PFI2014-00029 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00029
f 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/21/2014
Parcel: SEG847
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to 12034 SW Lynn Street. LIG residential service 130 feet under SW Lynn Street, one space
west from SW 119th Ave. SEG 847
Owner: FEES
Description Date Amount
PFI Permit Fee 07/18/2014 $300.00
PHONE:
Contractor:
PHONE:
FAX
Applicant:
HAP ENGLISH
2213 SW 153RD DRIVE
BEAVERTON, OR 97006
PHONE: 503-672-5489
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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00029
Type: Condition Name: Status: Severity;
ROW 19-UTILITY LOCATIONAL CONFLICT Continuing 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 24-TESTS/REPTS TO VALIDT CLMS Continuing 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 02-PERMIT&PLAN REQ ON SITE Continuing 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 08-TRAF CTRL-DEVICES IN PLACE Continuing Notice
Traffic control devices,flagpersons,etc.,shall be in place prior to initiation of construction work and shall be effectively
maintained.
ROW 15-EROSION CTRL REQ Continuing 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 Continuing 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 05-TRAF CTRL-ROAD CLOSURE Continuing 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 18-UTILITIES PRELOCATION REQ Continuing 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 22-AS-BUILT/ENGR CERTIF REQ Continuing 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 06-TRAF CTRL-ADVANCE WARNING Continuing 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 10-TRAF CTRL-MIN LANE WIDTH Continuing Notice
Minimum travel lane width shall be eleven(11)feet;pedestrian travel shall also be provided for.
ROW 11-TRAF CTRL-CITY CAN MODIFY Continuing 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 Continuing 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 Continuing 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 17-DRAINAGE CONTROL REQ Continuing 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 21-REPAIRS REQ-INSPTR OPINION Continuing 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 26-MONUMENT PROTECTION REQ Continuing 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 Continuing Notice
The permit holder shall provide to the City Inspector, in writing,the names and 24-hour emergency telephone number of two
(2)persoAs 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 29-ESMT/RT OF ENTRY-RESPON Continuing 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.
ROW 04-TRAF CTRL-CONTR RESPON FOR Continuing 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 07-TRAF CTRL-PRIV PROP ACCESS Continuing 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 09-TRAF/NOISE CTRL-WORK HRS Continuing 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 20-TRENCH-PATCH/SAFETY/LBILITY Continuing 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 23-DAILY INSP REPORTS REQ Continuing 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 25-RELEASE-WAIVER REQ Continuing 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 28-CONSTR SAFETY-RESPON PARTY Continuing 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 03-TRAF CTRL-SPECIF(CITY) Continuing 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 14-DEBRIS-MATERIALS Continuing 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.
REC7. jVED
JUL
10 2014
City of Tigard
Application For Work In The Rigof RD wG
SOW Permit IPF-
Property Address/Location(s): d J` T �. =ST FOR STAFF USE ONLY
CPG 4v)Re 7
Right-of-Way
Case No.: I 20I ^07Q0
*Applicant's Name: 7d1rf(a / 6, ul
r
ApplicationAccepted:,-H I C) By:f
Address: 3 `✓' /..53 ray ► i'✓t`°. Application Reviewed-?'
City/State: 664 V eAe J ? 1 7 062(/ "3-06 av
�� /i g� Application Fee Due:
Primary Contact: !
L Applicant Notified: 1 �S A-Y
Phone: 5_4 3—(e 72 5-
N){� tbl Il,� V>7 liI1 QJ
Receipt No.:
Email: �7^05u pobr� B L(f
REQUIRED SUBMITTAL
Contractor's Name: AIA INFORMATION
CCB# Expiration:
• Application form,completed and signed f
Address: • Submit one(1)copy of scaled sketch of
City/State: Zip: the proposed work to be done f
Phone: Fax: • Submit one(1)copy of traffic control
plan i
Email:
Professional Engineered Plans ase required
Plans By: PGe� ���rllt for:
f
Address: • Street Widening
City/State: Zip: • Subdivision Infrastructure
Phone: Fax: • Main utility line extension
Ems. R-.6/24/2013 I
I:aupin\murcrs\hnd use appbmdons\m%v•pp.do
f //� j
Description of work: t/L G 1-C 5i �cn&1 5(fK Vi'C_f. /3o -f-t "n dP_e `5 a. Lyrn n _ST,
Ort P_ span t4ze_i2l� :A err, S flim-
Estimated
1 i m-
"
Estimated value of work(within the public right-of-way): S
Is work related to a LAND-USE DECISION? YES F1 NO R1 a
If so, please specify(MLP,SDR,SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES El NO a
If so, please specify(BUILDING PERMIT)case#:
I
Signature of Applicant/Permittee: tTKe7
Print Name: K_4 r-i' ryii 11dhderz4r1d&1 Title: —F4 D sit Pyorl / �5D 1
47or fi�rt Fn l,'s h
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 www.tigard-or.gov
I i
ABC-556 AA
N-4/0 AAC WR CHECKLIST NEW PGE FACILITIES TO BE INSTALLED
ITEM YES COMMENT
HOLfDK;GER (UNLESS OTHERWISE SPECIFIED)
25 57496 BOOM ----- INSTALL 1-"AL-TX SECONDARY IN 3"PVC CONDUIT
01823- PROVIDED B INSTALLED BY CUSTOMER
06501 00298/ BRCKHOE
1979-45 PLO6501 EXIST LOAD 25KW ( INTER PE K) PGF TRENCH -------- INSTALL 1-40 AL-TX SECONDARY IN 3"HDPE CONDUIT
NEW LOAD 6KW
22 3-143
TOTAL EST DMD 31K W PROVIDED 6 INSTALLED BY CUSTOMER
F65T LOCATES PROVIDE 8 INSTALLED BY CUSTOMER
SECONDARY VAULT,
L06501 STAKING 0 ED
PD 09530 INSTALL HAND HOLE GOLD TEMP 1730 VAULT
1-41 FLAGGINGX
AC,Tk- TREETRIM a GOLD TEMP(17X30 STYLE)
_ 05301 0 TO BE REMOVED WHEN PERMANENT SERVICE INSTALLED
01823- LANDSCAPE
��p306 - 1970-25 00290/
1{79-20 130' PL05301 EASEMENT
4/0
PERMITS Y CITY OF TIGARD 2 TRAFFIC PUN
O vT 00132 Shy y CUTSHEET CONSTRUCTION NOTES: SFE)a
> 08011 L. UG OR VER
Q 1979-30 Sr TRANSMISSION I CUSTOMER To MONDE ALL TRENCHING AND BACKFILLING. TRENCH TO BE
36 INCHES DEEP,MEASURED FROM FINAL GRADE.
06697 ' -2 AL-Da SHUTDOWN
I 2 CONDUIT(IF NECESSARY)WILL BE GRAY,SCHEDULE 40,ELECTRICAL GRADE,
979-45 �RB CUSTOMER PVC CONDUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TEST)
v/ 1'2G240V SHUTDOWN K PGE TO DETERMINE THE SIZE AND NUMBER OF CONDUITS REQUIRED.
Rr'• 1-2/0 MAINTAIN 12 VERTICAL INCHES AND 24 HORIZONTAL INCHES CLEARANCE BETWEEN
2WAMP CLI DOOR HANGER GAS AND OTHER UTILITIES ALL ELBOWS TO BE 36 INCH(MM)RADIUS.
r HP/AC:3TON CONTACT ALL BENDS MUST BE FACTORY MADE RIGID STEEL OR PGE APPROVED FIBERGLASS
BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER OR FOR ANY LENGTH
0.7%VD COMPANY RUN WITH MORE THAN 180 DEGREES M BENDS.PVC SCHEDULE 40 BENDS ARE
3 2.2%FLKR ACCEPTABLE FOR RUNS OF 150 FEET OR LESS THE MAXIMUM TOTAL BENDS IN ANY
Ci CONDUIT RUN IS 270 DEGREES.
PNY
y 4,867A AFC DATE TIME 3. CUSTOMER RESPONSIBLE FOR ROAD CROSSINGS. USE ONLY GRAY,SCHEDULE M,
ELECTRICAL GRADE,PVC CONDUIT WITH NYLON PURL STRINGS(MIN.500 LIS.TEST)-
RIGHT-OF-WAY ERMIT NoncE: ANY DEVIATION FROM THIS DESIGN MUST 4. DIRECTIONAL BORING REQUIREMENTS:BUCK HDPE(HIGH DENSITY POLYETHYLENE)DUCT
OR SCHEDULE 40 PVC WITH A MECHANIGLL CONNECTION 'CERTA-LOK OR LIKE MECHANICAL
A PERMIT FROM TH LOCAL JURISDICTIO IS REQUIRED BEFORE ANY BE APPROVED BY PGE PROJECT MANAGER CONNECTION PRODUCT)AS AN ALTERNATIVE TO HOPE DUCT.HOPE SHALL MEET THE
REQUIREMENTS OF PGE SPECIFICATION LI2S01`AVAILABLE ON REQUEST FROM PGE PROJECT
W 823- WORK IN THE RIG -OF-WAY MAY BE P FORMED ONLY PGE APPROVED MANAGER),FOR SAFETY REASONS THE DUCT SHALL BE BUCK WITH
�THREE EQUALLY SPACE
00400/ CONTRACTOR$AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL PGE 1730 SPLICE BOX HDPE PIPE ISE STRIPES
WHHICHER I IS A
WITH PGP UIIREMEn PRESENT
TEST OF
PL 02108 AGREEMENTS WTH GE WILL BE ALLOWE TO WORK UNDER PGE'$PERMIT
THE CONTRACTOR UST NOTIFY THE LO JURISDICTION 48 HOURS S. SINGLE PRIMARY INSTALLATIONS-CONDUIT TO EXTEND A MMIMUM OF 10'FROM
BEFORE WORK IST BEGIN,A COPY O THE PERMIT MUST BE ON SITE. N 1- TRANSFORMER PAD.
