PFI2015-00102 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
_ COMMUNITY DEVELOPMENT Permit#: PF12015-00102
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/04/2015
Parcel: SEG1118
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to 10160 SW Walnut St. Install 2"PVC conduit and wire from existing pole 2070 approximately
100'down Walnut St. (Pacific Evergreen Homes-Graceland).
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
TIMOTHY BELL
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-672-5481
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: Not Present
Issued By:
Special Conditions Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00102
Type: 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 503.816.6146(cell), 503.718.2602(office), or
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 of Tigard
JUL 2 3 2015
Igq PUBLIC WORKS—ENGINEERING PGE WORK ORDER# MCM29fTIGARD
PLANNING/ENGINEERING
Public F,acitity Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: ❑ Utilities R Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: INSTALL 2" PVC CONDUIT AND WIRE B Minor work in right-of-way
(sidewalk repair,curb cut,street
FROM EXISTING POLE 2070 APPX 100' DOWN WALNUT ST
opening,etc.)requires:
(PACIFIC EVERGREEN HOMES -GRACELAND) •Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): 10160 SW WALNUT STREET of the proposed work to be done
jj ]� •Submit one(1)copy of traffic
/�— control plan
OR-
Applicant's name: TIMOT BELL FOR CHRIS JEWETT E] Substantial project work requires
PP above items and professional
Address: 10800 SW AVERY STREET engineered plans for:
TUALATIN, OREGON 97062 -Street widening
Ci /state: Zip: •Subdivision infrastructure
Phone: 503-672-5481 Email: T&DSUPPORTAVERY@PGN.COM •Main utility line extension:
Storm Drain,Sanitary—Tigard
Water--Tigard Water Service
Contractor's name: N/A Area(includes Durham,Icing 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.
Engineer's name: NIA
Tigard,OR 97223
Applications for"ttwtor work in right-of-way"
Address: only may be emailed to:
City/state: Zip: ro�l7ermitsdt1igard-or.gov
Phone: Email:
FOR STAFFUSE ONLY
Estimated value of work (within the public right-of--way): $ Case No.: Pj cam"s-- av)
Application submittal fee: _
Is work related to a LAND-USE DECISION? ye ® No Application accepted:
If so,please specify (MLP,SDR,SUB,etc.) c #. By:L— Date: AT
��(4+�0�2Appticarion reviewed:
Is work related to a BUILDING PERMIT? ❑ Yes W No )�
By.1�_ Date:
If so,please specify(BUILDING PERMIT)case#:
Applicant notified:
By:�_ Date: O I�
t:\CURPUI\M ntea\t.nd use AOPtiotscm Rea 07/16MI4
_ drxsar+aa�rec�
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 www.tig-ard-or.gov - 503-718-2421 • 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 purch2sef 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 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 imposed upon the subject pig r�tv.
• 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.
1 TIMOTHY BELL FOR CHRIS JEWETT 7/22/2015
App can / uthorize Agent's signature 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 • www.tigard-or.gov 503-718-2421 Page 2 of 4
6.4.4 VAULT WITH 7-TERMIDUCTS SUBDIVISION LEGEND
M °b' DIeN.i rNaroxM!MD,Rn IAA / NEW PGE FACILITIES TO BE INSTALLED
sRY OR r.Raro,aA i --
cvMufce lDAI ANr apwnpine Plr•8D7D
(UNLESS OTHERWISE SPECIFIED)
mucTAe 6 r >m6'AM!OI d
�°� M�^ B 15 316 6 3 , MONDED S NSi F�9r CUSTO EF
RMN rM A A F 02071 2015 2.. M7TALL cN
1990-4 CoNDUR �*\ MEE FlAING AS NOTED
TM fRCpAYY vAUtr,
IROV10[D{R4TM
3lD Rr LIAICMAFR
YC)OrlNDD1M7LICI O I INSTALL 2'POLE CONDUIT UNIT 0____. dAL 1-02 AR IRY ARY M 2
DD ""/ 12'°RA`L '",2`o E°' � a�
-------- µw M IKPLANNIN ENGIN LIGHTNING ARRESTER 010MA MSTAUM OV C(TOAER
oLrrn Ron.[ri51 - CUS/OAAR To MRTAII rrAc COlilm R SR4-LM
PO
�E G R nmL m AI-w soma
� o rLaaw
1 -142 00006 E NATURAL DAs CDNDUR
R.M,n RRD Ra ON r F 1 00 T O 1962-3C A STtw LGN,slue
P US
"R'A4O�� PL02071 CTQMER PROVIDED 6 IN7TALLED PYC CONDUD
`"°sow" '""`�j IOF C
'REFERRTO S!y B 25 52625 FAXTVGNDNG
r STIIEFTUCM f
JOR FOR 5� CMDUR.)
