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PFI2021-00191 V 0 1 ZCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT • L Request for Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractorx❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Indhidual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): © CAN PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: PF12021-00191 Site Address or Parcel #: Project Name: PGE Subdivision Name: Lot#: EXPLANATION: Duplicate of PFI2021-00158 Signature: Date: 6/29/2021 Print Name: Agnes Unddr Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 34 weeks for processing refund requests. • ' OFFICE USE ONLY Route to Sys dmin: Date B Route to Records: Date B Refund Processed: Date By,4 el I Invoice Processed: Date By 71 Permit Canceled: Date B Parcel Ta Added: Date B I:\Building\Forms\RegPemutAction_I 051 .doc City of Tigard ?�O�z Z PFI#: P F 12021-00191 ENGINEERING DEPARTMENT . Public Facilities Improvement (PFI) Permit PROJECT INFORMATION PGE Job # M3002339 TYPE OF WORK Project name: Brief description 8 TYPE 1—Franchise Utility Work of project: Replace 2 floods with LED's and remove 6 floods 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): 16100 SW 72nd Ave main line tap ❑ TYPE 3—Full Scale Development Work performed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Streetwidening Name: PGE DENISE CHOIN 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 ❑ TYPE 4—Small Cell Technology ❑ TYPE 5—Tigard Triangle Phone: CREWCOODI NATIO W W ESTE RN@pBn.wm Email: Phone: NOTE: Type ] and 2 applications may be Contact name: RICO Torres Solis emailed to rowpermitsQtigard-or.99V. Phone: +1 (503) 672-5417 Email: CONTRACTOR INFORMATION 91 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 workis required(if over$5,000):$ (within the public right-of-way) Is work related ton.LAND USE DECISION? DYes [D No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.guv 503-715-2421 • 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 owners 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. Z-4;� ort- Linda off 5.3.21 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: PF12021-00191 Permit fee: _ Received by: HPollardDate:5/24/21 Approved by: Date: Notified by Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www.fgard-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 Part2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Permit Fee). WATERLINE CONSTRUCTION FEE Part3: .0 public watts system improvements engineer's estimate X 12%. FOR ONLY • ' STAFF USE ONLY TYPE 4: SMALL WIRELESS DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way licenser ❑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 (pet 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 • www.tigatd-or.gov • 503-718-2421 0 Page 3 of 4 g SW ". - '. St. Ed a of Pavement I Ditch —' Streetlight I —.—.—.—.—.--- —r—.— � I I ' T—�iopos el�w'er me" I I - I I I a) I I Existing House Existing 1 Driveway a l I 01 ! dl a i O I Existing Shop � ' 1 Power` I o D mop—eVLne—-—-—-—-—- II Fire Hydrant(FH) I � I Scale: 1-=30" I � I TYPE 1 AND TYPE 2: MINIUM SKETCH I I I � I I I I � REQUIREMENTS 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 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 27M C2 1-12D LIGHTING LEGEND 9@ 55'-1 15960 158?0 1EW? G2 15985 A 1982 -. REMOVE FACILITIES •.T•�p ASSET#97325 REPLACE MH FLOOD LIGHT WITH ro CC - PO 85W LED BRONZE EATON UTILITY FLOOD LIGHT aL� ON EXISTING POLE 19G45 �`�$ GSEEXISTINGM SINGLEBRACHET '� ASSET497326 CONNECF240VOLTS ABC 150 3140', PD-8896 16200 THINK 76u;' PPG SAFETY NYDEVIATIONFROMTHISDESIGNMUST 35'-Unknown Peze1° EAPPROVEDBYTHEPGEPROIECTMANAGER Ifi08320107 3- 325 ABC 300404 -- FIRST 1751 0 p1' 55'-3 4 i PD7511 ^\0. 