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PFI2018-00285 A CITY OF TI GA RD PUBLIC FACILITIES IMPROVEMENT PERMIT 2 COMMUNITY DEVELOPMENT Permit#: PF12018-00285 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 10/30/2018 Parcel: SEG518 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Commstructure Consulting PFI Project Description: This project will provide connectivity with the existing TCA Metro Fiber Network to a mobility site. Owner: FEES Description Date Amount PFI Permit Fee 10/30/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: SHAWN DALBEC 10340 SW NIMBUS TIGARD, OR 97223 PHONE: 503-495-0112 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 ( ( (� Signature: )�� )k(� CAI ca 110 1�/ Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00285 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 R 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 Ken Fisher at 503 816 6146 or 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 RIVED OCT 16, 2018 City of Tigard CITY ""z TIGARD PLAN N1 •�GIN��RING PUBLIC WORKS — ENGINEERING Public Facility Improvement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) TYPE 1—Franchise Utility Work Check one: V Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE Detailed description: Conduit to be placed beginning from existing utility vault and/or utility agency. on the north side of SW North Dakota St just east of the RR crossing. Conduit will ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: extend west approximately 80'before crossing SW North Dakota • Sidewalk installation or repair. orth Dakota St • Driveway approach installation Property address/location(s): 10250 SW NC Q and/or repair 5 L ; • Sanitary sewer lateral installation and/or main line tap Applicant: Teleport Communications America, LLC dba TCA El TYPE 3—Full scale Development pp Work performed with Land use Address: 10340 SW Nimbus approval which includes any of City/state: Tigard, OR Zip: 97223 the following- Phone: ollowingPhone: 503-495-0112 Email: sdl461@att.com - Subdivisions or Partitions Contact name: Shawn Dalbec/Meredith Paeper Phone: 503-495-0112/971-266-4433 - Street widening • Mainline installation for Sanitary Contractor: TBD sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Zip: City of Tigard Planning/Engineering Phone: Email: 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: only may be emailed to: rowpermitsaliga_4 rd or.gov Address: City/state: Zip: k� now Phone: Email: Case No.: P F_TU 1'3 - ,002 �5 Contact name: Application submittal fee(.07%of Engineers Estimate) $ 309k 0405, Estimated value of work is required(if over$5,000):$ Less than$50,000.00 Additional fees: $ (within the public right-of-way) Application accepted: I � fO �b11 Is work related to a LAND-USE DECISION? ❑ Yes St No By. 1� Date: If so,please specify (MLP,SDR,SUB, etc.) case#: Application reviewed: By: 9r . Date: /y /rS^/B Is work related to a BUILDING PERMIT? ❑ Yes Wr No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: SC. Date: I:\ENG\PermitApplications\pfi—application Effective 10/16/2017 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"sliall be designated"Permittee"and shall provide financial assurance for Nvork,if required by the city pursuant to TNTC' 15.041.1.10. * With the exception of a utility operating punsuant to a valid franchise with the City of Tigard,when the owner and the applicant arc 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 si€n this application in the space provided or submit a written authorization with this application. Franchiscd Utilities are not required to obtain the owner's signature on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject proern=. • if the application is granted,the applicant will exercise the rights granted in accordance with the terms and sub)ect to all the conditions and limitations of the approval. • All of the above statements and the statements in any 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 