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PFI2019-00334 Decision - Comcast #61472_Plant Extension City of Tigard • COMMUNITY DEVELOPMENT DEPARTME T' 0 I II INRequest for Permit Action �0 3 q // TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one /� REFUND OR Name: !�- INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLE SE TAKE ACTION FOR THE ITEM(S) CHECKED (1): iCANCEL/VOID PERMIT APPLICATION. p REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: PPIUM--00539 Site Address or Parcel#: c .,G.Z21 Project Name: Came %614 'L.-116,1" .(-4 .41 Subdivision Name: Lot #: . IJ- r.EXPLANATION: f wpIii�. l n� ,L ' TTk. Oz.s will Vii i s f r 12 iii-O633IJ-6, �v 6, � rettivq1, Signature: ., Date: l— 1 i Print Name: i( tt.4'‘ itefund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY _ Route to Sys Admin: Date By Route to Records: Date /'p/3 /g By r Refund Processed: Date N/4- Byro Invoice Processed: Date By Permit Canceled: Date ZD/.3 9 By,,,. Parcel Tag Added: Date By I:\Building\Forms\RegPennitAction_1 518/doc RECEIVED V 1 SEP 2 6 2019 rd/3 /9r City of Tigard CITY OF TIGARD PFI#: 1PTO i4-0L339 ��p�NING/ENGINEERING ENGINEERING DEPART1� fiI'h T l G A R D Public Facilities Improvement (PFI) Permit PROJECT INFORMATION 61472 Plant Extension TYPE OF WORK Project name: — 0 TYPE 1—Franchise Utility Work Brief description of project: Aerial overlash between existing performed byN\VN,PGE, or utility agency utility pole on SW 72nd Ave and SW Locust St. o TYPE 2—ROW Sidewak/Driveway/Sewer Wort:performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 10175 SW 72nd Ave,Tigard,OR 97223 maim line tap 0 TYPE 3—Full Scale Development Work ("TG12,9 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: Tigard, OR Zip: 97223 ❑ TYPE 4—Small Cell Technology Phone: 0 TYPE 5—Tigard Triangle (971) 801-5787 Email: Van_Mesplay@comcast.com Phone: NOTE: Type 1 and 2 applications may be Van Mesplay emailed to toapermitgetiyard-orContact name: ,�ov. Phone: (971) 801-5787 Email: Van_Mesplay@comcast.com CONTRACTOR INFORMATION 0 Same as applicant Name: Tennessee Cable Service CCB Number: 77450 Mailing address: 17035 SE Evergreen Hwy City/State: Vancouver, WA Zip: 98683 Phone: (503) 358-7508 Email: micki@tenncable.com/tenncs@aol.com ENGINEER INFORMATION Name: K&B Technical Solutions Mailing address: PO BOX 2529 City/State: Clackamas, OR Zip: 97015 Phone: (503) 650-6041 Ext. 212 Email: Shane_Langley@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 • wwwtigatd-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. $sc•t As Ai 7- 2s-A7 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF t'SI'.ONL\ Case No: f vu Permit fee: Received by: _s Date: I ' Approved by: Date: Notified by: Date: 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 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 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 ❑ 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-Way 0 Private Property ❑ Cover—Site,Vicinity,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,\Vater,Signage,Street Lights,etc.) ❑ 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.) ❑ 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 • wwnvtigard-or.gov • 503-718-2421 • Page 3 of 4 9 S\V .•Y ,• SI Edge of Pavement 'PI\Streetlight I -•Ditch —Po'. •— .174 .1, I of train • 0 1 • T--"Pi l/Sr d•'S 661711TF-- 1 ki. I I I Q.) i , in Existing House 1 I �� I Existing I :l it • Driveway - rl op ! 1 I = 0 n , in .I i r"1 s • a 1I i 4 b) 1 1 1 Existing Shop � S \ L •� Powerpole • I ..&' 1• a — 1 �� o , Q 1 95' I • 1 -----TliopertyLine----- -- Ci? I C, / 1 FHydrant(FH) I TTT I • Scale: 1"=30' I • i I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) 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 • wwnvtigard-orgov • 503-718-2421 • Page 4 of 4 Page 118 2011 Edition Lane Closure at Intersection with Flagging Diagram 620 Diagram 620 covers work within an intersection when normal traffic control must be interrupted. Work vehicles may or may not be in the work space. 1. During flagging, traffic signals shall be turned off. Contact the road jurisdiction for approval and assistance (see Chapter 3). 2. For multi-lane facilities, traffic approaching the intersection shall be reduced to a single lane on each approach. See Chapter 3 for information on flagging through intersections. 3. There should be one flagger for each approach. One flagger may control two adjacent approaches if sight distance, low volumes on side roads, and flagger position allows for safe operation and clear direction to motorists. For low traffic volume intersections(fewer than 400 entering vehicles per day), one flagger may be used. 4. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should be considered on high volume or high speed roads, or when extended queues may be expected. Sign Spacing and Buffer Lengths(feet) Posted Spadng Be twee n Signs "Buffer" Speed A B C Space 20 50 25 100 100 100 75 30 100 35 40 350 350 350 15u0 45 180 50 500 S00 S00 210 55 250 60 285 65 700 700 700 325 70 365 Chapter 5 September 2016 2011 Edition Page 119 Lane Closure at Intersection with Flagging Diagram 620 ROAD WORK , W • AHEAD n ONE (OpRORRJ) ROAD LANE C A 4 1 AHEAD B BE PREPARED -_ _� TO STOP B A A (optional) 41 . ONE LANE . BE 700*' • PREPARED AHEAD ROAD • TO STOP AHEAD • WORK I A B B C 1 Buffer •• }c I* • ••• • .t . K K 4 ®. f C .loonm..� B B A I TROAD BE • WORK PREPARED • AHEAD TO STOP • 100n.MOI. ONE UNE ROAD • AHEAD (Optional) A ' •B IE PREMED A TO STOP B (opnone) I t IONLANE RAHEAAD VROAD WORK AHEAD September 2016 Chapter 5 Page 80 2011 Edition 5.3 Two-Lane, Two-Way Roads Shoulder Work w/ Minor Road Encroachment Diag. 300 Use this detail for non-freeway work which extends into a travel lane and maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane cannot be maintained, or when traffic cannot safely pass by in both lanes simultaneously, use the appropriate lane closure diagrams—for example, Diagrams 310 through 350. A lane closure may be appropriate for conditions such as high traffic volumes, high speeds, and inadequate approach sight distance to the work space, or heavy equipment adjacent to the travel lane. 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. Cones shall be placed along the entire length of the work space. If a protection vehicle is used and work is in place one hour or less, the taper and tangent devices may be omitted. 4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there is limited sight distance, consider placing cones or tubular markers on centerline. 5. An arrow board in caution mode or truck-mounted PCMS with "SHOULDER WORK"or other appropriate message may be used for higher visibility. Sign Spacing and Buffer Lengths(feet) Posted Spacing 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 70365 Chapter 5 September 2016 2011 Edition Page 81 Shoulder Work w/ Minor Road Encroachment Diag. 300 ROAD WORK • AHEAD • Initial Warning A • Sign it • (Optional) • • • • NI • • u • 1111 Protection Vehicle W' w/TMA(both Optional) See Chapter 4 --- • Buffer • 10' • minimum • 1-/3 • 1 A /OAD NARROWS V (Optional) B OAD Ir f — WORK / \EAD Initial Warning Sign September 2016 Chapter 5 4. g ra f X r H r y mil. zv i p+9 ' G $m i F zz 3 m o O y Z O _ ODZ u yp u 97 s Omi A ga Oy 9701 now .on Row±t‘ w nox I noxa.,... now Ron an SW 72ND AVE MOW M. ..n /, MU ,»ob A. MO. RSR ,OR t I 1111111{ ,jib ji a • Ix _ $$ 'V, ;O SS coCC IX lm it & < _O 0197 7 O Op y C L..N O '--I g2 •mm „ C yy D y 1 00 � 8 M El mo El m O 1 0 m V w �- \ z m 41 ti r3 I �� 8. m v O 97 `,!� TE oesronerwasreaxacw.saurgva I — 10175 SW 72ND AVE °"'°""�" TIGARD,OR 97223 COMCAST °� ^ 5 H.C._ TECHNICAL saunaas $ d Contact:Van Mesplay PO BOX 2529.Clackamas.OR 97015 81472 g Phone:(971)801-5787 omcs-(503)650-6061 Eat.212 - - - CABLE/FIBER PLANT EXTENSION Van_Mesplay@comcast.com Email:shana_langley@khmaa net - - - - CITY OF TIGARD ROW PERMIT DRAWING 6 QN p r ° d rp . U)0 ro O DESCRIPTION: EXAMPLE: DESCRIPTION: ; EXAMPLE: - 0' n W tl BORE/DRILL —.._.._.._.._.._..— JOINT USE POLE o I- —J TRENCH JOINT USE POLE W/TRANSFORMER EXISTING CONDUIT POWER POLE WI TRANSFORMER • U STRAND POWER POLE RIGHT OF WAY CABLE POLE • PROPERTY LINE TELEPHONE POLE , PUBLIC UTILITY EASEMENT PEDESTAL,VAULT o Ism CENTER LINE —« --- MANHOLE G FACE OF CURB - CATCH BASIN — EDGE OF PAVEMENT VALVE MATER.GAS,ETC) pd EDGE OF GRAVEL METER MATER.GAS.ETC) 0 • II I EDGE OF SIDEWALK FIRE HYDRANT V 1 D EDGE Of DRIVEWAY REMOVE M REPLACE LIMITS, S i ' BORE PIT SEWER 1r .. STORM ____ . q S O WATER - S $ GAS -- 0 C' POWER 1 P.11 x TELECOMMUNICATION S g w CAN TRAFFIC CONDUIT E I— .8 STEAM —• •— (/)m m FENCE UNE ------ Q $E GUARD RAIL 10 S 6 RAILROAD TRACKS I unnnninuniimm�n C t n O o g. UVac RP-L PERMIT NO .CHIS-2$72610718