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PFI2016-00096 �cvt"3a4 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00096 m 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/06/2016 Parcel: SEG3696 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: REISSUED ON 6/28/2016 DUE TO CHANGE IN SCOPE OF WORK. Replace bad order section to 12745 with 1 -4/0 AL-TX in 3" PVC conduit. Remove shoofly. Owner: FEES Description Date Amount PFI Permit Fee 06/28/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: TOM COX 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-867-0414 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 / ��," Signature: Gc e ��(i(CG(� G[�1/ Issued By: Aftij 4ullf Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00096 Type: Condition Name: Status: Severity: 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 twenty-four(24)hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. Ken Fisher 503-816-6146 or Kenny@tigard-or.gov 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 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. Agnes Kowacz From: Tom Cox <Tom.Cox@pgn.com> Sent: Monday, June 27, 2016 7:06 AM To: Agnes Kowacz; Linda Ott; ROW Permits Cc: T&DSupportAvery Subject: RE: Permit application for PGE JOB M2043232 Categories: Misc. Correspondence This job had to be re-deisgned from using an existing conduit to pull wire through to a full bore (95') 1 would like to re- submit permit number PF12016-00096 to the City of Tigard to show them we are now boring the entire job. It should not make that big of difference but I feel it is the practical thing to do so there are no surprises if/when the Inspector shows up on site. I have included the permit we received and the new sketch showing the bore. Can you please re- submit to Tigard showing we are now BORING the entire job so that they know what is going on and hopefully they will amend existing permit and we can be on our way. Any questions, please let me know. From: Agnes Kowacz [mailto:AgnesK@tigard-or.gov] Sent: Monday, June 27, 2016 6:35 AM To: Linda Ott; ROW Permits Cc: T&DSupportAvery; Tom Cox Subject: RE: Permit application for PGE JOB M2043232 Good morning- Is this a new application? It looks like you send a copy of the permit we issued to you along with it? Please advise. Thanks, Agnes Kowacz I Associate Planner City of Tigard I Community Development 13125 SW Hall Boulevard Tigard, Oregon 97223 Phone: 503.718.2429 Email: AgnesK@tigard-or.gov From: Linda Ott [mailto:Linda.Ott@pgn.com] Sent: Friday,June 24, 2016 9:21 AM To: ROW Permits<rowpermits@tigard-or.gov> Cc:T&DSupportAvery<T&DSupportAvery@pgn.com>; Linda Ott<Linda.Ott@pgn.com>;Tom Cox<Tom.Cox@pgn.com> Subject: Permit application for PGE JOB M2043232 Good morning; Attached please find a permit application and job sketches for PGP work order#M2043232. Please direct any questions you may have to our Project Manager, Tom Cox, 503-867-0414. 1 1luukyoo ].io6n 0u ' T&|) Suppo,/ Portland General Electric 1nmmmwAvery m,Tualatin,onaro*u � W: (503)612*0931:'Pi: (503)612'61501 DISCLAIMER: E-mails sent o/received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." z �� iS io►� 10 City of f Tigard JUN 2 7 2016 — PUBLIC WORKS ENGINEERING PGE WORK ORDER# ■ CITY OF TIGARD Public Facihty Improvement (PFI) Pdy fMIENGINEERING DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: N Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Replace bad order section to 12745 with 1 -4/0 AL-TX 8 Minor work in right-of-way (sidewalk repair,curb cut,street in 3" PVC conduit. Remove shoofly. opening,etc.)