Loading...
PFI2020-00422 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 City of Tigard pFi#: 2020-00422 i s " ENGINEERING DEPARTMENT TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFOO �,/RMATION /f J C /J TYPE OF WORK Project bare: �l7& a i-"�er LLZ(' .___........_ ❑ TYPE.1-Franchise Utility Wodt /Brief description of project: 6.40 f�� 1q1 i petfonnedby N'WN,PGE and/oi S77 �•� J II,` �q �r���, h�. Indio,ageocl 7SA Bi4 411.14 1 ;jinn D TYPE2-ROW Sidewalk/Ddreway/Sewer Wnti; performed for the impost of. • Sidewalk inata➢a Arm or repair. SITE INFORMATION • Driveway approach installation . . atd,rpair L.,catlon �y 777 address if available): ,rJ" Si 6 /34.07 'Z • Sanitary sewer latcul installation and tt.a:.. SEG1217 line up 0 TYPE 3-Frill scale Development w olk performed with Land use APPLICANT INFORMATION approval which includes any of j /` the following. Name: Ti I p/Y F/L/e, r ��, �j/�� //� // rr� j • Subdivisions or Partitions 11 \Luling address: #i5 ,SLU l� .421- Ml/S It/,14 • Street widening ^7 •Mainline installation for Swaim City/State: 5 nrby�1, 1 L.R (y/Zip: / 66� scam.Stotm sewer.Tigard water and //' Phone: 7�7/ qe T' and Wan Sen'ice Am '•'.JJ"/ ' ,Ctllll ❑ TYPE 4-Small Cell Technology Email. h(,(. $Niii, ei/5 Z'p?ioftt 1 0 TYPE 5-Tigard Triangle O Contact name: IY ,A S5 &.115 Phone:'SQ3--(p43--/e7Z/ Email: rzi sL'.1l.oe_lk �2/P�yr ltrj • RM CONTRACTOR INFOATION 0 Same as a icant ✓✓ Name: - CCB Number. Mailing addres • City/State: Zip: Ph Email: ENGINEER INFORMATION Name: Mailing add .: City/State: Zip: Pho . 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 ,WNo Case number. City of Tigard • 131225 SA-Hall Blvd. • Tigard,Oregon 972'3 • u roe.ngardor.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be desiptated"Permittee"and shall provide financial assurance for work,if required by the city pursuant to T1fC 15.04 14n_ With the exception of a utility cj re t.g pursuant to a valid franchise or licrose 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 aurhonzauon from the owner or an agent of the owner itt owner moist sign this application in the space provided or submit a written authorization with this applkaion. Franchised or Licensed Utilities are not requited to obtain the tamer's signature rnt the application. 1.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. PSa Cd'0i‹ \pp -a ' or authorized agent's signature Print name D: c Property owner's signature!if required) Print name Date Si I ! >I U\I\ ., Case No: PF12020-00422 Permit fee: Tet,e00 Received by: LS Date: 11/4/20 Approved by: %t't-6-7/Q. Date: la ho/ZOZO Notified by: Al-- Date: U D City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wsvwngerd-r r rptv • 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 lip'o of the Net PH Pemvt Fee.See below for calculations.l iinimwn of S300. NET PFI PERMIT FEE Part 2: All non-water system improvements engnleer c estimate\7°a(less the initial PM Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system unprovements engineer's estimate X 12'0. 