ROW2014-00012 CITY OF TIGARD RIGHT OF WAY PERMIT
111111 3 COMMUNITY DEVELOPMENT Permit#: ROW2014-00012
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/24/2014
Parcel: SEG1356
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent 13265 SW Ash Drive. Replace B/O UG primary. SEG 1356.
Owner: FEES
Description Date Amount
ROW Permit Fee 02/24/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
CLINT THAYER
2213 SW 153RD DRIVE
BEAVERTON, OR 97006
PHONE: 503-963-6928
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.
ttue/Applicant
Signature:Signature: /!/II
Issued By: i C�
at
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2014-00012
Type: Condition Name: Status:, Severity:
ROW 01-CUSTOM CONDITION Applied Notice
Inform the City's inspector, Kenny Fisher at 503-816-6146 or email at kenny @tigard-or.gov, of any required restoration
outside of the paved area.
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- Application CITY OF TI IGNARRE INQ
- . A lication For Work In The Rig ' " ay .
TIGARD ROW Permit
Zoo
Property Address/Location(s): St.,.i ASk Dt- FOR STAFF USE ONLY
I35(e Right-of-Way,, ,' 11
Case No.: 1-tJ�`tGUI"1- pool Z
*Applicant's Name: E 3Q'a -I ts'4 41 Application Accepted: 1 I28 By: 'iii-"'
^� SW t,J3 t - Application Reviewed:A'2a a 1By: i!'
Address: 2 \3
City/State: ra2QV t r 4 I\ , 0 Q- Zip: °f-1 Application n Fee Due:
0®
Primary Contact: C1` k 0.`l ex-- Applicant Notified: -2-1 2-0 (4 kLE_
Phone: 503-47(03-b4 2 8 i Fax: SOS-Co7 2.- S 59.5- Receipt No.: 94 9
,aa,,s.,-i
ji Email: 7 D S U.vo r�atC j pin. CO n^- —? z.t 0'+ `t REQUIRED SUBMITTAL
,„,„4. f'', y INFORMATION.
Contractor's Name: IA A cLer 1i 67 f per "s'`". • 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
Ciry/State: Zip: plan
Phone: Fax: Professional Engineered Plans are required
Email: for:
• Street Widening
PU E • Subdivision Infrastructure
Plans By: • Main utility line extension
Address:
Deliver application to rowpermirsn.rigard-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: I:\CURPLN\Masters\Lnd Use Applotions\Rightof-way Permit
Applia u
tion.do
Description of work: Rep Ike Bin 06 Pri 1M4•9
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 ❑ NO lil
If so, please specify(BUILDING PERMIT)case#:. ( L //(4
Signature of Applicant/Permittee: J 3 21A t. i' f Ct'Yt( 'Matto' Date: (/28
Print Name: t-Ir k- IAA A-- Title: qo 6 14OCessor
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2464 I www.tigard-or.gov
WR CHECKLIST LEGEND
ITEM YES COMMENT
HOLEDIGGER
•
ROOM NEW PGE FACILITIES TO BE INSTALLED
MCIO1OB (UNLESS OTHERWISE SPECIFIED)
A
PGE TRENCH
• FACILITIES TO BE INSTALLED
1 LOCATES X FACILITIES TO BE ABANDONED
R
' STAKING
ss u ` TUGGING X INSTALL I-R2 AL-XLP JKT PRIMARY IN 2V PVC CONDUIT
SO 6J6T5 / TREETAIN PROVIDED 8 INSTALLED BY PGE-APPROVED CONTRACTOR
RD gu 1 LANDSCAPE
B ��+ EASEMENT ABANDON PRIMARY CONDUCTOR
\d�s11 / R°vp PERMITS X CRY OF TIGARD
' S\O xx 00 i f; 1RAEFK PLAN X ALL CONDUIT i0 BE INSTALLED 36 INCHES(MIN)BELOW FINAL GRADE.
S\O �� .,� =HEFT
UG CIE YEA All AGE CONDUCTORS TO If INSTALLED IN GRAY,SCHEDULE 40.ELECTRICAL GRADE,
M a4 PVC CONDUIT WITH NYLON PURL STRINGS(MIN.500 IBS.TEST).PGE TO DETERMINE
iPANSAVSSIC'. ME SIZE AND NUMBER Of CONDUITS REQUIRED MAINTAIN IT VERTICAL INCHES AND
� / \ SHNDbvN 24 HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS
p„(, R INCH d SMALLER TO BE 36 INCH RADIUS.ALL BENDS MUST BE FACTORY MADE
_ CUSiOVf� ALL ELBOWS LARGER THAN 1 INCH TO BE 60 INCH RADIUS.RIGID STEEL OR PGE
�,r//'' DOOR HAN APPROVED.FIBERGLASS BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER.
