PFI2014-00078 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00078
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/23/2014
Parcel: SEG573
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Portland General Electric
Project Description: Adjacent to 8530 SW Pfaffle St.,replace overloaded overhead transformer. SEG573
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RON SLATTERY
2133 SW 153RD DR.
BEAVERTON, OR 97006
PHONE: 503-672-5471
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 y
Signature: OL 1 COL+)PPn�T f eStXI
J
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00078
Type: Condition Name: Status: Severity:
ROW 01-CUSTOM CONDITION Not Met Notice
No street cuts are permitted.
ROW 02-PERMIT&PLAN REQ ON SITE Not Met 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) Not Met 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 Not Met 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 05-TRAF CTRL-ROAD CLOSURE Not Met 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 Not Met 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 09-TRAF/NOISE CTRL-WORK HRS Not Met 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 07-TRAF CTRL-PRIV PROP ACCESS Not Met 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 Not Met Notice
Traffic control devices,flagpersons,etc., shall be in place prior to initiation of construction work and shall be effectively
maintained.
ROW 10-TRAF CTRL-MIN LANE WIDTH Not Met Notice
Minimum travel lane width shall be eleven(11)feet; pedestrian travel shall also be provided for.
ROW 11-TRAF CTRL-CITY CAN MODIFY Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met 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 Not Met Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders
expense.
ROW 29-ESMT/RT OF ENTRY-RESPON Not Met 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 27-PROB SOLVING-RESPON PARTY Not Met 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 Not Met 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
City of Tigard SEP 18 2014
Public Facihty Improvement CITY OF TIGARD
`�' P PLANNING/ENGINEERING
(PFI) Permit
General Information: FOR STAFF USE ONLY
Property
\_A1dddr�ess/Loca/t�iony(Is):B' Si" E . Engineerit>�FIZo`y �`
hL `V[. `T U- l SCV 3 Case No.: _
• Fee: - b
(�_
rr� Receipt No.: R O -
*Applicant's 2Name. OY'A turd C- Q nQ r� � OY-r j i 1�D� Date:9 q
Address: �� .).l S�� ���Qi1 d Jf IUB Application Accepted: ` By:
City/State:� `;VVQ-Y^(�1c1 4Q Zim C\-1 ij
Primary Contact: REQUIRED SUBMITTAL
U E_ INFORMATION
Phone: b4_71 Fax: `JU 3 ' LD IZ.LD I ci-b
E-Mail: ID1 . ����rt Q� ��Uff1 Professional Engineered Plans are rcquircd
for:
Contractor's Name: 'y
i �P • Street Widening
• Subdivision Infrastructure
CC_B# Expiration: • Alain utility line extension:
0 Storm Drain,Sanitary-Tigard
Address: 0 Watcr-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: C1 1J Q51 C Submittal Checklist attached.
Address: YYIt QS (N_bc),1e Wl[ fQSS For all other work:Submit scaled sketch of the
City/State: 'Lip: work to be done.(see attached minimum sketch
Phone: Fax: requirements and provided sketch area).
Updated 6/24/2013
L\CURPLN\M16uicn\Land Use Applicami \Public Fanlity
Description of work.- 4 L L C)J Q Y 1W d Pd Imptu�ement dcxs
y v er hind -�MMAR.mer,
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES F NO
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#:
City of Tigard 1 1..3,125 SXR/Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 5
APPLI CANT'S:
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"Applicane'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 ' T�fY l day of 1 120 14
Applicant/Authorized Agent's Signature Owner's Signature
Owner's Signature Owner's Signature
City of Tigard 1 13125 SAY/Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 -,vww.tigard-or.gov I Page 2 of S
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI)Permit:
Part 1: All non-water system improvements
Engineer's estimate X 5%(less$300.00 submittal fee)
Rngineer's estimate X 2%Plan Review
Part 2: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee=Part 1+Part 2
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
2. Addressing Fee: The fee for this service is$50.00 per address.
SAMPLE
Minimum Sketch Requirements
North Arrow Property Lines&Dimension 4 Slope of Property
Street&Street Name(s) Existing Building,Structures 4 Utility& Street Light Poles
Proposed Work Existing Curb or Edge of Pavement 4 Trees
Existing S/W or D/W Apron Existing Utility Locations(sewer,water,storm)
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 3 of 5
SAMPLE SKETCH:
Edge of Pavement
I +— Ditch —�
Streetlight I •—•—•—•—•---•—•—r—•—
I /• a Rata Drax►
1 I 4 ! r Trx 0--*, a
I I
I I
I ►�. I Existing House
IExM n
�„g I g
�. I �t • Driveway
Iul cis I
C I • .
CL i JA rl
1
al � I I vim' 1
bj I
Existing Shop
t
Powerpole I I = 1 m
I a 95'
I -------- ropertyLine----------
� I
I I
Fire
ir Hydrant(FH)
� � I
I Scale: 1"=30'
I I �
I I I
j I I
Minimum Sketch Requirements (Put"n/a"if Not Applicable):
North Arrow Property Lines&Dimension Slope of Property
Street&Street Name(s) Existing Building,Structures Utility&Street Light Poles
Proposed Work Existing Curb or Edge of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations(sewer,water,storm)
Cityof Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 4 of S
SKETCH AREA:
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 5 of 5
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3-142 \ PD 0 32 OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED
F40T \ BY
PLN302 06507 \ \ OF
THOSE E ORES ARE SET FORTH TIN OTAR 952-0 CENTER.
-MIO ,
PL00302 ��\• \ THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF
a 00302 \ \,\ 350 TX NOTIFICATION CENTHE RULES BY TER ADMINISTRATION Q UTILITYING THE OREGON (503-232-1987)
2000-50 \ 2-350 T
a I 019990340 . \ To REQUEST UTILITY LOCATES CALL THE OREGON
VT 01099 Know whaYs below.
UTILITY NOTIFICATION CENTER 811 AT LEAST
2 BUSINESS DAYS PRIOR TO EXCAVATION. fall before you dig.
V,\ \\
PGE CONSTRUCTION DRAWING
00053
I 499-35 �.\ \ \•
C-2 AL SDP/WENG REVIEW: JASBUILT BY DESIGNER:
AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
This document accurately represents FIELD construction.
Foreman: Date:
GF: Date:
DATE: 9�g/2014 SLICE: WA ACCOUNT: 1070001 AWO= 1000002846 JOB NO. 774111
T"" Transformer Replacement
aRculr West Portland-North slzE
REPLACE 33 583 WITH 7200V / 1 1x17SO C 12C1240V PGE LOCATION 8530 SW Pfaffle St
IPH, 3W DESCRIPTION
Replace overloaded overhead Transformer
Peak. 9 5 KW NG F uSe ke'red COUNTY SECTION(S) WORK WITH SHEET
BEAVERTON Washington C 17-350 I OF)
I
LINE CREW CENTER DESIGN BY PHONE (503) VIRAWN BY
VAI h 2213 SW 153RD DR CarterLassetter 503-672-5492 /1,
BEAVERTON,OR 97006 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RE64VED