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PFI2014-00107 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12014-00107 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/24/2014 Parcel: SEG1154 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 9815 SW Walnut St. Pole 3849 install new 2al-jet prim rider 1-142 C/O with lightening arrester with fuse 65 T. Replace primary cable&new vault. SEG 1154 Owner: FEES Description Date Amount PFI Permit Fee 11/19/2014 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: KOLBY HOLLINGSWORTH 3700 SE 17TH AVE PORTLAND, OR 97202 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. Permittee/Applicant n Signature: IA a- —t wlc Issued By: C—GL( V L Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12014-00107 Tvoe: Condition Name: Status: Severity: PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code,and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Utilities 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. 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 clean-up and suspension of work to accomplish clean-up. PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Utilities 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be reinstalled or replaced,with like kind of material. Obtain City approval of restoration work. PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area. Traffic control devices, flag persons,etc.,shall be in place prior to initiation of construction work and shall be effectively maintained. PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept., Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met) and 503-431-2345(Tigard School District)and other service providers impacted by such closure. PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City approval of any access closures. PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized by the City Engineer. PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules,contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense. PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice Applicant 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 applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI_Utilities 14-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities(roads,ditches, etc.)as may be necessary, as determined by the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>, to establish a preconstruction meeting. PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice The applicant 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, prior to any staged inspection, and after completing work covered by the permit. PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance,and all attachments,and a copy of the approved construction plan and all amendments shall be readily 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 these must be approved by the City, in advance of work performance. PFI_Utilities 19-MONUMENT PROTECTION Applied Notice Existing monuments, property corners,and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice 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 any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Utilities 21 -OTHER Applied Notice -15W 45Lp RECEIVED IsCity of Tigard NOV 0 4 2014 PUBLIC WORKS—ENGINEERING CITY OF TIGARD Public Facility Improvement (PFITLPerr�rii '"'`-�R►NG DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one:)<Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed descrii)don-%V_?RMih11 n w 7. 1 t.flP1YY1 QlAM Al ❑ Minor work in right-of-way (sidewalk repair,curb cut,street opening,etc)requires: •Application form,completed and signed (�(] 1_I ^' •Submit one(1)copy of scaled sketch Property address/locadon(s): -1C)��5W �WnLE� of the proposed work to be done •Submit one(1)copy of traffic control plan IS4- —OR— El `�� l�i SSW� ❑ Substantial project work requires Applicant's name: �1 (� above items and professional Address: �C� �_T�h GLQ, engineered plans for: Q�+'off � Zip: �10Z .Street widening City/state:rp - Subdivision infrastructure Phonetu3DLp3'td128Emai1: Q��1_ r�1DQL .l Q ) •Main utility line extension: —� Storm Drain,Sanitary—Tigard W��.L.n� bid . • - Water—'I"igard Water Service Contractor's name: —� Area(includes Durham,King City CCB#: Expiration: and a portion of unincorporated Washington County) Address: City/state: Zip: DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Tigard,OR 97223 Engineer's name: Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: row ermits tigard-or.= Phone: Email: Case No.: i -1 1204-00V 1 Estimated value of work(within the public right-of $�� way): 4*Q Q� �,�('�•�•es Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes �J_No Application accepted: If so,please specify (MLP,SDR,SUB,etc.) case#: By: Date: I� Application reviewed: Is work related to a BUILDING PERMIT? ElYes N6,No If so,please specify(BUILDING PERMIT)case#: By:"la Date: Applicant notified: By: Date: « I:\CUXPLN\Mute \land Use Apptl"dH Rev.07/16/2016 :e City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www tigard-oLgov • 503-715-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. When the owner and die 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 die space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions ha may be attached to or imposed Leon the subject PfQperr • 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 required. ��o �► ►I �p tom.ym;k�dity kiLdw44ca11►ccs"b N2n1A Applicant/Authorized Agent's sign re Print name Date Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 OVERHEAD LEGEND �kL-I-i r..I.I!I M INSTALL PIC IL1'It S 4�INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES P.-03"9 ABANDON FACIUMS -INSTALL NEW 7 AL XT PRIM RISER Q FAULT INDICATOR "2 COO W/LIGHTENING ARRESTER W FUSS 657 O PROVIDE &INS vAULT BY PGE CONGIETRACTOR TOP IDB SITE PGE TO 18 INSTALLED BY PGE CONTRACTOR REMOVE 1 A!08 PRIMARY RISER TO PGE TO INSTALL U WAY LATERAL TAI VT5637 AND ABANDON PRIMARY CABLE CONDL 7 CONDUCTORS INSTALL 12 AL-XLP XT PRIMARY IN 1 2'PE DUCT PROVIDED-PAND INSTALLED BY PGE CONTRACTOR VICINITY MAP K `��' IBIR2 7 • PO 00035 tv, �' 45 0 4 4 74 10774 1 1-210 Nu BEB I� PL-03460 t REMOVE 2'PRIMARY RISER UNIT z 2L 1.lEEY f� ,,� 'i z-m•90 • CO AND LIGHTENING ARRESTER �e y�B At23M-K A: L �.� ABANDON 2-Al DB GOING TO 2-500 rot tv Iw C i .L 4 100194z /MALT Il/ t-z.0 W IYn 1-14 ibi 2 z-m T. t-LD Eu F65I.PLO 2 803849 9 4 0012 � [ N 7Z vr'WV rH bLl 7 ,} 14-K z -INSTALL NEW 2 AL NT PRIMARY CABLE T D5 4-z.acu , B FROM NEW VAULT(VT 00720) TN - 1-7'0 h, ' 4 -ABANDON 1-AL DB TO PL 03809 .7 K tvfS j M 74 7q9 \3 zso BA Q r0 E c � 7 4t 40 70942' x 4 two rt OORBI F Vr-00114 CHANCE TO AB wlw •� z'0 2 -INSTALL NEW 2 AL JAT PRIMARY CABLE z1 FROM 4- 1 — 90 05580 T -ABANDON 2-AL D8 TO PL 03460 "{y �VI gA 75 621 7 zFD AND 20ALRJKT SH AND ROO-FLYS FROM PUC CVAULT y-14460 2 mm a z IT K Pzz IU AND GOING SOUTH ALONG EDGE PEW zA 1 OF APT BUILDING z PD 50 z 501-PGE VAULT 75-3zp-Pw pWpO PIAN ODOR 50140CsE YAIA.i I/( runs. SS UVJ6E PIRACM 947E DOOR AnRa7o ... .Ern°i�.:° ��':�•� :' .�rwoteo n EGt. O .1120 1-2'7 ' I r FI-.=1 K . EARe I i s7.6i rMiOw1O oW � PL 384 pI Ap 47• n rwio, n rr>E A 1-2'TC n SII00- 0 0 0 0 p p Q O K 576: FL aro RDa p' 9 5 525 w 1-r i0 VT-00120 p p p 0 FD 450 •^trer Eww • A yr 111 a-.rRA ss' Ro 2 Pa a TO n 3 tllEar ro 660 VT-00114 .--Ira 5yp WR CHECKLIST ITEM YES COMMENT 801fOGGfR ROOT MOfIOF Eft TlB,vl E N LofATO cowol AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED W M 11Ra dvrurrlrry x_E'nprere°M FIELD Cw, R Forenw0: Dol.. DERIM Garwol F°re , Dore: et LW6fAFE I A IOS1 f-field c°°rrvo—cha EAVAEM "MENG REVIEW:I ASBUILT BY DESIGNER: KRrRS IPEtwrs M414 scut I--80' c—1070001 — W429 "lo 756465 VAAK YiA4 irrtE HENT or. CALL 811 BEFORE YOU DIG CURIEFT ` PGF REM.ACE b CMIE CMCGO uw IFOunC(1O TO —RIMES A0011E0 UG OR 1% / trcun ev THE OREGON U 11`NODFIUTION CENTER. , 'EM'6"ciON PGE TIC.ARD-13362 13" sl=t17.22 =s Was—SEt FORTH IN OM 952-001-0Orl tOGTA.v+ ineouGn 9S)IAI" .OU A.u,ortAlr COPrS OF THINK Lumo 9615 SW WALNUT �ot vULtS by CAIUNG Int OREGON UEIDIY p nF�<AriO�<ENrtk Ao.wl.1—AT,ON 1503 RJ]19EP SAFBTY ooa lwrtz REPLACE 80 rRutARr CABLE AND INSTALL NEW VAULT Kew.whRrt below. FIRST( CONTACT chow:, wore went rrEr Call before TW LYp. fOWAN+ � WASHING70N cm T 0I r rMA Cr DA/F nA¢ Ausalown rmr KK0Ll Yn 1131126 ALLISON !ONES 0 PORDApD GENERAL EUCTDC CO.-ALL Rr.n RESERVED Page 94 2011 Edition Self-Regulating Lane Closure Diagram 350 Use this detail for closures of one lane of a low-speed,two-lane, two-way road. 1. Use this diagram only if all of the following are true: a. Work space is less than 200 feet. b. The posted speed is 40 mph or less (unless not posted and speed governed by basic rule). c. Average Daily Traffic(ADT) is less than 400. d. Sight distance(in feet) is more than 750 at each end. 2. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 3. For added visibility, a truck-mounted arrow panel or PCMS in caution mode may be used. 4. A"Lane Ends (Right)"(W4-2R)symbol sign, or"RIGHT LANE ENDS" (W9-1 R) sign, may be placed inside the cone taper for more emphasis. Sign Spacing and Buffer Lengths(feet) Posted Spacing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 100 35 40 350 350 350 125 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 95 Self-Regulating Lane Closure Diagram 350' ROAD � B WORK e lial AHEAD • arInfitnI WSiggnng A • • ONE LANE ® vROAD AHEAD • Protection Vehicle • TO YIELD wITMA(both Optional)) ONCOMING OR TO See Chapter 4 • TRAFFIC ' TRAFFIC • uffer �• 7— • 50'-100' • • T yORV IS' A ONE LANE B ROAD AHEAD ROAD 1 I C WORK AHEAD Initial Warning Sign December 2011 Chapter 5