PFI2018-00131 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00131
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/06/2018
Parcel: SEG2434
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications
Project Description: SEG2434,associated with 16290 SW Upper Boones Ferry Rd. Fiber Splicing in Manhole. Frontier
Communications Work Order 57351-W0640975.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RUSSELL 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
Signature:
Issued By: �-
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00131
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.
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---IZ(-YJFIbL IBRMAJMAIIW`�
almmoz- RECEIVED
City of Tigard MAY 31 2018
I'LIBIAC N\/(_)MS ......... 1:.-qN(ANI4',I1'AING G'A PI D
CITY C,)),
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Public Facility Improvement (Phi I) PO��T����'�:
TYPE OF WORK
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Address: A1111LICATION7'O:
("In, Citv ofTigard
I,/(/,1111inglEngincering
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Phone: No.: 00131
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APPLICANTS
NOTE: Person specified as 'AppOmW shil be dusippmed "Finnitive" and shall provide hibuWal assurance (&"W,A'
required by the cil pursuant-N)TN4C 15.(W1.140.
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w(sinar-w BELOW,THE APPLICAN'r(s) SHALL CERT11-A-11-I.A.'"I':
• The ,hove rujugst dee; notvkdawjmv gwrded decd restrictions thar may lie anychcd to ortnnosal upon the subkct-
• If die appticatrimi is gyanced, clic iqirdicanr 11111 cv-:1:cise the rig-lit';granted in accordance vvith dic i-crins all SuNica to all the
CUTIC[irion's, and hill-litations'..)f rile approval.
• .,-U of the above suronuirs and the sulkincilts in anY plot plan,attachments,and exhibits tralismill-ccl 11cl-cw-if"11,arc trek;and
die apphcaus so orknoWedge dim tiny permit issued, based w this application,nhiv be rcvOkcd if' it is Rmid that any such
swerilents are RISC.
® The applicant has read IIIc: uOr cuitunts of the ap1dicathm,jncludii)g the POKUS allCI COCA,MCI Widersrands dic
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SIGNATURES of each owner of the stibicct property, if required.
Owner's signatl-jrc.'. Print 11,111]c Dam.
Print millic
Owner's S1,1011,1111ft: Imilic Darc
PUBLIC FACTLITY IMPROVEMENT PERMIT
City qfTig,,u-d - 13125 SW KM Blvd. - TgW.(Agni 97223
.,ov 503-718-2-421 - Pigc2qj'4
SAAIPLE SKETCTI: 47TI440-0
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3 rD I
Fire Hydrant(FH)
Scale: 'I"=30'
MINIMUM SKETO.-I REQUI R.E'AlENTS (Plat:"N/A" if Not Aj)plic,able):
Nordi Pnj)(,rth 1111C." & (Ill I ISIOPC ()1"
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PUBLIC, FACIIATY IAI PROVENIE N"I"A"ER MI'Y
Q/223 18
Citi-ofTigard 1312-5 S\V I Lill Blvd. - Tlgm-d,(-)j - t )-7 -?_I21 * Page 4 Oj,4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
1
APPLICATION FEE
® '
Part 1: Required subtulttal fee$300.00
FRANCHISE UTILITY ANIS SIIDENVALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2:
CONNECTIONS,ETC.
Ill tion-w.tter sy-sl�cm it�zpt•ovct»cnt:4 (work in the right of«-arj
L-'.n ineer s estimate X:i �(less$300.00 sul_}mtrtal fee)
J-.' *peer's esiYm,tte X21%flan Review Sketch
(including u.ifortnn tion helots)
WATER SYSTEM FEE
❑ Dimensions
Part 3: 11.11 public water system irnl)ro-etlients ❑ Street itatne
l_itil inccr's estittlrtte X 121(b ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no pen-rift fee ch,ttged,or slssur<trlce rcgtlired
�Sltl7d1VislonS/P:trtiticros.111C1 Street IlnllrovCinent-.')
for the full owl ng ryp e s of work:
• Sidewalk repilir(less than 20 litical feet')
• Rcloc�tte or rcplttcc m,lilbo_r- Design Pknis
Ditch cle acting that clod not involve regrading. (ti sets,24x36 or 22-64)
• \'Veep hole rel)air ❑ Cover—Site,Vicinity,Al)breviadon,I-ege:.nd
• Curb rep;tir or. replaceni.ent(less than 20 lineal feet) ❑ General Notes(Cit},Water,Sewer,etc)
• Lawn sprinkler sttsteni installation or repair ❑ Street.(Plan,Pro Elie)
• Street tree prt111mg,or Planting ❑ \ Ater,Storm and Sanitaty(Plan Profile)
• Planter step landscape ln,,tinten�tllce ❑ Water QUaiit.y Facilities
• '.fest wells ❑ Gracling
❑ Landscaping/1'rce Flan
❑ Composite Utility Man(Electrical,Phone,Gas,
Note: A ccrsll assurcnice n:a),be requiredper
Stoma,Sanitary,Vlater,Signage,Street Lights,etc)
TALC 15.04..140. (customer-deposit) ❑ Details
❑ '1'rafflc:Sight Distance
❑ Signing and Striping
❑ Street l'.ight.flan suxl Pholometric
❑ Engineers seal/signature
❑ Sheet label q-)roject.land use naine,revision and
plan log 1}lock,elates and sheet nuini ers.)
