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PFI2020-00340 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT I COMMUNITY DEVELOPMENT Permit#: PFI2020-00340 Date Issued: 09/23/2020 TIGAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG995 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: SEG 995/ 12485 SW 128th Ave. Bore one 2'HDPE from ped at 12470 SW 3'then SW under ROW to meter on house 12485 at a min.depth of 36". Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) PFI Permit Fee 09/22/2020 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: LINESCAPE LLC 19100 SW 51ST AVE TAULATIN, OR 97062 PHONE: 5039694409 Applicant: RANDY SHIELDS 11308 SW 68TH PARKWAY TIGARD, OR 97223 PHONE: 5035963996 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: appu c -- Issued By: kiL` Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2020-00340 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 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, Trent Brickey at 971-228-9269,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 City of Tigard PH g 2020-00340 • INC;INF I KINC, \IITMLNT T14,;Altt> Public l-acilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF ORE Project name. t t 5:W. 1:4 Ave_ )11( TYPE I-I tatt..lum.: oh.:,Wud. prti..t.mtl NWN.NW. e4.unbtl Bricf Inc Itxt: t - ;t.. ▪ IN‘ IL-lit (Vt. 1.1 ;'"4.0 YOI t • 0 TYPE 2- SuIncill:Ilrivram.5<-4cr SC.ri rurp.c 0!,11 \ • • . !• •Sztrins..13 •Ornm.et An/v.:id{imullan.al SITE INFORMATION • ',anwtt Inut.11.11.u11.11,m 'LAC till 1A/CaTit i.fdrcss if at 411.11,11. I,• t . SEG995 TYPE 3-I :wale Ur,rluprtient ork CN- . '11 11- prril.tinniuith Litul wv sprn•val uluAt folkweng •Silluitst..t,ttp...t VurtAti,m, APPLICANT INFORMATION •Sottl tarring CPAVA r • m.Gribit, In..1.44Dmi 1,4 •Jr1J111) K.Ntr 'fig4111 Water. Mailing addrecc Pk:\A;'`A 4.11r1•<rvirC MY] City Start:: 7 hr. 1 4, .2, TYPE 4- till To Itc.410 TYPE 5 holioll Mom% ' ' Mit NI I .pc 1 :Ma 2AppliVi•Ndlt 111A, 17. • I (:iwitAct nanic: P.001A Plu h.• 7.. 43 .• Colt J CONTRACTOR INFORNINI'ION 0 Saint"..is applicant LLL. Number. )14 C..Li-CiS JsIailingdfiress: I'7'1 C NA 51 si A\re• it 4•••••R 1 lac Z Phs,nc (17)-t - 11-1c1t; —it,Al: • re_(-LC•(rott.0 ENGINEER INFORMATION Nam:: MiIing addre>s: I in Zip: Flit inc. I ADDITIONAL IN FORMATION lz.stirnattAi tiIu (4"0 1.tl IS marlin S within flu:public tiht...f-tay, Is witrk telaiLL1 it)a USE DECISI(IN? a Ye.5 a No (:a numlwr City of Tigard • 45123 \Nr 11311 lilvJ, • I:pm& hrgt.:1 • ..mw.tigmr.1 f.101. • '811, 2421 • Page I of 4 APPLICANTS NOTE: Person spealital us'11ppl cart".h.11 ha Jr. Th514d'Fermium-and shall pnxak Iinatxi4 assurance for auk,it required by the cut punuutt I, 1)1' I i nil I do • with Jx n..pu put a a.Ym•fit niter+n_uuc• .aid nw u=nn..4 rk .i'I#:uJ.•lull Ilia.ru1Nt+awl _rt.h'vnra.po{:n,th.•pp'taur nn:c lµ:Lc p.inns,i..r m..ml..•..k-..,•n:..w..:,.n va! uxIrmt .nra..0 atrc,h�.a.R, g.. m w:ct � .0 n,rc Ihr�vnn q.aq 1, , „ , . I ..irn ....• .i. .0 .... , ,. ,i .1 •..I ,lxrnnd a•;a,ate m• I.thy applicant,cenni.that: • Tu thy lest nt my knoa•kdgc,all tilt inlut:, . I prottdcd minim this applicant on package IS c.unpletc and aeeuraIC. • The alx.er rrqurst dors not eu.Lrtr am teu,:.ica deed restnctia.ns thin m:n Ile attached u1 or imp..sed upon thy subject pngxm•. • If the application is grained,I will csercise thy rigln..rutted in accordance nidt the terms and subject to all thy cnnditir.ns and limi121111ns 111 thy tytpn teal (j� • . 1 I 1.6/ ZC'LiJ \pplicant•s nr authonzcd.tgcnt•.strnawre tanrn n:mtt I,,:. NY pm) a.0 ncr.signarurt rif rc.luiredl Parini mink I).. STAFF USE ONLY case N..:PFI2020-0034p0 pt;..;1 300.Od Rcccitcd by: AL re ra : 9 16 2� Approved by: 7—be41,'A— Da1e: ?/e2/ZGZO Notified by: / Dater City of Tigard • lal is\\ IIa11141.J • I+.. • ...!,,._ • '4,3-II,21" • Page''u(. DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PP!PERMIT FEE Part I: !required submittal fee tsItt'r oldie.Net PH Pcnsnt I•cc.See below'lot calculations.Minimum of$30lli. NET PH PERMIT FEE Pan 2: All non-ualcr system intpu:rventcnts cnaysrcr's e.timate X 17.