PFI2016-00246 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00246
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/10/2016
Parcel: SEG1586
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: Adjacent to 7409 SW Tech Center Drive. HIT/CUT cable needs to be replaced along SW Tech Center
Drive about a 290' bore will be required between pedestals 11353 and 11256. SEG 1586/ 1583
Owner: FEES
Description Date Amount
PFI Permit Fee 11/10/2016 $300.00
PHONE:
Contractor:
SONICOM
1275 S KODIAK CIRCLE
CORNELIUS, OR 97113
PHONE 503-519-3443
FAX
Applicant:
JOHN COUSINEAU
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97005
PHONE: 503-643-0371
Total $300.00
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: S6-�f ( LtKC-t 1 �.
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00246
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 twenty-four(24)hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit. Ken Fisher 503-816-6146 or Kenny @Tigard-or.gov.
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
RECEIVED
NOV 0 3 2016
City of Tigard CITY OF TIGARD
v PUBLIC WORKS—ENGINEERING PLANNING/'ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: ® Utilities ❑ Sidcwalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: HIT/CUT CABLE NEEDS TO BE REPLACED ALONG ® Minor work in right-of-way
(sidewalk repair,curb cut,street
SW TECH CENTER DR.ABOUT A 290'BORE WILL BE REQUIRED BETWEEN opening,etc.)requires:
•Application form,completed
PEDESTALS 11353 AND 11256. and signed
•Submit one(1)copy of scaled sketch
Property address/loc tion(s); 7409 SW TECH CENTER DR. of the proposed work to be done
[:� ( •Submit one(1)copy of traffic
control plan
-
OR-
Applicant's
R-
A licant's name: Frontier Communications /Cousineau ❑ Substantial project work requires
PP above items and professional
Address: 4155 SW Cedar Hills Blvd. engineered plans for:
Ci / Beaverton Zi 97005 •Street widening
City/state: p •Subdivision infrastructure
Phone:503-643-0371 Email: •Main utility line extension:
- Storm Drain,Sanitary—Tigard
- Water—Tigard Water Service
Contractors name: Sonicom Area(includes Durham,King City
CCB#: 188116 Expiration: 9/24/2017 and a portion of unincorporated
Address: 1275 S Kodiak Circle Washington County)
City/state: Cornelius Zip; 97113 DELIVER APPLICATION TO:
City of Tigard
Phone:503-710-2972 Email:mattshore ansonicom.com Plawdng/Engineerfng
13125 SW Hall Blvd.
Engineer's name: John Cousineau Tigard,OR 97223
Appficadons for"minor work in right-of-way"
Address: 4155 SW Cedar Hills Blvd, only may be emailed to:
City/state: Beaverton Zip: 97005 roupermitsQtigard-or gov
Phone: 503-643-0371 Email:_iohn.cousineautr.com
Estimated value of work(within the public right-of-way): $ 0. Case No.:
.Application submittal fee: Jr
Is work related to a LAND-USE DECISION? ❑ Yes ISI No Applica'on accepted:
If so,please specify(MLP,SDR,SUB,etc.) case#: By: t Date: �""'i"`
App licatio reviewed:
Is work related to a BUILDING PERMIT? ❑ Yes ® No By; I�. Date.
If so,please specify(BUILDING PERMIT)case#:
Applicant nodded:
By: -S Date:
1ACURPlNWadersUandUse Apdkstioos Rev07AAM14
City of Tigard - 13125 SW Hall Blvd. • Tigard,Oregon 97223 wwwtigard-or.gov • 503-718-2421 - Page 1 of 4
LCl C , I S /i
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 must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property,
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations 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
requirements for approving or denying the application.
SIG TURES of owner of the subject property required.
John Cousineau 11/03/16
A licant/Authorized 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
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part 1: Required submittal fee$300.00
Part 2: All non-water system improvements
Engineer's estimate X 5% (less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2+ Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I Ditch ---4w
Streetlight -— ----------- —r---
Rain Dry
1 � 1
' Tl�iop'oe cf S elTiie"'
I I No I1
co it I Existing House
Existing
1 I ai Drivewy
�I
Ui I 1
0!
p �j
�I rl
O�
a.
L TI-S
>
oi V L I 1
IJ Existing Shop I
Power ole I
95'
I - Property Line-
1
iI Fire Hydrant(FH)
I i I
Scale: '1"=30'
I I �
� I I
MINIMUM SKETCH REQUIREMENTS (Put"N/A" if Not Applicable):
North arrow Property lines &dimension Slope of property
Street& street name(s) Existing building, structures Utility& street light poles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water, storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 Page 4 of 4
CONSTRUCTION NOTES
SW TECH CENTER DR.
LOOKING WEST 1.PLOW IN 290'OF 2"CONDUIT
AND AKF 2-24 CABLE.THERE IS N
Row
sod AND
SIDEWALK AND GROUND IS DUG
5' 15' 15' 1
UP IN ONE PLACE ALREADY.
EOR EOP SEVERAL CABLES AND
ANNOTATIONS LEFT 2.SECTION TRANSFER SPLICE
°6", CABLE AT THE PEDS.
3e OFF FOR CLARITY
NEW CABLE
IN
CONDUIT
I I I 1
nlu
I I �I III I
7405 If
SW TECH CENTER DR II III I III
II
ABANDOND IN PLACE376' u I II (350') III Iii
AKF 200 24 II (AE 200 26) III
BBGTD DAP,301-500 ii (BBGTD DAP,301-500) iii I
7477/7409 ii GRDORXA 11352 II BBGTD DA III
SW TECH CENTER DR I TGRDORXA 11353
BGTD 1002 I
----
--------------- ----
------___ _ � _ SW TECH CENTER DR. _ __J -�
r �i
BORE NVPARALLEL \\
WITH STREET IN R/W
PTH
7500/7550 SW TECH CENTER DR 7298 SW TECH CENTER DR \ fion pr"
un tions
TGRD-DAMD-HIT CABLE
7409 SW TECH CENTER DR.
PROJECT C.O.AREA TIG RD
MTWNSHP: .N
EXCH.CODE:
COUSINEAU :WASH
FILE:
RICT: DWG OF
SEC:
Frontier DRAWN BY: PLEASE SCHEDULE WITH DISPATCH K&D as the preparer of this traffic control plan makes no
503-723-7287 72 HOURS IN ADVANCE representation as to its general adequacy or being approNo
CONTACT:John Cousineau ALAN WARD AND PROVIDE A COPY OF THE APPROVED
971-708-2412 TCS# TRAFFIC CONTROL PLAN for implementation.Approval must result from the Traffic
Place No Parking signs Engineer or other public official having statutory enforcer
LOCATION:7354 WA 010434 48 hours before work begins authority in the jurisdiction. Utilization and implementatio
SW Tech Center Dr OR 05377 Notify FirelEMS,EPD and LTD of this plan shall be as a result of that approval.
Tigard_OR 48 hrs before beginning work Ref.MUTCD 2009 6A-01(10).
DATE: JOB#51351-5205494
11/9116 Lane Posted Merge Shift Flagger Shoulder Buffer Sign one
Width Speed Taper Taper Taper Taper Space Spacing Spacing
BILLING MANAGER:
Taper 30
12 30 180 90 60-100 50 100 100 Tangent 30/60
d;
Q
Legend ,15
N
Work Area
Cones N
T flagger
J6 Sign Stand + +
road work ahead
4> be prepared to stop -�
Flagger Ahead
Manifest
30 x Cones
2 x flagger
2 x road work ahead
2 x be prepared to stop
ROAD
2 x Flagger Ahead � 0 •. ,
it
WORK /
- - - - •- W20r1■-1 7a C
AREA j,
- CW26-1
•• •••••••••••
,SV3 Tech Center Dr
4CW11BE
-7b
W2O-7a
CW20-1