ROW2014-00021 CITY OF TIGARD RIGHT OF WAY PERMIT
_ COMMUNITY DEVELOPMENT
Permit#: ROW2014-00021
• 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/12/2014
TIGARD Parcel: SEG515
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to SW 119th Ave and SW North Dakota Street. Replace B/O cable from vault 6988 to pole
6617. Landscape work around vault 6988 and pole 6617.SEG 515/516
Owner: FEES
Description Date Amount
ROW Permit Fee 03/12/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
HASSAN AMAN
2213 SW 153RD DRIVE
BEAVERTON, OR 97006
PHONE: 503-963-6926
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.
Signature: licant nt
Signature:
Issued By: -k 1I ill tu1Lt'&
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for ROW2014-00021
Type: Condition Name: Status: Seven :
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 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 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.
RECEIVED
FEB 2 7 2014
.. City of Tigard CITY OF TIGARD
Application For Work In The Rig aetyFLESOR5FRI NG
TWA. Rn ROW Permit
r - . i 47 4
Property Address/Location(s): <P17 //f 77-rl ,4vF N// FOR STAFF USE ONLY
S by /Ya2]?a A.4.t 874 ST- 5I s'SI
Right-of-Way �`ry 4--t2i
Case No.: �/1 1
*Applicant's Name: deG� Application Acceptedl3I bl I y By: Alt-
Address: 7 713 c tt/ 1S?lLQ i)
Application Reviewed:3✓5%/ y;.1122g
City/State: /3 4v"Err TAN e.Q Zip: 9 7 0 4 6 .30 0 D d
Application Fee Due:
Primary Contact: NA.SSArt,/ .4-A4.4"/ O l
Applicant Notified: 3 _I `+ �
Phone: /5U-j) 963 -G 924 Fax: /S-D�)G72- 5-5'9.3"- 106 I a
Receipt No.:
Email: T &1 ASvPPort RU'. °c_ n.rArv►
REQUIRED SUBMITTAL
Contractor's Name: 8 E p F_ re E'.rdNG.6 —./D B INFORMATION
I
CCB# G u)--/v6- 77J g? Expiration:
• Application form,completed and signed
Address: • Submit one(1)copy of scaled sketch of
City/State: Zip: the proposed work to be done
Phone: Fax: • Submit one(1) copy of traffic control
Email: plan
Professional Engineered Plans are required
Plans By: PAL for:
Address: • Street Widening
City/State: Zip: • Subdivision Infrastructure
Phone: Fax: • Main utility line extension
Email: Re..6/24/2013
1.curpin\masters\lend use applications\cow app.doa
Description of work: K .6VA-G F 13 1 D GA-,Q Lf FA"afry p,4-44.-T (r 4i 6 A Ta
i
,OOZE eel,/7. G.4-rvb5c..-roE l4J!Ti¢!d- .4-t.7/vnl6 1r.4i'L-r G9BB
pt- //JL,F_ G(o/7.
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES n NO R
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#:
Signature of Applicant/Permittee: ^ h 4Y fry- itiA S.44-✓ 4:-..r..—Date: 2-/2-7/14
Print Name: Z-• M.fl ,t. ID( /,l4SS,47%/ Aft. Tide: JoB P.t'OGESS'OR
City of Tigard I 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2464 I www.tigard-or.gov
01537- WR CHECKLIST
I'W014 ITEM YES COMMENT LEGEND
a 1 PD 00040 0 A 75 2130 ODE
m 4 t C 25 54577 440 TO �HSOI r NEW PGE FACILITIES TO BE INSTALLED
Ve ~ MEMO, r (UNLESS OTHERWISE SPECIFIED)
4.o VT 04 989
PD 00002 uo Ts ® LOCATES r ■ FACILITIES TO BE INSTALLED
V STING r
` 3YU�M / �• 1 FACILITIES TO BE ABANDONED OR REMOVED
3 L 7EfffAW
_ UNOSUPE X POST INSTALL CUTOUT
0001 Al SIZE FUSING AS NOTED
1190-S C-E AR-011 yl FASEMNT
x604 OPOSED wf BORE FROM VAULT 6988,UNDER mhos X TIGARD INSTALL I-R2 AL-ELF JKT PRIMARY IN 2"PVC CONDUIT
am15 REMOVE STREET TO POLE 6617 LOCATION IRAfM PUN PROVIDED &INSTALLED BY PGE-APPROVED CONTRACTOR
OPEN KL161.67 - RECOMMEND TRENCH TO POLE WISHED
9006967 - W fIA.vH ABANDON PRIMARY CONDUCTOR
DO NOT C OSE HOT 22 DUE TO TREE ROOTS AND IevE SIN
0 3E- I TT 0000 A 75 2125 F LANDSCAPING SIIUTDORN
001621 =k-D♦ CUSTOHEA
PL10016 E 1 BORE 5'TO 10'FROM EDGE OF SVC'DOIN AU CONDUIT TO BE INSTALLED 36 INCHES(MIN)BELOW FINAL GRADE.
A-2 CU-D: VT 06988 12'VAULT
OOD16 1 e CURB �N HMGFP - AU PGE CONDUCTORS TO RE INSTALLED IN GRAY,SCHEDULE 40,ELECTRICAL GRADE,
1410-25 MANZANITA CT BAD OBOE' TO STREET EOMALT PVC CONDL/IT WITH NYLON PULL STRINGS!MIN 500 IBS TEST).PGE TO DETERMINE
-10[uDS ENE SIZE AND NUMBER OF CONDUITS REQUIRED MAINTAIN 12 VERTICAL INCHES AND
.d CQWAHY 24 HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS
YAr CF 4 INCH A SMALLER TO BE 36 INCH RADIUS.ALL BENDS*RUST RE FACTORY MADE
/ ALL ELBOWS LARGER THAN 4 INCH TO BE 60 INCH RADIOS.RIGID STEEL OR PGE
410 It - DAR ME APPROVED FIBERGLASS BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER,
t OA FOR ANY LENGTH RUN WITH MORE THAN 180 DEGREES IN BENDS.PVC SCHEDULE
a B' �� C. v 290' 40 BENDS ANr�co�f�DEAr n LSR of 150 FEET OR LESS.OW MAXIMUM TOTAL
A 50 6889 t 64 TOTAL POLE 06617 ,Ri.c TIONAL BORING REQUIREMENTS BLACK HOPE(HIGH DENSITY POLYETHYLENE)DUCT
A 25 71280 PO 06967 1 _ REPLACE TWIGS WITH CROSSARM 02 SCHEDULE 40 PVC WITH A MECHANICAL CONNECTION (CERTA-LOK OR LIKE MECHANICAL
I CONNECTION PRODUCT)AS AN ALTERNATIVE TO HDPE DUCT HDPE SHALL MEET THE
2 u OISn- 1 ROPO$ED REQUIREMENTS OF PGE SPECIFICATION 122501(AVAILABLE ON REQUEST FROM PGE PROJECT
�i 0016+, I EMOVE MANAGER)FOR SAFETY REASONS THE DUCT SHALL BE BUCK WITH THREE EQUALLY SPACE
PL00017 R REFRMW DRTRIPUTION 1C70T30, EXTRUDED RED STRIPES(WHICH IS A SPECIFICATION REQUIREMENT)MANDREL TEST OF
010-25 T m 1 PEN RIMS MU 0035 HDPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT
Q�= In A I VT06988 539 1 TANG.D,SOL R'LT,PRO PGE TO RE NOTIFIED AND INSPECT ALL coNOLRr,VAULT AND PAD INSTALLATIONS
I•2 -� Q O I CO NOT CLOSE S. BORE MCBPRL ALL NEW VAULT a PAD LOCATIONS TO BE FIELD VERIFIED
I C 50 24%1 Z Z 1 INSTALL 2"POLE CONDUIT UNIT WITH PGE AND CUSTOMER REPRESENTATIVE
I WITH 12"BRACKETS,1-142 CO F100T
Po f0000B 1 - REFER TO PGE ELECTRICAL SERVICE REQUIREMENTS BOOR FOR FURTHER DETAILS
o N ! & LIGHTNING ARRESTER a SPECIFIC REQUIREMENTS.LINK TO WWLV MI,LNnr:PNRII COR..Fr,.r,r,K
THINK x DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT NON-STANDARD
(17537- i �79b NEW UNDERGROUND EQUIPMENT MAY BE AN OPTION AT AN ADDITIONAL COST TO
SAFETY p 00300' PL06616 i 2"CONDUIT THE CUSTOMER.
FIRST! I 7958-40 2006-45
O T
ANY DEVIATION FROM THIS DESIGN MUST
CONTACT SERVICE COORDINATOR NORTH DAKOTA ST (� i BE APPROVED BY PGE PROJECT MANAGER
•OR TRENCH AND CONDUIT INSPECTION POE ll
TO BACKFILL PGE WILL 001 INSTALL WIRE 1-142 �M I 142 --UNTIL TRENCH IS 1005 RACKPILLEO FSOOT Iti 107
SERVICE COORDINATOR VT06988 1+10635
PGE CONSTRUCTION DRAWING
S03-736-5450 A 52624 50 61I%
AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
_ This document accurately represents FIELD Co,1I'wcl•an
(S �� I I Foreman, DON:
C7-- << q _ General Foreman: Date:
_ 10 yr RIGHT-OF-WAY PERMIT NOTICE: (Signature only required far field construction changes.)
�' ' �j U' t A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY $DPM•ENG REVIEW: 1ASBUILT BY DESIGNER:
-^—__ 3 9 .. WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED DATE Y3r11 SCALE: )".1�• 'ACCOUNT 1070001 IAWQ- 0000014628 1roe NO 707397
II``�• CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL
j AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. rrni
EP
THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS
REPLACE SO UG PRIMARY CABLE
- D T- - BEFORE WORK IS TO BEGIN. A COPY OF THE PERMIT MUST BE ON SITE ` CIRCUIT SIZE
N-,e. GL
i___, `,—_ PROGRESS-GREENBURG 11x17
C JOB 1S T-- --) /PGE, LOCATION
„— _ ATTEN: CALL 817 BEFORE YOU DIG 77960 SW SW MANZANITA C7,TIGARD
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED DESCRIPTION
. SW NORTH DAKOTA S7
BY THE OREGON UTILITY NOTIFICATION CENTER. �� REPLACE 60 UG PRIMARY CABLE
THOSE RULES ARE SET FORTH IN OAR 952-001-00q
Ai _ _ THROUGH 952 001-0090.YOU MAY OBTAIN COPIES OF —�WASHI CTION(S) WORK WITH SHEET
--12- =, I- �sy1 THE RULES BY CALLING THE OREGON UTMLR1' KAVERION WA$HING70NOTB-310 I OF I
II L l` -Cl f)` NOTIFICATION CENTER ADMINISTRATION @ (501232-1987) LIFER CREW CENTER DESIGN BY PHONE(425) DRAWN BY
TIIDMAS G',Df 1 ��__iii-- ) - IO REQUEST UTIUTI'LOCATES CALL THE OREGON SW 1030 03 HASSAN AMAN 963-6926 K MIERAS
UTILITY NOTIFICATION CENTER,BII AT LEAST Know what's below. .44110.+103 9
655 -3 - VICINITY- MAP 2 BUSINESS DAYS PRIOR TO EXCAVATION. Call before you dig. I 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED ■
1
IIIIII1 III 1104 •-- 1=smut
_____....... .4(30093MAN ZA N I T4.0 T
s S 34 C004
D lk-8"
_SS34C005
_
1.111 34,,,, 11334 MSC i ____ _ __
at
i s
1
2
i'• 11120 i : 11720 ...i
11690 I 1 1 6 6 0
Of
....m......2
ii
s, COO --
11111.511
SS 34 DOI .1'I
-05
— 1 ,
- co SS 34 C $534009
119 t3
\ III J
<03.
.. ..
•, 11po \
I .
1 ss. .111 ,„ ; liti-
DIAi-:" .. 3
i-- _
J
1
1
I. i
I pp LAIL
...
34 C13083 . I
34C:11.4
.--34 31(055F 34C C___34(012 _ 34(0127_.
— - . -7-7- f 11101.411 66-41 3* 4 C136,
NORTH DAKOTA ST S3440 1110--- S94 IMO 7
Feet -----1
0 125
11■1 , 1111.1.1... 1 f Mill I allaliM 1 [111.11111— i 1 i .
•
_1
71 CITY OF TIGARD RECEIPT
n
. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 195199 - 03/12/2014
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
R0W2014-00021 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 014820 AKOWACZ 03/12/2014 $300.00
Payor: Linda Miller
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1