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ROW2012-00035 1=1:4ar, 29. 2012: 4:30PMdjb' PGE WLC vec ENEO . 1�uwK , J No. 3085 P. 1 nZrdr D Mp,R 29 2012 RIGHT OF WAY PERMIT R CITY o� TIAR GA 11 11 COMMUNITY DEVELOPMENT cv“ d.T Permit 4; ROW2012.00035 G 1�N Date Issued: 0312812012 T i G r s, RD 13125 SW Hall Blvd., Tigard OR 97223 503,718 f(NN partner: SEG3585 Jurladlet)on: TIOARD Site address; 8ubdt'rtaion: Lot: Project; PGE Project Description.: will install a new e anchor O service 41134 opposite 14155 SW 103rd Ave. PGE 20ft south of the pole toba k PGE up �the re-routing of PGE overhead service to 4137 SW 103rd Ave. WR 977254 FEES Owner; Date ate Amount ROW Parmlt Fee 03129/2012 $300.00 PHONE: Contractor: PHONE; FAX: Applicant: PGE 9480 SW BOECKMAN RD WILSONVILLE, OR 97070 PHONE: 503- 570.4409 Total 3300.00 Please sign below to Indicate acceptance of conditions end return a copy with the proposed work schedule along with names and eontoct tnforinat:en of responsible parties before beginning work. �.... 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PPM Signature: ,v � issued By: Special Conditions (See Attached) Note: THIS PERMIT 00E9 NOT COVER WORK ON PRIVATE PROPERTY 1 } - CITY OF TIGARD RIGHT OF WAY PERMIT ` COMMUNITY DEVELOPMENT Permit #: ROW2012 -00035 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 03/29/2012 ..TIGARD Parcel: SEG3585 Jurisdiction: TIGARD Site address: Subdivision: Lot: Project: PGE Project Description: Replace & relocate aerial tresspass of OH service at PGE #1134 opposite 14155 SW 103rd Ave. PGE will install a new anchor 20ft south of the pole to back up the re- routing of PGE overhead service to14137 SW 103rd Ave. WR 677254 Owner: FEES Description Date Amount ROW Permit Fee 03/29/2012 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: PGE 9480 SW BOECKMAN RD WILSONVILLE, OR 97070 PHONE: 503 - 570 -4409 Total $300.00 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: A ' 1 :))17 1 Issued By: Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2012 -00035 Type: Condition Name: Status: Severity: ROW 01- CUSTOM CONDITION Applied Notice <Custom Condition goes here> ROW 02- PERMIT & PLAN REQ ON SITE Applied Notice A copy of the permit and all attachments, and a copy of the approved construction plan and all amendments shall be 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 the aforesaid must be approved by the City, in advance of work performance. ROW 03 -TRAF CTRL - SPECIF (CITY) Applied Notice The City's standard specification for traffic control is "Manual on Uniform Traffic Control Devices for Streets and Highways ", U.S. Dept. of Transportation, F.H.A., 1988 Ed. ROW 04 -TRAF CTRL -CONTR RESPON FOR Applied Notice Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in accordance with a City (job specific) approved traffic control plan. A copy of the approved traffic control plan shall be available at the work area. ROW 05 -TRAF CTRL -ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time, without having first obtained written approval from the City Engineer. The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide Emergency Services (Tigard Police Dept., Tualatin Fire & Rescue) and to Tri -Met and Tigard School District. ROW 06 TRAP CTRL - ADVANCE WARNING Applied Notice • Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance notification sign at each end of the construction area 72 hours (min.) before initiation of construction work. ROW 07 -TRAF CTRL -PRIV PROP ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not, shall be cause for work stoppage until effective access is established. ROW 08 -TRAF