PFI2015-00129 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2015-00129
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/17/2015
Parcel: SEG 620
Jurisdiction:
Site address:
Subdivision: Lot:
Project: Comcast Cable install 2"conduit with CAN
Project Description: Trench and bore at a minimum of 36"below grade and install 1, 2"conduit with CAN
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE.
FAX:
Applicant:
KENNETH PARRIS
11308 SW68TH
TIGARD, OR
PHONE: 971-801-5699
Total $0.00
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: l f/ / V ,),p z/GGA n ru
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00129
Tvpe: 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 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 09-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 10-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 11 -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 12-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 13-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 14-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 15-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 16-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 17-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 18-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 19-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 20-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 21 -OTHER Applied Notice
s '
RECEIVED
SEP 14 2015
City of Tigard PLANCITY OF TIGARD
PUBLIC WORKS—ENGINEERING NTNG/ENGINEERING
Publc FacffitY ImProvement (PFI) Permit
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DESCRIPTION OF WORK(in the tight-of-way) REQUIRED SUBMIT'i'.AL
Check one: dUtilitics 0Sidewalk/d:[i—y approach {❑ Street imprwcjnents ELEMENTS 1
Detailed description: ��'e-.,-L naJ 6.r6 t' c( .n� .�;n�r�� O d or work inrighr-of-way
(sidewalk repair,curb cut,street
O F
39" 'C`ems Q
b J9 QkA i rt sbll( C1,l` -2 opening,etc.)requires: 1
v[ r W e-!X^ •Application form,completed
'C and signed
^ 4 •Submit one(1)copy of scaled sketch t
Property address/location(s): sw tjiAtr L"Lke �r 4'• of the proposed work to be done
t.) 12� f •Submit one(1)copy of traffic
SC�� control plan
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Applicant's name: �.^sei " cw& ❑ Substaatiai project work requires
above items and professional
Address: 00k S k1 6 V,- PLOY engineered plans for: F
•Street widening j
City/state: I d2 Zip: -112-2=3 •Subdivision infrastructure 1
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Phone:4 h-9d- S6Q q Email: t t11 P.�-�..parr rtb�P.ccaKC4Si.Len •Main utility line extension: t
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- Storm Drain,Sanitary-Tigard r 1
-.� (� � - Water-Tigard Water Service
Contractor's name: `,I p x r-C,vt1Cr P—o SC5 .,T-HCl Area(includes Durham,King City
CCB#: l�� 4 iS Expiration: 101012016201S And a portion of unincorporated ' t
Washington County) j
Address: 0412-2- A4- A
DELIVER APPLICATION TO: t
City/state: A"taQ SQ- Zip. Q' �
r City of Tigard j
PhoneS63-19-904Q _ Email: txio�►S 1al�',� x5�af fcse5. Planning/Engineering s
13US SW Hall Blvd.
{ Tigard,OR 97223 t l
Engineers name: ().,aO . 5�a('d 1
Applicatiomc fnr"minor work in right-uf-way" 4 j
Address: L4122- A.-4 Q..J /IF ' iWonly may be emailed to:
&) #
City/state: -ro-rst , �� Zip: gT2 rownermits jgard-or.a�v
Phone:fit-7-4-5-6II Email: ort a6"jpk!A-, -CI&I
g
Estimated value of work(within the public tight of-way):
Is work related to a LAND-USE DECISION? ❑ Yes CJ No Application a;ceptglr � F
3
If so,please specify(MIP,SDR,SUB,etc.)case#: Bp::. gf�e; :p �S
API' . 1
Is work related to a BUILDING PERMIT? ❑ Yes (�No q�
If so,please specify(BUILDING PERMIT)case#:
ot
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Is�klfti �uryijAci�nir'4Kit<j/is/Zo1a
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 www.figard-,or.gov 503.718-2421 Page 1 of 4
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APPLICAN'T'S f
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
I
n When the owner and the applicant arc different people,the applicant must be the purchaser of record or a Icssc-c iU Possession with written
authorization from the owner or an went of the owner. The owacr(s)must 41 this application in the space provided or subrnit a written
authorization with this application.
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BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
s
• The above request does not violate any deed restrictions that may be attached to or im2osed uponthe bj rpt property.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the 1
a
conditions and limitations of the approval. l
:ill of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,axe 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. a
•
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.
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SIGNAT RES of each ownet of the subject ptopetty tequired.
Applicant/Authorized Agent's signature Print name Date
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Owner's signature Print name Date j F
Owner's signature Print name Date
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Owner's signature Print name Date
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 ww%tigard-or.gov 503-718-2421 Page 2 of 4
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Page 78 2011 Edition
1N_ork,on Sho�ic��r , :,. . . �sr�;;: _ • �;X�:;:s:. ...;�,:�la9r�:� x•10,`
Diagram 210 covers stationary work with work or parked equipment on the
shoulder. This diagram does not cover work on a freeway shoulder. See
Diagram 710 for Freeway Shoulder work.
1. Vehicles should be parked as far off the roadway as practical.
2. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3--Lights and Lighted Signs for exceptions. E
3. For added visibility, truck-mounted arrow boards or PCMS in caution
mode may be used.
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4. Arrow panels in caution mode are recommended for work on roads
with posted speeds of 45 mph or greater and high traffic volumes,
greater than 2000 average daily traffic(ADT).
5. Requirements for signing and devices are shown in Table 5-2, below.
Table 5-2: Device and Signage Guidelines
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u,'L34. sr .S,.w'?= � 'a•.- �i�,3q.+•..:S..Y iis;.
�<� Y One advance warning sign is I
Advance warning required and two signs are
recommended. r
signs, devices, and
7 flashing warning Cone taper is required. Cones `
0_ lights are optional. along the edge of traveled way r
are optional.
Advance waming signs and devices are optional.
Sign Spacing and Buffer Lengths(feet)
3
�''1Spacing Between Signs ;Buffer=:`
20 .. 50
25 100 100 100 75
30 100
35 350 350 350 125 g
40 150 i
45 180
50 500 500 500 210
55 250 i
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Chapter 5 December 2011
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2011 Edition Page 79
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Work on Sh+�ulder D� grar;r�2a0
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` Protection Vehicle
• w/TMA(both Optlona.
See Chapter 4
Buffer
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ROAD SHOULDER
WORK OR WORK
AHEAD /HEAD
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Initial Warning Sign
1 _ _
T Use as appropriate see Table 5 2
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December 2011 Chapter 5
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!
N Date:09-11-15 Author:Uriah Stewart Project:City of Tigard
Proposed New Comcast Facilities Comcast Project 0:45562 Contractor.Texater Enterprises Contractor Contact:Scott 503-793-3140
p Comments:
Water Restore all work areas to like or better condition.
y Sewer/Storm ,=FSK STAR ATTENTION.Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center.Those rules are set
forth in OAR 952-001-0010 through 952-001-0090 You may obtain
copies of the rules by calling the center.(Note:the telephone
number for the Oregon Utility Notification Center is(503)-232-1987).
Summerlake Park
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