PFI2015-00043 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00043
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/13/2015
Parcel: SEG 1031
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier PFI on East side of SW Knoll Dr
Project Description: PFI to replace defective 45C4 pole on East side of SW Knoll Dr. in front of 12420 with new 45C3 pole
north of existing pole.Attach DN guy and anchor to new pole.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
ROSALIE SIMS
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97760
PHONE:
Total $0.00
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: Not Present
Issued By: C _
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00043
Type: 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 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 09-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 10-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 11 -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 12-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 13-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 14-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 15-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 16-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 17-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector Kenny Fisher at 503-816-6146 or email at kenny@tigard-or.gov twenty-four
(24)hours prior to commencing work,prior to any staged inspection,and after completing work covered by the permit.
PFI_Utilities 18-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 19-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 20-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 21 -OTHER Applied Notice
?r
R E C it----1 Var"
City of Tigard APR 0 9 2015
PUBLIC WORKS— ENGINEERING
rrrync ^AR:)
Public Facility Improvement (PFI) Perm VEERtNG
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one:N Public Utilities (gas line,electric,data cable) ELEMENTS
/minor work in right-of-way
ElSidewalk/driveway approach
(sidewalk repair,curb cut,
❑ Street Improvements(subdivision/partition) street opening,etc.)
Detailed description: REPLACE DEFECTIVENAZARDOUS 45C4 POLE ON
EAST SIDE OF SW KNOLL DRIVE IN FRONT OF ADDRESS 12420 WITH For detailed submittal
NEW 45C3 NEXT TO AND NORTH OF EXIST POLE,ATTACH EXIST DN GUY elements see checklist page 3
AND ANCHOR TO NEW POLE.
Property address/location(s): IN FRONT OF 12420 SW KNOLL DR — OR—
1�EC'1 1011
❑ Substantial project work
FRONTIER COMMUNICATION (Subdivision/Partition)
Applicant's name: Street widening
address: 4155 SW CEDAR HILLS BLVD Subdivision infrastructure
City/state: BEAVERTON,OR Zip: _97760 UtihrV main line extension:
Phone: 503-319-7787 Email: rosalie.h.sims@ftr.com Storm Drain,Sanitan•—Tigard
Contact person:
ROSALIE SIMS Ph#: 503-319-7787 Water-Tigard Water.Service
Contractor's name: WILSON CONSTRUCTION
DELIVER APPLICATION TO:
CCB#: 68553 Expiration Date: 8-29-2016
Address: 1190 NW THIRD AVE City of Tigard
Planning/Engineering
City/state: CANBY,OR Zip: 97075
13125 SW Hall Bbd.
Phone: 503-720-0016 Email: khorraxCa_)wilsonconst.com Tigard,OR 97223
1pplicari(ms for"minor work in right-of-way"
Engineer's name: ROSALIE SIMS only may be emailed to:
Address: 4155 SW CEDAR HILLS BLVD rowpermit&Q)tigard-or.gov
City/state: BEAVERTON,OR Zip: 97075
Phone: 503-319-7787 Email: rosalie.h.sims@,ftr.com
ECase No.: FL 2�1 C��0�-3
Application submittal fee: �O
Estimated value of work is required(if over $5,000): $ Addirion'i fees:
(within the public right-of-way)
Application accepted:
Is work related to a LAND-USE DECISION? ❑ Yes XO No By: M(5 Date: q S
If so,please specify (1�1LP, SDR,SUB,etc.) case #: application reviewed:
¢
Is work related to a BUILDING PERMIT? ❑ Yes ENo Bv: A8 Dare: t
If so,please specify(BUILDING PERMFI)case#: 1PPlic t noci6ed:
Bv: v Date:
I:\CURPUVW&st n\Und Use Applications Rev.07/16/2011
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 - www.tigard-orgov - 503-718-2421 Page 1 of 4
.MCity of Tigard
A � Application For Work In The Right-Of--Way
TIGARD ROW Permit
FOR STAFF USE ONLY
General Information:
Right-of-Way
Property Address/Location(s): 12420 SW KNOLL DR Case No.:
Receipt No.:
Date:
*Applicant's Name: FRONTIER COMMUNICATIONS Application Accepted By:
Address: 4155 SW CEDAR HILLS BLVD Revised 7/1/10
City/State: TIGARD, OR Zip: 97075
Primary Contact: ROSALIE SIMS REQUIRED SUBMITTAL
Phone: 503-319-7787 CELL Fax: 503-643-0977 INFORMATION
Contractor's Name: WILSON CONSTRUCTION
CCB# 68553 Expiration: 8/29/16 Submit a scaled sketch of the proposed
work to be done
Address: 1190 NW THIRD AVE
City/State: CANBY, OR Zip: 97013
503-263-6946 Professional Engineered Plans are required
Phone: 503-720-0016 EXT. Fax: for:
Plans By: ROSALIE SIMS • Street Widening
Address: 4155 SW CEDAR HILLS BLVD
• Subdivision Infrastructure
City/State: BEAVERTON, OR Zip: 97075
• Main utility line extension:
Phone: 503-319-7787 CELL Fax: 503-643-0977
L•curpin\masters\land use applications\row app.docx
Descriptionofwork: REPLACE DEFECTIVE/HAZARDOUS 45C4 FRONTIER
POLE ON EAST SIDE OF SW KNOLL DRIVE IN FRONT OF ADDRESS 12420. PLACE NEW 45C3 POLE NEXT TO AND TO
NORTH OF EXISTING POLE TO BE REMOVED, ATTACH EXISTING DN GUY AND ANCHOR TO NEW POLE.