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? ❑1 TYPE I 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'lame Hpart ow many install sites ate proposed as of this permit ❑ Site Address application? TYPE 3-Muse 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 ❑ Cove:—Site,N iciaity,Abbreviation,Legend If equipment is to be located on private property,describe the 0 General Notes(City,Water,Sewer,etc.) type&use ❑ Street(Plan,Profile) Cl Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas,Stone, 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) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Georerhni.-al Report ❑ Preliminary Access Report(Sight Distance) • t 0 Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • l'igard.Oregon 97223 • www:ngard-orgov • 5(6-718-2421 • Page3 of 4 sue# S k ttJ ? SW " ,. SI Ed_e of Pavement 4' �� =etLght :h �.� 1 T-F�oj:os'd`Sav-errain' L _m 1 'i I E•ixnog House ( I I E:rsting 1 �aaY rl l 1 1 let/to & n I _ . 1 I. r 1 l .1_� y 1 "-" v .I I ` 1 Emoting Shop I 1 Porerpcte `__. 1 e I �r Ad_ 1a 95• 1 •Tiopertr Line—.---.—.—. t I Fir•H9Cren1 T1•0 1 Scale 1'_3. I I I TYPE I AND TYPE 2: MINIUM SKETCH REQUIREMENTS(Put N/A if not a: . linable) N rit_own 'lLflt n., Lis:-:1:dtiuLnnit nn LanUnl;utilities locations (se storm,water) (Street&street Hones 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 • wwu:tigacdocgov • 503-718-2421 • Page 4 of 4 r H NEW ZIPLY FIBER FIBER CA \ ' AND FIBER TERMINAL '\ - G G TGRDORXA H4012,427-432+ '\ D F XD,7.12 - 12 FIBER \• ; ' IF H-TGRDORXA C \ BBFTP FDT 483002 • CRY OF TIGARD . f+ \ \\\ PUBLIC WORKS 6. —i "` • W 8777 S /� D \\ \ � BURNHAM ST \ A TGRDORXA H4012 S \ TGRDORXA FC2041,745-7138+ �B XD25-48IN G,P� \\ , •\A TGRDORXA BBFTP H4012.1-432 OUT �9y - \B Sr -100 05.2017 - — RBN 432 _ _TGRDORXA H4012,1-432 I — _ C 300 052017 F. I 1 RBN 432 (TGRDORXA H4012,1-432) ZIPLY FIBER TGRDORXA H4012.1.426+ TIGARD C.O. CITY TIGARD XD.427-432 8720 B840 SW BURNHAM ST SHEET 2 OF 3 SW BUR HAM ST D 328' AKF 50 24 NORTH BBGTD 8.201-225+ XD,26-50 TIGARD SKATE E BLDG TRM 50PR PROT 50 2421.101 PARK BBGTD 12512 I ziplyfiber 4 BBBDG D 1251425+ XD,26-50 FACILITIES NOTE-REMOVE TGRD/FIBER CA ADDN- H4012.427-432 COUNT FROM 8777 SW BURNHAM ST BBFTP FDT273802 CITY OF TIGARD ryocopr co.MEA CITY HALL COMPLEX 1AT)R71ngo., 'vat[PAWN CATE ESOP .M£ll wARTT 13125 SW HALL BLVD ....� a e.e., 51351-W087 1176 EGLE'„J.. TAX DISTRICT , NO JOINT POLE NOTE L CONSTRUCTION NOTE S 1-CUSTOMER DRIVEN WORK ORDER- �.9CI\ "'JOB SITE CUSTOMER-CITY OF TIGARD 8777 SW TOTAL ALLOTTED HOURS ZIPLY SALES MANGER BOB BURTON-503-891-0920 ...S°' £:='41"9k"'A'd.... BURNHAM ST m WAR 2-CITY OF TIGARD PERMIT FOR THIS JOB t "L`'' SEE TRAFFIC PLAN VICINITY MAP mum N o " 51351-W0871178.WP1.PERMIT ZIPLY FIBER o.n nN.,: TIGARDC.O. m oa.,.PN«,L - 8838 SW BURNHAM G SW MCDONALD STREET G '"' ,jr. a n" ' wxsoaucons "IV:' o