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PFI2021-00023 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12021-00023 * 13125 SW Date Issued: 01/20/2021 Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG1612 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Bore one 2" HDPE from ped E under road and S/W then S through ROW and under D/W of 13890 and 13930 SW 118th Ct then E to meter on house at min depth of 36" Class of Work: FEES Type 1 - Utilities (gas, electric, data) Description Date Amount PFI Permit Fee 01/20/2021 $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 wyHeard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: RANDY SHIELDS 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 See application Signature: Issued By: Special Conditions(See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00023 Type: Condition Name: Status: Severi : 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. Please call to schedule inspections 503-639-4175, use code 738 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 MATERIAUCONSTRUCTION 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 11:1;.: 2021 -00023 U.NGINFERINc Ul'.1'.11t'I'\IItN'1' Public Facilities Improvement (PFI) Permit PROJECT INFORMATION Projeci namc: 1�� C V� I ttt GE • 'n PE OF R'ORK •�7 u T\Pt:I-rr.n,hisr rnhrn as.l. Rricf dcscriptii.n of proicct: mor r_ nn t, ,2 14 b l' is(V1 MT'+a^•I i:\tC�,i t:l', nx w,l:. W fun OPIS& IZDVJ n'PF2-R(AN Sdc A,Ilmm.n,Smo 3. .rc4� L\rW .,F i3g`IO 4, 13(13t.) +1nenE N+cap:(umdLn:h.pni . 1'tC...C.• •.� R.Mi✓1 C 7f ti n 2 . •\ulru�ll,alwlWtu al.a ht•1V • fh4nvm ap}+na.h ui.ua.nr uW np,: SITE INFORMATION >ae,s yr La rd n•altm•n m,l 1.gLLLLLn/V.�dtjrVVV j2Alablc): 169r1 30�YIIB tvCA TimPn6n 3lix-tr nr n.kh.r urx� U* Iaa� I. H•nslmthLwiuc u•nl. wd xNth urthetiJl.n•xry;- •Sul.Irchnm.or Namnom APPLICANT INFORMATION hu rt vxkra v Namc: _1 l)M C&-k t pa f i -- w.•rnx .epn. TwAcd pa.a. And Tytxd bailing addri:ss: 1 I?oA V� �• {`` PK L� .. Kn,:„�, ciry!Statc: 1 v %lp:- 7-) ;;L d 3 T1PL 4-iruL(:dl Ta9undrry� PhimC:_ 5V �p'3G' TYPHS-Tiradl' ,%:k Email: n.r ' Phoric ("-f- ^� NOTB: '11K 1 and?ulMdrt.ii.�n.mn !>< Contactnmc: �CannAm awkadr.. ....1w g'w Phone: 1"mail R t:r\(1�-SI..ftf��Q ayr\( S`I. 4c M1 I CONTRACTOR INFORMATION ❑Same as applicam '(� Nantc: �.lr1QSt:.A r✓ LLC., 1 1i-I04 pp 0 Q CC:Ii\umlxr. Mailing address: IC�100�V\I SIS AVE (.ori State:Twa.l"'r\ Ok %ap: �I�G(ocaZ Phunc: cii g17`t "�'�`1l0 {$ �it\e4Canv ll�C Cy('I Email: ��C(�, ENGINEER INFO&.\IATION Name: Mailing address: Cite;Statc: Li7r. Phone: I.mail: ADDITIONAL INFOPUMATION Esurnmcd ealuc of unrk is rcquircd(if over S5,i a1):S ru 11hin the public right-of-way) Is unrk rclurJ uta 1 \ND t`SC DGC151t!N: O,tcsI Nr <asr numixr. City of Tigard • 13125SWflallfihil • •Ilgattl,(hcgrnt472$S 311;.-18.2.1'1 • Page Iof4 APPLICANTS NOTE: Pcrsun specified as".Appkcanr•'shall be dcMMAI Vai"Itrrmntcd•and%hall pr.n idc tinand:d assurante for work,if required br the on.pur1uant It.1711(:I5,(N 1411. 1C'alr chs rsuj,dm 4�Wdrr,yarturl'1+.r„urn r.•a.ya1 iramiac..r b.cnn..tLh rim t:m'•.i 7:1;.+.4 uhrm rh.,r�nrr inl rhr.;,i an:rh(hYrrrr p..p.4,rhr nphtanr me.c be rhe porstuuz 'f rea•xd+n s k.xr to pnx,tara tied:u rttrn �orivm.�r...n hum J. �. ..r an akcnr..f .}m.ro�mr. 'Ihr a•a ate mtr.r.rtitt chi,+gwrmm m rhr.pert p.•nidrd 19--t n .r•xirrcn Aur6meari.m apphua%m. tranrlu..d.n la.m.t,l t clue.arrrv•rrytcrrrf m•..hrs r}rr..atkt i•;trwurt.ui rho rrp6.�rrr•�n 1,the applicant,certify that. • To the best of mi.knowicdyoc,all the infumtarion pros pled within this application package is compkic and accurate. • 1he Awwc request dots not vi-Lite imr rrcnrdrd dred restrictions that mac br attached to or imposed upon the subject property. • If the application,s granted,I pill eicrow the rights granted in accordance with the termx;end subject it,all the conditions and limitations of the apprr t al. Vz Awlwl' I ICG�vO 1 `I rOY Applicant's or authoriacd agents signature Prim nanit Date. Prnpcm'ownci s signature(if required, Print name Date STAFF USE ONLY Case No: PFi�n��-11no2 ermit lee; Rccuccd by: Dat . Approved by- ?yti�y`/e3 , Date: t//Y/Zot/ \wailed by: Dam: Cin a(higard • 1112;5%\ tjail filed. • 'I iQant.t rrcPM 9-22" w".__._-- -��.':!! Page?of4 DEVELOPMENT ENGINEERING FEES Public Facility Imprtmement(PFI)permit: INITIAL PFI PERMIT FEE Pan 1: Required submittal im is 1W.-of the Kct PH Pvtmt Pec.Sce below for calculations.Minimum of S3(IR. NET PPI PERMIT FEE Part 2: All nun-water sgsterta imprurrmaus cnwccr'a esumatc S"'rr, irss dtc INthd PF1 Penni•Frt) WATER UNE CONSTRUCTION FEE Pan 3: All public water system Jmpntvttnrnt%IF- atpnsti.estimate X 12"r.,. F01t STAFF USE ONIN TYPE 4:SMALL c DETAILED SUBMITTAL REQUIREMENTSCHECKIIST Doc.:aPplicaar hay ,_krof-..a}L•ccna-% O Yr+ ❑>.. 'n'PE 1 AND TYPE.2-Slust include a%?{etch showing: Under the%irdea>iac;l:re.sundard,,ix the pn,lnwvl D D trxnsiou: considered?(check All that app)y): ❑Sm�ll Ccil O.Slacn, ❑ stns Name {idman}instate rata arc Pn.iw.cd as pan of da.Irrur. Site Addre�- applicmim? TYPE 3-Must provide 4 sets of plume(sized 24 a:36 or 22 se 34)and an Occironie version of ill sulaminal The proposed cquiptvatr is lnuu:d w uhidt of chic fo9ou-ing: items. The plans must that include: ❑Pul,lu Ri f:ht-rtt-\lay ❑Ptiaata•Po,pcnr ❑ Cn.rr—site,l'ieinw,,aL:aa�tatiun,Lcgctu? If egwpaiew is to be hJca:cd on private pn,peny,describe the 0 General Nores Ran.N's¢7,Ssvxr,crr, type.'C"sr. ❑ Srmi(Man.Protilc) ❑ %V-Awr,Swan aml Sanitiry(Plan itrutilc• [i Vater QuAhty Intihtire [] Grading L� landxap rw/Trce Plan ❑ G niliowt Pdhtyigan(19ecui"l,Phune,(;as,Stooii, samun•,\Garr.,Signal•c,Swat Light%,etc.) 0 Dcuils ❑ Traffic Sight Diaancc l] Signifft-,and Strilung 0 Stria light Plan aryl Ph,nonua?r D Engimcnscai,is;gnaurc ❑ Sheet 121*1(Project land-> name.revision sod plan Ing bhxk,dans and sheet numbm) ❑ lingnceris Cmirrucdan I""marc rlddiriotral Srlhrnirralf (P"Und use ennditions,if APPbcahl y O 'i'nftic Rcpnn 0 Storm water Drina re Calcularutns ❑ Gcorcc6nicil ltcport ❑ PtchminaryAcars Krpnrt(Sight Distance) D Ptoptrocd flat C3 IYrhaap Design ❑ Water l'rn.idctAppuwal Gity of Tigard 13125 S'%YJ tilt 91st\- I•tg.,,a.ter;pian�:"... _..�.o. r,�...t;.. vo l.'in ':_'t • Pjxr}uf.— Work site address: 13930 SW 118TH CT. Indicate North Y L 0 ly V CO 33' 12' . - 5 Property Lines -r Stref tlig t Boreline 47' PED - ----- -- . .. - - 13890 cn D/ 001 I I I I 146' D/W 13930 D/ ------------------------------------- No slope v a' SW GAARD!ST. Pago 80 2011 EdrLion 2011 Edition Page e1 5.3 Two-Lane,Two-Way Roads Shoulder Work w/Minor Road Encroachment Diag.300 Shoulder Work w/Minor Road Encroachment Diag.300 Use this detail ler nen-Iroeway work which extends into a travel lana and Nr;'PD A. maintains a minimum 10 foot uavel lane. It a minimum 10 fool travel lane • can not be maintained,or when traffic can not safaly pass by in both lanes Initial simultaneously,use the appropriate large closure diagrams—for example, warning A ' Diagrams 310 through 350. I • A lathe closure may be appropriate for conditions such as high traffic , I • volumes,high speeds,and Inadequate approach sight distance to Ilia work space,or heavy equipment adjacent to die travel lane. • 1. Use truck-mounted flashing warning lights on work and protection (oplidrneq • vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 2. For added visibility,a truck-mounted arrow board or PC MS in caution �.[ mode may be used. • 3. Cones shall W placed along the onfue length of the work space. II a Protocli°n retudd w/I lAA(=Orxionid) protection vohicle is used and work is in place one hour or loss,Ilio Styr Gurxer a - I • BtOm taper and tangent devices may be omitted. L 4. If the speed is 45 nlph or higher,volumes exceed 2000 ADT,or there —_ is limited sight distance,consider placing cones or tubular markers on to. J contedine. m'xinum • LA 5. An arrow board in caution mode or truck-mounted PCAdS with 'SHOULDER WORK-or other appropriate message may be used for • _� higher visibility. , Sign Spacing and Buffer Lengths(feet) ! r Posted Ssiacili Between Sl ns Buffer i ROM Speed A B C Space 20 50 rAIV1Tll .. 25 IDD 100 100 7S 30 1110 fupprn,eno T.Ltr I loptiwuu) 35 125 40 350 350 350 1� 01. 45 ISO 5o 500 500 500 210 ♦�� - Nd'wd NOfY4 55 250 Sl!n 5 acin,and Buffer ten the feet Su dement InitiA Posted _ S act n Between Signs "Buffer" warn" _1peed A 0 C Space Sign 60285 CMpior 5 Dctnmlxr 7011 Decrrmbur 2011 Clwp;cr 5 65 700 700 700 325 70 _� 365 Work site address: 13930 SW 118TH CT. Indicate North Y ♦ Y p w • • w O ly 33' 12' No 5' Property Lines ---------------- ---------------------- ----------------------- ---- Strei tlig t Boreline 47' PED — --- — 13890 I I 1 DAV � 1 CO ------------------- I 1 1 146' p/W 13930 I I D/tV I I 1 --------------------------------------- ------------------ No ---------------------- ------ -- ----- No slope SW GAARDE ST.