PFI2014-00071 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
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COMMUNITY DEVELOPMENT Permit#: PF12014-00071
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/15/2014
Parcel: SEG1632
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to 10520 SW McDonald Street. Install 35'clearance pole. SEG 1632
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
TOD SCHATTUCK
2213 SW 153RD DRIVE
BEAVERTON, OR 97006
PHONE: 503-672-5466
Total $0.00
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
Signature:
Issued By: Aftj kw�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00071
Type: Condition Name: Status: Severity:
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 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 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 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 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 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.
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 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 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 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 12-INSP 24 HR NOTICE REQUIRED Continuing Notice
The permit holder or his contractor shall notify the City's inspector<name>, at<phone#>or email at<email address>,
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 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 01-CUSTOM CONDITION Continuing Notice
<Custom Condition goes here>
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 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 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 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 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 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 Qob specific)approved traffic control plan.A copy of the approved traffic control plan shall be
available at the work area.
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 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 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 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 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 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 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 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)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 10-TRAF CTRL-MIN LANE WIDTH Continuing Notice
Minimum travel lane width shall be eleven(11)feet; pedestrian travel shall also be provided for.
City of Tigard
Public Facility Improvement
} (PFI) Permit
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General Information: FOR STAFF USE ONLY
EngProperty Address/Location(s):C10 0 l ii) 1h f hCr� Case No.:oW1
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L' Case
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Fee: ��•.
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( Receipt No.: r"' G •
*Applicants Name: {( ('��I n '`ISO.n 1,10. �_ l C' 4e C--- Date:
Address: �. 1 4t1 � �U4 t J/ ,11-Q Application Accepted By:JW_
City/State: ,0(r tlf1HtPA, Q Zip:
7L}60
Primary Contact:Md SLa' GtCIL REQUIRED SUBMITTAL
f/ INFORMATION
Phone: :!in (0 Fax:
E-Mail: ! I' (L �1L^t✓e` ti;ll+ dFt1 Professional Engineered Plans are required
for.•
,{ � Street Widening
Contractor's Name: /11
• Subdivision Infrastructure
CCB# Expiration: • Main utility line extension:
0 Storm Drain,Sanitary-Tigard
Address: 0 Water-Tigard Water Service Area
City/State: Zip: (includes Durham,King City and a
portion of unincorporated Washington
Phone: Fax: County)
**Note:See Engineered Plan
Plans By: P6,f LC i C1 r!A f� ��t, / 0� Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
City/State: Zip: work to be done.(see attached minimum sketch
Phone: Fax: requirements and provided sketch area).
Updated:6/24/2013
{ 1.\CURPLN\Masters\Land Use Applications\public Faaliry
E I �`� nc.� py 1-pwo em t.docr
Description of work. -�tt'� t ( (�-•
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES ❑ NO `-1'-'
If so,please specify(MLP,SDR,SUB,etc.)case#: `-f'-'
Is the work related to a BUILDING PERMIT? YESNO
If so,please specify(BUILDING PERMIT)case#:
Cityof Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 W-ww.tigard-or.gov Page 1 of S
APPLICANTS:
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on
the front of this application in the"Required Submittal Elements"box.
NOTE: Person specified as"Applicant'shall be designated"Permittee"and shall provide financial assurance for work.
*When the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with
written authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided on the
back of this form or submit a written authorization with this application
(Detailed Submittal Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.)
BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT:
♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property
♦ If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions
and limitations of the approval.
♦ All of the above statements and the statements in the plot plan, attachments,and exhibits transmitted herewith,are true; and the
applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are
false.
♦ The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for
approving or denying the application.
SIGNATURES of each owner of the subject property.
DATED this day of 120
AL Gk .
