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ROW2014-00009
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Q 1 • . 'IN Request Permit Action f/ivir �.� T I G A R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant El Contractor ErCity Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: rk.C4.0 Ad t`4-60 o o Q Site Address or Parcel#: /igg S Sw G t-s t S ( o „rye,1 Oft- / Project Name: Subdivision Name: Lot #: EXPLANATION:ig PG-t_ ti•r%:( Signature: Pt -'; Date: g-/Z/ Print Name: 14km 65 F-12_. Refund Policy 1. The Community Development Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80%of the land use application fee for issued permits. d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80%of the building permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte to l ig--:\dmin: Date f /y /y By 4r, Refund Processed: Date A /t/ - By JOY— Invoice Processed: Date By Permit Canceled: Date //y//y By ?-. 'arcel Tag Added: Date By Receipt# Date Method Amount$ I:\Building\Forms\RegPermitAction_062614.doc • Kenny Fisher From: Kenny Fisher Sent: Tuesday, August 12, 2014 7:35 AM To: 'T&DSupportBLC' Subject: RE: right of way permit#2014-00009 I will cancel through our system.Thank You. From: T&DSupportBLC [mailto:T&DSupportBLC©pgn.com] Sent: Monday, August 11, 2014 1:25 PM To: Kenny Fisher Subject: RE: right of way permit #2014-00009 Hi Kenny. Per Hassan Aman,this job will be redesigned. We will need request another permit at that time. Does Permit ROW 2014-0009 need to be cancelled? Linda Miller Distribution Job Processing PGE Beaverton Office Office: (503) 672-5496 Cell: (503) 849-9375 From: Kenny Fisher [mailto:KennyOtigard-or.gov] Sent: Thursday, August 07, 2014 7:03 AM To: T&DSupportBLC Subject: right of way permit #2014-00009 Can you tell me if this permit was completed?Job #718130. 13485 SW Genesis Loop. Tigard. Thank You. DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 1 VOtO CITY OF TIGARD b//y/"y RIGHT OF WAY PERMIT COMMUNITY DEVELOPMENT Permit#: ROW2014-00009 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/05/2014 Parcel: Seg1375 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 13485 SW Genesis Loop. Replace B/O UG primary cable. SEG 1375/1425 Owner: FEES Description Date Amount ROW Permit Fee 02/05/2014 $300.00 PHONE: Contractor: J y ( L' PHONE: FAX: Applicant: WAYNE HAGAN 2213 SW 153RD DRIVE BEAVERTON, OR 97006 PHONE: 503-736-5411 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 not-ignt p'CS Signature: Issued By: Yt:4 Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY 4 Conditions for ROW2014-00009 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 @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. RECEIVED , _ JAN 2 g 2014 CITY OF TIGARD City of Tigard PLANNING/ENGINEERING Application For Work In The Right-Of-Way TIGARD ROW Permit .�:... :..,.. ._... :.. _ .... ...:.:'W. .n'...,.:. -..._.•....r.--..-._...:..:..-.rt'..-e'.r...r .� .-..,...i..v_ v...r.....�.,, x:_...ss .. .e......v ✓..a.. a -'.m ' Property Address/Location(s): I g `S'l4 Gen a ti'S`, 1.0 ) FOR STAFF USE ONLY aCq 15 142 Right-of--Way_ VJ 2C1'T"- Case No.: rQ�_ /,�'[d i.C�C/CJ`7 *Applicant's Name: PG E c1 o 3 118130 Application Accepted: ll Lb By: 1 y� Address: 22- 13 Su) L r 1 5 3 Y� t,j(I._ Application Reviewed:, By,� y/{ City/State: Seaver+O/t 01- Zip: g7uob Application Fee Due:.4 b I Primary Contact: �A/es y r b.3 d." Applicant Notified: i 245 I T Phone: 503-.73G- 5,4 l( Fax: 503- 672- 55 5 r Receipt No.: 1 "i 7 Email: 7 4.D 5 i.•ppaa€r 6 LC( p A . C tt"- REQUIRED SUBMITTAL INFORMATION Contractor's Name: (A-A ci fr.(' PC75 per te4- 'p" • Application form,completed and signed CCB# Expiration: • Submit one(1)copy of scaled sketch of the proposed work to be done Address: • Submit one(1)copy of traffic control City/State: Zip: plan Phone: Fax: Professional Engineered Plans are required Email: for: D • Street Widening Plans By: I- �E • Subdivision Infrastructure • Main utility line extension Address:. Deliver application to rowpermits@tigard-or.gov or to City/State: Zip: City of Tigard Planning/Engineering,13125 SW Hall Phone: Fax: Blvd.Tigard,OR 97223. Rev.12/10/2013 Email: 1:\CURPLN\Masters\Land Use Applications\Right-of-wny Permit /� I ` p AppGration.dou Description of work: WGp(C L2 3/o LA Pr;w1/4 a ley C",.j;:),Estimated value of work(within the public right-of-way): $ Is work related to a LAND-USE DECISION? YES n NO 4 If so, please specify(MLP,SDR,SUB,etc.)case#: Is the work related to a BUILDING PERMIT? YES El NO If so, please specify(BUILDING PERMIT)�case/#: Signature of Applicant/Permittee: 1 F�y1 1 / t/04.70..i: I I(Date: I/21 /14 Print Name: (± (�-P fff Title: 1J0/j t'rQCess or City of Tigard I 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2464 I www.tigard-or.gov i R / 0 LEGEND I 40 cu-" ii! k. NEW PGE FACILITIES TO BE INSTALLED _ ,. cAU*ION T.o)if°ERS ,B ` 1''- (UNLESS OTHERWISE SPECIFIED) I 4z �yp`{{p(, 15 A-2 " OIB FACILITIES TO BE INSTALLED IMMI ""'AR DTPfSEN RS 7LO°ID REMOVE VT 17052 ARC-2Va A(� FACILITIES TO BE ABANDONED OPEN �. C 50 71255 1111-2o/ VT07052 �- 2 INSTAL/I-620 AL-YIP JKT PRIMARY('A'PHASE)IN 2"PVC :AUTION TWO FEEDERS - D0RS- CONDUIT PROVIDED &INSTALLED BY PGE APPROVED CONTRACTOR INSTALL �'s R 10615 I/O / ABANDON PRIMARY CONDUCTOR OPEN / VT07052 Iq°;IA 4/0 CAUTION TWO FEEDERS/ _ � / N d TI/ iD All CONDUIT TO BE INSTALLED 36 INCHES(MIN)BELOW fINAL GRADE. ALL PGE CONDUCTORS TO RE INSTALLED IN GRAY,SCHEDULE 40,ELECTRICAL GRADE, jQ Y. THE SIZE AND NUMBER OF CONDUITS REQUIRED MAINTAIN TEST)PGE INCHES/AND �• 1,0 24 HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS 4 INCH d SMALLER TO BE 36 INCH RADIUS.ALL BENDS MUST BE FACTORY MADE. ALL ELBOWS LARGER THAN 4 INCH TO BE 60 INCH RADIUS.RIGID STEEL OR PGE 1= +OI