PFI2016-00236 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00236
13125 SW SEG4
Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 2016
Parcel: EG479
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace BO UGB primary cable PGE JOB M2047493
Owner: FEES
Description Date Amount
PFI Permit Fee 11/02/2016 $300.00
PHONE:
Contractor:
PHONE:
FAX.
Applicant:
CHRIS OLIVER
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-307-8574
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 PF12016-00236
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. call Ken fisher at 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
RECEIVE®
OCT 27 2016
City of'Tigard CITY OF TIGARD
" PI_13I.IC' WORKS —I.NC iI N1:ERINC, PLANNING/ENGINEERING
�'
Public Facility Improvement PFI Perr-lit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way
❑ TYPE 1—Ft nchi,e Litilit) Work
Check one: [?I !Utilities 1...] Sidewalkjdtiveway:ippxoac:L ❑St_reetienproeesneitts performed b7 N WN, PGL
Detailed description: replace BO UGB rip mark cable and,%o:utility agency.
❑
PGE JOB M2047493 TYPE 2—Worktiidc��>all:!Drive.Jay;ticwcr
ork performed for the purpose of:
• SidCWAlk installation or repair.
Property address/locadorn(s): 11960 SW MANZAN ITA CT • Driveway approach installation.
and/or repair
TIGARD, OR. • Sanitary sewer lateral installation
and/or main line rap
applicant:�licant: PORTLAND GENERAL ELECTRIC - LIND AOTT ElTYPE3—FuliscaleDevelopment
10$00 SW AVERY ST Work performed with Land use
Address: approval which includes any of
city/state: TUALATIN, OR. Zip: 97062 the following:
Phone: 503-612-6093 Email: T&DSUPPORTAVERY@PGN.COM Subdivisions or Partitions
•
Contact naive: I INDSTT Phone: _ Street widening
• Xtainlitxe installation for Sanitary
sewer, Storm sewer,Tigard water
Contractor: NA and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
Cit,/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"
only may be emailed to:
Engineer: r yRIg n1 IVER rowpermitsCtigard-or.gov
Address: 10$00 SW AVERY ST
FOR STAFFUSE ONLY
City/state: TUU ATIN, OR Zip: 97062 /�/�n /
Phone: 503-307-H574F_mail: CHRISTOPHER ni I\/Fati).2 N.COM Case �1 ao16�07 e�J_C,9(
Contact name: CHRISTOPHER OLIVER application submittal feeea�•yO HITT
_additional fees:
Estimated value of work is required(if over$5,000):$ ?39 833 application accepted:
(within the public right-of-way) By: L S Date: a ��
Application reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes EXNor
By:.-1&,-6 Date:
If so,please specify(MLP,SDR,SUB,etc.) case#:
apphcan notified: J
Is work related to a BUILDING PERMIT? ❑ Yes EXNo By: ^—� Date: /l Q
h�
It so,please speelly(BUILDING PLR 11'r)case#: I:\CURPLN\Masters\Land Use Applications R-0912612016
City of Tigard • 13125 SW I IallBlvd. • Tigard,Oregon 9722.3 www.4ard-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 Nvork,if
required by the city pursuant to TM1iC 17.041.1w0.
" lti uh th;e c^tccptioi;<,f a urilir,np�-ruing�;ursuat�t tea a v,Jid r:rnchi;:e:nth tl:t i:.itp ot't�a,d,udrett the ciw[it'Y 2LKI t15t a{>plicant :rc dit£crcn;
people,the applicant nrtut be the.purchaser of record or a lr s>ec in possession with written authotization fron the(Avner tat an ag;:nt of die
owner. The owner a must sign:thus application ui the apace provided or sul7tnit a wr.ttett authorization with this application, Prnnehised
Utilities are not required to obtain the owner's signature on the applicarion
BY SIGNING BELOW,THE APPLICANT(S) SHALT.CERTIFY THAT:
• The above request dne:5 nix violate.any recorded deed restrictions that may be attached to or imposed upon the subject
propert=...
• If the application is granted,the applicant will exercise the rights granted in accordance with the ten-ns and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements i.n 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/Au otized 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 SXX'Mall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
DEVE LOPMENT ENGINEERING FEES
FOR SI'AFF USE ONLY
Public Facility Improvement(PFI)Permit: DE TAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part I- Required subtnittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non water sVstein improvements
(work in the right of way)
Engineer's estimate X 5%(less$300.00 submiLud fee)
Engineer's esti-mate X 2%Plan Re-,,ie-%,,, Sketch
(including infornxition below)
WATER SYSTEM FEE El Dimensions
Part 3. All public water system improvements
I El Street Name
Engineer's estimate X 12% 0 Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required (Subdivision0larntions and Street Improvernents
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 clm-iing that does not involve regrading.
• Weep hole repair C3 Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) C3 General N-'otes(City,Water,Sewer,etc.)
• Lawn spritildez system insufflation or repair El Street(Plan,Profile)
• Street tree pruning or planting D Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance 0 Water Quality Facilities
• Test wells El Grading
0 Landscaping/Tree Plan
EJ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm,Sanirary,Vlater,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) 0 Details
El Traffic Sight Distance
0 Signing and Striping
D Street Light Plan and Photometric
El Engineers seal/signature
El Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
C1 Traffic Report
C3 Storm water Drainage Calculations
0 Geotechnical Report
F-1 Preluninary Access Report(Sight Distance)
0 Proposed Plat
0 Pathway Design(if applicable)
0 Water Departmen t Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW 1-10 Blvd. - Tigard,Oregon 97223 # www.tigard-or.gov - 503-718-2421 - Page 3 of
SAMPLE SKETCH:
Edge of Pavement
"o "'.." Ditch ""—go
sItteetlight
1 Raaf nes,
1 r o
' T –M"757P we l MI
Existing House
I ni I Existing I
y: Driveway
c•
ao1 ITT
I
(L73
I
as
I ( r 1
I J�
v• CIO I 1
T�
Eyisting Shop
Powerpole ,
i Q • -
�k---------7roperfij Line-----------
II Fir Hydrant(FH)
I j I
Scale: 1"=30'
I I �
i 1 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 Utih"7&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 S%K'I-Iall Blvd. • Tigard,Oregon 97223 • wwwutigard-or.gov • 503-718-2121 • Page 4 of 4
11085 WR CHECKLIST LEGEND
- VD=0.73% ITEM YES COMMENT _INSTALL FACILITIES
2145 FLKR=2.31% kBACKHE
-" - - INSTALL ADDITIONAL FACILITIES/MODIFYFACRITIES
11995 11125 X
12055 12025 _ - X
21371196516 -3 X
25'4
q STAKING
19
�= FLAGGING X
a 11155 14 TREETRIM
212 :zLANDSCAPE X POST
-.LSW.IIANZANITA CT
EASEMENT
Open
-. A 75 125, _\ PERMITS X
�—
C"•34C TRAFFIC PLA
Jai 9.G CUTSHEET
21 P - h� UG CIR.VER.
A 25 73280 A 25
PD-8467 11175 TRANSMISSION
SH UTDONJfJ
1 11%0
Cl1STCMER X 6 ACCOUNTS
SHUTDOLMJ
Q 12050 12020
DOOR HANGAR
h CONTACT
ry 11990 COMPANY
3 25'417 11195 !PH.
C#
N� 1990 DATE TIME
m
a WL 1 PD6967:
A.uNK� Install:
1 P 7.2 240/120 PM 25KVA NTLB
6 ACCOUNTS,23KW NY DEVIATION FROM THIS DESIGN MUST
' -
BE APPROVED BY THE PGE PROJECT MANAGER
1 P 7.2 240/120 PM 50KVA NTLB
--- ATTENTION: CALL 811 BEFORE YOU DIG
12045 12015 11985 11955 11935 11205 THINK OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED e
BY THE OREGON UTILITY NOTIFICATION CENTER.
/L �/ THOSE RULES ARE SET FORTH IN OAR 952-001-0010 li
05029961 SAFETY 1 THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF
0 25 50 100 Feet THE RULESSYCALLING THEOREGON UTILITY
PDS C,UNK PGE NOTIFICATION CENTER ADMINISTRATION&(501-131.1987)
FIRST TO REQUEST UTILITY LOCATES CALL THE OREGON KomitW alS��•
Vicinity Map „ WORK WITH WMS 707397 UTILITY NOTIFICATION CENTER,811ATLEAST Call bdoMY aay
1 BUSINESS DAYS PRIOR TO EXCAVATION
Al
µ
INOTE: PGE CONSTRUCTION DRAWING
v � LEVEL OUT GROUND 8 AS-BUILTVERIFICATlON6 NESC VIOLATIONS CORRECTED
gW SET MP ON EXISTING PAD
$ CorTCMPIY Foreman: ... ....,f.. �[-.•....Date:
LN
sx General Foreman Date:
y`� M£Anc'4tt CPffK �' L r
SOPMENG REVIEW I ASBUILT.1DESIGNER
SYt A4°;kz FHf > Y Y"MAg{FANI TA Si DATE SCALE ACCOUNT AWC JOB NO.
4
N • 1 :50'
sm 4/27/2016 1070001 1000004545 M2047493
�Ft TLY7THY TITLE
PL REPLACE LIVE FRONT TRANSFORMER
:^. CIRCUIT SIZE
H SW WW h VAKi)TA�� N PROGRESS-GREEN BURG 11.17
++
:5iN LOCA7JON
Bi1RLkY S.H g sti;.1 PGE,I� 11960 SW MANZAN I TA-TIGARD
5T ( t
DESCRIPTION
M Sx aM_R"w ` ` REPLACE LIVE FORONT TRANSFORMER SHEET
courySECT) NS WORN WITH
WASHINGTON C1134C WMS 707397 1 OF 1
BEAVERTON DESIGNBY PHO_"' ORA""
$w r:
SW S+Auxs CRLsr cR UNECREWCENTER CHRIS OLIVER 503-307-8574 Sara McCaughan
a
SPSP�YtW �A PGE till Swls�ROOR PORTLAND TR