CTRL - DEVICES IN PLACE Applied Notice Traffic control devices, flagpersons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. ROW 09 -TRAF /NOISE CTRL -WORK HRS Applied Notice No work will be permitted during the hours of darkness, nor between 9:00 p.m. to 7:00 a.m. Monday through Friday, nor between 9:00 p.m. to 8:00 a.m. Saturday, nor between 9:00 p.m. to 9:00 a.m. Sunday. ROW 10 -TRAF CTRL -MIN LANE WIDTH Applied Notice Minimum travel lane width shall be eleven (11) feet; pedestrian travel shall also be provided for. ROW 11 -TRAF CTRL -CITY CAN MODIFY Applied Notice The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic and to assure public - ROW 12 -INSP 24 HR NOTICE REQUIRED Applied Notice The permit holder • - • a • - nspector Zen Dutson, at 503 - 718 -2472 or email at zen @tigard- or.gov, twenty -four (24) hours prior to commencing work, twenty -four (24) hours prior to any staged inspection, and after completing work covered by the permit. ROW 13- HAZARDS -CERT OF INS Applied Notice Maintenance of the work area and approach roads is the responsibility of the permit holder. The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. A copy of the permit holders Certificate of Insurance shall be available at the work area. ROW 14- DEBRIS - MATERIALS Applied Notice 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 cleanup and stoppage of work to accomplish cleanup. ROW 15- EROSION CTRL REQ Applied Notice Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q. requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion control. • ROW 16- REPAIRS -LIKE MATERIALS REQ Applied Notice Property disturbed by construction activity shall be seeded with a standard grass mix; shrubs, flowers, barkdust, existing signs, pavement markings, mailboxes, etc., shall be reestablished, reinstalled or replaced, with like kind and material. ROW 17- DRAINAGE CONTROL REQ Applied Notice Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent private property, public property and the receiving system is not adversely impacted. The City may, at any time, order corrective action and stoppage of work to accomplish effective drainage control. ROW 18- UTILITIES PRELOCATION REQ Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. Copies of the rules may be obtained from the Center by calling (503) 232 -1987. If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders expense. ROW 19- UTILITY LOCATIONAL CONFLICT Applied Notice Contractor 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 permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall coordinate the work with affected utility agencies. ROW 20- TRENCH - PATCH /SAFETY /LBILITY Applied Notice A temporary hard - surface patch (Cold mix A.C. or Hot mix A.C. base paving) shall be placed on trenches within roadways at the end of each day's work. No trench, on site or off site, shall be left at any time in an unsafe condition. The permit holder is responsible for and is liable for hazards or damage resulting from the work. ROW 21- REPAIRS REQ - INSPTR OPINION Applied Notice Work provided for under the permit shall include repair of existing facilities (roads, ditches, etc.) as may be necessary, in the City Inspectors opinion, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the permit holders expense. ROW 22 -AS- BUILT /ENGR CERTIF REQ Applied Notice At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public right -of -way shall submit complete "as- built" drawings 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 engineers certification of installation compliance (form attached). ROW 23 -DAILY INSP REPORTS REQ Applied