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PFI2022-00057 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12022-00057 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/28/2022 Parcel: SEG132 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Jobs#M3027227 and M2994998 Project Description: PGE to replace pole 2060 add new transformer. Contractor to install conduit underground to home. PGE to pull wire through conduit and energize. Class of Work: FEES Description Date Amount PFI Permit Fee 02128/2022 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-6394175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.ligard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: JOE VELASCO 2213 SW 153RD DR BEAVERTON, OR 97003 PHONE: 5036725459 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. Perm ltteelAppiicant Signature: See permit application Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12022-00057 Type: Condition Name: Status: Severity: City of Tigard PH#: PF12022-00057 ENGINEERING DEPARTMENT . Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK PGE Jobs# M3027227 and M2994998 Project name: 8 'TYPE 1—Franchise Utility Work Brief description of project: PGE to replace pole 2060 add add performed byNWN,PGE, or utility agency new transformer. Contractor to install conduit underground ❑ TYPE2—ROW Sidewalk/Driveway/Sewer to home. PGE to pull wire through conduit and energize. 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): 9655 SW 74th Ave main line tap ❑ 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 [April Neale for Jose Velasco] • 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: 503-672-5459 ❑ TYPE 5-Tigard Triangle Email: crewcoordination-western c@pgn.com Phone: 503-464-7777 NOTE: Type t and 2 applications may be Contact name: Jose Velasco emailed to ro ermas tigard-or.gov. Phone: 503-672-5454 Email: crewcoordination-western@pgn.com CONTRACTOR INFORMATION ❑ Same as applicant Name: Hals Construction Inc CCB Number: 34434 Mailing address: 20666 S HWY 213 City/State: Oregon City, OR zip: 97045 Phone: 503-793-1402 ask for Lee Email: ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000): $ tinder$5,000 (within the public right- of-way) Is work related to a LAND USE DECIODN? Oyes 30 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Orcgon 9%223 • unuw.tigard-or.gov • 503-718-2421 • Pagel 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 Incensed 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. 48eAd/t,)"A April Neale 2/21/22 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Dare Case No: PF12022-00057 Permit f 3Oe-171100 2/22/2022 Received by: HPollarrl Date: Approved by: Date: 2 2 Notified by: AL- Date: City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 9 wwwtigard-orgov • 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 • ' STAFF USE ONLY SUBMITTALTYPE 4: SMALL WIRELESS FACILITY TYPE 1-3-DETAILED 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 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 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 sw )- " ':� I Edge of Pavement I -'*— Ditch -AAAA–P- Streetlight I —•—•—•—•—•—•— —f--- I I ' I T� Prop je a—= Existing I 1 I I Existing House � >. i Driveway ml i ti � 1 a. >C i v1 =I O' rl r� I >K o�`'a 1 :I I 1 oI i I Existing Shop 1 ' Cn vv1 Poerpole I = I a 1 I Ia gs' 1 Foe Line I I D per,._.------ n I Fire Hydrant(FH) I i I Scale: t"=30' I I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if I 1 I 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 Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 0 www.tigard-or.gov • 503-718-2421 Page 4 of 4 Page 118 2011 Edition Lane Closure at Intersection with Flagging Diagram 620 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. Sian Spacing and Buffer Lengths(feet) Prated SpodngBetweenSgro *Buffer" Speed A 8 C Spam 20 50 25 100 100 100 75 30 100 35 350 350 350 12S 40 150 45 180 50 S00 500 500 210 55 250 60 28S 65 700 700 700 325 70 1 365 Chapter 5 September 2016 2011 Edition Page 119 Lane Closure at Intersection with Flagging Diagram 620 POW* B B A (wD—n IA E� 1ODL V• • yE po1D 1 10 blot • �D A B B c 4- ®f 1m D.bwL A B ITIYI to aloe * B as 1 1 ° September 2016 Chapter 5 SINGLE FAMILY LEGEND NEW PGE FACILITIES TO BE INSTALLED 95J5 u Z (UNLESS OTHERWISE SPECIFIED) m A E� tEMc._F4CILITIES INSTALL FACILITIES m � A 12D124DV ---------INSTALL14A350A INSTALLED BY CUSTOMER CCUNDUT 209D PRONpm 8 INSTALLED BY CUSTOMER 320AMP W.4 1 23% ETON 1999 .3%VD 2.05%FLKR 7.926A AFC 80' C 25.0__•___ rrr 143 40 T WBOS MIS 2015 �T SW BARBARA LN N PL-2080 82 A JUN-UnMown 3P-UhI 2005 INSTALL: 2000 C B WKVA 142 C/O FST 720GV,120RAOV.10.3W W . MAXIMUM LOAD:28KW C1 1-25D ADDING LOAD:181 Q TOTAL LOAD:46KW h REMOVE: ^ C 25 78125 u ?+ N INSTALL 3-POLE CONDUIT UNIT z ON EXISTING BRACKETS 8 WEATHERHEAD r0 2•EXISTING 1`^iii —► 35'-u,eFD.YR C2646619 CONDUR 2Da S\ . RIGHT-OF-WAY PERMIT `! APERMIT RMOM OM THTLOCK JURISONCTION IS MED. CDBEFOREANY 3" 30E COTRATORSAND-0F-WqY IMV BE PERFORMED MADE OTHER D CONTRACTORS WITH RUE BE W HAYS MODEOTHERSPECIK CONDUIT p06 AGREEMENTS WITH US WILL BE MOWED TO WORN TIONMINISTER4 PGE'S PERMIT. TEFL WORK MUSTNOTIFY TE LO CAL RENAT MUST 4B HOURS BEFORE WORN IS TO BEGIN.A COPY OF THE PERMR MUST BE ON SITE 257 w 45.3 CONSTRUCTION NOTES: SFEXT 45.3 2020 9)m _2i' 1.SO WANES ANER TVPRVNBE KL 1.FINAL NO GCIt TRENCH TOBE 142407 NNC11E9C iWSESM9VREDf IBEE.DOLE RLLMD III IIF FRONN Mry WALECyhV.SCNEgILE FO EIECTRIGAL GPOLE. Hv uw,INwrtx THEE E BTRN¢5IMNSIMIBC YECT NARROWSTRE TF DERIBRRiICRL THE SEE AND Ee Ngt3M'T INCHES CLEiRE4MC BETWEEN OAS AND OTHER UTILITIES.AL ELBOWS TO BE M MCH IMIW WL ,Al,lN SS ARE FFPFOMNRFO RIPF.OFFO I PIG IS TECR1Rm,RR,,FARYM�S BB ACCERjESL FMR N90F bFEEt OR.EN3AS 7ryR SCt3NAfR LOT.LL�BESOSIN NIT 15Ln dm 1.AWE STANDLY CREW IS RUMORED FOR CPFMNN ALL pGCENVAllT3 OF CONDORS NO PULL 3TRMGS.CAASCMES LL S CE�OORRENTION Al.1. TO SCXE W IE A PGE STANDS V CR E W. ERALI .1EDMQ S-RFRRIECLLAGRIOEF WCCWfNR1 SCM NEVI R1HE911RINGSG ONES IBS.TES11 I DIRPEITIONFL0041NGREOUIREMEN :.NCKHJPE IAICENITr PLL LVLQF WC, VICINITY MAP Sicn nPa oucrR"M"EwANc^co7oeigBioS`ii o °-"l as`MM�r"ii�c"Ic°L a'ouNEMENIs of xE svici."icn.i«."Liiw� LEONIREOUESTFRoMPGEPRwFC� - - FEowNLY SPALL .LD,t .., i REMEMTIT9 SETTMEL TEST OF 'FC7 OILS 51NGI F PRIMARY INETM CATIONS{.aNMlR 101y11.O A NNIMJM OFGNFFM1W IMNSFORM�R PRO S ALL ROL BNLp4G WALLT,11INERS TO OR OVERIUN�AND4 FEETK�S FELT UMG AIR HUM ANY FNEE HYANY E p�E µW yRANMy CRNERS MOST BE NTiXN IS FEE TGf MAIN 10 FELT CLEARANCE M FRONT OF 4L TRANAFNLRMERS. T.RUSTOMER TREMOR MD EAOW CCNROIMATOXSNM ASi SE NSPECTED SY FGE FpCILTO INCIIFAUXGALLS YWNENE MUR AFTERNI.FRMWEdgLEES }W IIRIIIBf:i I.n NeAIS CALL wsa I.OR YFroGI3aFt` _ ..WTO1WORgI00MVSFM Alle ITOOGcuR TANI eN nr V12ERORC FFEpIR1EMWI�iORMT SMTµI%ENDMIMMLfgI CVSTgIE0. u � uDBxO JOB SITE Mwi. c.Fdr.r ENNNN ITRIAclm' NAMRo TM^°N a rm.rwry ANY DEVIATION FROM THIS DESIGN MUST -BUILT VERIFICATION & NESC VIOLATIONS CORRECTED BE APPROVED BY PGE PROJECT MANAGER "nI°"_ E^ ®6r[9A0 FPNnron: : ,MN r.R.N eARO CONTACT SERVICE COORDINATOR BRUM 4!!&2011 NONE AEEaIK+' AWG. Mo M•MIS O NII •w.e FroTRNCNAND(S un PARFROYN�aR TRUE,NTS 10)0001 150000199{ M2994985 eAav4L. EARNINARLIUM ` BRIAN LEET SERVICE COOROONTOR J U-Tm M.D LH / GARDEN 8QE A01Bh6100 aR 800619'8818 GARDEN Hdff-METZGER 1h22 TTElFT1ON: CALL 811 BEFORE YOU )G PGE 96 ATSN RETiON uW RfOURES vOU TO FglOw g11LE3 AOOPIED 95))SW 14TH AVE 95)7 TIGARD OR 9)223 THINK BY THE OREWNUTIHtt NOTBX=cSNTER. OESESSIT 1 THOSE RULES ARE SET FORTH IN OAR Es94D1-00D1 PROVIDE 320A 120I240V 1P SVC TO 4K SF HOME GAS MEAT ,:V,S'',.IUv I,• $AF6TY ROUGH 95zo0wIWYw rMv aBrAN COPIE3OF couN,Y ECTOx1s WORRWITH $NEU FIR971 OTMT9IGA fMI�N1EA UMMSTRA I M0TiS9>z3z-19Bn REASERTON wSRSNBy 7DN c11zsD �, IO RELVEST DRILY LOCATES CALL THE OREGON LFE CI�W CFMFR IESICN BV ON !S]9 ORAWry OY UTILITY NOTFICATION CENTER.BtI AT LEAST de ' uIxTLN,M .qSE VELASCO 6)1-5450 SVJATHA NARAYANAN 3 BUSINESS SAYS PRIOR TO EXCAVATION. CE�E11Fn ISS4 CPoRTLANp GENERK ELECTRIC CO..ALL RNiHT3 RE3ERYFD ay OVERHEADLEGEND a@ 11111 -vovFFAIN. TIF, INSTALLFACILITIES VI rvU� I POLES n HT ri OLE CUBS OLE HEIGHT (FEET HILPAMi AC )TON 20e0 FRAMING '. ) • 45'-3 TRAN5MI55KIN6g5TR9UTON 15EE CODES BELOWD5%F 2.05"hFLKH 1.926A AFC RO' / �FRu.R q>mpNpN aclanO.NOT"I ----------------- 143401 Flo- 0905 •`DI 11 PN TANo.,vN _... C O CIAL IDS _ 20- ms W47 'ems -- SW BARBARA LN P 2060 63 6] ♦ N-Unknown 45'-3 3D'-Unknown MOB 20me O UNE w p Cl 1-25D REMOVE POLE PGEOVMDPOLE Q PO PGE TO PULL = 8855 4S< � 3 TEMP TRANSFER COMM(5) N ❑PGE PULLED. � ❑TOPPED TOCOMM(S) CONSTRUCTION NOTES: Sp OH to[0.EOUIR�MF1Rf4R�B F�C1N�lFilRi lipel�FpvlLupawralmml f .81 x. CVS^�Rr 15 uTENilN3Mp1Ll°1P OfA TST�IERk1549(LICNECN�A.iRtE FOR�1iMMiS.V1R u'-unYJIO'M1 G26 MN! GseRINT 3 AND TREE-xNIMMNC PER..A3 REQUIRED, 20m ]. ALL E TUMMHG IS FFWFFO TO RF COMM FLED PRIOR TO FOE WsrALUN°SEWCE. 1. SPOTµo CONFFIIRRMCHATTHE SERVITICEEI�RMEETMALL�PPNVµALE MUEL C'TE�cE 1EM3 gEW11FA1EN15 WER CHAT THE 51PEETS PARSING LOTS.0.04F5 DECRSANCOME., 3(I•J ACROSSCR BE3CSOn4ROERIEAD OTIL YNWE4,ANOADl/EEMTOWINDOWS. 2009 5 AFI=Rffl TIEMPRCPRL NUNICIPNELECTRICALINSPECIICH CVSTOLER TOAR I ANNIPECPONBl PGEOVCONTACTMASE NCE COORdN . dD'RMM3.RJCIW INTMPORTJ MFA.PGEWLL ENERGIJE TE SEPKE UNTIL KL NSPfCTCN3IMVE FEEN PEPiCMRD. . 1 1428T PCF a.3 RIGHT-0F-WAY PERMIT NOTICE', A PERMIT FROM THE LOCK JURISDICTION IS REOURED BEFOPE ANY WORKINT ERIGHT-0F-WAY MAY BEPERFORMEO ONLYPO ARMOVED ' OT CONTRACTORS AND CONTRACTORS WHO HAVE MAUI,OOGR SPECIAL AGREEMENTS WON PoE WILL BE ALLOWED TO WORK UNDER POE IS PERMIT THE CONRRACTOR MUST TpTFT THE LOCAL JURISDICTION OB HOURS BEFORE WORK IS TO SEEING A COPY OF THE PERMIT MUST BE ON SITE. " ' DO WITH WOItM2994998 x VICINITY ASAP ANY DEVIATION FROM THIS DESIGN MUST AS—BUILT VERIFICATION R NESC VIOLATIONS CORRECTED BE APPROVED BY PGE PROJECT MANAGER Th° ,.n•,..N HEm FawI�I: DBIF: 1000001545 CON�TACIµSERVICE COORDINATOR SITE SMR021 ftKE-NTS Au—'1010001 AND 10 0 0 0 0154 5 �-M302122T lO TFENONFNM1-Clnl lRC— + A 1E TmE SB}3 mEr IpRleniG1B \ CTROAT GARDEN HOMF#IETZGER 54317.22 ATTESON: CALL 811 BEFORE YOU DIG /PGI% L(IUTRW EOON LAW I✓EgxNESYW TO THE: AOOPLFD Nr SW 14TH AVE 9811 MAW OR 91223 THINK Y THE OREGON LREITY NOTINCATKIN L:ENTER. OESCRIPmw OSE RULES ME SET FORTH N OAR L52dB1-0Wt DNN M2994998 halal New 45'C4u 3 Pde SAFETYTERRALUNIH T'S"-0Im.YOU MAY JETAN coPEs of cTaNls FIRSTI NOTIFICATION CENTER ADMINISTRATION (5012'12-19BO WASHNGTON C1125D M2994998 .K EIT UMECRES. CESSE e. NE lso r TH TOREOVESTUTILITY LOCATES CALLTHE OREGON _�rR be1� JOSE VELASCA 612-5054 SUJATHA NARAYPNAN U 2 BUSINESS DAYS TO EKC AATION. C011B.Im. eurena•.w• S WSINFSB DAYS PPIOP TO E%CAVATION. 1FRdig. 0 PORTLAND,GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED