PFI2015-00134 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00134
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/22/2015
Parcel: SEG841
Jurisdiction:
Site address: 12030 SW 135TH AVE
Subdivision: BELLWOOD TERRACE CONDO Lot: 33
Project: Comcast Cable PFI
Project Description: Bore one 3/4 inch conduit for cables from ped on west side of 135th ave
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX.
Applicant:
RANDY SHIELDS
11308 SW 68TH
TIGARD. OR
PHONE: 888-824-8264
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: ��,Q r Gt 0/-)
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00134
Tvoe: 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
RECEIVE,
SEP 17 2015
City Of Tigard CITY OF TIGARD
PUBLIC WORKS— ENGINEERING PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one:XUtifities X1 Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: on _314"c C Le.S Minor work in right-of-way
r (sidewalk repair,curb cut,street
f��.d. 61% W S;&A oT hyf— l,'na4A- opening,etc.)requires:
JLsYt . G1`?.t� n 4 30" G *'u,, S Mnsm4 , Row 1k5J- •Application form,completed
and signed
C ♦o Poul r ry a jen— en 12.L130• •Submit one(1)copy of scaled sketch
Property address/location(s): 1Q050 Sw 139"'N a3 of the proposed work to be done
•Submit one(1)copy of traffic
control plan
—OR—
❑ Substantial project work requires
Applicant's name: 01)1MCAR';t' C,%&Le, above items and professional
Address: 110 1►J to% engineered plans for:
•Street widening
City/state: i t OR, Zip: of-4�3
I •Subdivision infrastructure
Phone: ns-%2 - )-Io4Etnail: •juin utility line extension:
_c Storm Drain,Sanitary—Tigard
WateContractor's name: 1'1�C4x�� LLC, . km —Tigard Water Service
Area(includes Durham,King City
CCB#: N0420 Expiration: �` O� / 1 and a portion of unincorporated
Washington County)
Address: 19100 SW 51 st Ave,,
City/state: `_C-V.eel4A-t1- . OR Zip: q--0 to off.. DELIVER APPLICATION TO:
City of Tigard
Phone: Email: LMeScAe:g: lC•Cc>tit Plaxxixg/Exgixerrixg
13125 SW Hao Blvd.
Engineer's name:
Tigard,OR 97223
.applications for"minor work in right-of-way"
.Address: V1 10c) � ve_. only may be emailcd to:
City/state: T►-&AAA,tirn e) fz "Lip: *(D(00_ rQz3jC;mita1@6g&rd-or guy
Phone.A44.313-4183 Email:�aL1 tme. f tc�el,lC L t)rrt
TepFT 2 0 IS 0 01 3,
Estimated value of work (within the public right-of-u-ay): $
Applit aaior► &z...-'' ..
Is work related to a I AND-USE DECISION? ❑ Yes , 1 No Applicaoioak d
If so, please specify (MLP,SDR, SUB,etc.) case #: Bq V1/► - it
Is work related to a BUILDING PERMIT? ❑ Yes .6 No
If so,please specify(BUILDING PERMIT)cast:#: By.—�.-- Dam
Applicant nedfied:-
D,o� z,
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 wwwtigard-or.gov 503-718-2421 Page 1 of 4
APPLICANTS
[NOTE: Person specified as 'Applicant"shall be designated "P-mittec"and shall provide financial assurance for Writ.
When the ovuer and the applw=t are different PoiPk.the apphcmt must be the purcbaser of teemed or a kes.ee in possession v�written
aud+oaiaaotm faom the owtza or an agent of the owner The owners)must sip this Wph_tm in the
autho:i>s:with this sppliritiun. P submit a warren
BY SIGNING BELOW,THE APPLICANT(S) SHAI-L CERTIFY THAT:
• If the application is granted,the applicant V-Yll exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• AU of the aboVe statements and the statements in the plot plan,attarars,and exhibits transmitted herewith,are sue;and
the applicants so acknovdcdge that any permit issued,based on this application,may be revoked if it is found that any such
statements are false_
• The apphcant has read the entire contents of the application,including the policies and criteria,and understands the
requirements For apprcn-ing or denying the application.
SIGNATURES of CAC-h owner of the subject property required.
