PFI2019-00075 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
a COMMUNITY DEVELOPMENT Permit#: PFI2019-00075
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/12/2019
Parcel: SEG1612
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: SEG 1612/11805 SW Gaarde Street. Core one 3/4" HDPE from ped in ROW @ 11875 N 80'. Potholing
for utilities. Then bore a 2" HDPE from pothole in S/W/E under 118th Court and to ROW and bore one
3/4"HPDE from ROW to Dmark on 11805 at a min. depth of 36".
Owner: FEES
Description Date Amount
PFI Permit Fee 03/12/2019 $300.00
PHONE:
Contractor:
LINESCAPE LLC
19100 SW 51ST AVE
TAULATIN, OR 97062
PHONE: 503-969-4409
FAX:
Applicant:
RANDY SHIELDS
11308 SW 68TH PARKWAY
TIGARD, OR 97223
PHONE: 503-596-3996
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: C41' (,;C le'jG-v-1
Issued By: ! r 11/j
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2019-00075
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[OUCH].
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 ADVANCE WARNING Applied Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours(min.)before initiation of construction work.
PFI_Utilities 09-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 10-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 11 -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 12-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 13-DRAINAGE CONTROL Applied Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Utilities 14-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 15-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 16-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 17-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 19-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 20-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 21 -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 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI_Utilities 23-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 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice
The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Utilities 25-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 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI_Utilities 28-AS-BUILT DRAWING Applied Notice
1,2,3,4,5 28-AS-BUILT DRAWING
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
1,2,3,4,5 28-AS-BUILT DRAWING
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
PFI_Utilities 31 -OTHER Applied Notice
Other
RECEIVED
City ofTigard MAR 0 7 2019
CITY OF TIGARD
.1:'PI
t a PUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING
Public FacilityImprovement (PFI) Permit
TIGARD
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
j] TYPE 1–Franchise Utility Work
Check one: ,XII Utilities Sidewalk/driveway approach 0 Street improvements performed by NWN, PGE
Bore one 3/4" HDPE fromped in ROW11875 N 80'. and/or utility agency.
Detailed description: @
Potholing for utilities.Then bore a 2"HDPE from pothole in S/W E under 118th Ct.❑ TYPE 2–Sidewalk/Driveway/Sewer
Work performed for the purpose of:
and to ROW and bore one 3/4" HPDE from ROW to Dmark on 11805 at a min
• Sidewalk installation or repair.
depth of 36". • Driveway approach installation
Property address/location(s): 11805 SW GAARDE ST TIGARD, OR 97224
r��� and/or repair
I • Sanitary sewer lateral installation
and/or main line tap
Applicant: COMCAST 0 TYPE 3–Full scale Development
PP Work performed with Land use
Address: 11308 SW 68TH PARKWAY approval which includes any of
City/state: TIGARD Zip: 97223 the following:
Phone: 503-596-3996 Email: RANDY_SHIELDS@COMCAST.COM • Subdivisions or Partitions
RANDY SHIELDS 503-596-3996 • Street widening
Contact name: Phone:
• Mainline installation for Sanitary
Contractor: LINESCAPE LLC. sewer, Storm sewer, Tigard water
140408 01/14/2020 and/or Tigard }Vater Service Area
CCB#: Expiration:
Address: 19100 SW 51ST AVE. SUBMIT COMPLETED APPLICATION TO:
City/state: TUALATIN Zip: 97062 City of Tigard
503-612-7917 PERMITS@LINESCAPELLC.COM Planning/Engineering
Phone: Email: °� 13125 SW Hall Blvd.
Contact name: AARON NAKANO Phone: 503'793'9985 Tigard,OR 97223
Applications fur"minor work in right-of-way"
only may be emailed to:
Engineer: rowpermits@tigard-or,gov
Address:
FOR STAFF USE ONLY
City/state: Zip: -'}��+
Phone: Email: Case No.:1)c12D 161'0D073
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
—
Estimated value of work is required(if over$5,000):$ Additional fees: $ __5e:P0t
(within the public right-of-way) Application accepted: III
By: Date:311 i-1
Is work related to a LAND-USE DECISION? 0 Yes ® No
If so,please specify (MLP,SDR,SUB, etc.) case #: Applicati 'wed:
By: Date:
Is work related to a BUILDING PERMIT? 0 Yes K1 No Applicant notified:
I f so,please specify(BUILDING PERMIT)case#: By: .0 Date: }-11-H
1:\ENG\PermitAppHcations\pri appkwtion Rev.10/16/2017
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of4
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 Tigard,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 arc not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT:
• The above request dogs not violate any recorded deed restrictions that may be attached tq or imposed upon the subject
property.
