Loading...
PFI2020-00176 71 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12020-00176 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/26/2020 Parcel: SEG1380 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Ziply Fiber Project Description: SEG1380//7670 SW Cherry Drive. PGE replaced (Frontier's) defective pole (Frontier) now Zipley to remove pole on completion of transfers. Permit application is to work in the right of way. Class of Work: FEES Description Date Amount Type 1 - Utilities (gas, electric, data) PFI Permit Fee 08/26/2020 8300.00 Total 3300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: ROSALIE SIMS 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 5033197787 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. PermitteelApplicant See application Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12020-00176 Type: Condition Name: Status: Severi : 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 ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.) before initiation of construction work. PFI_Utilities 09-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 10-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 11 -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 12-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 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI_Utilities 14-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 15-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 16-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 17-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 19-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 20-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. PFI_Utilities 21 -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 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-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 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Utilities 25-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 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI_Utilities 31 -OTHER Applied Notice Other RECEIVED II City of Tigard MAY 1 9 202o PFI#: 2020-00176 _ ENGINEERING DEPARTMENT CITY OF TIGARD l ,...,,,D Public Facilities litillik'fl tht (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: (Frontier) now Ziply Fiber X TYPE 1—Franchise Utility Work Brief description of project: PGE replaced (Frontiers) defective pole Peed by NWN,PGE, or utility icy (Frontier)now Ziply Fiber to remove pole on completion of transfers ❑ TYPE 2—ROW Sidewak/Driveway/Sewer Work performed for the purpose of Permit appliation is to work in the right of way • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 7670 SW Cherry Dr. main line tap 0 TYPE 3—Full Scale Development Work just north of SW Fir St. performed with land use approval which includes any of the following • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: Ziply Fiber • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 4155 SW Cedar Hills Rlvd water service area Beaverton. OR 97005 0 TYPE 4—Small Cell Technology City/State: Lip: 503-319-778 ❑ TYPE 5—Tigard Triangle Phone: Email: rosalie.sims@ziply.com Phone: 503-319-7787 NOTE: Type 1 and 2 applications may be Contact name: Rosalie Sims emailed to rotivpermits(a'tu'and-or.[a Phone: Email: CONTRACTOR INFORMATION 0 Same as applicant Name: North Sky Communications CCB Number: 208747 Mailing address: 10860 SW Clutter Rd City/State:—Sherwood, OR Zip:-97140 Phone: _office 503-647-9991, Email:_tschmidtket northskvcomm.com cell 503-319-8405 ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes E No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-orgov • 503-718-2421 • Page 1 of 4 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 15.04.140. With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,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 owner must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I,the applicant,certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Rosalie Sims 5-19-20 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: PFI2020-00176 Permit fee: LZ6,Ct Received by: SC Date: 5/19/2020 Approved by: 77 .h7f, Date: 5772o72o20 Notified by: t- Date: 5124)I2° City orTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-orgov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7% (less the initial PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? ❑Yes ❑No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): ❑Small Cell ❑Macro ❑ Street Name ❑ Site Address How many install sites are proposed as part of this permit application? TYPE 3-Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: ❑Public Right-of-Way ❑Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Derails ❑ 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.