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PFI2015-00017 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00017 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/02/2015 Parcel: SEG#469 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Communications Project Description: Adjacent to 10890 SW 83rd AVE North of SW Steve ST. Repair of cable and conduit under SW 83rd AV. The street will need to be opened and splice pit dug for the repair. Owner: FEES Description Date Amount PFI Permit Fee 03/02/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: JOHN COUSINEAU 4155 SW CEDAR 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. Permee/Applicant Signature: 'a4 wn-y Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00017 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 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 Kenny Fisher at 503-816-6146 or email at kenny@tigard-or.gov 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 RECEIVED City of Tigard FEB 18 2015 PUBLIC WORKS— ENGINEERING CITY OF TIGARD ■. PLANNIN�XNGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Repair of cable and conduit under SW 83rd Av. ❑ Minor work in right-of-way (sidewalk repair,curb cut,street The street will need to be opened and a splice pit dug for the repair opening,etc.)requires: -SiE�77►►I L/�� •.Application form,completed �� and signed •Submit one(1)copy of scaled sketch Property address/location(s): 10890 SW 83rd.Ave- north of SW of the proposed work to be done •Submit one(1)copy of traffic Steve St. control plan –OR- 0 Substantial project work requires Applicant's name: Frontier Communications/Cousineau above items and professional Address: 4155 SW Cedar Hills Blvd. engineered plans for: •Street widening City/state: Beaverton Zip: 97005 •SuMvision infrastructure Phone: 503-643-0371 Email:john.cousineauQftr.com •Main utility fine extension: Storm Drain,Sanitary-Tigard Water-Tigard Water Service Contractor's name: Frontier Area(includes Durham,King City CCB#: 49350 Expiration: 11/7/2015 and a portion of unincorporated Address: 4155 SW Cedar Hills Blvd. Washington County) City/scare: Beaverton Zip: 97005 DELIVER APPLICATION TO: City of Tigard Phone:503-963-2091 Email:david.b.dodd0ftr.eom Planning/Engineerlug 13125 SW Hall Blvd. Engineers name: ,John Cousineau Tigard,OR 97223 Applications for•'minor work in right-of-way" Address: 4155 SW Cedar Hills Blvd_ only may be emailed to: City/state: Beaverton Zip: 97005 cogpermha0 igard-oa,zov Phone: 503-643-0371 Email: iohn.cousineauAr.com Case No.: WlZdIS'"/ Estimated value of work(within the public right-of-way): $2.000 w Application submittal fee: �_ Is work related to a LAND-USE DECISION? ❑ des ® No Appfica'on accepted: / If so,please specify (MLP,SDR,SUB,etc.)case#: By: �. Date: 2 �q /5 Is work related to a BUILDING PERMIT? [Iles IN No Application reviewed: If so,please specify(BUILDING PERMIT)case#: By:& 11 — Date: Applicant notified: By: 6 ' Date: 3 -oZ- IS 1ACURPUAMastersUand the Applications Rw.07/I6/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 \v\Ywtigard-orgov • 503-718-2421 • Page 1 of 4 ?•V Wo /,JL 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. Wien 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 die owner or an agent of the owner. 71te owner(s)must sign this application in the space provided orsubmit a written authorization with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed upon the subject Apert;'. • 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 and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found 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 for approving or denying the application. SIGNATURES oE each owner of the subject property required. `- John Cousineau 02/17/15 pplicant/Authorized Agent's signature Print name Date Owner's signature Print name Date Owners signawre Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 S\\/Hall Blvd. • Tigard,Oregon 97223 • Nvww.tigard-or.gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part 1: Required submittal fee$300.00 Part 2: AU non-water system improvements Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee=Part 2+Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells i PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 3 of 4 BSW Commit Date: 2015-02-12 `Z Cust TN: 5036207737/0 Cust Name: SARAH CARRIO Addr: 10825 SW 83RD AVE PRT,OR, PORTLAND, OR County/Twp: /0009-7223 CBR: 5036390820 CO: BBFTP Commit Date: 2015-02-13 00:00:00 O/T: Order C/F: Fiber Drop Type: Buried Serv.Term: BBFTP/FT-45379 PORT:0 Drop Term: 10890 SW 83RD AVE PRT,OR Notes: INSTALL 2/13/15 8:0017:00 *CANNOT BE TEMPED* SEND TO SONICOM X ST PFAFFLE DROP 200-250 USA 15025636 DUE 2/10 @ 12:15 CUSTOMER NH, LEFT DH. PULL 90 FT FROM TERMINAL TO FLOWER POT, DIG 10 FT IN DIRT, BORE DRIVEWAY 70 FT, DIG 10 FT IN DIRT TO POWER METER AND NID. JOB COMPLETE DETAILS DATE: 2-�L_�s NAME: 1tv&_ TICKET: EXCH: P59P DW BORE: 7.1 LS BORE: SW BORE: PSOA DIRECT BURY: 39 " 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: b,"`/ 5?4 cc vh�cr 0. j P36A hr �.C� -{,p f•�,Q��e L10A P22K P36B Al; J� �� - .. . � . ,:,, , .r . - , ,. � � _ I -� -- � � A+ j a i ,r. .� tt:�t. .�� • �� . ��,,y,3�.�i 1 8270 � I ■ cot 108251 10_03_0 _ Tf'IG'ARD SS36BO96 10855. 8380 S36B105CO 0890 895 . y' , llp 10905 �,✓'� 16-mp .6C 10935 I M T wp ss36 B oa a [i68024 ,�T O R N-S T. �Z H _. 10 / 36B015C i W34C 816 . 36 368012F36B069 SS368106 $8366097 �1. B095 . ,. 1 S S360094SS36 8090 a�•'3 b� B03 8017 9$ .�... .� C Dia.24p 8020 5360092 &T-E,V,MiTZ �., 7ee If 1 i C