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PFI2022-00147 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12022-00147 Date Issued: 04/25/2022 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG3882 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Job#M3128871 Project Description: PGE to replace car damaged pole 238 and energize. Class of Work: FEES Type 1 -Utilities (gas, electric, data) Description Date Amount PFI Permit Fee 04/21/2022 $300.00 Total $300.00 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: RICO TORRES SOLIS 2213 SW 153RD BEAVERTON, OR 97003 PHONE:5036725417 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 See application Signature: Issued By: 4"2 �l, Hope Pollard Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12022-00147 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 1 t -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 MATE RIAL/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 M City of Tigard PFI#: PF12022-00147 ENGINEERING DEPARTMENT Public Facilities Improvement (PFI) Permit PROJECTINFORMATION TYPE OF WORK Project name: PGE Job # M3128871 ® TYPE 1—Franchise Utility Work Brief description of project: PGE to replace car damaged pole 238 performed byNWN,PGE, or utility agency and energize. ❑ TYPE 2—ROW Sidewalk/Daveway/Sewer Work performed for the purpose of • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 16767 SW Bull Mountain Rd main line tap Location (address if available): ❑ TYPE 3—Full Scale Development Work Portland, OR 97224 performed with land use approval which includes any of the following. • Subdivisions or partitions APPLICANT INFORMATION • Streetwidening Name: PGE [April Neale for Rico Torres Solis] • 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—Tigad Triangle Email: crewcoordination-western@pgn.com phone: 503-464-7777 NOTE: Type 1 and 2 applications may be Contact name: Rico Torres Solis] cmailed to rowpermirs tigard-or.gov. Phone: 503-672-5417 Email: crewcoordination-western@pgn.com CONTRACTOR INFORMATION ❑ 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$5,000):$ $ 5,028.21 (within the public right-of-wap) Is work related to a LAND USE DECISION? OYes I]No Case number. City of Tigard • 13125 SW Hall Blvd. • 'Tigard,Oregon 97223 • www.tigard-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 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. April Neale 4/11/22 Applicant's authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: PF12022-0014 Permit fee: Received by: HPollard Date: 4/11/2022 Approved by: Date:�� Notified bv: T Date: 11/ Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www.fprd-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 STAFF USE ONLY • ONLY TYPE 4: SMALL WIRELESS 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 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 Cityof Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-ongov 503-718-2421 • Page 3 of 4 4 sw .. _ .. Sl Edge of Pavement +— Ditch �# Streetlight ( '—'—'— —r—' F4L �Dr Cing-- 1 > i N; I Existing House 1 =r Existing _1 Driveway I ' Existing Shop IA. 1 Powerpole I I o f 1 a I I 95 -----�•-- D property Line OI Fire Hydrant(FH) � I I I Scale: 1"=30' � I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not � I I � I I � � I 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 • www.dgard-or.gov • 503-718-2421 • Puge 4 of 4 ,4394 14391 me N 18'-Cuk VICINITY MAP P 14420 1 -0?D 14301 � 2019 318 16661 A M r 20 III 15 Sep 2 E -13• 4 • ! 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LOCATES,CITY OF TIGARD ROW PERMIT 8 TCP— -18L9Y9 REPLACE DAMAGED FACILITIES WITH: 2019 30'2 PC DB FIBERGLASS BLACK POLE VTa13 VTa O +• y t•b T? 88W LED LEOTEK GREEN COBRA BLACK LIGHT VT-132 CONNECT 240V CREW TO REMOVE REMAINING PIECE OF FIBERGLASS j 7 + •�A•age It POLE AND INSTALL 20'i10 TX UG ST LT CIRCUIT e $ 16697 231 riT W FROM POLE TO CARSON BOX VT-217 m �1 **QUESTIONS:RICO SOLIS 503-403-9084" 7' :PIECE FIBERGLASSlmMrosnE/PoaEC"n:suoAs rounlc 237 238 235 231 VT-111 I i— cplerorxw:w 232 ^• nrxr oneeov vrnmraTrwrinw arnrzn noane s 16882 2 r� I 1 17MOWnulesnMsn room rxun suaoamo 18670 16840 18]74 VTa14 16621 18790 cxnwo+aom rou Mor ueulx as 238 tell 7 �luirox a" i�misnmMaYe(sc+.+u�+an 6701 VT-217 -_i-nw roA[W[s7 VlAmnourzt cut 7xr axeeelr�WkyWs ]39 _ I� urlunxomcnaN rrrrtM,r»auur d6k�In1�t ABCIMALL `38 ABC IAAL 2018 ABC 1/DALC7e0AO x—AtlO'A'L'TK ASSETM9951664 ' ° s; YDEVWiION FROMTHIS DESIGN MUST REAPPROVED BY THE PGEPRCVECTMANAGER 241 h ....... WAIknown xa.w w y 2016 242 F X ? SW BULL M01.A1�AeN RD 30'J)M010Y`n aOT10M PIECE POLE/MSIAl1ATAN THINK 0 2D 8 >IMALTk�� A1*A-X� s-AVCA1rTX No eIe g SAFETY r1VT-231 4'_r —AIMAVTx�-2�� FIRST PGE CONSTRUCTIOIIOR11VMG N 7 B 5 4 3 2 1 ,,.r..-,,yL'� ,...,..a.�cc,,.,�. Foreman Date' General Foreman: Date.