Aciclitional Sulantittrtls
qwr Latul Use conditions)
❑ Traffic Report
❑ Storm water Dr:titt:igc(.;alculat.ions
❑ Geotechnic.,d Report
❑ PrelitninatT:access Report(Sight Distance)
❑ Proposed Plat
❑ Patliway Design(if applic:ahle)
❑ Vi'ater Department Approval
❑ Ei inecr's Construction Estin ate
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard - 1i1.25 S`\%.1-[;111 13lvd. • 'T'igslyd,(:)rcgon(17223 ��r«�c:tig:tlxlror�;ov 503-718-2421 • Page3 of 4
E-L-0W ! F G.m.f 4- &—"r-AL-r r p Jf v s {®O-l 1 ♦4g-,a LD .3
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Page 84 2011 Edition
Stationary Lane Closure with 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
N
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I CERTIFY THAT THE WORK I COMPLETED ON THIS WORK ORDER ANDA&BUILT IS
IN COMPLIANCE WITH FRONTIER QUALITY STANDARDS AS IDENTIFIED ON THE
IMP CHECKLIST.
CONSTRUCTION NOTE
{ (SIGNATURE MD DATE)
�¢ TOTAL ALLOTTED HOURS
1-WORK ORDER-SERVICE ORDER DRIVEN CONTACT SUPERVISOR IF ADDITIONAL
*****AS 83025393***** HOURS ARES REQUIRED TOX COMPLETE
TIME MAINTT
BLACKROCK FINANCIAL
CRE
SPLICING 0 0 0
TIGARD PERMIT REQUIRED ,Q 0 wo DRIVER
2 CITY / Q ,[, ❑ FTTP GROWTH THOMAS BROS.
,
7,Q/j,, QQ 1 ❑ FTTP OVERLAY MAP
FIBER
AFFIC CONTROL RE UIRED-FOLLOW fib ❑ CONDUIT ONLY
3 TR Q
CONSTRUCTION START
CITY/T[GARD PERMIT RESTRICTIONS ***JOB SITE IN SERVICE DATE
O
CONSTRUCTION COMPLETE
y4' S
CUTS REQUIRED
LABOR HO {� �I�y El YES IX NO CONSTRUCTION
URS .q,
^+ JOINT TRENCH Q(NO
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SPLICE-C-6/M-6/X-0 ❑ YES NO �FLAGGING
SPLI ^,
QQ i ❑ BRUSHING
CREW-C-8/M-0IX-0 ❑ YESES NO ❑ REQTDCTING I
CONSTRUCTION CONTACTS FRONTIER TO PLACEPERMIQ
DAVID CARNLEY 971
-940-9000 12 FIBER CABLE-450` JQ VICINTY MAP
MUNICIPALITY
G�� MUNICIPALITY
JAMES STAATS-503-758-3119
ACCT CODES- ❑ BLANKET
SCHEDULING CONTACT 2422.201 p DETAILEDFIC(NOT BLANKET)
RYAN ROBERTS-503-643-3713 6422.020 ❑ NO PERMIT REQUIRED
I
FACILITIES CONTACT ' JOINT POLE
MICHELE CRISMAN 503-643-0180 JFN/NJUNS 4
JFN/NJIINS r
NO JPN REQUIRED
MATERIAL REQUIREMENTS SHEET 1 OF 5 POLE JPN JPN
INSPECTION CONTACT *,�* _ OWNER o FROM
POWERRON SITTON 503-871-8065 12 FIBER - NORTH ❑ ❑ ❑ CATV
-450 FT EA ❑ ❑ ❑ FRONTIER
I
ENGINEERING CONTACT *,�,�,�*,� POINT OF CONTACT
RUSS WELLS 503-312-7330 ***12 PORT MDU TERM-0 FT ******METRO E WORK ORDER i RUSS WELLS
51351-5223976-68 503-643-1001
********ASR3025393*****************�` SCHEDULING RYAN S
PHONE N0. 503-643-37133-3713
**BLACKROCK FINANCIAL** ENGINEER RUSS WELLS
I PHONE NO. 503-643-3401
16296 SW UPPER BOONES FERRY RD ' TECH.
I PHONE NO.
LOON-CHUCK CHRISTOPHER FIELDED BY RUSS WELLS
_503-431-7795
ASSIGN-FDT 360302 flo e
Communications
T166 ,25 TGRD/ASR3025393-BLACKROCK-
16290 SW UPPER BOONES FERRY
PROJECT I C.O.AREA:-
NUMBER. 409ZB
REA:NUMBER EXCH.CODE:
DRAWN DATE: ENGR: RUSS WELL NTY: WASH
51354-5223976-68 PHONE51251901A : FILE:
51351-W0640975 SCALE: = TAX DISTRICT: DWG 1 OF
TWNSHP: RNG: SEC:
1676 07.2010
RBN 48
TGRDORXA H3017,61 -96+
870 07.2010 XD,37-48 1676 07.2010
RBN 72 RBN 48
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YGD 120 2022 01.1996 RBN 24
TGRDORXA T188,1-72+ YGD 24 TGRDORXA T188,23-24+
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TGRDORXA T188,79-96+ r TGRDORXA T188,21-22+
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TGRD/AS R3025393-BLACKROCK
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NUMBER: IEXCH.CODE:
DRAWN DATE: ENGR RUSS WELL PTY: WASH
051 5120119 PHONE: _ FILE:
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NEEDS DUCT VERIFICATION 51354-5223976-68 TGRDIASR3025393-BLACKRCCK
51351-W 0640975 16290 SW UPPER BOONES FERRY
PROJECT C.O.AREA:
NUMBER 640975 1 EXCH.CODE:
DRAWN DATE: ENGR: RUSS WELL N'TY: WASH
PHONE FILE:
SCALE - TAX DISTRICT: DWG 5 OF
TWNSHP: RNG: SEC: