PFI2015-00163 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00163
m13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/09/2015
Parcel: SEG1167
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: Adjacent to 7100 SW Hampton St. Dig on the street to place a man hole size 15'x15'x11'with top
section heavy traffic areas in order to replace/splice a section of 1800 pairs cable which has been
damaged and affected all customer in the area due to road work.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/04/2015 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
TAM NGUYEN
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97005
PHONE: 503-641-4463
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.
Perm itteelApplicant Not Present
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00163
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
NOV 0 2 2015
RCity of Tigard CITY OF TIGARD
�r_ZaApplication For Wo ' ndiePlight-Of-Way
ROW Permit
_ �.__�
Property Address/Location(s):7100 SW HAMPTON STREET. FOR STAFF USE ONLY
TIGARD, OR `S &&3,= Right-of-Way �^) �^ y
Case No.:
!—/ ��J"'
li1
*Applicant's Name: Frontier Communications A PPcation Acce Pted:1 ._B Y�
Address: 4155 SW Cedar Hills Blvd. Application Reviewed: r ii By:�l
City/Stare: Beaverton/OR zip: 97005 Application Fee Due: 6 30P
to
Primary Contact: Tam Nguyen Applicant Notified: // ftJ 2
Phone: 503-641-4463 Fax:503-643-0977 Receipt No.:
Email:tam.minh.nguyen@ftr.com REQUIRED SUBMITTAL
INFORMATION
Contractor's Name: SONICOM /PJ Fellows • Application form,completed and signed
CCB# 188116 Expiration:3/24/2016 • Submit one(1) copy of scaled sketch of
1180 S 12th Ave the proposed work to be done
Address:
• Submit one (1) copy of traffic control
Cit}=/State: Cornelius/OR. Zip: 97113 plan
Phone: 503-992-7711 Fax:503-519-3445 Professional Engineered Plans are required
Email:PJfellows@sonicomcorp.com for:
• Street Widening
Plans By: Nguyen Tam N u en • Subdivision Infrastructure
rlddress:4155 SW Cedar Hills Blvd. • Main utility line extension
Deliver application to ruwpermits[ct)ti r:trd-or.i,�ov or to
CiR/Stare:Beaverton/OR Zip:97005 Cin'of Tigard Planning/Engineering,13125 SW Hall
Phone: 503-641-4463 Fax:503-643-0977 Blvd.Tigard,OR 97223.
Rer.I2/10/2013
Em`A' L\CURPf\\Masten\land Use AppGntion\Right•of•teac Permit
Applicadonducx
Description of work: DIG ON THE SCREET TO PLACE A MAN HOLE SIZE 15X15X11' WITH TOP SECTION
HEAVY TRAFFIC AREAS IN ORDER TO REPLACE/ SPLICE A SECTION OF 1800 PAIRS CABLE
WHICH HAS BEEN DAMAGED AND AFFECTED ALL CUSTOMER IN THE AREA DUE TO ROAD WORK.
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES [—] NO R
If so, please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES NO ❑X
If so, please specify(BUILDING PERMIT)case#:
Signature of Applicant/Permittee: Date: p
Print Name: Tam Nguyen Title: Network Design Engineer
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-715-2464 1 -www.tigard-or.gov
APPLICATION TO CITY OF TIGARD
BY FRONTIER COMMUNICATION NORTHWEST INC.
LOCATION: 7100 SW HAMPTON STREET. TIGARD
NORTH
NOT TO SCALE
ROW
SIDEWALK EOC
SW HAMPTON ST. C/L
tJ C
PLACE NEW EXISTING
MAN HOLE MAN HOLE
0 0
SIDEWALK $0' EOC
ROW
3
7100
A
FRONTIER WILL DIG AND PLACE A NEW MAN HOLE SIZE
15X15X11' WITH TOP SECTION (HEAVY TRAFFIC AREAS)
AND STREET PAVING AS REQUIRED AFTER MAN HOLE IS PLACED.
www.invarion.com
CUSTOMER: I .I
FRONTIER
Legend
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CONTACT: JOHN COUSINEAU — - f
Work Area
503-643-0371 -' ® — —
SW BEVELAND ST Road Closed Detour Left
s
LOCATION: ..:...................._....;, .. ......-.. .... _,...... ...
TIDO sw HAMPTON ST I III . ......_.....
.:_.............. .......... ...
TIGARD OR If®; Q cone
ATE: WI06 } f —� Q detour(R) M4-9
18!22115 DAMAGE
Detour OC-24
Designed By;
':o Robert Pratt
wsreseaousa I road work ahead W20-1
oereseoura + }: Detour I./R
road closed ahead W20-3
1.Maintain Ped.access to } I
andftmogha=walks _ _ _ _ _ _ — — _ — — — — — — INVENTORY:
arMasklowalks. I SW GONZAGA ST 3-ROAD WORK AHEAD
2Maintain Mn101ane oeroua 1-ROAD CLOSED AHEAD
3.Maintain Localaccess 1-BARRICADE WIROAD CLOSED
4.TnaAc CordW Plan and ag I m 1-DETOUR STRAIGHT
DETOUR LEFT
shall all caWy with the I PLEASE SCHEDULE AIGHT
ZMMUMDand OTTCH2O11 } WiTH DISPATCH 2•DETOURRIGHT
standards. +I@ 503-723-7287 1-DETOUR LIR
5 Owesspachrg: 4 DAYS IN ADVANCE 2D•CONES
Flag taper 20' I
Alloberlapersequaltothe AND PROVIDE - Cn
posted speed.20'mfn.for tangent I = COPY OF THE APPROVED f I }
8.28:calm TRAFFIC CONTROL PLAN
35brows I raio°MOa
48.signs WRags } D
7.Coverstop signs and/ardisaVe I m . ..
HAhtswkanataconindedirdessecllon I t oaroua=
8.Place No Parking signs 48 t.i,advance. I Q s r _SW HAMPTON 9
9.Aajust to Tieid cond4ions —
o® (� —
Speed
Limit
t <a 35
} I Notify Tri-Met of Bus Slop Closure
and Detour Route to Beveland and 681h.
acro
awco
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woax
r
KBD Services,as the preparer of this traffic
control plan makes no representation as to Its'
general adequacy or being approved for Implementation.
` I wmuc Approval must result from the Traffic Engineer or NOT TO 5CALE
other Public Official having statutory enforcement authority NOTIFY EMS, FIRE
in lhejurisdiction.Utilization and Implementation ofthis AND POLICE
plan shall be a result of that approval.
Ref.MUTCD 2009 6A-01 10 72 HOURS IN ADVANCE