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PFI2020-00380 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 illigCity of Tigard PH#: PFI2020-00380 I ENGINEERING DEPARTMENT l 1,, -, i i, Public Facilities Improvement (PFI) Permit PROJECT INFORMATION PGE Job # M2939328 TYPE OF WORK Project name: 8 TYPE 1—Franchise Utility Work Brief description of project: performed by NWN,PGE, or utility agency install house side shield on street light pole 4410 ❑ '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 Location (address if available): S EG 1423 main line tap 0 TYPE 3—Full Scale Development Work 13535 SW 110TH AVE performed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: PGE LINDA OTT FOR RICO TORRES SOLIS • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 2213 SW 153rd DR water service area City/State: Beaverton, OR Zip: 97003 ❑ TYPE 4—Small Cell Technology Phone: 503.672.5417 ❑ TYPE 5—Tigard Triangle Email: crewcoordination-western©pgn.com Phone: NOTE: Type 1 and 2 applications may be Contact nam RICO TORRES SOLIS emailed to rowpermits@tigard-or.gov. e: Phone: 503.672.5417 Email: CREWCOORDINATION-WESTERN@PGN.COM CONTRACTOR INFORMATION ❑ Same as applicant Name: PGE CREW CCB Number: Mailing address: City/State: Zip: Phone: Email: ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: 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? DYes ✓❑No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwtc tigard-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. Leitdd. Ott LINDA OTT FOR RICO TORRES SOLIS 10.9.20 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: PFI2020-00380 Permit fee: AL 10/12/20 /� �i�- 00 Received by: Date: Approved by: /�^�Nt,7• Date: fO/R.3 /24'2V Notified by: Date: (01 j3f zo City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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 PH 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 initialPFl Penn it 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? ❑Yes ❑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 ❑Macro ❑ Street Name How many install sites are proposed as part of this permit El 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,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) El 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 ❑ 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 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 `I �11 •• ) • • SI Edge of Pavement / x.m nu i� .r.... YIP T'riup'osr701.141i.��Tine-- I • I ,ff _ EKist.ng • House Iii -xr-in- I F. `� iveway .� ! 1 1 o• = H rl O"I I i I Existing Shop I �� • J 11�� \``l • Pcwerpo!e I = a\ ` I . —�>" 1a p---- 95' I I F.re Hycrart tFH, I I II F,.alc 1 -_,T I I I I I I I 1 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 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 LIGHTING LEGEND PI.II44W/Asset II 93878 .01 Howe side Shield on 49W motel;Light R 4410 E. i ( I15TALL HOUSE SIDE SHIELD J / W SW FAIRHAVEN ST e P. 3 �`, , 7,<--ii. -- R ��� .,�,.. u '° 1iN� .. G111 BII lEEORE YOU DIG [1 A]IFMIQV: ][ THOORESE EWES REQUIRES YOU TO S LLOW952- IIVIES ADOIIE4 EY THE OPETON NYM P OTNUTION COMET T RO YUIES ARE SET FORTH IN OAS TAIN COMES THROUGH LE]-0LLNG iT OBTAIN COMES OF THE HCAT BY[RUING GM OREGON IlE4lIY NOTRGTON CENTER IANWISiMTON 0 (SOl-]JYNBn a..... lii TO MOLEST UIIM LOCATES CALL TNT OREGON elw MIel below. Glum NOTIFICATION CENTS/III Al NAM IE/9 Call eE A BUSINESS DAYS PRIOR TO EXCAVATION. LW g IP. POE CONSTRUCTION DRAWING — • SDFMSNO REVIEW: IASBUILT BY DESIGNER: I 1io I AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED TIAT de.umonl occuTTIOT Iw WHAT FIELD mnNufioi. •.E�.... Tonmon: We: E .119"f or: Dole: POT ,OYN TEAL to,I,MOVN,:4NGV1 IAw0:YC000056 n fOB SC SAM OS. 4 I6,/� = ""E' E@ CIry of Tigard PL it 4410 1 , E""" TIGARD-TIGARD 13 I toll 'GE/ii ulta/""13535 SW 11]kh Ave,Tigard46�110 THINK . ` "Install e house side shields on 49W Laotek Green Cobra light wow win SAFETY COWANIBLSDNNLLE TON I "I C21030I COI FIRST! r aw GSM more BY cre Tap n T 9n SAY 912.5M0 @.08oh IA"sONSYt£On=TO 0 FORUM OENBNL UECAIC co.-ALL PG/1 AMMO www.invarion.corn lane Closure at Intersection with Flagging • am Diagram 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 spacing Between Signs Buffer'; "Spee A ` B C �A ERRATA:d,, , , ra „ Space - 20 50 25 100 100 100 75 Supplement Table 30 100 35 350 350 350 125 Updated:February 12, 40 150 2016 45 180 By:ODOT Traffic•Raodway 50 500 500 500 210 Section 55 • 250 Signs Spacing and Buffer Lengths (feet) Supplement } �,., �x s !,;Aly Y tics M' ,s.- d z� 1l r } ; ' f?o$ted f , Spac[rtgl�et ee $igns5 , ' BuffegJ+. Y f r � L��e'Sppqq.�^a 1 aV t/��.1 1 Ye 4J �,�> .t i,b 1 �. l{�• „y,ti`. ".sS!S„�cY k y>t�.`fNii E.'cf`s. �+t It ,'`f ��i F'i u�Sai } 60 285 65 700 700 700 325 70 365 www.invarion.com Larim.Closure attlnterObtioh,w t�i;F�agg•ing , bwagr'ant .0 ROAD WORK AHEAD ONE LANE C a t (Optional) ROAD AHEAD B BE PREPARED TO STOP B 4 A (Optional) •0 ONELANE ROAD 100 ft.Max. 00 PE AHEAD ROAD 1PREPARED WORK O TO STOP AHEAD C A B B C 014, 0 0 O F O O O MOP O O 0 T 0 100 R.Max. 0 A BE PREPARED TO STOP B (Optional) ONE LANE t t ROAD AHEAD ROAD WORK •H ••