u,u.n mc a.x.:.:C • -crvucxa 0 rs moo 0 n n oo ;Low, REPRISE NJNIC1PALIIC CET9DGMD OPCEN NOTE 2020 STATION CONNECTION BLANKET MUNICI PALITY .T.. 1-CUSTOMER DRIVEN WORK ORDER- 51351-5255398-112 0 oNPO0.z0F,EON HAM, CUSTOMER-CITY OF TIGARD CUSTOMER-CITY OF TIGARD o N.I<N ON NEa"x'° ZIPLY SALES MANGER BOB BURTON-503-891-0920 8777 SW BURNHAM ST APM Pace 2-CITY OF TIGARD PERMIT FOR THIS JOB TIGARD,OR JX I pno an REQUIRED TRAFFIC PLAN BOB BURTON-ZIPLY SALES MGR 0... ,PN all 51351-W0871178.WP1.PERMIT 503-891-0920 D n o PD+u ASSIGN- o 00 0o FRONTIER CONSTRUCTION CONTACTS TGRDORXA BBFTP FDT 483002 POTNT OF CONTACT DAVID CARNLEY-971-940-9000 SHEET 1 OF 3 RUSS WELLS JAMES STAATS-503-758-3119 TGRDORXA BBFTP H4012,427-PORT 1 ,®0u,m, LCON-MIKE NOLOP-CITY OF TIGARD NORTH 'iemeL1NQ rRN N1s SCHEDULING CONTACT IT MANAGER 503-718-2757 RxurverS NOu TELLS RYAN ROBERTS-503-843-3713 oo xo rosasmm ¢N FACILITIES CONTACT PRO. eT ROSE ELLS LAUREL KIELTY 425-283-4008 LABOR HOURS MATERIAL REQUIREMENTS INSPECTION CONTACT SPLICE-C-10-M-0/X-0 12 FIBER-1000' ziply f i be r RON HAYHURST 503.292-3345 CREW-C-12.M-4-X-0 1-12 PORT MST FLA24 HOURS ENGINEERING CONTACT INSPECTOR-0 HOURS TGRD/FIBER CA ADDN- RUSS WELLS 503-312.7330 SONICOM WORK 8777 SW BURNHAM ST PRCT NUNMNERR WY)R7117R l@cCODE.. 51351-W0871176tionfrIn „„..,,; ""'" u Dsueo. ono ,o. , CRMXigLLle OIU NNE,. EMEM IN ENO - n Z.Y-L�4]-�Cb B -Y4v13�if W-RG-e „,_,,„ rm. IR Ill el a NO w. ,„ro,w Po l V 37 e s ® esC$0 66 ^ a _ st e1�aj� 5 a k -03UO G C9C^ . . 1 P v. a bYmz 1 u `@ I - E4R, ex re _ "e dSS H- u 3 7 a1:0, Ib r ,— ;M.- y a'y l gg ,Q a °'iO -_-- rIH la a SHEET 3 OF 3 .sI. 5 "5 Sr' • Bill NORTH _..—� Q ' [wn p,w ;M_N'" °`"' I ziplyfiber i«eF,w OVERPULL NEW 12 FIBER WITH ''Via FAH. EXISTING 864 FIBER/FC,2D421-864 51351-W0871176 8777 SFIBERCAADDN- SWB RNHAM ST THE 884 FIBER SHOULD GO TO THE INNEN, CNMIM HANDHOLE ACROSS STREET Numeez R71176 re cH cam .,„, e n i,eHr In AIITI mom, a� or r �s SIGN SPACING AND BUFFER LENGTHS POSTED SPACING BETWEEN SIGNS BUFFER SPEED A B C SPACE 20 50 25 100 100 100 75 30 100 35 40 350 350 350 125 50 45 180 . INTERSECTION WITH FLAGGING 50 500 500 500 210 PEDESTRIAN/BICYCLE SAFETY ESCORT REQUIRED _55 250 AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS ODOT DIAGRAM 820 REFERENCE I SHEET 1 OF 1 "'JOB SITE- NORTH CITY OF TIGARD PUBLIC WORKS 8777 SW BURNHAM ST O C OB O/p B E FLAGGER AHEAD SIGN C, /B CC A O m OF //\/b p i E BE PREPARED TO � C\�q s ; O STOP SIGN 51351-W0871176- \\\`/`V��_///// co `n 0 WP1 PERMIT. Bii O o O UTILITY WORK AA=ZIPLY FIBER- Sip AHEAD SIGN FIBER HUB-EXISTING BB=ZIPLY FIBER 4 O ROAD WORK MANHOLE-EXISTING yWP / N. AHEAD SIGN CC=ZIPLY FIBER \G('' HANDHOLE-EXISTING �Gy�.6�`�,g- /0_,Or ilt D ,40 BICYCLE F� ot•GP AO TRAFFIC LANE PEDESTRIAN/BICYCLE SAFETY ESCORT OO I Ziply f i be r FLAGGER DIRECTION SAFETY B SIGN O TGRD/FIBER CAD ADDN- O 8777 SW BURNHAM ST ROJE esiiueEO VIK)A7117R Iucn moe.. OOKALE ,Ty, OM DETECT N°- ILL L MPH IF TVft0 P RM'i.