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PFI2015-00167 CITY OF TIGARD , PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00167 * 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/10/2015 Parcel: SEG1375 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 13700 SW 115th Ave. Replace B/O primary cable. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: TSAHAI ANDERSON 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-612-6106 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: � r)p+ pre'se�yl+ Issued By: V(�v de Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00167 imL 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 City of Tigard RECEIVE® PUBLIC WORKS — ENGIN1���tI�1�201 PGE WORK ORDER# M1931601 DIDPublic Facility ement (PFI) Permit o _ DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: W Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: REPLACE B/O PRIMARY CABLE ® Minor work in right-of-way (sidewalk repair,curb cut,street opening,etc.) requires: •Application form,completed and signed •Subnit one(1)copy of scaled sketch Property address/location(s): 13700 SW 115TH AVE TIGARD of the proposed work to be done i�� � a� 1���' •Submit one(1)copy of traffic / `T%q�( control plan 9 —OR— Applicant's Anderson El Substantial project work requires Applicatlt's name: above items and professional Address: 10800 SW Avery Street engineered plans for: •Street widening City/state: Tulatin, OR Zip: 97062 •Subdivision infrastructure Phone: 503-612-6106 Email: T&DSUPPORTAVERY@PGN.COM • Main utility line extension: Storm Drain,Sanitary—Tigard - Water—Tigard Water Service Contractors name: TBD 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. Engineer's name: Ken Alleman Tigard,OR 97223 3700 SE 17th Ave Applications for"minor work in tight-ref-way" Address: only may be emailed to: City/state: Portland ,OR Zip: 97202 rowpermits a.tigaarrd-oror.gov Phone: 503-963-6927 Email: Kenneth.Alleman@pgn.com FOR STAFF USE ONLY //__� ����©�� Estimated value of work (within the public right-of-way): Case No.: ocvCU Application submittal fee: — O Is work related to a LAND-USE DECISION? ❑ Yes ❑i No Application accepted: If so, please specify (MLP, SDR, SUB, etc.) case #: By: /—.S Date: Is work related to a BUILDING PERMIT? ElYes ® No Application reviewed: , ! !• 9� If so,please specify(BUILDING PERMIT)case#: B}': � Date: IS' App a otified: By: Date: I I I:\CURPLN\Masters\Land Use Applications Rev.07/16/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • w«outigard-or.gov • 503-718-2421 • 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 the applicant arc 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 oxvner(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 proper4 • 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 an),perinit 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. Digitally signed by TSAMAI ANDERSON HI ANDERSON..=PGE.