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PFI2022-00005 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT s COMMUNITY DEVELOPMENT Permit#: PF12022-00005 Date Issued: 02/04/2022 • 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG952 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Ziply Fiber-W0912244 Project Description: SEG 952-Placing service drop on PGE poles t 9350 SW Tigard St. Class of Work: FEES Type 1 -Utilities(gas, electric,data) Description Date Amount PFI Permit Fee 02/04/2022 $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 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: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12022-00005 Tyne: 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 R City of Tigard PFI#: PFI2022-00005 ENGINEERING DEPARTbIENT Public Facilities Improvement (PFI) Permit PROJECT INFORMATION �5�1— WD71Z-7-44- TYPE OF WORK Project name: r,� 13 TYPE 1-I mnchw:Uril�•R trcl; Brief description of project: Z1 PL`( N Pcrfnrm�d br V\CN,PGI? ur unlet' TFLALlA/& SEUVM DIM17 Jw PLOP ❑ TYPE 2-R(11V Siddwvlk/Driw.ww/Suwcr p&ei Tn 9&A i W 77&AM TT \t'txk pdrforrnW for the parpi c of. • Srddualk Imallanon or a:parr • Unt uvu approach inStalLaum and reparr SITE INFORMATION Samran+eiwr Lmral insrall.rrion and 9 04 -Y i d / main lint tap Location (address if aP. blc: VlJ ��77����//�'� �•�- ?��''T7�� _._.^______... .._ ❑ TYPE 7-1 U11.1 cali Ihwdiupmcnr\th wk !l CW n Y 1 — 9 J.1.!� SEG 952 TYPE -with land use approval which iocludu am of the foliming: • Sulxlivphms or i'arritirms APPLICANT INFORMATION •Sirn t widrning ZIPLYFIFOL • \lainkac imwItarirm Fos svlioov Stec[, Name: gtq/7 snxm scwcv, 111g"4 wear, and 'I`rtianl Malting address/.Al ss,�- S �•'�WL W HILL S KLV0 "ter Service ann City/State: /1 61L zip: 974411 t ❑ TYPE 4-SrnW1(:d 1 Tvchmrk k, rnz_-Tia^7TO ❑ TYPE5-•Igprd Triangle phone: r7ttL/7 ` ry y1L.� z p�.T LM.j,.w``'WIG.Ia�54zi t' ` •-done: .SD5- J1���-7Y/ NOTE: 'Cypc 1 and 2 applications may 6c 1711CL"aL /'1 f}��� emitted to nny)t:rmir?Ayynnl-•lr,U,l . Contact name: �/(•(,j)) La�.iL/ Phone: SZK-31Z-7M Email: W61,MKi-zou, 1,E+1 CONTRACTOR�IpNnF�O�RMATION ❑ Same ns applicant Name: ;W1 16V CCB Number: n$�IIlO r Mailing address: a7 5 S MUL41L CI,L Cityl State: CIYI.UBI11 t Q1Z Ztp: 9ZII Phone: 5M-WZ- 7711 Email: AIIA ENGINEER INFORMATION Name: flailing address: Cin'/State: "Lip: Phone: f mail: ADDITIONAL INFORMATION Estimated value of work is required of ov er$5,000;:$ (within the public rigbt-of-way) Is work related to a L SND USF DL-CISION? 0 Yes 4No Case number. City of Tigard • 13125 S\\ I fall B1%d • Tigard,Otegan 9 223 • \v%%m.agatd orgm 503-719-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as Applicant'shall be designated"Pernuttee"and shall provide financial assurance for work,if requrred bi the cit)pursuant to ThdC 15.04.140. ' \\irh ilk e�atwon nF,t urdih opennng putvu.m[to a valid fmttehi r tx Irma wth tM:r:ih of 7 ttad,wlwn die nwncr and the applicant me diffLnnt pcopk,rhe applic tar mu,r be the puceimnr of%vad tar a k ace in pusse•a4m with written authaniarion faun thu m"ur or an agora of clic tnvnu the urwtcr must sip rhu appl"Hen in ilii span prnviduJ nr wbmtt a writtut authwiiatinn aid. dti, apphr tMnt I'amlla,cd ar I teett•ed Utilities arc nae required in obtaut the mvnor's sitmatute nn the applicatnut I,the