PFI2016-00232 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2016-00232
a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/28/2016
Parcel: SEG266
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace lid on VT 14661 PGE JOB M21257550
Owner: FEES
Description Date Amount
PFI Permit Fee 10/26/2016 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MICHAEL STAGG
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 971-804-4205
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: Not Present
Issued By: �—
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00232
Tv De: 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 503431-2345(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. call ken Fisher 503-816-6146 of 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
i
OCT 25 2016 I
City of Tigard
CITY OF TlGARD
PUBLIC WORKS—ENGINEERING PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1-Franchise Utility Work
Check one: ❑ Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE
and/or utility agency.
Detailed description: replace lid on VT 14661
ElPGE JOB M2157550 TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair.
11347 SW Springwood Dr • Driveway approach installation
Property address/location(s): and/or repair
Tigard, Or. 97223 • Sanitary sewer lateral installation
and/or main line tap
Applicant: PORTLAND GENERAL ELECTRIC ❑ TYPE3-FullscaleDevelopment
pP Work performed with Land use
Address: 10800 SW AVERY ST approval which includes any of
City/state: TUALATIN, OR. Zip: 97062 the following.
Phone: 503-612-6093 Email: T&DSLIPPORTAVERY@PGN-COM • Subdivisions or Partitions
Contact name: Phone: • Street widening
• Mainline installation for Sanitary
Contractor: NA sewer, Storm sewer,Tigard water
and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: MICHAEL STAGG only tnay be emailed to:
rowWrmitsatigard-of.gQ
Address: 10800 SW AVERY ST
City/state: TUALATIN, OR Zip: 97062 monommm
Phone: 971-804-4205 Email:T&DSUPPORTAVERYQPGN.GOM Case lo2Ql�'-
Contact name: Application submittal fee: ZOO. O d
Additional fees:
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By. 1—S Date: Zo J�
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application reviewed: `
By:J 6 S �- Date:
If so,please specify(MI-.,P,SDR,SUB,etc.) case#:
Applicant notified: /�
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By /-'"S Date: &-2- I
If so,please specify(BUILDING PERMIT)case#: ''\a"PLN\M•rt•nwd"""'°`""°"' Pe.09/26/2016
Cityof Tigard 13125 SW HallBlvd. Tigard,Oregon 97223 • wwwtigard-ongov • 503-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Person specified as`Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
• With die exception of a utility operating pursuant to a valid franchise with the City of Tigard,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(.-)must sign this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
property.
• 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 any 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.
Applicant/Authorized Agent's signature Print name
Date
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name Date
Owner's signature Print name Date
Owners 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 FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part 1: Required subtruttal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system improvements ❑ Street Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,24x3G or 22x34)
• Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW HallBlvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I '#— Ditch
Streetlight I ----•—•------- —r—•—
f I " x nr�,
1�
I 1 � •
–'propos cf'Selwer'1_i'ne"
Existing House 1
I Existing
3o Driveway
dl I 3' I 1
aI
I
3t, I
CL I I vti'O"
=I
o •
I Existing Shop
Powerpole I I o o
95
I--------�oPrrt�Lne'------!---
Fire Hydrant(FH)
I � I
Scale: 1"=30'
I i I
I 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 - www.tigard-or gov - 503-718-2421 - Page 4 of 4
WR CHECKLIST
_y ITEM YES COMMENT
HOLEDIGGER
BOOM
BACKHOE
PGETRENCH
RJrg.LVID X NO LINE CREW
LOCATES
\ STAKING
FLAGGING
TREETRIM
LANDSCAPE
EASEMENT
PERMITS X TIGARD
515 TRAFFIC PLAh X
10-4 CUTSHEET
IB75 UG CIR.VER.
635 I TRANSMISSION
30/ dHANGAR
1978}{ VT-14
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R CONTACT
QQQ Q COMPANY
1IAGPH* C#
11455 51? AT M
$18 51?
1 VT 14661:
Install
SU90OD6730-COVER,VAULT,4'x4',NON-SLIP,NO KEYWAY,FLAT BOTTOM,CONCRETE.
SU90006729-COVER,VAULT,4'x4',SOLID,DIAMOND PLATE,NO KEYWAY.CONCRETE.
