The URL can be used to link to this page

PFI2015-00044 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00044 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/21/2015 Parcel: SEG 1078 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Portland General Electric Project Description: Adjacent to 12600 SW 124th Avenue. Install service to 3-lot partition. Related to Minor Lot Partition case no. MLP2014-00004. Owner: FEES Description Date Amount PFI Permit Fee 04/15/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: LAURA TAYLOR 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-672-5466 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 Not Present Signature: Issued By: 7 � Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00044 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 RECEIVED City o,f Tigard APR 0 9 2015 PUBLIC WORKS—ENGINEERING TIGARD Public Facility Improvement (PFI) Perrif"'R P S DE CRI NOF WORE(in the right-of--way) REQUIRED SUBMITTAL Check one Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: or work in right-of--way (sidewalk repair,curb cut,street opening,etc.)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch Propert address/location(s): 0 r -! ` et ro of the proposed work to be done � l5 i 9 a 7� E�' �D�B 'Submit one(1)copy of traffic control plan —OR— Q l l ❑ Substantial project work requires Applicant's name:( G� a (01T•� ra �C 1� above items and professional Address: JOYQQdefyt I1 engineered plans for: p •Street widening City/stat �\ Zip: 7 (0 •Subdivision infrastructure Phone:�3"�o •5 b(0 Email VfT V S n.` •Main utility line extension: - Storm Drain,Sanitary–Tigard I - Water–Tigard Water Service Contractor's name �Q� j Q /P < ` Area(includes Durham,King City CCB#• � O � ��VVI_,��S �E iratio1{n: mid a portion of unincorporated Address: QA • Washington County) 5 p City/state: Zip: DELIVER APPLICATION TO: City of Tigard Phone: Email Plaxxixg/Exgixeerixg 13125 SW Hall Blvd. Engineer's name: /"/`y Tigard,OR 97223 Applications for"minor work m right-of-way" Address: only may be emailed to: City/state Zip: Phone: Email: � Estimated value of work(within the public right-of-way): Case No.: PM cq(-)1S• 9Q2J_11 Application submittal fee0! O — Is work related to a LAND-USE DECISION? ❑ Yes g"No Application accepted: If so,please specify(MLP,SDR,SUB,etc.) case#: By: L ' Date: Is work related to a BUILDING PERMIT? ❑ Yes Applicya�tiionnrreviewed If so,please specify(BUILDING PERMIT)case#: �(No By:`� Date: 3 l S Applicant notified By. t-5 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-mgov • 503-7111-2421 • Page I of 4 APPLICANTS 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 leasee in powriiion with written authorization from the owner or an agent of the owner. The owner(q)must sign this application in the 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 that may be attached to or imWsed ttsnon the subject propel. • 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 guh owner of the subject property required. (° -� loci Q„ , OR 9 M5 LM Applic /Au orized Agent's signature Print nam 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 • www.4ard-or.gov 503-715-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI) Permit: Part 1: Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee = Part 2+ Part 3 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 201incal 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 PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement pitch Streetlight I •— -------------r—•— 1 • Rain Drain 1 I 'sr.filar 0 I Existing House r� 1 Existing 1 Driveway C 1 n �• o ii 01 I i Existing Shop j Powerpole 1 I ' ----- ropertyUnne"---- -- I 1 ! 1 I I I Fire Hydrant(FH) I � I 1 Scale: 1"=30' I � I I I � j i 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 Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.fgard-or.gov - 503-718-2421 • Page 4 of 4 p-04012 SUBDIVISION LEGEND ego PGE TO REMOVE FACILMES -NEW PGE FACILITIES TO BE INSTALLED T]� (UNLESS OTHERWISE SPECIFIED) PL-05596_-0'5596 � 1906520 � 1 75 Bl•REMOVE FACILITIES=RIS'TAL FACILITIES REMOVE 30'ET LI 4 POLE Q INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES REMOVE STREET LIGHT LOT 3 3Zp 0 �WFRONTIER OWNED POLE pYP'"NY Ic FRONTIER TO PULL 'RomoE vADMdMi VAULT PROVIDED 8 RISTALLED BY CUSTOMER LOT 2 RP - ---- LNSTALL T-R2 AL-OP_PRI AM R,IN L4'hC CONOWr PROWDED R INSTALLED IT,OUSTOwR 1LOJIOV 200RAY _______.INSTALL L&I STN S ARY IN ra"K PGO/IDUIT 107 7 I IRRIe anoB4 y rRovlDEo a INnALLED BY er GVSIONER 4.SRMIOt i Q FALL INDICATOR xRaA AFC WR CHECKLIST C 15 36975 ' ITEM YES COMMENT T loom C 75 2862 L SIMIDE 00240V i 770' Ri flea 20dkw PD OMP zts%p o S' C 50 6.692 LOCAM x675A �� 10'PUE ITAOW (� �R'o'Pu ED �� O 4 PD 00113 j0 200}20 FLAGGINR VT 05838 R wOBrAa 300' 78S' rI b FA7 L -- �.� PWAFIS 7 T&M)RAVE CO ^�_^`-" - 05586 0 1967-30 I teunC nAN 01e23- 00106 �PyN UG aLym Br 07252/ a PLO5576 0 x > C 50 666112 VT D 100 �ow GO t�'"O S aA DOW . Ifth TO NOT" 0607zzD omK w N 00WAD CONSTRUCTION NOTES: RSDEV co~ m a 200A 0011E wF CI I.GiRrMLw ro f+ane wl nawnwlD,v+D R.aLnLR.O.IaRn Lr:TmcN 'MIN OAR IRD101 ro a M R4ae Bl!MD w Nall anR MWIMN wDM Q r 018 INE IINa aRAO[. VT 00126 3 01 r,AU roe GorOLATaa ro a NnMw N aur,BaaDLRe 4a aeR:laT 2006012-JD M pRONr,RM Hlloa ITR s rNw IBB L�la,,. 200A 01022- lae LxreRMRl M>@ MID MMIIt d MpRRe. 0007 AYMTAN a vwl1011 Noll MD N MDe a RVpe CLERRMICe BDWeN y P � LO A°wu B of MArucraerMwAu eRas woan+ABIiO 4aiNal Two R'eAORs" 2 -35 a noL R10RR.RDID!rm CAR roe AH1101ID.IIBaNAee arcs Aw RLGIRItD 06069 V7 00118 01IB PDLL URa o.al rtn LVL LarweR a roR AM LlraM CAR+IeIII Mae THAN 2012-20 m f01°mr dRwawalrouEll arcaN c' woLR' r Rini uiaio°foroars x nAroMeL IeIOHsre Tae Ra1p a101erOl.ALL alaarRq war eRTero 00105 rBaM worem•IRR ro worm ERI.CAR dar our,roImLRR 2006-35 ��BRAoea�nc carour.alaoNm m w 4R Noe Lnn,R�AIRao =v w Ne RELRMNAIfNrSeua HLRf KHf LxNsm POLrerHnENH o:,. •.�R�sc�°.o fvc wmI A MEc�i�cw+.�"craN aRrA.aoa oR II.I;, �`Pi L5 ,g�Wm DunIE.uENrsIs` IuiroN Laani AwAe _aLR ;. VT 00106 Y. 5GH aµv a' E,LaD"M""D`oNfa.