1982 Ny o IN o P 3 m VICINITY MAP j - -- 76 G 8907 �L Iti z P n 35'-Unknown QQ 911 m a _ G 16240 1 01 ro 11`A 20 VT-73 �J arG P 3-1422 19j ; L 17 952 1 + Sg00 62. . -_. --. �,+" W 45J 16101 ;. *,I No lass P �le� 9VT-72 ABC 300 838 m ;: 3-1 1007 PD BUS ¢ A SET#191 Ol 18250 { M + R MOVE F ODLIGHT 16330 , L ue9 2 1 ¢ V _ 13A D A 10 12660 F OM OH MIDSPAN 16220 Im L. r, \ 10'-2 r� m'� - 45'-3 -1861 ¢m * 1976 ,SSE 7290 4<' - ,j roe slTE ��ti,�J 16280 a Y„o,4 F-----� �� 6,40 1 � V 3-143657 1016 mute ASSET#97292 P956 18270 AB A CLI J N o Q Z C 3650 At m VT-30 N I I\ ��., Z ABCs 509 433 y LASSET#97291 , 588POE CONSTRUC71ON DRAWING ABC 2 440 16165 z MOVE FLOODLJG GROUNDING FLOOD LIGHTSAB(:2 AL VT-e8 A BUfLT VERIFICATION 6 NESC YI CATIONS CORRECTED OM OH MID SPAN ee - ABC PER LC 11560-NESC •,•,`"•",•`",•••1.11—'"`°'°"- , VT-8510 ABC2 AL- ¢ VT-6887 REQUIRES MAST ARMS Foreman Data PD-8808 z BE EFFECTIVELY BONDED z General Foreman: Date: u - -- -- - FLOOD LIGHT BRACKET ,i M boldconafvdion cn a:l a a SUPBbENG REVIEW.' SBUILTBYDESIGNER: n 0 / DATE- L m ASSET#97293 3/152021 1in1000 1070001 1000009108 M3002339 ¢ A 609 65802 1� C 350 AL "TLE 4t 2nl 60011Pecific 165]5 m 9 30 2 VTAU N"', GI1cu T RealityAssociates LP 17 BC 300 516 z TIE 2003 16416 /�E DCAURONAM-DURHAM 13 11 x 17 PO-8927 0 600A 16418 / 16100 SW 72nd Ave,TIGARD ASSET#97294 6-AWG CU' DESCRIPTION 9A I 16464 Replace 2 Floods with LED's and remove 6 floods and connect at 24 SHEET r'C,H V REMOVE FLOODLIGHT h TO BOND THE BRACKET FORNEW INSTALLATIONS AND COUNT sEc"DNS WDRx MATH y FROM OH MI oa RETROFITS,CONNECT A6-AWG COPPER NEUTRAL JUMPER WASHINGTON C2113A 1OF1 16420 m N1 CONDUCTOR FROM THE POLE GROUND WIRE. v4mFONVm DEsrGNer PHONE(5081 ORawN eY u IF THE GROUND WIRE DOES NOT EXIST THEN THE SERVICE c^' SAwc*mA RICO SOLIS 672-541 LU I6 RL ANCO m:a NEUTRAL USING A LUG TERMINAL BOLTED TO A HOLE IN ¢z THE FIR LIGHT BRACKET. "oro° ®PORTLAND GENERALELECTRIC O.-ALLRIGWS RESERVED Page 106 2011 Edition Diversion into a Continuous Left Turn Lane Diagram 430 Diagram 430 shows work in the travel lane(s) next to a continuous two-way left turn lane with one direction of traffic diverted into the continuous two-way left turn lane. 1. Use truck-mounted flashing waming 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. When two or more travel lanes are reduced to a single lane before the diversion, each lane shall be closed separately. Layout traffic control according to ODOT Standard Drawing TM 852 for 5-lane sections. 4. A shifting taper(L!2) may be added in the diverted traffic direction across the continuous two-way left turn lane (as shown). This option is recommended when the speed is 45 mph or greater. Sign Spacing and Buffer Lengths(feet) Posted Spacing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 100 35 40 350 350 350 125 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 107 Diversion into a Continuous Left Turn Lane Diagram 430 ROAD WORK AHEAD B Il t CENTER WJE CLOSED AHEAD A II U2 I ;I 1 Buffer Protection Vehicle w/TMA(both Optional) ✓See Chapter 4 Buffer • • u2 I ' U2 I• I A II 1 B ROAD WORK AHEAD December 2011 Chapter 5