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PFI2020-00142 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT 111 COMMUNITY DEVELOPMENT Permit#: PFI2020-00142 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued. 04/27/2020 T I G,4 R.D Parcel: SEG524 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast-886521 Project Description: SEG 524/9430 SW North Dakota St. Bore one 2" HDPE from pole at 9385 west through planter under D/W and then south under North Dakota Street and southwest and ROW to power meter on house at a min. depth of 36". Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) PR Permit Fee 04/23/2020 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tioard-or.00v to schedule inspections online. Contractor: LINESCAPE LLC 19100 SW 51 ST AVE TAULATIN, OR 97062 PHONE: 5039694409 Applicant: RANDY SHIELDS 11308 SW 68TH PARKWAY TIGARD, OR 97223 PHONE: 5035963996 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: ccee q jQ pl.( ( Issued By: 4 ,t Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2020-00142 Type: Condition Name: Status: Severity: PFI_Utilities 11 -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 12-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 13- DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI_Utilities 14-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 15-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 16-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 17-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 19-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 20-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 21 -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 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-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 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Utilities 25-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 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements,shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility,shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILTDRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility,shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility,shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI_Utilities 31 -OTHER Applied Notice Other 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 ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI_Utilities 09-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. RECEIVED APR 10 2020 Illq • City of Tigard CITx OF TIGARD Pt I#: 2020-00142 = I•\cil\I'.li1I(; Dr.v 1\ t NNING/ENGINEERING TIGARD Public 1-4acilitics lmprov-enzcilt (PH) Pcrmit PROJECT INFORMATION ScK , TYPE OF\C'oRK Prujeci name: Brief description t,f pp rlt•-r: �OrR.. tail&2. •IliFre Tr t-v. LAe_0_ PrG annd b• plc'. II, 1 . ,a r uin, C 1 r p ad,nil 13 ,5 k nil &t-iICr L✓lafl t/Vf r�iw r�y._1j,yy0.ir c_ 'INPF.2 It(r'.l :,,I,v.tll, l)n„vn `,1ttr tybrOn 1C l}....Jr5/1 A.�bviFti EGyJet- N� on • "A lx.i rm J ter, h, rI ,pvr uE in 04t.4 2- cw,_r' o,_ %W/1. ()ei)[41 fh �)(c a.. �,.i„jr.rtt•r dl.�n n r h.r.r • l in, a t.#n,u,h u,.r<Irnnt ..rnl np.nr SITE INFORMATION • \nl:r.4r...,.,ti t.t!r,.r.dl.1n.,, Atli! � n:.tin lu:t lal, t: ,:. ,,tldrl?S if :mailable.. C14 30 38.1 I, t rkl117aKrrk . r I\P1=.3 I't iI i It I.I ,rinlen.nit'A t•i, SEG524 'II r �l,,, c..i OP,. gl-a -3 Ix a II..tilt&!mill 3.m1 Iln .gq,n6ch A Alal , m Ind.,jot ni tint!dh vnt• • ?niwlni:i,at.of I'.,rtin,.u.. APPLICANT'INFORMATION • >r,arui.l,,,h,: Corn [+' • V.unln„ i,,Aiht„m 1L, \n,ltatt' >rytr. (� :n w,4 •rtcn, I yanl uAti,, and Iman# Mailing address:JJ?)O' SW ( +h p .W vl ,,.,,,,.,,,it, A,, d / OR. I 9'l^'3 I.' ItPE4-},tallt.II t hilt!... SO2 Vei L-399 b C. Il'PG3-""IirA,a lnm#'L I hone: :J C1• ,,',I J,,����1 4, 1'.Tna111,Afjat{ykieki SKI COr CA,SI,-�I{1r nt, ct IAN.L. �.