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 12745 SW Walnut St of the proposed work to be done •Submit one(1)copy of traffic control plan Home owner: James Taylor 503-274-9595 –OR– A Applicant's name: Tom Cox / Rachel Schoenheider [I Substantial project work requires PP above items and professional Address: 10800 SW Avery St engineered plans for: Tualatin, OR 97062 •Street widening Ci /state: Zip: •Subdivision infrastructure Phone: 503-867-0414 Email: T&DSupportAvery@pgn.com •Main utility line extension: Storm Drain,Sanitary—Tigard - Water—Tigard 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. Engineers name: Tigard,OR 97223 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: n rmits( igard-or.ggov Phone: Email: FOR STAFF I SF' ONLY 2,000 Case No.: �w'�P" �(P Estimated value of work (within the public right-of-way): $ Application submittal fee: 00 Is work related to a LAND-USE DECISION? ❑ Yes ® No Application accepted: If so,please specify (MLP,SDR, SUB,etc.) case #: By:Ay= Date: 2 �� Is work related to a BUILDING PERMIT? ❑ Yes JJ No Application reviewed: If so,please specify(BUILDING PERMI case#: By: 91f_ Date: Applicant notified: 1. �N�l�'"�l�•J t..2,irA l 7TeA41f_t G. / k67W14726C4 By: Date: L 70. ! Q � h4p I:\CURPLN\Masters\Land Use APMicaftes Rev.07/16/2014 A4,L kA 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 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 the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed upon the subject propcL. • 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. Dually sig—by R,&l SWe h— DN:—Ra ce =Po6a tl Gn alRachel Schoenheider E�aNesleGaina. 2016 hm, -US Rachel S c h o e n h e i d e r 05/16/16 D1,-016051]14735:15OrW 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 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4 SAMPLE SKETCH: Edge of Pavement I -a*— Ditch —� StreetlightI —•—•—•--- •—•— —C—•— I °• Ram LTun 1 0 6 � I , T--PioTaos cf'Se1weiTiiie'– II ,� Existing House 1 r� I Existing ' ,I I vDriveway �7CL � I vi I dl of I , CL o i CAI � Existing Shop I � J t Powerpole o 0 I I-------- 95� ---------- ( operty 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 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 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 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 SAY/Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 LEGEND WR CHECKLIST ITEM YES COMMENT HOLEDIGGER REMOVE FACILITIES INSTALL FACILITIES vVL 2-WL1 TO WL3: BOOM nSBACKHOE INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES (95')CONTRACT BORING (95')1-3"CONDUIT PVC PGE TRENCH (95')1-RUN OF 4/0 AL URD TX CONDUCTORS Remove: BORE X 95 FT (60)1-RUN OF 4/0 AL URD TX X _ __ ___ INSTALL 1-4/0 AL-TX SECONDARY 1N 1-3"PVC CONDUIT Abandon: LOCATES PROVIDED 9 INSTALLED BYAPPROVED CONTRACTOR (95')1-RUN OF 4/0 AL URD TX STAKING FLAGGING X REMOVE/ABANDON 1-410 AL-TX SECONDARY GROUND ABANDONED CABLES PER LC22035-7 TREETRIM 3 VD 1.3 LANDSCAPE � = EASEMENT .59 2 PERMITS X TIGARD TRAFFIC PLAN X i ONE-LINE DIAGRAM C21-04A CUTSHEET I , D UG CIR.VER 35' REMOVE SHOO �" VTRANSMISSION +- TENSION: is g 60' A4/0 AL 1 SHUTDOWN yr 59 a --► TENSION:22# 2 I A 4/0 AL TPLX-95 CUSTOMER ---- A 50 64623 OUNTS 1-3" PVC SHUTDOWN X 7 ACC - - - - - - - - - - - --- PD-1 PD-135 - - - - -90 DOOR HANGAR VT 79, VT-80 pp_� -91 A 2 AL ABC 2/0 AL CONTACT X TAYLOR -81 3 D-82 VT-652 - COMPANY -- VT-89 PD 85 PD- ABC 750 AL PH# C# 503-274-9595 I D-16 -� � 25 . DATE TIME PD-12 0 5 10 20 Feet CONTACT SERVICE COORDINATOR -102 I I I I I 1 1 1 I FOR TRENCH AND CONDUIT INSPECTION PRIOR m i PD-12 TO BACKFILL.PGE WILL NOT INSTALL WIRE _ Y UNTIL TRENCH IS 100%BACKFILLED. N S w PD-12 , SERVICE COORDINATOR m 0 1 D 1 ' j P`JL 503-323-6700 OR 503-463-4348(SALEM) -- a PID-6528 PD-121 PGE ANY DEVL47ION FROM THIS DESIGN MUST 4 BE APPROVED BY THE PGE PROJECT MANAGER sw y 5 9 a BES 1H *� a PGE CONSTRUCTION DRAWING THINK SIN , "'� AS-BUILT VERIFICATION&NESC VIOLATIONS CORRECTED BOUPLTF �" sw , SAFETY D,Ka—Im. 11111yrogex FIELD Cm sT r W CO) FIRST