PFI2019-00026 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
1111 s COMMUNITY DEVELOPMENT Permit#: PFI2019-00026
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/23/2019
Parcel: SEG2624
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Frontier Communications-W0715416
Project Description: SEG2624.Add/prove Frontier conduit SW 113th Ave from Durham Road to Willowbrook Subdivision.
51351-W0715416
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 p(; 1
Signature: ?''�-" r C/Ke ck.„
Issued By:
(yl . ( (10 c .CkAA,
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2019-00026
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.
Contact 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
RECEIVED
City of Tigard
JAN22 2019
Pr".' CITY OF TIGARD
I'I. lil.I(. \\.OR KS --- ENGINEERING PLANNING/ENGINEERING
TI -- - Public FacilityImprovement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) TYPE 1-Franchise 1104 Work
Check one: If.Utilities ❑Sidewalk/driveway approach ❑Strectimprovements perfoimed by N1t'�.. PG F.
Detailed description: MD/ Pme FI PZ Clik117 and/or utility agency.
SWr
h i'TN AVE 11)14 OW BAT) TI) f TYPE 2-Sidewalk/l)rivcwav/Scwc r
tu�� NOR- �ilES D'K[� 51367-
) 67- i3O /5-4& Work performed for the purpose of:
i'f► -- —_- • Sidewalk installation or repair.
1�ii't!I /157-14 AVE • Driveway approach installation
Property address/location(s): J and/or repair
/ia/ NOD /4.320 EK-71-62.9 • Sanitary sewer lateral installation
and/or main line tap
PEWTER_ U TATE 3-I�uU scale 1)rvclopmcnt
ilprlic;tnt: /,�/��R �1/ 1 -Tll)1.lnS Work performed with Land use
Address: 4/c c 1W COAL Mill &1/D apptlwal which includes any of
City'/s tate: l3�L L))L__ zip: VMS'j the following
LJ
Phone: :Sb "!Qty '"/Ah/I'.rail: YK) �
'i K¢ •c.6L l • Subdivisions or Partitions
"' /9nj
. / j • Street widening
Contact name: � E ._ URIC Phone: GI /
• Mainline installation for Sanitary
Contractor: AUM71 S.11-‘1 CMOL t 11AMI) sewer, Storm sewer. Tigard water and/or Tigard Water Service Arca
CCB#: LC).G07-747 _ Et)ir tion: - I 7,4-7A 7/1
J
Address: 11310 SC 1 w �AJ D j/J7 4L/J stmm1'f'COMPLETED APPLICATION TO:
City/state: VAX Irilc_ LIIlilr City of Tigard
Manning/Engineering
Phone: I.mail: - 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
.\Itl'Iications lin"minor work in right-of-way"
Engineer: only may he emailecl kr
rowpermits(ktigard-or.gov
Address:
�\ Zip: wit S i \J: : USE ONLY
City/state: \" [ �-00016
Phone: •.mail: Case No.: tF1��
Contact name: Application submittal fee(.07%of
Engineer's Estimate) 5
I:stimated value of work is required(if over$3,000):S �l Additional fees: $
(within the public right-of-way) Application accepted:
By: SC Date: 1-zz 1 q
Is work related to a LAND-USE DECISION? 0 Yes Ni
If so,please specify (MLP,SDR, SUIS,etc.) case#: ApplicatioLu reviewed:By: g. Aon
S/-1.42,l.)atc: ) -2-;---i
is work related to a I3UILDING PERMIT? 0 YesXNcl Applicant notified:
if so,please specify(BUILDING PERi1MI'I)case#: By: 15 Date: 112.3/ I q
I:ENG1PermlUpplkations1pti_application Effective 10/16/2017
6144 Qr ti i 9r 113 444 A-•rti A cox"' eaeu`T r .5 .. r 5 ,Jo c_iiT 5 Tvut--r S
City of Tigard • 13125 SW I lall Blvd. • 'Tigard,Oregon 97223 • wwwtigard-or.gov • 5113-718-2421 • Page 1 of'1
APPLICANTS
NOTE: Person specified as "Applicant"shall be designated "Permittee"and shall provide financial assurance for work. it
required by the city pursuant to TMC 15.041.140.
