PFI2021-00208 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
• COMMUNITY DEVELOPMENT Permit#: PF12021-00208
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/29/2021
Parcel: SEG688
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE Job#M2804858
Project Description: SEG 688/ 11640 SW 135th Ave. PGE to pull wire through contractor installed conduit. Installation of a
street light.
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.tioard-or.00v to schedule inspections online.
Contractor:
PHONE:
Applicant:
NIGEL KHAN
2213 SW 153 DR.
BEAVERTON, OR 97003
PHONE: 5036725462
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.
Permittee/Applicant
Signature: See application
Issued By: LA 46�i&
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12021-00208
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[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 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 anylall 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 agreements]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#: PF12021-00208
ENGINEERING DEPARTMENT
. Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
PGE Job # M2804858 TYPE OF WORK
Project name: 8 'TYPE 1–Franchise Utility Work
Brief description of project: PGE to pull wire through contractor performed byNWN,PGE, or utility
icy
installed conduit. Installation of a street light. ❑ 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): 11640 SW 135th Ave main Line tap
SEG 688 ❑ TYPE 3–Full Scale Development Work
Tigard, OR 97223 performed with land use approval which
includes any of the following.
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Name: PGE [Nigel Khan] • Mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tigard
Mailing address: 2213 SW 153rd Dr water service area
City/State: Beaverton Zip: 97003 — ❑ TYPE 4–Small Cell Technology
Phone:
503-672-5462 ❑ TYPE s-Tigard Triangle
Email: crewcoordination-westem@pgn.com Phone:
NOTE: Type 1 and 2 applications may be
Contact name:
Rico Torres Solis emailed to row_permitsna�ti ard-or.gc)v.
Phone: 503-672-5417 Email: crewcoordination-western@pgn.com
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 LAND USE DECISION? OYes 'M No Case number:
City of Tigard • 13125 SVC'Hall Blvd. • Tigard,Oregon 97223 • www.figard-or.gov 503-718-2421 • Page I 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.
lfl)i WI4i iy Nigel Khan 06/08/2021
Applicant's o authorized agent's signature Print name Date
Property owner's signature (if required) Print name Date
STAFF USE ONLY
Case No: PF12021-00208QQ Permit fee: .®� Received by: NT Date: 6/8/2021
Approved by: %y1Gn/ P Date: /02912aZNotified 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 Penn it Fee).
WATER LINE CONSTRUCTION FEE
Part 3: All public water system improvements engineer's estimate X 12%.
FOR STAFF USE ONLY • ' STAFF USE ONLY
TYPE 4: SMALL WIRELESS FACILITY TYPE 1-3: DETAILE D 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): ❑Small Cell ❑Macro ❑ Street Name
How many install sites are proposed as part of this permitEl 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-Wap ❑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.)
❑ Engineers 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
jEdge of Pavement
Streetligrt �� Witch -
1 1
j T- iohos d^SmaeiTine-
I I - 1
_ Existing House 1
I
.of i rxistinp 1
C'riv?wdy
I
aj I 1
n
L V yJ
I 1
rl
3 Existing Shop ;
Powerpole I I = 1 1
0
la 95,
77ni.71;t7ne-----------
Hyarard(F"
I
I I I
Scale1-=30'
� � I
TYPE 1 AND TYPE 2:
MINIUM SKETCH REQUIREMENTS (Put N/A if
I I �
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. a Tigard,Oregon 97223 a wwwtigard-or.gov e 503-718-2421 a Page 4 of 4
•5 LIGHTING LEGEND
x
NNN IF q.
II'• vwNm YAP - - �„"..
MLWe
_ E
a
' I I c/wwSLUT
II,R Y x.. rRoz neruLED ..I....�..
DM Mauna
f d
a
an
flGM#WAY PFRMIINOiKF' fl roNFov[un °
f NnmrtxeaY nw Locu nMlw rnox feEux
wofxrn fOxr.or.w. sf NarofMn OxlrfsEffnrowD
� ° (UVIMCIMfPMe CONIA9CTJPf WNe W1V(MxNPTMf1Y(MI 9.w[u WrtN.nouro;wssR.X�rw.x¢evwR°
.uNnaunn. rx
fi I� ILtI I4PEEMENiSWIMPGEWRL BE Pl10WEU i0 N. VXpEXP t'S IFPMII °ti.LLoo�n�M�
ravnxcroB MusTxonlrrxEla.M ruxselnnN.elwlXR .uNIE"..wx;n�.w.c 11.�;.a..u.w lo..Iw.•RMM.1
IS MWos.IsroeEDw aron OFm Iarrere.YSI.
f PRE-CONSTRUCTION NEET/NG/TRENCH AND CONDUIT INSPECTION
A r<'11TM YOUR PRDJEcr REQ01ResnPFEGCNS1RUCTION MEETING.G0fTY%CTYWRSERVBLE S DESIGN
PRGIELTnP ERiTOtOWORKNGOAYSPRNRTO11E WATCNTOCOORDNATE TIEi
{16fdMPI PRECOY PGE'S FIEIL CGMSTRµOCONDUIT RWSPECTIONS.IWLL PROVIDE YOVft 1REMLX ,.;.. emm
MIL—m
INSRll3MM/MES Ix SEWNMAYTttYiLLSORYCM
ULIS IWXKNEWPIS STIrfOWTCfMACXMFA'IIFMf11W wr W xr
JW/C]RW eOI NdLL1ATKl.Q CONIACi S[fVK[COOfnINITOR VArtI IK1rnY5Wle.flO(C llffO �.es
d1IMOM eNLYi•Y— w
gI.wTF[x TwOcDaMxtm M �..<.�_....�_ *.�
w11 MNSIOMEB
EpyKECOpNyry NNSNLLAr M[t.MF ArEPS iNF[WIWX. '
NS NSYMI400 Y P K-
��" " M DOW rN RsDEVWro{Mzewsw •" -wi,M.BYO SVB:
E
Q WOE 292f Mson
DO MSLCST r^�alu "� lwwoela MieWBN
/ saw S.a ms P
�L'i. 1Tw �"" �` Maa.YRLL1MJRR.VHLt rOn fiPG
NNN M' n aeelxwl»,S Na adlrs.{{ THINK \/rnsaosw rBsn P..TGMe
eePGE FACILITIES NOT DRAWN TO SCALE SAFETY P n tuD uru, lw .IaILED M.°awnM.. rov .�„
-L.���� _M�TMTM TRe oRAwixc isA m.PNWx REPRESExuTlax of PORrI.wD CERERu Ir'I' w.sxNolON cnvG scss
�, ..—�= OFVgRONfAtlRITHfD6KdIMIST ElEcrNC PACSRIESw NUMEESTNEMW LLOQSMDEEIEOTMDK FIRST
IL. ' %LT NENENTYTYPESAYDNUMBEITONSpIDUCTORd AVDPVLEYN1iCi L.
BLAMCO
•' APPROYHI6YTHf FCEVRNECI F'WWGNI NMNYMEMMTMN 11E 0�9TPMMdi SYSTFII.Iiq REfd1YBIPEOMAT
THE U9ERYOTRELY p1TN15 DIMRAM EQi GEOGRMIN'AL LOGilg6
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
N
a a H Single Flagger Operation �' 1
for Low Volumes (Optional) o Q
N N w y (ADT<400) ro vo o:
0 o u o Da o BE
0 0 0 ? e e c PREPARED ONE
RS E
m a Tt t• A M A TO STOP ROAD
r
7
ROAD
'm � � — —, , '"r•,�,.— — �— • � �
WORK
LO K aK e«• • I—.I AHEAD
O O O N m •�
nN.1.rve. I i LLN
N I i
N N�ii-3
HET
CD
I
b
_ 1 mile
r max. y
• • • ,r• • — — — — On
•
f!?
K K K K •
B B
Buffer
Protection Vehicle
w/TMA(both Optional)
ROAD See Chapter 4 O
WORK
AHEAD ;
BE �
ONE LANE
n ROAD PREPARED" Two Flagger Operation 07
AHFAD TO STOP.
W m
(Optional) pco