ROW2012-00037 14 "E' CITY OF TIGARD RIGHT OF WAY PERMIT
: ; Permit #: ROW2012 -00037
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 03/28/2012
Parcel: SEG1636
Jurisdiction: TIGARD
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: SW 104th Ave To SW 103rd Ave along SW McDonald St -City of Tigard storm drain improvement project.
Removing poles in conflict with City of Tigard's storm drain improvements along SW McDonald St SW
104th Ave to SW 103rd Ave and placing new poles 4.5' to 5' south of existing poles to clear conflicts.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
LARRY WHEELER
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97005
PHONE: 503 - 512 -9356
Total $0.00
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: •
it/UAL/
Issued By: 1111-1--a±
Special Conditions (See Attached)
Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2012 -00037
Type: Condition Name: Status: Severity:
ROW 07 -TRAF CTRL -PRIV PROP ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not,
shall be cause for work stoppage until effective access is established.
ROW 08 -TRAF CTRL - DEVICES IN PLACE Applied Notice
Traffic control devices, flagpersons, etc., shall be in place prior to initiation of construction work and shall be effectively
maintained.
ROW 09 -TRAF /NOISE CTRL -WORK HRS Applied Notice
No work will be permitted during the hours of darkness, nor between 9:00 p.m. to 7:00 a.m. Monday through Friday, nor
between 9:00 p.m. to 8:00 a.m. Saturday, nor between 9:00 p.m. to 9:00 a.m. Sunday.
ROW 10 -TRAF CTRL -MIN LANE WIDTH Applied Notice
Minimum travel lane width shall be eleven (11) feet; pedestrian travel shall also be provided for.
ROW 11 -TRAF CTRL -CITY CAN MODIFY Applied Notice
The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic
and to assure public safety.
ROW 12 -INSP 24 HR NOTICE REQUIRED Applied Notice
The permit holder or his contractor shall notify the City's inspector <name >, at <phone #> or email at <email address >,
twenty -four (24) hours prior to commencing work, twenty -four (24) hours prior to any staged inspection, and after completing
work covered by the permit.
ROW 13- HAZARDS -CERT OF INS Applied Notice
Maintenance of the work area and approach roads is the responsibility of the permit holder. The work area and approach
roads shall be maintained in a clean condition, free from obstructions and hazards. A copy of the permit holders Certificate
of Insurance shall be available at the work area.
ROW 14- DEBRIS - MATERIALS Applied Notice
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
cleanup and stoppage of work to accomplish cleanup.
ROW 15- EROSION CTRL REQ Applied Notice
Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q.
requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion
control.
ROW 16- REPAIRS -LIKE MATERIALS REQ Applied Notice
Property disturbed by construction activity shall be seeded with a standard grass mix; shrubs, flowers, barkdust, existing
signs, pavement markings, mailboxes, etc., shall be reestablished, reinstalled or replaced, with like kind and material.
ROW 17- DRAINAGE CONTROL REQ Applied Notice
Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent
private property, public property and the receiving system is not adversely impacted. The City may, at any time, order
corrective action and stoppage of work to accomplish effective drainage control.
ROW 18- UTILITIES PRELOCATION REQ Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952 -001 -0010 through OAR 952 - 001 -0080. Copies of the rules may be obtained from the Center by calling (503) 232 -1987.
If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders
expense.
ROW 19- UTILITY LOCATIONAL CONFLICT Applied Notice
Contractor 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 permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall
coordinate the work with affected utility agencies.
ROW 20- TRENCH - PATCH /SAFETY /LBILITY Applied Notice
A temporary hard - surface patch (Cold mix A.C. or Hot mix A.C. base paving) shall be placed on trenches within roadways
at the end of each day's work. No trench, on site or off site, shall be left at any time in an unsafe condition. The permit
holder is responsible for and is liable for hazards or damage resulting from the work.
ROW 21- REPAIRS REQ - INSPTR OPINION Applied Notice
Work provided for under the permit shall include repair of existing facilities (roads, ditches, etc.) as may be necessary, in the
City Inspectors opinion, to overcome deterioration or damage which occurred in conjunction with the work authorized by the
permit. Corrective work shall be done at the permit holders expense.
ROW 22 -AS- BUILT /ENGR CERTIF REQ Applied Notice
At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public
right -of -way shall submit complete "as- built" drawings 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 engineers certification of installation
compliance (form attached).
ROW 23 -DAILY INSP REPORTS REQ Applied Notice
The permit holders Engineer /Inspector shall submit daily inspection reports, on a weekly basis, to the City's Inspector. (see
Developer- Engineer Agreement note #5).
ROW 24- TESTS /REPTS TO VALIDT CLMS Applied Notice
The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's
engineer or contractor to validate claims of material or construction adequacy /compliance. Such tests /reports shall be
provided at the permit holder's expense.
ROW 25- RELEASE - WAIVER REQ Applied Notice
The permit holder shall provide a copy of a properly executed Release & Waiver document to the City for each ownership
disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction.
ROW 26- MONUMENT PROTECTION REQ Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders
expense.
ROW 27 -PROB SOLVING - RESPON PARTY Applied Notice
The permit holder shall 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 an
emergency. The permit holder shall notify the City Inspector, in writing, of any /all assignment changes.
ROW 28- CONSTR SAFETY - RESPON PARTY Applied Notice
The permit holder shall cause his contractor to provide to the City Inspector, in writing, the name and 24 hr emergency
telephone number of a designated "Competent Person" responsible for construction safety as per OR -OSHA, Chap. 437,
Div. 3 Construction, Subdivision P - Excavations. The contractor shall notify the City Inspector of any /all assignment
changes.
ROW 29- ESMT /RT OF ENTRY - RESPON Applied Notice
It is the sole responsibility of the permit holder to provide for 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 permit holder's failure to obtain or provide for proof of right -of -entry or easements.
ROW 01- CUSTOM CONDITION Applied Notice
<Custom Condition goes here>
ROW 02- PERMIT & PLAN REQ ON SITE Applied Notice
A copy of the permit and all attachments, and a copy of the approved construction plan and all amendments shall be
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 the aforesaid must be approved by the City, in advance of work performance.
ROW 03 -TRAF CTRL - SPECIF (CITY) Applied Notice
The City's standard specification for traffic control is "Manual on Uniform Traffic Control Devices for Streets and Highways ",
U.S. Dept. of Transportation, F.H.A., 1988 Ed.
ROW 04 -TRAF CTRL -CONTR RESPON FOR Applied Notice
Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in
accordance with a City (job specific) approved traffic control plan. A copy of the approved traffic control plan shall be
available at the work area.
ROW 05 -TRAF CTRL -ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time, without having first obtained written approval from the City
Engineer. The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide
Emergency Services (Tigard Police Dept., Tualatin Fire & Rescue) and to Tri -Met and Tigard School District.
ROW 06 -TRAF CTRL - ADVANCE WARNING Applied Notice
Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance
notification sign at each end of the construction area 72 hours (min.) before initiation of construction work.
RECEIVED
MAR 2 6 2012
City of Tigard
latjt: CITY OF TIGARD
SA Application for Work in the Right-ofMrrieffiff
GENERAL INFORMATION R EQI IRED
SUBMIT FAL
Property Address/Location(s): SW 104TH AVE TOSW 103 RD AVE ALONG INFORMATION
SW McDONALD ST-CITY OF TIGARD STORM DRAIN IMPROVEMENT
Submit a scaled sketch of the
PROJECT. FRONTIERS PROJECT W.O.# 51351-5098366 / sk, proposed work to be done.
FRONTIER COMMUNICATIONS • Traffic Control Plan
*Applicant's Name: • Filing Fee $300.00
4155 SW CEDAR HILLS BLVD
Address:
lY1.40
city/state: BEAVERTON, OR. 97005 Zip:
LARRY WHEELER
Primary Contact: Right-6 fAVay
503 Fax: 503-643-0977 Cs e.#: kige)40(a• 37
Phone:
Receipt #: At4
Contractor's Name: NORTH SKY COMMUNICATIONS Date: 3 i
ti 1141171 Expiration: 03/01/14 Application Accepted By:
10860 SW GLUIER DR Raised 07/01/20t I
Address:
SHERWOOD OR 97140
City/State: Zip:
503-647-9991 Fax: 503-647-9991
Phone:
Plans B Mark L. Cauthron
y:
Address: 4155 S.W CEDAR HILLS BLVD
BEAVERTON, OR. 97005
City/State: Zip:
phone: 503-939-6658 pa ., 503-643-0977
Description of work: REMOVING POLES IN CONFLICT WITH CITY OF TIGARDS STORM DRAIN
IMPROVEMENTS ALONG SW McDONALD ST SW 104TH AVE TO SW 103RD AVE AND PLACING NEW
POLES 4.5' TO 5' SOUTH OF EXISTING POLES TO CLEAR CONFLICTS.
Estimated value of work (within the public right-of-way): $
Is work related to a LAND-USE DECISION? n YES NO
If so, please specify (MU, SDR, SUB, etc.) case #:
Is the work related to a BUILDING PERMIT? El YES NO
If so, please specify (i\ILP, SDR, SUB, etc) case #:
City af Tigard 13125 SW Blvd., Tigard, OR 97223 1 503-718-2464 I www.tigard-ocgov I Page 1 of 2
AP PL[CAN'TS: To consider an application complete, you will deed to submit .ALL of the REQUIRED SUBMITTA.L ELEMENTS
as described on the front of this application in the "Required Submittal Elements" box.