Notice The permit holders Engineer /Inspector shall submit daily inspection reports, on a weekly basis, to the City's Inspector. (see Developer- Engineer Agreement note #5). ROW 24- TESTS /REPTS TO VALIDT CLMS Applied Notice The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's engineer or contractor to validate claims of material or construction adequacy /compliance. Such tests /reports shall be provided at the permit holder's expense. ROW 25- RELEASE - WAIVER REQ Applied Notice The permit holder shall provide a copy of a properly executed Release & Waiver document to the City for each ownership disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction. ROW 26- MONUMENT PROTECTION REQ Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders expense. ROW 27 -PROB SOLVING - RESPON PARTY Applied Notice The permit holder shall 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 an emergency. The permit holder shall notify the City Inspector, in writing, of any /all assignment changes. ROW 28- CONSTR SAFETY - RESPON PARTY Applied Notice The permit holder shall cause his contractor to provide to the City Inspector, in writing, the name and 24 hr emergency telephone number of a designated "Competent Person" responsible for construction safety as per OR -OSHA, Chap. 437, Div. 3 Construction, Subdivision P - Excavations. The contractor shall notify the City Inspector of any /all assignment changes. ROW 29- ESMT /RT OF ENTRY - RESPON Applied Notice It is the sole responsibility of the permit holder to provide for 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 permit holder's failure to obtain or provide for proof of right -of -entry or easements. 0 111°.1. PR 211° a RECEIVED ��eGP o a�NG APPLICATION FOR q G " tin IN RIGHT -OF -WAY (ROW) P�MIT12 I P� CITY OF TIGARD TIGARD Development Engineering PLANNING /ENGINEERING 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 624 -0752 FOR STAFF USE ONLY General Information: WR 677254 Rig ht -of -Way Property Address /Location(s): 14155 SW 103RD TIGARD Case No.: g..402- 011.- OUO 7S se 3S$ Receipt No.: *Applicant's Name: Portland General Electric Date: 312,41 L Address: 9480 SW Boeckman Rd A A ����'4 REQUIRED SUBMITTAL INFORMATION City /State: Wilsonville OR Zip: 97070 3 / ,30c. '52 Primary Contact: RALPH REISBECK Phone: (503) 570 -4409 Fax: (503) 570 -4420 Submit a scaled sketch of the proposed work to be done Contractor's Name: N/A CCB# Expiration: Professional Engineered Plans are Address: required for: City /State: Zip: • Street Widening Phone: Fax: • Subdivision Infrastructure • Main utility line extension: Plans By: Address: City /State: Zip: Phone: Fax: Description of work: REPLACE & RELOCATE AERIAL TRESSPASS OF OH SERVICE Estimated value of work (within the public right -of -way): $ Is work related to a LAND -USE DECISION? YES 1 NO If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES NO ■ If so, please specify (BUILDING PERMIT) case #: *NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide financial assurance for the work. e,sk,s e,a oson \windows \temporary internet files \content.outlook \kgkrOpch \wr 677254 city of tigard permit.docx ABC - 336 AAC OVERHEAD LEGEND N- 4 /01AAC O =REMOVE FACILITIES — INSTALL FACILITIES / 2 SW MCDONALD ST } I♦ INSTALL ADDITIONAL FACILRIES /MODIFY FACILITIES Q< 1.1- Q CONDUCTORS el ';‘, 1 - 143 00020 A 25 93765 - INSTALL 1-#20 AI-TX OH SECONDARY F10T 1967 -35 PL01027 14115 ' 11 I NSTALL 1-/16' OH GUY AS MESSENGER 10342 01846 - 0 A NCHORS 1 1 00788/ , x ?3 PL02766 1954 -45 oi A \ � y W /'°' \ LBS) L 3 b n ANCHOR CODE m�IM�CI 1-6 AL -T III w D1. - 02766 r- 20'L GUYING s = _ t(-1000 lain 0 5,003 # In (POS.