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PFI2016-00092 a CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT $ COMMUNITY DEVELOPMENT Permit#: PF12016-00092 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/12/2016 Parcel: SEG3035 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Communications Project Description: Access to 2 existing vaults on SW Upper Boones Ferry Rd. near intersection of SW 72nd Ave. Owner: FEES Description Date Amount PFI Permit Fee 05/12/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: JOHN COUSINEAU 4155 SW CEDAR HILLS BLV BEAVERTON, OR 97005 PHONE: 503-643-0371 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 PF12016-00092 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 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® MAY 0 5 2016 City of Tigard CITY OF TIGARD p PUBLIC WORKS —ENGINEERING '! ^. !KING/ENGINEERING 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: Access to 2 existing vaults on SW Upper Boones N Minor work in right-of-way (sidewalk repair,curb cut,street Ferry Rd. near intersection of SW 72nd Ave. opening,etc)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): Customer is at 16195 SW 72nd Ave. of the proposed work to be done •Submit one(1)copy of traffic Access to property communications is off SW Upper Boones Ferry control plan 03� -OR- A licanes name: Frontier Communications /Cousineau ElSubstantial project work requires PP above items and professional Address: 4155 SW Cedar Hills Blvd. engineered plans for: •Street widening City/state: Beaverton Zip: 97005 •Subdivision infrastructure Phone: 503-643-0371 Email:john.cousineau(cMr.com •Main utility line extension: Storm Drain,Sanitary-Tigard Water-Tigard Water Service Contractors name: Sonieom Area(includes Durham,King City CCB#: 188116 Expiration-. 9/24/2017 and a portion of unincorporated \�ashington Count}) Address: 1275 S Kodiak Circle City/state: Cornelius Zip: 97113 DELIVER APPLICATION TO: City of Tigard Phone:503-710-2972 Email:mattshore(c,sonieom.com Planning/Engineering 13125 SW Hall Blvd. Engineer's name: John Cousineau Tigard,OR 97223 Applications for"minor work in right-of-way" Address: 4155 SW Cedar Hills Blvd. only may be emailed to: City/state: Beaverton Zip: 97005 ro rmi s g tigard-or,9U Phone: 503-643-0371 Email: iohn.cousineau.ftr.com FOR STAFF USF ONLY Case Na: rX5"C u(, - Oa / Estimated value of work(within the public right-of-way): $2.000 Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes No Application 9e64ted: If so,please specify (MLP,SDR,SUB, etc.) case#: By: Date: S Is work related to a BUILDING PERMIT? ❑ Yes ® No Ap lira leases eci UILDING PERMI By If so �� (b �P P fY(B �case#: Aror L / Applicant;notified: 'V e4"r- �3' ��P � (Igp-lAot- j .J-torn- By: !/ Date- I:\NPPIN\Masbnwnd Uw App9otlau Rev.07/16/101 Cityof Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 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 *\/hen 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 APPLICANTS) 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 owner of the subject property required. a'olz John Cousineau 05/05/16 14 plicant/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 PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ww-wtigard-or.gov 503-718-2421 • Page 2 of 4 CONSTRUCTION NOTES �\ SEVERAL CABLES AND ANNOTATION LOVER PULL 12 FIBER INTO EJ(ISTING CONDUIT FROM HUB TO / HAVE BEEN LEFT OFF FOR CLARITY. MH102 THRU TO PED 9620 THEN TO PED 8704. 16083 SW UPPER BOONES FERRY 2.NOW FROM PED 8704 OVER PULL 4 PORT TAIL INTO EXISTING TGRD RXA(H3017.1-216+ /�/ H4/103 CONDUIT TO CUSTOMER'S DMARC O . TGRDORXA H3017,1-43+ qR_k�/ \ AND PLACE TERMINAL. XD,44+H3017,45 216+ 16101 SW 72ND AVE 3.SPLICE H3017,44 AT HUB3017 O � BRIV 9620 1 4.PLACE RED JUMPER FROM Jee� RBN 24 �y FIBER COUNT FC2040,561 IN TO TGRDORXA T188,23-24+ 1 FIBER COUNT H3017,44 OUT. TGRDORXA 7188,23-24+ 111 TGRDORXA T188,21-22+ 'I 5.CHECK LIGHT BACK TO TIGARD XD,7-24 I 16156 SW 72ND AVE CO. 16255 SW UPPER BOONES FERRY RD H1 102 AE 600 24 � SEE H BBRIV DAH,1801-2215+ I RBN 2 �� DETAIL WP3 I XD.2216-2225+ TGRDORXA FC2040,553-564+ / , BBRIV DAH.2226-2400 1a XD,13-24 618' 04.2016 0 / BRIV AH 12-FIBER 12 XD,1-7+ + TGRDORXA H3017,44+ ; XD,942 I TGRDORXA H3017 BRIV 8704 TGRDORXA FC2040,553-555+ XD,97-439+ \ 130 04.2016 / TGRDORXA FC2040,556-560+561+562-564 FTTP PIGTAIL 200FT 4 PROS / TGRDORXA H3017,1-43-44-45-432 / 7p5 A0007,150OA- + Fiber count:(FC2040:561 IN) (H3017:44 out) / 5ti�1p0 '— SG¢OO�2�301'I,�t ee'PiLO6j� X 1 .%A DWALGREENS INFUSION SERVICE 0 i \ 1.CONTACT:Jon Blackman 310580.2457 '�P. A 16570 SW 72ND RD 2ADDRESS:16195 SW 72 AVE. �OTI 3.Buslness Terminal:BBRIV 8705 4XIber count;(FC2040:561 IN) (H3017:44 out) \ SASR#2493047 TGRD-FES-PLC RED JUMPER-FIB 6.PON#1750326651NN0001 \ 7.813Tp 20160411004060 AND FDT-16195 SW 72 AVE B.OSP In service date:5124116 PROJECT C.o.ARFA TtCJ RD 16150 NuNeER:5192779 EXCR.CODE:S13sDPAMI1 \� WASH SW UPPER 04m4li DATE Ev o UM04 I niCOUSINFAU e BOONES FERRY RD saLE:1.100 TaroaTRrcr. ow0 2 OF 3 iwRs� RM sec: .lnvarion.com DW Frontier Notes: Lane Width 12 K&D as the preparer of this traffic control plan makes no representation CONTACT:John Cousineau 1. Maintain ped.access to and Posted Speed 35 as to its general adequacy or being approved for Implementation. through crosswalks Approval must result from the Traffic Engineer or other public official 971-788-2412 Merge Taper 245 �� PP 9' 2. Maintain Min.12'lanes Shift Taper 125 having statutory enforcement authority In the jurisdiction. 3. Maintain local access P Utilization and implementation of this plan shall be as a result 4. Notify Transit authority at least Flagger Taper 50-100 / of that approval. Ref.MUTCD 2009 6A-01(10). LOCATION: SW 72nd & 48 hrs.of bus stop closure Shoulder Taper 70 ROAD Upper Boones Ferry Rd 5. Traffic control plan and all Buffer 125 —RK devices shall comply with /' Notify Fife/EMS, Tigard OR MUTCD, ATSSA and OTTCH Sign Spacing 350 i %Spacing: EPD and LTD zo-1 DATE: JOB# 6.Adjust to field conditions Cone S P 9�35 w � 48 hrs before 514/46 51351-51927790/i }I beginning work DRAWN BY: ALAN WARD 04456 W9-3 PLEASE SCHEDULE 011 N I'll WITH DISPATCH @ Manifest } 72 HOURRSSIN ADVANCE AND PROVIDE A 40 x Cones i tea` COPY OF THE APPROVED 5 x road work ahead ® TRAFFIC CONTROL PLAN Place No Parking 1 x Left Shift \ O� % s a RORK signs 48 hours 1 x center lane closed ahead W9-3 c� / NEA before work begins i Q � �cw20-1 o ROAD �\ WORK Cw20-1 1 �I1 Legend `�� DW Driveway \ I r Work Area ROAD Cones Cw1-4 \ \\ WORN ROAD H WORM \ Sign Stand HEA \ CW201 l road work ahead cw20-1 Left Shift center lane closed ahead W9-3 (NOT To SCALE) ((//lKill K&D SERVICES OkEbdW,INC PHONE:503.723-7287 FAX:503-723-8750 DRAWN BY: ALAN WARD 04456