'NOTE: Pelson specified as "Applicant" shall he designated "Ycrmittce" : shall provide financial assurance for the work.
*When the owner and the applicant are different people, the applicant must he the purchaser of record or a lessee in
possession with written authorization from the owner or an agent of the onmcr, The owner(s) must sign this application in
the space provided or submit a written authorization with this application.
BY SIGNING BELOW, TILE APPLICANT(S) SHALL CERTIFY THAT:
• "Fhe above request does not violate any deed .restrictions that may be attached to or. imposed upon the
subject property.
• If the application is granted, the applicant will exercise the rights granted in accordance with the terms
and subject to all the conditions and limitations of the approval.
• All of the above statements in the plot plan, attachments, and exhibits transmitted herewith, ate true;
and the applicants so acknowledge that any permit issued based 00 this application, may be revoked if
it is found that.atty such statements are. false.
• The applicant has read the entire contents of the application, including the policies and criteria,
and understands the requirements for approving or deny=ing the application.
Applicant's Signature bate
Owner's Signature Date
Owner's Signanire Date
I,
//, W.r# ,� - fr � i „ 41' . ._ t s ■ ue } _ x /
.
Authorized z1'ge4it's Signature Date
I/ /
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# {
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Print Name Title Phone Number
Signatures of each owner of the subject property are required.
city o/ 1 igard I 13125 SW 1 Fall 111vd., Tigard, ard, Oh 97223 1 503-718-2464 ( www.tit;ard or.gov 1 Page 2 of 2
THIS PROJECT INVOLVES INSTALLING A NEW
15 "STORM MAIN LINE AND NEW STORM
MANHOLES AND 3 NEW CATCH BASINS SCHEDULER -
ON SW 103RD AVE AND A 18" STORM MAIN INSPECTION S
LINE WITH 3 NEW CATCH BASINS CONSTRUCTION
AND 2 NEW STORM DRAIN MANHOLES ON SPLICING /CON`.
SW MCDONALD ST. MICHELE CHR1
FRONTIER TO PLACE 5 NEW POLES, REMOVE 4 ENGINEERING
EXISTING POLES TO CLEAR AREA FOR ENGINEERING
PLACEMENT OF STORM DRAIN THAT CITY OF
TIGARD WILL PLACE ON THIS PROJECT.
CATV ARE ON 3 POLES AND WILL NEED TO 00
REARRANGEMENTS, AND PGE WILL NEED TO
DO REARRANGEMENT ON 1 POLE, NJUNS
JOINT USE TICKET WILL BE NEEDED FOR
PGE, COMCAST TO DO WORK WITH.
JOINT POLE NOTE CITY OF TIGARD CONTACTS
FRONTIER TO PLACE NJUNS JOINT POLE PROJECT MANAGER
TICKET TO HAVE PGE TRANSFER TRI -PLEX RAY WOLF 503- 718 -2458
SERVICE LINE AT 10342 SW McDONALD ST., ENGINEERING DEPARTMENT
MICHAEL D.McCARTHY 503 -639 -4171
COMCAST TO ADJUST SERVICE LINES ON PROJECT NAME:
4 POLES ALONG SW MCDONALD ST. 103RD AVE & MCDONALD STORM DRAIr
NEW FRONTIER POLES TO BE PLACED IMPROVEMENTS
4.5' TO 5 'SOUTH OF THEIR PRESENT
LOCATION TO CLEAR NEW C.O.T. STORM
DRAIN PLACEMENT ALONG SW McDONALD ST CONSTRUCTION /SPLICING /TECI-
FRONTIER TO PLACE 5 NEW 35' -5 POLES,
AND REMOVE 4 EXISTING POLES IN CONFLICT IF COPPER DROP(S) NOT ABLE TO 1
WITH PROJECT. REMOVE LID DROP(S) FROM FIELD
FACILITIES KNOW ADDRESS, PAIRS
TO REMOVE FROM RECORDS.
t.lflPVTNf: f /P'TPPP f1Pf1PQ
NEW ALLEY ARM i OLD ALLEY ARM
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7 NEW POLE OLD POLE
I POLE 3609 REPLACE EXISTING 8' TRANSFER
ALLEY ARM WITH 4' ALLEY ARM THEN - 405'
MOVE CABLES TOWARDS POLE AS NEW
SHOWN AT SW 105TH AVE POLES
I MOVE SEE SHEET -
TO SOUTH
4.5'
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SEE SHEET -4 EXISTING
LOCATION E/P
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I SHOWN JUST WEST OF 104TH AVE TOVEOUTH ROCATIOO
4.5'
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NOTE 10475 13950 LID 21-1637 TM 2956 503
DETAIL FOR DROP FIBER TM 42506
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