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES ❑ NO ❑X
If so) please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES ❑ NO ❑X
If so) please specify(BUILDING PERMIT)case#:
*NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for the work.
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 1
4.320 Lane'Closure with Flagging Diagram 320 Lane Closure With Flagging
Diagram No. 320 covers total closure of one lane of a 2-lane,2-way
roadway. The right-hand drawing illustrates the use of two flaggers, one for WORK
each approach. The left-hand drawing illustrates the use of a single flagger AHEAD
to control both lanes of traffic on low volume (less than 400 average daily A.
traffic) roads with good sight distances as discussed below. ONELANE C
ROAD -
1. Use truck-mounted high-intensity rotating, flashing, oscillating, or strobe AHEAD �`
warning lights with 3600 visibility on all work vehicles. For added (Optional) B
BE • Posted Slgn
visibility, truck mounted arrow panels or PCMS in the caution mode may BE
�i seed SracinBuffer
be used. To sroPB (mph) A (ft)
30 100erless100
2. Flaggers at each approach are required if any of the following conditions • A I 3s-40 350 250
eXlst: 45-55 500 350
a. Night Operations or,
b. Work space is over 200 feet in length or, T -
C. I •
/ \
Sight distance is less than 750 feet from each approach through the / B .•
lane closure or, I \ • Protection Vehicle
•
/
d. Traffic volumes are greater than 400 ADT. w/TMA
A \ • ® (Both Optional)
3. The length between the flagger signs shall not exceed one mile.
4. Cones should be used to outline the work space when curves or other J I.•• 1 Buffer
roadway alignments prevent clear direction for the motorists to pass the •® •
work zone safely. Cones along side the work space are recommended Tt
when posted speeds are 45 or greater, when working under heavy traffic �. I •
or when travel lanes are narrower than 11 feet. .
I i II •. I A
5. Extended queue signing(as shown on Diagram No. 001)should be used
when traffic queues extend beyond the initial advance warning sign. l ••
i ••
6. When flagging near an intersection, the Flagger symbol sign should be T BE
visible to traffic entering from any side road. Additional advance warning \ A PREPARED
and Flagger symbol signs may be placed on the side road(s). TOSTOP
7. Sign set-up and flagger placement shown in Drawing No. 320 may be \ I A �B
used for intermittent full road closures of 20 minutes or less. \
8 I B ONE LANE
8. The ONE LANE ROAD AHEAD sign is optional and should be ` ROAD
L - V AHEAD
considered on high volume or high speed roads, or when extended (Optional)
queues may be expected. Low Volume C
Single Flagger Option I ROAD
14, 1 12o S A w v'-. WORK
AHEAD
Diagram No. 320 Two Flagger Operation
- W a�Y' S T"• N 7V< F000 W
62
Jt.lr A 63
PERMIT REQUIRED PER CITY FT \
OF TIGARD R #36485 12360 SAFETY ISSUE - BAD
P2S5 3005 '1955 �, ORDER POLE FTR #36484
C2101133299 4 DROPS TO
SEE SHEET 1 FOR CABLE PGE SEC 24.2 \ REMOVE
PGE SLT 23.1 CONSTRUCTION NOTE
ASSIGNMENTS. FTR COMD 21.1 CONTRACT POWER CREW TO
SEE SHEET 3 FOR VICINITY FTR COMD 21.0 PLACE NEW 45C3 POLE, POLE
MAP. LOCATION IS STAKED.
WORK WITH PT TICKET # FOR
UTILITIES TO TRANSFER.
12390 PGE TO MAKE NEW RISER ON
NEW POLE PLACING 2" PVC TO
APPROX. ELITE CARE AT 12360 SW KNOLL
12387 SI-100' DRIVE ON PGE W.O. #M1437125.
A' G t�
10M
1 5' PLACE NEW 45C3 ATTA( G •- G V ��
' O EXIST DN GUY AND ANC
C REMOVE (FTR #36484( (P2S
2" POLY NWN (45C4) ('1954)
12419 GAS LINE C2101133298
FTR #501207 -A
35C6 '1996 10' ASPHALT PARKING STRIP
C2101 B20
FTR COMD 20.3 12435
FTR WILL NEED TO 13 24' 10' 3' R/W
ADJUST DROP
ATTACHMENT WHEN R/W 12420 SW KNOLL DR
WORKING NEW POLE
50' 51351-5118474
13' WP2 OF 3
RNV 5460-TIGARD
SW KNOLL DR 2S1W1B N
ROSALIE SIMS
503-319-7787
i
tw mFrs? 9
0 25 SAFETY ISSUE — BAD ORDER POLE
2792 FTR #36484 AT 12420 SW KNOLL DR III I \ FRONTIERA 2S5 BBGTD
2,676-681+
TIGARD.
X0,7+ 685+
III BBGTD 2.6B3-
,11+ CONTRACT POWER CREW TO PLACE
B 2'687-698+INEW 45C3 POLE DUE TO PRIMARY III II )(D,69 POWER. EXISTING POLE IS DEFECTIVE
VIII ��i BBGTD 2.
AND IS A SAFETY ISSUE PER PGE AND
IIII II RDORXA 2S3T D0RXq 46563 FRONTIER.
A (4 (01.1954) H70p4 PLACE NEW 45C3, NEW POLE LOCATION
45-325 186 IS STAKED, ATTACH TO EXISING DN
GUY AND ANCHOR. WORK WITH PT
Jill
1 27911+ TICKET FOR PGE TO TRANSFER.
20/ 8BG ,676-6 500 09.2006
y )(r),7+ 2 68 685+ FTTP MULT1PORT 6
TGRDORXA H1004,181-186
XD.G1+ 2,687-69B+ Q 9+ 223'
I \ TGRDORXA 2SL/ XAKF 25 26
\ FRONTIER / B G 5 191 BBGM 2,676-681+
1 .\ P 465 04 7 XD.7+
ORY to BBGTD 2,683-685+
SK \ / SG DORY► h x XD,11+
\ Z 7 600 BBGTD 2.687-698+
2��FR`\ 0 �6� XD.699+ SEE SHEET 2 FOR
6 ° BBGM 2.700 POLE DETAIL AND RE—SAGGING
9Q tib° OF DROPS
�\ 0G
\ SEE SHEET 3 FOR
\ VICINITY MAP.
\ PERMIT REQUIRED GRD SAFETY BOP REPLACE 45'POLI
\ PER CITY OF TIGARD. 12420 SW KNOLL DRIVE
PROJECT C.O.AREA.TGRD
NUMBER:5118474 EXCH.CODE.51351
' \ DRAWN DATE: ENGR: ROSAIIE SIM NTY:WASHINGTON
06-08-15 PHONE. 501319-7787 ILE. 7015 RHS 5118a
SCALE:1-100 TAX DISTRICT. DWG 1 OF 3
TWNSHP.2S IRNG: 1W I SEC:1B
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503-319-7787 n
4.320 Lalne'Closure with Frigging - Diagram;320.,,: '/ Lane Closure With Flagging
Diagram No. 320 covers total closure of one lane of a 2-lane,2-way
roadway. The right-hand drawing illustrates the use of two flaggers, one for ROAD
each approach. The left-hand drawing illustrates the use of a single flagger WORK
AHEAD
to control both lanes of traffic on low volume (less than 400 average daily
traffic) roads with good sight distances as discussed below.
oNELANE C
ROAD
1. Use truck-mounted high-intensity rotating, flashing, oscillating, or strobe AHEAo
warning lights with 360° visibility on all work vehicles. For added (optional) B
8E • Pasted Slgn
visibility, truck mounted arrow panels or PCMS in the caution mode may PREPARED �i seed s In ft Barter
be used. TO STOP B (mph) AT312
or3ess 100 2. Flaggers at each approach are required if any of the following conditions • A I 35.40 350exist: 45-55 500
a. Night Operations or,
b. Work space is over 200 feet in length or, 7— I •
c. Sight distance is less than 750 feet from each approach through the / B 0•
lane closure or, A \ Protection Vehicle
/
•
d. Traffic volumes are greater than 400 ADT. W/TMA
A \ • ® (Both Optional)
3. The length between the flagger signs shall not exceed one mile. �.
4. Cones should be used to outline the work space when curves or other � � .•• 1 •�} Buffer
roadway alignments prevent clear direction for the motorists to pass the •® •
work zone safely. Cones along side the work space are recommended 1
when posted speeds are 45 or greater, when working under heavy traffic �. I •
or when travel lanes are narrower than 11 feet. + '• .,
•i`... I I n 1 A
5. Extended queue signing (as shown on Diagram No. 001)should be used
when traffic queues extend beyond the initial advance warning sign. ` ••
f
6. When flagging near an intersection, the Flagger symbol sign should be Tip 1 � 6E
visible to traffic entering from any side road. Additional advance warning \ A PREPARED
and Flagger symbol signs may be placed on the side road(s). TO STOP
7. Sign set-up and flagger
9 p gger placement shown in Drawing No. 320 may be
used for intermittent full road closures of 20 minutes or less. \ B ONE LANE
B
8. The ONE LANE ROAD AHEAD sign is optional and should be �! ROAD
I •r AHEAD
considered on high volume or high speed roads, or when extended —L— (Optional)
C
queues may be expected. Low Volume
Single Flagger Option ROAD
WORK
AHEAD
Diagram No. 320 Two Flagger Operation
62 63 '