Applicant Auorized Agent's signature pent n acme �Q s
Date
tun Print name o Date
�t�v�v� . vv\v�i�cc�ttrv.I\ - f 0
Owner's s turc Print name
_Y�
Date
Owner's signature Print name
Date
PUBLIC FACILITY IMPROVEMENT"PERMIT
City of Tigard • 13125 SW Hall Blvd. • 'I-1gard,Oregon 97)?3 ave:tigud oLKov 503-71132421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part k Required submittal fee$300.00
Part 2: All non-water system improvements
Engineer's estimate X 5%(less$300.00 submitral fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 121/6
Total Permit Fee = Part 2+Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test we»s
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.6gard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKET .H:
SW
I
I Ed a of Pavement
I -'Q-- Ditch �►
Streetlight _-_-_--_-_
I t : Fb Tree .
I 0 1
MF e j
rrufffr
I ✓ I a, I Existlnw 4
Existing
Driveway
01
10i
I
1
Powerpole I I Ilk
L �� �• •
I 95' 1
I ---—-lrroper -u—ne------b----
r1ll
r Y I Fire Hydrant(FFfi
I I
! I ! Scale:
I I I
� I I
� I I
� I I
MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow \ ,Property lines&dimension Slope of property
Street&street name(s) Existing building,structures
_ Utility&street light poles
Proposed work Existing curb or edge V Trees
Existing S/W or of pavement Existing utdifty locations
D/W apron (sewer, tet, orm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 - wwwiigard-oLgov • 503-715-2421 • Pdge 4 of 4
-7NtROVGN STRE6r
w'TW Cuts LINE SfOEwALK
Cn reeh�icJlc�
V i L1 a�,Q,
S wJ 1'3rjN` Ave— .
C., .
soar PtaNTER 1 ►�v
wAI-k
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' Lane Closure with Flagging
4.320 Lane Closure with Fla"ing Diagratt) 320 00
I
DOgram No. 320 covers total Closure of one lane o(a 2-lane,2•wey i
roadway The right-hand drawing Illustrates the use of two ftgpem,one for
each approach. The left-hand drawing illustrates the use of a single fla9 . .`
to control bofh lanes of trafftc on bw vokxrte(less than 400 average daffy 8>T,
traffic)roads with good sight distances as discussed below. we I
<AW
1. Use truck-mounted high-intensity rotating, fleshing, oscillating,or strobe a _
warning lights with 360' visibility,on all work vehicles. For added _
visibility,truck mounted arrow panels or PCMS in the caution mode may .,.:enwto -^ r c
be used. TO B 11 •, iso M too
2. Ftaggers at each approach are required if any of the following conditions � - • A
exist: L
a Night Operations or I
t�. Wodc space over 2W feet it length or. we r
Sight distawe is less than 750 legit from each approacn through the / s� •••
\ • Peofection VeNcie
lane Closure or. ' \ • w/TMA
d Traffic volumes are greater than 400 ADT.
A ,1
3 The length betmien the fiegger signs shall not exceed one mile.
4. Cones should tm used to outline the work space when curves or other
roadway alignments prevent clear d€recbon for the motonsts to pass the ,
work zoite safef .f. Cones along side the work space ?ire recommended •
when posted speeds are 45 or greater,omen wortcing tinder heavv traffic �, �I I •.
Dr when travel Inner, are narrovier than 11 feet.
5 ExtendM yueur ^.tr>rtir (az� shown oft Dixjrain No DUI)shoulc be used I A i I•
when traffic quieues extend beyond the€n,ttai advance wamtrtg sion. I• 1 � 1 -
G `Nhen(tagging near an intersection, the Flagger symbol sign should be •• i I f �,ATIr ME
vtsible to traffic entering from any side road. Additional advance warning ,\ ! ,-� "UM
and Flogger symbol signs may be placed on the sloe road(s). f t
A, J B I
7. Sign set-up arM Flagger placement shown in Drawing No. 37.0 may be � �., � I// �--�/
used lex intermittent full road rinsures of 20 minutes of less. \ e r/ I B MAD
8. The ONE LANE ROAD AHEAD skjn is optional and should be f ,j. 1 �r I toP�^�1 �"•A°
rr.)nsidered on high volume or high speed roads, or when extended III C
:queues may he expected. Low Volume
Single Flagger OpWr. "Oft(
00 we..�
00 Diagram No. 320 Two Flagger Operation
1 62 63