T(Vial �� STREEtUGM IIIHRION
1- 2 —2. ROX•'
RrcONOMT-srRerT RM oNLn
P 2077 0990045 <� I DO WrTH SLCST *
ICF v26 srtlCr sox ,� ST NwN CONS" fIQT
r arorTr'iDLl�.rL7N•OM14+1;�E.. 'nw.R!M�o�e'r wr!'•Y�1•P,:!LR•H:R,RI•Pr';,.Il T;L•AI�;:�� .L.sa�n•'"wi'"ec,eMc n� % ♦ 4�M.L{' /{'SO r•P I • j 0
AA� �A�lDOMaOm u.bARRAM.v�EIorObYow�eeD.nWW+i.°RrilLc°.LRMdc oRo On4'1roHD1"RmR1I1O^xImMHALi',xcMMi.Rlw.wI�1DflRD/wnnI4roIi"RwI!r1o�Iw�+MIeA!wIro Q°C1wF^wMr�AMOd4R.i!rterALE.RLg1!LMsIiY!�H.�rTRe.^r�Ln,v°�RU.o.MT•.fOfY.wRI.Mn1rr1NDMRlr]^i-".AoPYwOar.RrnDiulreaaMIXw�wAO"•im Ir.R E%r`<DLRR,`wRReR.NwR°R.r.!RO6^M7.sO wP«�IaeiM°•wm66`p R'"dO'r1�iDnARar>'xwT'"•sI tiNpruM�aRn�.s{.Y'mKqMrrII.Mu•,fR.A1L,�Wf�sr.roe•nLFrrl"pNrLW/aO�e w"rr+ucwR!'.l"RrR,ab/"R..�xIrOsrr"r.e:iwI1rlarauQ'DIoMRR+s./elnasSi6MVR,Rw�Ri.r,.rey!Il.abn1rRLP e
rw"u.u•rmtwo"P�Mf'RMcWrr,rI.e...
rf YrgRIwN mYR.irM'r�.s rKT�l•rO..0
RrRMTr�a1rN�r1Ap
aNwO"IA R
AsaY'I.
�werIm
I
�Matlpx—bw
PAD X111 3 007'7
90-35
INSTALL 7200V
195 PAD MT 50 Cp 720240V
37KW DEMAND
I@ 7KW
TOR o `
O7C--
2069 7-wl'—
/C
50 CONSTRUCON NOTES:
1990-40
0011
V 00123 WR CHECKLIST
REM YES COMMENTV 1 DOM I --ROAR
Dom .l
Dor.a1A
1
fl
m1
Y
aR1RR
iM 1 A TWO ^
PO 00022 160' . R APC .. TRRORMoboL.uLeLnM �pMRR�pp��RAR1 /prl nl `,'..,
R LOCATES �pKr/Wt
SdOLG b�D SIurr6D TRJR ADAATlRO2lNluMegmM—ARM�rtLsM1'W
F
\ RAO ' F A ORTOMA ro Ab RlTA4 P{R{{R!MAW MM I4iIM�rirb CMa
�� UTNRY VN.ILT.NWR rrr AT ATPRpLMyeMr 0 pR FAp Mp r!•RT iRMWFO.IMEb.
� rADv.Lar ro rMN um IA oma oN aq.
/ \ 24
j/
PB1ND s now /M TRYAIIOIip AMIrT!WRIIW f 1!r{1 A RNW!AM•�• R At M,uRer,M 9 Nn�aE,�R,Nn M 1RWI M N11RMlIOOMb
// MRC RM ( 7.�M�IpIT.Ab Ap1I0 TprPOaAMtl TMI,b RPofeD
/ \\ Cl/IRHf a RRTra vALaT ro MEIn AT IRLw~If MnE/Mp 04.'N wr Mro
LG a ftCOWIXIEµ,�o� R+ra mE vrxt si LwLa RNoc*am rrtw-+-wrn:
9cm0L4011r
PRF RFE
9R mAEII�I UTRRY I,RAMM R.u.rf ro!R rm pwl.
