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ROW2012-00076 CITY OF TIGARD RIGHT OF WAY PERMIT I COMMUNITY DEVELOPMENT Permit #: ROW2012 00076 Date Issued: 08/21/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1929 Jurisdiction: Site address: Subdivision: Lot: Project: Installation of New Power Lines Project Description: Install 1 - #2 AL -XLP jacketed primary in 2" duct provided and installed by PGE /Contractor from PD5296 to PD5295 in front of 14460 SW 91st and 8995 -9075 SW Pinebrook Street. Owner: FEES Description Date Amount ROW Permit Fee 08/21/2012 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RALP REISBECK 9480 SW BUECRMAN ROAD 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. Perm ittee/Applicant Signature: �Vt, Issued By: CA • �3�.L. ✓�1 - �.� Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2012 -00076 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 -TRAF 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 safety. ROW 12 -INSP 24 HR NOTICE REQUIRED Applied Notice The permit holder or his contractor shall notify the City's inspector Kenny Fisher at 503 - 818 -6146 or email at kenny @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. ENGINEERING LEGEND PGE FACILITIES TO BE INSTALLED/REPLACED (UNLESS OTHERWISE SPECIFIED) ABANDOPN F:.. , . ENTAIL 1+2 Ali! JET PRIMARY N 2 PE DUCT PROVIDED b INSTAL® BY P08COMIIACTOR Na,,..61 VT 00095 w u nP M FONNE' :, 76p . t.,, L ANDSCAPING NO s MC DONALD M •.e1�1 REPLACE SOD 8 " R '®' W RN � � 7TOOV BOND. BARK OF P IN FROM ;-1'.. ' v W EIKE 72t PD -03296 9 CUSTOMERS PIN .1.00K 14109 KWH - I / 38.6KW WLM MID ER D \ SW DURHAM RD 1 l0 1F16t 'I, 169219-00 � 655-E6 JOB SITE T --. _ V N• air/ rrwlw • 00 1 ( Po 051111 • M •0011 - � J A 011119 / -- �\ NdSO 0 50 6074 / 8 50 40079 B 50 37074 .11.11911411 «ER/ rwE D 0092 '---_---- \ 1 / _ NNK9 JIM H aLOe Z 1 1 14660 — i 100 AIM _._ ._ - 1 7! 9lEI 9075 I 9 0/5 8995 8960 • x N 909E IX L ■ E wE OPE/ 80 MAP Al XIP if -. I 6198M1 R* I I ' -- T6{{ 1W Pf1ROOR A - ! L.. i II it I b NM `\ / B 10 WWI 1 ". _. LANDSCAPING NOTES 2 ROSE B OF USHES • REPLACE SOD DONT DISTURB ---- t FROM BORE PIT WR OWE 2.IST THINK IN .LOGIC ST m we common SAFETY sa gLEE q p IOC/ FIRST! 000555 • NOERY / t NE MO X CONIAAC01 1AN08 B 71 11612 POE CONSTRUCTION DRAWING / A PA LOCAL/ X SDPMEVo R!VlW: IASBULT BY DESIGNEE NNE w - I 1w KONG AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED RACING ION ' I ,,, iS 7 9mR99Iey 9eNew9r REED 9099 00999. MDR T� CONTACT GENERAL FOREMAN 85911159 ANDOR CONDUIT INDICTOR 7 TO 10 WOOEq OATS PRIOR LANDSCAPE X /Ca Foreman: Dole: TO EXCAVATION M CONDUIT INWECTION REQUIRE. PRIOR TO 80029L. NNW MOM GF: Mk: 13 A W . POE U NOT INSTAL WIRE WTI TRENCH /5 ION 10/ED � Al 190415 . ' CN190415 067808 OJH 01/T•RRQ PESOS I WIN 0 ' T 707/2012 t r-ace I' 1070007 IAwR rap� Mo. 688819 GENERA roMMAN CONDUIT INSPECTOR T NN T11n PRONE 503 6734802 CELL, 503- 969 -605 PRONE N3- 969-8964 � ` PGE dJlt 57158517 5700665 A" SIEOCDER man In:• • PRONE 503470 CELL 803 8/9-8 110 6/8 CRIB: 540 CLIP - I6THJROOK ORV $ \` OM Mil ATTEIIIDIF C:AL. 811 BEFORE YOU DIG / GE/ 5.04TION 17,22 OREGON UW REQUIRES YOU TO .CHOW RUM O ADOPTED 9 8965 SLY HMBROOIL ST TRURO TIN OREGON UDIT' N011RC CEDER 9111D0911 9111D0911 X SNSI DEOWA^N P THOSE RUUD ARE SET FOND N 048 OAR 9 51 001 CIORYi 0009 MAW X 9 N ` REPACE SO UG PRIMARY 8 IIYE FRONT XEMR TNRODUII 953001 YOU MAY OBTAIN COPE OF CCNfAD 1�.,,�, I 95,151 RCS BY CALLING NYE 090019 UTKJry Imo '••"^ 1 I I 840 NO11FICnTON 0154108 ADMBMSTYMON (503 752 - M97) CDWAM � A8.19998 � WASHINGTON I CRL1I 9 eP 1 Wow. A N mote poi Doom w Ulm Mon ow. PM C. RAVE REMBECC 570-8/70-44 09 I CRUTHEWORD COI Wen peak. 0AR M , +w , wlaw ,AA • roRNND 6BMAN 9/09C CO.- All RI NIS ROOM CITY OF TIGARD RECEIPT n , IN 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 188068 - 08/21/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ROW2012 -00076 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 080735 CCAINES 08/21/2012 $300.00 Payor: Brian Moore Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1 RECEIVE JUL 312012 II City of Tigard PLANNING/ENGINEERING CITY OF TIGARD Application for work in the Right-of-Way ROW Permit 'IGARD General Information: FOR STAFF USE ONLY Property Address /Location(s): 5 /mot/ f✓% /V /sifooi(' 5 7 ie. Right -of -Way A 5'W `// ST . 