PFI2016-00125 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
a COMMUNITY DEVELOPMENT Permit#: PF12016-00125
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/13/2016
Parcel: SEG285
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Overlash(1)48ct fiber 268'to existing Comcast facilities.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
SCOTT SARBER
11308 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 503-596-3819
Total $0.00
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: (�TT
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00125
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. KEN FISHER 503-816-6146 of KENNY@TIGARD-OR.GOV.
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
City of Tigard JUN 0 9 2016
PUBLIC WORKS— ENGINEERING CITY OF TIGARD
t I..ANNI G/ENGINHn!NG
Public FacilitY Imp rovement PFI Permit
DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK
Check one: ® Utility Connection
j ® TYPE 1—Franchise Utility Work
❑ Sidewalk/driveway approach Work performed by NWN,PGE
I ❑ Street improvements and/or utility agency.
l Detailed description: Overlash(1)48et fiber 268'to existing Comcast ❑ TYPE 2-Sidewalk/Driveway/Sewer
i
i facilities. Work performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s):
9600 SW Oak St. Suite 400 and/or repair
Portland,OR 97223 • Sanitary sewer lateral installation
51- and/or main line tap
❑ TYPE 3—Full scale Development
Applicant: Comcast Of Oregon Work performed with land use
Address: 11308 SW 68th Parkway approval which includes any of
Tigard, OR 97223 the following:
City/state: 9 Zip: • Subdivisions or Partitions
Phone: 971-801-5706 Email: scott_sarber@cable.comcast.com • Street widening
Contact name: Scott Sarber Phone: 971-801-5706 • Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
Contractor:
and/or Tigard Water Service Area
CCB#: Expiration: SUBMIT COMPLETED APPLICATION TO:
Address: City of Tigard
City/state: "Lip: Planning/Engineering
13125 SW Hall Blvd.
Phone: Email: Tigard,OR 97223
Contact name: Phone: Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: Utiligi Communications rownermitaQ�gard-orsoov
Address: 111 Nyberg Rd SW
City/state: Pacific,WA Zip: 98047 /_
Phone: 503.335.7106 Email: keola.vincent@utiligi.com Case No.: PR"201&-oola �—
Contact name: Keola Vincent Application submittal fee: '�-
Additional fees:
Estimated value of work is required(if over$5,000):$5700.15 Application accepted:
(within the public right-of-way) By: L--S Date:
Is work related to a LAND-USE DECISION? ❑ Yes (■] No Application reviewed:
L
Date:
If so,please specify (MLP, SDR,SUB,etc.) case#: By: 14-
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes IM No By: AV,
If so,please specify(BUILDING PERMI"I' case#: ckusPtMMa t rs\L•du""°°'w"°"' "'"07/°9/2°'5
City of Tigard • 13125 SW Hall Blvd. • "Tigard,Oregon 97223 www.tigard-or.gov • 503-718-2421 • Page I of 4
fl 14 rC t S A, 4e
i
APPLICANTS
NOTE: Person specified.as °"Applicant" shall be designated"Permittee" and shall provide financial assurance for work.
"When 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 owncr(s)must sigrt this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request doses not violate any deed restficti6ris that may be gitachecl to orimposed upon the subject 12roperty.
• 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.
SIG TUR y c f e subject property required.
A 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
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI) Permit:
APPLICATION FEE RFQUIREMENTS
Part 1: Required submittal fee$5300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$5300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE
❑ Dimensions
Part 3: All public water system improvements
❑ Street Name
Engineer's estimate X 12%
❑ Site Address
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required FULL SCALE DEVELOPMENT
for the following types of work: (Subdivisions/Partitions and Street Improvements)
• Sidewalk repair(less than 201ineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,24x36 or 22x34)
• Weephole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance maybe required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
S L
Edge of Pavement
+— Ditch
Streetlight I •—• or Rsin Drat<i — •—
r
i."pe-6— s
Se!IweTu
Existing
rivew
Existing House
.>ii, Day
1
H 31
I � I 1
0I �1
j r
v 1
a� I
r
I i
oi ! i
I J � Existing Shop �
� � I
Powerpole ( 1= I d 1
o a
0
I
I a 95' 1
r I �'-----•FroperiyLine—-—-—-—-—-
II Fire Hydrant(FH)
� � I
Scale: "I"=30'
� I I
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MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable):
North arrow Property lines &dimension Slope of property
Street& street name(s) Existing building, structures Utility&street light poles
Proposed work Existing curb or edge Trees
I:�xisting S/W or of pavement Existing utility locations
D/W apron (sewer,water, storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Halt Blvd. • 'Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 Page 4 of 4
CLIENT.
LEGEND SIGN SPACING stp
SIGN SPACING.=X FEET COMCAST
FLAGGER STATION FREEWAYS&EXPRESSWAYS 50/70 MPH 1500'+/-IOR AS PER MUTCDI
173085W 6801 Pkwy
f TEMPORARY SIGN LOCATION RURAL HIGHWAYS 60/65 MPH BW'+/- Tipard,OR 97723
URAL ROADS 45/SS MPH SOD'+/- (80D1266-2276
PREPARED BY:
Q TEMPORARY SIGN LOCATION FILIAL ROADS&URBAN ARTERIALS 35/40 MPH 350'+/- ��IfI
_I PROTECTIVE VEHICLE RUAL ROADS&URBAN ARTERIAL$ ZS 130 MPH 2(0'*J- v M L"e!
0i
RESIDENTIAL&BUSINESS DISTRICTS
CDMNUNICAP.GNS
® ARROW BOARD URBAN STREETS 25 MPH OR LESS 100'+/- SEATTLE-PORTLAND
ALL SKINS ARE 48'x48'BLACK ON ORANGE UNLESS OTHERWISE DISIGNATED 111 Nyberg Raad SW
® BI-DIRECTIONAL ARROW BOARD !1)ALL SIGN SPACING MAY BE ADJUSTED TO ACCOMMODATE INTERCHANGE RAMPS,AT GRADE Pacific WA 98047
INTERSECTIONS,AND DRIVEWAYS •r2S1)863-3881
0 DIRECTIONAL ARROW,CONE TOP SIGN 121 THE SPACING MAY BE REDUCED IN URBAN AREAS TO FIT ROADWAY CONDITIONS PROJECT INFORMATION;
O BI-DIRECTIONAL ARROW,CONE TOP SIGN COMCAST
TAPER OR/SW WA MARKET
MINIMUM TAPER LENGTH IN FEET(L3) "PROJECT NAME&ADDRESS"
LANEPOSTEDSPEED LIMIT(MPH)
LATH 25 30 35 40 45 50 55 60 65 7D
ISSUED FOR: /�
10 105 150 105 270 450 SOD 550 - I - TCP
NOTES 11 115 165 225 29S 495 550 605 660 I PROPRIETARY INFORMATION:
1. ALL SIGNS ARE BLACK ON ORANGE 12 125 180 1 245 1 320 540 1 600 660 7201780 1 840 THE INFORMATION
CONTAINED IN THIS SET OF
2. F.XTENDINGTHE CHANNELIZING DEVICETAPER ACROSS CONSTRUCTION DOCUMENTS
SHOULDER IS RECOMMENDED. BUFFER DATA
IS PROPRIETARY BY NATURE.
3. NIGHT WORK REQUIRES ADDITIONAL ROADWAY LIGHTING AT LONGITUDINAL BUFFER SPACE=B ANY USE OF DISCLOSURE
FLAGGING STATIONS.SEE THE STANDARD SPECIFICATIONS FOR SPEED(MPH) 125 30Lm-l-Loj 45 1 50 1 55 1 60 1 65 1 70 OTHER THAN THAT WHICH
ADDITIONAL DETAILS. LENGTH_(FEET)_ 1S5 I 20D 1sso 1305 1360 1425 1495 1570 I.G45 RELATES TO CARRIER SERVICES
4. ALL CONTROL SET UP,SIGN SPACING AND PROCEDURES WILL BUFFER VEHICLE ROLL AHEAD DISTANCE=R IS STRICTLY PROHIBITED.
CONFORM TO SPECIFICATIONS STATED IN THE M.U.T.C.D. TRANSPORTABLE ATTENUATOR '30 FEET MIN. REV DATE DESCRIPTION BY
5. PRIORITY PASSAGE THROUGH WORK AREA FOR MINIMUM GROSSVEHICLE WEIGHT 75,000 LBS THE MAXIMUM TO
WEIGHT SHALL BE IN ACCORDANCE WITH THE MANUFACTUERERS 100FEETMAX.
EMERGENCY VEHICLES WILL BE PROVIDED AT ALL TIMES. RECOMMENDATION.
PROTECTIVE VEHICLE NO SPECIFIED
6. DEVICES SHALL NOT ENCROACH INTO ADJACENT LANES.
MAY BEA WORK VEHICLE STRATEGICALLY LOCATED TO SHIELD DISTANCE
-
7. ALL SPACING MAY BE ADJUSTED TO ACCOMMODATE GRADE, THE WORK AREA, REQUIRED
8. THE DESIGNED CONTROLS CONTAINED WITHIN THIS TRAFFIC MOBILE OPERATION DIAGRAM
CONTROL PLAN WILL NOT BE IMPLEMENTED UNTIL APPROVED
BY THE PUBLIC AUTHORITY HAVING JURISDICTION.
MOBILE Z LANE 71 WAY CONTROL TYPE ALTERNATING TRAFFIC SHEET TRUE:
ALL CONTROL SET UP,SIG N SPACING AND PROCEDURES WILL .+TMewara,m,aeowaexuni.erw..+oure*.c n..00eaawu..rwa+Te m,.rycw
TYE WFJI:M:e Irs Acoara"r ro u:PERer.wrwm a earrrGOPEW.TpHrHMCIMM<ar4 wOa(
CONFORM TO SPECIFICATIONS STATED IN THE FEDERAL MANUAL
TCP LEGEND
aa...Pe-v roTw wwraa rPe.,e r,Twn uaees*m�cwcure wv ee.c eac.a..wr,.
ON UNIFORMED TRAFFIC CONTROL DEVICES(M.U.T.GD) na='Rsrmt°F>ti-•zwsP'�"+L"++r^u re:m+!'evaT"aco`"'°a•"'e
iTSRGyOy t9.�PCO W:va.iTTa.9U0 i0:W,DN!arga pi's414D.VA VR4CGV:LMa 6�
4iel.i a.1'V:laLC SK52 1L•RWs.TW a�ylPNV4RT•4�aPW+Yc6xS -s�` PROJECT MANAGER:
ra�it•I.TWinrmruLLfrnL'r:'l eOCLL•PLS
CITIES AND VARIOUS MUNICIPALITIES MAY HAVE ALSO ADOPTED —��:,�i Randall Renee
SPECIALIZED GUIDELINES FOR TRAFFIC CONTROL WITHIN THEIR _ - p
JURISDICTION.IT IS THE RESPONSIBILITY OF THE ON SITE TRAFFIC -- - " T '`• _- � _-�-IT ®'-- '-L`r-+^I SHEET NUMBEIL PROJECT NUMBER:
CONTROL PERSONELTO SEE IF AND ANY SPECIAL CONDITIONS ^/) 48116-0 R
-w".e.•...m.w.,.0 nunwrx..o _ (.
EXIST �__1],(, � _ ��iJ� PAGE NUMBER:
T-1
VIEWPOIM NAML' DATE:
TCP LEGEND SHEET 2 OF 3 5/23/2016 .
CUENT:
`1 ft
W ` E COMCAST
11308 SW 68'Pkwy
Tkgard,OR 97223
5 (800)266-2378
PREPARED BY:
UTI UOC
COMMJN!CATIONS
SEATTLE-PORTLAND
111 Nyberg Road SW
PadFR,WA 96047
17531 863-3881
PROJECT INFORMATION;
Road COMCAST
Shoulder Work OR/SW WA MARKET
Work Ahead''
"PROJECT NAME&ADDRESS"
Sp• R B L3 x x
LSSUED FOR:
_ TCP
j\ �_ Jl PROPRIETARY INFORMATION:
g CMMNJ
THE INFORMATION
CONTAINED IN THIS SET OF
Vz z CONSTRUCTION DOCUMENTS
f f- IS PROPRIETARY BY NATURE.
^ I o ANY USE OF DISCLOSURE
OTHER THAN THAT WHICH
RELATES TO CARRIER SERVICES
IS STRICTLY PROHIBITED.
REV DATE DESCRIPTION BY
SHOULDER CLOSURE - LOW SPEED SHEETTITLE:
TCP
(40 MPH OR LESS)
PROTECT MANAGER:
Randall Renee
SHEETNUMBER: PROFECFNUMBER:
NOT TO SCALE 48116-OR
PAGE NUMBER:
T-2
VIEWPOINT NAME: DATE:
TCP SHEET 2 OF 3 5/23/2016
Proposed Splice Case
SP-TG-0al95
298'
70' SW Oak St. 48CT
Cp) �
SW 95th Ave