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PFI2017-00093 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action 711% 7 - 7 )0 13125 SW Hall Blvd. • Tigard, Oregon 97223 - 503-718-2439 - www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 S`jU Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: PF/Ao17- 000 9 3 Site Address or Parcel #: /K 7a 3 S w /01 Lo Project Name: Subdivision Name: �{ph,�r,� ���� Lot #: EXPLANATION: A,,5 m, .5u 1 11% Co rwwt ur�Cc��10� � .AkJ&&JY afl ov�eo� 5� ���S;d� . Su ao�S•oo �3 / f'f/fid/G-000S0 Signature: Date: G�/y�/7 Print Name: n�+�/ ks L,. Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of- Any fAny fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE' USE, ONLY Route to Sys Admin: Date By Route to Records: Date 7/7—C), / Refund Processed: Date By Invoice Processed: Date B Permit Canceled: Date / 11'7 By, Parcel Tag Added: Date B I:\Building\Forms\RegPermitAction_092314. oc M RECEIVED MAY 22 2Q17 VC City o,f Tigard 10 PUBLIC GVORI<S — ENGINEERING CITY OF TIGARD ��'/� C PLANNI PFI)GJENGINEERING jPublic Fac' tY ImprovementPermit I TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1—Franchise Utility Wort: Check one: 9 Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by MVN, PGE Detailed description: Comcast proposes to trench/bore 290'and place and/or utility agency. (2)-2"conduit with .625 coax cable a minimum of 36"below grade within ❑ TYPE 2—Sidewall./Driveway/Sewer City of Tigard ROW Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s). 14703 SW 109th Ave and/or repair l MZI • Sanitary sewer lateral installation and/or main line tap Comcast Cable Communications Management, LLC ❑ TYPE 3—Full scale Development Applicant; g 11i�ork performed with Land use Address. SW 68th Parkway approval which includes any of City/state: Tigard, OR Gip. 97223 the following: Phone: (503)941-8656 Email: Alex_Silantiev@comcast.com Subdivisions or Partitions Alex Silantiev 503 941-8656 Street widening Contact name: Phone: ( ) • INlainline installation for Sanitary Contractor: Texstar Enterprises, Inc sewer, Storm sewer, Tigard water CCB#: 178798 Expiration: 10/10/2017 and/or Tigard Water Service Area Address: 14122 Arndt Rd SUBMIT COMPLETED APPLICATION TO: City/state: Aurora, OR Zip: 97002 City of Tigard Phone: (503)793-3109 Email:jimminer@texstarenterprises.com Planning/Engeneet ng 13125 SW Hall Blvd. Contact name: Jim Miner Phone: (503)776-5049 Tigard,OR 97223 Application~for"tninor work in ri�4tt-of-way" Engineer: K&B Technical Solutions only tna>,be emailed to: Address: 6566 SE Lake Rd rp,%yPermits iga� rd-or,,gov City/state: Milwaukie,OR Zip: 97222y Phone: (503)650-6041 Ext.215 Email: John_Foerster@kbmail.net Case No.: 1���� Contact name: John Foerster Application submittal fee: $ Additional fees: $ Estimated value of work is required(if over$5,000):$ Applicationccepted: (within the public right-of-way) By:—. Dare: Is work related to a LAND-USE DECISION? ❑ Yes 8 No Application reviewed: If so,please specify(MLP,SDR,SUB, etc.) case#: By: Date: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes © No By: Date: I If so,please specify(BUILDING PERMIT)case#: l:\ENG\PermltAppf"tlons\pR_applicatlan Rev.12/16/2016 City of Tigard • 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 I I APPLICANTS ; NOTE: Person speciFied as`Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.041.140. -f With the exception of a utility operating pursuant to a valid franchise Nvitlt the City of Turd,when the owner and the:applicant are different people,the applicant ninst be tine purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. 'I'lte owner(i)must sign this application in the space provided or subinit a written authorization with this application. Francliised Utilities are not required to obtain the owner's signature on the application BY SIGNING BELOW,THE APPLICANTS)SHALL CERTIFY THAT: • The above request does not violate n=recorded deed restficdons that mall beattached to or in-112osedthe subjectI properT. i I • 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. I • All of the above statements and the statements in any plot plan,attaclunents,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 an),such } statements are false. 1 i • The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for approving denying the application. John Foersterr 0119117 A can u orized Agent's signature Print name Date i i rGNATURES of each owner of the subject property, if required. ' i Owner's signature Print name Date Owncr's signature Print name Date I I I I Owner's signature Print name Date i f 1 i I i J; I I ; I i _ 1 PUBLIC FACILITY IMPROVEMENT PERMIT i City of Tigard 13125 S`}V Hall Blvd. • Tigard,Oregon 97223 • ,vw\v.tigard-or.gov 503-718-2421 Page 2 of 4 � I I i DEVELOPMENT ENGINEERING FEES FOR STAFFUSE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBmaTAL APPLICATION FEE Part 1: Required submittal fee$300.00 RRAN�C ISE:U'TXLIZ'Y.AND.SIDAWALK/ PERMIT FEE DRIYBWAAND.•UTILITY Part 2: All non-hater system improvements CQNTBC'rlaN$R'I'C: 4i&k in the VW:of. .. .._ :. . . . 1 Engineer's estimate X 5%(less$300.00 submittal fee} ;:... Engineer's estimate X 2%Plan Review Sketeb, ::.` .':. ::: .. ::• ;;: :: :. `:`.: :'.` 1 Onclu"infomifion beloW) WATER SYSTEM FEE ❑`.Dimegsions:`:. � Part 3: All public water system improvements ?b.:Street Nainc.•. : :: Engineer's estimate X 1.2% :.. PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required PULL SCAh.E DEVELOPMENx'. ::.: for the following types of work: ::(Subdivisione,/Pardtlpnr end..Strcet Improvements) • Sidewalk repair(less than 20 lineal feet) ' • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. :(6 sets,24x3b or.22x34) ! • Weep hole repair :,n Cover-:Site,Vicinity,AAbbreviation,Legend. • Curb repair or replacement(less than 20 lineal feet) `Cj._General Notes..(aty,Water,Sewer,etc) .:.: • Lawn sprinkler system installation or repair 11 Street(PkW6 Prable). `. • Street tree pruning or planting :D;Water,Stoanand;Sanitary.(Plan.Profile) • Planter strip landscape maintenance .Water. uak :Faexlsties ::: • Test wells :D...Landscapmg/Tree Plan I .0.:Composite.Utility Plan.(Electrical,Phone,Gas, Note. A cash assurance may be required per :' S rn?�:Sanitary�Water,Signage,Street Lights,etc) TMC 15.04.140.(customer deposit) ❑:Detail D.%F' ffc.Sight Distance O Signing Ond Stripsng :d:Street Light Plan.and Photometric Q.;'Engineers seal/signature Cl.Sheet label(project end use name,revision and :.:.Plan 101t block,dates and sheet numbers). Additional Subvd itals: ,:(p -Lead-Use:conditions) Traffic Report D :Storm water,Drainage Calculations. '.Geotechnical Repo .. Q.:Preliminary Access Report(Sight Distance). ;.Q::Proposed-Plat.. D::Pathway De4l.(if applicable) Q Water.Department Approval i PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-otgov 503-718-2421 Page 3 of 4 i 1 i r SAMPLE SKETCH: y �'vi I I Edge of Pavement ' `— Ditch Streetlight I .—•�.�•—.—•—.