12O , DDggLL� B EB ISMS DOOL NGEi X b&E ARE!ACCEPTABLE FOR RUNS ROF 50 FEET OR LESS•THE BRENDS MAXIMUM V TOTAL ULE
INSTALL `Alitibl:4\1.-
I R"efRS• CONTACT RENDS IN ANY CONDUIT RUN a MI DEGREES.110„:A.,p.F COMPANY DIRECTIONAL BORING REQUIREMENTS-BLACK HOPE(HIGH DENSITY POLYETHYLENE)DUCT
' 277 OR SCHEDULE�0 PVC WITH A MECHANICAL CONNECTION (CERTAIOK OR LIKE MECHANIC'AI
! PROPOSED`4114 �jE �A CI CONNECTION PRODUCT)AS AN ALTERNATIVE TO HDPE DUCT.HOPE MEET THE
IPIN, REMOVE R DAiF 11Mf REQUIREMENTS OF PGE SPECIFICATION UG S(AVAILABLE CK REQUEST EREQ PGE PROTECT• OPE _ MANAGER).FOR SAFETY REASONS THE DUCT SHALL BE BLACK wITM THREE EQUALLY SPACE
I p,., EXTRUDED RED STRIPES(WHICH IS A SPECIFICATION REQUIREMENT.MANDREL TEST OF
HOPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT.
u \ `. AGE EF RQ ■N LL ALL AND VAULT ALL CONWAY LOCH I VAULT AND TEL INSTALLATIONS
• 05277 BEFORE BRE HOL ALL NEW VAULT&PAD LOUTIO A ,o BE FIELD INSTALLATIONS LLD
PGE AND CUSTOMER REPRESENTATIVE,
THINK REFER TO POE ELECTRICAL SERVICE REQUIREMENTS BOOR FOR FURTHER DETAILS
A 0 64620 • I. w d SPECIFIC REQUIREMENTS,LINK TO WWW PIRR AULOSENERU COMBEOR0SE
I t SAFETY DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT.NON-STANDARD
y lOyl FIRST! UNDERGROUND EQUIPMENT MAY BE AN OPTION AT AN ADDITIONAL C057 TO
b THE CUSTOMER.
me
`�!. CONTACT SERVICE COORDINATOR ANY DEVIATION FROM THIS DESIGN MUST
ro.THE"`"AND CONDII.'T INSPFrnoN PR BE APPROVED BY PGE PROJECT MANAGER
�� TOµermL eE S In moo,�suu...PP
UNTIL•Rwc"a Lam. PACC•ue
JERVICE COORDINATOR
•OP 503-736-5450
W. PGE CONSTRUCTION DRAWING
RIGHT-OF-WAY PERMIT NOTICE: AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY This document accurately represents FIELD Cons/rut/m.1
L �J ! CORK IN THE RIGHT OF WAY MAY BE PERFORMED. ONLY PGE APPROVED Foreman-
General_ - CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL
\ AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT.
General Foreman: Date:
t ^ THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS
-��. • ♦ / It BEFORE WORK IS TO BEGIN. A COPY OF THE PERMIT MUST BE ON SITE. (Signature only required for field construdion Changes.)
I �"C - SDPAHENG REVIEW ASBUILT BY DESIGNER:
,•` .� DATE: 12/36'13 SOLO 1':100 ACCOUNT 1070001 Awo 0000011628 IIOe No.715417
REPLACE BO UG PRIMARY CABLE
� CIRCUIT SIZE
,/�� CALL 811 BEFORE YOU DIG
'�4ifitil., ATTENTION' TIGA UtD-TIGARD 13 11117
_ OREGON Uw REOURRFS YOU 70 FOLLOW ER ADOPTED /! \ / BY THE OREGON UTILITY TH IN DARN CENTER. PGE LOCATION
S_ THOSE RULES ARE SET FORTH IN OM 93T-004D TES R / 13155 SW ASH DR,TIGARD
S THROUGH 952-001-0090.YOU MAY OBTAIN COMES OF
� F _ � .' THE RULES BY CALLING THE OREGON WHIN �� DESCRIPTION
-_( • 17* `-I ProT ICATIO L CENTER ADMINISTRATION 6 (303-272-1987) ` REPLACE BO UG PRIMARY CABLE woRK WITH sHee,MP_ Af
TO REQUEST UTILITY LOCATES CALL THE OREGON Knew wises below. /COUNTY C83-I EC-TION(S)
t E UTILITY NOTIFICATION CENTER.811 AT LEAST BEAVERTON WASHINGTON IsC83-10C , of
\ 2 BUSINESS DAYS PRIOR TO EXCAVATION.
Call lrolore you dig.
1 LINE CREW CENTER DESIGN BY PHONE(475) DRAWN BY
SNOWS GUIDE � � ( RTD SW ISJRD w CLINT THAYER 864-0566 I K MIERAS
655—E5 VICINITY MAP sr.7.roN.OR V7006 O PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
CITY OF TIGARD RECEIPT
r
• . 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGAR.O
Receipt Number: 194983 - 02/24/2014
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
R0W2014-00012 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 056857 AKOWACZ 02/24/2014 $300.00
Payor: Linda Miller
Total Payments: $300.00
Balance Due: $0.00
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