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PFI2021-00271 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12021-00271 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/26/2021Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY Subdivision: None Lot: None Project: Comcast 716906- 13500 SW Pacific Hwy Project Description: SEG 1472/Overlash coax cable to existing spans at 13500 SW Pacific Hwy Class of Work: FEES Type 1 -Utilities(gas, electric,data) Description Date Amount PFI Permit Fee 07/21/2021 5300.00 Owner: Total $300.00 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: KYLE BROWNING 11308 SW 68TH PARKWAY TIGARD, OR 97223 PHONE:9718015787 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: ./.ASeeje a a/p�p�liic�atiionn4/,A� Issued By: ; Y'i1 1 `LI) Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00271 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 [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 maybe 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-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 #: PF12021-00271 s ENGINEERING DEPARTMENT Public Facilities Improvement (PFI) Permit PROJECT INFORMATION 13500 SW Pacific HTYPE OF WORK ac Project name: Hwy ® TYPE 1—Franchise Utility Work Brief j ro f o description project: Overlash coax cable to existing spans. performed byNWN,PGF, or utility P P agency ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer SEG 1472 Work performed for the purpose of: - Sidewalk installation or repair - Driveway approach installation and repair SITE INFORMATION - Sanitary sewer lateral installation and 13500 SW Pacific Hwy. Ste 78, main line tap Location (address if available): y Portland, OR 97223 ❑ TYPE3—Full Scale Development Work performed with land use approval which includes any of the following. - Subdivisions or Partitions APPLICANT INFORMATION - Street widening Name: Comcast - Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 11308 SW 68th ParkwayTigard, OR 97223 water service area City/State: Tigard OR Zip: 97223 ❑ TYPE 4—Small Cell Technology Phone: (971) 801-5787 El TYPE 5—Tigard Triangle Email: Van_Mesplay@comcast.com Phone: (971) 801-5787 NOTE: Type 1 and 2 applications may be Contact name: Van Mesplay emailed to rowpemuts[a).ngard-or.gov. Phone: (971) 801-5787 Email: Van_Mesplay@comcast.com CONTRACTOR INFORMATION ❑ Same as applicant Name: Texstar Enterprise, LLC CCB Number: 228361 Mailing address: 14122 Arndt Rdcity/stare: Aurora OR Lip: 97002 Phone: (503) 793-3140 Email: scott.boyies@texstarenterprises.com ENGINEER INFORMATION Name: K&B Technical Solutions Mailing address: P.O. Box 2529 city/state: Clackamas, OR Zip: 97015 Phone: (719) 244-1608 Ems. Kyle_Browning@kbmail.net 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? ❑Yes 0 No Case number: City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.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. R:,ted. Kyle Browning �_�=wv°�-'-� Kyle Browning for Van Mesplay 7/20/2021 Applicant's or authorized agent's signature Print name Date. Property owner's signature (if required) Print name Date. STAFF USE' ONLY Case No: PF12021-00271 Permit fee: 4 300 • evv Received by: NT Date: 7/20121 �' 2� 2d2 f Approved by: /�Yn><' Date: 710/12r/Zf Notified by:�Date: City of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwrigard-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 101/6 of the Net PFI 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 PFI Permit Fee). WATERLINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR ONLY • ONLY WIRELESSTYPE 4: SMALL DETAILED SUBMITTAL REQUIREMENTSCHECKLIST 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 Haw many install sites are proposed as part of this permit ❑ 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: ❑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 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.) ❑ 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 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4 Edge of Pavement I •— Ditch --go' n Streetlight I —•—•—•—•—•—•— —r—•— T r I t ati,�, I I '�I i Y�r vc, e'{�rmnr— I 1 Existing House r� I Existing Driveway 1 a, �I s I I rl I I c. >110 Existing Shop cm Powerpale I o l e l� 95' 1Tr0 a l.79 -.- L ��-- per,-- --- II Fira Lant(FH) I IT I Scale. 1"=30' I I I TITE I AND TYPE 2: MINIUM SKETCH I I I ' I I � I REQUIREMENTS 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 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Pdge 4 of 4 w 4q m 1 \ a µ` Oapp KOM CtlOIM1O110N � 6 S W L] // ,• �� / .. �� loos. toleo / / 131M // terve o OVEFOA6R=COAX InFKx) ) i' , \ ,fib E�POLE i i i \ /v \ E a e 8 40 u v v �ciio - \ a 1 > 116 � / � V i�I AREAS TO BE RESTORED TO LIKE OR BETTER 2 ALL OTHER UTILITIES ARE BASED OFF EKISTRO LO TES cMocaT,RP 1 OR u Lm 6TRu RES. 3.rt M TIE C0,6TRUCT COR,RA T7 +M, REsrorase TO FOR LOCATES e6soRs Or-GM. n.tue, z �m m �a O 0_EBCRIPMW. EAAMPIE: GBCRPfIOIt EYAMPLE: LL% K= JOWTUSEPOLE 9S2 l W LL7 J TRENCH ____________ JOINT OBE POLE W0 TRANSFORMER mJGL EAI$TFY4 CONDUIT fUNIR POLE NYTRAN.FWMB! U STRAMOANDMRGBLE ....._.-..__... POWER POLE - RNRR OF WAV CABLE FDIE PROPERTY UNE ------ - TELEPHONE POLE E . PANIC mlEASEMENT u-- POLE CONDUIT RISER .. . CB11911INE �n PEDESTAL.VAULT 8 FACE OF C/ --,< - MANHOLE --- --- ED=OMYEAIBEf v - - GTOItN.M _ • III. . EDGE aF GEMVEL s VALVE RYATER,ORB,ETC) X i EDGE OF SIDEWALK -•,._-__ MUM(WATER,GAAL - . EDGE OF ppAI[WAV on- FINE HYDRANT b REMM A EBLACELMM BONE PIT ffiWFIi -STORM WATER am Y PORTR • ' TBECAM UMMATION CATV TREFMCONOW -�-- >TEM FENCE LME - •-- QB QUARDRAE RAEROAG,MdfB i U RP-L tl1ElL0)M1.1{Y1 Page 80 2011 Edition 5.3 Two-Lane, Two-Way Roads Shoulder Work w/ Minor Road Encroachment Diag. 300 Use this detail for non-freeway work which extends into a travel lane and maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane cannot be maintained, or when traffic cannot safely pass by in both lanes simultaneously, use the appropriate lane closure diagrams—for example, Diagrams 310 through 350. A lane closure may be appropriate for conditions such as high traffic volumes, high speeds, and inadequate approach sight distance to the work space, or heavy equipment adjacent to the travel lane. 1. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 2. For added visibility, a truck-mounted arrow board or PCMS in caution mode may be used. 3. Cones shall be placed along the entire length of the work space. If a protection vehicle is used and work is in place one hour or less, the taper and tangent devices may be omitted. 4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there is limited sight distance, consider placing cones or tubular markers on centerline. 5. An arrow board in caution mode or truck-mounted PCMS with "SHOULDER WORK"or other appropriate message may be used for higher visibility. Sign Spacing and Buffer Lengths (feet► Posted Spacing Between Signs "Buffer" Speed A B c Space 20 50 25 100 100 100 75 30 100 35 350 350 350 125 40 150 45 180 50 500 S00 500 210 55 250 60 285 65 700 700 700 325 70 365 Chapter 5 September 2016 2011 Edition Page 81 Shoulder Work w/ Minor Road Encroachment Diag. 300 ROAD WORK • AREAD • Initial Warning A • Sign (Optional) • I • Protection Vehicle w/TMA(both Optional) See Chapter 4 � � Buffer I 10' minimum • U3 A ROAD NARROWS (Optional) B AHEAD M RoaD • WORK Initial Warning Sign September 2016 Chapter 5