-085.) O O o o 0 ® SE 5,003 # S % ^ go S k.. rn 01846- 0 1 GUY ©131CA E�lilflii 00786 / 2 GUYS m©m YR� 3 I�I1�I PI /21 111 � w 1 � Y} � � ii 1950 -40 ' in 3 GUYS © 1211: iliG�K� = / WR CHECKLIST 120/240 ITEM YES COMMENT 2008 137 6 HOIEDIGGR 5 SO, P 80096 MONDE N PGE TRENCH R 4 '` SW DRIFTWOOD CT REPLACE I 'OF #20 AL-TX LOCALES 2 W / #20 TX BRIDLE SVC ON STAIEiJ 5 5/16' OH GUY AS MESSAGER r 0 cr. RAGGING 2 ONE J \(I Q IREEIREA TREE THQLOONT N WWII 27 , C 25 16555 PEN/AS x 11cAR0 00784/ R •gT UG C PL01134 14155 50 CREEL 1950 -45 TRANp�ypN v SNUIDOWN THING CUSTOM 6 2 NW SW AMANDA CT 0 SAFETY DOOR HIKE 1 U CONTACT SDPM a a 01846 Al 2 L # FIRST! COWAN, C» Oa 00001/ (v PL00005 G13 S 5 # DATE IPAE I N 00005 U o 1901 -35 J. I ¢z O RMI_ H ®t 1 -1/0 AL-TX � C 25 11655 sw OONA r 'ARIL X JO II 1.-1-- 1 35Q • ILA 0 19'.0 45 -2 AL -TX 04908 _ A ! o 1964- 4 — C 3 3 1 -14 3� � s I w � F6T PL01 135 � �� � �9�, _ SW IN: Z ST tiV O7 w 7. i l i j i : . i. . 4, vir j , . 7:1 655 -D6 VICINm MAP PGE CONSTRUCTION DRAWING SDP/AGNG REVIEW: I ASBUILT BY DESIGNER: AS —BUILT VERIFICATION & NESC VIOLATIONS CORRECTED This document occurately represents FIELD construction. CONTACT GENERAL FOREMAN Foreman: Date: ANDOR CONDUIT INSPECTOR 7 TO 10 WORX/NG DAYS PRIOR TO EXCAVATION. CONDUIT INSPECTION REQUIRED PRIOR TO BACKFILL GF: Dom. PGE WILL NOT INSTALL WIRE UNTIL TRENCH IS 100% BACFRIED. GATE ACCOUNT: AWO: JOB Na AM £ACA1tR KEN GUTIERRQ 3/19/201 I' =60' I 1070001 I 700 0001921 677254 GENERAL FORMAN CONDUIT INSPECTOR mt.s PHONE 5034725502 C151, 503. 969 -6103 PHONE 503- 969-3964 ` PGE - RICK LOCK STREETLIGHT SPECIALIST: JEFF S:EIGLEDER CIRCUIT PHONE: 503570-4404 CELL: 503-849 -5648 TIGARD - 13 ISi 1 1x17 ATTENTION: CALL 811 BEFORE YOU DIG IP LOCATION LAW REQUIRES YOU To FOLLOW RULES ADOPTED 14155 SW 103RD AVE. TIGARD BY TIE OREGON UPILRY NOTIFICATION CENTER DESCRIPTION 771OSE RULES ARE SET FORTH IN OAR 952 REPLACE & RELOCATE AERIAL TRESSPASS OF OH SERVICE WI THROUGH 952-001-0090. YOU MAY OBTAIN COPIES OF COUNTY ECTION(B) WORK WRH SHEET THE RULES BY CAWNG THE OREGON UTILITY R50NYLLE WASHINGTON 1C21 -118 I NOTIFICATION CENTER ADMINISTRATION @ (503.232 -1988 LINE LSCO CENTER DESIGN BY PHONE 15031 DRAWN BY 1 OF 1 ERE. TO REQUEST UTILITY LOCATES CALL THE OREGON Knew Axel below. 9490 sI 00ECawI RD RALPH REISBECK 570-4409 BRIGANTE UTUTY NOTIFICATION CENTER 871 AT LEAST CGII before W di RSONYELE. OR 97070 2 BUSINESS DAYS PRIOR TO EXCAVATION. o,e T 9• OPORTLAND GENERAL ELECTRIC CO. - ALL RIGHTS RESERVED Kristie Peerman From: Ralph Reisbeck <Ralph.Reisbeck @pgn.com> Sent: Wednesday, March 21, 2012 11:17 AM To: Wilsonville JobProcessing; ROW Permits Subject: RE: WR 677254 CITY OF TIGARD ROW PERMIT City of Tigard: At PGE Pole # 1134 opposite 14155 SW 103` PGE will install a new anchor 20ft south of the pole to back up the Re- routing of PGE overhead service to 14137 SW 103 From: Melissa Griffith On Behalf Of Wilsonville JobProcessing Sent: Wednesday, March 21, 2012 10:34 AM To: 'ROWPERMITS @TIGARD - OR.GOV' Cc: Ralph Reisbeck Subject: WR 677254 CITY OF TIGARD ROW PERMIT Attached is PGE's ROW permit application & sketch for WR 677254. Please contact Ralph should you have any questions. Thank you Melissa • 1 : II OF TIGARD RECEIPT F ,� t 13125 SW Hall Blvd., Tigard OR 9722 503.639.4171 TIGP RO " .N r Receipt Number: 186127 - 03/29/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2012 -00035 ROW Permit Fee 100 - 0000 -43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 000422 KPEERMAN 03/29/2012 $300.00 Payor: BRIAN MOORE Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1