PFI2020-00399 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,Trent Brickey at
971-228-9269,to establish a preconstruction meeting.
Please call 503-639-4175 to schedule inspection, use code 738
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
City of Tigard PFI#: 2020-00399
• C ~ ENGINEERING DEPARTMENT
TIGARD Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
PGE Job # M2885936 TYPE OF WORK
Project name: B TYPE 1—Franchise Utility Work
Brief description of project: Replace Frontier owned pole 1297 performed by NWN,PGE, or utility
agency
❑ 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): 15685 SW 76TH AVE main line tap
SEG2345 ❑ TYPE 3—Full Scale Development Work
performed with land use approval which
includes any of the following:
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Name: PGE DENISE CHON FOR Linda Ott • 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 El TYPE 4—Small Cell Technology
❑ TYPE 5—Tigard Triangle
Phone:
CREW COODINATION-WESTERN@pgn.com
Email: Phone: NOTE: Type 1 and 2 applications may be
Contact name:
Nikee Weber emailed to rowpermits@tigard-or.gov.
Phone: +1 (503) 672-5455 Email:
CONTRACTOR INFORMATION 0 Same as applicant
Name: 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? EYes M No Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www:rigard-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.
.Laaa, Ott- Linda ott for Nikee Weber 10.23.20
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: PFE2020-00399 Permit fee: ,1)O.c) Received by: AL Date: 10/26/20
Approved by: % 7' /8- Date: fO/a7J2 '2D Notified by: AL Date: 1 /2i 10
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwcutigard-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 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): ❑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,Vicinity,Abbreviation,Legend
If equipment is to be located on private property,describe the 0 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
❑ 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
Q 51V .. y •• 1
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TYPE I 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
r OVERHEAD LEGEND
VV I Ij w N ,., w.] NEW PGE FACILITIES TO BE INSTALLED
hrIll3 „ ��i,L Y1 (UNLESS OTHERWISE SPEC IFIED)
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CONSTRUCTION NOTES: OH
1mose CONTACT SERVICE COORDINATOR 1. BEE TIE POE ELECTRIC SERVICE REOPIREMENFS IE]pp FOR THE PULL SET
lam _ _ OF REQUIREMENTS E ESR ROOK CAN BE fpH]AT Nam- A'PfwM.Mm
}Oil + 1 CIRTWERISRESPONBILS1 TerOi3ALLBULLONOA+DELECT1LCIl PERMR]FOR
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a01E3 00 50D6,2 1B BMINORSANO TRESTIMMINO PEpIrt6,A6 REQUIRED.
a• BT Z. ALL TREE TRIMMING IS REWIRED TO BE GUIWLETED PRIOR TO PIM INSTALLING SERVICE.
• YA l C5OMACi PG[S[RVILE LOORONATOR IX OPCERiO RE[EWE AXIPPRDYED BERfl
fi ANY DEVIATION FROM THIS DESIGN MUST REPOOTI IE"PITs1O�es WQ STRRFFTSwc`ARKI AG io.s ROOFS`DECKIKSS Am3 RNcONER
CI RY AAAP BE APPROVED BY PGE PROJECT MANAGER ACROSS UR BESIDE DTNER OVERHEAD UTILmLRE¢.ANC NNACEAT TO WINDOWS
I.
B. GMIWERGTO OUESTANMSPERION EY PoE SF005 CTNOI.BI HIKE COODOATOR
RIGHT0E-WAY PERMIT NOTICE: TARE SSTAMME UNHIiMS IOFECTIONa eENPRRFOAW LLNOTExERO¢E
A PERMIT FROM THE LOCAL JURISOICTIW IS REQUIRED BEFORE ANY PGE CONSTRUCTION DRAWING
WORK IN THE RIGHT.OE-WAY MAY BE PERFORMED. ONLY PGE APPROVED
CONTRACTORS AND CONTRACTORS WHO HAVE MATE OTHER SPECIAL tIAT,W5013010 ]ANTS IAcc.°.10)0001 I A01000004505 IB..M28B5R36
' AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER POE'S PERMIT TITLE
JOB SITE THE CONTRACTOR MUST NOTIFY THE LOOM_JURISDICTION 4E1111111:`: \ PGE-Knwf6514ivl,FAI
/ BEFORE WORN IS TO BEGIN.A COPY OF THE PERMIT MUST B""
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1, DURHAM-BRIDGEPORT no)
THINK ATTENTION: CALL 811 BEFORE YOU DIG PGE LOCATION
OREGON HAW REQUIRES YOU TO FOLLOW EES ADOPTED 15760 SW T6M Ave.,TIGARD,OR MD
SAFETY BY THE OREGON UTILITY NOTIFICATION CENTER. 8„
DESOBP BO
THOSE RULES ARE SET FORTE IN OAR IN COPIES1-0D10 \ Rep1R®BlO Fronts/pole 138T
J FIRST' 150 RULES
BYCM.L 90.vou MAY OBTAIN OF uN l]) NORM WITH SHEET
THE RILES BY CALLING THE OREGON UTILIN aTY `` vExrEN WASHINGTON C21-11C M2BS6213 1 0,,
I N )
OTIFICATION REOTICN CENTER LOCATESADMINIS CASE THE(aN-'(92-HMI, LINE CREW ENIERR GE¢OHN BY PHUM!Ib PENCE TANTILOVA
UTILITY NOTIFICATION CENTER,811 AT LEAST Call WIPP youd
2 BUSINESS DAYS PRIOR TO EXCAVATION. IS OFORTLAND GENERAL ELECTRIC CO..ALL RIVETS RESERVED
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
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 be 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 flagger placement shown may be 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
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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ERRATA: Posted Spacing Between Signs Buffer a
Speed A B C Space •�• Q Sri Q
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Supplement Tebl• 25 100 100 100 75
30 100 p
tes Update*rasnwrt2 40 350 350 350 150 O
erOeOtnd&awbvr 45 180 ixQ
fib' 50 500 500 500 210
55 250
Sign Spacin and Buffer Lengths(feet)Supplement
Posted Spacin Between Signs "Buffer"
December 2011 Speed A B C Space
Chapter 5
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60 285
65 700 700 700 325
70 365