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PFI2015-00186 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT a COMMUNITY DEVELOPMENT Permit#: PFI2015-00186 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/16/2015 Parcel: SEG469 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: Adjacent to 10855 SW 83rd Place. Boring 82'from 10855 SW 83rd Place to 10825 SW 83rd Place. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: WARREN SWENSON 1910 SE 8TH AVE CAMAS,WA 98607 PHONE: 503-856-2393 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: Not Present Issued By: ---�- -C Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00186 Type: Condition Name: Status: Severity: 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 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. RECEIVED DEC 14 2015 City of Tigard CITY OF TIGARD MTNPUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPT N OF WORK(in the right-of-way) TYPE OF WORK Check one. Utility Connection TYPE 1_Franchise Utility Work ❑ Sidewalk/driveway approach Work performed by NWN,PGI: ❑ Street improvements and/or utility agency. Detailed description: i"J!� 4-0 (--"tv\ ❑ TYPE 2-Sidewalk/Driveway/Sewer sw 834 PL To lOSZS Sw03`9 -9L-, Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): tDa57 Syt-/ � "� F'L'. and/or repair • Sanitary sewer lateral installation T % and/or main line tap ❑ TYPE 3-Full scale Development Applicant: GbWI CAST-- Work performed with Land use. Address: 11'-200 �- 0+—K (9A(r1.Y-WAa approval which includes any of the following- City/state: Zip: —[ 1 DZ Subdivisions or Partitions PhonegV-177•MOB Street.widening Contact name: 1\IW C 11 ARpL01- Phone: • Mainline installation for Sanitary sewer,Storm sewer,Tigard water Contractor: `f ( and/or Tigard Dater Service Area CC:B#: -ZQC? e& Ex iration:' ZO p SUBMIT COI+IPLFTED APPLICATION TO: Address: 1 Q 1 D `J � '&"\j6 City of Tigard City/state: r.*VAA A zip:jiky�_ PLrnning/Engineering Phone:' :mail:f�ttSu�GiI-J/J 4A " f1L/T!�`Jt CU,NJ 13125 SW Hall Blvd. Tigard,OR 97223 Contact name:\9a'N2"5ul6il.1. OIJ Phone: Applications for"minor work to right-of-way" only may be emailed to: Engineer: rows„err its(&riQa�rrd-or.vov Address: Pitt;/state: Zip: PF/t,-Z)/ �)l S �/ Phone: Ismail: Case No.: Contact name: Application submittal fee: 0 Additional fees: Estimated value of work is required(if over$5,000):S Applicatio}3 accepted: (within the public right-of-way) By: Date: � Applicari naewed: 1s work related to a L�Nll-L'Sl: DECISION' ❑ Yes: `o ����—f Date: � If so,please specify By:(MIT,SDR,SUB,etc.) case#: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes No By: /—S Date: �/ K If so,please specify(BUII., )ING PERN11-I)case##: I:\CURPLN\Mssten\twnd use Applcations Raw 07/09/2035 City of Tigard 13125 SW Hall Blvd. • "Tigard,Oregon 9?223 • www.tigard-or.gov • 503-718-2421 • Page 1 of4 V 3/' ' wo SI AL1 / G'c APPLICANTS NOTE: Person specified as":applicant"shall he designated"Permittee"and shall provide financial assurance for.work- Wheal rt7r(","ficr and rhe apphatnt aria differcw people,Clic applicant must lac the purchaser of recoal or a le-ce in possv:sion with written awhorizat+on from th(:.neu(:r or an a}sent of the owner, The owl)w")rnu,t�ifrn ehi< application in the,pace.provided or summit a written m,du,nzati�m with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • 'f`l.�air ao e rc(lue�t clow riot violate any deed restrictions that may be attached to or imposed upon the sul2W LPMP-li • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. • All of the nbcwe statements and the.statements in the plot phin, attacluncnts,and exhibits transmitted herewith,are true;and the.applicants so acknowledge that ant-permit issued,based on this application,may be revoked if it is found that any such statement_<are false. • The applicant has read the entire contents of the application,including the policies and criteria;and understands the reLjLuretnents for approving or deriving,the application. SIGNATURE5 o wa h owner of the subject property required. A4�" W Tas-���''S ��t`.mac-f�-t..�C- t Z 1 Ap cant,Aurhoriztd r\gent's signature. Prinr name Daic. Chuncr's signature Print tlaiTlcT_ Daw Ov,=ner's signature Print name Date C)wner's signature Print name, Date rm!yrs.- c...y�;;-;,_nx;-;,;,.,,r;.�aax.d.,v r.-a�a.c�', .�r.�"„"s;x,c„ :�-.--.v��:o..;;,m,�-3•�zc was' z„^. Mme.,.n,.,z�:�o;aw3vti,:; •:�.»�-;�?s,�„ate,: <_... PUBLIC FACILI'T`Y IMPROVEMENT PERM rr City of`rigatd • 1312 S\V 1-1all lih'd. • T1gard,Oregon 9 '33 • ww-a--.igard-or.gov 503-7118-2421 • Page 2 of 4 COMCAST REPAIR CATV MAINLINE 10855 SW 83RD AVE TIGARD, OR. CONTACTS SHEET INDEX IVAN CHANDLER 4 No. DESCRIPTION COMCAST CABLE ""'"`""s'. { 1 COVER CONSTRUCTION DEPT. 4 ; - x 2 STANDARD LEGEND 11308 SW 68th PARKWAY MaM� swows, w- TIGARD, OR. 97223 3 GENERAL NOTES AND CELL 971—777-0908 TYPICAL TRENCH DETAILS !van—chandler@cable.comcast.com �.. � �Mu 4 PLAN JOB�SITE WARREN SWENSON "'dc SN Sryuce St SM Sw.ae S: SN'lynce 5l NX UTILITIES FIELD SUPERVISOR 1910 SE 8th AVE CAMAS WA. 98607 Ph: 503-856-2393 WSWENSON®nxutilities.com m VICINITY MAP TWN 1s DIAL 811 WO.: 47231 SEC 36 1S 1947 CLAXTER RD NE RNG IW ND UTILITIESSALEM,OR CALL LOCATE SHT 1 PH: 971.600.0601 FAX:971.275.1852 DRWN DET BEFORE YOU DIG OF 4 nxutllitles.com SCALE:NONE DATE 12110/15 TYPICAL LINE TYPES SYMBOL LEGEND cvernac ---— n Y R My u n uon A v r/aWss yr nJP axE Pae-E%TB O O WRB/amEn aral moi mw Rwu aWre xe£r Ipwr use Pae-oasrrEG rl IE1F]'IM)NE REPUIFA-EPSOMG FACE % a • • • uTCH BASw-RECEwIae � r¢ePIpNE PEDESTAL-EJOS'tING LMVFI.EDGE a(iwL fJ'ERL% awrawL urc>t B1sIn-RWNo rEimxaXE urW Pm-E%RRNG PAVEx1Exr EDGE ev sroxx oww LEwHOIc C7�(�' PRDPFRfr L•IE merraxIm E sv Ewsnne Rw�D WEER area ® aEP D E GB•Er-EX 5 R G R1plf s evr — 90EW1( sFBEn EUIx1aLc O rtle»are-Hwlo Hac-nm r+c SrREAe/51%XaEIIIE . 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LOOP/CQ C/>0 C> R4Ef1C 5%iN11 WNIR0.CMCT ®�1-! BJP EIOrrOY OUISFIE N9010n SUx 116111 OR POWER COYFWlI MM1FNrmY XUYBEA wlElAl SPUf2 Imo► F105 BOr10Y WiSIDE SiRFET SIVE SWA 90EWwn ANOH(R Alq GIY lrtxirrC SI4TYL rol£ O CFI!lOBpl O PIP PW w1Y rPAEr1O SMYML LOOP J-BOT m If fA141AUC1g11 PL PALE ipel rU1WWl 1EOrE Ful iPIiS1O SIOBL 11110 1101E E% F)aSDNO 1WMS rrM115POw1FA (!) nulan s 1rElls rw[a SHAPE REWEST EOR POWrp colwANr ro aewl uP VbEO sELoznwr Porn ueltz Ano/oR Try s a Blm Al uBlEs s0 PROwSED UBIe Gw 0.E AnAo1m rerllour vxxArxEc TEE w'RERe TWN SEC. 36 COMCAST DIAL w.o.: 47231 1947 CLAXTER RD NE RNG 1W 811 UTILITIESPH A LEM,OR01 REPAIR CATV MAINLINE CALL LOC SHT 2 ND FAX:971.275.186210855 SW 83RD AVE BEFORE YOU SCALE NONE DRN. DET TIGARD, OR. nxutilitiea.com DATE- 12/10/2015 DIG �F 4 REPLACE WITH . MIN. I.12 GENERAL NOTES: a NATIVE TOPSOIL. RESTORE TO EXISTING 6" MIN. DEPTH OF 1" 1. CALL UTILITY LOCATE AT 811 72 HOURS PRIOR To TRENCHING OR DIGGING. CONDITIONS OR BETTER. DIA. CRUSHED ROCK 2. THE EXISTENCE AND LOCATION OF ANY UNDERGROUND UTILITY PIPES OR STRUCTURES SHOWN ON THESE PUNS WERE OBTAINED BY FIELD INSPECTION AND A SEARCH OF THE AVAILABLE CITY OR COUNTY RECORDS.SINCE THE ACTUAL LOCATION AND NATURE OF THE UNDERGROUND FACILITIES WAY BE SOMEWHAT DIFFERENT FROM T14AT SHOWN,THE (V MAINTAIN 95% CONTRACTOR IS REWIRED TO VERIFY PRIOR TO EXCAVATION. MAINTAIN 95% ':'>",-:a COMPACTION OR COMPACTION OR 3. THE RIGHT-0F-WAY SHOWN HAS NOT BEEN SURVEYED OR TIED.RIGHT-0F-WAY GREATER & BACKFILL GREATER & BACKFILL LOCATION IS ASSUMED WITH REFERENCE TO ONLINE DATA SOURCE MATERIAL CONTACTOR PER JURISDICTIONAL TO VERIFY ALL RIGHTS-OF-WAY AND/OR EASEMENTS PRIOR TO CONSTRUCTION. PER JURISDICTIONAL STANDARDS AND STANDARDS AND n SPECIFICATIONS M 4. FOR UNDERGROUND ACTIVITY:TEST AND VENTILATE MMIHOLE/UnLITY VAULT PRIOR TO SPECIFICATIONS ENTRY.PUCE WARNING DEVICES AND WORK AREA PROTECTION AS REWIRED,AND USE EYE AND HEAD SAFETY PROTECTION PER FEDERAL,STATE,AND LOCAL REGULATIONS. 5. ALL EXCAVATION.TRENCHING,AND SHORING IS TO ADHERE TO THE CODE OF FEDf]TAL PROPOSED PROPOSED RF .noec(FRT 1926.64n SURF FT P. SDR-11 SDR-11 PROVIDE ALL PITS WITH 1'x1'SLOPE AT ONE END OF EXCAVATION FOR TECHNICIAN INGRESS/EGRESS. C. Bb. BAARRMCAADE ALL OPEN ARE ANTO ONTORENNCCHIINGFOR�Pueuc SA�n.�iULL�awaNaDES. 4" MIN. BEDDING 4" MIN. BEDDING MUST BE EQUIPPED WITH FLASH DIG LIGHTS FOR NIGHT VISIBILITY. 4. FOR PIIS GREATER THAN 4'IN DEPTH.USE APPROPRIATE SHORING FOR WALL STABILITY. TYPICAL TRENCH DETAIL TYPICAL TRENCH DETAIL 8. TRENCH COVER IS TO BE 36'MINIMUM AND FREE OF ROCKS,DEBRIS.AND CLODS. UNIMPROVED AREAS GRAVEL STREETS THE TRENCH IS TO BE A MINIMUM OF 36'COVER IN DEVELOPED AREAS AND A MINIMUM OF 48'OF COVER IN UNDEVELOPED AREAS(ANY VARIANCE FROM THESE STANDARDS WILL DE NTS NTS SPECIFIED ON THE PIANS). 7. ALL ASPHALT/CONCRETE AND LANDSCAPING REMOVED,DISTURBED,DR DAMAGED AS A RESULT OF CONSTRUCTION SHALL BE RESTORED TO ORIGINAL CONDITION OR BETTER IN ACCORDANCE WITH JURISDICTIONAL AGENCY STANDARDS AND SPECIFICATIONS. SAWCUT EACH SIDE OF TRENCH S. NORMAL/GUIDED-BORING METHOD RECOMMENDED WHEN BORING. WIDTH OF TRENCH — SAWCUT WIDTH 9. ADHERE TO AIRTIGHT GUIDELINES UNLESS OTHERWISE NOTED. REPLACE ASPHALT CONCRETE6UU 12° 6" 12" OR LESS 6" MIN. PER JURISDICTIONAL GREATER THAN 12" 12" MIN. 10. BOND BURIED/AERIAL FACIIJf1E5 As REQUIRED BY JURISDICTIONAL ACENCY(s). STANDARDS AND 11. AERIAL FACILITIES ARE TO BE TESTED PRIOR TO BEGINNING WORK PER STATE AND SPECIFICATIONS. 3" MIN. LOCAL REGULATIONS. 12. ALL WORK AREA PROTECTIONS FOR TRAFFIC CONTROL IS TO BE WITH APPROVED WARNING DEVICES AND PLACED PER STATE DEPARTMENT OF TRANSPORTATION AND/OR MAINTAIN 95% PUBLIC WORKS ENGINEERING DEPARTMENT STANDARDS AND SPECIFICATIONS.IF REWIRED,A TRAFFIC CONTROL PLAN SHALL BE SUBMITTED TO THE REQUESTING PERMITTING AGENCY. COMPACTION OR PRIOR TO BEGINNING WORK,PERMITTING AGENCIES MUST BE NOTIFIED 45 HOURS IN GREATER & BACKFILL ADVANCE OF CONSTRUCTION ACTIVITIES. PER JURISDICTIONAL 13. EXISTING PEDESTRIAN CROSSWALKS AND WALKING AREAS SHALL BE MAINTAINED AT AL STANDARDS AND TIMES.AS NECESSARY,TEMPORARY PEDESTRIAN CROSSWALKS AND WALKING AREAS SHALL SPECIFICATIONS ,+7 BE PROVIDED AND MAINTAINED PER STATE DEPARTMENT OF TRANSPORTATION AND/OR PUBLIC WORKS ENGINEERING DEPARTMENT STANDARDS AND SPECIFICATIONS. 14. THE FOLLOWING FOOTAGES ARE ESTIMATES.FCOTAGES TO BE VERIFIED PRIOR TO PROPOSED CONSTRUCTION' SDR-11 4" MIN. BEDDING NO . TYPICAL TRENCH DETAIL CONTRACTOR OR HIS AGENTS SHAT NOT ENTER OR ENCROACH UPON PRIVATE PROPERTY ASPHALT SURFACE WITHOUT NOTIFYING THE PROPERTY OWNER A MINIMUM OF 72-HOURS IN ADVANCE OF ENTRY.NOTICE SHALL BE IN PERSON OR BY DOOR RANGER IF OWNER IS NOT PRESENT AT TIME OF PHYSICAL NSR.DOOR HANGER SHALL NOTIFY PROPERTY OWNER OF THE NTS CONTRACTOR'S NAME,PHONE NUMBER,AND NATURE OF ENCROACHMENT AND WORK TO BE PERFORMED TWN: 1S DIALW.O.: 47231 SEC: 36 1947 CLAXTER RD NE RNG: 1 W COMCAST UTILITIES SALEM,OR REPAIR CATV MAINLINE CALL81 SHT 3 N D PH: 971.900.0991 FAX:971.276.1992 DRN. DET 10855 SW 83RD BEFORE YOU DIG OF 4 nxutllltlee.com SCALE: NONE TIGARD, OR. DATE: 12/10/2015 1 I 10825 4'X4' BORE PFT 10830 — — — — IN GRASS — — — — I \sh 10855 EX CAN PED I 4'X4' BORE PIT BORE (1) 2' PVC IN CRASS EX CAN PED 10885 A, N I I I I 5, / L3O3220 NI Lij I IQ I — I ' M I ' M� 100 NEAREST CROSS STREET SW STEVE ST. FACE OF CURB TWN: 1 S SEC: 36 COMCAST DIAL w.0.: 47231 1947 CLAXTER RD NE RNG: 1W LITIES PH A�EM,OR801 REPAIR CATV MAINLINE CALLLO� SHT4 �����U-r FAX 971.275. 1862 20 ° 40 10855 SW 83RD AVE BEFORE YOU DW DET U nxutllftles.com SCALE:1"=40' DATE: 12/10/2015 TIGARD, OR. DIG OF 4