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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: .SdL Li�_ Pd b} .PGE and/r,r Bnef d�escnptlitm vti prujrctQ: Qd'11,,���� G�- „rihn.procV ��F+Y 11 r b�-I�S S��T• O -C1'PE3-RM' � MAG-1217 Sdra•.B:iD,ieaan/se•a<t SE 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 SEE; 5'1351- wo Sgoso I . wp I. p E6'<:SPavement I +— CCG C- f FC E-isung House lz °Y r"p:Pwdy a I 1 •I c� �c � Eeeeunq Shop I PO++R.`polP I I 1 is I 1' 1 11 95, i... 1 �1 Froprrtj Ona I I 1r I j I I I t I Scamp 1._30. j I I JYPE I AND 11 P] j j I j � I j I I North arrow _Propem lines&dimensions _Ewting utilities locations (sewer,storm,water) Street&street names U existing structures ::Zproposed work _Existing curb or edge of pavement Utdin•&street ligbt poles _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 NJMICIPAlItt 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 :eN/NJ1 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 FDH CABINET 48/432 TGRDORXA FC2041,746768+ \ C TVFBR XD,26481N 6935 SW 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/' • ° IN NEW 8 PORT"B"IN MH 1/1A \ CITYITIGARD C ORD HH 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; \\\ D 2422.101 G\ \\\\\ BBGTD 819428 BBGTD 8,7&76-100 \\\\ E 2422.101 H UGAKF:25-26 1000 10.2020 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) • ° enaecr coavEw- ww•w.W0880501 s,s� NAT f srxe�nm +u aemic.. m,aw z os a nm•v ix2LVRfiBER� tigV.—b.TOn.._y _- ruasaa. moTi-moi.+. c w.s ' "Is--310 `o:.iTu�D ro uH�s 9 w.T«TM1 TD ' r nm a i' y H x�R11 9Im08[ F.' O nH SHEET 3 OF 3 .. �, NORTH -- O cmu T..MH 1D ziplyfiber 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 /C+ _ ; E STOP SIGN AA S y A z o F ONE LANE ROAD 8� \ p AHEAD SIGN B UTILITY WORK PA ya G AHEAD SIGN So 9 PQOpO�9 C'F' d AA=ZIPLY FIBER- BICYCLE LANE F,VQtiOT FIBERHUB-EXISTING Z1 yfiber FLAGGER V4 PEDESTRIAN I BICYCLE SAFETY ESCORT BB=ZIPLY FIBER TRAFFICMANHOLE•EXISTING TGRDORXAIPSR 3385108 DIRECTION 8935 SW BURNHAM(TVFBR) SAFETY CC=ZIPLY FIBER SIGN HANDHOLE-EXISTING r..• MM0501 ucR moe.aoa RUNN GiE. lNGR. RU99 N8 1Y.W Ig6'1111 PIpNE'.!MM)I W1 lE. IGVE.. IYpB1RCi. P'/J Cf TMAW. RIIt: 9EC