•(lets the initial PH Permit Far). WATER LINE CONSTRUCTION FEE Part 3: All public water sssten:improvanents engineer's cstinutc X 12t.6. FOR STAFF USE ONLY FOR STAFF USC ONIX TYPE 4:SMALL WIRELESS FACILITY TYPE 1-3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Dra:,appGcxnt have a u�l'a•'t "TYPE I AND TYPE 2-Must include a sketch showing: Under the wireless t wAr,rs standards.is the prtq•.,.d 0 U!:ten i.at, considered?(check all that apply): O Small Cell ❑Slacnt El Street Name ❑ Site Addres. Flow many install sites ate proposed as part of tins permit application% TYPE 3-Must provide 4 sets of plans(sized 24 x 36 or 22 x 34)and an electronic version of all submittal The proposed equipment is located oil which of the foilowuiz, itent,.. The plans must that include: ❑Public Right-nf-R aye O Private Pmpern n Ct..et--Sac,"drum),Abbres Ina in.Legend Ifegtupmcat is to be located ern private propene,describe the • General Notes(tan,Water.Sewer, ; Mac;us:• ❑ .buret(Ilan,Profile) 0 Water,Storm seal Sanitary(Pian I'rulilcj ❑ llaa Qttattty haebtw O Grading ❑ landscaping/Trey Plan G' (ntp.aitn Utility Plan(l'.Ircincal,Phone,Gas.Sturm, +ardtare,Water,Sigttege,Street lights,ale.) ❑ Drtai!• ❑ Traffic Silett Distance ❑ Signing and Striping ❑ Sneer Light Plan and Photometric ❑ kngdneera seal!si;maturc [] Shin label jptnicct land usc corny,mention and plan log bit tel:,datra and shot ru:ubcrs) ❑ t:I.hire.Gm*truction Estimate .4dditinnai Sr.I.mitt ais Tr.land ran•tutnliriona,if applicable) ❑ Tratite Report ❑ Stnrot water Drainage Calculations ❑ GeotechnialRepttr ❑ Preliminary Aceees Report{Sight Distance) 0 Pntposed fim ❑ Pathway fa,.ip, ❑ Wata Pr't'it4er:lpprnva! City ofTigard • 13125 SW Hall Ishii, • Tigard,t hcetn%'-- • w n u.t:gatd-t t gin • D-7 Ih•2421 • Page 3 of 4 -,.•cvC LAr aa-'b-" SS t,Z1 . ` , 4r '0 ^"ord r crt1 ,ti <--,r=-- — — — °-� t — Mo9 to/S ,b •7ca 1 c k--- -C... qt--il Ja.eval nnS 15 ,hF �w c —'ui « p,oj M/S' ,7, : s- Mira t lN,v 6L.fi2 1 Page IN 2011 Edam 2011 Eo,t,n �ifs Sfa(ignary I:ane=QlosuGe wJfhiFil0 91D41'1:'.SCVNt iUIaetafi'IXa20; .S_fafionary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of ono lane of a Iwo-lane,two-way roadway. See the dead inset for the layout if using a single dagger to control both directions of traffic en tow volume roads peso than 400 M1DT)with good sight distance as discussed below, i qq®_ 1, Use truck-mounted flashing warning fights on dWork and protection • vehicles. See Section 0.3-Lights and Lighted Signs for eseepkals. S. I o 2. For added visibility,a Inch-mounted arrow board or PCMS in caution m a mode may be used. - - 1, t LL 3. Flaggers al each approach aro required if any of the following 9 S — — ( conditions exist: ® t a. Night Operation. — b. Work space Is over 200 feel in length. c. Sight distance is less than 750 feel from each approach I through Use Irmo closure. d. Traffic volumes are greater than 400 ADT. I�: >°S e. •�; QQ551?3 A. The length between the Flogger signs shall Cnotar exceeding one '® -. 1 • /gCi mile. U5o Diagram 340-Lane Closure with Pilot Car if exceeding one •- / ff C mule. p - II . 4 5. Canes should be used to outline the work space when curves or other l:' �E1 • roadway alignments prevent clear direction for the nolodsts to pass . -® !l ihn work space solely. a 3t tft II I•• 5. Cnnos along the workore recommended wheno.E j• 1� space postedor Oa (-- arc AS mph a greater,when working under heavy traffic or when navel `ate lanes are narrower than 11 feet. 9AR I I 8 - LL - 7. Extended queue signing(see Diagram 5-1)should be used when • — Y,.7 ^8 traffic quotes extend beyond me initial advance warning sign. j I t ,.(gp, _, y ! e B. When flagging near an intersection.the'Flogger Ahead-(CW23.2) I N �% sign should be visible to traffic entering from any side road.Additional • advance warning and flogger Ahead symbol signs may be placed on I ea kuuro.aumote toonsi..e Y the side road(s). wax: . ._ .' r .1 9. Sign set-up and flogger a shown may be used for intermittent hyd•�n*+r. pm®�11M I - hip rose closures d120 minutes or less. .... x ©©©® 10.he e'ONEconsidered E ROAD AHEAD'high speed is optionalor wh and tendld �•+ =©©©• ® he on high volume a high speed roads,or when extended ""` queues are expected. -"- rsoSpsrin and Wnnr l enehM1h(Mgll Supeh+n•nl :meta 5 134'o L.rc Pil a 2011 Fasted __Spadr{eerwnen Stint mutter Cb.gxnr5 sPe.e 11p < _ sd•ce 60 2e5 65 700 70e 700 325_ 70 I 365