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PFI2020-00420 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 MATERIAUCONSTRUCTION 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-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). 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 City of Tigard p�#; PF12020-00420 ■ ENGINEERING DEPARTMENT TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: Ziply Fiber J X TYPE 1—Franchise Utility Work Brief description of project: ZIPLY FIBER TO REMOVE 25 PAIR AERIAL performed by NWN,PGE, or utility agency CABLE BETWEEN 2 POLES TO RESLOVE HAZARDOUS CONDITION _ ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer APPROXIMATELY 203'FT. Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 6860 SW CLINTON ST main line tap El TYPE 3—Full Scale Development Work SW 69TH AVE AND SW CLINTON ST SEG 861 performed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: Ziply Fiber • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address:_4155 SW Cedar Hills Blvd water service area Beaverton. OR 97005 ❑ TYPE 4-Small Cell Technology City/State: Zip: ❑ TYPE 5—Tigard Triangle Phone: 503-319-7787 Email: rosalie.sims(a)ziply.com Phone: 503-319-7787 NOTE: Type 1 and 2 applications may be Rosalie Sims emailed to rowpermits@sigard-or.gov. tigard-or.gov. Contact name: Phone: Email: _ CONTRACTOR INFORMATION 0 Same as applicant Name: North Sky Communications CCB Number:_208747 Mailing address: 10860 SW Clutter Rd City/State:_Sherwood. OR Zip: 97140 Phone:_office 503-647-9991, Email: r. sitton(anorthskvcomm.com cell 503-277-0283 ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes 10 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www..tigard-ot.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 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license 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 must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I,the applicant, certify that: • To the best of my knowledge, all the information provided within this application package is complete and accurate. • 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, I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Rosalie Sims°"'"' °"ssATCO ON:c ntPss•Ik Sims.sMr(0 Cwn muMnfwn,I 035[400T00' Rosalie Sims 11-03-20 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: PF12020-004 Permit fee: CQ Received by: MB Date: 11/4/20 Approved by: Date: //,.5—/2d Notified by: Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PR Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PH Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? ❑Yes ❑No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): ❑Small Cell ❑Macro ❑ Street Name How many install sites are proposed as part of this permit El Site Address application? TYPE 3-Must provide 4 sets of plans(sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following. items. The plans must that include: 0 Public Right-of-Way ❑Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Iights,etc.) ❑ 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.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwvttigard-orgov • 503-718-2421 • Page 3 of 4 9 sly '• 1_ •• si Edge of Pavement �� Ditch �� 1"thStreetlight •-• •-•-•-•-�-•- 17.1.4/. II015. ] 1J '. Q� j "- Existing House I I :: i Existing 1 I • Driveway �i s� I o P.dI t (VI I I r1 alv`• 1 1.1 I co' I 1A 1 1 i j \ Existing Shop 1 I Powerpole ! ( o I a\ 1 •~ lc, 95' 1 —"—"—.i.-- ip-------747tylTrie" IN iI Fire Hydrant(FM I TTT I Scale: I"=30' ( I I I I I I I TYPE I AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer, storm,water) Street&street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 S' 'Hall Blvd. • Tigard,Oregon 97223 • w uw tigard-r r.gov • 503-718-2421 • Page 4 of 4 -- V j Q i CONTACT INFO INSPECTOR RON HAYHURST 1 X , VICINITY MAP = 503-292-3345 I I I— EXCHANGE ENGINEER RUSS W ill , SEE SHEET2 FOR 0 WELLS 503-643-1001 Q I VICIN TY MAP n FACILITIES LAUREL KIELTY 0 2 13 425-263-4006 25 I In ATCO ENGINEER ROSALIE SIMS 0) BBG7YJ 503-319-7787 ( I r BBCT0 2p893 I r • 1 II 5> -- 6 16p0 I CABLE FILL 1 CABLE OLD SIZE NEW SIZE WORKERS,FILL% 11800 SW 69th Ave, Tigard I 203' (01.1968) ' I' SW CLINTON ST (SW CLINTON ST) I (AE25 --.----------------- ----_ (BBGYD20,1576-1600) 'O ' 111 1I ----------� ___________ 308 C1136D6748 , 308 ZIPLY FIBER 250516 C1136D11 TO 348461C1136D3981 ZIPLY FIBER 250537 C1136D4549 ZIPLYFIBER ZIPLY FIBER vs 1 * ESTIMATED HOURS V PLACING. CAP.00 MAINT.00 X-TIME 00 �1 6860 SW CLINTON ST FV A�, I SPLICING. CAP.00 MAINT.W X-TIME o0 ,.� 4J OL /�� I n INSPECTOR:CAP 00 NAINT.00 X-THE 00 Pie ryt I I [�ix �B /`C�CrJ I ; FUGGERS: CAP.T00 OTAL HOURS X-TIME 00 * Nq3. fd'Oe I OB GJ� S co` `V`� ' ¢ PLACING. CAP._ MAINT._ X-TIME_ G 9 0 •S' SPLICING. CAP. MAINT._ X.TIME— ^ ^ O 9 Q A. ry I 'E> INSPECTOR:CAP._ MAINT._ MIME O WO DRNER /�C/>//�A. 0°u°YO 00 I ��5 O , = FUGGERS' CAP._ VENT._ %-TIME_ v CViQ O' I >s^7600 1 09 09 WERJ START CE 11.1520 °FTTP GR5YT" °FOP OVERLAY /1. I 0 FI5FR X V ' I cuss!.cOMFIfiF ❑c9Noulr Orly I O ' JOINT POLE- X I V' JFwuJllNsa curs REouIREO CONSTRUCTION NOTE , Q� I is)NO JPN REOAREC-- ❑YEs°"° 00 W OWNER TO FEES °NT TRENCH YEs mxO REMOVE 25 PAIR CABLE BETWEEN POLES 250537 AND 34846, I > ° ° ° POWER CQI REQO CABLE IS NOT ANCHORED AT POLE 34846.NO WORKING �� ^o Q °a °° °o FAN IER °EEs®ND SERVICE IN TERMINAL 2842. I = CONSTRUCTION PERMITS THIS WILL RESOLVE HAZARDOUS CONDITION VIOLATION. ryy*ti0 I ®°DLALANG fMyuei�P _clrvoFncvD / „O I "I []BRUS:IWG N TCP?RAFFlL �E1 (0 0 CONIRACTIG °DETNLEC INOT BIANKET) SEE SHEET 2 FOR VICINITY MAP. i B "'rg?, IREOO ❑NO PERMN RECOIRED 3 .I PERMIT REQUIRED PER CITY OF TIGARD. I BBGto 289 0 I N - ziply f i be r NO FLAGGING REQUIRED. ? I ,....---'"--- EAU. 8 111 ARFN,roN III BEFORE YOU dG , I tGON uw agms ra lD N]ROw aun&BOMB c�'C• �'— TGRD NESC REMV 25PR CABLE aT 1R CRIP wrr YRlnGI1GN CM,n 1 I �NI ' /' > IRON INNS a u„cPn...O„n. KRIO I r % O�" /_/� HAZARDOUS CONDITION SW 69TH/CLIN-ON DMICOAKAI R IN NY ON ION �RPNs f 0 ,A I PROJECT C.O.AREA TGRD flWP lmv ceaN AwWanunaN . :Jw.a,>-n.n '� , I 519P6 �•(t•>` J1{//' NUMBER 5502404 Ezell.eoDE.etas, m tllll„OWL\GtYN EAU:w iNFG(h / /� DRAWN DATE. ENGR: ROSALIE SIMENTY WASHINGTON < ror+r.xd+[F�,>a F�., r. BR..MNn Mte.' .II .�GRpoRx ``1 pP I 10-2020 PHONE: 503-31&77R7 FILE:2020 RHS 5511J1LL1 ..5 l.wse ELM MOM rU ea:..A•:h• COI kW.AAA. I III S� /- I SCALE:1.100 TA%DISTRICT: DWG 1 OF a J I TWNSHP:IS RNG: 1W SEC HD VICINITY MAP 9 Pgaa uaboosu P ]W.,•a„a n. I. SW nano:an Car Toys V = Oregon Federation - III'L Ceramics Weal a Be Cm Provo slate 'I a Regal Tigard Dental Lab® of NursesBHealth r j • F,aed Income 2 IS M _ i .rt COsmo Gas 9 9 1 j 9` SW e.„uA SW asyh S ' Pn.x Sl SSW BMaEr 9 �t PMy Farr Din By Design Mountain Pacific Q NW Public Add it Dutch Bins Coffee miry use Machinery 1 a r PetSmart i,• WioCo Foods © © CIS Lt Coatm Tee Garner �^' Jolo s Jaw int slop 9 o 11 1 W.. ordoo r rawvo 9 OMEF Event CenterW 15 ®Cerdlwm c s'ATM 5 2 n SW Cimrw Si -SM`ektOO9'- • Q '. 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Wm _dillii Woman super.. & .... ai..w.OOR! ocar asurd di WORK LOCATION ADDRESS 6860 51351-5502404 SW CLINTON ST, 5460-TGRD TIGARD 1 S1 W36D WP2 OF 2 N Page 84 2011 Edition Page 85 2011 Editioniiiiione �,,,,a Stationary Lane Closure with Flagging Diagram 320 Stationary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of one lane of a two-lane, two-way c roadway. See the detail inset for the layout if using a single flogger to control o ° both directions of traffic on low volume roads(less than 400 ADT)with good sight distance as discussed below. `° R 11 m 1. Use truck-mounted flashing warning lights on work and protection 604o g V * Oa vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. t rn 2. For added visibility,a truck-mounted arrow board or PCMS in caution ti o mode may be used. ce 0 1 t 3. Flaggers at each approach are required if any of the following a° leC ►— conditions exist: a. Night Operations. 6044 b. Work space is over 200 feet in length. c. Sight distance is less than 750 feet from each approach r--- I •a §5 e through the lane closure. 1 x •• y o u. d. Traffic volumes are greater than 400 ADT °x I � /. 8�g e 4. The length between the Flagger Ahead signs shall not exceed one ex 1 t 1 sa mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one ` .x T I -� d mile. I �`3' tt a ,:j • 5. Cones should be used to outline the work space when curves or other c I ' b T t I roadway alignments prevent clear direction for the motorists to pass o s :® t1 • the work space safely. Et m g {il mot, I %• • ' 6. Cones along the work space are recommended when posted speeds are 45 mph or greater,when working under heavy traffic or when travel ° lanes are narrower than 11 feet. ra 1n ° I 7. Extended queue signing(see Diagram 5-4)should be used when m o Ye 8 traffic queues extend beyond the initial advance warning sign. .1111114 To *e I g 8. When flagging near an intersection,the"Flagger Ahead"(CW23-2) I Y� a. sign should be visible to traffic entering from any side road.Additional m • i advance warning and Flagger Ahead symbol signs may be placed on ,, t the side road(s). , . ° 9. Sign set-up and flogger placement shown may be used for intermittent Sign sparing and Suffer Lengths(feet) full road closures of 20 minutes or less. Posted Spacing Between syn. SSuffer pec. Speed A B C Space 10. The"ONE LANE ROAD AHEAD"(W20 4)sign is optional and should 100 100 100 be considered on high volume or high speed roads,or when extended queues are expected. 40 aso 3s0 350 ISO 45 1130 SD 50p s00 SOU 210 50 55 250 Chapter 5 December 2011 December 2011 Chapter 5