PFI2015-00187 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00187
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/20/2016
Parcel: SEG1115
Jurisdiction:
Site address:
Subdivision: Lot:
Project: ELI -Integra
Project Description: Proposal to place fiber from existing vault on the NW side of SW Burnham St. through existing conduit
to R/R 6'x 6'section of sidewalk place 17"x 30"vault. Place(1)2"conduit, locate wire, and fiber 77"
(NW)by directional bore and trench 3.5 feet.
Owner: FEES
Description Date Amount
PFI Permit Fee 01/20/2016 5300.00
PHONE:
Contractor:
PHONE
FAX
Applicant:
DAVID MINER
18110 SE 34TH ST. BLDG 1. SUITE 100
VANCOUVER
WA, 98683
PHONE: 503-710-6290
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 i
Signature: f'n ec
Issued By: "I c1
ILL, b�-eb
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00187
Type: Condition Name: Status: Severity:
PFI—Utilities 21 -OTHER Not Met Notice
Mark extents of concrete removal and notify the City's Inspector twenty-four(24)hours prior to commencing work.
0Cite Of Tigard.
a PUBLIC NVORKS—ENGINEERING
C
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:
Integra proposes to place fiber from existing vault on NW side of ❑ Minor work in right-of-xvay
(sidewalk repair,curb cut,street
SW Burnham St.through existing conduit to R/R 6'x6'section of sidewalk place 17"00"vault. opening,etc.)requires:
Place(1)-2"conduit,locate wire,and fiber 77'(NW)by Directional Bore and trench 3.5'. •and signed form,completed
and signed
•Submit one(1)copy of scaled sketch
Propert)- address/location(s): of the proposed work to be done
9180 SW Burnham St, Tigard, OR 97223 •Submit one(1)copy of traffic
control plan
SEG HIS –OR–
❑ Substantial project work requires
Applicant's iinmc: ELI-Integra- Dave Miner above items and professional
.:address: 18110 SE 34th St, Bldg 1, Ste 100 engineered plans for:
•Street widening
Clc\'/state: Vancouver, WA Zip: 98683 •Subdivision infrastructure.
Phone: (503) 710-6290 F:mail: David.Miner@integratelecom.com •\lain utility line extension:
Storm Drain,Sanitary—Tigard
- water—"figard\Carer Service
Contractors Warne.: Standard Utility- Darrel Williams .\rea (includes Durham,King City
1 xpiration: and a portion of unincorporated
CCB#: # 66948
\C-ashington County)
Address: PO Box 1008
Salem, DELIVER APPLICATION TO:
City/state: OR Zip. 97308 City of Tigard
Phone: (503) 678-3030 Email: _ Planning/Engineering
13125 SW Hall Blvd.
Tigard,OR 97223
Engineer's name:
\pplicanona for"minor work in right-of-way"
Address: __ unlc mac be emailed ro:
City/state: Zip:
rocv�ermits(d tigard-or goy
Phone: I-'mail:
FOR ONIA
Case No.: P F1 a 015 —pp 1 b 7
Estimated value of work (within the public right-of-way): S
Application sulnnitral fee:
Is work related to a L,-\ND-USE DECISION? ❑ Yes 8 No Application accepted:
If so, please specify (NILl,SDR,SUB, etc.) case #: By: M-C' Date:
Applicati n re.
Td:
Is
Is work related to a BUILDING PF.RNIIT? ❑ Yes R No /
By: llate: I U /�
If so,please specify(BUILDING PERI\111)case#:
Applicant notified:
/ Iiy:__L_— Date: - S
1\CURPLN\Masters\Land Use Appl-bons Rev 07/16/20r4
2-4 1,,- k-
City of Tigard •/131245 SW Hall Blvd. • Tigard,Oregon 97223 • -,vv, ?.tigard-or.gov • 503-713-2421 • Page 1 of 4
APPLICANTS
NOTE: Person specified as `Applicant" shall be designated"Perinittee"and shall provide financial assurance for work.
wlwn the owner and the applicant arc different people,the applicant must he the Purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owner(>)nmst sign this application in the space provided ur submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The-above request does not v iol9te arts deed restrictions that mav be,Attached to or imposed upon the subject oroPert
• If the application is granted,the applicant-,.ill exercise the rights granted in accordance xvith the terms and subject to all the
conditions and linnitations 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 ani,permit issued,based on this application,may be revoked if it is found that ani, 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.
S NATURES of each owner of the subject property required.
)Sib J —?, f1w PS 4F�L
A plicant/1.1ut sized Agent's signature Print name D
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City 0f Tigard • 13725 S\\'Hall Bh-d. • Tigard,Orcgou 97223 • \\,xvNa.tigard-or.gov • 503-718-2421 • Pdge 2 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part 1: Required submittal fee$300.00
Part 2: All non-water system improvements
Engineer's estimate X 5%(less 5300.00 submittal fee)
Engineer's estimate X 2°ju 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(fess than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• 'lest wells
,6),
1A ntk) 4V4
-
�artC�c�C. Ic�%kiz ntct� L `�
X�
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 1312.5 S\\'f ial!Blvd. • Tigard,Oregon 97223 • -%k-\%-w:tigard-or.gov iO3-7118-2421 Page 3 of 4
Cheryl Caines
From: Justen Phillips <Justen_Phillips@kbmail.net>
Sent: Monday, December 14, 2015 2:16 PM
To: ROW Permits
Cc: Miner, David (David.Miner@integ ratelecom.com); Roy Spaulding;Jeff Mettert
Subject: ELI/Integra Fiber enhancement permit application.
Attachments: Permit Application-Fiber Enhancement_ES015-2810 (INT-6056-4010) signed.pdf, Permit
Drawing_ Fiber Enhancement_ES015-2810(INT-6056-4010).pdf, Diag 300 - Shoulder
Work with Minor Road Encroach ment.pdf
Good Afternoon,
Attached is a permit application, Drawing, and TCP in which ELI/Integra is proposing to place new facilities under the
back of the sidewalk on SW Burnham St. Please see drawing and application for more details.
Please call or email me with any questions or concerns.
Thank you,
Justen Phillips
Project Manager
K&B Technical Solutions
6566 SE Lake Rd Suite E
Milwaukee, OR 97222
Office - (503)650-6041
Fax - (503)650-7390
Mobile - (971)271-9317
i
2011 Edition Page 81
Shoulder Work w/Minor Road Encroachment _ `Diag 300'
ROAD
WORK to
AHEAD
•
Initial
Warning A •
Sign
•
•
•
(Optional) •
•
Protection Vehicle •
w/TMA(both Optional)
Buffer
See Chapter 4 I •
10' •
minimum • U3
•
A VNARROWS
NN
(OptionaD
B
ROAD
WORK
AHEAD
Initial
Warning
Sign
December 2011 Chapter 5
�Y
sf
h\Y�
\ Sf
4\
•P \ �i^k
\ Sf
Yr9 \ k
�,k \
TRENCH A MINIMUM OF 36" BELOW
sfk
GRADE AND PLACE 2" CONDUIT,
LOCATE WIRE, AND FIBER.
\ �k
� sf�
EX11 C11Y OF TIGARD ROW--_ Pp FY
TRENCH 3.5'�
REMOVE/REPLACE 6'X6' \ Y
SECTION OF SIDEWALK. \Y�
18' SIDEWALK
sf 4
DIRECTIONAL DRILL/BORE A MINIMUM
OF 36" BELOW GRADE AND PLACE 2' ♦ Oh
CONDUIT, LOCATE WIRE, AND FIBER. O 4
♦ '� �Y
\ 441 \
\\ / EXISTING INTEGRA VAULT TO
BE DUG UP AND MOVED INTO
\\ ♦ I / ROW AS SHOWN IN DETAIL
REMOVE/REPLACE 6'X6'
SECTION OF SIDEWALK.
0' 20' 40'
SCALE: 1" =20'
CONSTRUCTION NOTES
1. ALL WORK AREAS TO BE RESTORED TO LIKE OR BETTER
a CONDITION.
2. ALL OTHER UTILITIES ARE BASED OFF EXISTING LOCATES
OR UTILITY STRUCTURES.
DEC 14 2015 3. IT IS THE CONSTRUCTION CONTRACTORS RESPONSIBILITY
TO CALL FOR LOCATES BEFORE DIGGING.
FLA`' '' ._ _ .,_`r?NG
LEGEND
DIRECTIONAL DRILL -
EXISTING CONDUIT — —
PROPOSED INTEGRA VAULT
EXISTING VAULT FTI
RIGHT OF WAY
FACE OF CURB/
EDGE OF PAVEMENT
EXISTING SEWER
EXISTING INTEGRA 25TA VAULT EXISTING WATER —WrH
BORE AND/OR RECEIVING PIT �__J
P��r;('.I N r�0` 1 C' REMOVE/REPLACE SIDEWALK FLAG �__J
-PUSH/PULL FIBER THROUGH
EXISTING INTEGRA 4" CONDUIT
J'
integra
� Contact:David Miner
4- Title:Sr.OSP Engineer
BG ph:(360)5584213
cell:(503)710-6296
941 \ email:David.Min erlci�integratelecom.corn
l
PO BOX 2529
` Clackamas.OR 97015
.Sf R
k sf \ Design By:K 8 B(503)650-6041
TECHNICAL SOLUTIONS Email:Justen_Phillips@kbmail.net
REV. DATE DESCRIPTION DRAWN DESIGN
\ rf
k 1 12/11/15 CITY OF TIGARD PERMIT DRAWING RAS J.P.
,y \
rf
k \
1b.may., \ Sfk SCAI F PROJECT NUMBER:
A�\ 1" =20' ESO 15-2810
Sfk sfSHEET NUMBER TITLE:
t \ Fiber Enhancement Project
\ 9180 SW Burnham St.
f \
Tigard, OR 97223
\\ \
FILE NAME.
D \ °F 1 INT-6056-4010
f,
Page 80 2011 Edition
�ShotalcJe�;Work,w/:MinorrRoad Encroachment . ,Diag.'300
Use this detail for non-freeway work which extends into a travel lane and
maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane
can not be maintained, or when traffic can not safely pass by in both lanes
simultaneously, use the appropriate lane closure diagrams—for example,
Diagrams 310 through 350.
A lane closure may be appropriate for conditions such as high traffic
volumes, high speeds, and inadequate approach sight distance to the work
space, or heavy equipment adjacent to the travel lane.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Cones shall be placed along the entire length of the work space. If a
protection vehicle is used and work is in place one hour or less, the
taper and tangent devices may be omitted.
4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there
is limited sight distance, consider placing cones or tubular markers on
centerline.
5. An arrow board in caution mode or truck-mounted PCMS with
"SHOULDER WORK" or other appropriate message may be used for
higher visibility.
Sign Spacing and Buffer Lengths(feet)
Posted Spacin .Between Si ns_ - _ Buffer
Speed - A B C Space
20 50
25 100 100 100 75
30 100
35 125
40 350 350 350 150
45 180
50 .500 500 500 210
55 250
Chapter 5 December 2011