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PFI2015-00152 � e CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00152 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/02/2015 Parcel: SEG1370 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 13245 SW Village Glenn Dr. Bore one 3/4"conduit for Comcast Cable from ped at 13260 under Village Glenn Dr. at min depth of 30"to power meter on 13245. Owner: FEES Description Date Amount PFI Permit Fee 10/30/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 11308 SW 68TH PKWY TIGARD, OR 97223 PHONE: 888-824-8264 Tota 1 $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 Signature: — Not Present Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00152 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 Traff!c Safety Services Association[ATSSAI, and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Utilities 06-1 RAFFIC 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 503-962-8540(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 seriice and mai!service. Obtain City approval of an.v aCCZ�SS closures. PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in day!ight 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 Kenny Fisher at 503-816-6146 or email at 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. 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® OCT 2 2 2015 Cary Of "Tigard CITY OF TIGARD PUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING C ' Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK (in the right-of-way) REQ EIRED SXJ TTAL 'TS Check oneUtilities Sidewalk/driveway approach ❑ Street iutpru—its (� e- 3/�1 r.%f Q__ "�'a� Minor work in right-of-way Detailed description: Qt'l _ �"+ (sidewsA repair,curb cut,street _ _ te*ln opening,etc.)requires: • application form,completed and signed •Sutnnir one(1)cup),of scaled sketch o'L S S� V, C7 l e'ny) of the proposed wont to be done Property address/location(*): ,Submit one(1)cop}•of traffic control plan OR- L�� ❑ Substantial project work requires Applicant's name: q��Ca.St =-��' aboNv icons,and professional Address: 1 1 3 D V.} U$tom engineered wide ung lans for: City/state: Ti �'� ©� — Zip: ��a'a'� -Subdivision infrastructure ���C�0.1�Cable C�+^aLn�1 .Co ►L t •Main utility kine extersion: Phone: ggg ' 9-�-Sa I��Et�tail: - Storm Drain,Sanitary—'Tigard Water—Tigard Water Service Contractors name: 1.tl�P�C�a��1 1 C - krtm(includes Durtmat,King City and a portion of uniacorpoivtcd CCB#: I Expiration: �l 1 Washington County) Address: 1°1100 b(o'a DELIVER APPUca•rtox ro: City/state: 1 ta_t�a 'n C)R Zip: City of Tigard G�5c),3 - tErnail: PwEngaaeeriug Phone: 13125 SW Han Blvd_ Tigzscd,OR 97223 Engine",$ name: Appficatiuns for"ulnar rsvrk in 4hr-of-w2y Address: kmily may be eamiled nx City/state: Zip: Phone: E all: �o`. Estimated value of work (within the public right-of-way's: $ -` 1i1 sI Yes ❑ Nu ',. ,. �� t, '' � Is work related to a LAND-USE DECISION? O a ` ' ' If so please specify (ML-11 SDR, SUB,etc) case #: is work related to a BUILDING PERvII? ❑ Yes ❑ No ;pat.:t' If so,please specify(BUI.L.DING PERIVU-1)case#: X. .fir•, ',- :I:,: .`,�: City of Tigard 13125 SW Ball Blvd. Tigard,Oregon 97223 j,ww.tigard--or.go`' 503-71ti-2421 Page 1 of 4 APPLICANTS NOPE: Pasou specified as"Applicant"shall be designated"Permittee"and shall ptovjde financial assurance for WO& •Whm aha wane and the npp3oaaot an d0cmat pcuplt,the eppbemt must be the putehamcr of record at a 6raaxe is ponessioa asth a.itt� Esaoa the owner or nn Wat of the owaei. The owns(s)must zVa thio apphcaaw in the space provi&d or submit a artittpf with this apphmtion. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • Zheabove recawar does not violate anX deed rescrictionc that cam br 2rrnchM in ,r j..,nnjW up sa>►,::.