PFI2016-00155 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00155
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/28/2016
Parcel: SEG1524, 2817, 3583, 358
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Comcast
Project Description: Comcast proposes to overlash(1)-48-ct fiber 492'to existing strand then push(1)-48-ct fiber 1054'
through existing conduit within the City of Tigard ROW
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
IVAN CHANDLER
11308 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 971-777-0908
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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
RECEIVED
JUL 25 2016
City Of Tigard CITY OF TIGARD
s: a PUBLIC WORKS — ENGINEERING PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK
Clieck one: ❑ Utility Connection ❑ TYPE I—Franchise Utility Work
❑ Sidewalk/drive\vay approach Work performed by NVIN,PGE
❑ Street improvements and/or utility agency.
Detailed description: Comcast proposes to overlash(1)-48ct fiber 492'to ❑ TYPE 2—Sidewalk/Driveway/Sewer
existing strand then push (1)-48ct fiber 1054'through existing conduit Work performed for the purpose of.
within the city of Tigard ROW. • Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): 13460 SW 121st Ave, Tigard, OR 97223 and/or repair
t r Sanitary sewer lateral installation
and/or main line tap
W41 ❑ TYPE 3—Full scale Development
Applicant: Comcast Work performed with Land use
11308 SW 68th Parkway approval which includes any of
Address: y the follo\ving:
Cite/state: Tigard,OR Lip: 97223 • Subdivisions or Partitions
Phonc: (971)-777-0908 Email: Ivan_Chandler@eable.comcast.com • Street widening
Contact name: Ivan Chandler Phone: (971)-777-0908 • Mainline installation for Sanitary
sewer,Storm sewer,Tigard water
Contractor: Texstar Enterprises and/or Tigard Water Service Area
CCB#: 178798 expiration: 10/10/2017 SUBMITCOMPLETED APPLICATION TO:
Address: 14122 Arndt Rd City of Tigard
City/state: Aurora OR Lip: 97002 Planniug/Eugiueeriug
503-776-5049 imminer texstarenter rises.com 13125 SW Hall Blvd.
Phone: 1✓u�ail: 1 @ P
Tigard,OR 97223
Contact name: Jim Miner Phone: 503-793-3109
applications for"minor work w nglit-of-\t,iy"
only may be emailed to:
Engineer: K&B Technical Solutions rowPcrrnits(ktigard-or.gov
Address: 6566 SE Lake Rd FOR STAFF
ONLN
City/state: Milwaukie Zip: 97222 /, yy
Phonc: 503-650-6041 Email: John_Foerster@kbmail.net Case No.: Ar-7j, �/Cc—
Contact name: John Foerster ,Application submittal fee:
Additional fees:
Estimated value of work is required(if over S5,000):$ Application accepted:
(,,vithin the public right-of-way) By: I 1� Dater
Application reviewed:
Is work related to a LAND-USE llLCIS10N? El Yes ElNo By: K.(i0-Kd- Date: T �o
If so, please specify, (MLP,SDR,SUIS,etc.) case #:
Applicant notified:
Is work related to a BUILDING PERMIT?PERMIT? ElYes El No 6'No >�`
If so,please specify(BUILDING PERI4II'1)case#: \CUXPLN\IAastan\LandUwAppSutbns aa..07/09/201s
City of Tigard • 13125 SW Hall Blvd. 'Tigard,Oregon 97223 • \vx%,vmigard-or.gov • 503-718-2421 • Page 1 of 4er
1
T2\L-'N�\e ry 5 (P�4•^- g p"' �j 3�L. D w-
APPLICANTS
NOTE: Person specified as`Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
When the owner and the applicant are different people,the applicant mast be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The(Avner(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject prronern.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and littutations of the approval.
• All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
rccluircments for approving or denying the application.
SIGNATURES of Avner f the subject property required.
___14 F�v. �n n_c;S�e✓ �� Z 1
licant/ th4rized Agent's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 Sly'f fall Blvd. • Tigard,Oregon 97223 • wvcwvtigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/.
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way)
Engineer's estimate X 2%Plan Reviexv Sketch
(including information below)
WATER SYSTEM FEE
❑ Dime
Part 3: All public water system improvements Nam
[IStreet Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL
'There will be no permit fee charged,or assurance required SCALE DEVELOPMENT
for the following types of work: (Subdivisions/Partitions and Street Improvements)
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,2406 or 22:34)
• Weephole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City;Water,Sewer,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storni and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality*Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance stay be required per Storm,Sanitary,Water,Signage,Street lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dares and sheet numbers)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(f applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 • wwwtigard-orgov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCII;
1 Edge ofPnvemant
I -'*- Ditch
tip
eetliyl,t I •-•-•-•-•-•-•- -t-•-
• ° PAtn Dr*M
I r f ,
v�
I I II I
' 7`•'�ro m cr wer L�iig"
fI N Existing House 1
Existing
vl I U1 i Driveway
Vim'
�I
t
I Existing Shop
Powerpole
I I -----•- _----
I � �roperiy Line------
OFire Hydrant(F H)
I i I
Scale: 'I"=30'
� I I
I I I
� I I
� � I
MINIMUM SKETCH REQUIREMENTS(Put"N/A" if Not Applicable):
North arrow Property Lincs&dimension Slope of property
Street & street names) l.xisting building,structures Utility &street light poles
Proposed work Existing curb or edge "frees
Existing S/\\'or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cit} of Tigard - 13125 SWI Tall Blvd. • 'Tigard,Oregon 97223 - m-ommtigard-or.gov - 503-715-2421 , Page 4 of 4
SW HOLLOW LN
I !y'W_-
jVL
s x 5 5 YL /
s r r w 7'�av
wl
'BEGIN AERIAL OVERLASH IN
-- % CRY OF TIGARD ROW
SW QUAIL CREEK LN /
r '
135,5 �,
VL j OVERLASH(i F6ER ro FJDSTIN(i ATR go
7"�Ig 21&VW
12230
13615
12240 I 73560 / 12050
,3575 7
12052 12051
/ 12056
h
Q I 13610 /
13805 I
122 Z
50
21504T
®2S
12266 122{5 ,2225 .i r•�1j /, / 77w
�> I 12125 / 'N
END AERIAL OVERLASH -
/, BEGIN UNDERGROUND PUSH
h 12051 12033 12055
SW WHISTLER'S LANE �• ` J/ y ./ 12057
v try /
12079
----- -- -- 12177 12073
% ,2076 12071
GJ 13660
l 36M \
iI EXISTING PEDESTAL ----- -- -- -- --
122W 12240 12110 If
SW WHISTLERS LP
as 12265 12223 12185
PUSH FIER THROUGHE%18T�
__—__ /' I 12080 12078 12078 12074 12072
-- -' 12084 12082
-1
137W Qg
l i 13780 175
12250 ,22,9 12170 12130
L - - -
" SW ROSE VISTA DR
jr----------- ----------- ----- ,op
i13 13825 615
-_--� i 13830 12110
,2025
SW PLANTATION TER ----J i 1192p
- i 13870 1.ALL WORK AREAS TO BE
` RESTORED TO LIKE OR BETTER
CONDITION.
' I END UNDERGROUND PUSH 2.ALL OTHER UTILITIES ARE BASED
W IN CITY OF TIGARD ROW OFF EXISTING LOCATES OR UTILITY
> STRUCTURES.
Q
3.IT IS THE CONSTRUCTION
CONTRACTORS RESPONSIBILITY TO
N11990 CALL FOR LOCATES BEFORE
SW AERIE DR 13B°° DIGGING.
h4.EX.AERIAL-
5.EX.UNDERGROUND-
t7 mA.vr. nFIIOM.Y1t..1EWK.440LYIKW,4
?C K 13480 SW 121 OR 97223 AVE
TI COI'Y1CGSt, a "" TIGARD,OR97223
TBDlwrxaalumAa s
Contact:Ivan Chandler PO BOX 2529,Com,OR 97015 1 - - 49560
Phone:(971)-777-0908 0111.-(503)5504011&&215 COAX ENHANCEMENT
w Ivan_Chandler@cable.conIcastcom Ent.&J hn_Fwrw®mnr,rl - - CITY OF TIGARD ROW PERMIT DRAWING
FTtwl (P-001155
Page 80 2011 Edition
Should"er°>]Nork.:w/ MnorgRoad=Encroachment Dia 300
Use this detail for non-freeway work which extends into a travel lane and
maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane
can not be maintained, or when traffic can not safely pass by in both lanes
simultaneously, use the appropriate lane closure diagrams—for example,
Diagrams 310 through 350.
A lane closure may be appropriate for conditions such as high traffic
volumes, high speeds, and inadequate approach sight distance to the work
space, or heavy equipment adjacent to the travel lane.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Cones shall be placed along the entire length of the work space. If a
protection vehicle is used and work is in place one hour or less, the
taper and tangent devices may be omitted.
4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there
is limited sight distance, consider placing cones or tubular markers on
centerline.
5. An arrow board in caution mode or truck-mounted PCMS with
"SHOULDER WORK"or other appropriate message may be used for
higher visibility.
Sign Spacing and Buffer Lengths(feet)
Po�d ,;, Spacin'IBegfis, .� R, Buffer;`
AB; ;;C" ;Space;;
20 50 (ERRATA:
25 100 100 100 75 i
30 100 (Supplement Table
40 125
350 350 350 150 Updated:February 12,
'2016
45 180 By:0U0TTr4fic-Roadv`ay
50 500 500 500 210 Sect{an
55 250
Sign Spacing and Buffer lengths(feet)Supplement
P,csteci'•. -; spacjr;gBetween-'Signs,; :'8"uffee
Sp,eeci` -: ,A., >Spaee'-
60 285
Chapter 5 65 7001 700 700 325 December 2011
70 1 365
2011 Edition Page 81
Shoulder Work w1 Minor Road Encroachment �•n,
Diag 300
1/0<
ROAD
WORK Tt •
AHEAD
•
Initial
Warning A •
Sign
•
•
•
(Optional) •
•
Protection Vehicle
w/TMA(both Optional)
See Chapter 4 • Buffer
10' •
minimum • U3
•
A /ROAD
M NARROWS
(Optional)
B
ROAD
WORK
AHEAD
Initial
Warning
Sign
December 2011 Chapter 5