Loading...
PFI2020-00510 II CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT '''# °1 • COMMUNITY DEVELOPMENT Permit*: PFI2020-00510 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/30/2020 Parcel: SEG1866 Jurisdiction: Site address: Subdivision: Lot: Project: 51351 -WO 876385 Project Description: Place/splice fiber cable from ziply fiber manhole to jacksons food store-11290 sw Bull Mtn Rd in existing ug Class of Work: FEES Type 1 -Utilities(gas, electric,data) Description Date Amount Total Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: RUSSELL WELLS 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 5036431001 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 See application Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12020-00510 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 [MUTCDJ for Streets and Highways", U.S. Dept.of Transportation, FHWA, current edition,American Traffic Safety Services Association[ATSSAJ, 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. PFI_Utilities 10-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 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 applicants 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-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 III PFI#: PF12020-00510 ENGINEERING DEPARTMENT TIC,.ARD, Public Facilities Improvement (PFI) Permit PROJECT INFORMATION SOCI`110S16fec nrsoftYORx Project name: ___....... _ ❑ TYPE 1-Franchise I.'tibia:Work P project: ) JP j -v�/ct- lcfomxd6' AN.PGIt mdi,n Brief desrn non of ro ecr. ialn . IZ ❑ 'IYPE2-Rc1 Cu) (Z r-,u,E,�1`J WI,� Ecis v�' Sdewalli/Driceway/Seiner'Torsi }. �' performed for the purpose of: • Sidewalk installation or repair. SITE INFORMATION I`- • Dnrewar approach inslallmion �i7d 5u) 1 ILL.. /4 }}� and raiv i Location (address if available): �Lt/1 •4jniw}�sewer lateral installation ana main line tap 0 TYPE 3-Full scale De ek,pmnu \Vol:perfomced with Laud use APPLICANT INFORMATION apprcnal whirl,nuludes any or rail_ the following:Ne: Z 1 � A�� • Subdnisions or Pa dua:is Mailing addess: C 'c�w+-I.fw'—Oita f/ .-_. • Suer widening [] • Mainline installation for Sanitary City/State: /'J XJ OIL Zip: -!7LV sewer,Stuun; er.Gaud water and � j- /DO I _.... Tigard Water Serrire Area Phone: �,�? /A — J TYPE 4-Sean Cell Technokv Email: r k 1 K4 .1 (() shone: IC-i'("�_l�1 0 T1Tr s-Tigard Triangle Contact name: t �.-c Phone: ,S3-WIDO I Email; VIK5eji 1•U +-4 )111111I CONTRACTOR INFORMATION l Same as applicant 1 Name: CO3 Number. Mailing address: City/State: Zip: Phone: Email: ENGINEER INFORMATION Name: R ----- 11/4j Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$i,000):$11/41 tA (within the public right-of-way) Is work related to a LAND USE DECISION? es 0 No Case number. City of Tigard • 13125 SW Hall Blvd • 1 igard,Oregon 97223 • wwwngatd-or.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated-Permitter'and shall provide financial assurance for work,if required by the city pursuant to TAR;15 0-l.1i*0. • 'X"sb the errs-puce]of a utility operating pursuant to a valid franchise a'license with the City of Tigard_when the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. llte owner must sign this application m the space provided or submit a written authorzation with this application. Franchised or I icensed 1'ulities are not recpnired to obtain the owner's signature on the apslcation I,the applicant,certify that • To the best of my knowledge,all the informanan provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be ateiched to or imposed upon the subject property. • If the application is wanted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. 