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PFI2016-00009 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT >z COMMUNITY DEVELOPMENT Permit#: PF12016-00009 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/22/2016 Parcel: SEG 885 Jurisdiction: Tigard Site address: 12110 SW 124TH AVE Subdivision: BROOKWAY Lot: 51 Project: Comcast PFI SEG 885 Project Description: Bore one 3/4 conduit fro Comcast cables from PED at 12115 under SW 124th ave. to power meter on 12110. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: RANDY SHIELDS 11308 SW 68TH 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 Signature: Not Present Issued By: --ti- �1 Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00009 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 pavement cuts. RECEIVED City of Tigard JAN 212016 Y OF TIGARD PUBLIC WORKS— ENGINEERING CITY Facility Improvement Public F ty (PFI) Pe& t' TYPE OF WORK ,g$CgIPTION OF WORK(in the right-of-wiry) TYPE I-Franchise Utility Work heck one: gutibry Connection Work performed by N47N.PGE Sidewalk/driveway approach and/or utility agency. ❑ street improverneMs 2 }, I Goly►(�4 5� ❑ TYPE 2-Sidewalk/Dm'e"Y/Sew'er Detailed description: lk� '9,0J/4 s�`H A+ork performed for the pugx)se of 1x115 l�dam' SW • Sidewalk installation or repair. privrway approach installation and/or repair a`� Sanitary sewer lateral instanation Property address/locatiun(s): and/or main fine tap ❑ TYPE 3-Fun soak Development Vi'ork performed with IAM use Applicant: M approval which indudes any of 3rl the Address: Zip: Subdhisions or Pw icons City/state: 1 r ' ' Q 5��.S�Cabl�z�Car�a„1`1.0 • street widening Phone: y� - �4-� Email:-� Mainline installation for Sanitary Contact name: _ `��1(j y. 1M`e�l Ls S _ Phone: ►y/ scw�er,Storm Seaver,Tigard water and/or Tigard Waoer Service Arca Contractor: �ca �A - Address: suuwr ooMrisreu wrrucnrcoN raCCB#: 40 0$ Expiration: Cary of Tigard 5 'y' , Citi/state: Tit r �R — Lip: (lG ccl^� I3us SW Ha11 Blvd. X03-�12 41lEmail: •F (VIA �o JC c,eSC� Tigard,OR Phone: 'l U 1 � d'C- l� `� A, licadoru for"minor cork in right-of-wsy Contact name: 4s2NUi Ck__ Phone: l P o�roar be emailed m: Engineer. Address: City/st�ttc: 7aC': ._------ Case No.: Phone: Email: ppplK•ation submitral fee: _--- Contact name: Additional Ecce: BApplics6on Estimated value of work is required(if over$5,000):$ Date: (within the public right-of-way) Appy �Gt Is work related to a LAND-USE DECISION? D yes No By: Datr. Z fy' (MLP,SDR,SUB,etc-) case #: MI if so,please speciay: Data is work related to a BUILDING pERNH-P ❑ "'es N- If sea,please slxufy(BUILDING PERMM ease#: -- Oan 97223 ww tivn8a� t'r gO1' 503-715-2421 Pae[ 1 of 4 Cityof•piggy • 13125 SW Han Bh•d. • T�?t� re g 1 AppI1CANTS NOM P�Tmd'ed as"APP"cane,shall be designated`Tt��••sad shall provide bnancial assurance for work int taunt be the of:word of a kw-is powconi—uh-liaw •Wbstt tbt o�na and for at=dist P� as aabmu a a n from the awna o:aa�cnt of the own=- 71u awma(6)tun°tR°tom'°PP�tioa is the aPQO'prwtdod wish this qomdo- ly SIGNING BM.Ow.THE Appu AN'T(3)SHALL CERTIFY THAT: e cant will exercise the tights gmntcd in accordance with the terms and aubicct to all the If die Vocation is granted.the applicant ooaditioas and limitations of the approval. acta�o�ts,and exhibits�'�""""'" �"he:evutth,am true;and • All of the above statements and the smtcmcnts in the plot plan. n,may be revoked if it is found that any such the applicants$o ark OVACdge that any permit isaaod,bbaud �application, at" cats are false. • i,he a hesat hae read the entire conwats of the appi>mMn—including the poam=and cumu, and understandS the f,,.app.,i g or deayusg the applicanoti. gIGNATt38B8 ofh �of the eubiect pzop" K4 Agent's sigpature Print name yt h Date Print name JL Print name Dam Ownee s sism"m Print name PUBLIC PACLLITY DVROVEMIUNT PBRNLYr 503-718-2421 Page 2 of 4 City of Mgwd 13125 SW HUD Blvd. • 'Ttgatd.moo"97223 wavaao�aCd-ot-�v )EyELOPMENT ENGINEERING FEES 'ublic Facility Improvement(PFI)Permit. 10 APPLICATION FEESIDEWALK/ Part 1: Required submittal fee$300.00 FRANCHISE UTILM AND DRIVEWAY AND UITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (onxk in the right of wap) Engineer's estimate X 50/.