Loading...
PFI2021-00010 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12021-00010 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/11/2021 Parcel: SEG590 Jurisdiction: Site address: Subdivision: Lot: Project: 51351-WO 866849 Project Description: Place fiber cable for Fred Meyer service order 11565 SW Pacific Hwy Class of Work: FEES Type 1 -Utilities(gas, electric, data) Description Date Amount Total Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website atwww.tioard-or.00v to schedule inspections online. Contractor: PHONE: Applicant: RUSSELL WELLS 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 5033127330 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: L,�& I&" Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00010 Tvoe: 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. Please call 503-639-4175 to schedule inspection, use code 738 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 pE#: PF12021-00010 ENGINEERING DEPARTMENT Public Facilities Improvement (PFI) Permit PROJECT INFORMATION n T11aE OF'X ORK Project name: "I"�7T ❑ WPE 1-Frar chiar t titin Rad: Ilnef descn tical of projett: prdomwdbr N\\'N.PGE.and/m ' lJohm . ❑ T)PE 2-ROW Ias(.< SWT'DVAt' 1�6t�1 Sidewalk/Ih tea plrwer4 pnfomrrd for the purpose of • Sidra-,dk insmEau<m or repair. SITE INFORMATION Darrv%appmxb inatanAtenr and mpatz L� ncm 'address if avul.tldel: • Suutan•seance lateral ius[aDadrnr bnr up -. ❑ TYPE3- -u a ve gnuar., \\cd,pertomed with Laud use APPLICANT INFORMATION appxaa]aduclr uwludes mn of dle f"Hou,mg. Name: 14 �a � � Subdm idm or Part tiros Mailing addre+.: �� � (J„S I • St+ra a�idrturg •hiairdine ir,W.Raiira+ Brr Smriian CIty/`tate: _ Ltp: � over.Stomr n m Tigard water and „• �� Tigard Warr Sen'icr:1tea Phone: 1ri/�1L y,���� ��y�k�•y� ' ��'���- ❑ T5PE7-Small l:rO TrclutnlcV' EiTwl:{I {►•j4dk-C4 t hf�tne:�+--�—�� ❑ WPE5-Tigard Triangle Contact n.d-tc: jag6a 1 1_. Phone: 50;-4tz-TS5U -tdA----- Email: "r wtw4l5 -24�+Lpfkt �--- CONTRACTOR INFORMATION ❑ Same as applicant Name: _ mer. Mailing address: Cin,/State. Zip: Phone: Email: ENGINEER INFORMATION Name: I —_-- \flailing address: Cin/Start- Lip: Phone: b mad: ADDITIONAL INFORMATION Estimated value of work is required(if over S5,000):$ "-------- (within the public right-of-way) is work related to a LAND USE DECISION? O 1'es *Nto Case number. Ciry of Tigard • 13125 SW Hall Blvd. • Tigard,Omgon 97^"3 • waurigaalor.gov 503-718-2421 • Page t of a APPLICANTS NOTE: Person specified as"applicant"shall be designated"Permittee"acid shall provide financial assurance for work,if required by dte city pursuant to n1C 15,(4.11(). A'uh the execpum of a utility-ct—wig pur<uaut fo a raW fraaduse oe license with the Cir of 11gud.l*M the Darns and the applicua are diffmnt psWk,the applicaen must be the purchaser of record or a Iv.see in possession 11th antrrn authotizatiou from the miner or an agmt of dic olves ILe Olins must awn flus applicautm m the space ptonded or submit a%nn= authotuaum with this applicatim ptm¢lurod ut ljcevsed l ulaws are nra"Tared to obwa the(raner's sigumure am ale application. I,the applicant,certify that: • To the hest of my knowledge,all the information provided within dus application package is complete and accurate. • The above request does not violate an) recorded deed restrictions that ma} 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. li� -. 's �iK5�t6.�Ur is-< _1 21 ZI .lppli authorized agent's signature Print name Date Property owner's signature(if required) Print name u STAFF USE ONLY Case No: PF12021-00010 Pnntt tcc: Received by: HPollard Date: Approved by:�'"_- Date: 1/71UZJ Notified by.�Date: I I City of Tlgerd • 13111 SW Hall Blvd. • Tigard.Ore{.oii 97123 • er tvwngardor.fior • F013-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee iS 1 cw•of the Net PH Permit Fee.See below for calculations Minimum of"JO, NET PFI PERMIT FEE Part 2: All non-water sysieni unpn tvenents enprteer's estimate S 70 a;less die untJ PFI I'etmit Fee; (PATER LINE CONSTRI'CT'ION FEE Pan3: allpublic uucrcri; rioveintnrsengineer estimateS1T'.- WIRELESSFOR STAFF USE NLY FOR STAFF[ISE ONLY TYPE 4:SMALL • I 1 i 1 I REQUIREMENTSrrTALFACIUTYCHECKLIST kws applicant have a right-of-war 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): O Small Cell ❑Macro ❑ Street Name How many install sites ace proposed as part of this permit ❑ Sac Address apphcationr 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 fbKowirW items. The plans must that include: 0 Public Right-of--Way ❑Ptivate Property ❑ C-over—Site.\icutin-,Abbreviation,legend If equipment is to be located on private property,describe the ❑ (',eneral Notes(Cin,Water,Sewer,etc.) type&use: ❑ Street(Plan,Pcnfile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ landscaping/Trec Plan ❑ Composite L'ahty Plan(FJectrieal,intone,Lias,Storm, Sanitary,Water.Sigrtage.Street Lights,etc.) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Start light Plan and Photornenic ❑ I:aghteers seal/signature ❑ Sheet label(project land use name,recision and plan log block,dates and sheet aumbcm) ❑ Faiginecls Gonstmction F_rtimatc Addfrianaf Submittals (perland use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Prelim nary Access Report(Sight Distance) ❑ proposed Plat ❑ Pathway Destgn ❑ Water Provider Approval CityofTigurd 131255\\ IiailBhd. Tigard,Oregon 97213 • a�awngard4jcgcv • 5U3-7182421 • Page3of4� si3s�- ►,w ���49 ,� i .�=r I E6 eOfrwemmt I �— Cucl�--►. I r 1 I i T�Yopos.fYl'eiTiiie � I 1 E�.isb,.g mouse e� 6wes 1 Drne�ay A e_I M1� I a' I w 1 COO j €� I c Ea+tmp Snob 1 ` - 1 Powerpale' 1 I s Fiupn Una'—'—'—' I I �s.a.rt tFw> 1 I � I I I Scale 1'=30' j I I TYPE I AND TYPE 2: MINIUM I i ! I I � ! SKETCH _North arro%c _i'r��pern Irnts&dmicrsiunr _k.xnuny uu6ues li rcanuns - (seww,storm,umterj Street a street names _.0 existing structures proposed work —Existing curb or edge of pavement Utility&street light poles _Existing S/lC'or D/W apron _Slope of propertTrees City of Tigard • 13125 SW Hall Blvd. Tigard,Orcgon 97223 • w�ugardocgov • %3-718-2421 • Page 4 of 4 - I —JOB SITE KROGERS(FRED MEYER) BF+1I.� 11565 SW PAIFIC HWY(9W NO JOINT POLE NOTE (17R .MTALAALA 4ITrre°x°uas '7C-a'ry_D ur. uFw • a L oM CONSTRUCTION NOTE QvL; 1-THIS WO IS METRO E SERVICE SW F , PF PRDER DRIVE ASR 33774W A nnue 2-THIS JOB REQUIRES- GRo VICINITY MAP COOT.,CITY OF TIGARD fV PERMITS Q S(y h� 0xv"'P^vL° coesxFwcrvgR Qxo v . x DDI .n°Ec OPCEN NOTE 1-THIS WO IS METRO E SERVICE PRDER DRIVE ASR 3377466 2-THIS JOB REQUIRES 2020 METRO E BLANKET ODOT,CITY OF TIGARD 51351-5255669-116 0 xuXX== PERMITSO xvimwrac CUSTOMER-KROGERS(FRED MEYER) o xuun nor sv.axxvn 11565 SW PACIFIC HWY(99W) o xc eLwwr XLgmaeX PORTLAND(TIGARD),OR SO1P''POI'` ,rwiX�.c CONSTRUCTION CONTACTS ASR 3377466 DAVID CARNLEY-971-940-9000ASSIGN- SHEET 1 OF 3 JAMES STAATS503-758-3119 o s o o ewcN BBFTP FDTd99502 NORTH 0 0 0<an SCHEDULING CONTACT TGRDORXA FC2038,415 0 0 OFPIX1IIgt RYAN ROBERTS-503-643-3713e°Lxr