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PFI2019-00246 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT IIIj Permit#: PF12019-00246 COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/31/2019 T l�' Ix l3 g Parcel: SEG775 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Comcast Project Description: SEG 775/11720 SW 72nd Ave. Underground pull through existing conduit along SW 72nd Ave. Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) Total Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: TEXSTAR ENTERPRISES INC 17090 JORDAN RD SELMA,TX 78154 PHONE: 2106568775 Applicant: VAN MESPLAY 11308 SW 68TH PARKWAY TIGARD, OR 97223 PHONE: 9718015787 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: See application Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00246 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 ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI_Utilities 09-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 10-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 11 -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 12-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 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI_Utilities 14-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 15-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 16-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 17-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 19-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 20-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 21 -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 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-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 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Utilities 25-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 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI_Utilities 31 -OTHER Applied Notice Other RECEIVED JUL 30 2019 CITY OF TIGARD City of Tigard PLANNING/ENGINEERING PFI#: 2.O 19—002,4 LP = ENGINEERING DEPARTMENT III TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: 72nd Ave Apartments ® TYPE 1—Franchise Utility Work Brief description of project: allencY performed by NvvN.1'cl, or utility Underground pull through existing conduit along SW 72nd ave. ❑ TYPE 2_ROW Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 11720 SW 72nd Ave,Tigard, OR 97223 main line tap Location (address if available): 0 TYPE 3—Full Scale Development Work SEG! 715 performed with land use approval which includes any of the following • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Comcast • Mainline installation for sanitary sewer, Name: storm sewer, Tigard water, and Tigard Mailing address: 11308 SW 68th Parkway water service area city/state:te: Zip: Tigard, OR97223 0 TYPE 4—Small Cell Technology Phone: 0 TYPE 5—Tigard Triangle (971) 801-5787 Email: Van_Mesplay@comcast.com Phone: (971) 801-5787 NOTE: Type 1 and 2 applications may be Van Mesplay emailed to rowpermits(ti?tigard-or.gov. Contact name: Phone: (971) 801-5787 Email: Van_Mesplay@comcast.com CONTRACTOR INFORMATION 0 Same as applicant Name: Texstar Enterprises ATTN: Jim Miner CCB Number: 178798 Mailing address: 14122 Arndt Rd City/State: Aurora, OR Zip: 97002 Phone: (503) 793-3109 Email: jim.miner@texstarenterprises.com ENGINEER INFORMATION Name: K&B Technical Solutions Mailing address: 6566 SE Lake Rd Suite F City/State: Milwaukie, OR Zip: 97222 Phone: 503-650-6041 ext 210 Email: Corey_Dunston@kbmail.net ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes 0 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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 city pursuant to TMC 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,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 must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I,the applicant,certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Corey Dunston 7-30-19 Appli or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No:RV/DM-00214W Permit fee: -' Received by: L Date: 7 30 M Approved by: '7? . /9 Date: -7/3///, Notified by: � Date: /.g1/j_c7 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee.See below for calculations. Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? 0 Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): 0 Small Cell 0 Macro ❑ Street Name How many install sites are proposed as part of this permit ❑ Site Address application? TYPE 3-Must provide 4 sets of plans(sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: 0 Public Right-of-Way 0 Private Property ❑ Cover—Site,\'sanity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details El 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.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4 9 9 SW72ND AVE ■ � --- ----------- | m Z.' \ t \ j | 1 \\ § § /| § _\ . , j\ |§ ,. |- Iq 1141 | 11/l / E.; m ' 1 bit hi 0 , i ; §/G\ §%` Gm; �-- ) kx9A %-1 202 . . . \ . . . §, F §§g §§§ )2 rn . r!§ m P\7 t 4k& _ _. ..."".-m--- , 11720_/n_, ! . , - - - mmvm 97223 % 9 COQ'.AST , _ SOLUTIONS i ,1 _ EVERSION PO BOX__m_, , . 53526 Phone:(971)801-5787 _���___ n �Q %om . - -. FORCED RELOCATE CITY OF TIGARD ROW PERDRAWING Page 78 2011 Edition Work on Shoulder Diagram 210 Diagram 210 covers stationary work with work or parked equipment on the shoulder. This diagram does not cover work on a freeway shoulder. See Diagram 710 for Freeway Shoulder work. 1. Vehicles should be parked as far off the roadway as practical. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 3. For added visibility, truck-mounted arrow boards or PCMS in caution mode may be used. 4. Arrow panels in caution mode are recommended for work on roads with posted speeds of 45 mph or greater and high traffic volumes, greater than 2000 average daily traffic(ADT). 5. Requirements for signing and devices are shown in Table 5-2, below. Table 5-2: Device and Signage Guidelines Proximity to Edge of Traveled Way More than 15 feet or behind Barrier or Less than 15 feet Guardrail One advance warning sign is Advance warning required and two signs are Work in Place signs, devices, and recommended. More than 1 Hour flashing warning Cone taper is required. Cones lights are optional. along the edge of traveled way are optional. Work in Place Advance warning signs and devices are optional. Less than 1 Hour Sign Spacing and Buffer Lengths(feet) Posted Spadng Between Signs "Buffer" Speed A B C Space 20 50 25 100 100 100 75 30 100 35 125 350 350 350 40 150 45 180 50 500 500 500 210 55 250 60 285 65 700 700 700 325 70 365 fr) Chapter 5 September 2016 2011 Edition Page 79 Work on Shoulder Diagram 210 I 1rt . • . 1111 • (Optional) • 11La U Protection Vehicle • w/TMA(both Optional) I I See Chapter 4 • • Buffer • • • • 14* • 1 A * ROAD SHOULDER WORK OR N WORK AHEAD AHEAD Initial Warning Sign t *Use as appropriate-see Table 5-2 September 2016 Chapter 5 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT 111 1 r COMMUNITY DEVELOPMENT Permit#: PF12019-00243 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/31/2019 T"I co A p,C g Parcel: SEG301 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Wave Broadband Project Description: Adjacent to 8920 SW Oak St. Install 80'of new 2"conduit between existing vault and existing conduit. Class of Work: FEES Description Date Amount Type 1 -Utilities(gas, electric, data) PFI Permit Fee 07/31/2019 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: ROBERT VITRO 69 GLATT CIR WOODBURN, OR 97071 PHONE: 9712814231 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 See application Signature: Issued111111111W- By: "�-- ✓ Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00243 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 ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI_Utilities 09-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 10-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 11 -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 12-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 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI_Utilities 14-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 15-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 16-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 17-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 19-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 20-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 21 -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 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-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 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Utilities 25-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 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI_Utilities 31 -OTHER Applied Notice Other ,•,„,..,„.„,,,,,N„ RECEIVED City of Tigard PFI#:. :0019—.. 06,2y3 ',%-: ''yy•;,:.,, ito. ENGINEERING DEPARTMENT JUL 26 2019 1 1 . Public Facilitie,§_ • ii idigvir-Eient (PrF ) emit HI P A 1 1 et . PROJECT INFORMATION TYPE OF WORK Project name: 3n00s - u\k/we cp - git./0 51") 0:24( s)-* i TYPE 1—Franchise Utility Work ,,,., x Brief description of pmject: 1%AS T'\ \. `4,6 0 C rThe..,„) performed by NWN,PGE, or utility agency C 6 44 \ ecrik 0 or- eiCi 4-;h.) 0 0-0-2 t t's 0 TYPE 2—ROW Sidewalk/Driveway/Sewer Go•wk e k: ..„„.. c-py‘ea.,). ,.\-- Work perfOrmed for the purpose ofi 4 • Sidewalk installation or repair ...— ............ ......., • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and main line tap Location (address if available): Ajor^,41/4 5;tic ,P- si...) c.../(o 0 TYPE 3—Full Scale Development Work 4 A CI.) o4:—Clk— 1.. /0 •frO i performed with land use approval which includes any of the following: ....---.... • Subdivisions or Partitions APPLICANT INFORMATION - Street widening Name: kr.)&-t•---t Vortnta3;k Le-,,, • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: ( 0 b./4 44 ci‘i--- water service area City/State: wood L,0,--IN. OR, Zip: C) 70 7 I 0 TYPE 4—Small Cell Technology 0 TYPE 5—"Tigard Triangle Phone: cY 7 I ‘ Z1 Email: rot,e4,V:Vree v4Aitc GroA4,.4 Phone: 9 / , 7 . 4:-/2 ( NOTE: Type I and 2 applications may be emailed to rowpermits( tigard-or.gov. Contact name: Vo(„cpc-el- Phone: / 7) , Z' k , 617 1, Email: r--tt is er 1---- V;'l'te-c, e ,,,,„Lt.,:,,,,„(16„,k, row, CONTRACTOR INFORMATION 0 Same as applicant ____„,, Name: l W‘) ‘)voc• 4,1:12,vet v-c:A. CCB Number: Mailing address: City/State: Zip: Phone: Email: ENGINEER INFORMATION Name: eG/tr4.-- V(40 Mailing address: 66 t (7A.4,1- (,,,--- City/State: ta)00d vk Q . Zip: 9 7 0 7 / Phone: 9 7 I . ?II , 41 Email: rbloe 4--. V:,1-P-00 Wet i—e&roctet‘,-/,1 ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ A/19 4- &ifee-- 5,,c (within the public right-of-w:1\ , Is work related to a LAND USE DECISION? 0 Yes 0 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.ti8ard-or.go, . 503 718 2421 • Page 1 of I APPLICANTS NOTE: Person specified as'Applicant"shall be designated"Pcrrnittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.04.140. With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,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 must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. 1, the applicant,certify that: • To the best of my knowledge, all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted, I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. f2010-v- 1--rb 7/ 4// 9 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No:Pr-Pa 9-oo...wg Permit fe . 30D•Ce Received by: Date: 4- -24, Approved by: /4,tetsiJ Date: 7- 3 Notified by: fa. Date:1 511,kci City of Tigard • 13125 SW 1-lall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PH) Permit; INITIAL PFI PERMIT FEE Part 1: Required submittal fee is l0/ii of the Net PH Permit Fee.Sec below for calculations. Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7% (less the initial PH Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1 —3: DETAILED SUBMITTAL CHECKLIST REQUIREMENTS • Does applicant have a right-of-way license? 0 Yes 0 i TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal Ei Dimensions considered?(check all that apply): 0 Small Cell 0 Macro El Street Name O site Address How many install sites are proposed as part of this permit application? TYPE 3 - Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: 0 Public Right-of-N,Vay 0 Private Property 0 Cover—Site,Vicinity,Abbreviation,Legend II Notesenera , , , If equipment is to be located on private property,describe the (CityWaterSeweretc.) type& use: C.] Street(Plan, Profile) O Water,Storm and Sanitary(Plan Profile) • Water Quality Facilities D Grading 0 Landscaping/Tree Plan I: Composite Utility Plan(Electrical,Phone,(las, Storm, Sanitary,Water,Signage,Street I iights,etc.) LI Details LI Traffic Sight.Distance [11 Signing and Striping 0 Street Light Plan and Photometric LI Engineers seal/signature LI Sheet label (project land use name,revision and plan log block,dates and sheet numbers.) 0 Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) Traffic Report O Storm water Drainage Calculations LI Geotechnical Report LI Preliminary Access Report(Sight Distance) 0 Proposed Plat: O Pathway Design Water Provider Approval City of Tigard - 13125 sw Died. "E.4;arcl, Oregon 9223 • wwv,:tigard-ot.gov • DOD-716-242i • Page) of 4 SW • Y ,. St Edge of Pavement. f� -0-- Ditch --iw". Street ght ,......_._._. . ''',.7r—-— (7.45 tom;"` 1 v 3 T'�3'1,j>vss d`5 e1-1CHI '' ,. '', I I Q) s 1 i_:istinq House 1 ' Q; ,! 1 Existing 1 Driveway iii >�of 1 -I + 1 0 I j ... „7.,,' ' �I nI • _M ( E sting.hop, 4 I — l 1 — 5' — -- — — — l , 1 — Trntteriiine 4 " ' Fire Hydrant(FH) 1 I Scales 7"=30' 1 i 1 1 I " 1 1 I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if notapplicable) North arrow Property lines &dimensions Existing utilities locations (sewer,storm,water) Street&street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard - 13125 SW Hall.Blvd. - Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 ,, etund 30005 - Wave G - Oak St. Apartments ,_w 9010 SW Oak St. clue 03 MIN • EDIVcl NGL�INGSLLL A01 KIRKLAND PARKPLACE SUI1E 500 KIRKIAND,WA 9803] Tigard OR o o �— General Location Scope of Work v.. > ,�,, LEGEND =, Bore 1-Place 80'of new 2'conduit in the ROW on the North side of SW Oak St.3'BFOC. Sewer B,e t/�n d It r�on'.a Crl �) "lu HII eu�lIntercept 1-Intercept our existing conduit and couple together. Power ._ - 'it .�•.1 .1 I .- d rs Tie in 1-Plumb new conduit into existing vault. -NWN a Misc-Use a vac-truck or trailer to expose existing conduit and clean up any mess as it is created ---- -Existing conduit Call in locai. tes before work begins 1::::::: Exisitng Vault «ars Call the city to notify 48hrs before work begins. Proposed Path "" "=3 Maintain a minimum depth of 36" IC4 -Joint Pole t3,7 al CONSTRUCTION COORDINATOR 1 JEFF MCCONVILLE KFnq Il u- JMCCONVILLE@WAVEBROADBAND.COM s iEy U.,rtiaaa F 501318-9804 �_, z Underground Labor: Bore Footage:80' PERM IT TECHNICIAN ,ii, Bore Pits:1 ROBERT VITRO ROBERT,VITRO5WAVEBROADBAND.COM 1 - Total UG Footage:80' 9n-281-4231 Tualatin r- ,� %Or Vicinity Map Packet Descri•tion N .�, Sheets 110 � � � ,�, � � 1.1 z' t::ign I I �,r ,E. L. 15 30' 45' 60' +,r '--;"-.. j SCALE:1'=30' � 3.1 Traffic Control Plan . � � �� � 30005:9010 SW Oak St. Bore End 'Bore Start a D ,5.��n:::::: W�a�JJNESW ✓^ � I ' t ` TITLE PAGE "' d� �'$ ¢ r'8t A'g • ,,,,,,AT X00.2019 SHEET 1.1 .I -astound by wave WAVEDIVISION HOLDINGS LLC 401 NEWLAND PARNPLACE SUITE 500 0/RNLAND.WA 98033 RFV OESCRIPlY. SATE BY I 8935 Construction Notes 8930 0 All fluids and material from boring process must be contained with a vac-truck or trailer. O Must call in locates before digging —1 r ® Must call the city and notify 48hrs before work starts. ® Intercept and tie into our existing conduit O All disturbed areas must be restored to like or better condition. © Minimum depth of 38" ...,. .. F,,,, � A 07 Power _ __. Q Sewer Main ,,r-4,,.._._---------T-- O9O NWN Gas main -3'BFOC, 80'of new 2 c nduit '---� b • ♦ I r'' 5' \ I Plumb into existing vault L 16' 0 N d $ o �_ o J a N SW Oak Street I I 0' 15' SO' 46' 60' O CO SCALE f=15' \ 30005:9010 SW Oak St. wA,N r . ... �, ..,v rOWNSMI,55w+9r:1w SKMa 33 NE SW ROUTE DESIGN 8920 or'' "'-' 7262019 2.1 astound by wave WAVEDIVISION HOLDINGS 1.1.0 101 KIRKLAND PARKPLACE SUITE WO KIRKLAND WA 98033 2011 Ecii-on 2011 Eat en •riarpi..7; REV DESCRIPTION ' OZ0710 'R'‘v 0 Work on Shoulder Diagram 210 Work on Shoulder l,,r,:,,1::,',,;62ressp Diagram 210 ORIGINAL ISSUE Diagram 210 covers stationary work wilh work or parked equipment on:lie . shoulder. This diagram does not cover work on a freeway shoulder. See 4' 1 16. ' Construction Notes Diagram 710 for Freeway Shoulder work. 1. Vehicles should be parked as far off the roadway as practical. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Sectkan 4.3—Lights and Lighted Signs for exceptions. 1 e 3. For added visibility,truck-mounted arrow boards or PCMS in caution • 7 mode may be used. 0/ 4. Arrow panels in caution mode are recommended for work on roads • with posted speeds of 45 mph or greater and high traffic volumes. /VA greater than 2000 average daily traffic(ADT). / (091101151) • , 5. Requirements for signing and devices are shown in Table 5-2.below ,'Protectlon Vehicle • : wrrMA(both Optional) Table 5-2:Device and Sionade Guidelines See Chapter 4• Proximity to Edge of Traveled Way ----f- • More than 15 feet Buffer or behind Barrie-o, Less than 15 feet • Guardia]. • 1 One advance warning sign is • I Advance warning required and two signs are • Work in Place signs,devices,and recommended- • More than 1 Hour flashing warning Cone taper is required Cones SI N lights are optional. along the edge of traveled way are optional 01 Work in Place 1* Advance warning signs adevices are optional. Less than 1 Hour and A [ Sign Spacing and Buffer Lengths fleet) * * Posted Spacing Between Signs , 04,0(er . V POND SHOLLOBR WORK OR ware( o. 1 I I I Is. 3, .15' 60' Speed A B ' C- Spitpe AFEAD MEAD SCALE 1,15' 20 50 25 100 100 ma 75 Initial WeinIng Sign 30005:9010 SW Oak St. 30 100 1 1 C •10.pte,5 35 125 . 350 350 350 4:5 180 150 50 500 500 560 210 December 2011 December X111 *Use as appropriate-see Table 5-2 55 250 Chaser 5 TRAFFIC CONTROL PLAN PWTDATE SHEET 3 I 7/20/2019