(fess$300.00 submittal lice) Sketcb Engineer's estimate X 2%Plan Review (including information bcluw) WATER SYSTEM FEE ❑ Dimensions ❑ Street Name Part 3: All public water system Improvements ❑ Site Address Engineer's estimate 1 12% PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required (subdivisions/Partitions and Street improvements) fur the following types of work: • Sidewalk repair (less than 20 lineal feet) Plans • Relocate or replace mailbox (6 sets,24x36 or 22x34) • Ditch cleaning that does not involve regradi% ❑ Cover—Site,vicinity,Abbreviation,L,egeri • Weephole repair ❑ General Notes(City,Water,Sew"'ctc.) • Curb repair or replacement (less than 20 lineal fectj ❑ Screet(Plan,profile) • lawn sprinkler system installation or repair ❑ Water,Storm and Sanitary(Plan Profik) • Street tree pruning or planting ❑ Water Quality Facilities • Plan=scrip landscape maintenance ❑ Grading • Test wells ❑ Landscaping/Tree Plan ❑ Composite Utilics Pian(Ekccrical,Photic Gas, Storm,sanitary,Wattx,Signage,Street Lights,etc) Note A crib assxrance may be req rared per ❑ Details TMC 15.04.140.(awomer deposit) ❑ Traffic Sight Distance ❑ sung and Striping ❑ Street Light Plan and Photometric ❑ Enginecss sea/signature ❑ Sheet label(proiect land use mune,revision and plan log block,dates and sheet numbem) AddidOn d Subm'aah (per LAA Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechaia+l Report ❑ preliminary Accts Report(Sight Distance) ❑ proposed Plat ❑ Pathway Design('f aPpt'cible) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT �� www=.ti ard-ur.gov 503-718-2421 Page 3 of 4 City of Tigard 13125 SW Hail Blvd. • Tigard,Oregon 97223 g cwuor F Rlt�"I'Gkl�: ESge of P nrement DdcbL Streetlight 1 m� 4 1 t r .- ExWnto Y 3� 1 ;do-.K•�+.�Jci,�a.".,..: �. ir G 0. Cra • , Powerpole 95, 1 4 ( 1 Fire "Yd rAM CFM I ( 1 Scale: 1-=30• d 1 I � 1 1 1 1 1 t t I • 1 NTS (Put"N/A"if Not Applicable): MINIMUM SKETCH QUIREME � of propertylope Property lines&dimension SJ &street light poles � ENorth arrow u�ry xisting building, structures _— street& street name(s) Trees J Existing curb or edge �s�utility prions Proposed work Of pavement (sewer,water, storm) Existing S/W or U/W apron IMPRO�ENT PEST PUBLIC FACILITY 503-71&2421 Page 4 of 4 City of T • 13125 SV(% HA Blvd. • r,,Wd.Orcgon 9723 • -u�,•agwd-or.gov 4.320 Lane Closure velm Flagging Diagranj 320 Lane Closure with Flagging Diagram No.320 covers total closure of one lane of a 24ane.2-wayI'Cft g g aY. The right-hand drawing ilkrstrates the use of two I each> i fla99srs.one for drawing RlustreW the use of a single flogger to cxtrtt'ol botft lanes of traffic on low volume(less than 400average daily traffic)roads with good sight distances as dls=Msed below. ' 1. Use Uuck-mounted hlgh-;ntensity rotating, flashing,o8dUating,or,strobe � C nrJ� warning fights with 360,visibility on all work vehkc es. For added (optim" a visibility,truck mounted arrow panels or PCMS in the caution mode may 1PWW e used. °s 0 A D � 7o STS B O 2. Flaggers at each approach are required it any of the following rcnCitions m 1O0 +) tib exist: __ 3 40' � = So Ian a. Night Operations or ,fie; �-'s�� S0D Sm � ax b. work space,s over 200 feet in length or, • c. Sight distance is less than 750 feet from each a lane closure or, pproach through the / e d. Traffic volumes are greater than 400 ADT. � f � ' � Plotecttor,verdcna 3. ,P�The length between itis fl8gger signs shall not exceed One mile. mom OM&WO 1A 4. Cones should be used to outline the Mrk space when curves or other ! � .� roadway afignmenis pr®vent dear direction for the motorists to f Suft8r work zone safety. Cones along side the work pass the Space are }�• � I when Posted Speeds are 45 or recommended � 1 R �� • Of when travel lanes are narror er ,than t�eeL orkmg under heavy traffic f 5 e=xtendedueue signing •� 4 tg ng(as shaven on Diagram No. 001)should be used when traffic yueues extend beyond Ili--initial advance warning Sign I ' b. When flagging near an intersection, the Fla / • 9ger symbol sign should be ` -r visible to traffic entenng from any safe road.Additional advance warning 1•t � t R ' and Ftagger symbol signs may be placed on the sidra roe van A i li BE ' 7. Sign eot-up and ftegger Placement shown in DrawbV No. 320 may be ` AT ti used for intermittent full road closures of 20 minutes or less. 8 8, The ONE l.AP1E ROAD AHEAD sign is optional and should be we considered on high volume or high speed roads, or when extended \ � :lueues may be expeced. - L_. (Opsonaq 1001 Low Volume o 00 Single Flogger Option � ROAc > Diagram No. 320 Two F �99er gyration 62 63 -74PtOV&M STREETS WITH PkoffRTY Lima SI DEWA LX S I � F 1 ' Ito► WALK Ilin fOC . I r � f 5�} R►ter -WAY w sew srw Rhv K VIA -v + P + 1•� ItO +