02108 6. ALL PGE TRANSFORMERS TO BE INSTALLED B FEET IMIN)FROM ANY COMBUSTIBLE
1952-40 O 6'RADIO_ BUILDING,WALL OR OVERHANG AND 4 FEET/MM)FROM ANY FIRE HYDRANT.
C 15 8676 3'TO - PGE TRANSFORM 45 MIST BE WITHIN 15 FEET OF A DRNEABLE AREA
I TRANSFORMER OR PERMV SVC ' M1 ALWAYS MAINTAIN TO FEET CLEARANCE IN FROM OF ALL TRANSFORMERS.
ELECTRIC
MnRFF- I �� I CUSTOMER TRENCH AND ELBOW CONFIGURATIONS MUST BE INSPECTED BY PGE PRIOR TO
BACKFILLING.WHEN YOU ARE READY FOR PGE TO INSPECT(AFTER INSTALLATION IS COMPLETE)
TRENCH PLEASE CALL 503-736-5450 OR 503-JdJ 348(SALEM AREAI
PDLYMER COYER 'I IOW UP TO 2 WORKING DAYS FOR INSPECTION TO OCCUR
MARKED'ELECTRIC B DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT NON-STANDARD
CONDUIT UNDERGROUND EQUIPMENT MAY BE AN OPTION AT AN ADDITIONAL COST TO THE CUSTOMER.
�� MARKER
ST IT TOP VIEW BGROUND
OPTIONAL ✓IL Roo BY PGE PGE CONSTRUCTION DRAWING
————— AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
This document occumtely represents FIELD Construction
} ) ) Foreman: Dale:
' �y �� I Mu coeurs orF ) General Fonmon: Dale:
THINK i*6�-' :•'
(Signature on aired for field mnstnFtlon changes.)
" "'•�'. SDPM£NG REVIEW: ASBUILT BY DESIGNER:
SAFETY v.S:: si8`• DATE: yIS114 SCALE: I.;�� ACCOUNT: 1070001 Awo: 7000001928 B N -761951
FIRSTI 48-IMII�71'•., ••• yLMML/58,CKFRL TITLE
i IA_, Jl L CA sER'W ` WESTWOOD HOMES-LYNN 57
ST I UNDER SPIKE BOX MARK CAI B INSTALL
PIONAL IO'01 5004 IUIL STIIMG ORCUIT SIZE
trKxAs turas PROGRESS-GREENSURD 11x17
CALL 811 BEFORE YOU DIG PGE LourloN
655—C3 VICINITY MAPATTENTION: \ / 12034 SW_LYNN ST,TIGARD
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED
BY THE OREGON UTILITY NOTIFICATION CENTER. DESCRIPTION
CONTACT GENERAL FOREMAN THOSE RULES ARE SET FORTH IN OAR 952-=-0010 a 1PH 12G240V 200A UG RESIDENTIAL SVC
AND4OR CONDUIT INSPECTOR 7 TO 10 WORKING DAYS PRIOR THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF COUNTY CVDNR) WORK MATIN SHEET
TO EXCAVATION CONDUIT INSPECTION REQUIRED PRIOR TO BACKFILL THE RULES BY CALLING THE OREGON UTILITY BEAVERTON WASH C21-030 1 OFT
PGE WILL NOT INSTALL WIRE UNTIL TRENCH 15 100% BACKFILLED NOTIFICATION CENTER ADMINISTRATION ® (503-232-(987) UNE CREW CENTER DESIGN By PHONE(503) DRAWN BY
JIM KACALEK TO REQUEST UTILITY LOCATES CALL THE OREGON
GENERAL�AAAN Knee qys�Ipyy, RA sW IsnO a HAP ENGLISH 672-5489 DUMITRU ILIOI
CAL 503-969-6103 UTILITY NOTIFICATION CENTER,811 AT LEAST CON before wrTRroN.OR v7aoe
2 BUSINESS DAYS PRIOR TO EXCAVATION. • 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED