PFI2015-00177 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00177
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/25/2015
Parcel: SEG1945
Jurisdiction: TIGARD
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to 9930 SW Murdock St., provide service to new 3-lot partition.
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 Not Present
Signature:
Issued By: C
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00177
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 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
"JED
Tigard
City of T
PUBLIC WORKS —ENGINEERING PGE WORK ORDER# M1783571` 4 2015
�
–ARD
Public Facility Improvement (PFI) Permit�.G�NEERING
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: IR Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: PROVIDE SERVICE TO NEW 3 LOT 8 Minor work in right-of-way
PARTITION (sidewalk repair,curb cut,street
opening,etc.)requires:
•Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): 9930 SW MURDOCK STREET of the proposed work to be done
AND SW 100TH AVE •Submit one(1)copy of traffic
control plan
–OR–
A OR–
Applicant's name: TSAHAI ANDERSON ❑ Substantial project work requires
Pp above items and professional
Address: 10800 SW AVERY STREET engineered plans for:
TUALATIN OR 97062 •Street widening
Ci /state: Zip: •Subdivision infrastructure
Phone: 503-612-6106 Email: T&DSUPPORTAVERY@PGN.COM •Main utility line extension:
Storm Drain,Sanitary—Tigard
Water—Tigard Water Service
Contractor's 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.
Eng TOD SHATTUCK Tigard,OR 97223
Engineer's name:
2213 SW 153RD DRIVE Applications for"minor work in right-of-way"
Address: only may be emailed to:
City/state: BEAVERTON, OR Zip: 97006 rowpermits a-tigard-or.gov
Phone: 503-672-5466 Email: TOD.SHATTUCK@PGN.COM
1:011 STAFF VSE ONLY
Estimated value of work (within the public right-of-way): $ Case No.: 2 1201 S-W I`l7
Application submittal fee: O
Is work related to a LAND-USE DECISION? ❑ Yes 9 No Apph accepted:
If so,please specify (MLP,SDR,SUB,etc.) case#: By: Date: 1 2q 1S
Is work related to a BUILDING PERMIT? ❑ Yes N No Application reviewed:
If so,please specifyUILDI G PERMIT) case#: By: Date: d 4L s' r6'--
— �jN,�',f.f• /�__ .•.�-` Applicant notified: f 1
^�'re►�t �+rwl By:�1 Date:
IF
l:\CURPLN\Masters\land Use Applications Rev.07/16/2014
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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 au 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 properl;�
• 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.
Dgilally signed by TSAHAI ANDERSON /+� 1y. 1l 1y�
TSAHAI ANDERSON,email=TSAHAIA.ANDERSON@PGNOOM,c=US
Data:zois 11 za la,1 toe-0e�oo Permit Coordinator 11/23/15
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 HallBlvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4
TRANSFORMER 20851251141VICINITY MAP
2-B2/0AL 6KWPEAK —r3118 __1
SW MURDOCK Si �eiAAL: 25208$ WL1-3 Span: 2_G2S,L
6K W A DDED C z AAA
ABL 338 MC 1431MT Install: dw.R211 Lw
-.313k
4R)AAC
WL 1: csR '(380)498-1-PHASE OF JKT#2 AL
t Bw KMMSapLSY
,? Install i '(360)Y PVC CONDUIT PROVIDED
La,NNL e r AND INSTALLED BY CUSTOMER'SU3204-FUSE LMBC-TRAMP 2n7 _ _'439-UG PRI POLE A24L JKT 1 P-142 CIO ___SO '421-2-IN PVC CONDUIT UNIT WI721N BKTS 1 " aw+RAoqun
'412-3-IN PVC CONDUIT UNIT ;
WL1-2 Span: 4e ES a
Install: �2 � r
Y
'(180)494-1-RUN OF 410AL URD TX 1201240V'(180)3'PVC CONDUIT PROVIDED DA w vrnEK.1 wE
AND INSTALLED BY CUSTOMER 200AMP
-- J - --- HP/AC: 3TON
<2R/VD
1.97%FLKR p PUE SINGLE FAMILY LEGEND
4,008A AFC NEW PGE FACILITIES TO BE INSTALLED
W 3 UNLESS OTHERIN SE SPECIFIED)
Install:
WL 3-4 Span: RMICROPAD Provided and Installed by Customer '�� srr(EusINR As xorEo
Install: '629-TRANSFORMER 1P 7.2 120/240 MP 25KVA NTLB
'(130)494-1-RUN OF 4/O AL .TX
. pxoLRoeo WRMCRAVEL BASE.