- S brYM cmWueanc teeaD 16659 167MSOPM'ENG REVIEW: LLTBYDESIGNER: 6650 L Np 1/6r,!022 1 in:50 6 1070001 1000004547 M3128871 nn C 01 Tigard PLM 230 CIRCUIT SCROLLS FERRY-ROY ROGERS 31112E k 17 PGE/ L 78767 SW Bull Mountain Rd,TIGARD uEscRwn ar hil le 1112138,,re Iace with new 30' DB Black FiBe lass of -EEr COUNTY m 17 3 We l as5R WASHINGTON C2107A 1 OF 1 rrAYMTaw OESI PHONE 13031 ORAKNeV IAr<MnceneN RI 1 872- LUIS BLANCO PGE w�a.� T .ALLRICHT S Page 122 2011 Edition Work in a Roundabout Diagram 640 Diagram 640 covers an example of work within a roundabout. The diagram shows closure of a portion of the roundabout with flagging control of alternating one-way traffic. 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. If any of the road approaches can not access the intersection due to the work space, a detour may be required. Road closure approval and the detour route should be provided by the road jurisdiction. For short closures of 20 minutes or less, traffic may be held in place. 4. For work within the roundabout island, initial advance warning signs are required on each approach leg. If the work and all work vehicles are off of the travel lanes and island apron, a single sign per approach is all that is required. 5. If the center island apron will be impacted by the work or equipment, treat it as a shoulder closure for the length of work. But, consider diverting truck traffic due to large vehicle off-tracking. 6. For multi-lane roundabouts, if work can be done without closing both travel lanes, flaggers may not be needed. Appropriate signs for the lane closure at each entry are required. T Cones may not be needed along the splitter islands on the approaches if these are raised islands. In such cases, the flagger may have to move far enough ahead on the approach of the splitter island so that traffic can maneuver into the roundabout. 8. If work occurs in an approach leg, a minimum of two flaggers shall be used to control traffic. High approach volumes may require additional flaggers for the remaining legs. The ROAD WORK AHEAD, BE PREPARED TO STOP and Flagger Symbol signs are required in advance of each leg as shown. 9. If a travel lane width of at least ten feet can be maintained for shoulder work on an approach lane, the lane can remain open to traffic. Close the work space with shoulder taper and tangent cones. An initial advance sign and a SHOULDER (SIDEWALK) CLOSED sign are required unless the work will take less than 15 minutes. 10. In multi-lane roundabouts, merge traffic into one through lane prior to work. 11. See Diagram 640E— Roundabout Detour Alternative—for details needed if using a detour route in lieu of flagging. Chapter 5 December 2011 2011 Edition Page 123 Work in a Roundabout Diagram 640 "'AD' c wM MM B PFFD A l t To A 1 ROAD wows �� y NfID A 1• B3GH F T i .- K K K 4 C I B I A Nn: DBMld Anaws no.D Type III Berrlcede(6 denote tf H Wllor am S7pn PAa Y•R( t� Type Ill Banicede Tp aroP whh'Road Closed'Sign (OP9LTona� . K n IIIA � PFEPMED lY B ro BnJP Y awn C v Y 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 35 125 40 350 350 350 150 45 180 50 500 500 500 210 55 250 December 2011 Chapter 5 Page 52 2011 Edition Bicycle and Pedestrian Accommodation Diagrams The following practices and details address the accommodation of bicycles and pedestrians within work zones. The following detail drawings should be incorporated, where appropriate, into the traffic control plan for any short term work. 1. See Section 1.6 — Bicycle and Pedestrian Considerations for additional guidance. 2. Stay alert for pedestrians and bicycle traffic and accommodate safe passage for them, as needed. 3. The work space should be protected from bicycle and pedestrian intrusion by using barricades or closely-spaced channelizing devices. 4. Maintain access to transit stops or clearly close a transit stop using barricades or channelizing devices. Bicycle Accommodation Diagram 5-6 Bicycle Accommodation Principles: 1. If a significant volume of bicycles can be expected and work closes a marked bicycle facility, or requires bicycles to share a travel lane, install a "(Bicycle) ON ROADWAY" sign (CW11-1) or the Bicycle symbol (W11-1) sign with an "ON ROADWAY" (OBW1-5) rider, in advance of the work area. 2. Install temporary signing off the paved shoulder, within the planter (buffer) strip, or share the width needed between the shoulder and the sidewalk, as available. 3. Signs are to remain in place until the surface is restored and the width • made available for bicycle use. See Diagram 5-6 for typical bicycle signing placement. 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 53 Bicycle Accommodation Diagram 5-6 I I I I I I I NOTES: I Bicycles on Roadway(CW11-1)sign should not interrupt standard sequences. For example: i o BE PREPARED TO STOP/Flagger Symbol o _LANE CLOSED AHEAD/Lane Ends S mbol Work . Bicycles on Roadway sign typically follows ROAD Area WORK AHEAD sign and used as general warning. I I I I I I I � I l I I I I I i I I�I � I I I I I I I � i A I I I I I� I i B I I I I 11t ON I ROADWAY I I C I I I I ROAD WORK AHEAD December 2011 Chapter 5