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PFI2015-00136 q CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT • COMMUNITY DEVELOPMENT Permit#: PF12015-00136 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/29/2015 Parcel: SEG1344 Jurisdiction: Tigard Site address: 11308 SW 68TH PKWY Subdivision: PFAFFLE PLAZA CONDO Lot: 2 Project: Comcast Fiber Optic Project Description: Comcast proposes to push 1,48ct fiber optic cable through existing conduit on SW 68th Parkway Dr and 66th ave. Trench and bore to place a new conduit along/crossing SW 66th ave. Owner: FEES Description Date Amount PFI Permit Fee 09/28/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: SCOTT SARBER 11308 SW 68TH PARKWAY TIGARD, OR PHONE: 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: ar") ('��(r ca ' y r^l Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00136 Type: Condition Name: Status: Severity: 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 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. RECEIVED City o,f Tigard SEP 2 8 2015 r PUBLIC WORKS — ENGINEERING CITY OF TIGARD PLANNIN /ENGINEERING Public Facility Improvement (PFI) Pernuf DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: R Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Comcast proposes to push (1)-48ct Fiber Optic ;/Niinor work in right-of-way (sidewalk repair,curb cut,street Cable through existing conduit on SW Parkway Dr and SW 66th Ave and opening,etc.)requires: trench/bore to place a new conduit along/crossing SW 66th Ave. •Application form,completed and signed %A Qj •Submit one(1)copy of scaled sketch Property address/location(s): SW trkway Dr/SW 66th Ave of the proposed work to be done SG G 1344 315Q Submit one(1)copy of traffic P —OR— Applicant's R— A licant's name: Scott Sarber ❑ Substantial project work requires pP above items and professional Address: 11308 SW 68th Parkway engineered plans for: •Street widening Ci /state: Tigard Zip: 97223 •Subdivision infrastructure Phone: (503) 596-3819 Email: Scott_Sarber@cable.comcast.com •blain utility line extension: Storm Drain,Sanitary—Tigard - Water—Tigard Water Service Contractor's name: T2XStar Enterprises Area(includes Durham,King City CCB#: 178798 Expiration: 10/10/2015 and a portion of unincorporated Address: 14122 Arndt Rd. Washington County) City/state: Aurora Zip. 97002 DELIVER APPLICATION TO: 503-776-5049 imminer texstarenter rises.com City of Tigard Phone: Email: / @ P Planning/Engineering 13125 SW Hall Blvd. Engineer's name: Jon Arend Tigard,OR 97223 PO Box 2529 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Clackamas Zip: 97015 romWermits .tigard-or.gov Phone: (503)650-6041 Email: Jon_Arend@kbmail.net Estimated value of work (wCase No.: I �I ZdIJ'l�Or 3'6 (within the public right -of-way): $2,500.00 Application submittal fee: 3 00 Q Is work related to a LAND-USE DECISION? ❑ Yes 8 No Applicagtio�n accepted: If so,please specify (MLP, SD , SUB,etc.) case #: By:_ r " '� Date: al 26 R Is work related to a BUILDING PERMIT? El Yes reviewed:Yes R No By:. W Date: �J-2�-/S If so,please specify(BUILDING PERMIT)case#: p `_^ Applicant gified: By: � . Date: li 201 l:\CURPLN\Masters\Land Use Applications Rev.07/16/2014 City of Tigard • 13125 S\V Hall Blvd. • Tigard,Oregon 97223 0 www.tigard-or.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"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 from the owner 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 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 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 of each owner of the subject property required. o a pplicant/Authorized Agent's 'gnature 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 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4 EXIT CITY OF TIGARD ROW --35' s2 -21Y CONSTRUCTION NOTES: 7 N .n, f 1. ALL WORK AREAS TO BE '( RESTORED TO LIKE OR BETTER INSTALL PEDESTAL 12'---4 CONDITION. W E BORE TO PLACE(1)-2'CONDUIT CONTAINING(1)-48CT FIBER 11 0. ATTENTION:Orepon%w n*Am yep to kbv OPTIC CABLE AND(1)-COAX CABLE A MIN OF 36"BELOW GRADE II�..�.pr�yrlMourlk °A 2. ALL OTHER UTILITIES ARE BASED I yl'!'m"�*�' OFF EXISTING LOCATES OR UTILITY TRENCH TO PLACE(1)-2"CONDUIT CONTAINING pl�M�plt�l•om you n+ay octan S 50' I (1)-48CTFIBER OPTIC CABLE AND(1)-COAX 4ft61j0 6W1rd/NpthecanW (Note STRUCTURES. CABLE A MIN OF 36"BELOW GRADE MIIIg11 rAwdwW#ArM O,pon,tiny (TYPICAL) IllIIII10008 WbOW 232.1987 or 811 1. PLACE(1)-48CT FIBER OPTIC CABLE AND 3. IT IS THE CONSTRUCTION (1)-COAX CABLE IN EXISTING CONDUIT CONTRACTORS RESPONSIBILITY TO CALL FOR LOCATES BEFORE DIGGING. 4. BORE/DRILL- 77—/ —1—f/ I � 5. TRENCH - — — I , 6. EXISTING- Contact: Scott Sarber Title: Fiber Construction Analyst N W Mobile-(503) 519-7538 Q Office- (503)596-3819 = Email -Scott_Sarber@cable.comcast.com 0 o (CDD o ? 0 � c 3 vJ comcast,. 452' 11308 SW 68th Parkway Tigard, OR 97223 PO BOX 2529 Clackamas,OR 97015 Design By:K&B(503)650-6041 UNIMPROVED HARD SURFACE TECHNICAL SOLUTIONS Email:Jon_Arend@kbmail.net PLACE(1)-48CT FIBER OPTIC CABLE AND > AREAS Ir NATIVE TOP suP (CONCRETE) (1)-COAX CABLE IN EXISTING CONDUIT aTOPS04LEXISTED SITE ADDRESS: PRIOR TO EXCAVATION 13190 SW 68th Pkwy Tigard, OR 97223 AOOREWE 2 S 1 W 01 EXISTING VAULT N , �,, i, 4 , APPROVED PLACE(1)� NAI NAT REV. DATE DESCRIPTION 8CT FIBER OPTIC FOC I BACKS $ BAC z CABLE IN EXISTING CONDUIT i 8 SPECIE s 1 08/21/15 PERMIT DRAWING JLA 'SPE - -- ROW-- - - ,' �}- U►n _ FOC _ �.... SW PARKWAY DR - - -_- - FOC SCALE: PROJECT NUMBER - -ROw - _�- - 1"=60' 44980 f SHEET NUMBER TITLE: a EXISTING COMCAST PEDESTAL/ " COAX ENHANCEMENT PLACE(1)-48CT FIBER OPTIC CABLE AND (1)-COAX CABLE IN EXISTING CONDUIT PERMIT DRAWING EXISTING COMCAST PEDESTAL - FILE NAME: SHEET 1 OF CMEX-4744-3741 1