PFI2016-00242 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
• COMMUNITY DEVELOPMENT Permit#: PF12016-00242
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/02/2016
Parcel: SEG2313
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE PFI
Project Description: 2014 UG Fitnes BO Vault lid
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
NATHAN GRAVELLE
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-951-3714
Tota 1 $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant
Signature: Not Present
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00242
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
holders 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. Traffic Restrictions: no work on Upper Boones Ferry or
Sequoia Pkwy before gam or after 3pm.
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
V RECEIVED
City of Tigard NOV O 1 2016
_ PUBLIC WORDS —ENGINEERING CITY OF TIGARD
Public Facility Improvement ("Gfpaw G
TYPE OF WORK
DESCRIPTION OF WORK(iu the right-of-way) VTYPE 1—Franchise Utility Work
Check one: Utilities ❑Sidewalk/driveway approach ❑Streetilmprovements performed by NWN, PGE
Detailed description: PGE JOB M1451592 and/or utility agency.
2014 UG FITNES - B/O VAULT LID ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
SW Upper Boones Ferry Rd 8 SW Sequoia Pkwy • Sidewalk installation or repair.
Driveway approach installation
Property address/location(s): and/or repair
15670 SW Upper Boones Ferry Rd, Tigard, OR 97035 • Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric O TYPE 3—Full scale Development
Pp Work performed with hand use
Address: 10800 SW Avery St. approval wlvcli includes any of
City/state: TUALATIN, OR Zip: 97062 the following:
Phone: 503- 951-3714 Email:PreregCoord@pgn.com • Subdivisions or Partitions
Contact name, Nathan Gravelle Phone: 503-951-3714 • Streetwidening
• Mainline installation for Sanitaty,
Contractor: N/A 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-iu right-of-way"
Engineer: N/A only may be emailed to:
rowpermits_tigard-or,gov
Address:
City/state: Zip:
Phone: Email: Case P Fr �o- 00 2 2-
Contact
Contact name: Application submittal fee:
_Additional fees:
Estimated value of work is required(if over$5,000): application accepted:
(widutn the public tight-of--way) By: W1 0 Date:
I' / 1I � b
Is work related to a LAND-USE DECISION? ❑ Yes )A No application re-6ewed: 1 l/2/�
If so,please specify(MLP,SDR,SUB,etc.) case#: By: •61.. Date:
Applicant notified:
�f
Is work related to a BUILDING PERMIT? ❑ Y}�es `1/J No By: J Date:
If so,please specify(BUILDING PERMIT)case#: I:\CURPrN\Masters\Land Use Applkat*ns Rev,09/26/2016
Se- cO o « �cA_e dc, , 0,,- ,N-e-- 3jow,
City of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 ww wtigard-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,if
required by the city pursuant to TRIC 15.041.140.
t With the exception of a utilir.opL•rating pursuant to a valid fi-wiehise with the Citv of Tigardt Mica the owner and the applicant are different
people,die applicant must he the purchaser of record or a lessee in possession with written authorization from tie uwuer or an agent of the
owner. 'Ilic owner(s)must sign this application in die space provided or submit a written audidnizauon widi this application. l4anchised
Utilities are not required to obtain the owners signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate auto recorded deed restrictions that may be attached to or unposed 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 die 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 perinit issued,based on this application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
Applicant/Author' .ed 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
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-715-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FF FOR STAFF ITSE. ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
APPLICATION FEE e
UIREMENTS
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$300.00 submittal fee)
Engineer's estimate Y 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/Partitirms and Street improvements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
Design Plans
• Relocate or replace mailbox (6 sets,24x36 or 22x34)
• Ditch cleaning that does not involve regrading.
• Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Nater,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
❑ Geoteclurical Report
❑ Preluninary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 S\\'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge.Of Pavement
Ditch
Streetlight — —•—•—•—•—•— —1•—•—
C
r e l
' I��rc•�,oG cf"��isr�i��"'
I � I
II A Existing House �
Existing 1
e Driveway
a � 1
I 1
, C9 Existing Shop M
I • C
J 1
Powerpole I I = I 1
I i I_._.._.—.7-op rV 7ne —._._.e_._.
I
II Fire Hydrant(FH)
I I I
Scale: 1"=30'
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 natne(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,storin)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Ball Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4
WR`' ".LIST OVERHEAD LEGEND
ITEM YES COMMENT REMOVEIARANDON FACIL/nE5_INSTALL FACILITIES
WL 1 PD-3' HOLEDIGGER INSTALL ADDITIONAL FACILITIESIMODWY FACILITIES
Install: yR� x
1P 7.2 240/120 PM 75KVA NTLB VT-64 BOOM
S BACKHOE
'21.37 KVA 0 PGE TRENCH
MINIATURE TRANS UNIT(R.R),CONCRETE PAD BORE
JQQ�R LOCATES
Remove:
1 P 7.2 240/120 PM 75KVA NTLB S� STAKING
FLAGGING x LANDSCAPING NOTES
TREETRIM
0 LANDSCAPE X PRE PRE
EASEMENT
�r 0 U PERMITS
TRAFFIC PLA X NWTC
CUTSHEET
a0-5 B 751 UG CIR.VER.
000 PD-3 TRANSMISSION
SHUTDOWN
QIP w P� B 75 7981
�P eti Q vrTo
N CUSTOMER x
S� J�+ 5550 m SHUTDOWN
G VT-2 Q
0 DOOR HANGAR
CONTACT
O��S COMPANY
8p PH# C#
,1 vQP�R 15670 \ DATE TIME
38 �
40'-
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Pe
20 40 80 Fel'J' JT8653 9B
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I I I I I I I I I g'J P
15660 PGE
Vicinity Map ANY DEVL477ONFROM THIS DESIGN MUST7
!BE APPROVED BY THE PGE PROJECT MANAGER
PGE CONSTRUCTION DRAWING
AS-BUILT VERIQ(aK/.ft&NESC VIOLATIONS C
Foreman: Date:
OIR
General Foreman Date
fS; &—- mqu-d Feld consf—f—then es)
SDPM,ENG REVIEW ASBUILT BY DESIGNER
E� 10/12/2016 1:40 ft 1070001 0000016567 M1451592
BEV¢ TITLE
9F• - 2014 UG FITNES-B/O VAULT LID
00 CALL 811 BEFORE YOU DIG CIRCUIT s¢E
�6ATTENTION; �y`�^C DURHAM-DURHAM 13 11 x 17
�.
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , �I_VG LOCATION
Q9 BY THE OREGON UTILITY NOTIFICATION CENTER. / 15670 SW UPPER BOONES FERRY RD.WILSONVILLE
O THOSE RULES ARE SET FORTH IN OAR 951-001-0010 6 ` DESCRIPTION
R (' THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF DISTRIBUTION AND UG CONSTRUCTION
THE RULES BY CALLING THE OREGON UTILITY SHEET
COUNTY SECTIONS WDRK WITH
NOTIFICATION CENTER ADMINISTRATION @(501-131-1987) WASHINGTON C21.12D 10F1
TO REQUEST UTILITY LOCATES CALL THE OREGON Know What's below mTmvm_< DESICNBY PHONE DRa WNBY
UTILITY NOTIFICATION CENTER,811 AT LEAST Capt before You dig. NATHAN GRAVELLE 503.951.3714 RYAN WILSON
PGE M 2 BUSINESS DAYS PRIOR TO EXCAVATION c PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
DEVICE SPACING: �, .�., Northwest
TAPER: 20' �o m Traffic Control
O
360'+/-
TANGENT. 20' �+� Portland (503)262-6500
q°d Vancouver(360)604-5655
v
Fax (503)262-0357
Toll Free (800)783-9733
SOP.";EL
i • OOOa� �(�fL N
QED �
S � W E
arou \
350'+/-
360'+/-
35
50'+/-
350'+/-350+/
ODOT PERMIT#
SUMMARY OF DEVICES: ONMER PROJECTMOB NUMBER:
PGE M 1451592
4 X ROADWORK AHEAD PROJECT NUMBER/LOCATION DATE/TIME:
1 X RIGHT LANE CLOSED AHEAD SW Sequoia &Upper Boones Ferry TIGARD,OR
1XTRANSITIONLEFT PRIME CONTRACTOR TRAFFIC CONTROL CONTRACTOR
1 X TYPE III BARRICADE(R) PGE Northwest Traffic Control Inc.
30 X CONES CONTACT NAME/NUMBER EMAIL
Nathan/503-951-3714 Nathan.Gravelle@pgn.com
350+/a
PREPARED BY-
ao�o Northwest Traffic Control Inc.
abac
Edited by:
N OTE:All signs and devices SHALL conform to the MUTCD/OTTCH Nathan Burris Nathan@nvAci.com
Will adjust to field conditions
Plan NOT to scale FILE DATE:0811812016 FILE DATE:09109/2016