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PFI2021-00017 * CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT s COMMUNITY DEVELOPMENT Permit#: PF12021-00017 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/12/2021 Parcel: SEG3563 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Job#M2819745 Project Description: Install 2500a&2000a 120/208V UG; Install 2500a&2000a 120/208V UG 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: WAYNE BRAHBAHM PHONE: 5036725440 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 padies before beginning work. Permittee/Applicant Signature: fJSSeee ea Application Issued By: I& i A Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12021-00017 Tvue: 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 unsafe 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 pennit 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#: 2021-00017 ENGINEERING DEPARTMENT • . Public Facilities Improvement (PFI) Permit PROJECT INFORMATION PGE Job # M2819745 TYPE of Wolin Project name: g TYPE 1—Franchise Utility Work Brief description of project: Install 25008 & 2000a 120/208V UG permed by NWN,PGE, or utility acv Install 2500a & 2000a 120/208V UG ❑ 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): 11990 SW 72ND AVE main line tap ❑ TYPE 3—Full Scale Development Work SEG3563 performed with land use approval which includes any of the following. • Subdivisions or Partitions APPLICANT INFORMATION • Street widening PGE DENISE CHON FOR Linda Ott • Mainline installation for sanitary sewer, Nie' 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 ❑ TYPE 5—Tigard Triangle Phone: C RE W COODINATIOWW ESTER N@pgn.com Ercall: Phone: NOTE: Type 1 and 2 applications may be Contact name: Wayne Brabham emailed to rowl,eriTiitsra:,i��,ird,>r.�Lo%,. Phone: +1 (503) 672-5440 Ems: CONTRACTOR INFORMATION I] 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 I.AND USE DECISION? ❑Yes [E]No Case number: City of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • wkvwtigard-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. dim Linda Ott 1.8.21 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY 11 Case No: PF12021-00017 Permit fee: Received by: Lo Date: 1/8/21 Approved by: Date: 1 A 12-02/ 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 PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR ONLY • ONLY TYPE 1-3: DETAILED SUBMITTAL TYPE 4: SMALL WIRELESS FACILITY 7 REQUIREMENTS CHECKLIST 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): ❑Small Cell ❑;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: ❑Public Right-of-Way ❑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,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 SVi%Hall Blvd. Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 3 of 4 ' X11 1. • St Edge of Pavement IFaL � Cutch �•� Ios 1 QJ I v� Existing House I u Q I Ca I Existing 1 Driveway n i >d' OL' �' 1 d l I I o,Pz 1 ° ExMing S r'p I ;� •J � 1 Powe`rpole I = 1 la 95' 1 I lTioperty Line—•—�—•—•-- U I Fire Lant(FH) I � I Scale1'=30' � I � TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) � � I i i I 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 Cityof Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • ww"vtigard-or.gov • 503-718-2421 • PQge 4 of 4 J� Na APARTMENTS LEGEND ! NEW PGE FACILITIES TO BE INSTALLED Iwn121T2x1 (UNLESS OTHERWISE SPECIFIED) a cm eiL� _INsiALLFACIMTIEs rry y CUSTOMER TO CAU-PGE SERVICE OESN@ ! CLNSlA VAULT :Abffil..TD 6C1EIMLE CREW STINO-BY WNLEPLUMBINOINTOVT-. ,ro qy B10! GE SWITCHVAULT.INSTALEDBYCUSTOMER T.510673198 N31i TOP / M3E TO INSTALL 7 WAY LATERAL TAPS w !i Q FAULTINOILATOR •ea __________ INSTALL I.4]GL-TX EP0.IKT PPILNRY IN IOFJ-6"PVC CONDUIT -PROVIOED S INSTALLED BY CUSTOMER w qy p -----------IN PROVIDD&PLT%®RM CUSTOMER N'PVL GONWR INSTAL ED 61NBTNN SECONDARY BY CUSTOMER _.MOVID 0.I IN AL OLEDByCUSTOM CABLE TRAY, INSTALEDBMST-W SECYLUSTOMER PROM I&D&IN AL-OX SECGNDANY IN CABLE TRPY, -"PROVIOEDIIN$TALLED BYLVETOMER 5106-IGE VAULT k M Sp4FN2YJ6MF h'3 VY. T Vr-151 ETES 'L p■ IPM _ g N 1[61 I• \�' - ; /aro NNNY xf. ntl a `4y : • P ea ^4! •I 1•fly n� • r.im - ; Vr,w CONSTRUCTION NOTES: RSMnI ` m: R AlC1r, au AIM.Fas^EsnwiRo mow,"K•rc ..dab.. 2Froa ��� _ ___. LmEN i m i�rmu."�f`n'wi�nu�rier..'��rutl .nx.un.,w�m�ire ro I• wn vam_ .e ' "S.'.R".''.'>.'n" e..wu� y •0m'$�e:arg "d1;. :..F. ..,».ruraab',x�vc MNIITYd/IIIiI _ eme�.�v[L em ti� Vrr e,su,. vanuaY{'eil`rn ie'mu'me'�:,�"n nx.4..+.v �w•�+` onrncr sERYlcE coDRarGR THIN[ ��� t"' ""•"°•"� '"�"' 'u " SArCTYIft VICINITY AW flamww". efl PNI + vim• o��.0�F" 11 M• �"'� Yi8u,ertµ [awPiluYiwmpTw.Tn� ew me01�Yi,� uvx„ruM Aeeewn,w. S10B-PGE VAULT ANYDEVIATION FROM THIS DESIGN MUST...A 11� �ox.a.nwerexoroecuuunarv®row BIB4FISMAAY SE APPROVED BY PGE PROJECT MANAGER nRro�•- vrPz Raa :. ssaa ro \ RgHf#WAY PERMIT NOTGE. 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Wyn�P�M•m PRIMP KIMUTNIIRMI. fJleiewti eeaxn..00ri...,aa+.cco..N,wnnArsaMa FLOOR WALL PLAN UNISTRUT SUPPORT PLAN E1224TNGLL Roots CEILING s as s SHIP--- nY a A' 1' IF nd 6 ----------- ____________ ___________ _________ _ ___________ 1 TRANSFORMER VAULT VT IN IT MIN CMIN 5. °' TRANSPoRFR wILLT • ' • • • • r vT.lEo r i ID' • S APARTMENT T MlJ REruL %FMR xFIAR r • r s • • • • • • • • • ]Y 6' - 6 - yT. • APARTMENT 5' HOUSE)RETAIL %FMR XRAR W • • • • • • • • bMN 6'MIN -s • • • • • • • • Sm. r r f_ TNM�YTRA✓� • • • • • • SWEFJ AT CORNER Ib • ba NWD CDPlBi Ib -yl<.1 IT Ib OI • • • • • • • • • • S ° BB. i bd I.SETB�Y� p nd / of I LCOR 1111 \\� Cp18TRl%:TpN NOTE'INTFIQ;VEA! NOTE:RIXIIE YFER IN 1 , , EMMUaT FA!MISTAllF➢ON ' FLOOP AT DOOR 1 SOMRI EACMO W/1L N.IT NSTALLF➢6' -- I w L LEGEND LEGEND SU-P1 IN DIAMETER AND IT DEEP WITH STEEL GRATE THE FISHI SLOPE TO THE 6E 6MIC CO4NECTOR BVS-PHASE FUTE$MINIMUM I['ABOVE FLOOR SUMP WITHA1116-SLOPEPERFOO? 9-WA11I3HISWITCF Q A-N'PRIANRYGONDUITS • RECESSED BURNECLUTCH INSERT AND SPREAD TAL ANCHOR 1TOSWTH OF BLUE SAMERWOOD FORM INSERTS THREADED TO RECENE IIA RCOS TO BE IN>-' 1MNS NLRMIRROIXAMORSWIl16 SPACINGBETWEENTHE • IN THE CEILING IN A GRID PATTERN Ir OFF WALL WITH b'OC SEPARATION IN 1 W0(RL-S NNUS19 A GRID PATTERN.STRONG-TIE GOAPANY BBWF26N EI RECEPTACLE - I NSIALL RA I E IO RISE HEAT DETECTOR ABOVE EACH TRANSFORMER. 10'ABOK BOOR . RECEY®BURAE DILUTION III AND SPREAD TAIL ANCHOR INSERT IN WAIL BBI RECESSED ULPAE 0.UTCH INSERT AND MPEAO TAIL ANCHOR MEET IN FLOOR iS WIDE NONYETALIC NU KY SEISMIC CAERE TRAY IV MINES FLOOR RUTNEWSPAOREW SIDE RAIL NEIGH 6' A-A'PRIMARY CONDUITS UFER GROJNO CONNECTION POINT INSTALL 250 MOM BARESTRANOED COPPER WIRE SO WIDE N1111-TCI I It f N5�v 51 I1-11 CAII E I IFI 1'LEONT II'.".'.I • TO DRIVEN FILING OR BUILDING REBAR IMT WITH 3 CADWELD CONNECTIONS SPACED OVER 10 PUDENFIG H'„I;' TIE TAILS i0 250 MCM IN WALL GROUNDING LOOP WITH 3 CADWELD CONNECTIONS AT Y O.C. PREMAIUFACNRED ll la-11X Ll 1116 UEAOTTH BRONZE WOUND TAU`INSERT WITH A 1?DIAMETER STEEL ROD 24-MOVE FLOOR PGE C."E"Ru''NON dLA�NG • (6'OFF CORNER B MAC S SEPAMTION, OFF'12nWAM IWATENTs FINK1 16m001M1 wM211PN5 ATTACH TO 2EONCM OROUNpNG LOOP YITM 3 CMIVFLM PER NSERT • BATTERY BACKUP BUGEVE L•GHT ABOVE EGRESS DOORS ONLY AL OTHER LIGHTING WEST.. �I)x24 TORE WALL MOUNT 16 ABOVE FLOOR • N'LED.MOIST ENVIROUEHi FIttIIRES 11YN TLtlha TlyPD.MFTD3 INSTALL 250 MCM COPPER CONTINUOUS WOUNDING LOOP f w lmn w..e.>�A m Imrr�maou Iia�.eA rl.lr. -------- 20'ABOVE FLOOR IN WALL AND TIED TO VERTICAL REBAR WA&IRCTOR CM.3N INSTALL ON INTERIOR WNI 2-CONDUIT MOUNTED 3'CFF FLOOR.FROM SUMP TO EMTFNUR WALL lym>1Nn. 61E DFIIIA jAATIbNA INSTALL T MINA DISCONNECT COUPLING IN RECESSED NOT OF EATERFOR BUILDING WK_FOR SUMP EVACUATION rta OmRONYfeE^MUFLI1Km..M1 WOIT61FSRrt➢ �" w Jnvarion.corn aaar aeon 100'H• DEVICE SPACING: IN TAPER:20' TANGENT:20' 'I Ih sw canton st I I I Roan 5 I I P.I&sPPttrw to 104,'1- asslat"d..t an lrs'. � uNly aroun0 rOrk eroa. • � AAA a ee _ _ a s sw onroemn st i — — — — — — — — — — — — — h wo:K MOT PEMM a .o..po...nr.. on.l. i T P6r tvnxanik ucl---------- - MtmnUs ,usaw nr a.. rMµn >I wt mn.n+,reN.r• _ roves wtr,a.r./rmsasaaa _ __ wbw+�eev.ron All signs and devices SHALL conform to the MUTCD/OTTCH. Will adjust to fit field conditions as needed for safety. CbrYn PPtako lr". — Plan NOT to scale. POTELtO .INC