PFI2018-00216 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00216
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/27/2018
Parcel: SEG1167
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Astound/Wave Broadband
Project Description: SEG 1167/1173.Adjacent to 6950 SW Hampton Street. Bore a 2 inch conduit from existing vault to the
new customers. the conduit will be placed to the back of the sidewalk in the soil and crosses the 70the
into the customer's property.
Owner: FEES
Description Date Amount
PFI Permit Fee 08/22/2018 $300.00
PHONE:
Contractor:
NORTHWEST DRILLING AND BORING INC
PO BOX 250
SCOTTS MILLS, OR 97375
PHONE: 503-201-8218
FAX:
Applicant:
PHILIP FAGIN
669 GLATT CIRCLE
WOODBURN, OR
PHONE: 503-310-5340
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
(r1L
Signature:
e
r�
Issued By: � 1�!)
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00216
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. Call Jonny Gish 971-713-0281 or Jonny@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
'_`1
mECEIVED
City ®f` Tigard AUG 15 2018
®� PUBLIC WORKS ENGINEERING
RD)AIPIjbiffffif f_=PHNG
Public
0
Facility Improvement
DESCRIPTION OF WORD (in the right-of-way) TYPE OF WORD
Check one: N Utility Connection
N TYPE 1—Franchise Utility Work
❑ Sidewalk/driveway approach Work performed by NWN,PGE
❑ Street improvements and/or utility agency.
Detailed description: We will be boring a 2 inch conduit from ❑ TYPE 2—Sidewalk/Driveway/Sewer
our existing vault to the new customer. the conduit will be Work performed for the purpose of:
placed to the back of the sidewalk in the soil and crosses 70th • Sidewalk installation or repair.
into the customer property. • Driveway approach installation
Property address/location(s): and/or repair
6950 SW Hampton St, Tigard, OR 97223 �° ' • Sanitary sewer lateral installation
and/or main line tap
❑ TYPE 3—Full scale Development
Applicant: Phillip Fagin - Astound/Wave Broadband Work performed with Land use
Address: 669 Glatt Circle approval which includes any of
the following:
City/state: Woodburn, Oregon Zip: • Subdivisions or Partitions
Phone:(503)310-5340 Email: pfagin@wavebroadband.eom • Street widening
Contact name: Phillip Fagin Phone: (503)310-5340 • Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
g
Contractor:
NW Drillingand boring and/or Tigard Water Service Area
CCB#: 203196 Expiration: SUBMIT COMPLETED APPLICATION TO:
Address: P.O. BOX 250 City of Tigard
City/state: Scott Mills, OR Zip: 97375 Planning/Engineering
mike nwdrillin andborin com
Phone: (503)201-8218 Email: @ g g 13125 SW Hall Blvd.• Tigard,OR 97223
Contact name: mike Craig Phone: (503)201-8218 Applications for"minor Work in right-of-Way„
only may be emailed to:
Engineer:
rowpermits o tigard-or.gov
Address:
FOR STAFF USE ONLY
City/state: Zip:
Phone: Email: Case No.:
Contact name: application submittal fee: 30() ,.Vc)
Additional fees:
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of--way) By: &.1 Date:
Application reviewed:.
Is work related to a LAND-USE DECISION? ❑ Yes N No �
By: Date:
If so, please specify (MLP, SDR, SUB, etc.) case #:
Applicant notified:
C�
Is work related to a BUILDING PERMIT? El Yes ® No By: Date:15 .
I:\CURPLN\Masters\Land Use Applications Rev.07/09/2015
If so,please specify(BUILDING PERMIT) case#:
City of 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"Pei.rnittee"and shall pror.ide financial assurance for work.
\\-hcn the owner and the applicant are different people,the applicant must he the purchaser of record or a lessee in possession with-,�rritten
authon,zation From the oNvIlcr or an agcnt of the cower. Tile oa-ncr(s)111ust silgtl this application in the space provided or subinit a N ritLcn
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not v folate anv deed restrictions that may be attached to or iniposed upon the subject property.
• If the application is granted, the applicant trill 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 ackn o\x,l edge that any permit issued,based on this application,may be revoked if itis 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.