\ \ O 3574 '"700"
POLE NEEDS TO COWAV Onau'R
COW ■ }Mm IRe RRlrRRATM r Mw wAo4 TARRVR,AAM IDAIw
PPED IN G.I.S. �.�� D]wAM O 1RrcID.•RNCDIITRLKrIDH COIPa4rID..ICLLoeD M na ca+..Hv/ouv,roa rAK mCO.UH.Aw ou.
\ MI G 4 Deva+R Mrm DH TMi,rD lvEµrRGRDui[DIIARNI riNJTANDAo
0AR IRR ro nr�'Ou'Oosro.MRFawwrNr oma.A,-
AS-BUILT
T...AS-BUILT VERIFICA7, 8 NESC VIOLATIONS CORRECTED
Sy �+ 1Oo1O � FMRIIAp1: Owa:
�J � yr 0•-A••r• (� GMHrrd FvnrrAlA: Dom:
RO Sp O .. / for now LaRrw.DES d.,
Q T� SDPA6£NG REVIEW: ASRUK/n DESIGNER:
\ w. _ArrKT COORDINATOR uT 1A7017 •- P-60' •KAT'1070001 •�`� X)0DDDR716 MI678701
O IRICe b!411CRI COORDINATOR
TO _
O II,WirrMr n Wrl llp■w R v PACIFIC EVERGREEN HOMES-GRACELAND
l r K m n. r.r ,' tutor va
1303-736.S{!0 S02-d{1�26RISAlGQ / 7M.MD-17762 17.22
CALL III BEFORE YOU DIG �El L--
~ 4• p OBELION LAW WXAW YOU TO RO RUL[s ADO"80 )0160 SW WALNUT S7
P �• MG LWr AI WAY fERMIf NOTICE:
c
THINK RY Rn IX"AR 91 NorW GO 24R)Ct" DeIfxr T
o A Pawn naw re4 Iaat ARI®ICItON s IOOISelo2 R[IDC A!M
SAFETY w011 M Im NOM-0M1WAY MAT N PLVORAtO.CRAY Poe A"AO Trlofe�!]�-0OL�OOPO.YOI/Mj MAY Ow—Cosa PM Exr ro d LOT sURDMnON 12o2A0 R
M CONAACTIM AND COImACrOR3 WNO HAYR AMPS OTO VECW "n M OwLMO T ORMODH UTU" �� ATHW INGiCM D2T-Ole rORS WnH
FIRS11 AORHM Wmf FGM WILL R AUOMM TO WOK MM Mn MIMET TION CRROI ADWNWUTKW 4 Bos-7s}MA
THE CONTRACTOR MUST HCTIY THE LOCAL AWJUW ON p HOwtt TO REpIEST UTRITY LOUTFS CALL TNf OREGON w 04v ~ 'n RrDIR(T4 LIRAIAN n
R[FOK WdR(P TO ROM.A COPY OF THE FW/ff MW E ON SITE UTam'HOTRCAis01/ANTER m AT lfASi 81114��~�• liAwL-nor �S KWFfl 677-9/87 SANE WHITNEY
2 RWIISR DAYS MOOR TO DCAVµ1CN, YRIN4IA� OPORRANO ONLRAL ft Crwc CO-Au 4 m fjuM
CUn ONO(Wl� NN9O fY �
CD
3 a a 0 Single Flagger Operation
Cr 3 for Low Volumes (Optional; o' Q rn
Ln (ADT<400) .•r I :3 W
o o D ^ BE2) 00
ONE LANE N
PREPARED Op
iO �1•e I•a?•C�►
TO STOP ROADAHEAD r
ROAD
3 <i
WOF�C
KC K•K•K• l� AHEAD) "n
y
000-4
•
1 mile M
max. - — 2)
—• • • • • • •
to j
• •
to O
•
C—_B-�B AIS^
Buffer
Protection Vehicle
w/TMA(both Optional)
ROAD •
WORK See Chapter 4 v
AHEAD, BE C
ONE A p� TO s oP Two Flagger Operation
'a w m
(Optionaq IN)
OD
'O
Zn
Z � rn
Z
c
C7
r
m -
z � �, m
Z > o
M :X) 'Ln m
� v �
z