or cnrrAn TGRDORXA BBFTP H1002,72-PORT 1 Aurwvreau FACILITIES CONTACTLCON- 4D}MY1001 LAUREL KIELTY 42528ALT LC 3-4006 LISAST JOHN360-852-0507 scX ovivNC R„a • ALT ON-CORPORATE NOC 513387-7800 - INSPECTION CONTACT xciciia au®wLua en:mc xe��r RON HAYHURST 503.292-3345 PXJNC XO ENGINEERING CONTACTLABOR HOURS MATERIAL REQUIREMENTS vvueLX e. RUSS WELLS 503-312-7330 SPLICE-C-1494-2/X-0 I Z' yfiber CREW-C-32W-WX-0 BW1500'TAI PORT TERMINAL FLAGGERS-24 HOURS 7001500 TAIL INSPECTOR-0 HOURS 700 FT IF 1X FIBER DROP 51351-W0888849 TGRDORXA/ASR 3377466 SONICOM WORK 2W OF 1.25'SD 11565 SW PACIFIC HWY REE. C2E WlE'. EMiR RIWBY SL iM gBIPICP. ON4 NYA� 1tNbMP.a PHO. EC i SEE SHEET / ,9gY11 / Nvt4 B� AA A// / ty /r / SPLICING NOTE. l ONCE SPLICING COMPLETE \\ RUN"RED JUMPER"AT TGRDORXA H1002 LOCATED AT 7275 SW HERMO60 WAY OFF A 661 022007 OF SW 72ND AVE SIO SW DARTMOUTH 218 FIBER TGRDORXA H7002,1-98+TGRDORXA FC2038,427.432+ TGRDORXA H1002,103147+XD,148-173+TGRDORXA H1002,234-238+XD,179-180+TGRDORXA FC2038,433.435+ XD,182-167+TGRDORXAH 1002,250-276 B 327 08.2009 144 FIBER SHEET 20F 3 TGRDORXA H1002,1-14+XD,15+TGRDORXA H1002,16.98+ TGRDORXA FC2038,427-432+ NORTH TGRDORXA H1DO2,103.106+XD,07-113+TGRDORXA H1002,114122+XD,179-180+TGRDORXA FC2038.433.435+ XD,182-187+TGRDORXAH I D02,250-276 144 FIBER TGRDORXA H1002,1-14+XD,15+TGRDORXA H1002,16-71+ XD,72-76+TGRDORXA H1002,77-95+TGRDORXA FC2038,427-432+ TGRDORXA H1002,103108+XD,07-113+TGRDORXA H1002,114-122+XD,179-180+TGRDORXA FC2038,433435+ XD,182-187+TGRDORXAH1002,25D-278 NOTE-SPLICERS-CUT DARK 51351-WO866849 ziply g fiber TGRDORXA H1 DD2,72-78 TO FIELD TGRDORXA/ASR 3377488 IN 144 FIBER 11565 SW PACIFIC HWY nnaEcn co.Ane... WJYBEN. IXM.CCCf. NgNE H SALE'. 1NN6,R'.- FNGp9 i 217' 0 TERM 10 E3H BBGTDDEB,101-118+XD,119+ M/4688 E BB 4685TD 10 DEB,120+XD,121-123+ ZIPLY TAG 58335 BBGTD DEB,201-250+XD BBGTD DEB,124-150 C1136A6981-PGE 51-75+BBGTD DEB 1276-300 237' AE.5a22 TAG KROGER(FRED MEYER) BBGTD DEB,27"00 11565 SW PACIFIC HWY NEW FIBER CABLE AE25-22 SONICOM TO PLACE C 1500 FIBER TAIL 700'OF AERIAL IX FIBER TGRDORXA H1002, 258' DROP INTO KROGER 72-76+XD,6 BBGTD DEB,201-250 UIPMENT F G NEW FIBER TERMINAL AE'50-22 1.25 PLACE 200'OFF 1.25 SUBDUCT THRU ROW OF p SPORT FIBER TAIL TERM TREES-MINIMAL TREE BBFTP FDT 499502 TRIM AS NECESSARY TGRDORXA H1002. / O 72-78+XD,8 ZIPLY TAG 58310 F 6w / 1136AB962-P E XD,1-25+DEB,276-300 / TAG D AE:50-24 / G /. XD,1.25+DEB,278.300 AE / AE:50-24 ZI PLY TAG 252769 / C / PG�Fp TAG RISER /}— I / / A I SHEET 3 OF 3 NORTH 220'OF AERIAL TO UG BETWEEN / RISER POLES-ACCT CODE CHANGE ONLY NO SPLICE ZIPLYTA 250509 C1138 PGE / TAG U RISER./� f zi yfiber I / TGRDORXA/ASR 3377488 H -�/ i \ $1351-M888849 11585 SW PACIFIC HWY vw ccw SEE SH wnwxwre Ewe nuaec �.,a �' 6VLE: geiPlR Cf TM191P: PNG MC. ot O\ LANECLOSURE AT T INTERSECTION WITH FLAGGING PEDESTRIAN/BICYCLE SAFETY ESCORT REQUIRED TONO E AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS ,140fOA Op P 6\ ODOT DIAGRAM 820 RE / REFERENCE i /1 SIGN SPACING AND BUFFER LENGTHS POSTED SPACING BETWEEN SIGNS BUFFER SPEED A B C SPACE 20 100 100 1 350 350 35 45 50 500 500 5001210 55 R @a. O FLAGGER AHEAD SIGN SHEET 1 OF 1 f BE PREPARED TO NORTH �9� E STOP SIGN F RIGHT TURN LANE A =ORANGE SAFETY CONETRAFFIC FLAGGER CLOSED AHEAD SIGN BICYCTt LANE LE O RIGHT LANE CLOSED ZI yfiber AHEAD SIGN TGRDORXAIASR 33T7488 O " 11505 SW PACIFIC�HWI H UTILITY WORK aqr na�«ae AHEAD SIGN 51351-WOBBU4&PERMIT ronveiwre Axa " "E w"9X TM1911R.' RNGp9