PFI2022-00034 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
s COMMUNITY DEVELOPMENT Permit#: PF12022-00034
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/08/2022Parcel: SEG811
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Ziply Fiber#5511935
Project Description: Ziply Fiber pole relocation western oaks subdivision; SEG 811
Class of Work: FEES
Type 1 -Utilities(gas, electric,data) Description Date Amount
Owner: Total
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 HILLS BLVD
BEAVERTON, OR 97005
PHONE: 5033127330
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 appimcafion
29 p
Issued By: I&WL UMA41b
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12022-00034
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.
Contact Ken Fisher at 503 816 6146 or kenny@tigard-or.gov
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#: 2022-00034
ENGINEERING DF.P.ARTMENT
Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
Project mune: 51351-5511935 ❑ TYPE 1—Franchise Utiliw Work
petinmedbt v�4�,PGL and/or
Brief description of project: 7LPL v CLQEER onL EE REEL nreTLnnl cttilltyagence
WESTON OAKS SUBDIVISION ❑ TYPE2_RONN•
Sidewalk/Driveway/Sewer «'ork
perforated for the purpnse of
• Sidewalk inst:dlatiotr or repair.
SITE INFORMATION Dmetcay approach installation
and mpalr
Location (address if available): 119nn sw 95TH AVE • Sanitirysewer larcralinstallation and main
fate t_•tp
❑ TYPE 3—Full scalcEkieloptnent
Wail perfomtcd with Lind use
APPLICANT INFORMATION approval which includes am•of
die foll
Nam • Subdivisions ZIPLY FIBER visio
sorPartitions
'\Iailingaddress: 4155 SW CEDAR 1-111 I C RI VIS ' Stmettaidtadng
• Mainline installation for Sanitary
City/State: RFA\/FRT(')N,nR Zip: 97005 sceuer,StormsmeSTigardwaterand
Tigatti Water Service Area
Phone: Sn3-31 9-733n
❑ TYPC 4—Srnall Cell Teclutology
Email: rtll;%Pll wellc@7iplV c�.om Phone: 5n3-312-7330 ❑ TYPEs-TtgardTriangle
Contact name: Russell C Wells
Phone: 503-312-7330 Email: r sell wells4ziply cpm
CONTRACTOR INFORMATION ❑ Same as applicant
Name: Northaky CCB Number. 208747
[ailing address: 16701 SE McGillivary Blvd Cith/State: Vancouver ,WA Zip: 986R3
Phone: '160-95e1-6920 Email: N/A
ENGINEER INFORMATION
Name: 4114A._
Mailing address: Cit}•/State: Zip:
Phone: En-rail:
ADDITIONAL INFORMATION
Estimated ralue of work is required (if over$5,000):$ NSA (within the public right-of-way)
Is work related to a L:1.ND USE DECISION? ❑Yes [A No Case number.
City of Tigard 1 13125 SW Hall Blvd. • Tigard,Oregon 97223 • vm-wtiprd-orgov 503-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Peron specified as"applicant"shall be designated"Permittee"and shall provide financial assurance for
\vork,if required by the city pursuant to T9iC 1 .04.140.
- A Ith die exception of a utility operating pursuant to a valid franchise or license with h the City of Tigard,when the owner and the applicant
are different people,the applicant must be the purchaser of record or a lesser in possession with written authorization fmm the owner
or an agent of the mt= The owner must sign this application in the space provided or submit a written authorization with tlus
application. Prancldsed or Ucentsed E'alitie s are not required to obtain the owner's signature on the application.
I,the applicant, certify that
• To the best of my knowledge, all dhe information provided within this application package is complete and
accurate.
• The above request does not violate any recorded deed restrictions that mai'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.
F44SCM C NPIUS Russell C Wells 1/31/2022
Applicanes or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
.Case No.PF12022-00034 Permit fee Received by Sfl1f Dater 21312�22
Approved by K 46 5 M�'✓ Date L ZZ . Notched by R'1:: Date Z
City of Tigard 13125 WHO Blvd. Tigard,Oregon 97223 Nww.eard-orgov • 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 10°'o of the Net PFl Permit Fee.See below for calculations.Minimwn of$300.
NET PFT PERMIT FEE
Part 2: All non-,,t-ater system improvements engineer's es61 ate 17"'o/less the initial PF1 Pennit Fee).
WATER LINE CONSTRUCTION FEE
Part 3: Ail public%nater sysrem unprovements enguieer's estimate X 12%.
)'OR STAFF I ISE,ONLY FOR STAFFUSE ONLY
TYPE 1-3:DETAILED SUBMITTAL
`IYPE 4: SMALL WIRELESS FACIJ,ITY REQUIREMENTS
CHECKLIST
Does applicant have a right-of way license? O Yea :❑No
TYPE 1 AND TYPE 2-Must include a sketch
showing:
llnderthe wireless fadlides standards.*is the ptopo�l ❑ Dimensions
musidema? check all that ❑Small Cell ❑Mean ..
( . ePP� : . . `StreetName
How maty install sites are proposed as part of this permit ❑ Site Address
application?
TYPE 3,Must ptovide 4 sets of feized 24 x 36
vbi 22 x 34) and an electronic version of all snbtnittal
Thep%posed egutpmentis located on which of the 5ollowmg items The plans must that include
❑Public Bight of Xray ❑Pinata Property ,
7. ❑ :Covet ,site, ranttp Abbretnahop,].egeud
if egwpmentis to be located on private Property,describe the Geueral.l\otes(City;'\Tv'ater,Sewec,.etc)
tYPe g rise. L3.Street(Plan Profile)
{_I,\grater,Storm and Sanitary(Platy Profile)
l] l��aecr Qisaiity Fatxlitiiis
`Q Uraduig `,,
laridscaping/TreePlan
❑ Composite Utility Plan;(Electrical,Phone,Gas,Stotin, .
Sawtar%,%C'ater,Siguaee,Street I tSht�,etc)
❑ Details
,❑ T6ffic Sight D Distance
❑ $gatng and Striping
❑ Street Irgltt Plaft and Photonietac
❑ 13ngzneers seal/signature
❑ Sheet label(project land use name,revision and plan
log block dates aad sheet tu,niben)
❑M. .EngincClBCAnsdUGtionFStmtatc.,;:..,
�1fjllidtt)AdY$t/(7t7sitdt[Ya,'
(per land use eondttions;if applicable)
1'raffc Report
Q storm water Drainage Calculations
D Geotechnical Report,'
❑..Preliminary Aceess Report(Sight Drstance)
`Proposgd Plat
!� Padtwar llesrgn
0:WaterNovxkr Approval
City of Tigard 13125 SW Hall Blvd. 'ligard,Oregon 97' 3 tvww:tigard-or.gov 503-718-2421 Page 3 of 4
SEE ATTACHED 51351-5511935.PERMIT
Edge of FOL ement
I
t 44 Ditch —}
Streetlight I . .............rte —
, I 1
� I
' T�'Pio'p'os d'Seliw'etTitie" 1
� I I
It Existing House
I Existing 1
FI ti Driveway
di 1
QI�
" 1 1
O)
I � Exrhng:hop 1
J
Po%mr\le I I = 1 1
o
I O FopertpUne—'-""'
1 ( Firo H}M rant(FH) 4
1 I i �dlfJ�
I
I Scale. V=30'
] I i
TYPE I
1 1 I
1 I
� � E
1 T17PE 2:
pp
X Nottli arrow Property lines&dimensions Existing utilities locations
X (sever,storm,water)Street&street names All existing structures
X 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 • wnvw tignrd-orgov • 503-718-2421 • Page 4 of 4
JOINT POLE NOTE �Rtl SWG
1-PGE/COMCAST TO TRANSFER TO /eenbGT9 Rd
NEW POLE-VZ TAG#32092
nburg
Bitches Apartments qry TOTAL ALLOTTED HOURS
A Z13ACT CAP.T"X-TIME MAINE.
PEW D D D
m
SPLCIxm 1
Do N
e 1
TBSo
CONSTRUCTION NOTE Sly
LwieLn n ❑FIGEHTN
n
BR08.
p FCVERLiY MqP{
®FIBEl.S R
1-THIS WO IS CIAC DRIVEN-CRANDALL ❑`°"°°IT°""
GROUP usrRUCITON soar
IN SERVICE DALE
SW p CCN811GICTIO"CMPLEIE
d�
2-OITYrrIGARDPERMIT REOD WPINNTaLP 0°'5REQ°1RE° CONSTRUCTION
❑YEs allo
asW Tenaela Cl JOINT TRENCH ❑DIu.A DIG
3-FLAGGING NECESSARY ON THIS JOB s PrestigeMobile [3 YES ANO QFLANGING
FOLLOW ALL CITY OF TIGARD TRAFFIC SAFET Y < Auto Repair scan FED'D 0 CONTRACTING
PLANS INCLUDED BICYCLE AND PEDESTRIAN " ❑YES NNO REp'D
SAFETY ESCORT g •11900 SW 95th AVE, PERMITS
Tigard,OR 97223 MUNICIPALITY CITYrnQARD
29mma,,,� ore Greenburg Oaks MUNICIPALITY
CONSTRUCTION CONTACTS
DPve cl ,s-„ Apartments O ELANAET
REED JHORT971-343-2450 it o TCP/TRAFFIC
JAMES STAATS-503-758-3119 O DETAILED (NOT FLANENT)
p NO PERMIT REONIRFD
SCHEDULING CONTACTMINT POLE
JPA/N.IONB #
RYAN ROBERTS-503-643-3713 i"IN,rvAS I
SHEET 1 OF 2 0 N°FICA RZOVIRED
FACILITIES CONTACT areEDR TO [ROM
ROBYN RUSSELL NORTH ❑ ❑ ❑ POAAR
CAW
503-260-9525 0 0 0 FRo TIER
INSPECTION CONTACT POINT OF CONTACTRUSSw LS
TROYULLRICH-503-765-4900 "CIAC WORK ORDER" 5113-6111001
SCHEDULING RYAN ROBERTS
ENGINEERING CONTACT 51351-5511935 NICNZO, 33713
ENGIg Russ WELLS
RUSSWELLS 503312-7330 LABOR HOURS 44'BILLING INFO"-" PNONENO.503a. 1001
TECs
CRANDALL GROUP
FIELDED BY R ICC IWF R
MATERIAL REQUIREMENTS SPLICE-C-O/M-O/X-0 14787 SW MILLIKAN WAY
ZIPLYFIBERTO CREW-C-4/M-1/)(-2 BEAVERTON ,OR97003 Ziplyfiber
SONICOM-FLAGGING-8 HOURS MATT WELLNER
RELOCATE 1-30'-5 POLE`
2411.001- 503-970-5699 TGRDORXA/CIAC-POLE RELOCATE
3411 004 11900 SW 95TH AVE
PROJECT0 0.AREA
3421.104 NUMBER'. EXCH.GODS
51351-5511935 DRNMNDATE. PHONE. RUSSWELL Nw WASH
INEC�SCALE - TAX DISTRICT: jDm I OF
TWNSHP: JRNG. I SEC:
NEW SUBDIVISION-WESTON OAKS-51351-WO910331
CIAC POLE MOVE-SIDEWALK-51351-5511935
PLACE T ARM PGE/COMCAST TO TRANSFER
(30'5 BT VZ 32092 1966
01 J�12'
U '�I
i
I I �
-----------
I
J
Q SW EUNICE LN
= SHEET 2 OF 2
iNORTH
I
f ziplyfiber
51351-5511935
TGRDORXA/CIAC-POLE RELOCATE
11900 SW 95TH AVE
PROJECTGO.MER
NUMBER E%CH.CODE:
d+AWN DnTE. ENGR. gllss WELL TY:WASN
PHONE: T
SC&E: TA DISTRICT IDWG 2 OF
N SHP'. RNG. SEC:
O °
//� NOTE-TRAFFIC CONTROL ORANGE CONES TO BE
O FLAGGER AHEAD SIGgI '/ B n SPACED PER TRAFFIC SAFETY GUIDELINES
�/ DEPENDING ON POSTED SPEED LIMIT AND TAPERED
E B O PER POSTED SPEED LIMIT
OBE PREPARED TO Op A Jr` 11850 SW 95TH SIGN SPACING AND BUFFER LENGTHS
STOP SIGN 100'MAX POSTED SPACING BETWEEN SIGNS BUFFER
u SPEED A B C SPACE
F ONE LANE ROAD n 20 50
AHEAD SIGN 25 100 100 100 75
❑1 30 100
p35 125
40 350 350 350 150
G ROAD WORK m
AHEAD SIGN n ZIPLY FIBER WORK ZONE 45 180
50 500 500 500 210
ZIPLY FIBER POLE#VZ 32092 p 55 250
TO BE RELOCATED 2'TO WEST z
STATIONARY LANE CLOSURE WITH FLAGGING
PEDESTRIAN/BICYCLE SAFETY ESCORT REQUIRED
A AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS
ODOT DIAGRAM 320 REFERENCE
WESTON OAKS SUBDIVISION
o UNDER DEVELOPMENT
C B 6I A I I n
❑
G E O z0 100'MAX SW EUNICE LN(NEW STREET)
F m
F A O 11900 SW 95TH
Bw
DOVE CT SHEET 1 EOF I
NORTH
B O PEDESTRIAN
FLAGGER rn BICYCLE
TRAFFIC 3 TRAFFIC
DIRECTION C O y
SAFETY SAFETY
SIGN ESCORT
ORANGE SAFETY CONE �'���fi be
A TAPER VEHICLE TRAFFIC TO CENTRAL
il-
LANE TGRDORXA/CIAC-POLE RELOCATE
11900 SW 95TH AVE
PROJECT CO.ARE&
NUMBER. EJtGM.CODE'
51351.5511935 °RAv.N°aTE. PHONE. RUSSwILL ae WASR
PERMIT SCALE: - Tax rlGTRiCT. owc oR
TYNBNP, RNG. SEC.