- with the exception of a utility operating pursuant 10 a valid franchise with the City of Tiganl,when the owner and the applicant are different
people,the applicant must he the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the
owner. lire owner(s)must sign this application in the space provided or submit a written anthoniation with this application. Franchised
tilities are not required to obtain the owner's signature on the,illl+lication
BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT:
• The above request does not violate_any recorded deed restrictions that may be attached to or imposed upon the subject
hrc perry.
• 11 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'tun] the statements in any 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 applicatit in,including the policies and criteria,and understands the
requirements for approving or denying the application.
zuSSa. tdjUaLS ///Y1llll7
11�hlie. nt Authore.ed1 Agent's signature Print name ilii('
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name late
Owner's signature Print name late
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW 11all Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 5t)3-718-3421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS ETC.
Part 2: ill non-water systm improve improvements
(work in the right of way)1 ngincer s estimate X 5'o(less$300.00 submittal tee)
Engineer's estimate X 2%Plan Review Sketch
(including in formation below)
WATER SYSTEM FEE
0 Dimensions
Part 3: All public water system improvements n Street Name
Engineer's estimate.X 12%R ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
!'here will be no permit fee charged,or assurance required
for the followingtypes!)f work: (Subdivisions/Partitions and Street Improvements)
• Sidewalk repair(less than 20 lineal feet) Design Plans
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading. (6 sets,2.1x36 or 22x34)
• Weep hole repair 0 Cover--Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) 0 General Notes(City,Water,Sewer,etc.)
• I.aum sprinkler system installation or repair 0 Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• flatter strip landscape maintenance 0 Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/"free Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) 0 Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ 'Traffic Report
O Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
O Engineer's Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW l-lall Blvd. • Tigard,Oregon 97223 • vwwtigard-or.gov • 510-7 18-2421 • Page 3 of 4
SAMPLE SKETCH: SEE' �'T71kt -i�]
fee.-- Edge of Pavement
yT yT '•I*- Ditch -0"~
0)114
Streetlight •!•!■!■! ■!■!■!■!r!■—
r 'ier
fie• `■ 1 RaIII I.$'$II't �!r i 1';`�1
A / 16'• �1 •
® ) r,
/ ■ tR • t� , lin 1
I '
I •
I T! Vio'posirSel+►rv'ei'rinee
it 1 1
CD a
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I A 1 Existing 1
1.-11 . Driveway .
0i 1I
CI n. 1 i ;hi
O ^ t �i J
a.I -
il 1 rl
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.31 I 1 c;e 1
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�. I Existing Shop
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.= '
Powerpole I 1 1 ,3' I
10._
95' 1
1R.-------To-p ttyLni e"
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Fire Hydrant(FH)
I I
I
I Scale: .1-=.313.
I
I I
/
I I
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I •
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/ MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
i
rest & street tume(s) Properly lines & dim
er i n
I:xisting building, structures Slope property
Utility street light
,t icles''rIposed work I:.Nisting g cul) or edge
'frees
I;.xisting S/\\'or of pave ric>>t I:xisting utility locations
17/\\'Apron (sewer,water,storm)
PUBLIC FACILI'T'Y IMPROVEMENT PERMIT
City of Tigard • 13125 SW I fall Blvd. • Tigard,()rcgon 97223 • \vw\t:tigard-.ur.gov • 503-718-2421 • Page 4 of 4
faiJT1lL CDD [lel/& TILI(.lI
MAFFIL CL 4i11ML_ PL4LI
37 3S-1 140 .7154-11a
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
01 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 he 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 (tagger placement shown may he 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
1 &/Lvm-1 yrs
2011 Edition Page 85
N
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Posted Spaeinsi Between Sipes Buffer p -�1
Speed A B C Space V z rc & i
20 50 I
25 100 100 100 75 l /-,
30 100 \125 L..... ��
4U 350 350 350 150 /O O"'
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December 2011 1GLllX7ZL I 4. Chapter 5
OW/ 14V/11/I Xl MS
CERTIFY-NAT THE WORK I CORPLETED CN IHS WORN MOER AND REAR,•S
IN CORPLIUICE RAN FRO.,ER OWLITv 5,0013E AS ibNRHEO ON T4
IPO'➢CNECRIIT
NO JOINT POLE NOTE t
(f1G,TJRF4/4D,TF1
\\.74314.7 TOTAL ALLOTTED HOURS
CONSTRUCTION NOTE �('� CONTACTSUPETN RIF ADDITIONAL
V� = HOURS ARE REQUIRED TO COMPLETE PROJECT
1-THIS WO IS DEVELOPER DRIVEN WORK 37 VICINITY MAP CREW LDAP. X-7DIME M purr.