—PGE TSAHAI ANDERSON email=TSAHAAANDERSON@PGNGOM,-US Tsahai Anderson 11/4/15 Data 2015 11 t)4 12.45 50 09.00• Applicant/Authorized 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 Cityof Tigard • 13125 SW 1-fallBlvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PPI) Permit: Part 1: Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate Z 5% (less $300.00 submittal fee) Engineer's estimate 1 2%Plan Review Part 3: All public water system improvements Engineer's estimate 1 12% Total Permit Fee = Part 2 + Part 3 PFI Permit Fee Exemptions: There will be no pernnit 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 PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 S\\/Hall Blvd. • Tigard,Oregon 97223 • -,vwwtigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: 1v , y Edge of Pavement f— Ditch --W Streetlight I •—•—•— —r--- ` f• e Rant Dram 1 � I ' i— io1) cl'Sow'er ii'ne" I v; j iNt Existing Existing House 1 � > >� Driveway � I cii I 1 CI n I • �• 0 o� ' I I "I CF,s 1 a' I o� i � I Existing Shop i J I Powerpole 0 ------ — I ---------- • I � -properly Line- iI Fire Hydrant(FH) � � I Scale: 'I"=30' � I I � I I � 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 Cityof Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - tvvilt�tigard-or.gov - 503-718-2421 - Page 4 of 4 www.invarion.com DEVICE SPACING: � .�., Northwest Traffic Control „ TAPER: 20' z ` Portla (503)262-6500 TANGENT.- 20Vancouver (360)6045655 01 Fax (503)262-0357 Toll Free (800)783-9733 �@>/ 100'+/- y ZE dO1S 01 n 03i1Vd3Nd 30 A C 100'+/- rc Oa n mwti W �3Q J•. VAULT#00034 4— a 5 1001,a-50'-100' / SW 115 AVE too'+/- —100,+–Ttoo'+/ T T m 0 100'+/- n m 2 h =`ez Om C 0 D�j yDm � m � Z � Oxo 0 o y ilk ROAD WORK AHEAD ODOT PERMIT# SUMMARY OF DEVICES: OWNER' PROJECT!JOB NUMBER: 4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601 PROJECT NUMBER/LOCATION: CITY: 3 X BE PREPARED TO STOP 13485 SW GENESIS LOOP TIGARD,OR 3 X FLAGGER SYM PRIME CONTRACTOR: TRAFFIC CONTROL CONTRACTOR PGE CONTACT NAME/NUMBER: E MAIL 20 X CONES Ken Alleman 503-963-6927 PREPARED BY NATE:All signs and devices SHALL conform to the MUTCD/OTTCH Nathan Burris Will adjust to field conditions E MAIL: Plan NOT to scale FILE DATE:10/01/2015 www.invarion.com DEVICE SPACING: .�., Northwest Traffic Control H TAPER: 20' z Portland (503)262-6500 TANGENT. 20' Vancouver (360)604-5655 t-1 Fax (503)262-0357 Toll Free (800)783-9733 <'I cc OYD OO wQ0 W m 6 N = 4rc� W3Q • VAULT#00033 / H---100+i ►}� loo+i.T loo+i ►{� So—►{ r p- -�- - - SW 115 AVE 100'+/. �• 100 n jAD 10 p 7C0 om = OAm C �.l ROAD m I n■ � Z WORK 100'+/. Z y AHEAD y ~ y BE PREPARED 0 TO STOP ROAD WORK 100'+/- AHEAD ODOT PERMIT# SUMMARY OF DEVICES: OWNER. PROJECT/JOB NUMBER: 4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601 PROJECT NUMBER/LOCATION: CITY: 3 X BE PREPARED TO STOP 13485 SW GENESIS LOOP TIGARD OR 3 X FLAGGER SYM PRIME CONTRACTOR TRAFFIC CONTROL CONTRACTOR' PGE CONTACT NAME/NUMBER: E MAIL. 20 X CONES Ken Alleman 503-963-6927 PREPARED BY. NOTE:All signs and devices SHALL conform to the MUTCD/OTTCH Nathan Burris EMAIL' Will adjust to field conditions Plan NOT to scale FILE DATE:10/01/2015 cTO. C 50 71255 \Z 19 �Peo20 �. LEGEND A OX m r- G' UNK . THINK REMOVE FACILITIES ®INSTALLFACILITIES ( _ SAFETY f D 0615 20'+1— �, �•' .92 _0 FIRST ® INSTALLADDTNONALFACILITIESMODIFYFACJUTIES 3 1974 90100 so it s�� CONDUCTORS Y + d j 82AL ;7698 L `�� r NY DEVL4TION FROM THEDESIMMU57 INSTALL I.210AL-Tx JK7 EPR PRIMARYIN —JI ! BEAPPROVEDBYTHEPGEPROJECTMANAGER EXISTING 4'PVC CONON7. i \j-- RIGHT-OF-WAY PERMIT NOTICE. REMOVE APERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY WORK IN THE R/GHT-OFWAY MAYBE PERFORMED. ONLYPGEAPPROVED t974�^ , { CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL EQUIPMENT AGREEMENTS WITH PGE WILL BEALLOWED TO WORK.UNDER PGES PERMIT. THE CONTRACTOR MUS T NOTIFY THE LOCAL JURISDICTION 48 HOURS FAULTINDICATOR BEFORE WORK IS TO BEGIN,A COPY OF THE PERMIT MUST BE ON SITE. KIT-JKTD CABLE-#2/DAL u.-. (� r t I (3)ELBOW CALL 811 BEFORE YOU DIG KIT- CABLE- ATTENTION: CONTACT SERVICE COORDINATOR 1 OREGON LAW REQUIHFS YOU t0 FOLLOW RULES ADOPTED 0. fOR TRENCH AND E WILL N I INSTALL PRIOR 1 fl J O SO _'IOD, ZOO FOBI BYTNEULES ARE.J"DI 1 THOSE RULES ARE SET FORTH IN OAR 951-001.0010 � TO BACKFILL.PGE WILI.ND7 INSTALL WIRE , 50117468' � -_ ¢ `t , -I I THROUGH 952.001-0090 YOU MAY OBTAIN COPIES OF UNTILTRENCHIS 10076 OACKFILLED. Cv� \,! 1 ` y k• THE RULES BY[ UNG THE OREGON UTILITY - " SERVICE COORDINATOR QX -7250\-" I NOTIFICATION CENTER ADMINISTRATION 6 I502.232.1987f 503-323-6700 0R 503.463-4348(SALEM) ✓""^ '"""•"""`^^ --U_ ¢_t 7h TOREQUEST UTILITY LOCATES CALL THE OREGON Nllow vfiel§IIBIOVA r" v U•t �,'2. I UTILITYINESS CATIONCENTO EXCAATLEASi CBII bB10TB i/W dlg. mm w`I }BUSINESS GAYS PRIOR TO EXCAVATION I 8 eD_53 _ 20.5 ; SW FAIRHAVEN ST A 50 2438 _ 197 Y ) t WR CHECKLIST REM YES COMMENT VT-22 f I ) HOLEDIGGER VIL 2: Insm6 BOOM F , (765)1425-1-RUN OF 210 AVrG,AL,TRIPLEX.EPR,15KV,TINGFEET) Remove. BACKHOE 12 t JOB SITE r+ `) •r----,� ))19 , I (765)1-RUN OF#2 AWG.AL,TRIPLEXED EPR,15 KV,(1600 FEET) PGE TRENCH BORE LOCATES �[•q +vr 041 -!`_ ti Q, STAKING X �y caNs VICINITY�M4P> I ! v � .. � 1 � FLAGGING :,.,..0 ttt C 10'17,195 ,� 2I y TREETRIM PGE CONSTRUCTION DRAWING !c 16 5i ( I LANDSCAPE AS-BUILT VERIFICATION&NESC VIOLATIONS CORRECTED 4121 2 EASEMENT msIB11: X Foremen: Date: PERMITS TIGARD I 19 (3)ELBOW KIT-JKTO CABLE-02/0AL Dale: General Foremen: I (3)INDICATOR LARGE FAULT VAR TRIP 200 A MINIMUM TIME RESET TRAFFIC PLA X I t (3)ELBOW KIT-JKTD CABLE-#2AL Cl1TSHEET SOPM+ENG REV/EW KEN ALLEMAN JASBUILTBYDESIGNER: i _ 1 C 1 - ! 53 UG CIR.VER. DA SCAT. ACCOUNT. AWG: NO 6 - i _ — 0'-unknown 11/02!2015 1"=70' 1070001 10000014628 M1931601 LY�� 3, Jtj( -�, I 2006 ;c'� TRANSMISSION TITLE SHUTDOWN REPLACE BO PRIM CABLE t VT-646 --'�j i y0 P( -O\ � r /� CIRCUIT TIGARD?IGARD 13 SIZE LLL I l� r CUSTOMER 11X17 A C'S0-1261 _ A BS24 CSHUTDOWN TION �� 13700 SW 115TH AVE.,TIGARD,OR ~�� 0 '4N Rv20'-4 1072 � LY_ DOOR HANGAR REPLACE BO PRIM CABLE �G 1 F' CONTACT BEAVERTON COUNTY SECTIONS WO 'I'M / SHEL7 �s_—, COMPANY LINE CENTER WASHINGTON C2103D PGE' DESIGN BY PHONE(503 DRAWN BY 1011 PH# Ca 2213SWI53RODR KEN ALLEMAN 963-6927 HUGO UP IIA DATE TIME VERTQY.OR97006 I