PFI2021-00306 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
3 COMMUNITY DEVELOPMENT Permit#: PFI2021-00306
Date Issued: 08/24/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
Parcel: SEG1073
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Ziply Fiber PH 5504207
Project Description: Accessing 3 exisitng MHs to splice fiber
Class of Work: FEES
Description Date Amount
Type 1 -Utilities (gas, electric, data) PFI Permit Fee 08/24/2021 $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:
MICHELLE ROSE
6074 N DISCOVERY WAY SUITE 125
BOISE, ID 83713
PHONE:
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.
PermitteelApplicant
Signature: See application
Issued By: G6 14-I(J
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2021-00306
Type: Condition Name: Status: Severi :
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
IMUTCD]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
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 applicants 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).
City of Tigard PFI#: 2021-00306
i s ~ ENGINEERING DEPARTMENT
TIGARD Public Facilities Improvement (PH) Permit
PROJECT INFORMATION TYPE OF WORK
5504207-437 TYPE 1—Franchise Utility Work
Project name: performed by NWN,PGE, or utility
Brief description of project: Accessing 3 existing MHs. to agency
splice fiber. 0 TYPE 2—ROW Sidewalk/Driveway/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair
• Driveway approach installation and repair
SITE INFORMATION • sani
Sanitary sewer lateral installation and
main line tap
Location (address if available):
12562 SW Main St Tigard, OR 97223 ❑ TYPE 3—Full Scale Development Work
performed with land use approval which
SEG 1073 includes any of the following.
• Subdivisions or Partitions
• Streetwidenirrg
APPLICANT INFORMATION • Mainline installation for sanitary sewer,
Name:
Ziply Fiber-Michelle Rose storm sewer, Tigard water, and Tigard
water service area
Mailing address: 6074 N Discovery Way Ste 125
Zip.
83713 ❑ TYPE 4—Small Cell Technology
Boise,ID
City/State: ❑ TYPE 5—Trgazd Triangle
Phone: 208-576-4031
permitting@mountainitd.cortshone: NOTE: Type 1 and 2 applications may be
Email: emailed to row-permits(n,tigard-or.gov.
Contact name: Russ Wells
Phone: 503-643-1001 Email:
russell.wells@ziply.com
CONTRACTOR INFORMATION 0 Same as applicant 0012725
Name: Northy Sky Communications CCB Number:
11818 SE Mill Plain Blvd ste 410 Vancouver WA Zip: 98684
Mailing address: City/State:
Phone:
503-206-4550 Email: dmatton@northskycomm.com
ENGINEER INFORMATION
Name: Russell Wells
Beaverton, OR 97005
Mailing address: 4155 SW Cedar Hills Blvd City/State: Zip:
Phone:
503-643-1001 Email: russell.wells@ziply.com
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? 0 Yes 0 No Case number: g {•.t _ 3`�� we
/n4tAC ST r s /(u--rz c . u a�lt.11- a.,iv to s T/ut-r Q L
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-orgov • 503-718-2421 • Page 1 of 4
I
CUSTOMER:
ORDER A:
ISSUED: DUE'
ADDRESS'
lSERVICE TYPE:
ASSIGNMENT
TEST re® kHz
SPECIAL NOTES'
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PROJECT 51351-#5507057-W0895394
BBGTD-TIGARD-METRO-E-12925 SW PACIFIC HWY-PORTLAND/TIRGARD OR
CONTACTS Order.ASR 3392522fircu,t lD:43(IFGi/323913//NWFC/Service:Ethernet 158 � KF PDN�CAKES nto CLOVEN.ALWAYS
DMA
KI.AMORAL
ENGINEERINGCustomer End User Verlcon Wireless ORHI-Tlgard/99 ME
R1153 WELLS Address:12925 SW Pacific Hwy,FL 1-Portland,OR -MONDE APPROVED TRAFFIC CONTROL KM.ALWAYS GET LOCATES BEFORE My AND
ALL 303-643-1001 Exchange:rGRD/51351 LCON:TECH ON DUTY 5033503250DIGGING.ATTENTIONFAno y0.TlUE CATER HEAD POWER ALONG BY lI DIME TIORK
tEFF KEEL Copper Terminal:BRGTD 19862 AREA.ANY QUANGO OR ADDITIONS ES TO BE PRE—APPROVED THE LOCAL
ENGINEER.F BR ALL LOCAL NO FEDERAL SAFETY UOLRE µ TERIING AND
972 249 8968 Fiber Count:X0,1-21TGRDORXA FC2042,843-84H CI
XD,7-24 SAFETY EQUIP EMO UP ANY YORR AREAS IIEFCRE LEAVING TO TIE TEXT LOCATION,
FACILITIES Reavenon Facilities Reserve FC2042,847 CONN:7 ENSURE MADE AND GROUND IS REARMED.ENSURE THAT ALL REGIRED PERMS ARE
5fl44 E0191W 5504207.437/W0895394 MUTED AND ON HAND, MUM AU.NAWIOIE PPE AND SAFETY
503-643—QT90 Solution: PROCESSES
INSPECTOR TGRDORXA•129255W Pacific Hwy,EL 1-Portland,OR
DAVE CARNLEY Locate Mn 11/383 on HWY 99 N/OMCKENZE.Spike FC20e2,847443 train the
971-940-9000 864-Fiber(IPR1-47963)to the 24Rber ORIEL-6/1693)going to the customer.This wilt
SPUONG/PLACING go with FC2042,X0,1-21TGRDORXAFC2042.843-846.1D,7-24.FC2042,848 will be
DAVE CARNLEY a spare to this customer.fiber good to terminal at the customer MPOE.Test Fiber UNITS/ACCT CODES
971-940-9000 FC2042,847 from MPOE back to TGRDORXA FOF 005-35-55.