�•�r�"" ' TFro'—1) f�S ei�'ine" 1 1 1141 "i Existing House� 01 . Existing >1 Driveway • di _ 1 ID • of a C3's� 1 E� • • I Existing Shop .J Powerpole o ------- ---------- 15raperty'Llne- IFire Hydrant(FH) � I I Scale: I I I I I I I I I I I 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 Existing S/W or of pavement Existing utility locations D/W apron (sever,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard 13125 SW IIall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 4 of 4 i 3 NJUNS PT+Ticket I i Ticket Number 2973747 Pole Owner PPLOR Status Open Ticket Type Other Created On 11/11/2016 11:27:18 AM Pole Number 01101001.0 145706 Created By Tonja Valderas i Contact Phone 503-813-6478 Created By Member PPLOR Contact Phone Ext Contact Name Tonja Valderas House Number ' State Oregon Street Name NE 15th Ave County Multnomah Cross Street NE Place Portland Bryant St Latitude Priority Code 8 Longitude Misc ID WO 006262805 Start Date 11/1212016 Work Requested Date 11/11/2016 I Next 7o Go Step PT Step:1 Next To Go Member COMOR Remarks JOINT USE:COMCAST&CTL TO REMOVE THEIR DOWNGUY OFF OF PPL'S SIDEWALK GUY.PP&L NEEDS THE POSITION ON THE ANCHOR TO SUPPORT OUR OVERHEAD SECONDARY. Cancel Ticket Comment Order Member Job Type Status Interval Next To Go Start Response Request Completed Date Date Date 1 COMOR OTHER Pending 30 11/12/2016 12/11/2016 Number Of Poles 1 Member Pole Number Job 1D Latitude Location Longitude Task ID Reference Remarks 11/14/16•ISSUED TO COMCAST CONSTRUCTION;NRM ' 2 ICTLOFM THER Pendin 30 1/10/2017 Number Of Poles 1 Member Pole Number { Job ID Latitude { Location Longitude Task ID Reference Remarks 3 PPLOR NOTIFY Pendin 0 1/10/2017 _ Number Of Poles 1 Member Pole Number , Job ID 006275705 Latitude Location Longitude i Task 1D Reference Remarks 4 4 JCTLOR1 IFYI Pendin 30 2/9/2017 Number Of Poles 1 Member Pole Number Job ID Latitude ' Location Longitude Task ID Reference Remarks PT Disputes r s I Comments r I i i 1 4 I { I i I l 4 i f i COMCAST CONSTRUCTION POLE WORK ORDER SHEET-2016 Nesc Compliant X Not Nesc Compliant Pole Transfer X I 3rd Party Make Ready No Comcast PT# 2973747 Pole I lig/Power Pole Ta 2/Phone Pole Tag 3!Other UTILITY MAP: Ali 14A 115706 7005-A1008022 COMPLETE DATE 5/1612017 LOi::ATION 6935 NE 15TH AVE SYSTEM EPDX I%Iode E3 number MEMBER CODE POLE HE%GHT/CLASS: 60-3 Year Set: 1964 CONTRACTOR Date returned to Comcast 6/17/2017 Complete Yes Cable bundle count and diameter Strand .260" .500" .67.F," .760" .876" 1.00" Fiber cable Total Bundle Size TEMP TRANSFER APPROVED: PERM TRANSFER APPROVED: TOPPING APPROVED: NO YES NO FIELD SIDE HEIGHT CS STREET LIGHT HEIGHT 1 24 10 " I) Attachment PS / Typo Comcast HEIGHT 1 21 10 " Attachment TL Type: M STREET SIDE Comcast HEIGHT " Show strand,conduit,climbing space locations&down guys Attachment Type Comcast Remarks Attachment BC Brace Contact CTL HEIGHT 21 0 " DQE Double Dead-End Attachment TL DE Dead End Type M FGA Fiberglass Arm FOE False Dead End H J Hook PS Power Supply R Riser Riser bracket owner with Comcast's conduit. Contractor Remarks SB Seattle Bracket COMCAST NO ANCHOR FOR COMCAST TO ST Straight Through ATTACH TO TL T Lead WA Wood Arm FGA Arm length Attachment type D Drop FO Fiber Only Anchor owner with Comcast's down 9u . M Mainline CA Comcast anchor SO Strand Only PA Power anchor SS Self Support coax TA Telephone anchor aU U O O O O r tL Ls. LY i 14595 I i � I i i I I REMOVE AND REPLACE 64 SQ FT SECTION OF ASPHALT EXIT CITY OF TIGARD ROW I 18'_� REMOVE AND REPLACE(1)8'X8'FLAG OF SIDEWALK I i i d 10695 UNIMPROVED ' AREAS ,r NATNE TOP SOIL E TOP SON.EXITED - PRIOR TO EXCAVATION y 2 PIACEB NTER PIN i�,/ SKID RESISTANT g� r� ANULA' W SURFACE M3-e8[ i DR Q S i NATIVE BA LL' / YSf1ULFLAT WASHER ae / AS 1, = 2 PLACES 31WY PL4CES '8 -'S CIFI�,/ I-. 