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www:tigard-or.gov • 503-718-2421 • Page 3 of 4 c) III .. ) .. t Edge of Pavement - Ditch -r Street tight —•—•—•—•—•—• •-t •— '{ R�wtr�]kat� � • IC . 1 1 'oi -1 JJ 1 T-'Pi PUred"SAVi rT1=e-- i v.1 1 1 Qi ! J ii 1 Existing House 1 •< r' • Existing tr • Driveway vi u= _ 1 CI • c t tnl a.• a 1 r) E., ti L i e'i 1 1 C. Existing Shap 1 1 J? Powerpole • = I m 1 1c'- 95' 1 J 1 Flre Hydrant(FH) 1 ( Scale- 1-=30' 1 I 1 1 1 TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer,storm,water) Street& street names All existing structures Proposed work Existing curb or edge of pavement Utility& street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 • ee �� as I r �o4ga B� a ii 2 j I M I O SEESHEET2 ' % X ID r 03 FOR VICINITY MAP ti,q� % II0 in IwiI35987 C2101C4185 a u S/ 'I-F' N�� 2' 7700so O' I FRONTIER ' 0 �P ACHERRY DR IQ 621 102006 ,D I . CR21G1C4188 CABLE FILL '� "V I JD 72 1 CABLE OLD SIZE NEW SIZE WORKERS FILL% t�g014y,7b rts0, I� TCRDORXA H1003,1-72 • • i. `b_ ttU.9 c saij 'U FTTP 500 I PIGTAIL 500FT 4 ' 4 gr? SFO TGRDX IREPLACE POLEORXA H1003,43-46 I xP 4�620 z5� '' 7 X0a N1 6 6,,1:9 I I (40-4)(01.1959) I -00 0 00 I 0-4 I xo 6 7s7o SW q� = C2101 C4186 11,0.y5 CHERRY DR SW FIR ST ' G�10�00 PLACING: CAP.DO ESTIMATED MANT 00 X-TIME 00 -- ----_—_ I,00 ZO 35997 C2101C4187 7650 SW 000 FRONTIER SPLICING: CAP.00 MAINT 00 X-11ME 00 CHERRY 6T I 745' 0 INSPECTOR:CAP.00 MAINT.00 X-TIME 00 FLAGGERS: CAP.00 MAINT.00 X-TIME 00 AKF 100 24 TOi HouRs 0 ,0- BBGTD DCD,801-837+ PLACING: CAP,_ MAINT._ X-TIME_ CONTACTS LIST `®LJ. XO,38+ SPLICING: CAP._ MAINT._ MIME -kJ?'TJ, BBCTD DCD,839-840+ INSPECTOR:CAP._ PAINT._ X.TIME_ 890,�p„�p„`�j . 35985 C2101G4799 XD.41+ FLAGGERS. CAP._ MAINT._ X-TME_ ENGINEERING `17 FRONTIER BBGTD DC0.842-869+ WO DRIVER ROSALIE SIMS 503-319-7787 TT`�P QS �°`\ X0,70+ c0usr.START 4ierm FTIP OVOWM FACILITIES 6) ��� IN SERVICE GATE FIBERTIP OVERLAY BBGTD DC0,871-900 FIBER LAUREL KIELTY 425-263-4006 •••s. ` 1 CONS!°°"""— crn0urtarar INSPECTOR 6 hie&?�S 347 70.2006 doINTPdF YJD 72 JFWNJUNS. MIS 400080U RON HAYHURST 503-292-3345 SJ ' P� TGRDORXA H1003,1-72 ID NO JPN REQUIRED Ores IS NO SPLICING/PLACING "Sfyi 'T- POLE LPN 1PM JOINT TRENCH OWNER ro FROM p YES®NO DAVID CARNLEY 971-940-9000 O� p 0 0 POWER BOON READ BB/PLANENG ,- CONSTRUCTION NOTE pp p p CAW TIER 0 YES 0NO SARAH COMBS 503-644-3569 n� WORK WITH PT3186637 PGE TO REPLACE FRONTIER CONSTRUCTION PERMITS OPCEN To p DEFECTIVE POLE,POLE HAS SEVERE BOW AT 20'FT a DIAL.A DIG MUMCIPALITY CITY OF TIGARD RYAN ROBERTS 503-643-3713 +o; 0qp kq ism 5F TO THE TOP. REPLACE 40C4'1949 WITH NEW 40C4. 0 B` B"` 0 BLANKET CVRR FC H I CAPS 6 A y7 9g? �� 0 CONTRACTING 0 DETAILED(NOT BLANKED FRONTIER TO TRANSFER AND PULL OLD POLE REOR 0 NO PERMIT REQUIRED MIKE SHANNON 503-936-2428 �3s 135984 C12701C4798 �A9x o FRONTIE 0 ' -." SEE SHEET 2 FOR VICINITY MAP. �6. IfiTiii-her. AN„�,p„ CALL III rFoaP YOU RIG pe�7p1,is ?s PERMIT REQUIRED PER CITY OF TIGARD Cormuniaat'ens oamN o NawJs 70u r0 FOLLOW ens AOONrOaA 11 NO FLAGGING REQUIRED. TGRD NESC PGE TO REPL FTR BOP re WE QAIGIX,OWN NDPRGIION UMW O -J I THOSE N.•.MI SO 10EIN w OAP*52-0DI!<M 00 4, 7670 SW CHERRY DR r.wousa F52-down P.Ou MAW drAYL cars OF a 25 .g) O6B M MIIFS r exam N.s OHOON WARY Lj�p l� X PROJECT C.O.AREA TGRD NORFATON(NUR ACAVNI1J ION 5: 8T.7TJ.rvsU M ' 9j NUMBER 5225385 !EXCH.COGS:51351 ' rw,. " r 99= 352 876_900 S A,oalr.ar.MloN. TD OM 35983 C2101C4797 DRAWN DATE:E: EHON: ROSAOE187FEE:2020 RHO 522 y�A. r. TON �v.:•.. Tar M4N T«e;,1 BBG 9 RONTIER SCALE: TAX DI 511331P7787 FEE:2020 RHO 522536 SCALE:1=100 TAX DISTRICT: DWG 1 OP 2 TWNSHP:2S RNCS 1W SEC:1C VICINITY MAP Google recommends using Chrome p;......., NO THAN.. YES p Sgn In i ;r. l dangle o r n Corporate Park II C 7670 SW CHERRY t DR,TIGARD swell e u,}pry 4 M20 a3b L 2011 Cows uneea Stain Tana Se'O IEb'A2tt 3C:'*._ -._.. 51351-5225385 5460-TIGARD 2S1W1C WP2 OF 2 N Page 84 2011 Edition 2011 Edition Page t Stationary Lane Closure with Flagging Diagram 320 i Stationary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of one lane of a two-lane,two-way 0.4 roadway. See the detail inset for the layout if using a single flagger to control I c both directions of traffic on low volume roads(less than 400 ADT)with good sight distance as discussed below. 7 $• R 41014 m a 1. Use truck-mounted flashing warning lights on work and protection 004 8. 