12KW PEAK LOAD sruLEo er cusroMER
'(130)3-PVC CONDUIT PROVIDED o R Ix
AND INSTALLED BY CUSTOMER - coxouD
----'-- Ix:ALL I-.IAL.xi,ED YLUS'rrNA
I PROMo(o a wsAu(D ar cusroMER
CONDIRT
25'
OVIDED AINSALLM SYCUSTOMER
I—ALICV]TOMfRroWSTALL J'pvt LOxOMidSNPUP
pOR PUTME IJOAETY SERVICE
1
I
1
1
I
1
1
I
I
1
1201240V 1 _
T
200AMP I 55� --e 2Arrx
HP/AC: 3TON". WL 3-5 Span: 20-4
C7 .nd
<2%VD Install +W9 1l NO7FN� T
135 494-1-RUN OF 410 AL URD TX I cUsroMER TD PRDv10(ALI AFNwWGANo sACKFrwNG AENOI roe,
1.93%FLKR ( ) rJ orfs Olfl.M UA(n FROM FIML GRADE
4,087A AFC 1, -(135)
'(1.10)3-PVC CONDUIT PROVIDED I cavour nF NfcrsvRr/MH of MAY SMEDULE40 Elrouc.L GRAD,.
AND INSTALLED BY CUSTOMER III CONDU lWITNNrION puu SA,_ft7IN 50DleS.FEITL
PGf rO DETERMINE Mf SIE AND NUMBER OF LDNDMTS REQUIRED
1 MNN'All II VFROGlWCHf5 AND 24 roR 20NTA(INCHf REARANCf NRV LN
5 PGE CMSANDOMfR unllO(S All HAOWSTOIE341N61 IARNf AADUS.
ALLBEN05MUSTREFACTORYMADE RINDSTFELOREIGf APN[DVEDFISMIASS
BENDSAAf RFOMRFDFORRUNSOF 15:FETOR LONGER,MFOR ANYLENGM
RIGHT-OF-WAY PERMIT NOTICE: M MME TNAN IM DfGRrrs Ix efxOS pVC XNEDuIr R0 BfNOs Mf
PMS((FMRUNSOFl50FfETMIEi,WWVMWTOT4l RMN INANI
A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY WR CHECKLIST
o(M[ES
WORKINTHE R)GHT-OF-WAY MAYBE PERFORMED. ONLYPGEAPPROVED STEM YES COMMENT 3 Cu5'OMfR RESPpYSIL[FORRMD ROSS USEONLYGRAYSCNFDULf AR
CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL _ EL[Cr1UCu GRADL TC NNDUITWIM NnaY PIAt STR6vG5IMIN.SmteS,TEST{
AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. apMl H IG ER A MSECTIONALBMINGREgUIRLME—SACKHOPEIHIGHDENsIN Yf MYLENEIDUCT
MF CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS A -rrpKM Y'' R-03117 OR SCHEDULE 40 PVC MMA MfLHANRAL EONNECTION ICEATTA LCK M LIKE MECHANICAL
RI rrIPF LA'rIRK IC TT1 Rhf.IN Arr1Pvltr rHf RFPMIT M!ICi Rf(IN SITE BOOM - - x� CDNNEC71IMPR—11ASANALTERNARVE TOHOPEDUC7.HMf SHALLMIIFME
BACKHOE REOUIREMENTSOF PGf SpfOFXADON LC20515IAVAIA4Lf LW Rfq(NSTFROM OGF PROTECT
_ R.�kRll OcW:ue�.., YFwN� MANAGfFl FM 5AFf1YREASONSMEWY.r5P1 REOWRW/7MNEgUFFSTOF
PGE TR NCH - I fxn[uOP[IS RFO AFTFCNIS ASpFCION MPrf IAR[MLNTJ MANORf(IfiT OF
:�/E� V /3�. NnPfPIPrrsRmMRFDAFrrRINS rnlunoNvnMpr,FlNmrrlr,AnnrsrNr
rl.4®cadM LOCATES - ^rr VONDUIT 5 SINGLEPRIAMA TMIISFMMfRPAD
SALLATpVSC MTTDF NDAMMMFUMMIO'FROM
CUSTOMER INFORMATION o � STAKIN a ALL LG,TRANSFMMERS TO BE INSTALLED a FELT(MIN)FROM ANr OMEUSOR,F
_,- ' _ FLAGGRN X 7 LGETRANSWORMRRSALL OR MUS REMPEWISFfET—DRIYEABLFI&MI)TRW ANY IAREARE rppANT
ALWAYS MAWTNN IOFEETCL"MWE IN FRONT M ALL rRANSFMMfRS
8arvb!mel TREETRIM 1 8' r1-USTOWR AENTN AND TO—COVF-RAT OAS MUST BE INSlf CT(D Br PGf IRI! TO
xom.,I ac.rv.gr e..o.e..vA..e cary LANDSCAPEPAD 11I.6—UVYpUAAE1EADYIM LGE TOINSPfRlAlrfR INSrALM nON n(tw1Pl(TO
2" PLEASE CAll 501 TBASl50MS05J63JBb IS4LfMARfAI
EASEMENT - CONDUIT RII OW IN TO 2WMK1_DCH rS FM INSPECDON TO OCCUR
PERMITS X TIGARD a DESIGN IS BAS(D M STANDARD UNMIIGROUNO EQUMMFIET.NONES1 DRRD
TRAFFIC X VNDFRGROUND EOMPMfNT MAY Of AN OPTION A TAN ADDITIONAL COST TO Mr CUS TOMER
MICPOP PAD'CONOUIT DETAIL TWO 19 PVC ELBOWS Br ' 'n CUTSHEET
cusroMER POR oarEMP
OLD—
UG UG CIR VER -ANYDEM7701VMOM TFQSDESnVMUST
IIF REOMEN 1
RANSMISSiON
w'e wNus MusrrEO Rou
MA_ 11—WN - CONTACTSERNCE CL70RDINATOR ISE_-4PPROVFgBYTHEPGEPRWKTMANA6ER
^'LEEPAAM BY E)\ AND E ---- _ _- -
Cus10MEF ME CONSTRUCTION DRAMINI
5HLETDOWN SERVICE COORDINATOR AS-BUILT VERIFICATIONR NESC NOLATIONS CORRECTED
f r L) 503 736 5450 OR 503 463-4348(SAIEMI
,T ,, • • I Ax
'SIDE HAfnerrbn: Darn:
CONTACT R
K l ✓�\ ..". _ General F__ Dale
COMPANY
\:\\ -++ - ) /•f •-•••// PHR CA - SOPMENG REVIEW
2TBYDESKJJHt
INC TOMEN, E\� /l.•.' / _
:iYROUdIDRER ^ ,,, lw AT IM - 10!7/201$ 1-'30' 1070001 100000{594 M118J5]1
BE
I i •p`/v/ ( I MURDOCK STREET PART TION
T[I I -RY'R-is �corRlur Y \
ATTENTION Cdllall aFfORf YOU DIG ` TIGARD 13KV 17.22
OUTRIDE I.5'IB[ROM MCROPAD
Ax/.LEVEL OREGON UW REWIRES YOU TO FOLLOW RULES ADOPTED PC
MCONDUM; )DRIVEWAY I--: PLACEMENT GRA VEL 44dF THINK BYMEORfGON VnIIrr lronflGnoN CFN1FR. •__/ SW MURDOCK STS SW 1OOTHAVE.TIGARD
MOSF RULES ARE SET FORM IN MR 9S2-OGI-0010
CONDUIT
� AD GUI I I� IHROUGN 912.ODLAO90YOUMAYOBTAINCOPIESOF ' ` NEW 3LOT PARTITION
eYr2 COMER � SAFETY THE RUL ES IT CALLING ME OREGON UTILITY sFEEF
NOnFICAT10N CENTER ADMIWSTMTIONaISD2.212-19d71 WASHINGTON C21.118
/ PORBSO A"'Y IR»w" FIRST r0 REQUEST UTILITY LOCATES CALL THE OREGON"R!MniN I 1 OT 1
TONSTE./ + P0.1 UTILITY NOTIFICATION CENTER,.1 AT LEAST -1 Bd10rd 90U 014 rn TODSHATTUCK 8T2y166 MASON HODGES
0P" 2 BUSINESS DAYS PRIOR TO EXCAVATION
Page 84 2011 Edition
Stationary,?Lane:Closure;:with:Flaggng';;; ;:: �.�<;; ::=:;:;�Dagram320.
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads(less than 400 ADT)with good
sight distance as discussed below.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater,when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection,the"Flagger Ahead"(CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should
be considered on high volume or high speed roads,or when extended
queues are expected.
Chapter 5 December 2011
N
Single Flagger Operation ,p -
uta m
x I for Low Volumes I (Optional) p' a
i'.y'•t NI (ADT<400) ro amo now :�
BE
RAGM I ONELANE
Tt
PREPARED ROAD '`
cn w �"�"'W e I A H U t• TO STOP AHEAD
4- I i 4- I :�
du� � I — — —. . — — — I • ROAD
= I ♦ r•® --► I WORK
+yr v' m I K K K I 11 AH
K
0 0 o n N = c e e n
(------------------------ I11 �t
1 mile
max.
• •
B B A
Buffer
Protection Vehicle
ROAD • W/TMA(both Optionaq
WORK See Chapter 4 0
AHEAD
BE
ONE LANE
PREPARED .
n ROAD TO STOP Two Flagger Operation
AHEAD 3;?
W N
c, (Optionaq C. OD