ORDER- SPLICING o a o
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G 0£TTP GROWTHTHOMAS OS.
2-CITY/TIGARD PERMIT REQUIRED 0 FTTP OVERLAY MAP
TR
iFIBER
SW MCDONALD ST 0 CONDUIT ONLY
3-FOLLOW ALL CITY/TIGARD CONSTRUCTION START
TRAFFIC CONTROL,PEDESTRIAN SAFETY W IN SERVICE DATE
AND ANY OTHER CITY/TIGARD PERMIT Q SW BONITA RD CONSTRUCTION COMPLETE
PERMIT RESTRICTIONS IN COMPLETING )
THIS PROJECT Qo CUTS REQDIRED CONSTRUCTION
F ❑YES D(NO
4- THIS WORK ORDER WORKS WITH JOINT TRENCH Q DIAL, A DIG
co ❑YES [$NO (x FLAGGING
51351-5237748
0 BRUSHING
SW DURHAM RD SW DURHAM RD SCCN REO'D 0 CONTRACTING
❑YES CI NO RFD.D
PERPCITS
LL1 MUNICI PALITY TIGARD
CONSTRUCTION CONTACTS < MUNICIPALITY
DAVID CARNLEY-971-940-9000 2 ***JOB SITE ❑ BLANKE
❑ TCF/TRAFFIC
JAMES STAATS-503-758-3119 TIGARD HIGH ❑ DETAILED (NOT BLANKET)
SCHOOL 0 NO PERMIT RF.QL'IRED
SCHEDULING CONTACT
RYAN ROBERTS-503-643-3713 c JOINT POLE
NTS JFN/NJUNS k
FACILITIES CONTACT JFN/NJUNS a --'
SHEET 1 OF 2 [INC URN REQUIRED
MICHELE CRISMAN 503-643-0180 POLE JPN JPN
NORTH OWNER TO FROM
❑ 0 0 POWER
INSPECTION CONTACT
0 0 0 CATV
RON SITTON 503-871-8065 \ o 0 0 FRONTIER
POINT OF CONTACT
RUSS WELLS
GINEERING CONTACT
503-643-1001
SAN ST
RUSS WELLS 503-312-7330 PHONE NO 5CHEDULIN�RY03-64RO3-3713ERS
ENGINEER RUSS WELLS
PHONE NO 503-643-1001
TECH.
LABOR HOURS PHONE NO,
FIELDED BY RUSS WELLS
NORTHSKY TO PROVE
CONDUIT PATH # on-her
SPLICE-C-0/M-0/X-0 1
CREW-C-0/M-0/X-0 Communications
FRONTIER CONTRACT TGRD/ROD DUCT-SW 113TH AVE
FLAGGING-12 HRS
UER Co AREA
INSPECTOR-4 HRS PROJECT
M W0715416 DE: HITRI
DRAWN DATE ENGR: RUSS WELL PITY WASH
51351-WO715416 Iti7nn14 PHONE: 5D-4-A44,'nn.FILE:
w SCALE: 1-100 TAX DISTRICT: ""r DWG 1 OF
TWNSHP: RNG: SEC:
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—CONDUIT BETWEEN HUBPED 12010,12011,40817
—
VALID PATH. IF NO VALID PATH NEEDion
RECOMMENDATION TO CREATE PATH BETWEEN IN FIELD PED#12011 0ii I
HUB AND PEDESTAL 40817
THIS WILL PROVE PATH FOR 51351-5237748 II II'
WILLOWBROOK SUBD PH I&II II I
PLACE MULE TAPE FOR OVERPULL 51351-W0715416
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FIBER TAILS/TERMINALS PLACED ON
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51351-5237748/WILLOWBROOK SUBD
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FIBER TAILS/TERMINALS PLACED ON TGRD/ROD DUCT-SW 113TH AVE
51351-5237748/WILLOWBROOK SUBD PROJECT CO.AREA
NUMBER W071541 6 EXCH.CODE 51151
DRAWN DATE ENGR RUSS WELLENTY WASH
111712f115 PHONE: Sbl-fill-mn.FILE:
SCALE: 1.100 TAX DISTRICT: DWG 2 OF 2
TWNSHP: RNG: SFr: