PFI2015-00158 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00158
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/02/2015
Parcel: SEG1869
Jurisdiction:
Site address:
Subdivision: Lot:
Project: Astound Broadband
Project Description: Underground installation of PVC or HDPE conduit, fiber optic cable and associated utility vaults.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/04/2015 $300.00
PHONE:
Contractor:
PHONE:
FAX
Applicant:
TIM LEWIS
669 GLATT CIRCLE
WOODBURN, OR 97071
PHONE: 971-264-4401
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: .l
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
1 Conditions for PF12015-00158
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
No traffic obstructions are permitted 6:30-9:00 am and 3:30-6 pm.
f .
City of Tigard W ��
Application For Work In The 015 f-Way
ruffZS61 ROW Permit P CITY OF TIGARD
L 11VlaI.IAIC,IE-[�CK.-+I.NEcf3lAt
Property Address/Location(s):SW Bonita Rd - From 50' East of FOR STAFF USE ONLY
SW 74th Ave to 125' East of SW 72nd Ave Right-of-Way PFl�QiS'- L58
Case No.: �
*Applicant's Name:Astound Broadband, LLC Application Accepted: 19 (a By: �
Address: 669 Glatt Circle Application Reviewed: r✓ "C By:
City/State:Woodburn, OR Zip:97071 Application Fee Due:
Primary Contact: Tim Lewis Applicant Notified: L a 1
Phone: 971-264-4401 Fax: Receipt No.-
Email tlewis@wavebroadband.com
REQUIRED SUBMITTAL
INFORMATION
Contractor's Name- Northwest Drilling and Boring • Application form,completed and signed
CCB# Expiration:
203196 • Submit one (1) copy of scaled sketch of
Address:
PO Box 250 the proposed work to be done
o Submit one (1) copy of traffic control
City/State:Scotts Mills, OR Zip:97375 plan
Phone:503-201-8218 Fax:
Professional Engineered Plans are required
Email:NWdrillingandboring@yahoo.com for:
0 Street Widening
Plans By:Commstrueture Consulting, LLC • Subdivision Infrastructure
Address:
811 Railroad Ave • Main utility line extension
City/State: g y'
Oregon Cit OR 97045 Deliver application to rowpemiitsna tilrard-or.gov or to
Zip: City of Tigard planning/Engineering,13125 SW I-call
Phone:971-266-4433 Fax: Blvd.Tigard,OR 97223.
Email:tammy@eommstruetureconsulting.eom Rea.12/10/2013
1:\CURP1,N\Masters\land Use Applications\Right-of-way Permit
Application.docs
Description of work:Underground installation of PVC or HDPE conduit, fiber optic cable and associated utility vaults
as detailed on the attached construction plans.
Estimated value of work(within the public right-of-way): $26,000.00
Is work related to a LAND-USE DECISION? YES ❑ NO Z
If so, please specify(MLP,SDR,SUB,etc.)case#-
Is the work related to a BUILDING PERMIT? YES EJ NO
If so, please specify(BUILDING PERMIT)case#:
Signature of Applicant/Permittee: ` t Date: 10/26/2015
Print Name: Tim Lewis Title: Permit Manager
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 ( www.tigard-or.gov
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CONSTRUCTION NOTES
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PIT/ BOND #12 AWG LOCATE WIRE TO ACCESS POINT.
ONG PIT PL NEW SINGLE #6 AWG TAIL BETWEEN GROUND ROD & TEST STA 110N GROUND LUG.
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PRELIMINARY SET
CONSTRUCTION NOTES
EXISTING RISERS O DIRECTIONAL DRILL - ALONG BACK OF SIDEWALK.
(2) 6" RISER PWR SEC N PL THREE (3) NEW 1-1/4' SCH-40 PVC OR SDR11 HDPE CONDUIT.
(4) 2" RISER CATV PL NEW 4' GRC RISER ON PULL NEW 144E CABLE AND #12 AWG LOCATE W7RE THROUGH ONE (1) NEW CONDUIT.
EXISTING STANDOFF BRACKETS PULL NEW 288F CABLE THROUGH ONE (1) NEW CONDUIT.
O2 PL NEW 24X36 UTILITY VAULT - WMEAVY DUTY TWO BOLT LID.
PL NEW GROUND ROD, LOCATE WIRE ACCESS POINT AND GROUND WIRE IN VAULT.
D BOND ,#12 AWG LOCATE WIRE TO ACCESS POINT.
0 PL NEW SINGLE #6 AWG TAIL BETWEEN GROUND ROD & TEST STATION GROUND LUG.
O LEAVE 50' SLACK STORAGE IN NEW 144E AND 288F CABLES COILED IN VAULT.
O EXISTING PGE POLE 18728 - PL NEW 4' RISER (10' GRC REMAINING PVC)
PGE POLE 418728 PL NEW 144F AND 288F CABLE INS NEW RISER CONDUIT AND TRANSITION TO UNDERGROUND.
RISER QUADRANT DETAIL 2 PL 16 VERTICAL GROUND ON POLE AS REQUIRED - BOND LOCATE WIRE TO MGN ON POLE.
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