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ROW2013-00124 CITY OF TIGARD RIGHT OF WAY PERMIT Permit #: ROW2013 -00124 � COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 12/19/2013 Parcel: SEG1064 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to SW Grant Ave and SW Johnson Street. Relocate anchor on pole 1601 out of gravel path. SEG 1064. Owner: FEES Description Date Amount ROW Permit Fee 12/19/2013 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: LORRAINE KATZ 2213 SW 153RD DRIVE BEAVERTON, OR 97006 PHONE: 503 - 672 -5484 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 no- pr.en+ kerA Signature: Issued By: Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2013 -00124 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 - 816 -6146 or email at kenny @ tgard - 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. RECEIVED DEC 18 2013 City of Tigard CITY OF TIGARD /ENGINEERING Application For Work In The Right-'-Way TIGARD ROW Permit (";;; 0.4 743.57 r Property Address /Location(s): S W 67C.E -s✓r A"fre SAO FOR STAFF USE ONLY s (,v JO, 44./.10 57 - 1010 Right -of -W1 20(3 -� I 2.4 Case No.: *Applicant's Name: /O61. Application Accepted: al By: A'+4- Address: Z Zli S W AS 3 1 p4 r p{ � Application Reviewed: y: s , � _ City/State: a fz1vE.LTDA/ el of Zip: '1 700(. Application Fee Due: Primary Contact 1. /e R.4'1 NE A . 4 d r Z Applicant Notified: I (( i Phone: r S 3, 47 - 5 /Fax: (60.0 p � � �J Receipt No.: !' Email: r #D Su p•r•i 5L c P Cn... REQUIRED SUBMITTAL Contractor's Name: INFORMATION CCB# - " irati°a: • Application form, completed and signed Address: • Submit one (1) copy of scaled sketch of City/State: Zip: the proposed work to be done Phone: Fa= • Submit one (1) copy of traffic control pm• ;1; plan Professional Engineered Plans are required Plans By: P for. Address: • Street Widening City/State: Zip: • Subdivision Infrastructure Phone: Far • Main utility line extension Email: Rev. liA m \kod use applinuom\mw spp.doa Description of worlc / # - C - # 1 f 4-.y Gs1e4* D N rO LE / (•co I U vT O ft e- 1t4-Y L. / Estimated value of work (within the public right -of -way): $ Is work related to a LAND -USE DECISION? YES ❑ NO If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES NO RI If so, please specify (BUILDING PERMIT) case #: - - 1 4 1 If -3 Signature of Applicant /Permittee: Date: Print Name: G . O r r / . u (1,6 d Z Title: 5 & 1 0 / + 4 4 0,0 I I v ' - P a y (V i ( City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 718 -2464 I www.tigard- or.gov t OVERHEAD LEGEND • '� 1 0 / 4/0 TX WR CHECKLIST tr� /,6 9 � M ITEM YES COMMENT REMOVE FACILITIES EN INSTALL FACILITIES 44 HIXFDIGGER x = INSTALL ADDITIONAL FACILITIES /MODIFY FACILITIES • 1/0";14. ° ROOM DOME 1950 , y 9 O � D , TT IEA NE TIM E % i I ti S � 66349 972 ANCHORS L O CATES x d _ 3 6 ';- o ABC -795 AAC STAKING x LE / LEAD � . N-4 /0 ACS /0 TX RAGGING C APE ANCHOR CODE mpg= • 4/0 TX EASEMENT 00037 01383 PEWS x MY OF TKAND 00084 2001 -35 J 1 995 50 O RAMC PLAN GUYING = d p o = d 0 0 2010-35 • Q� , d p ° . • • 1 t 00029 00067 ` , CUISHEET 07880 1995 45 2010 50 • I '' UG I G Pos ABS ^ r t / ^ r § SHUTDowN 980-40 / O Q 01618 �� 1 200A 2010-50 ,1` PE S 2 I GUYS 1311=11== 00154, 3944 mmmm/����R� FL 00084 01382 • DOOR HANGER 3 GUY IMMICI i EME B 15 44816 2010 - 50 CONTACT COMPANY 1 -4/0 AL- •• 1 1819- 0181 - - :19- LOT 3: PHF C, PLOT 3: 00350/ 0 / 07190/ DATE TIME 3 -142 PLOI61 •L01601PL01601 PL0160T 4 elf "0 PO 00115 �'& , f S• ABC - 140 01 • o• � ? • 1-45 'P'31< ,a 4 +, q s q 0 pL-01601 T RELOCATE ANCHOR 2' SOUTH -WEST PGE CONSTRUCTION DRAWING NEW LEAD 8 # AS —BUILT VERIFICATION & NESC VIOLATIONS CORRECTED /� This document accurately represents FIELD Construction '. �� / A 8 L Foreman: Date: /All 5 # < General Foremon• Dote: (Signature only required for field construction chonges.) SDPMAENG REVIEW: I ASBUILT BY DESIGNER: 4 gilbr ,' • • �� DATE: 72/443 SCALE: 1':60' (ACCOUNT 1070001 I Awa 7000001921 (Nos NO. 74 33 75 • IDLE \ . Ate,.. ST. ANTHONY'S COM CTR - RELOCATE DOWN GUY 4 E1 ATE +. \ / CIRCUIT \ TIGARD SIZE T IT - 13362 11x17 ATTENTION: CAL 811 BEFORE 5 , YOU DIG e�, b PGE LOCATION OREGON LAW REQUIRES U IRES YOU TO FOOW RULES ADOPTED SW GRANT AVE, TIGARD BY THE OREGON UTILITY NOTIFICATION CENTER. DESCRIPTION ` • 4 ' , SAFETY TH RULES ARE SET FORTH IN OAR 952 -OO -00 8�' . RELOCATE ANCHOR ` y 7 s i. T 952 -00 1 -0090. Y OU AN OBT COPIES OF � COUNTY SECTION'S WORK WITH SHEET � THE RULES BY CALLING THE OREGON UTILITY BEAVERTOH WASH C21 - 028 I OR I 7a . ` DAW .. FIRST! THINK NOTIFICATION CENTER ANSTRAiION @ (503 232 - roa7l LINE CREW CENTER DESIGN BY (HONE 1507) \< RA]MAl , `. `r � 1 TO REQUEST UTILITY LOCATES CALL THE OREGON UTILITY NOTIFICATION CENTER, BD AT LEAST sxo DR • Knew what's below s r LORRAINE KATZ 672 -5484 I DRAMA BY DUMMW ILIOI 655—D4 „ 13 SW w Woos ' 2 BUSINESS DAYS PRIOR TO EXCAVATION. Call before you dig. 0 PORTLAND GENERAL ELECTRIC CO. - ALL RIGHTS RESERVED iliAl CITY OF TIGARD RECEIPT q G t 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 194354 - 12/19/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2013 -00124 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 043558 AKOWACZ 12/19/2013 $300.00 Payor: Brian Moore Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1