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PFI2019-00036
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT 1111 = COMMUNITY DEVELOPMENT Permit#: PFI2019-00036 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/05/2019 TIGARD 13125 SEG2622 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Century Link Project Description: Adjacent to 16195 SW 72nd Ave. Install 537'of 4" HDPE via directional bore. Install 2 new handholes. Owner: FEES Description Date Amount PFI Permit Fee 02/05/2019 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: SCOTT MILLER 8021 SW CAPITOL HILL RD 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 rAC L LILA-1101J / -110 I,BJ I ignature: J Affs �r1 I Issued By: ,)Zildirvakti Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00036 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. Contact Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov 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 RECEVED CityofTigard JAN 3 0 2019 ., PUBLIC WORKS —ENGINEERING CITY OFTIGARD PLANNIINGJF rl:1,0 ERING Public FacilityImprovement (PFI) Permit 1 I ORD .=0.x.7eS.1`.3F T.in7ella :91r: ', wan= TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ® TYPE 1—Franchise Utility Work Check one: [] Utilities ❑Sidewalk/driveway approach ❑Streetimprovernents performed by NWN, PGE 1 Detailed description: and/or utility agency. Install 53T of 4"HDPE via directional bore in front of 16195 SW 72nd Ave. ❑ TYPE 2—Sidewalk/Driveway/Sewer Install 2 new handholes. Work performed for the purpose of: • Sidewalk installation or repair. 16195 SW 72nd Ave o� • Driveway approach installation Property address/location(s): and/or repair • Sanitary sewer lateral installation and/or main line tap Applicant: CenturyLink El TYPE 3—Full scale Development pP Work performed with Land use Address: 8021 SW Capitol Hill Rd,Room 110 approval which includes any of City/state: Portland,OR Zip: 97219 the following Phone: Email: Scott.Miller4©centurylink.com • Subdivisions or Partitions Contact name: Scott Miller Phone: 503-242-4144 • Street widening • 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 SITBMIT COMPLETED APPLICATION TO: City/state: Portland,OR zip: 97220 City of Tigard bheiberg©c-2utility,com Planning/Engineering Phone: Email: 13125 SW Hall Blvd. Contact name: Bruce HeibergPhone: 503-772-1878 Tigard,OR 9722.3 Applications for"minor work in right-of-way" Engineer: only may be emailed to: napermits®tigaard=orrgQy Address: I'OIt S I Al-F 1'St ()NIA City/state: Zip: J� .. Phone: Email: Case No.: ?F)2O/9 - 0003(0, Contact name: Application submittal fee(.07%of Engineer's Estimate) $ 30D . a Estimated value of work is required(if over$5,000):$ 14479.90 Additional fees:$ (within the public right-of-way) Application accepted:+ By: /V_C Date: dZeph C� Is work related to a LAND-USE DECISION? ❑ Yes ® No 7 If so,please specify (MLP,SDR,SUB,etc.) case#: Applic/atio�n reviewed: By: K•ff 442-pates l-3 1 - (Q Is work related to a BUILDING PERMIT? ❑ Yes ® No Applicant notified If so,please specify(BUILDING PERMIT)case#: By: J C Date: -t•) —' I:\ENG\PerrnttApplkationa\pfi_applicator Ef ective 10/16/2017 /" rs J [ 2T4e c t4 L - 1_..14114' e3.4l gL 43 9'e' '.4u, g:'a f" City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4 ` /L6 5 rig- v� l �..d a gam.EK) Le-1),)-.412_ '7;114Amt 1s ,� 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 • wwwtigard-ongov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR SrAFr= I SI. ONLY Public Facility Improvement(PFI)Permit: 1)FTAILF.I)Sl.iB11I1"TAL REQUIREMENTS APPLICATION FEE 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 (work in the right of 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 ❑ Dimensions Part 3: All public water system improvements ❑ Street Name Engineer's estimate X 12% 0 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: (Subdivisions/Partitions and Street Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design FIans • Ditch cleaning that does not involve regrading. (6 sets,24x36 oL 22x34) • Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • 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 ❑ Wates,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance El Water Quality Facilities • Test wells ❑ Grading O Landscaping/Tree Plan O Composite Utility Plan(Electrical,Phone,Gas, Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,ctc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature O Sheet label(project land use name,revision and plan log block,dates and sheet numbers) Additional Submittals (per Land Use conditions) D Traffic Report ❑ Storm water Drainage Calculations El Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) El Water Department Approval ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 SAMPLE SKETCH: ? SIA_ " )r ' St Edge of P avement 1 Ditch � . 0*-7tbStreetlight ._. . .,._...�. �.� 1 Rain� _r 4 I I iiii0,,e, ® , lNes— - CI T"�'"i�a�Srs -1 1 1 r I II Existing House I v. I Exii n 9 I " + aI • Driveway ;I 0i ! I O, R ii r,• w a. • 4li-! 1 r I I I ilI C/a A I I I Existing Shap i .:5 111/4‘. I IPowerpole I a I - I r 1 ri-r:;------ 95�I Roper Line- - - -�.-- I I i 1 I Fire Hydrant(FH) I I II I Scale: 1-=-31:3' I I I 1 II I I I I 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 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 VICINITY MAP THIS JOB PROPOSES TO PLACE 17' OF PVC BY TRENCH AND g� 520' OF 1-4" AND g� 1-2" HDPE BY ��g DIRECTI❑NAL BORE 01$ FROM EXISTING POLE 1L -$0 T❑ RIGHT ❑F WAY , 441 THROUGH NEW HH, WORK LOCATION N N x ATTENTI❑M OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED BY THE OREGON UTILITY N❑TIFICATI❑N TOWNSHIP: 2 SOUTH DESIGNED BY: CHRIS MCKISSICK PROJECT: N.477349 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 SECTI❑N; 13 CONTRACTOR: CYIENT INC WC CLLI: TGRDORZF THE RULE BE CALLING THE CENTER WASHINGTON COUNTY, OR ISS#:1 ISS DATE:1-3-2019 SH:1 OF4 WI > < I 16125 SW 72ND AVE o X CUSTOMER LOCATION Q NOTE,MAINTAIN I I 3 3 DRIVEWAY L.,J01_2_3'1L.I ACCESS DURING J Q I BORE 2-2'HOPE CONSTRUCTION I\ (RESTORE ' (36"MIN DEPTH) q ASHPALT) DRIVEWAY BORE PIT, M '6'4 '' DRIVE AY 3221' I t ® ® 5+,Am`© -—7'1'I r -86'5' V �,i11 + © 9PROPO48 S 11'7; 22• HRNDHOLE +19. r > v v t a - 22' ? ' - -2' 40' R/W ¢m 4. 111111 40' R/W 3 L., o, , 0447' 71 , BORE 1-4-HOPE W1 J (36'MIN DEPTH) Q 16195 SW 72ND AVE 5'5• DRIVEWAY CUSTOMER LOCATION I m. N J N N�+o L..ttiW DRIVE AY 75' Iin w r D BORE ® N ' -.---z (36-MIN DkTH) 5 ,�. i N f I 1 - --r; 1:11 v � V) DRIVEWA 0 ate �,-.d --2' f DRIVE AY 5'5' I 1 J O Efiiii 4'X4' in o BORE 1-4-HOPE BORE PIT\ O J t (36'MIN DEPTH)\ v 1 5, 1 DRIVEWAY 1 4'2' 39' EDP o M` - _ .1 0I ii TRENCH 1-l'PVC 19'5' CSL (36'MIN DEPTH) 40' R/W--. 40' R/W ATTENTI❑NI OREGON LAW REQUIRES YOU TO FOLLOW DESIGNED BY: CHRIS MCKISSICK PROJECT: N.477349 RULES ADOPTED BY THE OREGON UTILITY NOTIFICATION TOWNSHIP: 2 SOUTH 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 SECTI❑N: 13 CONTRACTOR: CYIENT INC WC CLLI: TGRD❑RZF THE RULE BE CALLING THE CENTER WASHINGTON COUNTY, OR ISS#:1 ISS DATE:1-3-2019 SH:2 ❑F4 1 16125 SW 72ND AVE CUSTOMER LOCATION j N d X • 054'j Q TRENCH 1-2" HDPE s r,-, N (36" MIN DEPTH) CI CUT&RESTORE ASHPHALT NOTE MAINTAIN > DRIVEWAY >- MPDPI ¢ C4 ACCESS DURING ¢ r 3 La CONSTRUCTION LJ T / ® > (RESTORE BORE 2-2" HDPE I cz ASHPALT) s 1 / (36" MIN DEPTH)/ q \ / 4'x4' .