applicant,certify that: • To the best of ml knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded decd restrictions that may be attached to or imposed upon the subjectproperq. • If the application is granted,l will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. @155Q.1 CGl�LS 1/41ZIYL 1p G n o authorized agent's signature Print name Datc Propertl owner's signature(if requirrdl Prutt name Date Case No: PPI2022-00005 Permit fee: 3O0CU Received by NTDate: U4/22 Approved bp: Trevi Date: Notified bp:_ _Date: CIryof Tigard • 13125 SW I Ia813h d. • Tigard,Oregon 97223 u�v%vogard-or.gov • 503-718-2421 4 Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10°o of the Net PFI Permit pee.See below for calculations.hGnimum of$3U0. NET PFI PERMIT FEE Part2: VI non-nater system improvements engineer's estimate S?" Qess die initial PPT Permit 1•eei. WATER LINE CONSTRUCTION FEE Pan 3: ,111 public water system improvements engineer's estimate S 12"o. Does applicant have a right-of-way license? O Yes O 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): D Small Cell ❑Macro ❑ Street Name How many install sites are proposed as part of this peunit ❑ Sire-\ddrms application? TYPE 3-Must provide 4 sets of plans(sized 24 x 36 of 22 x 34)and an electronic version of all submittal Tat proposed equipment is located on which of the Kowing. items. The plans must that include: ❑Public Right-of-Way D Private Property ❑ Cover—Site,\'icutin•, lbbreyt.mnn,Ixgend If equipment is to be located on private property,describe the ❑ General Notes(City,\\"ater,Sewer,etc) type&nue: ❑ Street(Phar,Profile) ❑ waren,Storm and Sanitan (Plan Profile) Cl Watez Quality racihties Cl Grading ❑ Landscapmg/TreeKin ❑ Composite Udhty Plan(I-Jecuical,Phone,Gan, Storm, Samttu),Water,Signage,Street Lights,etc.) ❑ Details ❑ Traffic bight Distance ❑ Signing and Striping ❑ Street JAght Plan and Photometric ❑ Rngineerssenl/sigmamte ❑ Sheet label(project land use name,reiesion and pLin Ing block,dares and sheet numbers ❑ Engineers Construction Estimate Additio sal Sx6mittals iper land use coadidons,if applicable; ❑ TrafficRepon ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary \ccessReport,StgbtDistance ; ❑ Proposed Plat ❑ Pathway Design D water Provider,lppmr.d City of Tigard 13125 S\\ I1a11 Blvd. Tigard,Oregon 9 223 • mvw.tiga:d-orgon • 503 18 2421 • Page 3 of 4 -WI) 41ZZ44. RRWIT Q sil- It St I Edge ofPevament Duch��► Streeethghl ( �•—•�•�•�•— ���•� " 1 1 1 I I l1 y , � Existing House �i �' 1 Vi �Drnevray � €i 1 tpj f� cla l j 6uMmg Shop 1 Powgz018 t 1` 95' 1 1 � Forel%Uni—•—•—• I Fln MVAranl CFMI 1 1 It ( 1 scale 1-=30' I 1 I I i ! I i ! I I _ orrh arrow _Property lines&dimensions _Existing utilities locations (sewer,storm,water) S eet&street names ,All existing structures _Proposed wort- Existing curb or edge of pavement _Utility&street light poles Existing S/W or DAV apron Slope of property Trees City of Tigard • 13125 S\C Hall Bh d. Tigard,Oregon 9 223 • nunvtigard-ocgov • 503-118 2421 • Page 4 of 4 JOINT POLE NOTE • .., -.:_. ."..R,... a,..d„m...,�....,o•.,,.."w.. Commerual CRP NEEDED ON PGE POLE od,k • ��•�• CONSTRUCTION NOTE TOTAL ALLOTTED HOURS � DeS."m"N""L xDul'e'r&"S1 e*°" unrRDacr. Q P.CATxX-TIME MxINT. 1-THIS WO IS SERVICE ORDER DRIVEN- ,{. �.. - 4'5S1 garC St. REw D D o PSR-3400340-SMARTRAKC/PGE mij •_ g3'c. P O 7t23 aPLKWO a D D 2-CITY OF TIGARD/ODOT - 'o C' - '" -,'Offee Q ' FiteG ', TR,VPBR`S- PERMIT REQUIRED ® gym^ CONDUIT ONLY - Oregon Rif CUESTRUCTTON SART Gun NMOD IN SERVICE RAT4'. 3-RUN RED JUMPER AT TGRDORXA H4019r` CONSTRUCTION Ca PLETE THEN"VERIFY"AT CUSTOMER FIBER NID 41''Y 'IdShQ CUTS AEGUIReD CONSTRUCTION �Seach Hut Deli 0IRS axo CONSTRUCTION CONTACTS O ® Tigard TC WES StationE JOINT Tall O DIAL.A DIG The Jax Ores n"" MELCG DAVIDCARNLEY-971-940-9000 /Thai Delicious O oRRDSETNG JAMES STAATS-503-758-3119 George Morlan v nT•,-5 o.CH REuxo 0 CCONTRACr.. Plumbing Supply iw Tigard Liquor Store Sh SCHEDULING CONTACT °4'N,Ro ,,DON else �I LIG"nae PERMITS ' MUNICIPALITY CfrymGARD RYAN ROBERTS-503-043-3713 xs^ Aft rlmncNiac MUNICIPALITY O ELAn¢x NTSO TEP/TRNTIC FACILITIES CONTACT O DETAILED (NOT SIARRHT) ROBYN RUSSELL 503-260-9525 p NO PERMIT IUOVIRED SHEET 1 OF 2 JOINT POLS Jrvxaoxs I INSPECTION CONTACT NORTH JFNINJONS I TOM WATSON 503-998-2586 POLE JEN JPF REDDTREn OMER TO FROM EI o 13 POMER ENGINEERING CONTACT °o O a IRMTIER RUSS WELLS 503-312-7330 POINT OF CONTACT **'2021 ETHERNET WORK ORDER**** RsouX 0001 51351-5504207-716 SCHEDULING RYAN ROBERTS PHONE NO 503EISD713 LABOR HOURS SMARTRAKC-PGE ENGINEER RUSSWELLH PHONE No 503 331001 9304 SW TIGARD ST n`x exoxE so MATERIAL REQUIREMENTS SPLICE-C-1-M-1-X-0 TIGARD OR YIELDED eY RIR4 WELLS CREW-C-0-M-0-X-0 PSR 3400340 "`*1X FIBER DROP-800"" SONICOM-FLAGGING-16 BBFTP FT 553252 1 ziply-fiber 1-RUN RED JUMPER- -TEST FIBER STRAND AT FC2041,7441/H4019,157-PORT 1 0340 CUSTOMER FIBER TERMINAL LCON-RAY SIMILA 503-413-9432 TGR 04 SW IGA 3D ST 9304 SW TIGARD ST AND AT NO 51351-WO912244 PUM ER COUCH COX_ 21=1 RANM DATE: ENGR'. RIIW WELL N,Y WASH PHONE E ECALE _ TAXDISTRICT' OWO I OF MNEMP. RNG SEC. Sy, Tj G.gRO \ sT GE POLE-C2102A 331 PGE POLE-C2102A 4450 x �� APRIY CRP VZ#50024 g i PGE00246 2102A332 OREGONRESTORATIZNL( VZ#500246 9350 SW TIGARD ST A BBFTP FT 553252 C / TGRDORXA H4019,157-161+ `�.0 /,/ `� VZ POLE 32 / / XD,6 12 B 1x FIBER DROP G\�N6� , `\ � \COMM R ElCHAMBER/ / NTS 750'(NEW) QP A C TGRDORXAH4019 y� / C SHEET 2 OF 2 FDH GEN IV 288 TGRDORXA FC2041,724-744+ /'/' j/ NORTH XD,22-24 IN TGRDORXA H4019,1-288 T 5 i ziplyfiber TGRDORXAIPSR 3400340 51351-WO912244 9304 SW TIGARD ST PROJECT NUL6ER: EXCH,CODE: DRAM DATE' ENGR' ROSS WELL Ntt:wmm PHONE' ILE: SCALE _ TAXDRITRICT mO OF MNSHP. RNG SEC'. SIGN SPACING AND BUFFER LENGTHS zi POSTED SPACING BETWEEN SIGNS BUFFER • SPEED A B C SPACE 20 50 25 100 100 100 75 30 100 35 40 350 350 350 125 150 STATIONARY LANE CLOSURE WITH FLAGGING 45 180 PEDESTRIAN/BICYCLE SAFETY ESCORT REQUIRED AT WORK SITE WHILE CONSTRUCTION WORK IN PROGRESS 50 500 500 500 210 5 250 jR RCOOTEFERENCE DIAGRAM 320 5 B -` REFERENCE <G> /� D FLAGGER AHEAD SIGN F /A 9�l O100' BE PREPARED TO O PG\oG STOP SIGN D J Q S1 O ONE LANE ROAD OREGON RESTORATION �ioA�l F AHEAD SIGN 9350 SW TIGARD ST G ROAD WORK NTS Pte✓ AHEAD SIGN TIGARD CHAMBER OF COMM RCE SHEET 1 OF 1 O� 12345 SW MAIN ST G NORTH F \ C PEDESTRIAN R E B BICYCLE s� �\ p g TRAFFIC SAFETY TjC� 00, A ESCORT �QO TRAFFIC DIRECTION SAFETY 1 ziply fi be r SIGN A TRAFFIC FLAGGER \ g D TGRDORXA/PSR 3400340 C\B / \O _`_AP�� Pgoirr.T 9304 SW CO AaEnD ST F V`r- NUMBER E%CH.CODE. G 5 51351-WO912244 DRAWN DATE ENGR' gU55 WELL NN WABN PERMIT SKETCH BCALE 11.1.11 TRTOo STRICT PNQ OF T SHP I RNG ISEC.