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PFI2022-00121 q CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2022-00121 13125 SW Hall Blvd.,Tigard OR 97223 503.716.2421 Date issued: 03/31/2022Parcel: SEG738 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Ziply#550970 Project Description: Access existing hub on NE comer of SW 136th Ave and SW Morning Hill Dr., pull fiber through existing duct to MH 20 on east side of road,splice fiber in MH 20, bore 30'to intercept developer stub. SEG 738 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: JACKIE HENDON 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 2085764031 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(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12022-00121 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_Utilides 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 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 PF1 #: 2022-00121 = ENGINEERING DEPARTMENT . Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: 550970 RF TYPE 1—Franchise Utility Work Brief description Of project: ACCESS EXISTING HUB ON NE CORNER OF SW 135TH performed by NWN,PGE, or utility agency AVE AND SW MORNING HILL DR,PULL FIBER THROUGH EXISTING DUCT TO MH 20 ON E SEE E ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer OF ROAD,SPLICE FIBER IN MH 20, BORE 30'TO INTERCEPT DEVELOPER STUB Work performed for the purpose of • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 11640 sw 135TH AVE main line tap ❑ TYPE 3—Full Scale Development Work performed with land use approval whicb includes any of the following • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: ZIPLY FIBER • Mainline installation for sanitary sewer, -- storm sewer, Tigard water, and Tigard Mailing address: 4155 SW CEDAR HILLS BLVD water service area City/State: BEAVERTON,OR Zip: 9/005 ❑ TYPE 4—Small Cell Technology Phone: 2085764031 ❑ TYPE 5—Tigard Triangle Email: PERMI'PIING@MOUNTAINLTD.CO%One: NOTE: Type 1 and 2 applications may be Contact name: JACIDE HENDON emailed to rowpermits(a ti .e -orov. Phone: Email: PERMITrING@MOUNTAINLTD.COM CONTRACTOR INFORMATION ❑ Same as applicant Name: NORTHSKY COMMUNICATION CCB Number: Mailing address: 11811 SE Mill Plain Blvd,Ste.410 City/State: VANCOUVER,WA Zip: 98614 Phone: 503-209-6856 Ems, gcasmngwy@northskycomm.com ENGINEER INFORMATION Name: Malachi Statberg Mailing address: 4155 SW cedar Hills Blvd City/State: BEAVERTON,OR Zip: 97005 Phone: 503-676-0114 Email: matachismtberg@ziply.com ADDITIONAL INFORMATION Estimated value of workis required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? ❑Yes B No Case number: City of Tigard • 13125 SW Hall Blvd. 'Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 0 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. Jackle �Iehdo l JACKIE HENDON 3/29/2022 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY PF12022-00121 Y SPV Date: 3/29/2022 Case No: Permit fee: -� Received by: Approved by: Date: Notified by: Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www..tigaid-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 10%of the Net PFI Pem-iit 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). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR ONLY • ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1-3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-wap 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 How 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,Server,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 Cityof Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.figard-or.gov • 503-718-2421 • Page3 of 4 Edge of Pavement Ditch � Streetlight I (00� -0 -----•----- —r--- :t / I f ate,n"in I I � Existing House 1 �I .k Driveway u , t n' I rl "s I GL fl I I 134 1 j Existing Shop L Powerpo` I I old 1 I la 95' 1 . I D grope—[iyLme—•---•—•-- i l ) I Fire Lant(FH) � I I Scale: t"=30' � I I TYPE 1 � I I I I I I I � I 1 TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not 1 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-orgov • 503-718-2421 - Page 4 of 4 Page 84 2011 Edition Stationary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of one lane of a two-lane, two-way roadway. See the detail inset for the layout if using a single flagger to control both directions of traffic on low volume roads (less than 400 ADT)with good sight distance as discussed below. 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. Flaggers at each approach are required if any of the following conditions exist: a. Night Operations. b. Work space is over 200 feet in length. c. Sight distance is less than 750 feet from each approach through the lane closure. d. Traffic volumes are greater than 400 ADT. 4. The length between the Flagger Ahead signs shall not exceed one mile. Use Diagram 340— Lane Closure with Pilot Car if exceeding one mile. 5. Cones should be used to outline the work space when curves or other roadway alignments prevent clear direction for the motorists to pass the work space safely. 6. Cones along the work space are recommended when posted speeds are 45 mph or greater, when working under heavy traffic or when travel lanes are narrower than 11 feet. 7. Extended queue signing (see Diagram 5-4) should be used when traffic queues extend beyond the initial advance warning sign. 8. When flagging near an intersection, the"Flagger Ahead" (CW23-2) sign should be visible to traffic entering from any side road. Additional advance warning and Flagger Ahead symbol signs may be placed on the side road(s). 9. Sign set-up and flagger placement shown may be used for intermittent full road closures of 20 minutes or less. 10. The"ONE LANE ROAD AHEAD" (W20-4)sign is optional and should be considered on high volume or high speed roads, or when extended queues are expected. Chapter 5 September 2016 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 03= I p iCDo CD M rn CO <9>, < 1 t a am O maN 3 a G _ _ • N c • UOQ I •• m (1 i • �O i V CL tl • EMU U I � ii I • � o ii • m a-E Z� • I � g 1'. j • vov ® �' 1 tY � I m Wo � Sign Spacing and Buffer Len the feet t � Posed Spacing eenueen Signs "BUHer" [0 p C Speed A e I C Space ®� LO 20 50 25 100 100 100 75 30 100 125 40 350 $0 350 ISO Y 45 180 p Q= so Soo Soo 500 210 m�i a 55 z50 60 295 65 700 700 700 325 70 365 September 2016 Chapter 5 TGRDORXC I GF SFU 111640 SW 135TH AVE 16 LU 5509770 SCOPE OF WORK REQUIRED MATERIAL PLACE 24 FIBER FROM HUB H2O03 TO MH 20. 531'24 FIBER 500' 12 PORT FIBER TAIL BORE FROM MH 20 TO CONDUIT STUBOUT. 30'2'PVC CONDUIT PLACE TAIL FROM MH 20 TO HAND HOLE. SPLICE COUNT INTO 24 FIBER AND 12 PORT FIBER CONTACTS TAIL. ZIPLY ENGINEER: MALACHI STALBERG 1541-419-1964 INSPECTOR: VICINITY MAP JESS LIDDELL 1360-901-9937 SCHEDULING: *LNRYAN ROBERTS 1503-643-3713 SW FEIRI N CONSTRUCTION: 3 REDD HJORT 1971-343-2450 SW MORNING HILL DR — FACILITIES: CORKY BELANGER 1503-643-0181 a x N N CONSTRUCTION NOTE PLEASE CALL IN TO CITY OF ZIpIy BEAVERTON 503-526-2400 PRIOR TO TGRDORXC-GF41640 SW 135TH PNEE W START OF WORK AND AT WORK — COMPLETION FOR PERMIT CLOSEOUT. mwaeA 55U9TT0 t° — PMW[F.QIRCBLLWIMAII RiTIII RtUNG!➢N4 w�E i u.a nrosrtm— dw i of I nn9r— ffc — i I 4PATH � 2 3BFFTP FT-794402 500'TAILOIN:BVTNORXB H2O03,121-126+ O XD,7-12z0 180, 0 z 0'BOTE PATHFROMTUB UPTO STING6LMT MHW FOR MH DETAILS SW FEIRING LN > 1=— I CONSTRUCTION NOTE n I FACILITIES SHOWN IN THIS PLAN WERE 3 I OBTAINED FROM RECORDS ANDIOR VISUAL y SURFACE INSPECTION. SOME FACILITIES MAY BE OMITTED OR 531' SHOWN ATAN INCORRECT LOCATION. 24-FIBER 24 EXACT LOCATION OF ALL FACILITIES MUST TGRDORXC H2O03,121-126+ BE DETERMINED PRIOR TO THE START OF CONSTRUCTION. XD,7-24 ALL MATERIALS,METHODS OF PLACEMENT AND RESTORATION MUST MEET THE REQUIREMENTS OF THE CITY OF BEAVERTON. ONSTRUCTION MUST REPLACE AND 334 01.2005 I CR STORE ANY LANDSCAPED AREA YJD TGRDORXC H2O03 DISTURBED DURING CONSTRUCTION BACK TGRDORXC H2O03,1-9+ FDP TO ITS ORIGINAL OR XD,10-12+ IN:TGRDORXC FC2002,385-400+ BETTER THAN CONDITION. (TGRDORXC H2O03,13-216) XD,17-24+ TGRDORXC H2O03,13.120+ XD,129-364 zi XD„121.126+ 0.OUT:TGROORXC H2O03,1-432 7 TGRDORXC H2O03,127-216 TGRDORXC-GF-11640 SW 135TH AVE-SW c rao.Ecr � cn.vsx — �” SW MORNING HILL DR � mr�wnrt. Guw.sruePc mon arssuuvwrr>t mxai w.twxc2unc 9CME t 15 IMOGw— PIG 2 w 2 MN4P— IIG — TO MI-119 TO OONNA PARK SURD DE:601-800 &- 2 AE2-24 O10 O C4:1-4200 O UGSLM42-26 �a O w x. ZO O C1:1-9OO+50DD UGAE15-24 LL a i u, CONSTRUCTION NOTE a a FACILITIES SHOWN IN THIS PLAN WERE o a n + OBTAINED FROM RECORDS AND/OR VISUAL N SURFACE INSPECTION, ma io SOME FACILITIES MAY BE OMITTED OR o SHOWN AT AN INCORRECT LOCATION. U EXACT LOCATION OF ALL FACILITIES MUST BE DETERMINED PRIOR TO THE START OF CONSTRUCTION. O2 ALL MATERIALS,METHODS OF PLACEMENT AND RESTORATION MUST MEET THE O Oq REQUIREMENTS OF THE CITY OF BEAVERTON. ry= O C4:1-4200 6 UGSLM42-26 M143 LS CONSTRUCTION MUST REPLACE AND RESTORE ANY LANDSCAPED AREA O MH2O 42+16 DISTURBED DURING CONSTRUCTION BACK 84484TH W.0.7846785 TO ITS ORIGINAL OR BETTER THAN CONDITION. O O 48 SM S.W.135TH AVE. C2002: 4132XD YJD 48 SM UG151 W33 REV 04/13/94 VLR Z1 fiber O O TGRDORXC-GF-11640 SW 135TH AVE-6 LU MH2Oaan�cT co..au _ M.MBEK: 716 EOL6II dPCMLLICXMNI wit ,:idea AvmRsc— � or �P_