anj such statements are false. • T'he applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for approving or denying the application. r V Shawn Dalbec Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property,if required. Owner's signature Print name Date Owner's signature Print name Date Ovmer's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 S%K7-1Iall Blvd. • Tigard,Oregon 97223 - www.tigard-or.gov 503-718-2421 • Page 2 of 4 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 S acing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 100 35 40 350 350 350 150 • 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 79 Work on Shoulder Diagram 210 4 t • • • (Optional) • • ' Protection Vehicle w/TMA(both Optional) See Chapter 4 • Buffer • • • • U* • A ROAD SHOULDER WORK OR WORK AHEAD AHEAD Initial Warning Sign I t *Use as appropriate-see Table 5-2 December 2011 Chapter 5 \ 425'f TO f. OF SW TIEDEIWAN AVENUE - - - - - - - -R/W- - _ _ _ \ 1 TIE IN POINT "A" - - - -R/w- -- - - 3 2 EOP 1 `� - - i - - --R/W- - 4 - ,� — STRIi - - low SW NORTH DAKOTA STREET `�AT� p --`�-- — — — am +— — T— - - — � — - - - - - - - EOP PKD�P MEET POINT "X" •R/W� _ _ __ CONDUIT PATHWAY PHOTO DETAIL P1 DRIVEWAY Pi / SCALE: 1'=N.T.S. 2.0 ' 2.0 4 0 r 17' 2 MEET POINT "X" i TIE IN POINT "A" Lw 80 i s I� %X- CONDUIT CONDUIT PLAN l i SCALE: I-=30' 2.0 MEET POINT SCHEMATIC 2 CONSTRUCTION NOTES SCALE: I--N.T.S. 2.0 EXISTING TCA 444LA UTILITY VAULT O1 EXISTING SPLICE LOCATION - TIE IN POINT "A" CORE DRILL NEW HOLE IN EXISTING VAULT TERMINATE NEW 2"HDPE CONDUIT IN EXISTING VAULT AND RE-SEAL OPENING PER SPECIFICATIONS EXISTING SLACK STORAGE IN FIBER CABLE(S) COILED IN VAULT LEAVE SLACK STORAGE IN FIBER CABLE OR MATCH EXISTING UNDERGROUND CONSTRUCTION NOTES. �2 PL ONE �Ij NEW 2" SCH-40 PVC OR SDR11 HDPE CONDUIT I. ALL NEW DUCTS 7I BE THREE(3) AWG 7-114'CATS HDPE INNERDUCTS(UNLESS OTHERWISE SPECIFIED) B SDUD/'10 AWG LOCATE 1NRE. ALL INNERDUCTS PL ONE 1 NEW FIBER CABLE AND SOLID J10 AWG LOCATE WIRE IN 2" CONDUIT ARE TO BE EQUIPPED WITH PULL-ROPE OR MULE TAPE AND PLUGGED WITH JACK MOON PLUGS OR EQUIVALENT. O3 FIELD BEND - MAINTAIN 36" MINIMUM RADIUS 2. A MINIMUM SEPARATION OF 36'SHOULD BE MAINTAINED FROM OTHER UTIL177ES UNLESS OTHERWISE SPECIFIED. DEVIATION FROM THIS MINIMUM SEPARATION OR O4 PROPOSED CUSTOMER "MEET ME" VAULT LOCATION - MEET POINT "X" THE PLAN AS LAID OUT REQUIRES AUTHORIZATION FROM OWNER. TERMINATE NEW 2" CONDUIT IN PROPOSED VAULT OR STUB AND CAP 2"CONDUIT AT PUBLIC RIGHT-OF-WAY LINE 3. WHEN S O OTHER UTILITIES AT THE TIME OF CONSTRUCTION, AS BUILT DOCUMEENTNT SHOULD BE TAKEN AS TO THE UTILITY, AND THE ACTUAL CONTRACTOR M CONTACT TCA PROXCT MANAGER PRIOR TO CONSTRUCTION SEPARATION FROM THE PLANT do DEPTH OF COVER BOTH FACILITIES. n SEE CLIENT SITE VENDOR PLANS FOR DETAILS 4. ALL DEPTHS OF CONDUIT OR DIRECT BURIED INNERDUCT PLACEMENT WILL BE RECORDED AT THE 77ME OF CONSTRUCTION. 5. PLACE CONDUIT IN LOCATION SHOWN ON PRINTS WITH MINIMUM COVER OF 36" C ON PUBLIC RIGHT-OF-WAY AND 36"ON PRIVATE PROPERTY. LUMINAIRE JB OX 0-4Y. 4 SPLICE DESIGN B • D. MCNEELY CHECKED BY.. S. BUTLER TOTAL TRANSMISSION POLES_— - SIGN FIELDED BY.. W. BREWER DRAWN BY.. C. JOHNSON FA#10034024 GPM#2018-POR21-52532 � COMM PEDESTAL rr FIBER SYMBOL "CONFIDENTIAL & o TOTAL DISTRIBUTION POLES-- - WATER VALVE FIBER SYMBOL l GAS VALVE PROPRIETARY INFORMATION" zTOTAL NEW STRAND- - _ - - - GAS METER CABLE DATE: BY REVISION APPR. Cr NATER METER TOTAL AERIAL PLANT- - _ HYDRANT CABLE 7k LUMINAIRE ADDRESS CATCH BASIN --- CONDUIT TRZJPORT COMMUNICATIONS T A TOTAL U.G. PLANT- - -- - - _ l ((,J� 10340 S.W. NIMBUS _ _ __ _ PERMIT SET AgAICA, UC TIGARD, OR 97223 STORM MANHOLE � � - CONDUIT COMM l�tC E y TOTAL SLACK— - - ® SEWER MANHOLE T POWER TRANSFORMER © STORAGE PLOT DATE. SCALE: SHEET: o NEW VAULT Oregon i y A Oregon Main Office: � �TJ�i �B��� � Oregon City,Oregon 97045 503-343-4134 LOCATE WIRE ACCESS PT STORAGE 9126120181 AS SHOWN 2.0 www.commstructurcronsultin.com