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PFI2021-00305 • CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT . I COMMUNITY DEVELOPMENT Permit#: PFI2021-00305 Date Issued: 08/24/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: seg1728 Jurisdiction: Site address: Subdivision: Lot: Project: Ziply Fiber-5506186 Project Description: SEG 1728/1734/ 1729. Removing and relocating facilities at the intersection of SW Bull Mountain Rd and SW 153rd Ave Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) 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: JASON BELL 4155 SW CEDAR HILLS BLVD. BEAVERTON, OR 97005 PHONE: 5036261134 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: See application Issued By: j6lajA X1A/tek Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2021-00305 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 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, <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 27 -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. PH_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). City of Tigard PFI#: PFI2021-00305 _ ENGINEERING DEPARTMENT iT TIGARD Public Facilities Improvement (PH) Permit PROJECT INFORMATION TYPE OF WORK Project name:5506186-SW Bull Mountain Rd Relocation/Removal m TYPE 1—Franchise Utibry Work performed by NWN,PGF., or utility Brief description of project: agency Removing and relocating facilities ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer Work performed for the purpose of: in conflict with"Bull Mountain Summit"development. • Sidewalk• installaton ox repair • Driveway approach installation and repair SITE INFORMA1'ION • Sanitary sewer later al installation and main line tap Location (address if available): 15345 SW Bull Mountain Rd ❑ TYPE 3—Full Scale Development Work erformed with land use approval which (Intersection of SW Bull Mountain Rd and SW 153rd Ave) includes any of the following: • Subdivisions or Partitions • Stretwdening APPLICANT INFORMATION • streetMandine installation for sanitary sewer, Name: Ziply Fiber storm sewer, Tigard water, and Tigard water service area Mailing address: 4155 SW Cedar Hill Blvd ❑ TYPE 4—Small Cell Technology City/State: Beaverton/Oregon Zip: 97005 ❑ TYPE 5—Tigard Triangle Phone: 503-626-1134 ason.bell@ziply.com Phone: NOTE: Type 1 and 2 applications may be Email: jason.bell@ziply.com to rowpermits@,tigard-ot.gov. Contact name: Jason Bell Phone: 503-626-1134 Email: jason.bell@ziply.com CONTRACTOR INFORMATION 0 Same as applicant 208747 Name: North Sky Communications,LLC CCB Number: Mailing address:11818 SE Mill Plain Blvd,Suite 410 City/State: Vancouver/Washington Zip: 98684 Phone: 503 582 8797 Email: awpalmer@northskycomm.com ENGINEER INFORMATION Name: Jason Bell- Ziply Fiber Mailing address: 4155 SW Cedar Hills Blvd City/State: Beaverton/Oregon Zip: 97005 Phone: 503-626-1134 Email: jason.bell@ziply.com ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ $0 (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes 0 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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 TbEC 15.04.140. With the exception of a utility operating pursuant to a valid franchise or license with the City of l'igard,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. 'Ihe owner must sign this application in the space provided or submit a written authorvation with this application. I ranchised or Licensed Utilities are not rcyuircd 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. Jason Bell 08/18/2021 A c is or uthorized agent's signature Print name Date Property owner's signature (if required) Print name Date Case No: PF12021-00305 Permit fee: `� Received by: NT Date: : Approved by: -0-77.