°.ra""'ul FE THE 217 PAD #00734 i m vji x urQRR 1DAa aA"o�MLN'l'i of ra ne Brno w XLP JKT-D INSTALL NR~'ro a ar A,w.L auoR Ds m a oN sw" 7200V F ♦.0 roe TRAMrOWaf ro a wsnum B leer woM MnPee Ala'tzMemie pA. S wAll a oLesnlRo ARD 4 rte• IIroRANr. 1613 j0 O 1 Ell PAD M7 25 01 120,240V ?� „1pI NWA�D�raauRAlta�. pARRA. . p0C'pg` ` VT 00125WALN PD 00PEAK AT 18KW �ep`Lr' 777 TONNE 7,s ro�roaa Aa apRaD ARallo TRMaroRwND nwr Aa eaaaFo 0 JOB WE x A mfnlm w aell�w ne"Mar ago w4aaacam Pew-d y. r>e arAa oN enTo B 50 66657 e..4 r.aLuwnr eAmMerlr P.uA.)ro Be B rsr RAr0. ALD GAAROE ST a'rima RSL LaP lo"O1OR,vo wl'L'"rA«N6oRw R,snar R,�DR, R. VICINITY MAP rwRana«:. R.carmR,r Mrm Tae RpRaeETMRe I wml M lle DARING MAN foxy TRagIRA)tae 1 we0d4wUanN COHBBXR.NLYDOfD N Tla CONIlIaHDr �yy N{l e!fRGVAIOR Ka 111GQ Ga:AID Gt _ n LeIaN!BAsm LTN SwIRY11D LIIDaWdlID eLAMrle+r.lONSIAFDAn YMaOR01M0 e0111IMMf AMr/All Q/IION MAN AOORgNV.Gar ®Nlr ro TNe QR:Ia.Al. O BiRAW P W _RI�v Br 411-PGE VAULT NO.,NO., W e.wu.LNre..n.r )N DRAWING WYPAD MOUNT LID THINK AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED rOe SAFETY Ai.do mr n orc✓mre1,nprts FIELD CRnpmalRn PD-00134 ,,CAP a,D ro M ee EG Ar waRL Fonmon: Dew: SRLM. ANY DEVIATION FROM THIS DESIGN MUST FIRSTI �F �. ` x alae BE APPROVED BY PGE PROJECT MANAGER Gwiefor RRk LelwrtleNorl DORR`B �( ,A^eL n SOPMfNG REVIEW: ASBUILT BY DESIGNER: .Boo w CONTACT SERVICE COORDINATOR my 17875 ' r.60' —T070001 Awo 7000001929 w.MISM75 3'PVC 7D pa�tm AAI. RIGHT-OF-WAY PERMIT NOTICE: LOT 2 SwIlO M EV]I rK. A PERMIT FROM THE LOCAL IURISDKTION IS REQUIRED BEFORE ANY 1 1-1"wi I"T I ��+ne� WESTWOOD��, Y PVC TO WORK M THE RIGNT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED LOT 3 CONTRA T AND CONIMaORS WHO HAVE MADE OTHER SPECIAL SERVICE COORDINATOR Ir ALMR JURISDI NOTIFY ME LO..• AGREEMENTS Y D PGE—BE ALLOWED TO WORK UNDER RGE'S PERMIT. 505-736"'450 OR 505-465-4MIRSLLEM) / THMM_13362 17822 C11elRD ROOL -/ .' THE COR NTRLCIOMUST LOCM JURISDICTION 49 HOURS CALL an BEFORE YOU WPGE LOGTId1 BEFORE WORK IS TO BEGIN.A CO%OF ME PERMIT MUST BE ON SITE, TFIMION: Yf{B6 SW rJ4}N AVE,?*AM •� �+ OREGON LAW RIMURan YW ro v01LOW RINEf ADontO • 6' NY TM OREGON L/IRIIY NOTTPIGr10N CLTITDI. ` OaC1•InN •• FACILITIES NOT DRAWN TO SCALE TNDSE WAS ME BIT ROM 04 OM 952-MI-WM B/STALL SERVXE To 3 PARIRION J:_PGE IS DRAWING R A GRAPHIGIL REPRESENTATION OF PORTLAND GENERAL THROUGH N2.0044010.YOU MAY OerARE COP=Or LOUND' wow RrIH slew 3•RIOT° ECTRIC FACILITIES IN THE FM.TWS MAP ILLUSTRATES ELECTRICAL THRNOR�Ow"no �f�2��n �� WASN CO C2L02B I a I Rr we rG NNECTNW,TYPES AND NUMBERS OF CONDIKTORS AND PLACEMENT OF '�+ LIODIIpBRUIPMCM WIIIIIN THE OISTRI/UTION SYSTEM.IT IS RECOMMENDED THAT TO RFWFST UDUTY LOCATES FALL THE OREGON •lBe,�„Iy IOD SNATIVCI( 672�i466 DUMITRU 8101 E USER NOT RELY ON THIS DIAGRAM FOR GEOGRAPHICAL LOCATIONS 7 UTILITY NOTIFI DAYS PRI RTO BTI AT EXCAVATION/ECST �6 4ela1B RIfNRlatp mM BUSINESS FN C NT . Tw 0 PORTINA OB!lRAL[LlCTaC Co.-ALL RIOIIIS REilRYlD