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PFI2014-00114 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT i COMMUNITY DEVELOPMENT Permit*: PF12014-00114 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/24/2014 Parcel: SEG677 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Communications Project Description: Adjacent to 11500 SW 98th Ave and 11415 SW Greenburg Road. To bore 22'from existing PGE pole to south property line at 11415 SW Greenburg Road. Place interdict and fiber for new service. SEG 677 Owner: FEES Description Date Amount PFI Permit Fee 11/20/2014 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: JOHN COUSINEAU 4155 SW CENDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 503-643-0371 Total $300.00 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: I/ Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12014-00114 Tyne: 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 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 09-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 10-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 11 -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 12-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 13-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 14-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 15-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 16-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 17-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 18-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 19-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 20-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 21 -OTHER Applied Notice REQ City of Tigard Np V 17 2014 14 1 ganPLA /1�'O:_TIG ARD WORKS— ENGINEERING MOM6 j�MARD Gi r Public Facility Improvement (PFI) Permit "ESR'"� �!s<cr.�n�, r _:fr',.:a,x..�..+..a:z:s.=�u'^w:,.00er azrw'rr;.t,..<s.;,._c•.a:a.....�.__a...,:.;rrcas.�^:k:��vsaavw:zan,�mrcs^s Baan.....:.�r,, .�+.:.:�.,.c ...x�.k.:.s.n ..x+s va:.-':enc•,e2xzz DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one:iX 1.16lities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: To bore 22' from existing PGE pole to ® 'Minor work in right-of-way (sidewalk repair,curb cut,street south property line at 11415 SW Greenburg Rd. Place opening,etc.)requires: interduct and fiber for new service. SSG l!! 'Application form,completed and signed S�`/�l�h" •Submit one(1)copy of sc•.tled sketch Property address/location(s): 1150/tot11415 SWaald. of the proposed work to be done •Submit one(1)copy of traffic control plan —OR— D Substantial proiect work requires j Applicant's name: Frontier Communications / John Cousineau above items and professional Address: 4155 SW Cedar Hills Blvd engineered plans for: ' Beaverton OR. 97005 •Street widening Cih'/St;lte: / Zip• •Subdivision infrastructure Phone: 503-643-0371 Email: john.cousineaumftr.com •Main utility line extension: Storm Drain,Sanihtry--Tigard \\"ater—Tigard\\••'cuter Service Contractor's dame: SONICOM Area(includes Durham,ling City CCB#: 188116 Expiration: 3/24/2016 and it portion of unincorporated \\ashitlgto,t Count)') Address: 1275 S Kodiak Circle Cite/state: Cornelius / OR Zip: 97113 DELIVER APPLICATION TO: City of'Tigard Phone:503-519-3445 Email:pjfellows@sonicomcorp.com Planning/Engineering I 13125 SW Hall Blvd. Engineer's name: John Cousienau Tigard,OR 97223 Applications for"minor work in right-of-way" j Address: 4155 SW Cedar Hills Blvd oily may be ennnled to: rmyPermitseti �r4' g or. ov City/state: Beaverton / OR. Zip. 97005 Phone: 503-643-0371 Finail: john.cousineau®ftr.com Case Nu: ?-F 1201 L 'OD 114 Estimated value of work(within the pubhe right-of-way): $ 1500 �30DApplication submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes ® No Application accepted: If so,please specitj.(LQ.P,SDR,SUB,etc.) case #: Br. Date: Is work related to a BUILDING PER\II1? El Yei 91 No Application reviewed: / If so,please specify-(BUILDING PERi\1IT)case#: By. AB Date: / y, Applicant notified: BT. &� Date: I:\CURPU1�ldiriln\lJnd USMOD�iutWns RN.07/16J7 � _ City of Tigard 13121 S1\'Hall Blvd. TiGard,(]rrgon 97223 a to u%ctigarcl-or.}air103-71 8-2421 Prtge I of APPLICANTS NOTE: Person specified a%"Applicant"shall be designated"Permittee"and shall provide financial awar:utce For work. \\'lull the Owner and the applini t are dilterent people,the applicant nntst be the purchaser of record m n lessee m possession with written auflu,rixation ffOtn the cnvuer of nn agent of the owner. 'Ila owner(')must sign this application in thr space ptus•ided or submit a m•ritten antltoricatiuu n•it6 flus applinuiou. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not rialate any deed restrictions that may he attached to or knposetpon the stthiect_t ropertct • 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 nppro►cd. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted here►cith,are true:and the applicants so acknowledge that ani•permit issued,based on this application,may be revoked if it is founts that any such statements are false. • The applicant has read the entire contents of the application,Including the policies and criteria,and understands the requirements tier approving or denying the application. SIGNATURES of=h owner of the subject pr ty requir d. John Cousineau11/13/14 Applicant/Authorized Agent's signature Fnam e Date Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC'FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SSC'i lall Blvd. • Tigard,Oregrnt 9?233 • www.ti-ard-or.gov 503-718-2421 • Page 2 Oro Cust TN: 5034312141/�0 Cust Name:AUDILIA GONZALEZ Addr: 11415 SW GREENBURG RD PRT,OR, PORTLAND, OR �. 4 County/Twp: /0009-7223 �,�J v� CBR: 5039013870 CO: BBFTP O/T: Order C/F FiberDRIV U p Temp: No WAY WAY Drilled Entrance:No Drop Length: - Cross St: Appr Drop Rte: Y?_J d Hub: BBFTP/H4004 Strand: Port: 0 Serv.Term: BBFTP/FT-44697 PORT: 0 D t� Drop Term: 11500 SW 98TH AVE TIG,OR �r 2-60 14 67 s�� Notes: INSTALL 11/03/14 9:00 11:00 &- z-.-- 106 MPLETEDETAILS DATE: NAME: TICKET: EXCH: P59P DW BORE: LS BORE: SW BORE: P50A DIRECT BURY: P43D PULL: P77C CORE DRILL: Y N QUANTITY: 1 2 3 4 P16C GROUND ROD: Y N QUANTITY: 1 2 3 4 P71A TRIP CHARGE NOTES: ^ �� P36A C,U ��✓ G/vz— L10Ac- P22K P36B