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PFI2022-00029 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT tt COMMUNITY DEVELOPMENT Permit#: PFI2022-00029 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/07/2022 Parcel: SEG1396 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: SW Frewing Street, Comcast Project Description: boring 3.75"conduit 36"deep from the house to the Comcast pedestal on the SW side of the road Class of Work: FEES Type 1 - Utilities (gas, electric, data) Description Date Amount PFI Permit Fee 02,107/2022 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Cali 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tiaard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: RANDY SHIELDS 6916 NE 40TH ST VANCOUVER,WA 98661 PHONE:9714013530 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: applicanun Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12022-00029 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. Please call at least 48 hours before starting work. 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[sj 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 PFI #: PFI2022-00029 0 ENGINEERING DEPARTMENT Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: �W iY1 LS� �y'� �1 B,(T1TE 1—rra„chicc Ltdtq�\C%tido Brief description of ro eels o 1 � 1 r n [' agen°rr'?'�by 1`�GI�,PGF, or urih'[} � �\�P � P I agency m "�'r VI Se/ C(Afi e—&Vx1 ❑ TYPE 2—ROVI Sidewalk/Driveway/Su%vcr Work performed for the purpose of: • sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATIONnn • Sanitary sewer lateral installation and Location ddress if available):9IU5 � '�!.?.�\!�q ��3 main line tap ❑ TYPE 3—Full Scale Development Work QAperformed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMLATION • Strectwidcning Name: • DlainGne installation for sanitaq sewer, tt ,^ f storm sewer, Tigard warer, and Tigard Mailing address: unk to WE q r\�h O T ,rater service area City/State:WMCf�U"Vrt W A Gip: � )LQ(Dt ❑ TYPE 4—Small C.cll'IechnnlnF} Phone: q 11 — Li Q 1 " J S x) ❑ TYPE 5—Tigard Triangle YAnckt!�..�Shie� S �Cur"CSS}• CoM Email: J Phony:: NOTE: Typc 1 and 2 applications may be Contact name: wy-Nclt� Sk)) Q-1 Cly emailed to ma •motsa tq+anl•rrr.nrn•. Phone: Ismail: CONTRACTOR INFORMATION ❑ Samc as applicant Name: 'ICM Ott IM,CCB Number: 05Y1 1 Mailing address: City/State: MnCOLOCf, Wp Zip: ' cb(.e LP I Phone: ���O - Vb- lb- \ 10°J Email: MUJl > W e-,rfC;;Z)CV V?�. cram ENGINEER INFORMATION Name: IIT Mailing address: City/Sate: Gip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over S5,000):S N 'A (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes I(No Case number: City of Tigard • 13125 SXX Hafl Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page I 0f4 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 15.04.140. ■ With the exception of a utility operating pursuant to a valid&andhise or ligase with the City of Tigard,when the owner and the applicant are different people,the applicant must be the purdhaser of moord or a lessee in possession with written authoriution from the owner or an agent of the owner The owner must sign this appli kation in the space provided or submit a written authorisation with this application. Franchised or ticensed Utilities are not required to obtain the owner's signature on the application. I,the applicant,certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval fiz4A- ) )MUM-Ut U.�11Le� 2 I !12 p cant's or authorized agent's signature Print name Da e Property owner's signature (f required) Print name Date Cade>\ToC 'PFI202 -0$� � r PeedauQe;tet ,e 3 Received; SIt 312lYD2 F = + bY• 'p " I]atew Nottfiet3 9 � J ... . ::V •. ...... .a ...A..J. ..n..Y a.:T ru:i>�Y. 3 S L ♦ .. . Cky of T*W 13125 SW HaU Blv& Tigard,Oregon 97223 wwuctiprd-orgov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Pemvt Fee). WATER LINE CONSTRUCTION FEE Part 3: AN public water system improvements engineer's estimate X 12%. RE• Does applicant have a right-of-way license? ❑Yes []No TYPE 1 AND TYPE 2-Must include a sketch showing- Under howingUnder the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): ❑Small Cell ❑Macro ❑ Strcet Name How many install sites are proposed as part of this permit ❑ Site Address 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 on which of the following. items. The plans must that include: ❑Public Right-of-Wap ❑Private Property ❑ Cover—Site,vciniry,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Wates Quality Facilities ❑ Grading ❑ Landscaping/TreePlan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineersseal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.6gard-orgov • 503-718-2421 • Page 3 of 4 Y SI-V _ ,. St Edge of Pavement Ditch --NO- Slreethght I —•—•—•—•—'— r— — �1 f L r Y✓i.m! 1 14k7, 111, o i T--l"It—pp'0srf5 W-FFTttie" ! r I I in= E;!isling House 1 =t I Existing 1 Fr I N i Driveway o ln V I 3 01 I � F r imp Shop 1 J \t }. Powerpole i I = I ". I o . o 95' ------- --- I Ftoperry t.me' ydrant(FH) Scale: '1-=30' � I I TYPE 1 AND TYPE 2: MINIUM SKETCH I I ! I I i REQUIREMENTS North arrow Property lines&dimensions -UtE Existing utilities locations ' (sewer,storm,water) VStreet&street names V All existing structures _V Proposed work Existing curb or edge of pavement 0—Utility&street light poles Existing S/W or D/W apron fA T Slope of property Trccs City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-urgov • 503-718-2421 • Page 4 of 4 d� 1 rd na Co. r� o�Srd�cu / 3' \ gT 15�a J \ 2gi,Ed&*n "age 01 Shoulder Work wi Minor Road E=ncroachment Qiag. 300 PAWAKAD I I tallipl A o• Warrdng S gn ( e 1 e � 0 (Opbonal) • Protection Vehlcler- vr( n,,A(both OptloneQ Seo Chapter a I S Duller minknum • l! 0 I o A ROAD NARROWS (Optional) B NIF�W Initial Werning Sign pocemhsr 2011 ^'