® /RIVEWAY BORE PIT / ;.. ini , iCcJtU DRIVEWAY _i, 4'6I j DRIVEWAY � j //rJr ////.`/////z/. �31 7,1, __--4.-/ co TRENCH 1-2" \ f ( Tcu H \ 3 HDPE / o i I] e F (36" MIN DEPTH)2 , ¢ / r CUT&RESTORE c 3 ASPHALT >///'"/?MP0PI �' -� - -22' r 0 - 40' R/W "' 3 1 40' R/W wI> r..--- .1 °' 1 7 Q •tit W 16195 SW 72ND AVE 5'5I• •--- DRIVEWAY CUSTOMER LOCATION 1 f (U o dior d DRIVEWAY 7 5' re }. ?I I riCif:,, •< 1 C N a o z5 W NI C4I z >1 nDT, ATTENTION' OREGON LAW REQUIRES YOU TO FOLLOW DESIGNED BY: CHRIS MCKISSICK PROJECT: N.477349 RULES ADOPTED BY THE OREGON UTILITY NOTIFICATION I TOWNSHIP: 2 SOUTH RANGE: 1 WEST TELEPHONE: 980-265-8661 WIRE CENTER: CENTER. THOSE RULES ARE SET FORTH IN OAR 952-001-0010CONTRACTOR: CYIENT INC WC CLLI: TGRDORZF THROUGH OUR 952-001-0090. YOU MAY OBTAIN COPIES OF SECTION: 13 THE RULE BE CALLING THE CENTER 1 WASHINGTON COUNTY, OR ISS#11 ISS DATE:1-3-2019 SH:3 ❑F4 N X 47 518' 30118 kor- 1 40.00000 49 7W mo 36 �432 1!" 111 Inside Dimensions Length Width Depth 4513/16" 28 3116" 39 13116" 22 3/16" 33" ,, B.1 ATTENTION, OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED BY THE OREGON UTILITY NOTIFICATI❑N TOWNSHIP: 2 SOUTH DESIGNED BY: CHRIS MCKISSICK PROJECT: N.477349 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: 13 CONTRACTOR: CYIENT INC WC CLLI: TGRD❑RZF THE RULE BE CALLING THE CENTER WASHINGTON COUNTY, OR ISS#:1 ISS DATE:1-3-2019 SH:4 ❑F4 CUSTOMER: Century Link ROAD f‘I4 11 WORK AHEA. CONTACT: Scott Millerj'r 503-242-4144 49 LOCATION: 16195 SW 72nd Ave / Tigard OR (NOT TO SCALE) DATE: W/O# NOTIFY EMS,FIRE 2/4/19 N.477349.C.05 /<e\6� ® AND POLICE 72 \\ DRAWN BY: /o(§%e- HOURS IN ADVANCE ALAN WARD zJoe�O/,.v\ - `� \ allt <14 z ' K&D SERVICER OR 05377 ico TRAFFIC MANAGEMENT WA 010434 �' \ PHONE:503-723-7287 FAX:503-723-8750 ORTCP@kndservices.net 350' — ROAD Spacing PLEASE SCHEDULE WITH DISPATCH WORK HEA. @ 503-723-7287 ,moo 72 HOURS IN ADVANCE AND PROVIDE A COPY OFA THE APPROVED TRAFFIC CONTROL PLAN I PREPARED 70 ft TO STOP Legend , . � . I. Cone 125 • ft 350• CW1-4 reverse curve Sp"' o Tt Flagger K>Flagger Ahead 125 ft 4 Sign StandL______ .i A - %W20-1 road work ahead o•W20-7b be prepared to stop 1 W9-3 center lane closed ahead •'•'•Work Area 350' Spacing d INVENTORY: 4 Road Work Ahead 2 Be Prepared To Stop .,i 2 Flagger Ahead 2 Flaggers , .::.. 1 Lane Shift Left , 1 Center Lane Closed Ahead A Al • A i fir 55 Cones i I p 350' i u I ae. 4 Spacing NOTES: 35 4 1. Maintain ped.access to and through crosswalks c 2. Maintain Min.10'lanes 3. Maintain local access co �'�� 4. Notify Transit authority at least 48 hrs.of bus stop closure 5. Traffic control plan and all devices shall comply with MUTCD, ATSSA and OTTCH350' 6. Notify Fire/EMS,EPD and LTD 48 hrs before lilliS`� a pacing beginning work a�a 7. Place No Parking signs 48 hours before work —, begins WOAD \ - - % 8. Adjust to field conditions 1 ti BE PREPARED K&D as the preparer of this traffic control plan makes no TD STDP representation as to its general adequacy or being approved for implementation.Approval must result from the Traffic Engineer or aciOSED E j other public official having statutory enforcement authority in the t 'HE'. jurisdiction.Utilization and implementation of this plan shall be as a Spacing ROAD result of that approval. I WORK AHEA.