-, Date: 67? ?hC'' Notifiedq. b : f 1t- Date: • City of Tigard • 13125 S\V Hall Blvd. • Tigard,Oregon 9'223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 SCOPE OF WORK: FOR FACILITIES USE NCINRY MAP 5 _ t NEW DEVELOPMENT BULL MOUNTAIN SUMMIT WILL BE WIDENING ROADWAY AT INTERSECTON OF SW BULL MOUNTAIN RD AND SW 153RD AVE,CREATING CONFLICTS WITH g ZIPLY FIBER FACILITIES.REMOVING PEDESTAL.3X5 IN SIDEWALK,AND RELOCATING 17X30 EFFECTED TERMINALS: Y HANDHOLE.DEVELOPER WILL BE REPLACING HANDHOLE AT NW CORNER OF SW BULL ORK AREA MOUNTAIN RD AND SW 153RD AVE WITH TRAFFIC RATED 3X5 VAULT. TGRDORXC 456P73S1 Ee^ sw,xmAvT REMOVE PEDESTAL BFHAW 469 AND 25PR COPPER TERMINAL OH SW BULL MOUNTAIN RD. BFHAW469(REMOVED) ffi/ rC's BUTTSPUCE COUNT BFHAW DE8,1826-1850+BFHAW DEB,1576-1900 IN 600PR COPPER CABLE j/ oNP" AND BURY SPLICE IN STEEL SPLICE CASE.BURY 96-FIBER THAT PASSES THROUGH �.$• aw>� g 0' PEDESTAL 469. a7 I �_- ` REMOVE 3X5 HANDHOLE 5013031N SIDEWALK ON SW BULL MOUNTAIN RD.BURY EXISTING �.Py„o,M I / STEEL SPLICE CASE AND PLACE SPLIT-DUCT OVER 1.25'CONDUIT CONTAINING 96-FIBER k wn i i J CABLE. IL /ILd�I ON SW 153RD AVE,MOVE 17X90 HANDHOLE CONTAINING FIBER TERMINAL 46559 2 8 ' I M A HAKE APPROXIMATELY 5'NORTH. TRRDORXC 46559 REL'CATE CONTACTS: _IN:TGRDORXC H2008.193-195* HANDHOLE RTH ENGINEERING Xp.4 OUT: JASON BELL-503-626-1134 /1.7 BOO 09.N 6 FACILTIES ✓/ RBN 1696 ANGELA ECHAURI-503-613-0390 TGRDORXC H2O09,9RH9+ i 'r�XD,24-39+ INSPECTOR TGRDORXC H2O09,136-144+ JOHN GAYLORD-509-268-7182 XD,49A3+ TGRDORXC H2O09.159-164* �1,� SPLICING/PLACING %166-173* ' DAVID CARNLEY-971-940-9000 TGRDORXC H2O09.XD,78-2+ I AE 2522 Xp,78-96 BFHAW DEB,1876-1903 LOCAL MANAGER EITMATEO HOURS h _ 1.25'CONDUT I( 1 _ NISHA CARLSON-50}259-3428 PLACING: may_ MNNT.00 X-11ME 14 R 1 SPLICMG: CAP_W MNNT.00 X-TME 06 252 44 '. A _ ' I�TB INSPECTOR CAP.00 MUNT.00 X-TIME 12 _�__ _ �3 is- NAGGERS: CAP.CO WONT.00 X-11ME 16 AKF-1 21 m J% TGTAL HOOTS LL 489 01 IGT PLACING: CAP._ WONT._ MIME_ BFHAW[#8,1801-1825 •� ' 0 SPLICING. CAP-_ MUNT._ %TME_ 11 rY > FTTP PIGTAIL 1000FT 4 )(TIME_ TGRDORXC H2O08.193-195+ INSPECTOR.CAP._ NNW__ ' X13,1a3 , l�3AO I AE 2s 22 FLAGGERS'. CAP._ MAW._ z-TIME_ I`Z�_- �� '<.ZP I BFHAW DEB.1876-1900 XD,4 SHIVER ____a 1 I I LONST.START ❑ APOWIN ARE 60020- � �_ 2%3 NANDHOLE TO BE INNEmce COMPLETE _ MEP F "MLA', �� ' REPLACED WITH 3X5 qb0 BOOST.C ETP O FIT,'" LA', BFHAW DEB,1801-2000+_` • JOINT POLE XD201-b00 �`' � � INTERCEPT VAULT BY e.OJ Curs REQUIRED IIIIIII ! I . _= I DEVELOPER y6 O NO ��6 W REQUIRED ❑YE9 I(TGAW DEB,401-1821� �jl:�` _.,. PaE TO PROM sN LPN 0 00 TRENCH sIpN -- HAW DEB,1801-1825 AKF 600 2fi I'll14-----=`---- � 04•�ZS' 0 R ❑ 0SOCN BFHAW DEB,1801-2000+ L-,�_ I �� Xy5 XD.201.800 > 3W B�L ❑ 0 0 PoWERZIPVI RBFA _ _ '` MAIN �� CONLGGING N PERMITS %D,1-25+ `' \ RO Mu'AaPADTY of neAfiQ BFHAW OEB,1826-1850+ �' \_ ❑DIAL ADIG ❑w � O FLAGGING IQ TCPI'IUFFL 1 %D 51-75* 1.25'CONDUIT ~+` �'J/-�J ❑eRus0Nc I I BFHAW DE6,1876-190M i I _ \ �� `� ❑ ROOD G 0 DETAILED(NOT BLANKET) ` peat Io { 0 XD•191-690 P I \` _\` z - ILM1T HH 501301.25'CONDUIT I BFHAW DEB,1801.2000+ '3 26 `~ `�- \� Zi� I§ (REMOVE3 ,BURY)( PPER SPLICE CASAKF6002fi BFHAW BULL MOUNTIAN SUMMIT-CIAO I tit,- PLACE SPUT-00CFHAW DEB,1801-2000* II 'Q BFHAW DEB,182&1850+ \1 1 OVERCONDUIT W X0,201-600 %0.51-75+ m 96-FIBER CABL �' I _BFHAW DEB,187Mt908a Q P�� LhMEI en Iy XDi'2'-� IA XD.t918f10 NUMBBt 55I✓I� MII.031E MAW* BFHAWO .1826-1850+ I{ Z I `RUNlprre Mm.yVpefil cNR M1TSIRIOI SW ARI FNF N _ XD 51.75* 1 Cn 1,25'CONDUIT M2 POE NMI1Y iM MIMING BFHAW DE15,1816-1900*-_ II yyE: nm AMINO' I OP I X0101.600 I I 1 ._ - I / ll Il Ili Page 94 2011 Edition Self-Regulating Lane Closure Diagram 350 Use this detail for closures of one lane of a low-speed, two-lane, two-way road. 1. Use this diagram only if all of the following are true: a. Work space is less than 200 feet. b. The posted speed is 40 mph or less (unless not posted and speed governed by basic rule). c. Average Daily Traffic(ADT) is less than 400. d. Sight distance (in feet)is more than 750 at each end. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 3. For added visibility, a truck-mounted arrow panel or PCMS in caution mode may be used. 4. A"Lane Ends (Right)" (W4-2R)symbol sign, or"RIGHT LANE ENDS" (W9-1R)sign, may be placed inside the cone taper for more emphasis. 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 35 125 40 350 350 350 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011