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PFI2016-00002 n CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT C COMMUNITY DEVELOPMENT Permit#: PFI2016-00002 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/04/2016 Parcel: SEG2346 Jurisdiction: Tigard Site address: - - Subdivision: Lot: Project: Comcast Project Description: Adjacent to 7700 SW Bond St. Bore one 3/4"conduit from ped then E through ROW and under Bond St. at min.depth of 30"to power meter on 7700. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 11308 SW 68TH PKWY TIGARD, OR 97223 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 Not Present Signature: Issued By: —�- Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00002 Type: 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 No street cut. RECEIVED City of Tigard DEC 31 2015 PUBLIC WORKS— ENGINEERING CITY OF TIGARD s P NNING/ENGINEERING Improvement Public FacilityIrovement (PFI)Permit DESCRIPTION OF WORK (in the right-of-way) TYPE OF WORK Check one: Utilic%,Connection �TYPE 1-Franchise Utility Work ❑ Sidev.-alk/drivm-Ay approach V _Work performed by NWN,PGE ❑ Street improvements �, ` and/or utitin•agency. Detailed description: nrve 3J4 C � -�'� �"� ❑ TYPE 2-Sidcwalk/Driveway/Sewer RbW y ceder -8_�hd S�• Work performed for the purpose of: ak r't") . 1 k-vx «��f r MQ� 'b n ��. • Sidewalk installation or repair. • Driveway approach installation . �� . and/or repair Propern, address/location(s)• dx 0. b + • Sanitary sewer lateral installation G' and/or main line tap ❑ TYPE 3-Full scale Development Work performed with Land use Applicant: 1ylC � Workapproval which includes any of Address: 11the following: City/state: 7',,t 14-y EZ Zip: Cl • Subdivisions or Partitions Phone: 2y�g2-L 1:mail: RQ u��'C�b�� $} • Street widening Contact name: S'tt`L� Phone: NI-A Mainline installation for Sanitary sewer,Storm sewer,"Tigard water and/or Tigard Water Sen-ice Arra Contractor: inLLC-.• } J CCB#: HOI•• o� Expiration: 1� � / �� SUBMIT COMPLETED APPLICATION TO: Address: 1100 S,6 51 5tA'—V'e-- City of Tigard 1n a�� Q l Planning/Engineering Cit}/state: P 13125 SW Hall Blvd. Phone: 563 I7 Jq I-:mail:Et.'rMtitS�gi�L%yw-.SC'LP-e- rvt Tigard,OR 97223 Contact name: 44& L' CSC I,t-+ -- Phone: ° T/` SL`{- I`(7(0 I)plications for°minor work in right-IIt-%%M only may tx emailed to: rOy,'�Cf fnii LsCQ�yard-or.g= F nginccr: Address: City/state: Alp Case No: Phone: Email: Contact name: Application submittal fee: C2 - Additional fees: Estimated value of work is required(if over$5,000):S Application accepted: within the public right-of-way} By: L-S Dare: ( Applicad r ed: Is work related to a LAND-USE DECISION? [I yes No By: mr Date: if so, please specify (MLP,SDR,SUB, etc.) case #: Applicant�ori� Datc: 1fied: l ��Q Is work related to a BU II.DING PER\117'? C3 Yes \u By: --- �r"— 1:\NRRINV.lauenWnd UU Appl"rions Rev 07/09/I015 If so,pIcase specify(BUILDING PERMIT)case#: Cityof Tigard • 13125 SVG'Hall Blvd. • Tigard,Oregon 97223 w•ww•.tigard-or.gov • 503-718-2421 • Page 1 of 4 /10 14 Wo s G�/ y_ APPLICANTS q�f � < f t )) NOTE:�Person specifiedas-"Applicant shall be designated `Permittee and shall provide financial assurance for work *When the owner and the applicant arc diffecwt peuplc,the applicant must be die purchaser of record or a lessee in possession with written authorization f v=the owner or an agent of the owner. 71e owner(s)must sign this application in the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above r Q=r does not violate any deed restrictions that may be atm h rl to or'pQsed upon t_ h�iect pmpa4 • If the application is granted,the applicant will exercise the tights granted in accordance with the terms 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,may be revoked if it is 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 swh owner of the subject property required. pplican orized Agent's signature Print name Date D40 V) VV%rv\ MI'L,m'N", Owntore Print name ` Date • , o fP4`l 13 d��cam, � � /S signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROWMENT PERMrr City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-orgov 503-718-2421 0 Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI) Permit: SUBMITTAL RlZQU1RE.N11-N-.l'S APPLICATION