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PFI2021-00130 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12021-00130 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/02/2021 Parcel: SEG870 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: SQF, LLC Site#4 Project Description: SEG 870/SW Garden Place. New small cell facility. Class of Work: FEES Type 4-Small Cell Wireless Facility Description Date Amount PFI Permit Fee 05/13/2021 5300.00 Additional Plan Review(minimum charge 0 511 312 021 $270.00 Owner: 1/2 hour) Total $570.00 PHONE: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of Tigard website at NAigard-or.gov to schedule inspections online. Contractor: TILSON TECHNOLOGY MANAGEMENT INC 16 MIDDLE ST 4TH FLOOR PORTLAND, ME 04101 PHONE:2075916427 Applicant: NICHOLAS BOURNAKEL 16 MIDDLE STREET 4TH FLOOR PORTLAND, ME 04101 PHONE: 2076710893 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. PermitteetApplicant Signature: See application Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00130 Tvos: Condition Name: Status: Severity: PFI—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 16-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches wfthin 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 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—Small Cell 28-AS-BUILT DRAWING Applied Notice 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—Small Cell 31 -OTHER Applied Notice Other City of Tigard PFI #:2021-00130 ENGINEERING DEPARTMENT Public Facilities Improvement (PFI) Permit For use by Utility Providers (Small Cell) PROJECT INFORMATION TYPE OF WORK Project name: SQF, LLC—Tigard Small Cell Wireless Facilities ® TYPE 1 —Small Cell Technology Node Description of project: See attached Project Description Installation ❑TYPE 4—Utility energzation psformed by PGE or utility agency What utility services Will the facilities provision? PERMITTING - APPLICANT SHALL See attached Project Description Apply for&obtain PFT Permit.Pay all required fees. SITE INFORMATION Permit will be issued to applicant by City staff and Location (address if available): 11860 SW Pacific Hwy., Pole on will expire after 90 days. SW Garden Place SEG 870 INSPECTION - CONTRACTOR SHALL Notify rowpetmits0aa tigard-or.gov,within 5 days of APPLICANT INFORMATION (Service Provider) beginning installation. Name: SQF, LLC Notify rowpermitsa tigard-or.gov,within 5 days of completion of installation. Mailing address: 16 Middle Street,4" Floor Notify roa-pennitsCtigard-or.lntc,5 days before City/State: Portland, ME Zip: 04101 connecting or energizing facilities. Phone: (207)671-0893 Contractor mu call 503-639-4175 to schedule inspections before 7 a.m.(at the latest)on the da_ Email: nbournakel@tilsontech.com phone: (207)671-0893 of inspection.Use code 738 Contact name: Nicholas Bournakel Phone: (207)671-0893 Email: nbournakel@tilsontech.com ROW License Number: 2020-00039 CONTRACTOR INFORMATION ❑ Same as applicant Name: Tilson Technology Management, Inc. CCB Number: 212930 Mailing address: 16 Middle Street,41" Floor City/State: Portland,ME Zip: 04101 Phone: (207) 591-6427 Email: prolicensing@tilsontech.com City Business License Number: 02519(This is SQF's business license#.Tilson is an affiliate of SQF.) ENGINEER INFORMATION Name: Emad Badiee,Tilson Technology Management, Inc. Mailing address: 16 Middle Street,41"Floor City/State: Portland, ME Zip: 04101 Phone: (404)480-5555 Email: ebadiee@tilsontech.com City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.fgard-or.gov • 503-718-2421 1 ADDITIONAL INFORMATION Estimated value of work:$ $14,500(does not include the cost to run power and does not include any 4G/5G equipment. Is work related to a LAND USE DECISION? ❑ Yes ® No Land Use Case number: 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. 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. Applicant and Contractor acknowledge receipt of all the City's regulations and TMC and agree to abide by all regulations contained therein. Application and Contractor acknowledge receipt and agree to abide by the permitting process and all other City of Tigard regulations listed on this application. I hereby certify,on behalf of Applicant,that to the best of my knowledge and belief this information is true and correct as of the date hereof. Licensee agrees to comply with the provisions in the Tigard Municipal Code, including,but not limited to Chapter 15.06. By executing this application,the undersigned affirms that she/he is an authorized representative of the Applicant with the authority to execute the application and bind applicant to all provisions of the Tigard Municipal Code C. ;V–, (/A Nicholas Bournakel 4/16/2021 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY PFI No: Permit fee: 5741•oy Received by: AL—Date: 4/16/2021 Approved by: # Date: 6/1/2041 Notified by: Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.6gard-or.gov 503-718-2421 2 DEVELOPMENT ENGINEERING FEES All Public Facility Improvement(PFI)Permit fees due upfront 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 calculated from engineer's estimate x 7% (less the initial PFI Permit Fee). FOR • TYPE 1 PFI: SMALL WIRELESS TYPE 4 PFI: CHECKLIST FACILITY CHECKLIST NOTE:Applicant must have a ROW License with Is all applicable small cell equipment installed? the City of Tigard prior to applying for the PFI (Check box) ❑Yes ❑ No Does applicant have a right-of-way license? (Check box) ® Yes ❑No Date of Completion: ROW License Number: 2020-00039 Contractor must provide photos of the location of the Small cell installation site from all angles: (N,S,E,W) Under the wireless facilities standards,is the proposal considered? (check all that apply) ® Small Cell ❑ Macro How many install sites are proposed as part of this permit application? 1 The proposed equipment is located on which of the following: (Check box) ® Public Right-of-Way ❑Private Property If equipment is to be located on private property, describe the type&use: Who will be using the facilities to provision services? Wireless cellular companies for siting small cell antennas. Will the facilities allow other providers to use capacity?,Yes City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 wwwtigard-or.gov 503-718-2421 3 Ede ofYavea,ent 1 LMtch �► Stleetl,ghl •—• —�— _ r; k � I 1� j T--ri–CI 'os bWEMAT-- " Existing House � I a, IExisting j Fj I �I ('�rirIVeW3y y ( ty I _ c, .. tl7j QL I Ile cI aj UO I I j Unting Shop j L Powerpole la 95' iI Fire Hydratrt(FH) � I Scale: 1_=M' � I I TYPE 1 AND TYPE 4 PFI MINIMUM SKETCH REQUIREMENTS (Put N/A if not applicable) � I I � I I i � I 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.6gard-or.gov • 503-718-2421 4 SQF, LLC SQF�LLC SITE NAME: SQFCH-CON1003_TIGARD_OR 04 PROPOSED WI-FI SMALL CELL NODE 11860 SOUTHWEST PACIFIC HIGHWAY,POLE ON SOUTHWEST GARDEN PLACE TILS 0 N TIGARD,OR 97223 ox a M;:zioN WASHINGTON COUNTY LAT:45°26'01.31"(N)/45.433697° v Mo-wn wartnrn rtm.2Ea m. LONG:122°45'47.17-(W)/-122.763104° 8006NPE MAD B��Y�� p i, fl emsax msaxr: _ _ ' IA tl4OVRi ttS Fr�{R IE.4KY.1R nl3 $yCt� liAl ^�FiJ C. 9W d9 SATELLITE IMAGE STREET MAP SITE NAME: SOFCH-CONIOD3_TICA9D_DR 04 PROJECT SUMMARY PROJECT INFORMATION SHEEI INDEX 11860 SOUTHWEST PACIFIC THE PURPOSE DE THE DOCUMENT IS TO FRONDS GENER>E INFORMATION M REGARDS TO LOCATION AND 'rn HIGHWAY, POLE ON SIZE OF THE PROPOSED WI-n SM4L CELL EQUIPMENT SNE 20p6C I'm SDMDIMEST PIENILMDMAY,Wm SbJRMF51 GNDEX HOME .1 v sot SOUTHWEST GARDEN PLACE P NCEMENT.THIS DOCUMENT IS ISSUED FOR INAm,CH,51223 TIGARD, OR,97223 PERNITUNG PURPOSES ONLY,AND SHAEL NOT BE USED WASHINGTON COUNTY FOR CONSTRUCTION. 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Il C56YM5 tI LYnXMall"Mils HIAYa w M YniMll MB1n.11fbttx I(.MLI HL E lVm[0 b WlQ HY r IR ]PlB nwRW[WHm.SNR Ab RMRVI HRxllx 1H Mx IRA Pi][fMN MO w 9A11Y HS @ LMx116 MATERIAL NOTES: I. usvin �wuMrs,�oGlmoulme sw H Hsmr xoom ro M�mm ru a Huls maf m IB _ x. u uxuHs awx:x.icoHva all lac HRwRms xY uuL PRm swarWOR mW HImRIRx BWL Bm SITE NAME: E awes s�s�a wxo[u`xn[0.uufa xua.a sumrm H Rata. vH art Hos W Iw xRvsef. 57tH-OON1003 IYJAD_�M L. HxR a WAf Wl Av wBxs nue xo usa.axuar Mm.xe ra lHY HRwm.wB/H EIm1T s. Hnr M wwm WM W rm Rms H Wonxs xxwfo moon. 11860 SOUTHWEST PACT C e u ms,xAu¢no I�Ixme HUM sAx E wwx®n Hmu¢xml YSA Llv-u mvs twlax a HIGHWAY,POLE ON Y}I N S1LLl NN]eH x. ".oirnc'+cabHA sxx""°®"lox A BOWsa. SOUTHWEST GARDEN PLACE e. wa u rYAx�o RPA vron rsm swL n wamcrcw wxc e H ERR wa .u xerv.®HB xRB urmr WLs srx]E o[ss x.PLFs oIwI.H sxaYB TIGARO,OR, 97223 WASHINGTON COUNTY ,T GENERAL NOTES M..x sw am A H. 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Q 1� r,a1 r` r 1Y f Fy�O BAWF'E wsoo�■[.0 all 1a<.. � T nxm�rmanr a m K.nm.x m `1` 0 \ J YXT t' Z SITE NAME: mFCH- NIUAI_TCARD-O-a 11860 SOUTHWEST PACIFIC i HIGHWAY,POLE ON SOUTHWEST GARDEN PLACE TIC.tRO, OR,97223 WASHINGTON COUNTY ` ENLARGED NODE LOCATION PLAN w X e +a I� P.x. ax am a KR NOTE.POWER ROUTE 6 PRELIMINARY N NATURE AND IS SUBJECT TO CHANGE ENLARGED NODELOCATIONPIAN v CD-3 C n-w'-r Ixxt.tM'-r tasst ��w YYLL au umm�re 0 im or Mne w fuu au rmeY xR>Yeo ran. mrYm,axa rrY nQ.a'4st vs-a'(ret r•Yx.R�pw euow ,.�. 