Foreman: Date: SW General Foreman. Date. S� MARIF ST T � c l &rST SW WALNUT ST-- sw �N��s� sW tTPtt r SDPMIENG REVIEW ASBUILT BY DESIGNER: DATE: SCALE: ACCOUNT- AWO JOB NO yRi ai n < SW CALL 811 BEFORE YOU DIG 03/16/2016 1"=60 5940001 14628 M2043232 V LU F�' ATTENTION: TITLE u y p 5 LANSDOWNE OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , REPLACE B/O SEC TO 12745 n g W Xi LN BY THE OREGON UTILITY NOTIFICATION CENTER. CIRCUIT SIZE 61 THOSE RULES ARE SET FORTH IN OAR 952-001-0010 ` TIGARD-13362 11x17 z TS C7 SW ALBERTA ST THROUGH 951-001-0090 YOU MAY OBTAIN COPIES OF $ OCATON U) yy� BETHE RULES BY CALLING THE OREGON UTILITY PGE/ L I 12745 SW WALNUT ST.,TIGARD, OR LN �t a " K, BEAGLE g' NOTIFICATION CENTER ADMINISTRATION @(502-231-1987) DESCRIPTION tr a TO REQUEST UTILITY LOCATES CALL THE OREGON Know what's below. REPLACE B/O SEC TO 12745 SHEET yv a A S q Vicinity Map sw JAMES ST UTILITY NOTIFICATION CENTER, 811 AT LEAST Call before you dig. BEAVERTON COUNTY SECTIONS WORK WITH o- Ri k PGE 2 BUSINESS DAYS PRIOR TO EXCAVATION LINE CENTER WASHINGTON C21 04A DESIGN BY PHONE(5031 DRAWN BY 1 of 1 2213 SW 153RD DR TOM COX 867-0414 1 HUGO MEJIA BEAVERTON,OR 97006 C-) PORTLAND GENERAL ELECTRIC Co.-ALL RIGHTS RE ERVED j 2011 Edition Page 17 Figure 2-3: Cone Spacing Example i 1,4 wdrd� I Q F g Line Device Spacing along buffer and work space= -- — r 2 x taper spacing I I ; Spacing equals MPH in feet Taper Length Cone#3,2 foot offset Cone#2, 1 foot offset All cones 1 Cone#1,on fog line foot offset throughout taper December 2011 Chapter 2 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2016-00096 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/06/2016 Parcel: SEG3696 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Replace bad order section to 12745 with 1 -4/0 AL-TX in 3"PVC conduit. Remove shoofly. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: TOM COX 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-867-0414 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: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00096 Type: Condition Name: Status: Severi 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 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 MAY 16 2016 City of Tigard RPUBLIC WORKS —"4kgEE PGE WORK ORDER# NG Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: R Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: Replace bad order section to 12745 with 1 -4/0 AL-TX R Minor work in right-of-way (sidewalk repair,curb cut,street in 3" PVC conduit. Remove shoofly. opening,etc.)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 12745 SW Walnut St. SEG3696. of the proposed work to be done •Submit one(1)copy of traffic control plan Home owner: James Taylor 503-274-9595 -OR- Tom Cox / Rachel Schoenheider ❑ Substantial project work requires Applicant's name: above items and professional Address: 10800 SW Avery St engineered plans for: Tualatin, OR 97062 •Street widening Ci /state: Zip: •Subdivision infrastructure Phone: 503-867-0414 Email: T&DSupportAvery@pgn.com -Main utility line extension: - Storm Drain,Sanitary—Tigard - Water—Tigard 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. Engineer's name: Tigard,OR 97223 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: rg=ermits .tigard-or.Qov Phone: Email: Case Na: PFI2016-00096 Estimated value of work (within the public right-of-way): $2,000 `gam Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes p No Application accepted: If so,please specify (MLP, SDR, SUB, etc.) case#: By: LS Date: 5/16/16 Is work related to a BUILDING PERMIT? [:1Yes p Application reviewed:No ..r By: Date: If so,please specify(BUILDING PERMIT)case#: Applicant notified: By: Date: l:\CURVLN\Masters\Land Use Applications Rw..07/16/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 a 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 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 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 proper . • 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. °mftM ag.W Ey Ra W SO ,,h— °"°�-R'�"s-=.°p°`°P m°�"" Rachel Schoenheider 05/16/16 Rachel Schoenheider E�,�,a.�,�65,.,�. ,�a_�.�•.5 .�,�.�5��m._�s rte,2pf5.05.i51•JS 15-0T00' 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 Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 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 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 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement I :FExistin hStreetlight I ------- —C--- ift1 1 `o ' aalTdr�� g House 1 Existing Driveway j I vi I 1 CI ^ I • �• 0.1 3 I o� L o') I 1 I � Existing Shop I � J Powerpole I�-------7rop9�ine'------�--- � I ' I I l I Fire Hydrant(FH) � � I Scale: 'I"=30' � I I 1 I I I I � � I MINIMUM SKETCH REQUIREMENTS (Put'IN/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.tigard-or.gov - 503-718-2421 - Page 4 of 4 -- - - LEGEND WR CHECKLIST ITEM YES COMMENT HOLEDIGGER REMOVE FACILITIES INSTALL FACILITIES WLI-WL1 TO WL3. BOOM Install' INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES (35)DIRT-CONTRACT BORING BACKHOE (35)1-3'CONDUIT PVC (95')494-1-RUN OF 4A AL URD TX PGE TRENCH CONDUCTORS aemove: ORE X 35 FT (60)494-1-RUN OF 410 AL URD TX _______ INSTALL 1-"AL-TX SECONDARY IN l-3'PVC CONDUIT Abandon: LOCATES X PROVIDED d INSTALLED BYAPPROVED CONTRACTOR (35)494-1-RUN OF 411 AL URO TX STAKING FLAGGINGI X REMOVE/ABANDON 1J70AL-TX SECONDARY GROUND ABANDONED CABLES PER LC22035-7 TREETRIM 3 VD=1.3 LANDSCAPE 12760 EASEMENT 4902 NEW 35'- PERMITS X TIGARD - 3'PVC 12745 -ABANDON 35'OF PULL OUT 60'OF EXISTING 4/0 SEC TRAFFIC PLAt X ONE-LINE DIAGRAM EXISTING 4/0 TX IN PLACE AND INSTALL NEW 4/0 TX IN C2 1-04A EXISTING 3'CONDUIT 12725 CUTSHEET , U yT-5901 UG CIR.VER r 35' REMOVE SHOO-FLY RANSMIssION �- TENSION:i8p 60 A410AL SHUTDOWN VTC -----► TENSION.22# 2 A 4/0 AL TPLX-95' A 50 64623 CUSTOMER X 7 ACCOUNTS 1—1 1.3'PVC SHUTDOWN 1 90 DOOR HANGAR VT-79 VF-80 PD-90 VT-91 352 A 2 AL ABPD-71 C 210 AL -61 8 coNTgcr X TAYLOR vr�sz - COMPANY -18 0 V7-89 P 5 ABC 750 AL PH# C# 503-274-9595 i�i�... 25 DATE TIME � IPO-124 ❑PD-72 0 5 10 20 Feet CONTACT SERVICE COORDINATOR -102 I I 1 I I I I I I FOR TaENCH AND CONDUIT INSPECTION PRIOR m PD-123 TO pACKFILL PGE WILL NOT INSTALL WRE UNTIL TRENCH IS 100E 9ACCFILl1D PD-717 PD-122 z SERVKE COORDINATOR �ID-117 503-3231700 OR 503463-43494SALEM) m PD-6528 PD-121 PGE 71 YDEVL4770WROM 7H5DE_WlV MUST gg BEAPPROVED BY 7HEP6EPR0JECT AMA646ER l IW 5v i AL a� BfItH N 61 ry THINK PGE CONSTRUCTION DRAWING B e1lEf; SAFETY AS-BUILT VERIFICATION&NESC VIOLATIONS CORRECTED FIRST ForemanDate n 4 General Foreman: Date: i T4�P SW WALNUT aw TRp+I VL SDPM�ENG REVIEW' SBUILT BYDESIGNER: I1 ST A SCALE. ACCOUNT AWO 108 N ATTENTION: CALL 811 BEFORE YOU DIG 03116!2016 1'=60' 5940001 14628 M2043232 SIR,LAAsn mArt OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , nTI F REPLACE BIO SEC TO 12745 p: 5 LN BY THE OREGON UTILITY NOTIFICATION CENTER, CIRCUIT soF tiTHOSE RULES ARE SET FORTH IN OAF 1-0010 /\ TIGARD-13362 11 z1/ # L CI SW Al6ER 1431 � THROUGH 952-001-0090 YOU MAY OBTAINTAIN COPIES OF LOCAnON }j N f 3W THE RULES BY CALLING THE OREGON UTILITY ME 12745 SW WALNUT ST.,TIGARD,OR r. 6LAgl NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) p $- (� DESCRIPTION i c1 7 y TO REQUEST UTILITY LOCATES CALL THE OREGON �� ' REPLACE BIC,SEC TO 12745 slue r Vicinity Map 4, g,m JAMES 51 UTILITY NOTIFICATION CENTER,811 AT LEAST Cd6dwymft BEAVERTON COUNTY SECTIONS !P PIt 2 BUSINESS DAYS PRIOR TO EXCAVATION LINE CENTER WASHINGTON 021-04A DESIGN BY PHONE(503 DRAWN BY 1 DI 1 n+arn+sTRD UH To COX 867-0414 HUGO MEDIA 'RTON.OR 9]006