FEE Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ DRIVEWAY AND UTILITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketcb (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: AU public water system improvements ❑ Street Name Engineer's estimate 1 12% ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required (Subdivisions/Partitions and Street improvements) for the following types of work: • Sidewalk repair(less than 20 lineal feet) Design Plans • Relocate or replace mailbox (6 sets,24x36 or 22x34) • Ditch cleaning that does not involve regrading. ❑ Cover—Site,Vicinity,Abbreviation,Legend • Weephole repair • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Note: A cash assurance maybe required per Storm,Sanitary,Water,Signage,Street Lights,etc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Georechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval I i I PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • w%muigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement I •6— Ditch Streetlight 1 —'—......'.'�•'�'r—•— I ! a Rat%nom. 'Sn.\tet rr 1 rt yd�s3;•:S�ifit'er f.tf� '''t. 1;�.y • � iF''S7fij�f__`�.9fC4�t,{;,k,;;.'�a�:�i(C`.�,I:'?$t • Exiding -ji 0t i � I �" I -�.: !.'Y..•....�Y,r'. - 2'.:1••1:S�,`:-;�; • Iwo Powerpole i 1 0 o 95' 1 I -------lfrcpe—[iy'Lane-------a----- I Fire Hydrant(FH) � 1 1 I I ' I Scale: 1'=30' I 1 1 � 1 I ' 1 I � I 1 I / MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable): V North arrow ` / Property lines&dimension v// Slope of property Street&street name(s) -7 Existing building,structures ✓ Utility&street light poles Proposed work ✓ Existing curb or edge Trees Existing S/W or of pavement Existing utility locations (sewer,water,storm) D/W apron PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 • wwu:tigard-or.gov - 503-718-2421 • Page 4 of 4 r -Tso-ov&m STREETS r WITH Pkor6ATY Lime Sr p6wq tK S ' r wuK _ x z PIAN M l3' s •r foc SQ„pct i0. 3'+,• (o RtC.Rr WAIT, i srit,� h' sewJ—Z W4r ►r�KK __ _..__ CA r t'o ts�CY i I c r I � r r r 4.3'20 Lane Citasure with Flagging Diagratlj 320 Lane Closure with Flagging Diagram No.320 covers total dosure of one lane of a 2.lane,2•vay roefteBy The right-hand drawing lltu�3ea the um of faro flagg:?rs,ora for ' f M - The tart-hand dmwirg fltustrstes the use of a single flapgerRM to control both i 01 traffic on lava voAuvso(teas then 400 average dally traffic)roads with good sight distances as(UMMAsed below. -mounted high-intensity rotetittg,flashing,osciffagng,or strobe ra Use truck f warning fights with 360'vtsib7ily on all v✓ork vehicles. For added i Wsibittty,t�mounted arrow panels or PCMS in the caution mode may �� e be umd. � 1 1 2. Flaggers at each n MUM 8 A 6 ° PProa<:h are required if any of the following conditions +M roe reo exist: j n f f-46' ZO Wo ase eso a. Night Operations or A .L u + L"?-$a h• YvorR space,s over 200 feet in length or. g— • c. Sight distance is less than 750 feet horn each b lane closure or, aPProacn through the t / is T\ t •• d. Traffic volumes are greater than 400 ADT. / ( I • Patect►on vetame f o® Vd TMA 3. The length between the flaggvr signs shall not exceed one mile. / lA 4- COfM should be used to outline the work space when curves or other j ~ roadway alignments prevent dear direction for the motorists to pass the � i • � • [�lrfter *Ork zor*safely. Cones along side the work space are recommended • when Poster)speeds are 45 or greater. when working under heavytrafnc • or when travel lanes are narrower than 11 Feet. ; g i I • F). Extended queue signing(as shown o,Diagram No. Ot71)should De used Tt h�I1f • > +vhen traffic� tueues extend beyond the initial advance a✓aming sign. 40 S When flagging near an intersection,the Fla er s 4 /f / g9 symbol sign should in 1 ' visible�iraf5c entering from any side road,Additionsl advance warning � � A� and Flagger symbol signs may be placed on the side road(s). � EX � r �A 7• n relPlacement \ TO stop c�t �rtittBnl full road r�ass of a0 m rtes or le s20 maybe t ^ / a 8- The ONE LANE ROAD AHEAD sign is optional and should be \ f \y s � �e uvea considored on high volume or high speed roads, or when extendedAW-An�" queues may be expected. ` L__ Y� .�. tope Low Volume c Single Fla9ger Option i VL; Diagram NO. 320 Two Flogger Operation 62 ,