PFI2021-00041 rt CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12021-00041
13125 SW Hall Blvd ,Tigard OR 97223 503.718.2421 Date Issued: 02/24/2021
Parcel: SEG1217
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Ziply 51351-WO880501
Project Description: Add new fiber cable to TVF+R station
Class of Work: FEES
Description Date Amount
Type 1 Utilities (gas, electric, data) PFI Permit Fee 02/24/2021 $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.tigard-or.gov to schedule inspections online.
Contractor:
PHONE:
Applicant:
RUSSELL WELLS
4155 SW CEDAR HALLS 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(Soo Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12021-00041
Tvoe: 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 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 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, <Trent Brickey>at
<971-228-9269>,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 PFI##: 2021-00041
ENGINEERING•DEPARThENT
s Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION nTE OF WORK
Project name: 51351'u/O R nTE I-Ptw wast•Dtilim thommci'NtGod:
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MAG-1217 Sdra•.B:iD,ieaan/se•a<t
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F,erfnm,ed for the PurPaxe of.
• Sidm A msta➢ation or repai.
SITE INFORMATION • Ddrmal approach instanai<>tt
f and rcpau
Location (address if arailablel: 3 S�RoBIh 4Wl Sr. Saoira r s<®erlatetal os allauun and nam
It,r tap
❑ TYPE 3-Fu0 scale Drt ek pm t
Work-prrf t ed arim Land use
APPLICANT INFORMATION appro+d aiich itchider floc of
flat folk M
i
Name: C�� A —' Subdirisions or Parrmaus
lIailingaddress $,,,I
n q •M&nhae i,abl6tinn fat sanitan
C1tv'stair:� _LGL.—_.-.__�,{ _/ snit.Stonu seamc Tigard svter aad
Photic:
"�117�1m � TigardR'atet 4rtitt.Mea
❑ TYPE 4-Sna91:e8 Tnauwk'4^
Erruit:o elf4w '� hone: -(,43 j1b --- ❑ rrrss-r dr ar
Contact name: 91550
Phone: 663'31Z'1550 Email:
CONTRACTOR INFORMATION I1TSartu as applicant
Name; CCB Number.
\-tailing address: city/state, Zip:
Phone: Email:
ENGINEER INFORMATION
Name:
hailing address; Lip:
Phone: Email:
ADDITIONAL INFORMATION
F_stinuted ralue of work is required(if orer$5.000):S — (within the public right-of-way)
Is work related to a LkND USE DECISION' 111'es PLNo Case number.
PaR[1 Of 4
_ ,
City Of TiEud 131^_i j� Hs11 NI'd iagaro.t+rcg<m>..mo :.+r+«waw..aJ+.s•n iu}71 d-�i_I
APPLICANTS
NOTE: Person specified as'Applicant"shall be designated"Permitree"and shall protide financial assurance for
work,if required by die city pursuant to TMC 15(4.140
With she eseeptioo of a utilin.oPtr112118 pmaumt m a slid fra wlaw of license with the(:ar of Tigatd,wbeo she owner and sbe applicaul
are dffiett r peopk,she applicant muss be the purchaser of record os s kssec iu possesssw with wr&m suthOwstion fmm dtc owncs
or an agent of the ow an The owsstr seas sign this sppbcaticm in the space pronded or submit a wrirteo ambonzaaon with this
appbutio Franchised of licm"d(fumes aR ea re(iured to obtain the ow rtees signanre sin Ihr am,be.tiu a.
I,the applicant,certify that:
• To the best of my kmnvledge,all die information provided within this application package is complete and
accurate.
• The above request does not violate any recorded deed restrictions that mar be attached to or imposed upon rhe
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.
A C#�-Iijud
.Applicant's or authorized agent's signature Print name Da e
Property owners signature (if required) Print name Date
Case No: PF12021-00041 p Permit fec: 3JJD,t7V Received by: NT Date: 1/27/21.
Approved by: T!li�1 O, Date: I/?-8 Z12/ Notified by:_M.1--Date:gpm �
Ciryof Tigard 1315 Sa'Hall Bl d. • Ttgasd,Oregon 972.3 • x .as trdoLgpv • %3-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
INITIAL PFI PERMIT FEE
Part I: Reyuued submittal fee is 1(1"•of the Net PH Permit Fre,See below for calculations.Minumim of S31)0.
NET PFI PERMIT FEE
Pan 2: lill non-water system unpmvements rngnter s estunate\i"o(less the niml PFI Peanut Fee).
WATER LINE CONSTRUCTION FEE
Pan 3: -U public water system unprovements enpicei s estimate S 12"
FOR STAFF USE ONlY FOR S,1AFU I ISE ONLY
TYPE 4:SM.ALLWIRELFSS FACILITY TYPE I—3:DETAILED'
SUBNffTTAL
D> es applicant Lair a nght-of-way license? 0 Yes O 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 [I Site Address
application-t
TYPE 3.Must provide 4 sets of plaits(sized 24 x%
or 22 x 34)and an electronic N ersion of all submittal
The proposed equipment is located on which of the following: items. The plans must that include:
D Public Right-of-Way ❑Private Property
❑ Cagey—Site,Vicinity,Abbreviation,legend
If equipment is to be located on private property,descnlre the [I General Dotes(City, 'ater,Sewer,etc.)
type g use ❑ Street(Plan,Profile)
❑ R'atcr,Storm and Sanitary(Plan Profile)
❑ Watcr Quality Facilities
❑ Grading
❑ l.andscapmg/Tns Plan
❑ Composite Utility plim(Flecmcal.Phone,Gras,Storm,
Senuaty,wn' r,Simage,Street lights.etc.)
❑ Details
❑ Traffic Sight Mtancc
❑ Signing and Striping
❑ Street light Plan and Photometric
❑ Ltgmeers seal/sip�tature
❑ Sheet lslxl(project land use name,recision and plan
log block,dams and sheet munben)
❑ FngmccYs Construction Fustimate
Addidandl SisbmUtals
(per land use conditions,if applicable)
❑ Traffic Report
❑ Stom water Drainage Cnlctulotions
❑ Geotechnical Report
❑ Prelinamarr Access Report(Sight Distance)
❑ Proposed Plot
❑ Pathwal Design
❑ Weer Providet Approval
City of Tigard •v 13125,W Hall Blc-d. Tigard,Oregon 972.3 www:tigardocgov • 503-718-2421 • Page 3 of 4 w
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Street&street names U existing structures
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_Existing S/w or D/A'apron Slope of proper _Trees
City of Tigard • 13125 SIXHall Blvd, "Tigard,Oregon 97223 • auu:ngmrdocgov • 503-718--2+21 • Page 4 of 4
NO JOINT POLE NOTE
—JOB SITE
CONSTRUCTION NOTE 8935 SW BURNHAM ST ,,N _.-•,
1-CUSTOMER DRIVEN WORK ORDER- eG rouuxu
CUSTOMER-TVF&R
PSR 3385108
ZIPLY SALES MANGER BOB BURTON-503-891-0920 A�, aucw n x 60 0
VICINITYMAP
2-CITYOF TIGARD PERMIT FOR THISJOB ZIPLY FIBER
SEE TRAFFIC PLAN TIGARD C.O. m -
51351-W0880501.WP1.PERMIT 8938 SW BURNHAM
SW MCDONALD STREET
OPCEN NOTE KIM
1-CUSTOMER DRIVEN WORK ORDER- oxo. Th " Dula.w xxv
a«o ntt
CUSTOMER-TVF&R
o cw Piwcews
PSR 3385108 0*� a"° u•e
ZIPLY SALES MANGER BOB BURTON- eexnxrs
503$91-0920 wxxclvuln tm/mrAo
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2-CITY OFTIGARD PERMIT FOR THIS JOB 2021 ETHERNET BLANKET j n nn
SEE TRAFFIC PLAN 51351-5504207-28 0 o mncu�xar euxxx.�
57351-W0880501.WP1.PERMIT o xo ream:amecxm
CUSTOMER-TVF&R
8935 SW BURNHAM ST /xNssoPxr rou
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TIGARD,OR M..rex reaT161,
BOB BURTON-ZIPLY SALES MGR eanoz du x
0 0 o PtlRS
503-891-0920
O O D exaxre"
ASSIGN-
PORU OPv�LLS
CONSTRUCTION CONTACTS BBFTP FDT-509202 xxmua
DAVID CARNLEY-971-940.9000 TGRDORXA BBFTP H4012,421-PORT 1 SHEET 1 OF 3 aroa6%lum
JAMES STAATS-503-7511,3119 LCON-ERIC KENNEDY NORTH
'c w'
SCHEDULING CONTACT _": `"
RYAN ROBERTS-603-8433713 TVF&R-503-855-8846 exm+i eo
wvaun
FACILITIES CONTACT
LAUREL KIELTY 425-2834005 LABOR HOURS MATERIAL REQUIREMENTS
SPLICE-C-BIM-21X-0 I zi yfiber
INSPECTION CONTACT 1-8 PORT TERM EM
RON HAYHURST 503292-3345 CREW C-141WM-D 1000'TAIL
FLAGGERS-20 HOURS TGRDORXA/PSR 3385108
ENGINEERING CONTACT INSPECTOR-0 HOURS "'SONICOM TO PLACE 8935 SW BURNRAM(TVF&R)
RUSS WELLS 503-312-7330 SONICOM WORK TO PLACE 21X FIBER DROPS INTO FIRE nwern W0880501 tmxcope.mssi
DROP STATION-300'EA Exm axe xee LAI.
51351-VV0880501 °°�.x�;.
.ee
TGRD i
A TGRDORXA H4012 HH E
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TGRDORXA H4012,1-432 OUT `� BURNHAM ST
B NEW
1000 8 FIBER TAIL `� H
Z TGRDORXAH4012,42142B+XD,7-8
xszm LIGHT UP H4012,421-426 ST ,j/'
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8 PORT EAN 1000'TAIL "_'°' ACCEPTANCE TE 238 289 SW BURNHAM ST
BBFTP FDT 509202 • o NEW FDT 509202
TGRDORXA H4012,4214 + D 7-8 A; \\\
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BBGTD 8,7&76-100 \\\\
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BBGTD 8,78-100 12 FIBER SHEET 2 OF 3
F TGRD MH TGRDORXA H4012,427.432+XD.7-12 NORTH
7/1A I TGRDORXA BBFTP FDT 483002
TGRDORXA H4012,427432+XD,7-12
G TGRD B K 300 05.2017
1S2/1B NOTEED ON
432 RBN l
PLACED ON NEW FIBER TAIL TGRDORXA H4012,1426+ l
OVER PULL NEW FIBER TAIL"B"WITH ` XD,427.432
j 225850.2008 884//FC2042,1-884
YGD 864 300 05.2017
FC2042,1-864 432 RBN
TGRDORXA 1-14012,11420+
XD,421432 51351-W0880601 Ziyfiber
CUT DARK"K"432 RBN H4012,421-426 TGRDORXA/PSR 3385108
•"•°0D 8835 SW BURNHAM(TVFBR)
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OVER NEW 8 FIBER TAIL WITH
EXISTING 581 FIBER/FC,2042,1-884 51351-W0880501 TGRDORXATPSR 3385108
8935 SW BURNHAM(NFBR)
THE 884 FIBER SHOULD GO TO THE
HANDHOLE ACROSS STREET wn'Ap1EiE`n;W0880501 co•a+. a
RODDING TIME GIVEN TO ROD w.e emea m� im.
DUCT cl owo or s
I
SHEET 1 OF 1 SIGN SPACING AND BUFFER LENGTHS
NORTH POSTED SPACING BETWEEN SIGNS BUFFER
SPEED A B C SPACE
20 50
25 100 100 t00 75
30 00
35 350 350 350 125
40 150
45 180
50 500 500 500 210
55 250
P
***JOB SITE-
G TVFBR
8935 SW BURNHAM S7
/e 51351-W0880501-
FO/� WPI.PERMIT
t LANE CLOSURE NTH FLAGGING
E �� AT WORK SITEIWHI LE SAFETY ESCORT REQUIRED
Op u ��` AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS
OOOT DIAGRAM 820
REFERENCE
/ OZIPLY FIBER WORK ZONE ��� C9 O FLOGGER AHEAD SIGN
AND
F m
AND NEW FIBER CABLE ROUTE /e O �+ o
G A BE PREPARED TO
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AA
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8� \ p AHEAD SIGN
B
UTILITY WORK
PA ya G AHEAD SIGN
So
9
PQOpO�9 C'F'
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FLAGGER V4 PEDESTRIAN I BICYCLE SAFETY ESCORT BB=ZIPLY FIBER
TRAFFICMANHOLE•EXISTING TGRDORXAIPSR 3385108
DIRECTION 8935 SW BURNHAM(TVFBR)
SAFETY CC=ZIPLY FIBER
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