PFI2016-00079 n CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT - Permit#: PF12016-00079
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/26/2016
Parcel: SEG1477
Jurisdiction: TIGARD
Site address:
Subdivision: Lot:
Project: Integra Telecom
Project Description: Overlash a new fiber to existing aerial facilities along SW 72nd Ave.; place new aerial facilities on SW
Cherry Dr. and new underground facilities across Cherry Dr. SEGS 1477, 1499, 1583.
Owner: FEES
Description Date Amount
PFI Permit Fee 05/26/2016 $300.00
PHONE:
Contractor:
STANDARD UTILITY
PO BOX 1008
SALEM, OR 97308
PHONE: 503-849-4828
FAX:
Applicant:
DAVE MINER
18110 SE 34TH ST. BLD 1, SUITE 100
VANCOUVER,WA 98683
PHONE: 503-710-6296
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 Not Present
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00079
Type: Condition Name: Status: Seven
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[ATSSAJ, 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 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.
Kenny Fisher @ 503.816.6146
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
RECEIVE®
APR 21 2016
City of Tigard CITY OF TIGARD
e
PUBLIC WORKS—ENGINEERING PLANNING/ENGNP77RING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK (iii the right-of-«-ay) TYPE OF WORK
Check one: ❑ Utility Connection TYPE 1—Franchise Utility WorkIM Sidewalk/driveway approach Work performed by NA'N,PGE
❑ Street improvements and/or utility agency.
Detailed description: From the(SW)corner of SW Tech Center Dr&SW ❑ 'TYPE 2-Sidewalk/Drivevmy/Sewer
& SW 72nd Ave with aerial over lash(N)along 72nd Ave to SW Cherry Ave Work performed for the purpose of:
then goes underground(N)across SW Cherry or to private property.Please see attached drawing. • Side\valk installation or repair.
• Drive-way approach installation
Property address/location(s): and/or repair
• Sanitary sewer lateral installation
13535 SW 72nd Ave,Tigard OR 97223 and/or main line tap
❑ TYPE 3—Full scale Development
Apphcalit: ELI-Integra Work performed with Land use
18110 SE 34th Street, Building One, Suite 100 approval which includes all),of
Address: g the follo'aing:
Cir state: Vancouver,WA 7.i�. 98683 ,
/ I Subdivisions or 1 artitions
Phone: (503)710-6296 )•;flail: David.Miner@integratelecom.com • Street widening
Contact name: Dave Miner Phone: (503)710-6296 • 111ai1lhne installation for Sanitary
sewer,Storm sewers Tigard water
Contractor: Standard Utility and/or Tigard Water Service Area
CCB#: 66948 Expiration: 5/29/2017 SUMMIT COMPLETED APPLICATION TO:
Address: PO Box 1008 City of Tigard
City/state: Salem, Or 'Liar 97308 Planing/Engineering
503 849 4828 cell Barrel standardutilit com 13125 SW IIall Blvd.
Phone: ( ) l,maul: @ y• 'Tigard,Olt 97223
Contact namo: Darrel Williams Phone: (503)678-3030
Applications for"minor cork in right-of-way"
only may be emailed to:
Engineer: I
row ermitsk)dg,ard-or.gov
Address:
City/state: Zip: I MMU t Isms
��]
Phone: Email: Case No.: PF12016 QQ ! l
Contact natue: Application submittal fee: - �
Additional fees:
Estimated value of\vork is required(if over$5,()00):$586 Apph accepted:
(within the public right-of-way) By: Date: �_l _-
Is work related to a LAND-USE DECISION? El Yes MNo AppliA7liewcd:
B): Date: Z�
If so, please specify (HILI,SDR,SUB,etc.) case #:
Appl t otified:
Is work related to a BUILDING PERMIT? O Ycs 8 No By: Date: y 25
If so,please specify(BUILDING PERAIM case#: \CURPM\%1astenit•ndUse Apgk•Uuns a-m/ovnors
t Cityo Tigard - 13125 SW Hall Blvd. • Tigard,Oregon 97223 www.tigard-ocgov - 503-718-2421 • Page 1 of 4
Iva r�a�rt (13 D-9 a,••. 3
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for«>ork.
When the owner and the applicant are different people,the npplicnnt must be the purchaser of record or a lessee in possession with written
authorization liom the owner or nn agent of the OR-per. The oo•ner(s)must sign this application in the space provided or submit n written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above reaue t does not violate anv deed restrictions that mat he attached to or imposed upon the subject h .
• 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 acknom,ledge 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.
t�LJU Fire-'j�Wa-� 6 MO2 q 2,hip
Ap scant/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
i
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • \v\ett lgard•or.gov 503-718-2421 Page 2 of 4
I
I
NEW STRAND h FIBER i I POLE NUMBER:1165
/J I INTEGRA HOA:23'-5' CONSTRUCTION NOTES
1.ALL WORK AREAS TO BE RESTORED TO LIKE OR BETTER
CONDITION.
SW CHEERY DR SEE SHEET 2 FOR ,til
2.ALL OTHER UTILITIES ARE BASED OFF EXISTING LOCATES
UNDERGROUND TIE POINT---,,, OR UTILITY STRUCTURES.
— — � I^ 3.R IS THE CONSTRUCTION CONTRACTORS RESPONSIBILITY
R
POLE NUMBER:4793 TO CALL FOR LOCATES BEFORE DIGGING.
INTEGRA HOA 23'-2"
Ii POLE NUMBER:1952 LEGEND
a INTEGRA HOA:24'-1' _ —
I! ODER LASHED FIBER
I NEW STRAND g F18ER
RIGHT OF WAY
i —" ------ FACE OF CURB/
SW SANDBURG ST EDGE OF PAVEMENT
EXISTING SIDEWALK
OVERLSH FIBER TO EXISTING STRAND Ili �V _ s.
--
�lj
iI POLE NUMBER:5003
� I INTEGRA HOA:25'-2'
Contact:David Miner
N Title:Sr.OSP Engineer
z ph:1360)558-4213
^ cell:(503)710-6296
i email:Davld.Mlner(a)integratelecom.com
I � PO BOX 2529
RILE NUMBER:4229
IK]5
POClackamas,BOX21 Oft 97015
INTEGRA HOA 25'-0'
Design BY:K 8 8(503)6506041
Ali TECHNICAL SOLUTIONS Emad:Justen_PhlRpsa@k6maA net
iREV. DATE BESCmRIgN DRAWN DESIGN
1 1 4/15/16 CITY OF TMUtD PERMIT DRAWING RAS J.P.
� I
BEGIN FIBER ENHANCEMENT PROJECT scALe PROJECT NUMBER
SW TECH CENTER DR ICERT-28606(INT-7071-4404) 1"=75' ICERT-28606
0' 75' 150' SHEET NUMBER TITLE.
Fiber Enhancement Project
------ ----- 13535 SW 72nd Ave
\ SCALE: 1"=75'
Tigard OR 97223
POLE NUMBER.
INTEGRA HOA:22'2'-8-8' i DE
2 INT-7071-0404
iCONSTRUCTION NOTES
1. ALL WORK AREAS TO BE RESTORED TO LIKE OR BETTER
ra « raffia `« ra a I I ON.
ALL OT
K I 2.ALL OTHER UTILITIES ARE BASED OFF EXISTING LOCALES
OR UTILITY STRUCTURES.
K R R
i I 3.RIS THE OR LOCATES FORE DIOGRS RESPONSIBILITY
TO CALL FOR LOCATES BEFORE DIGGING.
x `
o f I i I LEGEND ---
DIRECTIONk DRILL
s BORE/RECEIVE PIT
EXISTING SEWER .o
EXISTING WATER
i I I RIGHT OF WAY ow
13535 SW 72ND AVE FACE OF CURB/ ,a
TIGARD OR 97223 a t? EDGE OF PAVEMENT
R R IEXIT CITY OF TIGARD ROW s
_�•'�/.,,____.�. —"ry 4,�" r/s�_, .75„" x/c" .�s" �./"// R ATTfiNrgN:6pTwl trsrplhnnM..tvmrmer
Ir« I
WTR W
WTR WTR TR ` roc r«-_�rx/ cpr �,wp.�mwaa
WiR—« —1 r I rotm1Doaxalaoon rm.rmnn
SW CHEERY DR - -I I WTR WTR
- I I i Na.eeetwom�l4m)z3x.lwreetli
nt-1,2 c)ra
TRENCH 5' wb I Contact:David Miner
°• w.._(_Ao,. "o. "o. —s7,.� Title:Sr.OSP Engineer
R cel(360)558-4213
c\ cell:(503)710-6296
J TRENCH&DIRECTIONAL DRILLA R $$$! email:Davld.Miner(dintegratelecom.com
3'X6'BORE/RECEIVE PIT MINIMUM OF 36"BELOW GRADE AND I 7 Po eox 2129
PLACE(I)-2"CONDUIT,LOCATE I Clackamas,OR 97015
TRENCH DETAIL BORE DETAIL WERE,AND FIBER 5'(E),45' (N). R IK]5
Deslgn By:K B B(503)650-6041
II TECHNICAL SOLUTIONS E-0:Justen_Phlllipsr@kb—I net
DATE OESCIII— DF-1 DESIGN
'CFA
16 r EQIE yr I al 4/15/16 Citt OF TIGARD PERMIT DRAWING RAS J.P.
0,,
95x D94PACiIDN N �, OR
fNCANFILI, _ 95S COMPeGrgN NATIVE I R
5 - ,BACAKDLL
S,�CIFIEO,' 5
PIFIA
I
SECED
I i SCALE -EGTNUMNER
1"= '
20' ICERT-28606
o I
i 12 R SHEET NUMBER nnE:
PIPE zoNE O O I 0' 20' 40' Fiber Enhancement Project
PPE zD4E 13535 SW 72nd Ave
FL SCALE: 1"=20' Tigard OR 97223
2 FILE79w NAMe
= I \ OF 2 INT-7071-4404
Page 106 2011 Edition
[Diversion into a Continuous Left Turn Lane_ Diagram 430,
Diagram 430 shows work in the travel lane(s) next to a continuous two-way
left turn lane with one direction of traffic diverted into the continuous two-way
left turn 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. When two or more travel lanes are reduced to a single lane before the
diversion, each lane shall be closed separately. Layout traffic control
according to ODOT Standard Drawing TM 852 for 5-lane sections.
4. A shifting taper(L/2) may be added in the diverted traffic direction
across the continuous two-way left turn lane (as shown). This option is
recommended when the speed is 45 mph or greater.
Sign Spacing and Buffer Lengths(feet)
Posted Spacing Between Signs Buffer
Speed A B C Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 107
W1 rsion into a Continuous Left Turn Lane_ Diagram 430_
ROAD
WORK
AHEAD
B
CENMR
llylt
LAME
CLOSED
AHEAD
A
II
U2 I . I
Buffer
Protection Vehicle
w/TMA(both Optional)
See Chapter 4
Buffer
• U2
I �
U2 A
r
II
lyt B
ROAD
WORK
AHEAD
December 2011 Chapter 5