Applit/Au "ed Agent's Signature Owner's Signature
Owner's Signature Owner's Signature
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 2 of 5
Page 84 2011 Edition 2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320 Stationary Lane Closure with Flagging Diagram 320
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control s ¢ c
Moth directions of traffic on low volume roads(less than 400 ADT)with good ¢ o
sight distance as discussed below. elm 15
1. Use truck-mounted flashing warning lights on work and protection c uj r) O
vehicles. See Section 4.3-Lights and Lighted Signs for exceptions. V o o I '�
2. For added visibility, a truck-mounted arrow board or PCMS in caution eo" m
� 1 t
mode may be used. a 0
3. Flaggers at each approach are required if any of the following a ~
conditions exist: �` a
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach • m
through the lane closure. $ ••• >R m
d. Traffic volumes are greater than 400 ADT. i I • `o o r
I EEO
IWD
4. The length between the Flagger Ahead signs shall not exceed one I AV e 4 1 I o • s n
II
mile. Use Diagram 340-Lane Closure with Pilot Car if exceeding one I E E P a
mile. IriI
5. Cones should be used to outline the work space when curves or other i c �.® 3�{ I •
roadway alignments prevent clear direction for the motorists to pass I I I •
the work space safely. g I m ;fit s I ••
I aE Z
6. Cones along the work space are recommended when posted speeds 1 02-§ I'. •
are 45 mph or greater,when working under heavy traffic or when travel I o,>V I
lanes are narrower than 11 feet. I as o
u�a
7. Extended queue signing(see Diagram 5-4) should be used when - 2 Y' m
traffic queues extend beyond the initial advance warning sign. I c 1 I 1 r I CC o
r o.�
8. When flagging near an intersection,the"Flagger Ahead"(CW23-2) I ________________
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on Low Sign Spacing and Buffer Lengths(feet) I 1 S P
Posted S acro Between signs Buffer p g
the side road(s). - speed A I B c Space o�� o
9. Sign set-up and flagger placement shown may be used for intermittent CIWO- 25 100 100 100 is
full road closures of 20 minutes or less. 35 125 Y
_.., 40 350 350 350 150 O O
10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should 45 180 Q 3
be considered on high volume or high speed roads, or when extended 5W Soo 500 55 1 z'0
queues are expected. _
W
V
Chapter 5 December 2011 December 2011 Chapter 5
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A 15 21792
1-350 AL-OX- -4/0 AL-TX OVERHEAD LEGEND
400A
3-14 PD 00012 4/0 TX M INSTALL FACILITIES
F I OOT M INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES
PL00742 ABC 112.5 220 4/0 TX 4/0 Tx
00742 O 01470 00052/
2005-50
L01470
1-6 AL-TX ' ABC-336 AAC POLES
N-4/0 AAC WR CHECKLIST
3-14 1_1 4 I REM YES COMMENTr cL POLE CLASS (1,2,3,4,H1,H2,S)
ABCN-2 ACS F100T F65T ,90' HOLEacGFR X HOLE HEIGHT(FEET)
LO1470 %R32470 RI 00002 MCDONALD ST Boom
1998-3` 4-35 BACKHOE
3-143 PGE TRENCH
ABC-2 AL-0 FIOT
L05521LOCATES x
05521 � p STAKING X DONE
1967-40 O FLAGGING X
LUTREETRLM
> 10520 L WDSCAPE
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= 4/0 TX x
PERMITS X TIGARD/FLAGGING OMY
c 1-143 a PL-00002 TRAFFIC PIM! x THINK
VT 08110 F6T CUTSHEET SAFETY
PLO8109 N INSTALL POLE AT STAKED LOCATION
ABC 112.5 443
y a oc CrKvsMs off FIRST!
08109 CUSTOMER
1979-40 35-4 CUSTOMER
A-2 AL-DB DOSHUR RAN X PM i0 NOTIFY
DOOR RANGER
O CONTACT
FRONTIER OWNED POLE COMPANY
PHM CR
- 7 PGE TO OWN NEW POLE DATE TIME
VT 05725 TRANSFER SECONDARY TO 10520
PGE CONSTRUCTION DRAWING
= AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
This document accurately represents FIELD Construction.
JOB SITE Foreman: Date:
General Foreman: Date:
M DONALD CONTACT GENERAL FOREMAN (Signature only required for field construction changes.)
ANDOR CONDUIT INSPECTOR 7 TO 10 WORKING DAYS PRIOR
TO EXCAVATION.CONDUIT INSPECTION REQUIRED PRIOR TO BACKFILL. SDPMfNG REVIEW: JASBUILT BY DESIGNER:
PGE WILL NOT INSTALL WIRE UNTIL TRENCH IS 100% BACKFILLED. DATE: SCALE. ACCOUNT: AWo JOB NO.
O ED BURNS KEN GUTIERREZ B'19/11 1':60' 7070001 - 7000001924 773000
�N GENERAL FOREMAN CONDUIT INSPECTOR TITLE
G A A R � X71 � CELL 503-849-8670 PHONE:503-969-3964 PGE
ISAL STREETLIGHT PROJECT MANAGER: JEFF STEIGLEDER "BCU" SIZE
PHONE:503-57"404 CELL 503-849-65481pGE TIGARD -TIGARD 11x17
CALL 811 BEFORE YOU DIG LO
—J ATTENTION CATION
B
M 3 VICINITY MHP OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED *' 10520 SW MtDONALO 57 TIGARD
,-
2 Q BY THE OREGON UTILITY NOTIFICATION CENTER. DESCRIPTION
THOSE RULES ARE SET FORTH IN OAR 952-001-0010 ' „ e INSTALL 35'CLEARANCE POLE
THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF COUNTr SECTION(S) WORK WITH SHEE
SW DURHAM RD T
THE RULES BY CALLING THE OREGON UTILITY 6EAYERioN WASH C21-10A I OF I
THOMAS GIROf NOTIFICATION CENTER ADMINISTRATION @ (503-232-1987) IMIE CREW CENTER DEi1GN BY PHONE(503) DRAWN BY
655-D5 TO REQUEST UTILITY LOCATES CALL THE OREGON KRoel who rs below. nu$w nom AR TOD SHATTUCK 672-5466 DUMITRU MOT
UTILITY NOTIFICATION CENTER,811 AT LEAST RE"sTeron°^nroa
2 BUSINESS DAYS PRIOR TO EXCAVATION. Call before Youdlg• 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED