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PFI2015-00093 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT * COMMUNITY DEVELOPMENT Permit#: PF12015-00093 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/09/2015 Parcel: SEG358 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: 12100 SW Scholls Ferry Rd Project Description: Bore one 3/4"conduit for Comcast cables from pole#12149 under 121 st Ave 76' in ROW N.to 12140 SW Scholls Ferry Rd. at depth of 30". Owner: FEES Description Date Amount PFI Permit Fee 07/09/2015 $300.00 PHONE: Contractor: LINESCAPE LLC 19100 SW 51 ST AVE TAULATIN, OR 97062 PHONE: 503-612-7917 FAX: Applicant: RANDY SHIELDS 11308 SW 68TH PARKWAY TIGARD,OR 97223 PHONE: 888-824-8264 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 Not Present Signature: Issued By: '�— Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00093 Type: Condition Name: Status: Severity: PFI_Utilities 01 -WORK SITE REQUIREMENTS Not Met 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 Not Met 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 04-WORK SITE REPAIRS Not Met 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 Temporary Patch Continuing Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of pathcing method. No trench shall be left at any time in an unsafe condition. Applicant is responsible for and is liable for hazards of damage resulting from the prosecution of the work. PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Not Met 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 03-WORK SITE EROSION CONTROL Not Met 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 09-TRAFFIC CONTROL WORK HOURS Not Met 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 14-TEMPORARY PATCH Not Met 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 18-PERMIT/PLAN ON SITE Not Met 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 11 -TRAFFIC CONTROL MODIFICATION Not Met 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 19-MONUMENT PROTECTION Not Met Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Not Met 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 07-TRAFFIC CONTROL ROAD CLOSURE Not Met 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 20-EMERGENCY CONTACTS Not Met 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 12-UTILITY NOTIFICATION Not Met 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 Not Met 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-PRECONSTRUCTION MEETING Not Met 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 Not Met 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 -OTHER Not Met Notice PFI_Utilities TRAFFIC CONTROL PROPERTY ACCESS Continuing 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 08-TRAFFIC CONTROL PROPERTY ACCESS Not Met 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 06-TRAFFIC CONTROL PLAN Not Met 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 10-TRAFFIC CONTROL LIMITED WORK HOURS Not Met 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 RECEIVED 'JUL 0 6 2015 City of Tigard CITY OF i .­eAD D = PUBLIC WORKS—ENGINEERING PLANNING/EN&NgEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: Utilities Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: -2a oTG Mnp_3/`{�� C�dJ-aidGo�v Cay$+ Minor work in right-of-way (sidewalk repair,curb cut,street C*2bke-S ! � IrLe,d34,121 401 l tr1 d PX' 1 z.-1st Alm-_ -4-V ,'n opening,etc.)requires: lk,OVJ � L2Vqp •Application form,completed Nl• $W $f.Lw�l S d and signed O - •Submit one(1)copy of scaled sketch Property address/location(s): 2-•1 sw Sc c,its , • of the proposed work to be done %k sg •Submit one(1)copy of traffic control plan -OR- Applicant's name• _��m C-�- ❑ Substantial project work requires • above items and professional Address: engineered plans for: •Street widening td City/state: Ti°5ra ' V R Zip: q}2--2/3 •Subdivision infrastructure Phone:9 - K24-1124, t(Email: Art U-Skill"R C461i2•Cawt�, •Main utility line extension: C Storm Drain,Sanitary-Tigard ` � , �� i✓I-�. - Water-Tigard Water Service Contractor's name: J� Area(includes Durham,King City CCB#: 140 4:og Expiration: 11A I Ito and a portion of unincorporated Washington County) Address: I° I C50 W 51St Ay,'- City/state: T1�A_k1h b V.- Zip: DELIVER APPLICATION TO: -Io12_ 1 City of Tigard Phone: Email: �t�rYvt.it-S �1�2,SCst t}e.11GC�a1 Planning/Engineering 13M SW Hall Blvd. Engineer's name: Tigard,OR 97213 Applications for"minor work in right-of-way" Address: 1011 W 5 I S+ ArU2• only may be emailed to: City/state: �'[�D��Q-�t�n,_O R Zip: ��'O{02- ro rmiLCa�tig��_oov Phone: Sd3-to 17-- j 17-Email: (g� 1.� 4,",[�P.e. ((C. Case No,: b od"V Estimated value of work (within the public right-of-way): Application submittal Is work related to a LAND-USE DECISION? Oyes )�No Appliauioneaccx1SAd:- If so,please specify (MLP,SDR,SUB,etc.) case#: By: Is work related to a BUILDING PERMIT? O YesNo �li��, # Peaseseci P �' �► If so l (BUILDING PERMIT)case#: By 1 Date. Applicant notified:.. By:. Date:'-- � City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www tigard-or-gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as "Applicant"shall be designated'r'crmittee"and shall provide financial assurance for work. 'When the owner end the appliant are different people,the applicant roust be the purchaser of record or a lence in possession with written authorization from the owner or an agent of the owner The owners)must sign this application in the space provided or submit a warren authorization with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL.CERTIFY THAT: • Theabove r Quest d ^s no t7olate anv deed restri tions rhar m,� be•attar fi to or imnoc a -�- ---t�Zn th c ihafS'� . • If the application is granted,the applicant Neill exercise the rights granted in accordance with the rums and subject to all the conditions and limitations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and the applicants so acknowledge that any permit issued,based on this application,mai be revoked if itis 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. SIGNATURES of soh owner of the subject property required. _ZW Z - 4651? 5�1^ Applicant Au prized Agent's signature Print name Date tore Print name Date A0\'u0 Z eu, Owner's s turc Print name IK Date Owners signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SN'Hall Blvd. • Tigard,Orcgon 97223 • wwwtigard-or-gov • 503-718-2421 • Page 2 of 4 NOV SW 121gtRJe Till-, it e wAcK 8, Foe. 11,91 R01rr 1V )n Rtc-HT F'WAY S FOC Bow RMV �vrvylk Tope, 40-Agl u x&ey- l� P }o ��LI b �� ScpllS F a 0. vvu��`' `� P �. CITY OF TIGARD 7/8/2015 7:59:18AM 13125 SW Hall Blvd. Tigard,OR 97223 (503)639-4171 Conditions Associated With Case #: PF12015-00092 Project Name: 8605 SW Pinebrook ST PgWDESCRIP1 PERMIT/PLAN ON SITE Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 14-TEMPORARY PATCH Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 08-TRAFFIC CONTROL PROPERTY ACCESS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef Access to existing properties shall be maintained at all times, including normal delivery service and mail service.Obtain City approval of any access closures. 12-KWORK WORK SITE REQUIREMENTS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 13-UTILITY LOCATION CONFLICT Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 05-TRAFFIC CONTROL SPECIFICATIONS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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]. Off/ -PRECONSTRUCTION MEETING Applied 7/6/15 Notice Betsy Ruef Betsy Ruef Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>,to establish a preconstruction meeting. 1pe_WORK SITE REPAIRS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 19-MONUMENT PROTECTION Applied 7/6/15 Notice Betsy Ruef Betsy Ruef Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. Page 1 of 3 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 12-UTILITY NOTIFICATION Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. WORK SITE EROSION CONTROL Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 20-EMERGENCY CONTACTS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 07-TRAFFIC CONTROL ROAD CLOSURE Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 06-TRAFFIC CONTROL PLAN Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 11 -TRAFFIC CONTROL MODIFICATION Applied 7/6/15 Notice Betsy Ruef Betsy Ruef The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. NOTICE TO COMMENCE WORK Applied 7/6/15 Notice Betsy Ruef Betsy Ruef The applicant shall notify the city's inspector Kenny Fisher 503.816.6146(cell),503.718.2602(office),or kenny@tigard-or.gov TWENTY FOUR(24)hours prior to commencing work, prior to any staged inspection,AND after completing work covered by the permit. WORK SITE AREA Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 09-TRAFFIC CONTROL WORK HOURS Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 15-REPAIR OF EXISTING FACILITIES Applied 7/6/15 Notice Betsy Ruef Betsy Ruef 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. 21 -OTHER Applied 7/6/15 Notice Betsy Ruef Betsy Ruef Page 2 of 3 # DESCRIPTION STATUS STATUS DATE SEVERITY APPLIED BY ACTION BY Page 3 of 3