50 100 Feet
Y DEVL477ON FROM THIS
GN MUST
Vtinity Map o`Sf�aaLa�`�ap` NAP O �VEDBYPGEOJEICTMANAGER
OF0
POE CONSTRUCTION DRAWING
AS-BUILT VERIFICATION B NESC VIOLATIONS CORRECTED
Foreman: Date:
THINK General Foreman Date:
SAFETY ISI r wired br Reld const—h-then es
SDPM,ENG REVIEW! JASBUILT BY DESIGNER:
FIRST DATE
7/8/2016 1:46 ft 1070001 mr-
0000014628 G157550
REPLACE 8/0 VAULT LID
CALL 811 BEFORE YOU DIG c cur s
ATTENTION U PROGRESS-ROBINSON 11 x 17
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED - g2GLOCATION
BY THE OREGON UTILITY NOTIFICATION CENTER. _ / 11347 SW SPRINGWOOD,TIGARD
THOSE RULES ARf SET FORTH IN OAR 951001-0010 DESCRIPTION
THROUGH 952001-0090 YOU MAY OBTAIN COPIES OF ` 1LID REPL SHEET
THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS I WORK WITH
NOTIFICATION CENTER ADMINISTRATION @(502-232-19871 WASHINGTON Cll-34A 1 OF 1
TO REQUEST UTILITY LOCATES CALL THE OREGON 8100/V1dy�bw' wveAroR DESIGN, PHONE DRAWNBY
UTILITY NOTIFICATION CENTER,8II AT LEAST Cabdaetl-ft uwr cReworRrrR MICHAEL STAGG 971-804-4205 Nathan Falke
N 2 BUSINESS DAYS PRIOR TO EXCAVATION C PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
Page 76 2011 Edition
5.2 Shoulder Work
Short Duration Road Work Diagram 200
Diagram 200 covers activity in the roadway of 15 minutes or less with
vehicles parked on the shoulder. Typical work includes debris removal,
tagging of survey markers, or marking utility lines. Work in the roadway
coincides with gaps in the traffic so flow is not impeded.
1. Do not use this diagram if traffic must be controlled to gain safe access
to the work space due to conditions such as high travel speeds or
traffic volumes. Use the appropriate lane closure or mobile work zone
layout.
2. Use truck-mounted flashing warning lights on work vehicles. See
Section 4.3—Lights and Lighted Signs for exceptions.
3. For added visibility, truck-mounted arrow boards or PCMS in caution
mode may be used.
4. The work vehicles should be parked as far off the travel lanes as
practical.
5. If a ten-foot minimum travel lane can not be maintained or when
opposing direction of traffic can not safely pass, use the appropriate
lane closure diagrams such as Diagrams 310 through 350.
6. The initial warning sign should be used if the sight distance is less than
750 feet and traffic volumes are over 400 ADT.
7. A spotter may be used to warn workers of approaching traffic. This is
especially appropriate when sight distances are limited or speeds are
high. See Section 1.12—Spotter Performance and Training
Guidelines for additional information.
Chapter 5 December 2011
2011 Edition Page 77
Short Duration Road Work Diagram 200
t
Work Vehicle
(Optional)
ROAD
* 3 or more cones WORK
may be placed •• �k AHEAD
behind vehicle
for added visibility
Vehicle mounted
(Optional)
1 mile maximum
r <9>
It
Initial Warning Sign
(Optional-See Note 6)
December 2011 Chapter 5
Page 78 2011 Edition
Work on Shoulder Diagram 210
Diagram 210 covers stationary work with work or parked equipment on the
shoulder. This diagram does not cover work on a freeway shoulder. See
Diagram 710 for Freeway Shoulder work.
1. Vehicles should be parked as far off the roadway as practical.
2. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
3. For added visibility, truck-mounted arrow boards or PCMS in caution
mode may be used.
4. Arrow panels in caution mode are recommended for work on roads
with posted speeds of 45 mph or greater and high traffic volumes,
greater than 2000 average daily traffic(ADT).
5. Requirements for signing and devices are shown in Table 5-2, below.
Table 5-2: Device and Signage Guidelines
Proximity to Edge of Traveled Way
More than 15 feet
or behind Barrier or Less than 15 feet
Guardrail
One advance warning sign is
Advance warning required and two signs are
Work in Place signs, devices, and recommended.
More than 1 Hour flashing warning Cone taper is required. Cones
lights are optional. along the edge of traveled way
are optional.
Work in Place Advance warning signs and devices are optional.
Less than 1 Hour
Sign Spacing and Buffer Lengths(feet)
Posted Spacin Between Signs Buffer
Speed A B C Space
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 79
Work on Shoulder Diagram 210
t
(Optional)
•
• Protection Vehicle
w/TMA(both Optional)
I •
See Chapter 4
• Buffer
•
•
• L/3*
•
if
•
A
if ROAD /SHOULDER
WORK OR WORK
AHEAD AHEAD
Initial Warning Sign
It *Use as appropriate-see Table 5-2
December 2011 Chapter 5