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PFI2020-00170 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT s COMMUNITY DEVELOPMENT Permit#: PFI2020-00170 T[G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/05/2020 Parcel: SEG1333 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Ziply Project Description: Adjacent to 13170 SW Grant Ave. Fiber drop bore. Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) PFI Permit Fee 10/05/2020 $300.00 Total $300.00 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: RUSSELL WELLS PHONE: 5036431001 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: See application Issued By: /tA�� l �Fil - 4 _.'j. Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12020-00170 Tvpe: 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 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,Trent Brickey at 971-228-9269,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 City of Tigard MAY 1 1 2020 PFI#: 2020 00170 ENGINEERING DEP_�RT\1E.�'"}' rl GA im Public Facili� naTY OF , t (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: 51351 WO855023-- — ❑ TYPE I_!Anodise entity\\Od; Brief descnption of project: FIRER DROP FIORE- pr fore r hyN1CT1.PGL end/or Italy ageary ❑ TYPE 2-ROM Sldnvalkifmrn•m•/Sower Work ----_- --__-_ lwritum d fur the purpose of: • Sidewalk inrialauca:or repair. SI'l'E INFORMATION • Deieway approach installation Mid repair Location (address if available): 13170 SW GRANT AVE • Sanitary sewer lateral inrtallarion and main SEG1333 line tap ❑ TYPE 3-Rat rude Tkweloromit Teak pertomrrd with Land ux APPLICANT INFORMATION glirma al which b includes:my of Name: FRONTIER COMMUNICATIONSLZIPLY FIBER the following: • Suhdmruns or Partitions \tailingaddrexs: 4155 SW CEDAR HILLS BLVD _ •Sur+widening •:\I:anline installoriorr for Suritarc City/State: RFAVFRTON , OR Zip: 97005 'rage.Storm sewer,Tigard water and 'rived l\aer Service Arra Phone: 503-643-1QQ1 ❑ TYPE a_small Cell Teduwiug, Email: tltssellwelist ,co..__Phone: 509-643-1001 ❑ TYPE s_rga d TaH gk Contact name: RUSSELL C WELLS raffia, 1• i5 f P1`1 Phone: 603 6-13Email:1001 CONTRACTOR INFORMATION 0 Same as applicant Name: Sonicom CCB Number. 1R8116 Mailing address: 11A0 S 17TH AVE- City/State: COR'EI LUS Zip: OR Phone: 503-902.77-1I _ (snail: N/A ENGINEER INFORMATION Name: N/A 9lailing address: City/State: Zip: Phute: Email: ADDITIONAL INFORMATION Estimated value of wont is required(if over55.000):5 /N/A (within the public right-of-way) Is work related to a AND USE DECISION? 0 l'es 14 No Case number: City of Tigard • 13125 SIC.Hall Blvd. • llgard,Oregon 97223 • m-rs:hga¢l-orgov • 5u3-718-2421 • Page!of 4 • APPLICANTS NOTE: Person specified as"Applicant"shall be des ic9aated"I'ermitree•'and shall provide financial assurance for wrack,if required by the city pursuant to T'n1C 15.Oa.14O. • Won the nraptiou of d utility operating ptnsinir la a valid francium or beam.with Mc Croy of Tigard,when t r owner and tie applicant are diffetwo,people,die applicant n11M be the prltciraser of record or•Imme in possession with written no hrtrtr_+lawr from the owner or an agent of the owner The ow nc,mutt sips this application at the space;omitted or submit a written truth 4lntion with this application_ Franchised or Licensed Indies air not required to°Indict the uwlrr's signature on Ian 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 rceorded 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. . RlI SFI I C WFI I S RUSSELL C WELLS 4/2712020 :\ppliclnt's or authorized agent's signature Print name Date Property owner's signature(if required) Print name Date STAFF USE ONLY Case No: PF12020-00170 Permit fee: 3v'•de) Received by: L Date: Approved by: 7i'tLs/f.Q Date: 5-1:•//2OZu Notified by: / / Date: ®zo City of Tigard • 13125 S\'Hall Blvd. • Tigard,Oregon 97223 • tcnn.rigant-ocgov • if13-71 R 242I • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10P;oldie Net PR Permit Fee.See below for calculations.Minimum of S31)0. NET PFI PERMIT FEE Part 2: All non-water system impruvunents engineer's estunate N 7%(less the initial PA Perin r Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system inrprovetnents engineer's estimate N 120 a. tilt titAll,IISI:ONLY 1'01t SIM I ONLY TYPE 4:SMALL WIRELESS FACILITY TYPE 1-3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license?. O Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dns considered?(check all that apply): 0 Small Cell 0 Macro ❑ Streetet Name How manyinstall sites areproposed ❑ Sire Address 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 0 Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the Cl General Notes(Gq•,Water,Sewer.etc.) type&use ❑ Suret(Plan,Profile) ❑ Water,Stoma and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ landscaping/Trcc Plan ❑ Composite Utility Plan(FJcctrical,Phone,Gas.Storm, Sanitary,Water,Siguage,Street Lights,etc) ❑ Derails ❑ Traffic'Sight Distance ❑ Signing and Striping O Street Light Plan and Photometric ❑ L'.ttgineecs seal/sigroturc ❑ Street label(project land use name,revision and plan log block,dates and sheer numbers.) ❑ Enjneer's Construction Fstinuuc Additional Submittals (per land use conditions,if applicable) ❑ 'Traffic Report ❑ Sloan water Drainage Calculations ❑ Geolechnical Report O Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Bled. • Tigard,Oregon 97223 • n.iiv:tiynrd-nr.gov • iO3-718-2421 • Page 3 of 4 SEE PERMIT SKETCH 51351-W0855023.PERMIT.TRAFFIC.CONTROL S' sly. ..\ SI Edge of Pavement. `Strertlrphl 1E I t IC:51 v:".'n D's''' T— SAnIS — 1 r. t 1 0.) j ii 1 Edsting House s j basing 1 F ;i Dnveway o! of . I 1 a! yG "/ 41' LI a an cs I di I I I \ Emboli Shop i � I Powarpole I I 8•I I I -.......r or— I' 95' I ', 1 - ._._.i l `\\'_'_'FroP�gLmi i I ilr•MydraM(FH) Y4, I I 'Y I l Scale 1-v+30' I I 1 I 'I11'E 1 AND TYPE 2: MINIUM SKETCH 11,1,:Qt I KEMENTS(Pot N/A if not applicable) E —Property lines&dimensions _Existing utilities locations (sewer,stoup,water) IMMICIIIIIII -All existing structures •Cia 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 • a-wwtigardor.gov • 503-718-2421 • Page 4 of 4 CONSTRUCTION NOTE 1-THIS WO IS SERVICE ORDER DRIVEN- TOTAuuOTTED HOURS TIGARD EYE CARE/PDOR"-OIDY7011819 ..ki 11x'�IRiBY84dGP1479MA..i ce 2-NO PERMIT REQUIRED y, CREW 0P- o E RA0 3-TIGARD EYE CARE 7850 SW DAR MOUTH INSIDE COSTCO Oy, ***JOB SITE �l'Wg7NOTS. +• `wo�`x°°"R E �.''i rne OvSRL 'L Sky :nU�ncN esuT OPCEN NOTE 1T` h'9(N .ssx+Tce wee UTp7 e:HSTRUCnCS eaRLETE 1-THIS WO IS SERVICE ORDER DRIVE- DAVID NESSBBFTP FT 900 SW PARK 5T o TAU R uI•� CONSTRUCTION 13170 SW GRANT AVE rove,RExcR 0 um..A DIG PORTLAND,OR 0YES NND S1N,+s.1114 2-CITY/TIGARD PERMIT REQUIRED VICINITY MAP 06CYv o g ENE . PERMITS V CONSTRUCTION CONTACTS QP w P 0 BLANKET L NKET DAVID CARNLEY-971-940-9000 y3� o DETAILED IN°T PLANNER! JAMES STAATS-503-758-3119 0 x°PEPSIS REQUIRES SCHEDULING CONTACT NTS OOIET POLE SIN RYAN ROBERTS-503-6433 NORTH 713 ,...,.ter. a NQ,Px REQ,IRED FACILITIES CONTACT LABOR HOURS SHEET 1 OF 2 CLE aex arx LAUREL KIELTY 425-263-4006 SPLICE-C-0/M-0X-0 1 0ER 0 0 PAR CREW-C-0/M-0/X-0 0nw 0 0 FRGxTIER INSPECTION CONTACT SONICOM-16 HRS POTNP OE CONTACT RON HAYHURST 503-292-3345 FLAGGING PUPA ACAS SONICOM TO PLACE Nmeaseaa CONTRACT INSPECTION ** 2020 STATION CONNECTION**** ,RaLEL„oQ RrAN JERRV MOORE 360-513-0337 51351-525398-31 - xxoN v�[Le ENGINEERING CONTACT DAVID NESS RCN,„;, -- RUSS WELLS 503-312-7330 13170 SW GRANT AVE `I-ED R1 NPSNN`LLS OID#70118191 07Ther. MATERIAL REQUIREMENTS TGRDORXA ORXA BBFTP 39900 cNm .R..00s 1X FIBER DROP-200' TGRD/FIBER DROP BORE 51351-5255398-31 ECT 13170 SW GRANT A_VE 51351-W0855023 NIL SR. NK)R55071 l= ., EPINNMTE. E'ER w RUSSNELL VMS, sSONE vs eon No.:Aix SCALE M /YdNd WA eC7 , K 1 TMISHP SSG SSC • • • • 13170 040'ROAD BORE \ SW RANT 11.25"SUBDUCT INSTALL \ Q IX FIBER ria „\ DROP 200' �p. 0 UNDER NEW INSTALLND is 0 TGRDORXA 39904 �,(9 TGRDORXA H5020,224-228+ 7 U • �` TGRDORXA 39900 \ TGRDORXA H5020,251-252+ XD 3-4 PARK 9ST� NTS NORTH SHEET\F 2 POLE GRANT AVE CROSS SECTION DETAIL LOOKING EAST FROM SW PARK ST NOTE-HAND DIG AND/OR TRENCHING WILL RMft50' BE NECESSARY TO EXTEND CONDUIT TO POLE I 5' 27' ' ,f ro II SIDEWALK PAVEMENT Communisations I I �F/C TGRD/FIBER DROP BORE NEW-1.25'CONDUIT/40'BORE 13170 SW GRANT AVE 51351-5255398-31 REA p550r+�°°a" 51351-W0655023 awvM alE E.. R"r'' �iY vasty SCALE of 1PS DISTRICT a,,OF ' WOW RNG. SIGN SPACING AND BUFFER LENGTHS POSTED SPACING BETWEEN SIGNS BUFFER SPEED A B C SPACE 20 50 25 100 100 100 75 30 100 O25 ONE LANE TEMPORARY TRAFFIC 40 350 350 350 150 DURING CONSTRUCTION BETWEEN CONES 9g 180 50 500 500 500 210 A 55 250 41110. ZIPLY FIBER/FRONTIER 111\1\ WORK ZONE A 13170 O SW GRANT .� AVE i A \ A. �� �\ A SAFETY NORTH; ' A \`�-- It.ESCORT PEDESTRIAN \ \; / \ AV�Tl BICYCLE O FLAGGER AHEAD SIGN 1.„ A A A •A \ A O BE PREPARED TO STOP SIGN• • 4 • \ \ A.A. O ONE LANE ROAD • AHEAD SIGN • slIt ROAD WORK W0855023-PERMIT 1 O O AHEAD SIGN WESTBOUND A=ORANGE SAFETY CONE 1 I•on-h er EASTBOUND Communications TGRD/FIBER DROP BORE 13170 SW GRANT AVE MM WORS,M21 Ida CODE . IXUwEDATE. ENGGRiE Rygy, ry.WAGE SCALE.I,. TARN!AC NG T C C£ I RAG SCC'.