• 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 for approving or denying the application.
Aref• 6/(4241)
A 'cant/Authorized Agent's signature Print name 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 ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2of4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI) Permit: DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$300.00 minimum Sketch
submittal fee) (including information below)
Engineer's estimate X 2%Plan Review
0 Dimensions
WATER SYSTEM FEE ❑ Street Name
Part 3: All public water system improvements 0 Site Address
Engineer's estimate X 12%
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements)
There will be no permit fee charged,or assurance required
for the following types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (6 sets,24x36 or 22x34)
• Relocate or replace mailbox 0 Cover—Site,Vicinity,Abbreviation,Legend
• Ditch cleaning that does not involve regrading. 0 General Notes(City,Water,Sewer,etc.)
• Weep hole repair 0 Street(Plan,Profile)
• Curb repair or replacement(less than 20 lineal feet) 0 Water,Storm and Sanitary(Plan Profile)
• Lawn sprinkler system installation or repair 0 Water Quality Facilities
• Street tree pruning or planting 0 Grading
• Planter strip landscape maintenance 0 Landscaping/Tree Plan
• Test wells 0 Composite Utility Plan(Electrical,Phone,Gas,
Storm,Sanitary,Water,Signage,Street Lights,etc)
❑ Details
Note: A cash/bond assurance may be 0 Traffic Sight Distance
required per TMC 15.04.140. 0 Signing and Striping
(customer deposit) 0 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 Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
❑ Engineer's Construction Estimate
1111111111MISIIMMIMINIMA .11=1.1.0121=1111110111
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of
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5.3 - Two-Lane,Two-Way Roads Shoulder Work w/Minor Road Encroachment Diaa. 300
Shoulder Work w/Minor Road Encroachment Diag. 300 ROAD I
Use this detail for non-freeway work which extends into a travel lane and NNOA 't` J
maintains a minimum 10 fool travel lane. If a minimum 10 foot travel lane
can not be maintained,or when traffic can not safel i •
y pass by in both lanes Initial
simultaneously,use the appropriate lane closure diagrams–for example, Warning A •
Diagrams 310 through 350. Sign
i_ •
A lane closure may be appropriate for conditions such as high traffic
volumes,high speeds,and inadequate approach sight distance to the work •N•
space,or heavy equipment adjacent to the travel lane.
•
1. Use truck-mounted flashing warning lights on work and protection ( i •
vehicles. See Section 4.3–Lights and Lighted Signs for exceptions.
_1__ 1 .r .
2. For added visibility,a truck-mounted arrow board or PCMS in caution • • #.
mode may be used.
• l 0
3. Cones shall be placed along the entire length of the work space. If a Protection Vehicle
protection vehicle is used and work is in place one hour or less,the vd MA(nom Optional) 1
taper and tangent devices may be omitted, ieQ Chap er 4 - - • Buffer
I
1. If the speed is 45 mph or higher,volumes exceed 2000 ADT,or there j --j
is limited sight distance,consider placing cones or tubular markers on go
centerline. 10' _ i_ _ J • I
minimum • In
5. An arrow board in caution mode or truck-mounted PCMS with • I
'SHOULDER WORK'or other appropriate message may be used for •�
higher visibility. I •
• —_I_
Sign Spacing and Buffer Lengths(feet)
I
Pasted Spacing Between Signs Buffer ^_ i ROAD
Speed A B C Space r�nARarv3
20 50 ERRATA:
25 100 100 100 75 ..._ -____1 -
30 100 Supplement Table (Optional)
35 125
40 350 250 350 'kw...dr I rEnury 12, '
45 150 tore H
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50 500 500 500 210 ,,.. I ( I ROAD
55 _ 250 I t L.._ vorx
AHEAD
„Tim Sac_inp,and Buffer ten hs feet Su•.lement
Posted S acing Between Signs "Buffer" . Initial
warning
Speed - A a Ci Space Sign
GO 285
Ci;nntty 5 December 2011 December 2011
65 700 700 700 325 Chapters
70 f
�– '— _ _ 365