41'e Case No.: fC U 14✓ -0007‘ Receipt No.: *Applicant's Name: Date: v � / /(41 Address: 9 4f}© , w Application Accepted By: Si /1/if / C.:- City /State: - ` ewee e74 Zi 97074 Revised 7 /1/11 - Primary Contact: te,4-4- " /,! J2 E - 1413S REQUIRED SUBMITTAL Phone: C 503) 5 70 - 4 441 Fax: �52 5 76 - 4420 INFORMATION Contractor's Name: ret, Submit a scaled sketch of the proposed CCB# Expiration: work to be done Address: City/State: Zip: • Traffic Control Plan Phone: Fax: • Filing Fee $300.00 Plans By: 1 r 1,4714 l✓/. -1V e4.4 ii��z-r-ie /rte I:curpin \rnasters \I:ui 3 use apptications \rnw app.descx Address: City /State: Zip: Phone: Fax: Description of work: til/5/74 -1-L /- 2 4`4— XLe J.4- ,C 4r6j Pfi-bL-i j ,W 2 - " ("cr p/e kr4,60 o-A.sr.4 1,c /. By /° /` co/vr/44rz ,c eiri Po Cz ?e, 6 Estimated value of work (within the public right -of -way): $ Is work related to a LAND -USE DECISION? YES NO jg If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES C NO IX If so please specify (BUILDING PERMIT) case #: City of M„ Ti gard ( 13125 SW Hall Blvd., Tigard, OR 97223 I 503 - 718 -248 www.tigard- or.gov Page 1 of2 • APPLICANTS: To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on the front of this application in the "Required Submittal Elements" box. *NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work. *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(s) must sign this application in the space provided or submit a written authorization with this application. BY SIGNING BELOW, THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property. ♦ If the application is granted, the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. t All of the above statements in the plot plan, attachments, and exhibits transmitted herewith, are true; and the applicants so acknowledge that any permit issued based on this application, may be revoked if it is found that any such statements are false. ♦ The applicant has read the entire contents of the application, including the policies and criteria, and understands the requirements for approving or denying the application. Yh • 2t4-6-14-r j - t v .moo j // - 7/3///2— Applicant's Signature Date Owner's Signature Date Owner's Signature Date Authorized Agent's Signature Date 1-7;etc .r-!. ,tiitt„e,e tad P/e0 Gg SS ere ( 649 —1,37a Print Name Title Phone Number Signatures of each owner of the subject property are required City of Tigard I 13125 SW f lall Blvd., Tigard, OR 97223 I 503-718-2468 I www. tiga or.gov J Page 2 of Cheryl Caines From: Cheryl Caines Sent: Monday, August 20, 2012 4:36 PM To: Linda.Miller @pgn.com Subject: FW: Request for Permit - SW Pinebrook St & SW 91st Ave (PGE WR 688829) Attachments: PaymentAuthorization_031612.doc From: ROW Permits Sent: Monday, August 20, 2012 4:36 PM To: 'Linda Miller' Subject: RE: Request for Permit - SW Pinebrook St & SW 91st Ave (PGE WR 688829) Hi Linda, A fee of $300 is required for the ROW permit. It has been approved, I just need payment to issue it. Please complete the attached form and fax back to the number on the form. Thanks, Cheryl Caines Planner on Duty (503) 718 -2421 From: Linda Miller [mailto:Linda.Miller@pgn.comj Sent: Tuesday, July 31, 2012 8:43 AM To: ROW Permits Cc: Ralph Reisbeck; Melissa Griffith Subject: Request for Permit - SW Pinebrook St & SW 91st Ave (PGE WR 688829) Attached is the application and a pdf sketch. This permit is being requested so that PGE can put the job out for bid. We can provide the contractor information once the job is awarded. Thanks. Linda Miller PGE Wilsonville Office (503) 849 -9375 1 Cheryl Caines From: Linda Miller <Linda.Miller @pgn.com> Sent: Tuesday, July 31, 2012 8:43 AM To: ROW Permits Cc: Ralph Reisbeck; Melissa Griffith Subject: Request for Permit - SW Pinebrook St & SW 91st Ave (PGE WR 688829) Attachments: 688829.pdf; 688829 City of Tigard Permit Application.pdf Attached is the application and a pdf sketch. This permit is being requested so that PGE can put the job out for bid. We can provide the contractor information once the job is awarded. Thanks. Linda Miller PGE Wilsonville Office (503) 849 -9375 1