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PFI2020-00185 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT s COMMUNITY DEVELOPMENT Permit#: PFI2020-00185 TIGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/01/2020 Parcel: SEG3530 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: CenturyLink Project Description: Adjacent to 10385 SW 87th Ave. Bore 519'from existing pole to pole, placing(2)4"conduits at 36" depth. Class of Work: FEES Type 1 -Utilities(gas, electric, data) Description Date Amount 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: PHONE: Applicant: BREANNA HODGE PHONE:2085764031 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. PermitteelApplicant Signature: j"" loch- Issued Issued By: /�s‘ Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2020-00185 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[OUCH]. 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 RF ° !VED mxi 2 8 2020 City of Tigard C(i t UI- f iGARD pm#: 2020-00185 ENGINEERING I)EPAIPLANNING/ENGINEERING R G Public Facilities Improvement (PH) Pcrmir PROJECT INFORMATION Project name: N 558391 TYPE OF WORK t I l mnpoan:: Iu bore 519'from existing g TYPE 1 Fnmluu t'ttiq w<rk ptrt.antad M Nw\.v(:r. of unite Brief description of pn,jecc 4 pole to pole,placing(2)4"conduit .it ;r:',I,pih i TYPE 2. ROW stdrwa&i Omens)/Sava w iak performed ton thy purpose of •Sidewalk moaI6iant or tcpau •SITE INFORMATION Dntry approval)Installation and reran •Samson NNE"ittctal inatallataon and I"iF i \\ fi th:�\t main lint tap Location (address if available): —_ 1 TYPES- 1 tall Scale lkcckopmcm V.ork prkrnr l With land use approval which _. includes an of the hdktuing: •Sulxltcpta^,of Partitions APPLICANT INFORMATION •Soros urlrmng Name: Centurylank/(2west •Mainline. uutallatum for aanitan ,.,,. sto onn %nca. Tigard water, and II,:i I Mailing address: 6U74 N Drumm w'ay Ste.125 %Watt son rce area CitV/State: 1Stau.ID zip:Sr1; l TYPE 4-soar 1.d1 T xhtx me Phone: 2tkt974 Mlil Li TYPE 5-Town i nan le Email: permitting(a mountainitd.com phone: ..__._._.. NOTE Tvpt I and 2 appicati n%nut I. Contact name: Rrc9 •,s Hmmd a cmukd to.n w •+.+tin=eA4111.t., -... Phone: 208-576-411.I Email: pennitttng@nutuntainitd.o II CONTRACTOR INFORMATION 0 S.tna as applicant Name: Jason Scherf/Quanta Telecom CCB Number: Mailing address:2;1 1 I I.I q City/State: Vancouver,WA zip: 98661 Phone 360-605 6'21 Email: jscherf@gtantatelcom.com ENGINEER INFORMATION Name: Keith Frazier Mailing address: 4501 NE Minnehaha St Bldg 2 City/State: Vancouver,'t A lip: 98661 Phone: 360 669-3707 Email: ADDITIONAL INFORMATION Estimated value of work is required(if over S5,(00):$ (within the public right-of-way) Is work related to a LAND USE DECISION? 0 Yes D No Case number: City of Tigard • 13125 SW!tall Blvd. • Tiganl,(begun 97223 • wwrot:tigard...ur.gt„' • iO3-718-2421 • Page/of 4 PF12020-00185 Received by LS on 5/28/20 Approved by: Date: AtFee: '69- Notified by: Date: AS•.1 3TY3S NV1d 311S a I I I i — — i II I I LI 1 1 i 11 y � i I I Yet Hui AI WM I AVM I 111141061%) lntwu w MO. lir Zi LI Z ,..--.- ,...... .. ....... ,,,, ......p I, ram rpm% . ---- . --___ . .77.--. 7-S.c.... ....L _ I :Mu r r ' 4w.a sc W siMO ).Y tYi.2Yld pu.MS area a Yfiii LS fOf171001Y MI alw I 4100 Wart At S.qii I I 3 L. 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