S APPROVED FIBERGLASS BENDS ME REQUIRED FOR RUNS OF ISI FEET OR LONGER I+]B 01 OR FOR ANY LENGTH RUN WITH MORE THAN IRO DEGREES IN BENDS.PVC SCHEDULE 40 BENDS ARE ACCEPTABLE FOR RUNS OF 150 FEET OR LESS.THE MAXIMUM TOTAL 0 B2� PLOOp00 T 0]698 BENDS IN ANY CONIXOT RUN IS 270 DEGREES. a -1574-2o B •• 21819 ,,IRECTIONAL BORING REQUIREMENTS BUCK HEW(HIGH DENSITY POLYETHYLENE)DUCT a IS SCHEDULE 40 PVC WITH A MECHANICAL CONNECTION (rCERTA-LOK OR CAKE MECHANIC.G ONNECTION PRODUCT)AS AN ALTERNATIVE TO MOPE DUCT HOPE SHALL MEET THE .FQUIREMENTS OF PGE SPECIFICATION 122501(AVAILABLE ON REQUEST FROM PGE PROJECT '5 H. [u-DS `✓'NAGER)FOR SAFETY REASONS THE DUCT SHALL SE BUCK WITH THREE EQUALLY SPACE C-20 AL-0B 'TRIJDED RED STRIPES(WHICH IS A SPECIFICATION REQUIREMENT,MANCRCI 101 OF U PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTCI ^■'• Z Z 8-20 AL-0B 575"O O PGE TO BE NOTIFIED AND INSPECT ALL CONDUIT,VAULT AND MD INSTALLATIONS A 1 A -OR _ _ BEFORE team_ ALL NEW VAULT&PAD LOCATION TO LI W W - •'NS CUSTU,IV REPRESENTATIVE ~~ REFER TO PGE IECTRKAL SERVICE 811311 EAEENTS ROOK FOR FURTHER DEEMS 6 SPECIFIC REQUREMENTS.LINK TO WSrW DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT.NON-STANDARD UNDERGROUND EQUIPMENT ANY RE AN OPTION AT AN ADDITIONAL COST TO THE CUSTOMER. °1 \ R 1 I,BO SW FAIRHAVEN ST < VT 00022 I • ANY DEVIATION FROM THIS DESIGN MUST A-2 RL RLP JOT-D BE APPROVED BY PGE PROJECT MANAGER I :41 I I I -20 WR CHECKLIST IL/1 ■ ITEM YES COMMENT Jm422-72 IF... YT 07051 IaLELRCCER C 10 17195 A 50 1208') BOOM 0 IACDIOE PGE TREND/ 04121 0T825- I459-40 00655/ 0 P 066 5 LOCATES x JLSMM-72 STARING 50 1261 FLAGGING y I• °ODH9/ TREETRR6 P YT 06462 • L J68422.72 200420 LANDSCAPE 1._� EASEMENT •1 PERMITS X OTT OF rlcrm TRAFFIC PUN x CIRSREET UGCBWI rIIUI501RQV RIGHT-OF-WAY PERMIT NOTICE: SHLRDOWN A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY CIJTOIP SHUTDDOW N S) WORK IN THE RIGHT OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED CO M IOWA x CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'$PERMIT CONTACT THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS COWAM BEFORE WORK IS TO BEGIN A COPY Of THE PERMIT MUST BE ON SITE PH, Cr DATE 511E OREGON L CALL 811 WORE YOU DIG � OREGON LAW REQUIRES YOU IC TO FOLLOW RULES ADOPTED CONTACT SERVICE COORDINATOR BY THE OREGON UTILITY NOTIFICATION CENTER. THINK OR TRf CH AND CONDUIT INSPECT ON vs THOSE RULES ARE SET FORTH IN OAR 952-001-0010 l0 BA(KT'll oGE w'LL N +IISTxt 0/U THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF -'F"-s " 1 L, THE RULES BY CAWNG THE OREGON LIDUTY SAFETY SERVICE COORDINATOR' NOTIFICATION CENTER AOMINIS7RATION ® (503-232-1987) FIRST! 503-736-5,450 Know Acre Wow. Cali before you dig. PGE CONSTRUCTION DRAWING AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED This document occurotey represents FIELD Construction. c% 4 � � Foreman: Date:� Q ,� General Foreman: fie: G —=r I l u � (Ssgnofvro only required for field construction changes.) �O� �J �C SOP/WENG REVIEW: ASBUILT BY DESIGNER: i �17: R DATE: 12/3043 SCALE: 1':100' ACCOUNT: 1070001 AWO: JOB Na `��a :y _ ]` 000001/628 1 718130 Li. R `� TITLE �r <.00p C' J ~ REPLACE 80 UG PRIMARY CABLE - S .SW FAVAVEN� , .. ` CIRCUIT SIZE r $T ` \� 4GE:// 17GARL7 TIGARD 13 11x,7 .- R,, LOCATION / ` 13485 SW GENESIS LOOP,TIGARD �� SW cAnRDE_sr ' 'I � i� DESCRIPTION 1 REPLACE 80 UG PRIMARY CABLE N • • II ;l 4�)' � / k COUNTY ECTION(S) WORK WITH SHEET VERT� WASHINGTON fC21 3D I OF 1 UNE CREW CENTER DESIGN BY PHONE(425) DRAWN BY THOMAS GUIDE �° nu u sW n0 OR WAYNE HAGAN 864-7213 I K MIERAS REAVERTOM,OR•70. 655-05 �� / VICINITY MAP 0 PORTLAND GENERAL ELECTRIC CO-ALL RIGHTS RESERVED CITY OF TIGARD RIGHT OF WAY PERMIT 1111 I y �r COMMUNITY DEVELOPMENT Permit#: ROW2014-00009 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/05/2014 TIGARD Parcel: Seg1375 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 13485 SW Genesis Loop. Replace B/O UG primary cable. SEG 1375/1425 Owner: FEES Description Date Amount ROW Permit Fee 02/05/2014 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: WAYNE HAGAN 2213 SW 153RD DRIVE BEAVERTON, OR 97006 PHONE: 503-736-5411 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 Sign ature: V1 Issued By: A /Q �� Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2014-00009 Tyne: 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@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. RECEIVED _ JAN 2 8 2014 CITY OF TIGARD I City of Tigard PLANNING/ENGINEERING ' :I - Application For Work In The Right-Of-Way TIGARD ROW Permit Property Address/Location(s): 13 1'45 Su Gen e ti i Loup FOR STAFF USE ONLY 31S /1425 Rightof--Way_ _�xi 4-cco l ('� p Case No.: rQ� y��f �--�/q�y7 *Applicant's Name: I�G E 4 03 1 1 o 13 Application Accepted: l'2 By: 1 t� 2 Z (7J S w ( 5 3'`! 'p(L_ Application Reviewed:f M 2 g 1't Byfi Address: '1° City/State: Sea v¢.r+1) + t0 - Zip: q7004, Application Fee Due:' 3� I Primary Contact: t.t!r .'t.:1- Tf GS.et Ct." Applicant Notified: 1 2-1517 Phone: 503-73( - X5 4 it Fax: 5 3' 672" 55 cr Receipt No.: l 47-7 Email: T4.D St.p i,.) fir g LC p 11 . C• - REQUIRED SUBMITTAL INFORMATION Contractor's Name: n ci 24- P Cl E p,e r F "t 4-- • Application form,completed and signed CCB# Expiration: • Submit one(1)copy of scaled sketch of the proposed work to be done Address: • Submit one(1) copy of traffic control City/State: Zip: plan Phone: Fax: Professional Engineered Plans are required Email: for: • Street Widening P6 E • Subdivision Infrastructure Plans By: • Main utility line extension Address: Deliver application to rompermits@ltinrcl-or.gov or to City/State: Zip: City of Tigard Planning/Engineering,13125 SW Hall Phone: Fax: Blvd.Tigard,OR 97223. Rev.12/10/2013 Email: 1:\cURPt.N\Masters\Land Use Application\Righao(wy Pennic Q J Applintion.doa Description of work: ?e7(&cP_ ��O LAC3 Pe-;-/v,a1 (4, i) f 4- Estimated value of work(within the public right-of-way): $ Is work related to a LAND-USE DECISION? YES n NO If so, please specify(MLP,SDR,SUB,etc.)case#: Is the work related to a BUILDING PERMIT? YES LJ NO N If so, please specify(BUILDING PERMIT)case#: j c. Signature of Applicant/Permittee: et N [Dr LA)j � mate: 1 12-e I) Print Name: 1B€r-k- ( 1( fff Title: l.1,O Ji t'rOCeSS o r City of Tigard I 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2464 I www.tigard-or.gov / 0 LEGEND 1-I°CD-" 4► �_ `dh,' NEW PGE FACILITIES TO BE INSTALLED OPEN c.un°H Tro NNE IK ,11 I` (UNLESS OTHERWISE SPECIFIED) ] 2 E�(p7I�RI�tB��L A-i -. \ III=M FACILITIES TO BE INSTALLED CwflU0,5 tr IS qALp FACILITIES TO BE ABANDONED REMOVE VT 17052 RK_21 02 OPEN C 50 71255 im/B-20 VT07052 12 _ INSTALL.I-420 AL.XLP JET PRIMARY('A'PHASE)IN 2"PVC :AUTION TWO FEEDERS �! °I11ry- CONDUIT PROVIDED &INSTALLED BY PGE APPROVED CONTRACTOR INSTALL PPL0600615 II0 •OPEN ABANDON PRIMARY CONDUCTOR VT07052 19110 •i0 • -AUTI.N TWO FEEDERS .. B` `III 4 ALL CONDUIT TO BE INSTALLED 36 INCHES(MINI BELOW FINAL GRADE, ALL PGE CONDUCTORS TO BE INSTALLED IN GRAY,SCHEDULE 40,ELECTRICAL GRADE, 1 j�`k.' PVC CONDUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TEST).PGE TO DETERMINE ME SIZE AND NUMBER OF CONDUITS REQUIRED.MAINTAIN 12 VERTICAL INCHES AND 1/0 24 HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS 4 / 4 INCH 6 SMALLER TO BE 36 INCH RADIUS.ALL BENDS MUST BE FACTORY MADE. _ 4 ALL ELBOWS LARGER THAN 4 INCH TO BE 60 INCH RADIUS.RIGID STEEL OR PGE APPROVED.FIBERGLASS BENDS ARE REQUIRED FOR RUNS OF 51 FEET OR LONGER, In 1eB/B1 011123 OR FOR ANY LENGTH RUN WITH MORE THAN LBO DEGREES IN BENDS.PVC SCHEDULE 40 BENDS ARE ACCEPTABLE FOR RUNS OF 150 FEET OR LESS.THE MAXIMUM TOTAL °0110' N. 9 T 07698 BENDS IN ANY CONDUIT RUN IS 270 DEGREES. PLflIB B ... 21819 DIRECTIONAL BORING REQUIREMENTS BLACK HOPE(HIGH DENSITY POLYETHYLENE)DUCT �� P P 2 \ CONNECTION PRODUCT)AS AN ALTERNATIVE TO HOPE DUCT HDPE SHALL MEET LIKE MECHANICAL P P _ REQUIREMENTS OF PGE SPECIFICATION 1225(11(AVAILABLE ON REQUEST FROM PGE PROJECT e MANAGER).FOR SAFETY REASONS THE DUCT SHALL BE BLACK WITH THREE EQUALLY SPACE C-20 -� 1-10 Cu-DR EXTRUDED RED STRIPES(WHICH IS A SPECIFICATION REQUIREMENT).MANDREL TEST OF HDPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT 3z 8-20 AL-DI 575'_O_O POE To BE NOTIFIED AND VAULT ALL CONDUIT,NATO APO PAD INSTALLATIONS S A-AI AL-0B y y BEFORE MCWL.ALL NEW VAULT B PAD LOCATIONS TO BE FIELD VERIFIED Z Z WWII P(;F AND CUSTOMER REPRESFNTATNF It'12 I REFER TO PGE ELECTRICAL SERVICE REQUIREMENTS BOOK FOR FURTHER DETAILS I I l ` &SPECIFIC REQUIREMENTS.LINK TO 152DI EOBILA DGENEOAL CLIMBEOBnnr 1 DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT NON-STANDARD UNDERGROUND EQUIPMENT