10I 0 1 vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. to 2. For added visibility,a truck-mounted arrow board or PCMS in caution m co mode may be used. w a _� 1 t ,� maN 0 3. naggers at each approach are required if any of the following a t— conditions exist: _ ' a. Night Operations. ' . •FBI b. Work space is over 200 feet in length. I c. Sight distance is less than 750 feet from each approach �• —=e through the lane closure- O : I ee >$s d. Traffic volumes are greater than 400 ADT. 6044 °x I I o o um g°1 4. The length between the Flagger Ahead signs shall not exceed one 0 "x 1 t mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one .'t' I mile. I © 1 e �,I 3 5. Cones should be used to outline the work space when curves or other c ( I' 11'[f e roadway alignments prevent clear direction for the motorists to pass g s I ;Ell la �. the work space safely. is m ilt � ( ! a) ix' e 6. Cones along the work space are recommended when posted speeds 0 2 g I . L. `1 are 45 mph or greater,when working under heavy traffic or when travel €) • lanes are narrower than 11 feet. I cn I1 l - . i I . 7. Extended queue signing(see Diagram 5-4)should be used when II c ", traffic queues extend beyond the initial advance warning sign. c"- I r° V v 0 8. When flagging near an intersection,the"Flagger Ahead"(CW23-2) 65 1 t :1 ! '� sign should be visible to traffic entering from any side road.Additional advance warning and Flagger Ahead symbol signs may be placed on 4 1 the side road(s). • 9. Sign set-up and flagger placement shown may be used for intermittent Sign Spadng and Buffer Lengths(feet) $Z full road closures of 20 minutes or less. Posted Space Between sag", sorter Speed A B C Spice 20 10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should 223 100 100 100 75 112 be considered on high volume or high speed roads, or when extended 30 100 queues are expected. 40 3so 3so 3so �� as tao so soo 500 500 210 se 250 Chapters 2011 Decembo-20'1 'ha ter Decen - p City of Tigard PFI#: - ENGINEERING DEPARTMENT TIGARD, Public Facilities Improvement (PFI) Permit .04101116. PROJECT INFORMATION TYPE OF WORK Project name: (Frontier) now Ziply Fiber Qg TYPE 1—Franchise Utility Work Brief description of project: PGE replaced (Frontier's)defective pole performed by NWN,PGE, or utility agoicy (Frontier)now Ziply Fiber to remove pole on completion of transfers o TYPE 2—ROW Sidewalk/Driveway/Sewer Work performed for the purpose of: Permit appliation is to work in the right of way • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 7670 SW Cherry Dr. main line tap Location (address if available): ❑ TYPE 3—Full Scale Development Work just north of SW Fir St. performed with land use approval which includes any of the following. • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Ziply Fiber • Mainline installation for sanitary sewer, Name: p Y storm sewer, Tigard water, and Tigard Mailing address:_4155 SW C:actar Hills Blvd water service area Beaverton. OR 97005 ❑ TYPE 4—Small Cell Technology City/State: Zip: ❑ TYPE S—Tigard Triangle Phone: 503-319-778 Email: rosalie.simsaziply.com Phone: 503-319-7787 NOTE: Type 1 and 2 applications may be Rosalie Sims emailed to rowpennits@tigard-or.goi. Contact name: Phone: Email: CONTRACTOR INFORMATION ❑ Same as applicant Name: North Sky Communications CCB Number: 208747 Mailing address: 10860 SW Clutter Rd City/State:_Sherwood, OR Zip: 97140 Phone: _office 503-647-9991, Email: _tschmidtke@northskycomm.com cell 503-319-8405 ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? D Yes E No Case number: 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"Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,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 owner must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I,the applicant, certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Digitally signed by Rosalie Sims DN:cn=Rosalie Sims,0-Aten Rosalie Sims eommunica ions/Zipy Flber,oar, emall=rosalie.sims@apy<om,c=US Rosalie Sims Date:2020.05.1913:48:51-06'W 5-19-20 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: Permit fee: Received by: Date: Approved by: Date: Notified by: Date: City of 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: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PH Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7% (less the initial PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? 0 Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): 0 Small Cell 0 Macro ❑ Street Name How many install sites are proposed as part of this permit ❑ Site Address application? TYPE 3-Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: ❑Public Right-of-Way ❑Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ 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.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) LI Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 c11 •• " Si Edge of Pavement t r f-""- Ditch —r Streetlight , — —. •—•—•—• it.',-I o. , i i 7--ri7DVosrd•Sow7r71ine-- l rz, 1 I L ! Existing House 1 E%Isti n c ,I ii • Driveway dl u'� ! 1 iI - I r! ,-1 ii o S Existing Shop ( 1 L 95' 1 � o 1 IN F Ira Hydrant(FH) I I Scale 1'=30' I 1 I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer, storm,water) Street& street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www..tigard-otgov • 503-718-2421 • Page 4 of 4