PFI2017-00271 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00271
13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 12/05/2017
Parcel: SEG2824
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: Fiber splice at SW Hazel Fern and SW Bridgeport Rd
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE
FAX:
Applicant:
RUSS WELLS
4155 SW CEDAR HILLS BLVD.
BEAVERTON, OR 97005
PHONE: 503-643-1001
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 1 L
Signature: 9t 4n�I1��T1�%�
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00271
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_UtiRies 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_UtTties 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_UtiRies 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.
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
RgCE1VF7D
FIII)finF2L Lr4u#Luj1a77dAj4s 1i11JL 0n
City ofg'Tigard Y!d 5_02711 NOV 30 2017
13UBLIC WORKS ---ENGINEERING CITY OF TIGARD
FLANNING:3''NGINEERING
� r
Public FA acifiIm ro-rement (PFI) Permit
tY �
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) [I TYPE 1—Franchise Utiliry Work
Check one:xCScr1Vt1o11:
Utilities ❑Sidewalk/driveway approach ❑Streetim rovements perforated by NWN, PGE
l,:I r� �1'LILL' and/or utilityagency.
Detailed
�� j� .,� � �� ❑ TYPE 2—tiidewalk/Dri��ewa}'/ Ver
��"� _ Vir'ork performed for the purpose of:
• Sidewalk installation or repair.
r� / - Driveway approach installation
Property address/locatio : 7495 5 .�YVV/ ! i and/or repair
P3lami-�ffifLT iff— Aiw N11/0, �faE - ti sewer 1 ral installation
Sanitary ate ton
1 : and/or main line tap
Applicant: L.L.tuMAJ)CA TIM S 1 TYPE 3—Dull scale Development
\Work performed with land use
Address: �� 5,�V 4EJAZ- WILaS JRLUn approval which includes any of
City/state: KEAV� DIL 'Lip: 97Mthe following:
Phone:4-DT ,, ;mail: Y 5 �'�' (,� - Subdivisions or Partitions
Contact name: W-9; 14HIS Pltone: 00:5 2047 11 Street widening
• Mainline installation for Sanitary
Contractor: sewer,Storm sewer,Tigard water
and/or Tigard Water SerVice Area
CCR#: I aspiration:
Address: SUBMIT COMPLETED APPLICA'T'ION To:
City/state: Lip: City of Tigard
Planning/Engineering
Phone: I.t»atl: ---- 13123 SW Hall Bbd.
Contact name. Plione: Tigard,OR 97223
/lpplicatirnls for"mincer work in right-of way"
I algltlecr: T— only mat•be eimiled to:
rowpermits&_tigard-or.gov
Address:
FOR STAFF USE ONL)
City/state: Zip:
Phone: I?tnail: Case No.: _U3�:—
Contact name: application submittal fee(.077°;%of
Engineer's Esdinate) +
Estimated value of work is required(if over$5,000):$ additional fees:$
(witlihi the public right-of-way) .application accepted:
By: Date:
Is work related to a I..AND-USI?DECISION? ❑ Yes 0
If so,please specify (NILP,SDR,SUB,etc.) case#: :application retiliewed:
Bv: Date' t
Is work related to a BUILDING PI;RN•IIT? ❑ 1'es No applicant notified: I Z e�
If so, Tease specify 3tTII.DIN(;PI?RMl' case#: By: L Date: JJ-
1 r . � �
1\EfNG�PennitAppkaI"s\pti__application Efteet*e 10/16/2017
City of Tigard - 13125 SW 11all Blvd. 'Tigard,Oregon 97223 xvwwtigard-or.gov • 503-718-2421 - Page I of 4
APPLICANTS
NOTE: Person specified as".Applicant"shall be designated"Permittee"and shall provide financial assurance for Nvork,if
required by the city pursuant to'1 NIC 15.011.140.
` With the exception of a utility operating pursuant to a valid franchise with the City of'l c ard,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)+rust sYni this appfic ition iu the space provided or submit a written authorization with this application. franchised
Utilities are not required to obtain the owners si};nanire on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
12LO12er-ty-
• 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 any plot plan,ittachments,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.
• 'I1ie applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
iZUSS 1C-Z�-17
A p an /sAutlnorized Agetit's signature Print name Date
SIGNATURES of each owner of the subject property,if required.
Owner's signature 11rlllt IM111C Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 ti\\'11all B1vd. • 'figard,Oregon 97223 • %,o.%,N-.t1g1,rd-or.g0 v 703-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water systenh improvements (work in rhe ri.;ht of xvay)
Engineer's estimate X 5%(less$300.00 submittal fee)
Engineer's estimate X 2%flan Review Sketeb
(including infc)rmation below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system improvements ❑ Street Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fcc charged,or assurance requited
(Subdivisicros/I'artitinns and Street lmprovcments)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that dos not involve regrading. (G sets,24x36 or 22r.3 )
e
• NXIcep hole repair ❑ Cover—Site,NTicinity,Abbreviation,Legend
• Curb repaix or replacement(less than 20 uncal feet) ❑ General Notes(City,Warer,Sewer,etc)
• Lawn sprinkler system installation or repair ❑ Street(Plan,,Profile)
• Street tree pruning or placating D Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• 'Test wells ❑ Grading
❑ IAndscaping/'free Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note. A casb assurance may be required per Storm,Sanitary,Xtr.trer,Signage,Street i tights,etc)
TNTC 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,dates and sheet numbers)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Dr.unage Calculadons
❑ Geotechnical Report
❑ Prclinunary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ V later Department Approval
❑ Engineer's Construction Fstimatc
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW l-Tall Bhvd. • 'i'igard,0rcgot197223 • wwur.tigird-or.gov • 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
I 9
Edge of Pavement
I
I -*— Ditch
`_}treetlight I •—.—.—•-----•---`r---
• P_#,Ji,tr&jn
r
T-763-15—' d•• g;RerTin"
� I
I � Existir-,g House
�r I Existing
r, >: Driveway 1
5' I
CI R ,may•
O I •` �.l J
NI I
p
� �-- mss$ •
a
r
■ I Existing Shop
C" ,3 1
� J
1
Powerpole I I I 1
1. o • e
------- -7- ----------
�ra�erh�+Line
Ii Fire H'yrdrant(FH)
1
I I I
Scale: 'I'=�0'
� I I
I I
I ' I
1 I I
I 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 "frees
Existing S/W or of pavement Existing;utility locations
D/W apron (sewer,water,storm)
PUBLIC I:ACILITY IMPROVEMENT PERMIT
Cityof Tigard - 13125 SV-'I Tall Blvd. - TWIard,thegozi 0722; - «,,An%:tigard-orgOv - 503-7718-2421 - Page 4 of 4
Page 118 2011 Edition
Late'rlos:ut's at lntersection:wllth Fagging Diagram:.SO
Diagram 020 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging,traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance(see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. There should be one flagger for each approach. One flagger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections(fewer than 400
entering vehicles per day), one flagger may be used.
4. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should
be considered on high volume or high speed roads, or when extended
queues may be expected.
Sign Spacing and Buffer Lengths(feet)
Pbtd : 5 loin Between Si ns
Sped B
20 50
25 100 100 100 75
30 100
45 350 350 350 25
150
45 180
50 500 500 500 1 210
55 1 1 25071
Chapter 5 December 2011
2011 Edition Page 119
Lane Closure at Intersection with Flagging Diagram 620
ROAD
WORK
AWEAD
( R� - --
1 t
AW-AO
B�
PREPARED TO STOP
B
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_ LANE
ROAD
• BE
10011.Max. PREPARE ROAD
•
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•
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K K ( M �71IPo�lI1B T - - - 0 1 r
100&Max 3 I I A
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December 2011 Chapter 5
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TOTAL ALLOTTED HOURS
CONTACT 3 ERYI80R IF ADDRIONAL
�j HOURS ARE REQUIRED TO CONFIFTE PROJECT.
CAP. X-TIME MAINT.
CONSTRUCTION NOTE �,L CREW 1 0 0 1 0
Q SPLICING 1 0 0 1 0
1-THIS WO IS SERVICE ORDER DRIVEN-ASR2913823 9L� ND DR-VER
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7493 SW BRIDGEPORT RD ONS^RUCTION START
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CONSTRUCTION COM?LETE
2-CITY OF TIGARD &WASHINGTON COUNTY
PERMIT REQUIRED TO ENTER MH15/65 .�Qp �� OCUTS YES REQUIRED(NODCONSTRUCTION
3-FLAGGING REQUIRED QOM X00
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®NO JPN REQUIRED
CONSTRUCTION CONTACTS ****RIVERGROVE RSU OWNER TO ROM
DAVID CARNLEY-503-269-2608 [I Cl ❑ POWER
JAMES STAATS-503-758-3119 NORTH ❑ C] ❑ FRONTIER
El [I [I
SCHEDULING CONTACT POINT OF CONTACT
ELS
RYAN ROBERTS-503-643-3713 8503--643-I
VICINITY MAP D01
ING RYAN
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FACILITIES CONTACT SPHONEJNO.5 3-643-383RTS
MICHELE CRISMAN 503-643-0180 ENGINEER RUSH WELLS
PHONE N0,50343-1001
TECH
PHONE NO.
INSPECTION CONTACT I FIELDED B`-RUSS-WELLS
RON SITTON 503-871-8065
ENGINEERING CONTACT Orifi er-
RUSS WELLS 503-312-7330
Communications
BLANKET WORK ORDER 51351-5208154 TGRD-ASR2913823-FIBER SPLICE
7493 SW BRIDGEPORT RD
51351-WO582711 PROJECT C.O.AREA
NUMBER:W0582711 EXCH.CODE:51351
DRAWN DATE: ENGR: RUSS WELL NTY:WASH
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USSWELLwASH
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' z D
G UGMK 9-26 N 4 L
3R1:2101 -2700+1801-1900+20ODD
K 6L21 MF58
Os NORTH
H SLM 2100 26 PE 701 AIR PPEJ MH42 69+70
XD,1-175+
612TH 546-0121784
BBRIV 3R1,176-200+ - G-
XD,201-275+ I H— J2S1W13D
BBRIV 3R1,276-300+ BRIDGEPORT & HAZELFERN
XD,301-400+ O REV JAM 07/24/08
BBRIV 3R1,401-1000+ TO MH 43
XD,1001-1300+
XD,1301-1500+
VH 42
BBRIV 3R1,1501-1650+
XD,1651-1700+
BBRIV 3R1,1701-1800+ -nb e! F
X0,1801-1900+900+
XD,1901-2000+ 1473 12.2014
BBRIV 3R1,2001-2100 ******* 24-FIBER 24
cations
TGRDORXA FC2040,361-364+ TGRD-ASR2913823-FIBER SPLICE
1 XD,5-24 7493 SW BRIDGEPORT RD
6422.020 PROJECT C.O.AREA
NuM9ER WO582711 EXCH.CODE:51351
2 51351-W0582I 11
DRAWN DATE: ENGR RUBS WELLSICNTY.WASH
11129/17 PHONE: 503.312-7330 FILE:
SCALE:1-100 TAX DISTRICT: DWG 4 OF 4
TWNSHP: RNG: SEC: