PFI2016-00140 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00140
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/05/2016
Parcel: SEG1580
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Provide 200A 120/240V 1 PH UG service to new construction residence
Owner: FEES
Description Date Amount
PFI Permit Fee 07/01/2016 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
TOD SHATTUCK
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
Signature: kc& (� a-ho. ,.
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00140
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 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
RECEIVED
City of Tigard JUN 2 8 2016
PUBLIC WORKS — ENGINEE %lTY 0F' . A' ORDER# M2043958
■ ,11 NING/ENGINEERING
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: 8 Utilities ❑ Sidewalk/driveway approach El Street improvements
ELEMENTS
Detailed description: provide 200A 120/240V 1 PH UG service ❑ Minor work in right-of-way
to new construction residence (sidewalk repair,curb cut,street
opening,etc.)requires:
Application form,completed
and signed
-Submit one(1)copy of scaled sketch
Property address/location(s): 15110 SW Sunrise LN �. of the proposed work to be done
Tigard Or. 97224 -Submit one(1)copy of traffic
control plan
OR-
Applicant's name: Portland General Electric-Tod Shattuck E] 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: 503-672-5466 Email: tod.shattuck@pgn.com -Main utility line extension:
- Storm Drain,Sanitary—Tigard
- Water—Tigard Water Service
Contractor's name: na 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.
�� ^i ; Tigard,OR 97223
Engineers name: P,-
Ll`'
t Applications for"minor work in right-of-way"
Address: only may be emailed to:
City/state: Zip: roc ,ermits(g��ti�wrd-oar Dov
Phone: Email:
Estimated value of work (within the public right-of-way): $ Case No.:
Application submittal fee: too.ed
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application accepted:
If so, please specify (MLP, SDR, SUB,etc.) case #: By: tDate:
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No Application reviewed:
If so,please specify(BUILDING PERMIT)case#: By: . 15 t 14 4 Date: G
Applicant notified:
By: / Date:
I:\CURPLN\Mesten\land Use Applketlons Rev. 7/16/2014
Cityof 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 APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject propulr�-
• 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.
DIgI.11,111.1,LINDA OTT
ON.LINOA OTT.
AND
LINDA OTT e0�elLIINOA.OTTgPGNCOM.-USENERA Linda Ott 6 28 16
Daly.2016 N 2815:18 26 4T
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
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:
99'N" St
Edge of Pavement
I -40— Ditch
Streetlight I 11—•—•---•---•— —�—•—
coxl Run Drun
r 'o
' T-�ro'pos cf'Se1werT'irie- �
I I -
Ne
61 Existing House
r� I Existing
2:� Driveway
a l I ci i t
0. I .
al I I 1
3
1
a o'
o
I � Existing Shop �
Power: � I o l 0 1
I C�-
--------7roperiyLine-----------
I I
Fire Hydrant(FH)
I � I
Scale: '1"=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 0 www.tigard-or.gov • 503-718-2421 • Page 4 of 4
PGE 1730 SPLICE BOX RoW Bid,. t4" ` SPoil
_-T�;„ NEW PGE FACILITIES TO BE INSTALLED
"F (UNLESS OTHERWISE SPECIFIED)
M'tLRON's LF.GEHU
ERREI•IfIDMYR w sx s, su 30, ,O PGI:P, FACILITIES IN GREEN ARE TO BE REMOVED
m•• NLn B„g1d.,y CW1e 1730 SECONDARY VAULT,
rtENCH •M.+1uNal a tare, INI�Du.I O
Trncb 'rwry PROVIDED 6 INSTALLED BY CUSTOMER
®LB" -------- INSTALL V40 AL-TK SECONDARY IN 3"PVC CONDUIT
Top
VIEW
PROVIDED b INSTALLED SY CUSTOMER
°nlo.w pt It,.Rsl. O usel.o.H.,a - - ---- - INSTALL 1 1350 AL TX SECONDARY IN 3"PVC CONDUIT
———— E.nR O 1954- PROVIDED B INSTALLED BY CUSTOMER
1954-40
• • J-1 U,e T-1,Wq G-
' `I d• 1.
- B 50 8044
a1A.
Ln
�DR HK a. a
00362 m WR CHECKLIST CONSTRUCTION NOTES: SFEKT
O 131.•2848 ITEM YES COMMENT
1996-35 B ., HOIfDIGGER i CUSTOMER TO PPOVIDE ALL TRENCHING AND BACKFILLING TRENCH TO BE
800. R 36 INCHES DEEP,MEASURED FROM FINAL GRADE.
_
SICK" Z. CON (IF NECESSARY)WILL BE GRAY.SCHEDULE 40,ELECTRICAL GRADE,
120240 50' Vi 69 CONDUIT
V 3 P E CONOUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TEST)
ryf%\ EAETO DETERMINE THE SIZE AND NUMBER OF CONDUITS REQUIRED
200AMP ______ ♦ _01 MAI
12 VER CAL INCHES AND 24 HORIZONTAL INCHES CLEMMICE BETWEEN
HP7AC.3T `'t _ GAS AND OTHER UTILITIES.ALL ELBOWS TO RE 3e INCH( INT RADIUS.
ALL RENDS MUST BE FACTORY MAGE RIGID STEEL OR PGE APPROVED FIBERGLASS
INSTALL 3'POLE CONDUIT UNIT LOCATES BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER OR FOR ANY LENGTH
2.3441A I W112•BRACKETS STAKING RIJ ACCEPTABLIE FOREIHAN RUNS OF8150 FEEEORNSENDS,PV1 I�NWLJLF 4D LESS THE AAXIAILMI TOTAL BENDS ARE
IN ANY
3,31BA AFC 1 0 848 FLAGGING CONDUIT RUN IS 270 DEGREES
I 1 54-4c B 10 35488 1REERIM 3, CUSTOMER RESPONSIBLE FOR ROAD CROSSINGS. USE ONLY GUY,SCHEDULE 40.
BO'I LWDSC PF ELECTRKl GRADE,PVC CONDUIT WITH NYLON HULL STRINGS(AIN 500 IIS TEST),
I O EWMEM R DIRECTIONAL BORING REQUIREMENTS:BLACK HDPE(HIGH DENSITY POLYETHYLENE)DUCT
I PEWSCCONNECTSCHETIION ULE 40 PRODUCT)ASWITH AN ALTERNATIVE TIVE CAL TONECTH EIODULYCEHOPE RTA-LOSHALLRMEET LIKE THE HANICA
1 REQUIREMENTS OF PGf SPECIFIGiION LC20515(AVAILABLE ON REQUEST FROM PGE PROMCT
02849 TRAFFIC PLANMANAGER).FOR SAFETY REASONS THE DUCT SHALL BE BLACK WITH THREE EQUALLY SPACE
Cl15NFN EXTRUDED RED STRIPES(WHICH 15 A SPE CATION REQUIREMENT/MANDREL TEST OF
142 C70 -F6T 1954-40YEA HDPE HPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT
REPLACE 35488 WITH 72oov O rt
s.sn4G E PRIMARY
NISTAUATK3Ns-coNDLRT To EXTEND A MINIMUM OF 1D•FROM
BN-2 A C S R (H N) SHUTDOWN RANSFOM ER PAD.
)O 25 B01 12L1240V CUSTOMER 6. ALL PGE TRANSFORMERS TO BE INSTALLED B FEET(AIN)FROM ANY COM0USTIBLE
1PH,3W SMUIQOWN R PM ro NO—
BUILDING,WALL OR OVERHANG AND 4 FEET fMIN)FROM ANY HRF HYDRANT.
PGE TRANSFORMERS MUST BE WITHIN 15 FEET OFA DRNEABLE AREA
4KW EXISTING LOAD DDDR HANGER ALWAYS MAINTAIN R2 FEET CLEARANCE IN FRONT OF ALL TRANSFORMERS.
6KW ADDED LOAD S W SUNRISE L N CONTACT 7. CUSTOMER TRENCH AND ELBOW CONNGURATIONS MUST BE INSPECTED BY PGE PRIOR TO
IOKW TOTAL LOAD CWWAM' BACKFILLING WHEN YOU ARE READY FOR PGE TO INSPECT(AFTER INSTALLATION IS COMPLFU
PL CALL 503 736 5450 OR 503 443 4348'SA:EM ARfA
PNI Cs -OW UP TO 2 WORKING DAYS FOR INSPEC' v
DATE TIME B. DESIGN IS BASED ON STANDARD UNDERGROUND STANDARD
NON-STANDARD
UNDERGROUND EQUIPMENT KAY RE AN OPTION AT AN ADDITIONAL COST TO THE CL5TOMER.
- PGE CONSTRUCTION DRAWING
RIGHTofPERMIT NOTICE: AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
A PERMIT FROMOMT THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY
WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED This document accurately represents FIELD Conslruelon.
CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL Foreman: Date:
AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT.
THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS General Foreman: Date:
BEFORE WORK IS TO BEGIN,A COPY OF THE PERMIT MUST BE ON SITE. Signature only required for field construction changes.
SDPANENG REVIEW: —_ ___ _ JASBUILT BY DESIGNER:
CONTACT SERVICE COORDINATOR DATE' 426/1016 SCALE 150' Accou0001 AW0 1000004594 100 NO�M2043958
FOR TRENCH AND CONDUIT INSPECTION PRIOR 1111E
u� A f i0 SACK ILL PGE WILL NOT INSTALL WINE
--N UNTIL TRENC IS 10Dk BACKFUED HORIZON NORTHWEST INC
SERVICE COORDINATOR CIRCUIT SIZE
503-347-2207(BEAVERTON) SCHOLLS FERRY - ROY ROGERS 11X17
E ATTENTION: CALL 811 BEFORE YOU DIG PGE/ LounDN
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ' 15110 SW SUNRISE LN
E THINK BY THE OREGON UTILITY NOTIFICATION CENTER. i DESCRIPTION
4 THOSE RULES ARE SET FORTH IN OAR 952 001-0010 • �. R NEW 200A UG SERVICE
SAFETY THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF COUNTY SECTION(S) WORK WITH SHEET
5 THE RULES BY CALLING THE OREGON UTILITY WASHINGTON C21-05D
3 FIRST! NOTIFICATION CENTER ADMINISTRATION @ (503-232-7987) BEAYERTON i Of I
'n.,•+M•[ LINE CREW CENTER DESIGN BY PHONE 11 311 DRAWN BY
7 TO REQUEST UTILITY LOCATES CALL THE OREGONnowofs 7113 s 153RD Ia TOD SHATTUCK 672-5466 LANE WHITNEY
AS
!.4v:.5'111•"°�� UTILITY NOTIFICATION CENTER 811 AT LEAST II before you dl "'"YF RroN or P700e
.2 2 BUSINESS DAYS PRIOR TO EXCAVATION. Y 9 O PORTLAND GENERAL ELECTRIC CO. ALL RIGHTS RESERVED
y� I--------- --------�
[a A W W N N 9 O
Single Flagger Operation
for Low Volumes
W b y I (ADT<400) ro nov m,
v
0 0 >m ^
I I
m ° II >•e e c I BE
FLAGGM
PREPARE RE
10 b T• TO STOa DP
m
K eg C a K e K A I--I
�.
0,0M a
I------------------------iTt
II � 1 mile
4 r max. 4
•
K K K K Tt •
B
Buffer
Protection Vehicle
ROAD w/TMA(both ter Optional)
WORK See Chapter 4
AHEAD BE
ONELANE PREPARED
ROAD TO STOP Two Fli
AHEAD
(Optionao