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PFI2019-00020
111 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT I COMMUNITY DEVELOPMENT Permit#: PF12019-00020 TEG A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/28/2019 Parcel: SEG285 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: CenturyLink Project Description: SEG285, associated with SEG285. Install 142'of conduit via directional bore and trench on SW Oak St. near 10500 SW Greenburg Rd. Owner: FEES Description Date Amount PFI Permit Fee 01/22/2019 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: SCOTT MILLER 8021 SW CAPITOL HILL ROAD, ROOM 110 PORTLAND, OR 97219 PHONE: 503-242-4144 Total $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: See G1ip ['� ., Issued By: AryC"` Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00020 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[0-ITCH]. 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 Mike White @ 503-804-0658 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 RECEIVED JAN 1 6 2019 City of f Tigard CITY OF TIGARD : i , PUBLIC WORKS —ENGINEERING PLANNING/ENGINEERING RD TIGA Public FacilityImprovement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ® TYPE 1-Franchise Utility Work Check one: LI Utilities ❑Sidewalk/driveway approach Cl Streetimprovements performed by NWN, PGE Detailed description: and/or utility agency. Install 142'of conduit via directional bore and trench on SW Oak St near 10500 SW Greenburg Rd ❑ TYPE 2-Sidewalk/Drivev,ay/Sewer Work performed for the purpose of: • Sidewalk installation or repair. 10500 SW Greenburg Rd „Se, _ s • Driveway approach installation Property address/location(s): and/or repair • Sanitary sewer lateral installation and/or main line tap CenturyLink El TYPE 3-Full scale Development Applicant: Work performed with Land use Address: 8021 SW Capitol Hill Rd,Room 110 approval which includes any of Portland,OR zip: 97219 the following: City/state: Phone: Email: Scott.Miller4@centurylink.com • Subdivisions or Partitions Scott Miller 503-242-4144 • Street widening Contact name: Phone: • Mainline installation for Sanitary Contractor: C 2 Utilities LLC sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: 154786 Expiration: Address: 11618 NE Sumner St,Suite a SUBMIT COMPLETED APPLICATION'IO City/state: Portland,OR Zip: 97220 City of Tigard Phone: Email: bheiberg(c-2utllity.com Planning/Engineering 13125 SW Hall Blvd. Contact name: Bruce Heiberg Phone: 503-772-1878 Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: only may be emailed to: rowpermits@tigard-or.gov Address: FoR STAFF USE ONLY City/state: Zip: Phone: Email: Case No fFiLoict-00 02_0 Contact name: _ ipplica«on submittal et (0'0'°of Engineer's F srlma t el Estimated value of work is requited(if over$5,000):$ 5357.76 .additional fu.s $ J 6C. (within the public right-of-way) .kpphcation accepted. Bc S - Date 1- 16-1q Is work related to a LAND-USE DECISION? ❑ Yes ® No Application resit��cd If so,please specify (MLP,SDR, SUB,etc.) case#: By Date _ I 2/0 Is work related to a BUILDING PERMIT? ❑ Yes ® No .kppltcantnorificd I If so,please specify(BUILDING PERMITS case#: B7Date "1-7--1q \ENC\Fer.nh•npllcatnos\p;i-rppllc.tion Effec:rve 10i1612017 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"Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.041.140. * With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. Franchised Utilities are not required to obtain the owner's signature on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • 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 above statements and the statements in any 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. David Dodd 01/16/19 Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www tigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILED StiBMITTAL APPLICATION FEE REQUIREMENTS Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY.AND UTILITY CONNECTIONS,ETC. Part 2: All non-water system improvements (,c011,in the right ot way.) Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Tj+mensicrs Part 3: All public water system improvements ❑ Sheet Name Engineer's estimate X 12% ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required for the following types of work: (;ubdnr,ions/Partitions and Street imptcnern,nts) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans ' • Ditch cleaning that does not involve regrading. (6 sets,24x36 or_23.341 • Weep hole repair ❑ Cover—Site, ,-tbiev►ation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ Genual Notes(City,nater,Sewer.etc) • Lawn sprinkler system installation or repair ❑ Stieec(Plan,Profile) • Street tree pruning or planting ❑ %Ater,Storni add Sanitary (Plat.Profile) • Planter strip landscape maintenance ❑ Ater Qt'ahty Facilities • Test wells Cl Grading ❑ Landscaping/Iree Plan ❑ Composite Utdit} Plan(l=.lectuc.al,Phone,Cas, Note: A cash assurance may be required per Stoma.,Suutary,' Ater,Signage,Street Light.,:.Y.) TMC 15.04.140.(customer deposit) ❑ >7Eta1f. ❑ I raffic Sight Distal:e ❑ Signing and Stsipiug ❑ Sueet Light plan arcd Phe tomet.is ❑ Engineer_seal/signature f] Sheet Label(project land use name,rF;stsion and plan log block,dates and Lhei t numbers) Additional Submittals (per Land Use:.ondttions) ❑ Traffic Report ❑ Storm'vatei Drainage Calculations ❑ Geotecbnr.il Report El Preliminary..aces: Report(Sigh►Dr,cance) ❑ Proposed Plat ❑ Paihwaj Design(if applicable) ❑ \s,ate'Department Appfos al ❑ F nginee/s Const uc000n F stimate. PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ww,.v.tigard-or.gov • 503-718-2421 • Page 3 of 4 SAMPLE SKETCH: 7) ..1. y• 5..;, 1 Edge of P avement "41.--- Ditch """ ►- }lI Streetlight ■--■—■i■..–.—•_■!.►+■.1.i■� ! 4 VI RamM/ KEAY` i i i 1 : ' Tl�i a'Pro rf�Sinrr riThr I I (1-) il1 r— � E.:fisting House Existi n • I 'vi i Driveway Cil .,w. rou . a. 6 I I I I 11 • g1 1 I �xl5tifl��h0� • 1 ii, I c I i , ..., Power�p I 1=1a - I 1 --—-—-—-Trr'opnyLine –`- I I o II r1N iCr:) I, Fire Hydrant(FH) I I I I I Scale: 1"-.=-30` 1 I i I l ! 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 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 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 VICINITY MAP THIS JOB PROPOSES TO PLACE 45'11" OF 1-2" HDPE BY TRENCHING AND 86' OF 1-2" HDPE, FROM EXISTING MH07250380 TO RIGHT OF WAY. WORK LOCATION 41.11� II' SW 0A QST N x ATTENTION, OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED BY THE OREGON UTILITY NOTIFICATION TOWNSHIP: 1 SOUTH DESIGNED BY: CHRIS MCKISSICK PROJECT: N.464668 CENTER. THOSE RULES ARE SET FORTH IN OAR 952-001-0010 RANGE: 1 WEST TELEPHONE: 980-265-8661 WIRE CENTER: THROUGH OUR 952-001-0090. YOU MAY OBTAIN COPIES OF SECTION: 35 CONTRACTOR: CYTENT INC WC CLLI: TGRDORWH THE RULE BE CALLING THE CENTER WASHINGTON COUNTY, OR ISS#:i ISS DATE:01/02/2019 SH:1 0F2 N x I 10500 SW GREENBURG RD CUSTOMER LOCATION \ I \\ o 0 h 22 '") CLC-..j1= l� V Z FQe O �� FRDITIER*E n, �� j J6.2. �, ..�JJ' ■,,,"'•'''''i'c; ®1-2-NDPE �, 12'1" r�-.i d 2O' (56'4N DETm) 14'6' _ nia I — — ,'b , 6., F� l.z. .P 6 9" o'"'��' ,iii,„„'iiii��4 3 27' ' '. r 1 t N ns CONC. S/W enndpi{ 3 4” d03 Ai,'' TRENCH 7-2'PVC +© `w^JI PF. I ` (36 MIN DEPTH) N -+'7'6"-•— III„ „a �28'5• +__ SW OAK ST top TRENCH 1-2'PVC N (}6"INN DEPTH) d03 d03 ATTENTION, OREGON LAW REQUIRES YOU TO FOLLOW DESIGNED BY: CHRIS MCKISSICK PROJECT: N,464668 RULES ADOPTED BY THE OREGON UTILITY NOTIFICATION TOWNSHIP 1 SOUTH TELEPHONE: 980-265-8661 WIRE CENTER: CENTER. THOSE RULES ARE SET FORTH IN OAR 952-001-0010 RANGE: 1 WEST CONTRACTOR: CYIENT INC WC CLLR TGRDORWH THROUGH OUR 952-001-0090. YOU MAY OBTAIN COPIES OF SECTION: 35 ISS# THE RULE BE CALLING THE CENTER WASHINGTON COUNTY, OR ISS DATE 01/02/2019 SH.2 DEC