PFI2017-00249 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00249
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/12/2017
Parcel: SEG3011
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier
Project Description: Bore in 1.25 inch conduit and fiber about 40 feet across SW Fonner St at a depth of about 36 inches
path from pole 30886 to property line between 10700 and 10720 SW Fonner St.
Owner: FEES
Description Date Amount
PFI Permit Fee 12/12/2017 $300.00
PHONE:
Contractor:
SONICOM
1275 S KODIAK CIRCLE
CORNELIUS, OR 97113
PHONE: 503-519-3443
FAX
Applicant:
JOHN COSINEAU
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: It LH
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00249
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. call Jonny Gish @ 971-713-0281 or Jonny@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
I ED
RECE"V
Nov o G M7
City of Tigard CIV OF-T,(--
PUBLIC WORDS --ENGINEERING
P
Public Facility Imrovement (PFI} Permit
p
....- .... .•..'�K.S3:C+�C�'4'C'K'.'�t�w'!;'�!'�tx}'a't�.,'. C�'�°t!! ;`ik'!°"..%"'rMh`r`.rS?4!'J!'!"!rlStKK.�?!W '� '.... .�.e r w. •t .. x
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1-I-r.anclzisc:Cfitilitr%X"urk
Check otic: ® Utilities ❑Sidex,,alk/dri<<e vay approach ❑Street improvements perfurnicd by NWN, PGL'
Dctailyd description:TO BORE IN 1.25"CONDUIT AND FIBER ABOUT 40'ACROSS and/or utility agency.
SW FONNER ST.AT DEPTH OF ABOUT 36"PATH FROM POLE 30886 TO PROPERTY ❑ TYPE 2-Sidew-adk/Driveway/Seticer
1Xfork performed for the purpose of
LINE BETWEEN 10700 AND 10720 SW FONNER ST. - Sidcw:alk installation or repair..
Propernc address/loeatian(s)- 10700 SW FONNER ST. • Drive«-ay approach installation s And/or repair
�
S • Sanitary sewer lateral installation
and/or main line tap
FRONTIER COMMUNICATIONSMOHN COUSINEAU ElTFPE 3-Full scale Development
Applicant: % ork performed with Land use
Address: 4155 SW CEDAR HILLS BLVD approval which includes:u,y of
City/state: BEAVERTON Zip: 97005 the following.
Phone: 503-643-0371 Email: lahn.cousineau@ftr.com - Subdivisions or Partitions
JOHN COUSINEAU S03-643 0371 - Street wideni ng
t'Ontact name: 1 hone.
- Mainline installation for Sanitan'
Contractor:
SONICOM sew-cr.,Storm sewer,Tigard water
and/or Tigard%X,ater_Service Arca
CCB#: 188116 Expiration: 09/24/17
Address: 1275 S Kodiak Circle SUBMITCOMPLE'1'EDAPPLICATION TO:
City state: CORNELIUS/OR. Zip: 97113 City of Tigard
Phone:503-519-3445 rmail:Plfetlows@sonlcamoorP.com 1'l(ru7,rtiglErrgrxec'ri>,g
13125 SW Hall Blvd.
Contact trams: PJ FELLOWS Phone: 503-992-7711 Tigard,OR 97223
Applica6o ns fi)r"miner workill ri�ght-cit-WRV!'
l�ngincer:JOHN COUSINEAU only magi be email, tt,:
raM32crmits anigard-or.gov
Address: 4155 SW CEDAR HILLS BLVD. FOR S*I'AFF USE ONL'Y
City/state. BEAVERTON/OR. 7ip: 97005 to
Phone: 503-643-0371 Email:jotan.cvusineau@ftr.com Case No.:
Contact name: JOHN COUSINEAU application submittal fee: 360,d
Additional fees: - -
Estimated-value of work is rcquited(if over$5,000):$ 3,000 Apphcation :
pted
:accer S
��. �
(within the public 1'I��Xt--(J�'-t�'i11'} 1�1. Date., 7
Is work rc]ated to a LAND-USE DECISION? ❑ Yeq ® Application revitu�t:d:No Z6.2 B4: Date.:
If so,please specific (NIT-P,SDR,SUB,etc.) case#:
Applicant notified-
Is work related to a BUILDING PrRiMIT? ❑ )'es El No By: Date:
If so,please specific(BUILDING PI.RMI'r)case#: 1!\ENGlPemdtApp4wtiortApfi-application 1W.12AGAors
-_ � � � � r.
City of Tigard • 131,25 SW Hall Blvd. • Tigard,Oregon 97223 - %,,�«�:tigard-or.gov - 503-718-2421 • Page 1 of,4
APPLICANTS
NOTE: Person specified as`Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the citta pursuant to'1 11C 15).041.140.
" With the exception sof a c►tilih.nperatinL pursuant to a valid tranchise with the Cin-of'I igard,when the►mncr and the applicant are different
people,rite applicant must lac the purchaser of record or a kw cc in px►sm--<siun with written autboi iiat.ion from the owner or an agent of the
owncr. "11te owner(s)must sigm this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not rc;quired to obtain the owne'ti signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request dues not violate anv recorded deed restrictions that may be attached to or imposed upon rlae subject
• if the application is granted,the applicant will exercise the rightsgranted in accordance with the terms and subject to all the
conditions and limitations of the approval.
•
All of the above statemetus and the statements in any plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge thatany permit issued,based on this application,may be revoked if it is found that ant-such
statements arc false.
• '1he applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements For approving or delayIng the application.
JOHN COUSINEAU 11106/17
A )licant/Authorized Agent's signature Print game Date
SIGNATURES of each oN%mer of the subject property,if required.
Owner's signature Print name Date
Owner's sigiiature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 Sal;'l[all 13l d. • Tigard.Oregon 9 223 • ww wtigard-or.gov 503-7119-2421 • Mage 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED
SUBMITTAL
REQUIREMENTS
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 S1'SCetll ftril7r(J�etllCntS (work in d.:ic right of way)
Engineer's estimate X 5`i11-(less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: ,ill public water nsten7 improvements ❑ ,Street Name
Engineer's�stimate X 12°'o
❑ ,Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
'T'here will be no permit fee:chaiged,or assurance required
far the following types o£work: (5ubdiv':signs/I'arriticrns and Street iiYtprov��mcntti)
• Sidcxvalk repair{less than 20 lineal feet}
• Relocate of replace mailbox Design.Plans
• Ditch cleaning that does not in-vole regrading. (G sets,2406 or 2x34)
• Weep hole:repair ❑ Cover—Site,N-icinity,Abbreviation,Legend
• CLirb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,W'ster,Server,etc)
• Lawn sprinkler system insuilladon or repair ❑ Street(Min,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 casb assurance may he required per Storm,Sanitary,\Vater,Signage,5treer Lights,etc)
TMC 15.04.140.(customer deposit) EJ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ F,ngincers scull/signature
❑ Sheet label(project land use Ikune,revision and
plan log block,dates and sheet numbers.)
Additional Submirtals
(per Land Use conditions)
❑ 'Traffic Report
❑ Storm Nvater Drainage Calculations
❑ Geotechnical Report
❑ Preliminary,Access Report(Sight Distance)
❑ Proposed Platt
❑ Pathway Design(if applicable)
❑ Water Department Approval
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW I-lall Blvd. • 'ligard,nregon 07223 • ww tigard-orgov -503-7718-2421 • Page3 of 4
SAMPLE SKETCH:
Edge of P aventent
1
Ditch
Streetlight -*-•--wpm----- --- -----r---
Rain Drain
Ka�ef:Rer_'t�
n
1 i �►
( 1 '
T`rMpos chS'ewet"'Cine
Existing
,.
>1 Driveway
a( 1 vi 1 I
O 1
� I
=1 1
o
lrxisting Shop
( -
Powerpole 1 1
-77i,p rtp Lin e
( Fire Hydrant(FH)
( 1
1 Scale: 1"=30'
( 1 �
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MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow Property lines&dimension Slope of property
Street &street natne(s) Existing building,structures Utility&street light pales
Proposed work Existing curb or edge 'frees
Existing S/W or of pavement Existing Utility Ideations
D/`tl apron (sewer,xvater,storm)
R7S93'.a:NF%1X+4:i.".!'-':kX�t�!:'r;�-"�$�1.Xi2�`:�lY..L".`,-4`7X,"L`�! �'tG1±!�••e3�4'R',,.`S'+-�fC_T•+}J2Y1M..�JiY.tk+ET7."CJ�'•3A4'G'E�+!*S^..t:.S,Y.^.2!?.�"^^�!tNSNR!f;f'�:N�itiSCXit,�J'M:RL�Fr!Y7!!�X';�M!�!!f!LW.':C.rt!'!!1�2tY.M;?45�'17NV1+7"td..+yff!n!?S/#:..'.EDtC�✓.f�
PUBLIC FACILITY IMPROVEMENT PERMIT
Cit} of Tigard • 13125 Std'11,A tiled. - 'Tigard,nregm 97223 - wmxv.tigard-or.gO v - 503-718-2421 • Page 4 of 4
N
BSW Commit Date: 2017-1I-06
Cust TN: 5035981030/0
i �
Cust Name: ABIGAIL REEKIE
Addr: 10700 SW FONNER ST, PORTLAND, OR
County/Twp: /0009-7223 / ` 5--�,k, �- -t y,;o.
CBR: 5038582321
CO- BBFTP
Commit Date: 2017-11-07
O/T: Order �I
C/F: Fiber
Drop Tyo: Buried ��"
Temp: No
Drilled Entrance:No � �(,>���.._
10720
Drop Length.
Cross St: U)
Appr Drop Rte.-
Hub:
te:Hub: BBFTP/H4008 O R/W
Strand:
Port.- 248 ry SW FO N N E R ST. 40'
Serv. Term: BBFTP/FT-45824 PORT: 248 w PJW
Drop Term: 10705 SW FONNER ST PRT,OR 3: TERMINAL 45824
Notes: INSTALL DATE 11/07/17 13:00 17:00 C/) POLE 30886
JOB COMPLETE DETAILS
DATE: r I NAME: P TICKET: EXCH:
P59P DW BORE: LS BORE: SW BORE:
P50A DIRECT BURY:
P43D PULL:
P77C CORE DRILL: Y N QUANTITY: 1 2 3 4 5
P16C GROUND ROD: Y N QUANTITY: 1 2 3 4 5
P71A TRIP CHARGE NOTES: 'Ah h[, I t �'j /�„ f�:/ ext,C SS
- Y N
P 36A V
L10A
P22K S 1we&7
P-3 68 - —- ---- --- - -- /�'� !13
PO L- r� 13 a� A cllb
Page 118 2011 Edition
Lane::C asur� a lntersectiolr�;W.1th"ir a ging Diagram 620:
Diagram 620 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)
'�4�xed S acin BetwWo, 5i ns (duffer
Sppcd A e � C Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
L50 500 500 500 210
k55 250
Chapter 5 December 2011
FRO)UPOL TRAFFIC_ a u TF L_ FAA J
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2011 Edition Page 119
Lane Closure at Intersection with Fly
. 20
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WORK PREPARED •
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LANE TO STOP • 100 It Max.
ROAD •
AHEAD j I JA
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