PFI2015-00083 4 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00083
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/22/2015
Parcel: SEG1151
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Electric Lightwave, LLC
Project Description: Adjacent to 8300 SW Hunziker St. Directional bore&place 71'-2"HDPE conduit&fiber optic cable in
ROW.
This is a no cut street until 2016. See Condition # 21.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRIAN DAVIDSON
18100 SE 34TH ST.
BUILDING ONE, SUITE 100
VANCOUVER,WA 98683
PHONE: 360-558-4215
Total
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: Not Present
Issued By: �—
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00083
Ty De: 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
This street is under a"NO CUT moratorium". The Blank Inlay method of pavement restoration is required if unable to avoid
street cuts. Please contact Kenny Fisher 503.816.6146(cell), 503.718.2602(office), or kenny@tigard-or.gov prior to any
construction activity.
RECEIVED
CityTigard of Ti g' CIN OF TIGARD
C
PUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
!Check one: L'7,/i3tilities ElSidewalb/driveway approach ❑ Street improvementsELEMENTS
Detailed description: Dllunrwht &R-&r � R.4c= 71 ' - 2'` Minor work in rigbt-of-"y
(sidewalk repair,curb cut,street
NDO6 GWPOr d FOAM OP71G CR$I.E W AVA). opening,etc.)requires:
•Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/loeation(s): 8309 SW 111AIZIZER S'T' of the proposed work to be done
•Submit one(1)copy of traffic
�- control plan
-OR-
A licont's name: r=L FCYk/C. 447*7'1- t�E, - ❑ Substantial project work requires
PP UC above items and professional
Address: /g/00 S-t 34r"S' &DG WE t SHITE /q19 engineered plans for: �
✓flsJC0005e W� Zi 9g6g3 •Street widening
Cltp/state: p: •Subdivision infrastructure
Phone:
(3&)55$-q.2!SIsmail;r!N iQI1.AQ✓1 q�Son.�%/l�P��L7��eCoAt. Ceyt •Alain utility line extension:
Storm Drain,Sanitary--Tigard
' r� �s - Water-'Tigard Water Service
Contractor's name: ST�M/DA;2.0 Lf>IL/7i! 4Da/T12i9ZS}IAS• Area(includes Durham,King City I!
CCB#: L694tg A/C
and a portion of unincorporated
Address:
1209`, &M-494 l�. A/E Washington County)
140"(44 ge 97002 DELIVER APPLICATION TO:
City/state: Zip:
City of Tigard
J
Phone:(563) 849-Mg Email: arre,166&.rdardo4il.�t4xom Planning/.Engineering
13125 SW Hall Blvd.
Engineer's name: � /�igl/Id?�•/ Turd,OR 97223
Applications for"minor work in right-of-way"
Address: S4MC_ QS APPl.1C4rlT only may be cmailed to:
City/State: Zip, rownermitsfu7tiaard-ori
Phone: Email:
Case No.' J U
Estimated value of work (within the public right-of-wap): $ 2940 Application submittal fee:
Is work related to a LAND-USE DECISION? ❑ Yes 19/No Appficati accepted:.
If so,please specifv (MLP,SDR,SUB, etc) case#: By Date
_ S
Is work related to a BUILDING PERMPI7 ❑ Yesp)icstion reviewed
®'leo
Ifs as p ' ca
C� Applic�twdfied: f
Al40 e_z_z� By: / J Date
��' I;�[i1R%.N�Mpt•n\Und Use Apyiotlom IIRa aT/16/roY4
j(�"rnL Zo tvZ/
i 13125 SW Ball Blvd. Tigard,Oregon 97223 www.tigard-or.gov 503-715-2421 Page 1 of 4
APPLICANTS
NOTE: Person specified as"?applicant"shall be designated"Pertnittee"and shall provide financial assurance for work.
*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 fmm the envner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any decd restrictions that may be attached to or imposed upon the subject proms.
• 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.
• 'I7ie applicant has read the entire contents of the application,including the policies and criteria,and understands the
tequirements for approving cir denying the application.
SIGNATURES of gagj owner of the subject property requited.
Applicant/Authorized Agent's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW HallBlvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 2 of 4
I
RECEIVED
JUN 16 2015
CITY OF TIUA CONSTRUCTION NOTES:
• \. '\ PLANNING/ENGINEERING Facilities shown on this plan were obtained from records.
\• \ visual surface inspection,andlor information obtained from
other utilities.Some facilities may be omitted,or shown at an
\ \• ���.!!!�/`//, \ \\ incorrect location.Facilities shown are in assumed locations
•\.:•\ PGE POLE#1198- based on all information received,but exact locations must t>e
\••\ /�/ \ BUILD NEW 2"RISER verified prior to start of construction.
•\ /� \ `\ TO UNDERGROUND)
\• •' Aerial facilities are to be bonded&grounded at all aocessable
�i '•\ �/� 'A\ locations,with cable tags placed at each attachment.
'% \ \ All aerial attachments are to be street-side unless otherwise
\•:•\ ` noted.(FS)indicates"Field side'.
\• �• V /� All materials,methods of placement,and restoration must
0 \• �• j % meet the requirements of the City of Tigard,OR.
\•\ `�• Place cable tags at each pullbox,slack loop,aerial
•\• \• DRECTKA&BORE3 PLACE attachment or accessible location.
• NEW r CONE).a F.O.CABLE
\ \ • 3"Ill DEPTH Contractor to contact Utility Notification Center prior to start of
�\• /• any excavation work.1.1 W 24.5555 or 811.
SW HU ST. j \.:.\ j SCOPE OF WORK:
\ \••\• `� 2"HDPE COND.W/FIBER OPTIC
\• \• / \ CABLE=71'IN RIGHT OF WAY.
\•v�; `\ COND.TO BE 36"MIN.DEPTH
E \. \•
\••\• NORTH
•\. CITY P mif PIAN
\\ Integra Q LIGHTWAVE
ewmp a., ,u
1—WA
oesea
o„ own o, Western Partitions-8300 SW Hunziker St.Tigard OR
Brian Davidson (380)5584215
„h 8!18115 � (360)558-4700
b C21933 OSP.15.ND.12JM.SUC
1 f7
Machine Mill The Sand And Seal
�
12" Area For A 1-1/2" Paving Joints With
Exsting 12„ Min Blanket Inlay Hot Paving Grade
Aspholtic Oil (pg 64-22 Or
Concrete Min " See Notes Below
Equivalent)
Exsting ,R
Road - �
Bose j J�� •) q �S ; tit.� {�l^��)�t�7(/
i
_ f
Non-Compressible
Backfill-Cement Slurry •, 'I i---
1 I i (for Major Roods Or As • i f I
Asphaltic Concrete Pavement _ i Specified) Undisturbed
7" Patch, 6" Thick Or. Match ---I _ ;rl ! Ground
Existing Pavement (whichever Is
Greater) Up To The Level Of Ii I I
Original Pavement.
I—I
:i
Crushed Aggregate
_-III_) d Or Granular Pipe
if I Zone Backfill
Material
I ,-
1_I;-f ►—I f �—I ��f;-I I i�I I
a
z
j
Trench Width
e
Per Plan or
*Notes: As Specified
• Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, Pg-64-22
' Hmoc In Dry Pavement Conditions, Where Existing Pavement Is At Least 60' F
And Rising.
• Tack All Pavement To Be Inlaid With Emulsified Asphalt.
• The City Engineer Shall Determine the Final Width and Length of the Inlay Patch
to Best Fit Travel Patterns.
CAPITAL CONSTRUCTION AND City of Tigard
TRANSPORTATION DIVISION MFILENO
i3I15 s.w. B`►�. Blanket Inlay
71GARD, OREGON 97711
VOICE: 503-639-4171
FAX 503-614-0751 WWW.nWD-OR.GOV Detail