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PFI2015-00162 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00162 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/03/2015 Parcel: SEG767 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Frontier Communications Project Description: Adjacent to 11645 SW Tiedeman Ave.Asphalt has been paved over existing Frontier man hole from city paving road improvement project. Expose the man hole lid, place man hole steel ring to road elevation if needed and re-pave as required. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: TAM NGUYEN 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 503-641-4463 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: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00162 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 No obstruction of traffic permitted 6:30-9:00 am and 3:30-6:00 pm. RECEIVED NOV 0 2 2015 CITY OF TIGARD City of Tigard PLANNING/ENGINEERING Application For Work In The Right-Of-Way ia, ROW Permit Property Address/Location(s): 11645 SW TIEDEMAN AVE. FOR STAFF USE ONLY TIGARD, OR Right-of-Way Case No.: *Applicant's Narne: Frontier Communications Application Accepted:"// L Address:4155 SW Cedar Hills Blvd. Application Reviewed:z"'A' a By: 3-'S- city/state:Beaverton/OR Zip: 97005 Application Fee Due:— - Primary Contact: Tarn Nguyen Applicant Notified: lif,312z L-I,? Phone: 503-641-4463 Fax:503-643-0977 Receipt No.: Email:tam.minh.nguyen@ftr.com REQUIRED SUBMITTAL INFORMATION Contractor's Name: SONICOM /PJ Fellows 0 Application form,completed and signed CCB# 188116 Expiration: 3/24/2016 0 Submit one (1) cop):of scaled sketch of Address: 1180 S 12th Ave the proposed work to be done 0 Subnut one(1) cop),of traffic control City/State: Cornelius/OR. Zip: 97113 plan Phone: 503-992-7711 Fax:503-519-3445 Professional Engineered Plans are required Email: pjfellowsAsonicomcorp.com for: 0 Street Widening Plans Bv:Tam Nguyen 0 Subdivision Infrastructure Address:.4155 SW Cedar Hills Blvd. 0 Main utility line extension city/State:Beaverton/OR lip;97005 Deli\,er aPplicarion to ro\%l2ermits6D.tiZ,rd-ori or to City of Tigard Planning/Engineering, 13125 SW l+ffl Phone: 503-641-4463 Fax:503-643-0977 Blvd.Tigard,OR 97223. Re,.12/10/20i3 Email: 1:\C1:RP1_N\A1asren\Lnd Use Appli-d.­Nltight­f­m.Pemit Applicationxim. Description of work: REMOVE THE ASPHALT HAS BEEN PAVED OVER EXISTING FRONTIER MAN HOLE FROM CITY PAVING ROAD IMPROVEMENT PROJECT, EXPOSE THE MAN HOLE LID, PLACE MAN HOLE STEEL RING TO ROAD ELEVATION IF NEEDED AND RE-PAVE AS REQUIRED Estimated value of work(within the public right-of-way): $ Is work related to a LAND-USE DECISION? YES El No If so, please specify (MLP,SDR,SUB,etc.)case#: Is the work related to a BUILDING PERMIT? YES El NOFXJ If so, please specify(BUILDING PERMIT)case#: Signature of Applicant/Permittee: Date: to -�-2-yy,!;—_ Print Name:— Tam Nguyen Title: Network Design Engineer City ofTigard 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 "N'vvw.tigard-or.gov APPLICATION TO CITY OF TIGARD BY FRONTIER COMMUNICATION NORTHWEST INC. LOCATION: -11645 SW TIEDEMIAN, AVE. TIGARD NORTH NOT TO SCALE i' SW TIGARD STREET EXISTING MH I C 1 1645 1"aa1" zr�A i61 10 EXISTING FRONTIER MAN HOLE #161. CITY'S CONTRACTOR PAVED OVER MAN DOLE DUE TO CITY ROAD PAVING IMPROVEMENT PROJECT. FRONTIER WILL REMOVE THE ASPHALT TO EXPOSE THE MAN HOLE LID, PLACE MAN HOLE STEEL RING IF NEEDED TO ROAD ELEVATION AND WILL PAVE THE ROAD AS RE�I�. www.invar*ton.com Frontier Notes: Lane width 12Posted Speed 25135 Notify FirelEMS,EPD Place No Parking signs K&D as the preparer of this traffic control plan makes no representation CONTACT:Tam Nguyen 1, Maintain ped.access to and Merge Taper NA and LTD 48hrs before 48 hours before work begins as to Its general adequacy or being approved for Implementation. 5034641-4463 through crosswalks Flagger Taper 100 beginning work Approval must result from the Traffic Engineer or other public official 2. Maintain Min.12'lanes Buffer 1001250 having statutory enforcement authority in the Jurisdiction. 3. Maintain local access Sign Spacing 1001350 % Utilization and implementation of this plan shall be as a result 4. NotifyTrans(t authority at least Cone Spacing: LOCATION. SW Tigard Ave 48 hrs.of bus stop closure Tangent 25135 of that approval. Ref.MUTCD 2009 6A-01(10), SW Tiedeman St S. Traffic control plan and all Taper 20 aow Tigard OR devices shall comply with MUTCD,ATSSA and OTTCH PLEASE SCHEDULE (� DATE: JOB#5131431 6.Adjust to field conditions WITH DISPATCHo-t 10129/15 @ 503-723-7287 / 72 HOURS IN ADVANCE AND PROVIDE / z0_ Manifest COPY THE APPROVED �+ TRAFFIC CONTROL PLAN 30 x cones w20-7a 4 x flagger flagger 4 x stop sign cover 4 x road work ahead 3, 4 x be prepared to stop co 0 4 x Flagger Ahead arzea uwR t1 55 `~ S�SL�igr_t1A�en _ 00, 350 f arqSpacing cwzo-t cw20-7b 350wzoaa 350' Spacing .kms Spacing __ ti� Tem 350 7b Spacing Legend w20-7a �0- Work Area ! f 44* 201 cones cwzoab � $1 Flagger flagger stop sign cover t; J6 Sign Stand '„we 'o cwzo-t 4' road work ahead 25 ;yL�" be prepared to stop Flagger Ahead K A 00 fiTiuiCt \ K 8 D SERVICES OF OREGON,INC PHONE:503-723-7287 FAX:503.723.8750 DRAWN BY. ALAN WARD 04456