1p tc n s or authorized agent's signature Print c.r.; Dat Property owner's signature!if required) Print name Date STAFF USE ONLY' Case No: PFI2020-00510 Permit etc• -$ Received by:HPollard Date: 12/29/20 Approved by: %rw,f A Date: /2/ 9/Z ? ' Notified by: Date: City of Tigard • 13125 SW 11alI Blvd. • Tigard,Oregon 97221 • wv wngard-or gov • Sft3-718 242I • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is AN'o of die Net PH Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: 911 non-water system 6npnn etnents engineer's estimate X 7"0(less the initial PH Permit Fee). WATER LINE CONSTRUCTION FEE Pan 3: All public water system improvements engineer's estimate X 12"o. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4:SMALL WIRELESS FACILITY TYPE I—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS • Does applicant have a right-of-way license? 0 Yes {]No TYPE I AND TYPE 2-Must include a sketch showing Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): 0 Small Cell 0 Macro ❑ Street Namc Ho many install sites are proposed as part of this permit ❑ Site.Address w • 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 0 Private Property ❑ Cover-Site.Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the 0 General Notes(Croy.\L'ater,Sewer.etc.) type&use: ❑ Street(Plan.Profile) • ❑ Water.Storm and Samtan'(Plan Profile) ❑ Water(luahty Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical.Phone,Gas,Storm, Sanitary.Water.Sigrage.Street Lights.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) ❑ Fnbtinccr'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 • uww:ngard-ocgov • 503-718-1421 • Page 3 of 4 — r5 Edge of Pavement w— Cnccn—+e Streetlight — —• •—•—•—• r—•— ® _ j _ I T'Ti:5133Tecr5sw'eiT.3e"' y t• I IL1 7 t • Eusttng House 1 < s, j Exstmg 1 it [.rne4,'•r [I IZi ' l pI • • t /r4)ri it i %—I RI ' I d iI J' 4 I j of 1 je % Entngsner I c I a . Powerpole I I> I ~� !a 95' I I dranf[FNI I I Jryt1 Scale 1'=r I I 1 I I I 1 TYPE I AND TYPE 2: I I NIUM SKETCH REQUIREMENTS(Put N/A if not y.licable) NUrth arrow [':apart:loves&.lunensl.ms Ensot:b u:dmes lr,canrins (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 SVC Hall Blvd. • Tigard.Oregon 97223 tigardoegov • 503.718-2421 • Page 4 of 4 �SW GAARDE STREET SW MCDONALD STREET . �q NO JOINT POLE NOTE Bryn•4 ,�3� OTRLALLOTTED HOURS Siv S tr A4P �•ov x.x MA Xxr. CONSTRUCTION NOTE e ��0� x2rx DRIVER n 1-THIS WO IS METRO ESERYICE '14"'TF(„-_ 4's' VICINITY MAP W:;:a°°`K°' PRDER DRIVE PSR3383534 �F PG o�°.o",:x... _ �R °.a°C °" 11n1ne 2-THIS JOB REQUIRES- Sip y ,x"c' ODOT WASH CTY.CITY OF TIGARD Q14,..... 14, IOK>K:r°a ar1°m- PERMITS "� cc.',:aryVIK° caxxrnucTlal SW BULL MOUNTAIN ROAD vRy o.K ox° OPCEN NOTE 1t o°.. u.M.a 0XEw„a ETD an oxa 1-THIS WO IS METRO E SERVICE ***JOB SITE ""'" '. o`°"'""Iwc PRDER DRIVE PSR3383534 JACKSON'S FOOD STORE 0 Y. a.° MP,e 2-THIS JOB REQUIRES- 11290 SW BULL MOUNTAIN ROAD m"G_IIt5____ ODOT,WASH CTY,CITY OF TIGARD wx0 rzWOxCFYroWr PERMITS 2020 METRO E BLANKET TCR UT 51351-5255669-261 o DETAILED IxCT BLOOM. CUSTOMER-JACKSONS FOOD STORES JOINT POLE CONSTRUCTION CONTACTS 11290 SW BULL MOUNTAIN RD 'F,'AX'"" DAVID CARNLEY-971-940-9000 PORTLAND(TIGARD),OR SHEET 1 OF 3 ax1X Qec aX norm: erne all JAMES STARTS-503-759-3119 PSR 3383534 `moo N ox o ewEa SCHEDULING CONTACT ASSIGN- NORTH o o a (AN O O o F*uxnEa RYAN ROBERTS-503-643-3713 BBFTP FDT 498202 IOIXr or coXracm FACILITIES CONTACT TGRDORXA FC2042,527-PORT 1 , RU89WELLx LAUREL KIELTY 425-263-4008 LCON-ROEL GONZALEZ 512.687.7405 srn«>-1m1 x-FroNRTTIT a 6 FMEKXE %NW11) INSPECTION CONTACT Ruesxeus RON HAYHURST 503-292-3345 °X'�E MO "� 1Ecx me C ENGINEERING CONTACT LABOR HOURS MATERIAL REQUIREMENTS EeEEoeu e1 RUSS WELLS 503-312-7330 SPLICE-C-13IM-2/X-0 12X FIBER SERVICE DROP CREW-C-9/M-0/X-0 8 PORT FIBER TERMINALFLAGG } ziply fi b t. INSPECTOR-0RS-24 HOURS 51351-W0876385 INSPECTOR-0 HOURS TGRDORXMPSR 3383534 SONICOM WORK 11290 SW BULL MOUNTAIN RD C.ARv: NAE� Ve(y17H'A5 exa Ca., DPATM DARE. �WEL, LRIIN WASH E TWO, Zap FAX d9TRICT Lmi TaRW X ryf6Hi-1 RxE DEC A BBFTP FDT 498202 FC2042.527-528+ XD,36 B 100012 FIBER TGRDORXA FC2042,527-528* XD,312 f C BBGTD 18426 JACKSONS FOOD STORES / •n• BBGTD 7,2078-2083+ 2084-2100 / / COPPER CABLES OMITTED /. / FOR CLARITY D BBGTD 7,2076-2083* _ 2084-2100 UGAFT:25.24 =c —JG—� / .� ,� TGRDORXA MH E BBGTD 18425 3SHEE BBGTD 7,2076-2091+XD,17+ -- — SEE SHEE129T 3-MI-I DETAIL BBGTD 7,2093+XD,19-20+ H / / BBGTD 7 BBGTD 7,2099-2100*X0,23a SW BULL MOUNTAIN RD / / B / / F 984 05.2006 C A.,.: / / TGRDORXA FC2042,1-624+ / / / XD,625672*873664 /• $ / 1p G 932 05.2006 l TGRDOXA FC2042,57724 BSHEET 2 OF3 NORTH H 1928 05.2006( > TGRDORXA FC2042 1-576*X0,577624+625-8644 H 1928 TGRDORX08 // // /// ziply fiber TGRDORXA FC2042,1-526+ XD527-528+TGRDORXA FC2042,523576+XD,577-624+625-864 TGRD4 112905W MOUNTAINRXA/PSR 53 RD PROJECT �ID `%*' NOTE-CUT DARK TGRDORXA FC2042,527-526 "D.,:„„u.. S. F 7,.r ,,a, BEYOND TGRD MH 32/129 51351-W0876385 vrc' L4°?uwf W of . .wiaw wnc. aes• _ , S TO MH128 TO CO N/E WALL FF00CC gA66 55yy FC2O42�1-624+625-864XD —III OYG03272 Q. Q„_ NI © a ' OSS87-2- 951114V �� C21:1-1800+900DD � n� �� � %D 1ri ]�,��® —UGSLM27-26 LL + 44 7 O I+ L2 MH32v p / 78 9W+OB• O 2 /484TA 8 1 •❑cv— , .N,I UC251W10A BULL MTN RD h FRONTAGE RD ® 691.11111REV 5/25/11 OP 3F0A06F S V T74:1-24+3011D C7:1-115 g q CYGO54-, p ucssia— : MH 129 RLL ® a C21:1-t c21:1-1500 Ilk SHEET3 OF 3 UGMNFIS-26 10A1:15 • 100'loop FOC 8649.1 C7:2076-2100 F2042,1-576+577-86490 NORTH Monii 1041:25 S - \ 84'coo TO MN 131 FOC 48 SIR WALL FC2042.577-624 SEE'E'-SHEET 2-OVERPULL TO PED 18426 THEN OVERPULL t INTO BLDG I ziplyfib TGRDORXA/PSR 3383534 51351-W0876385 11290 SW BULL MOUNTAIN RD mmnrR 61 DATE EWA 90.5 ova owaLEce.n RY.NNwe. F SCALE P,�f(B 0 B 7.PBIgCI'. W�® rBEG � SIGN SPACING AND BUFFER LENGTHS LANE CLOSURE AT T INTERSECTION WITH FLAGGING POSTED SPACING BETWEEN SIGNS BUFFER SPEED A B C SPACE PEDESTRIAN/BICYCLE SAFETY ESCORT REQUIRED 20 50 AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS Y5 100 100 100 75 ODOT DIAGRAM 620 30 100 REFERENCE 35 350 350 350150 125 G C TGRDORXAZIPLY MANHOLE LE 3E 2 OO 50 500 500 1.130 500 Y�10 O TGRDORXA MANHOLE 32/129 45 O /B�GHT TURN •NE CLOSURE 55 250 O q OO a\o\ A =ORANGE SAFETY CONE 0/ •° \9\ ob BICYCLE >6"4. ' j�,� i LANE TGRDORXA MH DA -N \` BOr.,-� �/ 32/128 A 6 �� -'gyp .1 �� , ' JACKSON FOOD STORE 1+ �� ,' 11290 SW PACIFIC HWY(99V ' , TIGARD OR O ' / ,r ''Z> ;' �7 s�'e it\ SHEET'IOF 1 \ \ NORTH \G\0 > D FLAGGER AHEAD SIGN \ OO O BEOPPRSEPIGANRED TO ziplyfiber O ONE LANE ROAD AHEAD SIGN TGRDORXAAPSR 3383534 11290 SW BULL MOUNTAIN RD 51351-WO876385 PROJECT �n7�q��`5�aa„'•A PERMIT ...'''m'e' E'"^ 5V54'r'u`H^_�wsH G AHEAD WORK n.xc M••••m AHEAD SIGN %n'f " F 'VMSXV. 'm RW SEC