 11VIPROVEMENT PERMIT'
Citv of Tigard 1312:1 S1V'1-hdl 131vd. • "lis arci,0rgg ni 97223 • wwxvt1gitrcl-or.gov iO3-713-2421 Page 3 of 4
SAMPLE SKETCH:
t�
Edge �If P+i-r einent.
Ditch
I
�i Streetlicil"ItI •�-------------- �•�
�.
RaEk
h-t Drain `s .
A 4
I •
T!-r oj�'os cf•'Sewe�'rne"'
A.
I �
Existing House
� I Existing 1
J I I
C 1 t o
� -••� I I r.� r
Li �
E g h
c � I
Power-pole
�. C . .
'--—-—-— - ------ ---
�ropa�t-;Lina-
I •
I '
I ' I Fire H,rdrant(:FH)
I I I
� I
II i i f::�I e
I I i
I � I
' I I
i I
I I i
MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
—�orth lrrc►w Irncs & dunc-nsum Slope ut hrurc•rty
I i r , r t thIMU( ) I:xis in ilding, sh*uctrcs Lt-ilir &street fight
I
I'rO pOscd wc►r I: I:xisting curl►ur-cclgC l'rces
I-xisting S/W or of pavement I lmsting utiliry locati()ns
DAV ,apron (sc\vcr,w,rrer,storm)
PUBLIC FACILI. Y IMPROVEMENT PERMIT
City of Tigard 13125`\V I Tall 131\,1. • 'Y1gard,('trNoa 97?''3 • a•ww.ugarcl-or-gov • 503-718-2421 Page 4 o/•-;
R M,JTOL 011,111Uij IcARW5
Ta FR L (111A&L X11 i)
�vdll1L_ D1Z��L 513 l- It/0 091:9-o
J
Page 120 2011 Edition
Work in the Center of an Intersection Diagram 630
Diagram 630 covers work within an intersection of two-way streets.
Movement of traffic through the intersection is regulated by existing traffic
control only.
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 multi-lane approaches, merge traffic into one lane in advance of
the intersection.
4. For high speed or high traffic volume operations, consider using
flaggers to control traffic.
5. When the posted speed is 40 mph or less and work is in place for less
than 15 minutes, cones and signs are not required.
Sign Spacing and Buffer Lengths(feet)
Posted S acin Between Signs Buffer
Speed A B c Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
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CONSTRUCTION NOTE w
***VICINITY MAP*** > TOTAL ALLOTTED HOURS
1-7HIS WO IS SERVICE ORDER DRIVEN- w
\ T CONTACT SUPERVISOR IF ADDITIONAL
ASR 3074410 ❑ Q 1. H011RS ARE REQUIRED TO COMPLETE PROJECT.
I--' CAP. X-TIME MAINT.
co CREW 0 0 0
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PER,vITS
CONSTRUCTION CONTACTS S, MUNICIPALITY CITYrriGARD
MUNICIPALITY-
DAVID CARNLEY-971-940-9000
��� ❑ 3LANANKET I
JAMES STAATS-503-758-3119 RNtiq ❑ TCP/TRAFFIC
SCHEDULING CONTACT , C3 DETAILED (NOT ET)
MS ❑ NO PERMIT REQUIRED IT_RED
RYAN ROBERTS-503-643-3713
JOINT POLE
JFNINJUNS r
SHEET 1 OF 3 -
FACILITIES CONTACT JFN/NJUNS 4
NORTH f$NO JPN P.EQUIP.ED
MICHELE CRISMAN 503-643-0180 POLE JPN JPN
LABOR HOURS OWNER TC FROM.
❑ ❑ ❑ PO:iF.P.
INSPECTION CONTACT SPLICE-C-O/M-5X-0 1 ❑ ❑ ❑ CATV
RON SITTON 503-871-8065 CREW-C-O/M-O/X-0 N _ ❑ ❑ ❑ FRONTIER
SON]COM-8lFLAGGING
POINT OF CONTACT
CONTRACT INSPECTION RUSS WELLS
503-6431001
JERRY MOORE 360-513-0337 ACCT CODE
6422.020 ******METRO E WORK ORDER**** SCHEDULING RYANROBERTS
ENGINEERING CONTACT PENGINEER 503-643-3713
U S WELLS
RUSS WELLS 503-312-7330 51354-5223976-190 PHONE NO. 503643_1001 _
CENTENE CORPORATION -_
I PHONE NG
FIELDED By PilISSWELLS
13221 SW 68TH PARKWAY �
PORTLAND ,OR
ASR 3074410 la�' I I e
MATERIAL REQUIREMENTS mmunications
FDT 5460-736 PNL 1
TGR DIAS 0-
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FC2038 , 392,393/PORT 2,3 132211 SW 68TRH PARKWAY
LCON-LEE JOSLYN PROJECT C.O.AR
51354-5223976-190 NUMBER: EXCH.CODE
DRAWN DATE ENGR- RUSS WELL NTY WASH
503-213-5066 51354-WO698156 PHONE FILE:
SCALE: 1=inn I TAX DISTRICT: DWG 1 OF
ITWNSHP. RNG: SEC:
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RBN 12
TGRDORXA T1009,29-30+
XD,3-12
1038 01.1997
2100 01.1998 YGN 550 10.2014
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TGRDORXA T1009,25-40+ 2307 01.1998 I� XD,19-24
XD,41-42+ YGD 48
TGRDORXA T1009,43-44+ XD,1-32+
XD,45-48 TGRDORXA T1009,33-40+ I I(
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300 10.2014
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Communications
TGRD/ASR3074410-
13221 SW 68TH PARKWAY
PROJECT C 0.51354-5223976-190 NUMBER ri c EA,
DRAWN DATE: ENGR� NTY:WASH
51354-W0698156 r,l,
PHONE: FILE:
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NUMBER: EXCH.CODE:
51354-5223976-190 DRAWN DATE: IENGR. RUSS WELL NTY:WASH
PHONE' FILE:
51354-WO698156 SCALE: TAX DISTRICT. DWG of 3
TWNSHP: IRNG. SEC: