PFI2018-00124 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00124
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/04/2018
Parcel: SEG1677
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: SEG 1677, associated with 10580 SW McDonald. Placing aerial fiber I span-200'attaching to poles on
SW 105th Avenue.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RUSSELL WELLS
4155 SW CEDAR HILLS BLVD
BEAVERTON, OR 97005
PHONE: 503-645-1001
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
Signature:
F,
Issued By: "L�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00124
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 KEN FISHER AT 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
rMIJARIC11— WWWAII(�AIIIJAJ I RECEIVED
City 57+DTigards!_W22 1727 MAY 2 4 2018
f
I'U.131_,1 C \\/0 lZ ISS .___ 1 .\�C^;l\�l JI-:lZ.1\(: CITYO
PIANNING1EN11Qjj,�1FHc1-,ING
-W�
Pubhc Facility Impravrement �I'I•��'I) Perlmit
�� _-..`..... �t.�`-..".rY`.�.t�?.'Y��:fAz.�s`S.f.h.K':.5....>:.ntv.�ch.,.r;aSY"t•..Y..fr'.,';Y,:ti•1ti�'hvt�'ltix:l�;,.3*.^R'z?Y�',...,..:iEki. e+.T..�"..rr!..W.,t`�-.'Ta4.... :,�...�-...«wcF.rf q�Y.^. ..x+'�.ry5. ..9,_[s �T�.u'f�is� iRSL.�..:+.... .a..i^us.k'Y..w'.E.^5�4..-".'.. .F'1.ailfi�.�^l.i�_:�:
TYPE OF WORK
DESCRIPTION OF WORK(in the right-cif-way)
[�• '1'x'1'1? 1 — I'ranchisc l.'tility\\`ctrl:
(!heel:one: l tilitics ❑Sidewalk/di- apprn;lch ❑ sLreetinlltru�enunt� perlornled by NWN, PC�J.:
4criptloAMAL +� //(L f And/or uhilly;IQT111:`r'.
Dmilled d:: n: LMb!� �.
5 —WO/ �// Ir D Ph 4 �..� �1 1 hl';2— icic:wa3.h%[�ll��c�u;lti-;Sc�e�s:l,
M5-TI4 f4� \\%cork perf'Ormed far the:l:tttrpc,se 0I.
• Sidew-11 c ills ta11;11]OIt or rcp:lir.
J : � • Dri��c��-a5-;tl�l�r(t;u:}t irl�tallation
1)ropert�- �tdt'lre:ti ,llc)c:at'ic_)r1(;}: ;Incl/or rcltitir
J cjG • Sartilar)'sei:cr}alter:!! insla11;lt'011
;(ltd/m.maul line: tah
�/��j,�`� � � EJ '1 1'I�1';3—full :c;tic 1)c��-el�lpa�cnt
-lpplic,ulT: �tA i[.�L..- j� \�.od� aerformcd with L.,11-Id
� use
ddrl-;ss: 8 -5 Ul J l :tpptoval which include:~amv o
Zip: �+f I:he}c>llrnc-ini:
�/ -� � t 5ulxlivisions r)r 1'artitic,cts
Pllolle:
(�(jtlt'ill t:11'r1I71t: i l'll()11(.:
• NhInlinc himallation for Salrui:irV
seiner, Sloral sewer,
Colltractor: .I'.i ald i:ltcr
:trld/or•Ci;,lrcl.\\�':.itc'r Service Arca
0_113#:
.fl.cichess: 5l_;13hf:I"['C:(�l`Il'J.,l 1'L:la Al'1'JJCA1'.l)3' 1''0:
C;it\/state _,Ih: Cit, of Tigard
1'1cri*n 1zg1r?gi ueerbtg
131.25 SW Hall Blvd.
('ollr<la 11;1n1t:': "hol-le: Tigard,OR 97223
Applic:riliolls{;-,rW(.,tl itl rii`Ilt<s1 tit<ii,
oldv alae;.e•rm.aIlkd ic):
Address.
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P11one: 1":tl7,lil: Case No.: �41 W Z I
�"ontact 11an1c: Application suhmitial fee{.(17;4,of
. f_u�>ti.ncc�r s f''.sti retic.)
Istillim-ed N-,Ilt.te(ll vt-ork is recjuire;d (if OV(21 75,1)00):S 'Additional ices:
(wit-11111 Tile public right-c)f-wa\'1 ?\1�}�l calilon acGc°latcd:
5114
r8
is \vork\ o1-krelated to a LAND 1:St-: D[1: _11`1'0_? ❑ Yes o
Application reviewed:
It so, plels� spcc:it-� {1'[!.11 SDJl , SUB, etc.) clisc� �®
Is v ork refire cl ol-) rt BUJ I.DI NG I)F�sR 1I1] [...1 Yes `N, 411 OU
\ppl.ic,tlti tlol:it:lcd:
It so,pk':,tse specie\. (1:;UIL.DlN ; PL1101I'll)c;tsc:4: [3\: Date:
l;\EtiG\PcrmltApptications\pfi-application Effie-tive10/161'2017
..„�.... .,..,. .....,_,. .rh i ^� �s .., :i.t?«:F:�^v::.? r.h..a.Y.£" my.'+Eur ac'F�rF:+r:'v?Y4§'S•'tr'`k;5x,4e str•.ar: #.?s'3F;?4�N-..,.w
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City of Tigard ° 1312.5 S\\`J-tall 1.31t-c1. I']v;IIcl,(..�rct,oIi X1722tirn-w 6v:iI-(]-c)I-.s:o 503-71,`i-2-121 Page 1 of 4
APPLICANTS
Nam Persf:rn sperihed a.,",Applic mil"shall be desigmatcd 'Tcriilirwe" mid shall provide financial asstirailcc, For Nvm�kif'
required by the cit)-pursuant to FN4(-:
:Ipplicirlt IIIcISI he dii.pur.c.111:1sc-1-i'd,rtck-.rd tc'r f,,irsn!e in wilh V,-rilic-ri ilii'o'xj)":( -;I-nn
Thc uwjlc-r�s) mtlsl sift i1115 ipplicAt i in the spwc pnwkkd ur WAS m w6um mmhorkiiir,n lhis
Uuhues j(V 1101!'Cti1.6[vJ ovvilet's sig-w-11k,m.(m ill'!
BY SIGNING BELOW THE A.PPLICNNT(S) SFIJVLL CERTIn"THAT:
• 111cabove I-CL.111cst clocs.not Nriolatcaiiv recorded clecd restrictions that may beattachal to or iqlposcd 11poi) dic"'tihica
if the apl- licarkmi ;p-anted, the qq.01cmir%vT exercise the rights ganted in accordance\011 the 1,ccills and sub,cut tri all tile.
conditions and limitations of the approval.
Ail of die above srativincrus and the shiturnmits i.n aig plot plan,amichinents, mid exhiiijits transnAtted hei-cmd,are uric::mid
the applicants ',(-)acknow-Uge t1mc ajiv permit issued, [)ascd oil this application, mav be revoked Jit is found that any stich
statements are fidsc,,
The apphcant has read Me entire cc namts of the application,Including die pAciesand ciltciia.,m)d tindcrstands the
i-ccitilren-mits for aj)j)covM,,,;oi-denying the application.
/Za JJaL
AppK*aTtr) Print nailer Date
SIGNATURES of each owner of the subject property, if required.
(-.)Wi1cA*1 S signat-1-1tv 1*16111. nall-le Datc
0\vIler's sib nah.ljv PI-inf.I-lame Date
(Ame"s signature Print.nallic Data
PUBLIC FACILITY IMPROATMENT PERMIT
City of Tigard - 13125 S\V Hall Blvd. - TignA(Agni 07223 503-718-2.421 - Page 2 of
DEVELOPMENT ENGINEERING PEES
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
Pari l: Required submittal.fee$300.00
FRANCHISE UTILITY AND SIDENNALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC,
Part 2: All non-water system improvements ([vorlc 111 the rlght.OC way)
n�,inecr's estirrlate-X-5'-•a(less$300.00 subtnitttl fee)
17-'1 *ncer's estimate X 2% Plan 1Zeview Sketch
(including in formation below)
WATER SYSTEM FEE
❑ Dimensions
Part 3: All public water system imp rovemell t.s ❑ Strect Mame
I�t�gilleer's estiimte X "12°u ❑ Site address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no pemiit fee charged,or Assurance required
for the following h-pes of work: {Subdivisions/1':trtitio.ns ail(l Street lmprovements)
• Sidewalk repair(less than 20 litical feet)
Design Plats
• Relocate or replace miulbo::
(G sets,2406 or,21;.04)
• Ditch cleaning that does not involve regrading.
• Weep hole repair ❑ Cover—Site,�7icini.(y,Abbreviation,T.,egend.
• CLlrb repair or replaccinctlt(less than 20 lineal feet) ❑ General Notes(Cite,Water,Sewer,etc.)
• Lawn sprinkler systen-i tnt0atl0I1 Of rCp'<tIr ❑ Street(Ilan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading;
❑ Landscapingf`free Plan
❑ Composite Utility Plan(l lec€xical,Pbone,Gas,
Note: A cQs11 assurance�rirxy be requiredper
Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(ctcstamer,depasit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street 1.fight Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use naine,revision and
plan log block:,dates and sheet.nitnibers)
Additional Sub)nittals
(per I,and Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary recess Report(Sight Distance)
❑ proposed Plat
❑ Pall-away Design(if applicable)
❑ Wder Department Approval
❑ Ltzgilieer's Construction Estimate
w�„""M..�T-J.a��.__.. ..:..;c.._,..;r.......--:r ,:r;aA�".�'.F..?�?5.�..'F*?.'"S»":^..'Fc:..�,:� �3'FwTe."-.��.:e_n-•"..�>' 9:+a-�-.'�"..✓..t�1_-:'..oc�:ax�..._..._.._ . ::=:..e...,.-:.fin; ?i!'SL!�.;1"nzs+rnlra.'„'s'".?.Fx?u�:'S*Zr'Si.S:rte`","-�'r";::FR7
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 • 1vwn-Algard-ongrov 503-71.8-2121 Page 3 of 4
SAMPLE SKETCH: .92_-
Edge of P;nreiuent.
p P-
-A*— Ditch
Streetliqht I :i�, -w III—-— a—-..v
T 'M'or)—0 S— r5 owe i�-rl�lj;I
N
:> Existing.House
E,.,.1--.ti n g
>I E)riveway
Em I
LL
-71
hL
IL
U4
0
IN
Powerpole
95
-—-—-—-T17 c�p TF�L 75 e-------_---
Fire Hydrant(FH)
ka I e 'I"=30'
A
MINIMUM SKETCH REQUIREMENTS (Put"WA") if Not Al)l)lic,,-tb.le):
North :trro\v Propel-l-v lilies & C1111-1c l-l"Mil Slope or
strecl- & st-lvcl. liall-le IS 'Xis &
ting building, structurcs
1-(-.)Pos(.'C,i Work F'X11,1-11-Ig CL-11-1.) 01-
F X,S 6 1-1 S
Of 1-11-111tv
DAV
PUBLIC FACILITY IMPROVEMENT PERTMIT
City of Tigard 1112.5" S\\,-* I hill Blvd. - Tigiml, 97,2223 503-718-2421 Page of'4
F
MILD n IZDBL
Lt 7-V 6 F WORD
Page 84
'777A)-F)(' _ TOL RAM-1 2011 Edition
Sativrtary Lanelosue vvth-Flagging; Diagram 320
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT) with good
sight distance as discussed below.
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. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater, when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing(see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the"Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. 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 are expected.
Chapter 5 December 2011
%-A
o
CD
0
3 Single Flage,,0,e Operation Cr Low to u m
for es m
N f Optional) '
LimCL
AMD
(ADT<400)
BE 0
ONE LANE
A a 9 C PREPARED
TO STOP ROAD
o 0 8
CL AHEAD
0 0 -1 4-
ROAD
IC .0
cn M I WORK
01 AHEAD
Mw
C) CD �,! —
PlOtICUM VON* .0
L I BE WfT=op"
FCJD I LA
Em
B
------------------------
I mile
n.
4max.
Q
S.
FIB
-1-B -L B
Buffer
Protection Vehicle
ROAD • W/TMA(both Optional)
WORK See Chapter 4
Tt
AHEAD
BE Q.
ONE LANE
PREPARED
0 ROAD
TO STOP Two Flagger Operation
AMH EA
CD 10
(Optional)
co
Crl
vz
t
ZtN
g
Q3
STATE FARM INSURANCE
MICHAEL NELSON
10580 SW MCDONALD ST
SUITE 103 / TO C.O.
TO SW PACIFIC HWY
! fr
BLDG TERM W/0 JMPER 50 2421.101
BBGTD 7530 SW MCDONALD STREET
BBGTD 14,2301-2350
200 05.2018
-� BFO(l) (3)
156, uJ TGRDORXA H5018,305
AE 100 24 ,�y
BBGTD 14,2301-2400
W
� Q
SHEET 2 OF
7g ` 500 05.2018
NORTH
FTTP° PIGTAIL 50OFT 6
r
TGRDORXA 1-15018,300-305
TGRDORXA FC2042 721-726+ U)
XD, 191-374+TGRDORXA ,FC2042 ,727-734 IN
H5018 11-432 CUT
70 04.2015
100 04.2015 RBN 24 360102
RBN 432
TGRDORXA FC2042,721�-744 TGRDORXA H5018,300--305
TGRDORXA H5018,1 -417+
TGRDORXA H5018,418-420+
XD,421-429+ `
TGRDORXA FC2042,742-744
Communi ations
51354-522397670 TGRDIASR3022784-STATE FARM
51351-WO641397 10580 SW MCDONALD ST
PROJECT C.O.ARE--
NUMBER W 64139Z 1EXCH.CODE:
DRAWN DATE: ENGR: RUSS WELL NTY-' WASH
PHONE: FILE:
SCALE: TAX DISTRICT: DWG 2Ot~
TWNSHP: RNG: SEC:
I CERTIFY THAT THE WORK I COMPLETED ON THIS WORK ORDER AND AS-BUILT IS
IN COMPLIANCE WITH FRONTIER QUALITY STANDARDS AS IAEMSFMDON THE
CONSTRUCTION NOTE IPOIPCHECKLIST.
S41,
4%R {SIGNATURE AND
1-WORK ORDER-SERVICE ORDER DRIVEN Nh,�
*****ASR3022784***** �S�- TOTAL ALLOTTED HOURS
STATE FARM INSURANCE-MICHAEL NELSON COHRERE SUPERVISOR
HOURS ARE REQUIRED TO COMPLETE PROJECT.
/•. CAP. X-TIME MAINT.
co CREW 0 0 0
2-CITY / TIGARD PERMIT REQUIRED SPLICING o 0 0
�- SW MCDONALD ST WO DRIVER
3-TRAFFIC CONTROL REQUIRED-FOLLOW Q ❑ FTTGROWTH THOMAS EROS.
[I FTTP OVERLAY MAP #
CITY/TIGARD PERMIT RESTRICTIONS 0 = ' FIBER
❑ CONDUIT ONLY
W ;-CONSTRUCTION START
IN SERVICE DATE
co
J
Q m CONSTRUCTION COMPLETE
ME
0 ***JOB SITE < � CUTS REQUIRED CONSTRUCTION
O
� } i ❑ YES �NO
} JOINT TRENCH ❑ DIAL. A DIG
LABOR HOURS i ❑ YES IX NO Cg FLAGGING
❑ BRUSHING
CONSTRUCTION CONTACTS SCCN YES REQ NO R
❑ CONTRACTINGE
DAVID CARNLEY-971-940-9000 VICINTY MAP ❑
SPLICE-C-4/M-0/X-0 SW BONITA RD '
JAMES STAATS-503-758-3119 CREW-C-8/M-01X-0 PERMITSCITY/TIGARD
SONICOM-BORE/PULL UG MUNICIPALITY
MUNICIPALITY
SCHEDULING CONTACT FIBER DROP(3)-200 ' EA ❑ BLANKET
RYAN ROBERTS-503-643-3713 ❑ TCP/TRAFFIC
FACILITIES T ACCT CODES- ❑ DETAILED (NOT BLANKET)
CONTACT
❑ NO PERMIT REQUIRED
2421.201 SHEET 1 O F 2
MICHELE CRISMAN 503-643-0180 2422.201JOINT POLE
NORTH , JFN/NJUNS #,
} JFN/NJUNS 4
INSPECTION CONTACTCK NO JPN REQUIRED
RO N S ITTO N 503-871-8065 POLE J JPN
OWNER TOO FROM
MATERIAL REQUIREMENTS ❑ ❑ ❑ POWER
ENGINEERING CONTACT ° ° ° F
***SINGLE FIBER DROP-(3) ❑ ❑ ❑ FRRONON
TIER
RUSS WELLS 503-312-7330 pp ,Ad ^
—209 FT EA ******METRO E WORK ORDER**** POINT OF CONTACT
51351-5223976-70 Russ WELLS i 503-643-1001
**i`6 PORT E/W 500 FT TAIL ****** *** *,�* ******
ASR3022784 scHEDULING RYAN ROBERTS
*
PHONE NO. 503-643-3713
**STATE FARM INSURANCE ENGINEER RUSS WELLS
PHONE NO. 503-643-1001
TECH.
MICHAEL NELSON
I PHONE N0.
10580 SW MCDONALD ST FIELDED BY RUSS WELLS
SUITE 103 -nfi
LOON-MICHAEL NELSON 503-502-9331 flo
ASSIGN-FDT 360102 51354-5223976-70 Communications
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