---- NOTE: "Itrr I and 2 alrydicancros may Ix J l c t_I .1 nnadrtl ru L'7:1.0_111ci_'r±i i4J1iL .t'h- Cuntact name. RANt�{�? t&(_SZ_.__ _ pi ,in, — -- ---�aM4._ t'nr 1: 50.Y+\4. CONTRACTOR INFORMATION 0 S.unc as .tppli;:Int \amc: 1„t1'12 S(L)`Q. LLC lay' li \i1iuih r- 140 0 Uailing uldru-.s: �91.QP._SW SL IpLYt---- I in":still,Ikataiivt 6 K. ----- zip: ` 1-062- Phnnc: ¶�t_c{'o'1. iii 1 a — — I:m.ul: _'Vet Nit-sg1 e tt DP 1Lc,. ENGINEER INFORMATION Name: \Iailiny adds.,, ------_ _ I Jn ""tilt-: Yip: MOM:: I m.ul: ADDITIONAL INFORM:11'1ON I•sunlatcd 1 alut iii work i required(u t,ccI S !III :j .,-__._ Within lh. public r1,4111 of v.;tc I,vcork related u,a I..1NI) I SI I)I?(:ISlt )\:- ©'i ,\., I..1-t nnu)bt r City of'rigard • 1312i S\\ I WI lilt LI. • I4t.m.l.t lit#n'u'1 ' • t:a-a:u#'atd-t tciu. • 5111 I#t-2-121 • Page 1 0f 4 vPI'l It:'�Tvrc NOTE: Pcti.on specified a,".\pplic:un' ,:t nlcc 311.1.ha11 pttwidc Iinanclal a :uranic f11r work. if required In the ea pulsuanr 1,11 NIt, ' wliht6t.0 trip o 41,1 p.u:, s!._ _, ml 11a1 V. at ';nl,' L,n III/1//11111.rr.tlha.ggd 1.:.1 me,Ifrlcrott Ik^q,k.lilt appl:r.nn t•al'!1,1 the tluah 1t 1 r.! !r.,nd n AL. Li it,h. .....-hill•::1!L a lilt,n dblllotlp.Qluq Ir11111 16, .a n, 1rt Alt.9.111111,1 ilia „uu,r I I,. v.an.r ,I.Iliu.lmm ill Ih. .lab(,r.,...', .1 .,111,1,9 a;,ti:lctl a,ulllnic.lti,nl wllit it., awl..Ali di. i1rendn?vi,,,I It .t I 1.1111t.- trot 1114 rt.yta .t i i.4Nnr 11,..q.11u'.-10011.11: ..1i:is atgdn.amn I,the applicant,certiti that: • 'Co the best of nn' knowledge,all the intilrmatii in pr,aided within this application package is complete and accurate. • -I'F•r:thine rttlucst doe, lit l clnlalt-am recorticd deed restrirrions that ut:n be attached to or imposed upon the subject prupera. • If the application is granted, I will cxcrt'isc ti t r! ia.granted in accordance with the terms and subject to all the conditions and limitatii,n.of the appn ival et to(z•to tlicant's or authorized age' ';...iglu]tit\ Print r. . Date Property owner's signature(if retjuiredi Print name Date STAFF USE ONLY Case No: PFI2020-00142 Permit fee: tia• Recci\ed by: pate: 4/10/20 Approved by: T�^wif 4, l),tc: V/2/i2O?rlj Notified by: M- Date: •�© City of Tigard • I t t_ >\\ I Iall ltfvd • I i Itct.t)1,: I „c Lett • ;n> —IS S 2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement (PFI)Permit: INITIAL PFI PERMIT FILL Pan 1: Required s thanntal tee a lir'„nl the Nrt I'I 1 I'urtn t I rr Pee belt nc t.rr c4kuI t,.Iris Minimum td$300. NET PH PERMIT FEE Pan 2: All nun-water system unpruvnnents engineer+esmn:uy\ .:1e.s the timid PI'I Penmt For). WATER LINE CONS'IR I C FION I I I Pun 3: All 1iubht r:ucr - ins FOR STAFF USE ONLY FOR STAll t tili ONLY TYPE 4:SMALL WIRELESS FACILITY TYPE 1-3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a ru,,hrofwar license? O Yes G No TYPE I AND TYPE 2-Must include a-ketch showing: Cofer the wireless facilities standards.is the propmal ❑ vim,trts:,,n, considered?(check all that apply): 0 Small Cell ❑Macro ❑ Street N; nc How many install sites arc proposed as part of this permit L� Site dtlres> application? TYPE 3-Must provide 4 sets of plans(sized 24 x 3b or 22 x 34)and an electronic version of all submittal The profaned equipment is Icn;Ltcd on SIluCk of the tali(iau:g.. items. The plans usual that include: ❑Public Right•of-Way 0 Private Property ❑ (.rots— :r.\'tr:mr,,.\hlmwa•trxt,Legend If equipment is to lac located on private prnpern•,descrine riu. 0 Gerrr.,i Nuttti ti.\\stet. 's5 cr-ire.) type h use: ❑ Street LPN,.Pruftldi [] \Y'anr.Sn,rat and Sault an;Plan Profile) ❑ \C'aterQt,ality FAA:Auie ❑ CIcu b:1g �.) I:miis.apit 1 ti'-I rcr Cl Crampr>surl:rtlnt PLtnflarrtrical,Plume Gas,Storm, Sanitary,\C'arcr,S:gnarc,Street Lil;hn.et;.) Li Derails ❑ 'Iiuffic Sight Distance ❑ Signing and Striping ❑ Street light Plan and Photometric O Engineers scal,'signature L Sheet lapel{project land use nante,revision and plan Mg block,dates and she.;numbers.) Li fat,inrrr'sCons'ruetitntFsrureue .Additional Submittals (pet Iand u.c amdniuns,if applicablcj • C I nubs:Report ❑ btcenl water Drainage Calculations ❑ Gcorechrtiod Report ❑ Preliminary:\ceess Report(Sight Distance) ( Prup,.sed PLtt ❑ Parh•s ac Del ign L \\'.tact Pr rvuh t,\ppn'vat Ciy of Tigard • III_S S\\ l call lil+d • l'tg id.t n, ,n' • 'ssisi!:.u:l t r a • -t„' 'I s 2121 • Page 3 0 4 • ,.,,.,S.k-ava-. ._aao\s ON 1 1 _ • y �111[7Iii , —✓— —� r„rs,s —3 3 2Sairovla ,4X 0 fe. a p 1 m M 4 _ 9 7" + j 1 '+S nC`1�'°N NNS s -- + P ,c.2 1 /) r.S• rid UOC2 ..„...____A__V-1/4'4 rld T. 17 Et/-7:-.)) - rcrle, 11,14k\f— [ I ri\I ,5' ,, J Page 04 2011 CrI0an 7011 Editnn Papa 8S ,Stationary lane Closure with.Flagging Diagram:328 Stationary Lane Closur&wilh Flagg arF%=' 'Dlagrom'320. Diagram 32e covers total closure they of a single i n two-way roadway. o ag ay. See the delta inset layout if los y using g a a l-n lc,nagger W control both directions of traffic an low volume roads(toss Man 400 ADT)with good I S sigh)Olsfenw as discussed below. e 1 ..._---F•2 1. Use buck-mounlad Oa9hing warning fights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. ' m 2. For added viability,a truck-bunted arrow board or PCMS In caution o mOde may be used. _ o 3. naggers al each approach are required if any of the following / 1 I . conditions exist: i "ilL[ a. Nigr Operations. Iuo h. Work space Is over 200 Ice!n length. c. Sight distance Is toss hen 7501ed from each approach I o through rho lane closure.. ,�((]],, --------- •- d. Traffic volcanos are greater than 400 ADT. �V1tJrrrr• mod 4. The length between llxr Fleenor Ahead signs shall not exceed one vim\—: 111 ...0 .115 Mile. Use Diagram 340—Lone Closure will P40!Car if exceeding one r^/Y�li- I I'2' �; i nF Mile. 5. Cotes should be used to outline the work space when curves or other 1 • roadway alignments prevent clear direction for the motorists to pass rd pp lb •——�m the work space safely- o m t !It -' I I�, 6. Canes along the work space are recomme rded when posted speeds O� �, .iS • are 45 mph or greater,when working under heavy traffic or when travel o tones are n:aruwer than 11 feel Z { 7. Extended queue signing(see Diagram 5-4)should be used when e§6 '- :/_ .t- e� / •3 tralc quotes extend beyond the inkier advance warning sign. �'= I •! ) t a y� q 8. When Baggingnear an intersection,the'Ftr _. 1* 7o ggcr Ahead' Additional re Vim ,. sign should be visible to trains entering from any side rood. 1I advance warning and Flagger Ahead symbol signs may be placed on • s rwe. t •` 1 — fhbaitleroad(s!. �� sp..: s—�s�.�s �� c• •o ,f \ 9. Sign set-upclosuresusedroad of 20 minutes or kss. an 100 tr 10° ='.— ...,.e,x ma no 113 10.The'ONE LANE ROAD AHEAD" I sign is optional and should `_,... ." >a "'lW Stree' P u bo considered on high volume or high sleet roads.or when extended ""' w m bee sm vie queues are acceded. .. _ _ w _ ,.., ci ralp_Ine me Dune,len s on.Si, .ncm•n :nyaer 5 Uneen5or ROII 0.cea n,'30r1 rooted Szrdn aaween ikS '9eneC any Co .SJ A _ a T C S-.4• 60 MI OS _ 700 700 700 IIM 70 365