MAY BE NJ OPTION AT AN ADDITIONAL COST TO THE CUSTOMER 01 ` 1 - ' 19 SW FAIRHAVEN ST vT 00022 a ( ANY DEVIATION FROM THIS DESIGN MUST R A-2 AL KO MIT-0 BE APPROVED BY PGE PROJECT MANAGER Et ma, 0 .e Pl ` WR CHECKLIST l: ITEM YES COMMENT 268422-72 1,A= VT 07051 IIIXEO GGBI C 10 17140 BOOM A 50 I2085 u S PGE IEBIOI ,5.10 4 °occo, - a 806623 LOCATES X O 1173-20 J6R4M-72 FLAGGING 50 12614 ' . FLAGGING X 00064 UMW • L �• 268422-72 LANDSCAPE V T 06462 ` R. B.__ HISEAEM 0 MAWS X OTT CP MAI TRAFFC PLAN 0 WISHED W OR Yd DIASMISSION RIGHT-OF-WAY PERMIT NOTICE: SNUIWmN CUS)ONBT A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY SHUTDOWN WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED DOOR 1MNG9 X S;' CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL COMAO 1 AGREEMENTS WITH PGE WILL BE ALL OWED TO WORK UNDER PGE'S PERMIT THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS COWNa BEFORE WORK IS TO BEGIN.A COPY OF TilE PERMIT MUST BE ON SITE MIA CA DATE TIME ATTENTION/ CALL 811 BEFORE YOU DIG 81 ' � OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED CONTACT SERVICE COORDINATOR Br THE OREGON UTILITY MOTIF/CATION CENTER. THINK FOR MENU/ANB 00 0)Ar INSPECTION WP THOSE RULES ARE SET FORTH IN OAR 952-001-0010 TO LIORBL POE WILL NOT INSTALL WINE THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF IRJII TRENCH rs 100%BACXFKUD THE RULES BY CALLING THE OREGON UTILITY SAFETY SERVICE COORDINATOR NOTIFICATION CENTER ADMINISTRATION O (503-2321987) FIRST!1 503 736 5450 TO REQUEST I,;. .,TE5 CALL THE OREGON Knoll rhar5 below. f'IRST! ',,LITY NOIIF:C.:l,C;r, CENTER 811 AT LEAST Call before 00 d SUS/NESS DAYS PRIOR TO EXCAVATION. Y 19• PGE CONSTRUCTION DRAWING AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED 4 This document accurately represents FIELD Construction _ ~ ' { N °r�j - Foreman- Dote: _ �/ General Foreman: Dote: ♦ r I I 1 (Signature only required for Bold conatrucNon changes.) IL SDPM'ENG REVIEW: ASBUILT BY DESIGNER) �' 016 DATE 1 043 SCALE: 1•,�• ACCaUNT: 1070001 A 0000014628 Joe No.718130 �� el TULE rlik T REPLACE 80 UG PRIMARY CABLE $ SN"f"f CIRCUIT SIZE i _tI • I - /PG` ❑GARD-iIGARD 13 11X17 ail� qJ •� LOCATION J \/ 13485 SW GENESIS LOOP,71GARD `� �' r�L^_ ST 'Skf REPLACE 1147 UG PRIMARY CABLE - VD∎∎ j Lse�� opn NNE 'l ` I COUNTY ECIION(S) WORK WITH SHEET BEAVERroN WASHINGTON ISC21-030 I I OF 1 C I LINE CREW CENTER DBS,G, By PHONE THOMAS GUIDE - nu sw IlIRO OR WAYNE HAGAN 864-7213 I MIERAS REAATRIOH,OR 57006 655—05 s VICINITY MAP 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED CITY OF TIGARD RECEIPT !PI 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 194774 - 02/05/2014 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ROW2014-00009 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 002189 AKOWACZ 02/05/2014 $300.00 Payor: Bert Kephart Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1