LOCATES Place NM and turn-up service.
•
OREGON B11
HORS Jeff Keel
PLACING-0 HOURS le lTey.keelpziPN,com
PLACING FUGOER-B HOURS 972-249-8968
PLACING NSPECTOR.0 HOURS -
SPLNRM-12 HODS
OR HWY PERMIT MAY BE REQUIRED
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SAUCING REARRANGE CLOSURE IIG-3 2422201
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•
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/ (THROW 2 FIBER COUNT INT0)4 FIBER TO CUSTOMER)
✓pN 1520 02.2011 /
NS RBN 24
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v `rl (XD,7-24) 51
RBN 24 //� ��'/'
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.N. )ID.9-24 / /�
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\4',` Customer End GRO/51 VeriIT Wireless
TECH ON DUTY ORHI-Tigard/99
Address:12925 SW Pacific Hwy.FL 1-Portland.OR
Exchange:TGnal:88 51 119862 CH ON DUTY 5033503250
�` 6> A Copper Terminal,RBTTD 19862
,+ Fiber Count XD.1-2R RDOR)U2FC26g643-8464%D,7-24
�, 4• ". r
Beaverton Facilities Resent FC2042,84]CONN:7
5394
j'� TGRDORXA.1W05 SWP
Solution:
• TGRDORXA-1I925 SW Pacific Hwy,FL 1-Portland,OR
/ __� Locate MH11/383 on HWY 99N/O MCKENZE.Splice ingto the cu48 from the
864-Fiber(IPI2-4]963I to the 24-fiber(IPIO-686931 going to the customer.This will
50.• /' — �M go with FC2042,XD,1-2-.TGRDORXA FC2042,843-B46.1M,7-24.FC2042,848 will be
• ��. t aspare to this cowmen..fiber good to terminal at the customer MPOE.Test Fiber
FC2042,847 from MPOE back to TGRDORXA EDF 005-35-55.
Ga / / `Z , �Q a Place MD end turn-up service.
/ N 3 Jeff Keel
4Q% 808 D2.2011'%a,'i r tJi JeffrKeel @siply.com UNITS/ACCT CODES
�. RBN 24 S e 972-249-8968
TGRDORXA FC2042,841-848+ IC
g C \ (�724-24) o / 1
/' •N` TGRDORXA FC2042,841
2
CD (TRW 2 FIBER COUNT IN 2® FIBER TO CUSTOMEB)—'---)
(MH 97iF�A ND 9F21115 AR C ONNED H � O CRK
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,•V7808 2011
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/ (THIS FIBER SHOULD GO TO MH 9/116 AND 9F2/115) %o
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•
4
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Itis\` 596 01.2008 Fn / `
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TGRDORXA FC2042,1-830+
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\
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GRDOR)fA FC2042,880-884
III \\T Zit*
(RECORDS REFLECT THIS MH OULD HAVE AN EXISTING CLOSURE,HOWEVER THE MH DETAIL DOE3.NOT SHOW THIS) fihr
(VERIFY EXISTING COUNT 841-8444450 SHOWN GOING TO CUSTOMER AND THE FIELD/2/2")
(CUT COUNTS DEAD TO THE FIELD AND INTO 24 FIBER GOING NE TO MH 9/116 AND 9F2/115) SAL CONSTRUCTION NOTES: 5.5042 -4t/W0895394 12925 SW PACIFIC HWY PORTLANC
MANY FAC1UTES AND CABLES ARE WITTED FOR Y.ALWAYS UER1ZE ALL PERSONAL
PPE PROVIDE APPROVED TRAFFIC CONTROL PLAN-.ALWAYS GET LOCATES BEFORE ANY AND
\ ALL E WORK
AREA ANYCRINGES OR*051110y15 NEED OVER HEAD
MPRO POWER�D81 THIS E LOOM. _ SL VES W08953945504207 I&Wrla ,tw.ao
FA%am aEALTOrA1
ENGINEER.FOLLOW ALL LOCAL AND FEDERAL SAFETY LAWS.UTIIIZE ALL TESTING A pfUANOaR MI FI65FLLRFILi Om:RI®WWmn FTERE
SEE MANHOLE D ETENSV E GRADE AND GROUND IS REPAIRED.ENSURE THAT
SAFETY EQUIP.CLEAN UP ANY LeCtil(AREAS BEFORE VIAU_REQUIRED PERMITS NG TD THE NEXT AI NA[11D;0iN t IRR—ROC E NJ m DW fPFOIW'P21MWRE V4,VON AWELESS S5
�L S SHEETS: #3-#5 ADORED AND CPI HAND.UTILIZE ALL MANHOLE PPE AND SAFETY PROCESSES
- 90 - SC -
NOTE: PLEASE REDLINE AS-BUILTS WITH FIBER INFO FOR RECORD UPDATES
SEE BELOW DETAIL DOES NOT INCLUDE FIBERS INVOLVED IN THIS PROJECT
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NOTE
•Lind[work to one corner at a time
9DEWue aosto I * # to minimize pedestrian distruption
AHEAD DETOUR DETOUR and detour length.
DETOUR DETOUR �E �-► F
- DETOUR li CROss xERE
_1.
g on
M1-9b CRLOSED. *
M4-96 M9-96 R9-11 30x29 30x29
MO-96 3Dx29 3px2a EIx16 (Mount en ellllw Mown an 911nx: <L(sYD DETOU0.
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Within Roadway rN0T6: -� (Mourn on MIIWJ .� s DESVAL
030x sox18
SIDEWALK DIVERSION •Ramp size will tarp. ,— DETOUR R9_9 Mg•ntnn90Rw
RDA requirementsmusr meet 24x12
NOTES: ADA �� MI-9b Mount on KIN
Incl.max design grade 3ox29 (2 Regd.)
•Place or construct temp.sidewalk of T.5%and max design r 1 Mount an Rim
ramp.as needed. cross slope of 1.5%. •t
•For roadways with a pre-construction
posted speed of 40 mph or less. PC➢ 4R'.Mn. • MEL DETOUR
Drain * gDwlMx C)mEn y
•See inset'A'for Temp.Sidewalk Ramp Plea DETOUR x�r xo ,
details. - y CROSS NFRE 30 9b
....•^ 30x29
•W.•60',or,where 60'width cannot he �����^. Max1e s9-I I (Mount on sant/
provide
48'miough the entire route, Ramp y�1el' (Mount on NOR) nAOtt * S,xwµ CLOSE 1 :
provide min.width2 with 60'x 60" *.4I - (Meant en MION I I
passing spaces every 200 R. .;i �' DETOUR �� DETOUR
` CROSS xfAE
•Use temporary ADA compliant surfaces �I\R M4-9b Rs-I I 30xE4
to cross-travesable stdfaces. her INSET"Am ----- j tro 3ox24 a4xlg
non-traversable surfaces. IR'min mount on BOn0.1 Mount on 9116R1 (Mount on BODRI
LTemp.Sidewalk Rampl-I Pco , II
MI—• _ INSET"B" �/ �3 I
IClwwe Debt) J „
Masa KO
KO alone each
sNer.lkxnrn9 .— SIDEWALK CLOSURE,MIDBLOCK
INSET eta
y L_ (Closure Detail)
SIDEWALK CLOSURE,CORNER
GENERAL NOTES FOR ALL DETAILS:
'w' —
• When closing or relocating crosswalks or other pedestrian _MLA_- soa Pare
�� features provide ADA compliant facilities.Include acceszihlliry
' �� adequate slope
btransIions nn9 surfacing.
pedestrian facilities by providing NOTE al material rM.mkmmdp.heR be in accordance MO
DER 1.:: /� adequate slope transitions and surfacing. I;;';;;!..1 UNDER PEDESTRIAN TRAFFIC Asa current Oregon standard specifications
The selection and use of this OREGON STANDARD DRAWINGS
Ma-96 { I • ProWde non-slip,601nch minimum w{de surfactiro:h entire ® UNDE0.CONSTRUCTION
3px2a s- pedestran route. If not possbk,provide 46'mwh with Standard Drawing,while de-
(Mount on Pan 60'x 60'passing spaces every 200 feet along ta . ",,,�" PEDESTRIAN CNANNELIZINO signed in accordance with
,_ • Only TCD far petlesmans are shown.Other dev y be DEVICE(KDI generally accepted engineer- TEMPORARY PEDESTRIAN
necessavon
to control vehlcula.traf c. engineer-
ing principles and practices, ACCESSIBLE ROUTES
H • Stage work,as necessary,to provide a temporary pedestrian is the sole responsibility of
3 access route at all times. For roadways with no available detours, the user and should not be 2021
CO maintain one open sidewalk at all times.
A DETOUR NISi used without Consulting a ots1 REVISION DOARIWMN
.0. r • Minimize pedestrian out-of-direction travel. Registered Professional En-
Ma-91) Additional Right of Way • To be accompanied by Dwg.Nos.TM820&TM821. gineer.
30x24 SIDEWALK DIVERSION
,.oum on PCD)
TM844