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PROPOSAL SUMMARY INFORMATION...................................................................1 II. INTRODUCTION .............................................................................................................2 IiI. PROJECT NARRATIVE .................................................................................................2 SQF— Small Cell Facility Application I. PROPOSAL SUMMARY INFORMATION SQF File No.: TIGARD_02 TIGARD 04 Applicant: SQF,LLC 16 Middle Street, 4'h Floor Portland,Maine 04101 Phone: (207) 671-0893 Preparer for Applicant: Nicholas Bournakel, Staff Attorney Tilson 16 Middle Street,4`h Floor Portland,ME 04101 (207)671-0893 Property Owner: City of Tigard(Public Right-of-Way) 13125 SW Hall Blvd Tigard,Oregon 97223 Request: Small Cell Facility Application to install new freestanding small cell wireless facilities in the right-of-way Location: Public right-of-way next to the following addresses: TIGARD-02 Southwest Pacific Highway,Pole on Greenburg Road Lat: 45.433449 (N) Long: 122.767814(W) TIGARD_04 11860 Southwest Pacific Highway, Pole on Southwest Garden Place Lat: 45.433697 (N) Long: 122.763104(W) II. INTRODUCTION SQF, LLC, an affiliate company of Tilson, is working to improve the infrastructure located in the right-of-way to facilitate wireless carriers' deployment of next generation wireless communications, SQF, LLC 3 4116/2021 SQF— Small Cell Facility Application including small cell/5G facilities and smart city solutions. SQF has a Right of Way License with the City of Tigard and is licensed by the state of Oregon as a telecommunications provider with a certificate of authority to provide telecommunications service in Oregon to install small wireless infrastructure in the public right-of-way to facilitate the expansion of small cell/5G wireless technology. Tigard is one of the select few cities SQF has identified for early deployment of small cell facilities to position the City for the future in wireless communications. To accomplish this goal, SQF is proposing to deploy new freestanding Wi-Fi small cell poles, which would provide Wi-Fi service with the intent of supporting multiple small cell carriers in the near future. The benefit of SQF's proactive approach of deploying Wi-Fi small cells include: • Poles designed for multiple carrier which will reduce the number of new poles by minimizing the need for individual poles for each carrier. Typically each wireless carrier deploys their own small cell poles and doesn't share their facilities with other wireless carriers, resulting in the proliferation of poles in the right of way. • SQF always allows and encourages multiple wireless carriers to collocate on its poles whenever technically feasible. To help position Tigard for the future wave of small cell facility deployments, SQF has identified proposed locations to deploy new freestanding small cell wireless facilities in the right of way designed to support multiple wireless carriers. The proposed facilities will be capable of supporting future wireless carrier collocators at the top of the pole which will be permitted separately. IV. PROJECT NARRATIVE SQF proposes to install two new freestanding Wi-Fi small cell wireless facilities to improve the infrastructure located in the right-of-way and facilitate wireless carriers' deployment of next generation wireless communications, including small cell/5G facilities and smart city solutions in Tigard. As shown in the enclosed plans, the proposed freestanding small cell wireless facilities will be designed with steel integrated poles, located in the right of way. The steel pole design will integrate the antennas and radio equipment within the poles for a clean design that blends with the surrounding built environment and existing infrastructure in the right of way. The design will utilize non- reflective materials and color to help blend in with the surrounding built environment. The proposed steel pole design is customary and common in the right of way, is similar to the existing steel light poles and traffic signal infrastructure in the right of way. The proposed freestanding small cell wireless facilities will be designed to accommodate the collocation of at least two future wireless service providers which reduces the number of new poles needed in the right of way by minimizing the need for individual poles for each carrier. SQF always allows and encourages multiple wireless carriers to collocate on its poles whenever technically feasible. For illustrative purposes, future small cell antennas are shown within an enclosure at the top SQF,LLC 4 4/16/2021 SQF—Small Cell Facility Application of the pole, not to exceed three cubic feet, integrated into the pole design, and will be permitted separately. The proposed small cell facilities will be located outside of the roadways and will not alter vehicular circulation or parking within the right-of-way or impede pedestrian access or visibility along the right-of-way. The facility will comply with the ADA and other applicable regulations and will not cause unreasonable interference. The fiber and power utilities servicing the facility will be vaulted near the base of the pole to minimize visual impacts. SQF,LLC 5 4116/2021