1,0)PAL NU, a ® a QUAZITE LOGO IM 14733 ,r i 38,BUNC N O S.$,INSERT 2 PLACES GALVANIZED n�] BMT STRUT 14703 6 8 If (CENTERED ONE ENO) 14741 1a IT ; 1 HARD SURFACE 14707 10, ,o-w exv2ll3> (CONCRETE) r Iz�EAC SIDE d 2 EACH END) 13'— Q 3' PG,T30B5/0 I � 0 0 3 r LL LL I Cr HANDHOLE 17"X30'71!24" 20K RATING-BOX AND COVER. • •/•/,•,/, AGGREGATE M SERIES-F1730 NDLAR i OR BACKFILL•/ / SPECIFIED _ BORE AND PLACE(2)-T CONDUIT 2 2r A MIN OF 36'BELOW GRADE O (TYPIC AL) a— SD SD�_ SW MURDOCK ST SD w _ S V V y Y Y V -_ O'FROM ROW 8'FROM FOC_- -_-- BEGIN CONSTRUCTION AT EXISTING PEDESTAL `REMOVE AND REPLACE 64 SQ FT SECTION OF ASPHALT JI� TRENCH AND PLACE(2)-2'CONDUIT REMOVE AND REPLACE(1)5'X5 FLAG OF SIDEWALK A MIN OF 36'BELOW GRADE 10790 14805cAL) it � SII 1 N 1.ALL WORK AREAS TO BE I RESTORED TO LIKE OR BETTER CONDITION. AE J U 2.ALL OTHER UTILITIES ARE BASED 14807 OFF EXISTING LOCATES OR UTILITY 0 Q ? STRUCTURES. 3.IT IS THE CONSTRUCTION CONTRACTORS RESPONSIBILITY TO v SCALE`l'-W CALL FOR LOCATES BEFORE DIGGING. ? 4.BORE/DRILL-/-7 T � 14815 5.TRENCH 6.REMOVE S REPLACE- OY19�f7 DESIGN aYXd9TECNfNCAI SOlIlT10M5 �'`'�" 14703 SW 109TH AVE com aJ b, IK]5 �� DEsewP K TIGARD,OR 97224 N TECHNICAiSOLUTIONS 2 Contact:Alex Silantlev 53194 PO BOX 2529,Clackamas.OR 97015 3 AN ro �7► Phone:(503)941-8656 O -(503)650-6041 FxL21g COAX ENHANCEMENT ff Iv Alex Silantiev@comcast.com Email:John_Foersler@kbmail.net 4 - - CITY OF TIGARD ROW PERMIT DRAWING Page 78 2011 Edition Work on Shoulder Diagram 210 Diagram 210 covers stationary work with work or parked equipment on the shoulder. This diagram does not cover work on a freeway shoulder. See Diagram 710 for Freeway Shoulder work. 1. Vehicles should be parked as far off the roadway as practical. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 3. For added visibility, truck-mounted arrow boards or PCMS in caution mode may be used. 4. Arrow panels in caution mode are recommended for work on roads with posted speeds of 45 mph or greater and high traffic volumes, greater than 2000 average daily traffic(ADT). 5. Requirements for signing and devices are shown in Table 5-2, below. Table 5-2: Device and Signage Guidelines Proximity to Edge of Traveled Way More than 15 feet or behind Barrier or Less than 15 feet Guardrail One advance warning sign is Advance warning required and two signs are Work in Place signs, devices, and recommended. More than 1 Hour flashing warning Cone taper is required. Cones lights are optional. along the edge of traveled way are optional. Work in Place Advance warning signs and devices are optional. Less than 1 Hour Sign Spacing and Buffer Lengths(feet) Posted Spacin Between Signs Buffer Speed A B C Space ERRATA: 20 50 25 100 100 100 75 Supplement Table 30 100 35 350 350 350 125 updated:February 12, 40 150 2016 45 180 6y:0D0rTrafric-Roadway 50 500 500 500 210 Sectio" 55 1 250 Chapter 5 Si in Spacing and Buffer Lengths Beet Supplement December 2011 Posted S acing Between Signs "Buffer" Speed A B C Space 60 285 65700 700 701 325 70 365 2011 Edition Page 79 Work on Shoulder Diagram 210 • • • • (Optional) • • �` Protection Vehicle w/TMA(both Optional) See Chapter 4 • Buffer • • • • U3 • • A ROAD SHOULDER WORK OR WORK AHEAD AHEAD Initial Warning Sign I t *Use as appropriate-see Table 5-2 December 2011 Chapter 5