Phillip Fa in 8/15/2018
>l- ,
p 9
plicant/.' z Agent's signature Print nainc
Owner's signawre Print name Date
Owner's Signature Print name Date
Chyner's sign.atui:e Print name Date
PUBLIC FACILI'T'Y IMPROVEMENT PERMIT
City of Tigard m 13125 SW Hall Blvd. a 1'1gard, (-)egon 9722 3) 503-71-8-2421 - Page 2 of 4
DEVELOPMENT ENGINEERING FEESFOR STAFF USE ONLY
Public Facility Improvement (PEI) Permit:
DETAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee $300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT EEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
(work in the right of_way)
Engineer's estimate X 5% (less $300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM EEE
❑ Dimensions
Part 3: All public water system improvements
❑ Street Name
Engineer's estimate X 12%
❑ Site Address
PEI 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 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets;2406 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 Ll 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
El Traffic Sight Distance
Signing and Striping
Street Light Plan and Photometric
❑. Engineers seal/signature
Sheet label(pro.ject.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)
0 Proposed Plat
❑ Pathway Design(if applicable)
Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 Page 3 of 4
Hampton Square
6950 SW Hampton St • • • • • •
Tigard, OR 97223 CONSTRUCTION NOTES:
1-ALL WORK AREAS TO BE RESTORED TO
LIKE OR BETTER CONDITION.
General Location Scope of Work 2-ALL OTHER UTILITIES ARE BASED
OFF EXISTING LOCATES OR
UTILITY STRUCTURES
C
V �K'° 3-IT IS THE CONSTRUCTION
— c.wve re, .e.str
$w6'snku Peler•{°n°dDe,y P°r.�yy Curler
.OCONTRACTORS RESPONSIBILITY
TO CALL FOR LOCATES PRIOR 5
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m, o - R.O. W. BORE FOOTAGE = 171 TO DIGGING *_I ftp.
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!' ^DdNar Pro°ertef yyflr(K.^M.tnuro
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CONTACT
�- own(;- Construction Manager-Jesse Martin
® jmartin@wavebroadband.com
�«
71)281-4
AOIMtT
Menpmnn!
O
� 0 ax nrarisen
Permit Tech-Phillip Fagin
pfagin@wavebroadband.com
(503)310-5340
SITE ADDRESS/SECTION:
Vicinity Map Legend/Symbology 6950 SW Hampton St
Tigard,OR 97223
Packet Description
Page
1 Cover page
2 Route Detail
- BORE LINE
F7 - EXISTING VAULT
sw r�'ANn A
SW W°orm A SW rYnNen v ....i..rr s_
O O Spectrum^0'rio
..,n lan .p�ntl..tluM�a a 4stlR°n M,Uiure
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,an.nxt 9e•nce°
Nees Cb1!UUC1Mn C
PAGE NUMBER PROJECT NUMBER
QMwn.0D"I 9
10001 8820
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1
�i Pr°urpenl5t°IUny
PAGE 1 OF 2
O O O N
W ' E
5
O O O 0
O
0_
�)From Our exisuny vauui wve will buic 171 feet
southeast into the private property. 0 0 0 O
B)Bore will be to the back of the sidewalk.
C)We will bore onto private property. CD
O O O 0
R 91.41r- W Ix -4 � x x
ROW---- ROW W
D
CD
Right of way width
60'-0"
Sidewalk widthL— 0
Sw Ha„ ROW---.--ROW--- ROW
10'-0pion St 93'-0"Right of way width ROW ROW
"-
R ROW— 0
k0w,
SW Hampton St
Sidewalk width
•8,-0„
-ROW RO
ROW •ROW ROW
22'-0"
I
3
PAGE NUMBER CONTACTS: SITE ADDRESS PROJECT NUMBER
Construction manager Permit Tech
Jesse Martin Phillip Fagin
2 'martin@wavebroadband.com pfagin@wavebroadband.com 6950 SW Hampton St
(971)281-4069 (503)310-5340 . . • , Tigard, OR 97223 100018820
PAGE 2 OF 2
O O O N
W ` E
5
0
O O O
O
A)From our existing vault we will bore 171
southeast into the private property. 0 0 0
B)Bore will be to the back of the sidewalk.
C)We will bore onto private property.
O O O O
C>
OW
ROW —ROW W s
D
CD
Right of way width
60'-0" O
Sidewalk width 0
o:
o:
w far"Pton St
ROW -ROW
R 101-019. -
"_ 93'-0"Right of way width
h'0�,_.
SW Hampton St
Sidewalk width
.8'-0"
—ROW R
ROW ROW-- RO
22'-0"
1
3
PAGE NUMBER CONTACTS: SITE ADDRESS PROJECT NUMBER
Construction manager Permit Tech
Jesse Martin Phillip Fagin •
2 'martin@wavebroadband.com pfagin@wavebroadband.com 6950 SW Hampton St
(971)281-4069 (503)310-5340 . • • • . Tigard, OR 97223 100018820
PAGE 2OF2