-r a..w.., T` 4 �- a)� • If the apphmtion is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the appro-w-al. • All of the above statemecits and the statemwts in the phot plan,attachments,and exhibits uanmaitted herewith,air true;and the applicants so acknowledge that any permit issued,based,on-this,application,;may be remked if it is found that any such statements are false. p, • The applicant has read the entire contexts of die appltcatsog ancludwg the policies and c*+�and unders- the requirements for approving or denying the application. SIGNATURES of cgwh owner of the euJbject Property requited, Be b /to z< < s Appiirax, Au o�.ed Agent's Signature+ Print name Date tore Print name Date ms's Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PER1f4IT Gey of Tigard - 13125 SW HaD Blvd. • Tigard,Oregon 97223 • - w..ng"-or_gov 303-'71&2421 Page 2 of DEVELOPMENT ENGINEERING FEES L Public Facility Improvement(PFI)Permit: Part k Required submittal fee$300.00 Part 2• All ton-water system improvements Engmoees estimate X 5%(less$300.00 submirtal fee) Engineer's esti;matc X 2%Plan Review Part 3: All public water system improvements Engiocces estimate X 12% Total Permit Fe:e=Part 2+ Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace nu box • Ditch cleaning that does not involve regrading. • Weepbole repair • Curb repair or replacement(less than 20 lineal feet) • Lown sprinkler system installation or repair • Street tree pruning or Planting • Planter strip landscape maintenance • 'rest wells PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwauigani-or.gov 503-718-2421 Page 3 of 4 SAM LE SKETCH: Edge of Pavement I ,s— Ditch —�► ht I —•—•—•--•---•—•—�--- a Rasa Drain G-w I � i Tie i T O t ' b T: I Existing iQ; "Q+ z� Driveway . ail I V, I L I i Prnaierpole / I .'L I m •:4- '�cf�.:��i' 1 O I I CL 95' � I Fire Hydrant(FH) ( I I I Scale: 1"=30' I I I � I / I I I MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable): V North arrow V"'Property lines &dimension Slope of property Street&street name(s) ✓ Existing budding, structures Utility& street light poles Proposed work ✓ Existing curb or edge Trees ✓ Existing S/W or of pavement Existing utility locations D/W apron (sewer,water, storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www6gard-ot.gov - 503-718-2421 - Page 4 of 4 r STREETS I I < w`r�t P�zo�E�rY Lime St C�EwA Lac s F 13��-IS 3 t. �,y S� V;1L Gil2nn fir. it D/\ PLANr - - o -- v)as44T �c 5$r 32• 58 �IGHI"')WAY roe. PLAmTErk STRIP rsf - - d �+r D/AV` oma► 13ac�o 3x40 I 4.320 Lane Closure with Flagging Diagrarrj 320 Lane Closure with Flagging Diagram No. 320 covers total Closure of one lane of a 2-lane,2-way roadway. The right-hand drawing Illustrates the use of two flaggers,one for each approach. The left-hand drawing Illustrates the use of a single flagger "IM( to control both lanes of traffic on low volume(less then 400 average dairy traffic)roads with good sight distances as discussed below. _ C 1. Use truck-mounted high-intensity rotating,flashing, oscillating,or strobe A�Ks o warning lights with 360'visibility on all work vehicles. For added (optilm" B visibility, truck mounted arrow panels or PCMS in the caution mode(nay � d. be fused. rw�AMO -.- 'TO � t �., TO MP B A y a 2. Flaggers at each approach are required if any of the following --ondit on °' too 100 100 leaf exist A 4 "t0 350 sso 00 1-14 Sao 500 Sao Yd! a. blight Operations or b. Work space!s over 200 feet in length or, • r.. Sight distance is less than 750 feet from each approach through the cane Closure or, ° �' I °• d. Traffic volumes are greater than 400 ADT. • Fratection Vehicle W/ ° 3. The length between the flogger signs shall not exceed one mile. A (B th C"onc^.n 4. Cones should be used to outline the work space when curves or other 00, ' work zone safely. Cones along side the work space are recommended roadway alignments prevent Gear direction for the motorists to pass the I ° Butte` I ft when posted speeds are 45 or greater, when working under heave traffic or when travel tares are narrower than 11 feet. 5 Extended queue signing(as shown on Diagrain No. 001)should be used I ! when traffic�ue l ' r' t ues extend beyond the initial advan,.;e warning sign. o. When flagging near an intersection, the Flagger symbol sign should ba y visible to traffic entering from any side road.Additional advance warningGoo BE and Flagger symbol signs may be placed on the side road(s). f a, I �N�n '�'—fir ` 'M sroP ' 7. Sign set-up and flogger placement shorn in Drawing No.320 may be �� ^� / e If mad rInsures or 20 minutes or less. used far intermittent full . AD The ONE LANE ROAD AHEAD sign is optional and should be considered on high volume or high speed roads, or when extended _! -- I--- � (O(Optional) �D wr queues may be expected. C Low Volume � Single Flagger Option ROAD ANa n Diagram No. 320 Two Flagger Operation 62 63