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PFI2016-00249 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00249 11/09/2016 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: SEG2310 Parcel: EG2 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 15660 SW 79th Avenue. 200A 120240 service with temp. WO#M2118142. SEG 2310. Owner: FEES Description Date Amount PFI Permit Fee 11/09/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: PGE 10800 SW AVERY STREET TUALATIN, OR 97062 PHONE: 503-612-6093 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 Not Present Signature: Issued By: S i'Z Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00249 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. 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 NOV 0 7 2016 City of Tigard GIN OF TIGARD C ° PUBLIC WORKS —ENGINEERING PGE WORK ORDER# M211814 NINGIENGINEERING Public Facility Iinprovetnent (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: 200A 120240 service with temp ❑ Minor work in right-of-way (sidewalk repair,curb cut,street opening,etc.)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 15660 SW 79th Ave of the proposed work to be done c> e & n 3 I n�J •Submit one(1)cop}'of traffic L control plan –OR– Portland R– Portland General Electric ❑ Substantial project work requires Applicant's name: above items and professional Address: 10800 SW Avery ST engineered plans for: Tualatin, OR. 97062 •Street widening City/state: Zip: •Subdivision infrastructure Phone: 503-612-6093 Email: t&dsupportavery@pgn.com •Main utility line extension: Storm Drain,Sanirary—Tigard Water—Tigard Nater 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. Dory Engineer's name: DO Roanhorse Tigard,OR 97223 10800 SW Avery ST Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Tualatin, Or. Zip: 97062 ro=ermitsn.tiaard-or gov Phone: 503-672-5531 F.mail: t&dsupportavery@pgn.com FOR STAFF USE ONLY Case No.: i 7 120* tp�-41 Estimated value of work (m ithin the public right-of-way): Application submittal fee: ;tea•00 Is-,vork related to a LAND-USE DECISION? ❑ Yes ❑ No Application accepted: If so,please specify(MLP,SDR,SUB,etc.) case#: By- &__: Date: 1 Le Is work related to a BUILDING PERMIT? ❑ les LlNo Application reviewed: If so,please specify(BUILDING PERMIT)case#: By- 'A!4ta2 Date: Applicant notified: n . By: Date: I:\CURPLN\Masters\Land Use Applications Rau 07/16/!019 Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 e ww-mtigard-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. \C-hen rhe owner and dre applicant me different people,the applicant must be the purchaser of record or a lessee in possession with writren authorization from the owner or an agent of the owner. The owners)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 am,deed restrictions that may be attached to or unposed upon the subject proper_rt. • 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. 0100ca�> Il 1 Il�p applicant/Au horized 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 Ball Blvd. • Tigard,Oregon 97223 • wwwtigard-ocgov 503-715-2421 • 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 estiunate Z 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: • Sidcwallt 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 Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.dgard-or.gov 503-715-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement. -4— Ditch —� ry Streetliciht I — —•—•— —r—•` ' ` », f • •—•—•— fi I I IV T!77riioj'os crSe1w'erTne I I � I inC Existing House Existing Driveway 1 ail v l ii) I a_ b I Existing Shop o Powerpole I • - l i Imo.—._.._.lsopne------•�--- I I Fire Hydrant(FH) l I I Scale: 1"=30' I I I ( I � i I I i � I MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable): North arrow Property lines&diunension Slope of property Street&street names) 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 Bled. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-715-2421 • Page 4 of 4 6.4.4 VAULT WITH 3'TERMI-DUCTS 1-142 A 25 31055 2904 w/IW/.fFDKMER F6T �'" NEW PGE FACILITIES TO BE INSTALLED OIFNING M iR.WSfORMH1 IID MIAST FMY STREET s10F OR PARKMD AREA PL02904 rr (UNLESS OTHERWISE SPECIFIED) MMRADM[EARM[E PRDM AN [DMWS n E 1-142 sTRucruRE a B•noM voEs AND SACK of D2904 LWIM p'UFAR SPACE IN FROM 644-PGE PADMOUN7 VAUL7,WITH 64-332P-2125-PGE TOP n+AL GRADE NHEN CIosER Cr 1 1972-40 F15T J�� 2" V T 0020 PROVIDED &INSTALLED BY CUSTOMER """°SD""" Y PL02904 Yrfr 1 CONDUIT INSTALL CUTOUT SIZE FUSING AS NOTED / IRA4 cRAOE WHEN M L PF 300 SECONDARY PEDESTAL, 0 I.umscArE Mu 00215 O I llp, ; + ❑ PROVIDED BY PGE&INSTALLED BY CUSTOMER 2006-35 INSTALL 2"POLE CONDUIT UNIT ON I EXISTING BRACKETS,1-142 CAD F6T -------- INSTALL 1-#2 AL-EPR JK7 PRIMARY IN 1-2"PVC CONDUIT o M I PROVIDED & INSTALLED BY CUSTOMER 0 wx s roD>H E..) , I& LIGHTNING ARRESTER ""00 ). PD 00203 -J -------- INSTALL 7-#350 AL-TX SECONDARY IN 7-3"PVC CONDUIT a 0 0 = B 25 PROVIDED & INSTALLED BY CUSTOMER 0 O U 126240V -------- INSTALL 1-40 AL-TX SECONDARY IN 7-3"PVC CONDUIT 0 ��Y'COrL01Rf N PROVIDED & INSTALLED BY CUSTOMER 6• (FHAR MY FIELD SIDE-IN) Q PD 720 CUSTOMER TO INSTALL 3"PVC CONDUIT L•'MMus CRIJneD Rotes �' m ;( 5'PUE 200AMP FOR FUTURE e-DEEP INTRO =" Q I HAAC:3 TON 0 218 'l%VD WR CHECKLIST 30' 1.01%FLKR ITEM YES COMMENT LS�DNDMY SIDE—1) 2006-30 PF 121-- • 6.338A AFC HOLEDIGGER CONSTRUCTION NOTES: SFEX7 S1•I C T B 1 0 '13406 02903 /F1W SECONDARY SPLICE IEDESEAI BOOM W K E L S 0 C I 1963-40 RAC HO % 1. CUSTOMER TO PROVIDE ALL IRENCHMG AND BACUMUNG TRENCH TO BE u�a a in..er en mw•nen. +nu im+e.m me wMe n DD217 wp u.e-..w a.w 36 INCHES DEEP,MEASURED FROM FINAL GRADE. ____ __ _ .,...,, „" +�.+rm...r.�n.e.�.�,w. PGE TRENCH 2. CONDUIT//If NECESS T')WILL BE GRAY,SCHEDULE 40,ELECTRICAL GRADE. 2006-30 PVC[ONOUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TFS w LOCATES PGE TO DETERMINE THE SIII AND NUMBER Of CONDUITS REQUIRED. MAINTAIN 12 VERTICAL INCHES AND 24 HORIZONTAL INCHES CLEARANCE BETWEEN PD 0021 1 - STAKING ALL BENDS MUSTOZER BE GAS ANDIRUTIESORY MADE RIGS)STEEL ORALL ELSO TO BE 36 CPGEMAP�RO DS FIBERGLASS TUGGING % BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER,OR FOR ANY LENGTH ^� RUN WITH MORE THAN ISO DEGREES IN BENDS.PVC SCHEDULE 40 BENDS ARE PD 00208 V1=1w ®.e I,MA TREETRIM CONDOR LF FOR 270 SO F 150 FEET OR LESS.THE MAXIMUM TOTAL BENDS IN ANY PD 00210 2006?35 CC A a�n�4 L EASE16 DSCAPE MENT X 5'PUE OBTAINED 3 ELECTRKALCUSTOMER RES"GRADE,SIVC FOR WITH CROSSINGS. HYLON NHL STRILNG$LAAINSCHEDULE 500 MRS.TEST). (n - \ PERMITS X 4. DIRECTIONAL BORING REQUIREMENTS:BUCK HDPE(HIGH DENSITY POLYETHYLENE)DUCT V U V�� OR SCHEDULE 40 PVC WRH A MECHANICAL CONNERION qr.ERTA-LOK OR UEU MECHANICAL a m TRAFFIC PUN % CONNECTION PRODUCT)AS AN ALTERNATIVE i0 HDPE DUL7.HDPE SHALL MEET TME REQUIREMENTS OF PGE SPECIFICATION LC20515(AVAILABLE ON REQUEST FROM PGE PROJECT PD 00209 - CUTSHEET MANAGER).FOR SAFETY REASONS THE WR SHACL BE BLACK WITH THREE EQUALLY SPA 1 EXTRUDED RED STRIPES(WHICH IS A SPECIFICATION REOUIREMETI MANDREL TEST OF w N UG CIR,VER. HDPE PIPE IS REQUIRED AFTER IN5IALLATION WITH PGE INSPECTOR PRESENT m I TRANSMISSION Z N ouzo or,snw c..•r.uo�ou.w.0 cvnw zn ar mr otwr TRANSFORMER PAD. S.SINGLE PRIMARY MSTAUATIONS-CONDUIT TO EXTEND A MINIMUM OF XI•FROM Q SHUTDOWN CUSTOMER SHUTDOWN 6.ALL PGE TRANSFORMERS TO BE INSTALLED B FEET(MIN)FROM ANY COMBUSTIBLE RIGHT-OF-WAY PERMIT NOTICE: BUILDING,WALL OR OVERHANG AND 4 FEET THIN)FROM ANY FIRE HYDRANT 2 DOOR HANGER PGE TRANSFORMERS MUS1 BE WITHIN 15 FEET OF A DRIVEABLE AREA A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY ! ALWAYS AWNIAM m FEET CLEAVAICE M ERS FRONT OF ALL TRANSFORM . WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED CONTACT ]. CUSTOMER TRENCH AND ELBOW CONFIGURATIONS MUST BE INSPECTED BY PGE PRIOR i0 CONTRACTORS PLEASE CALL 503-73 5450 OR 503-E63^AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL COMPANY BACKFILLING.WHEN YOU ARE READY FOR PGE i0 INSPECT(AFTER INSTALLATION IS COMPLETE) 1� nPFAi AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. RP.R PH* CR ALLOW UP TO 2 WORKING DAYS Tr- - 1"All' THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS ~. DATE TIME e. DESIGN 5&AM ON STANDARD UNDERGROUND EQUIPMENT.NON-STANDARD BEFORE WORK IS TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE. 3 UNMRGROUND N21ArMRJr ANY BE AN OPTION AT AN ADDmONAL COST TO THE CUSTOMER. (n PGE CONSTRUCTION DRAWING ' r ' 1 -142 m •r w GT AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED SW BamI H3 SW F 4 0 T U-1t.HD SW Bonita Rd rR.�.n w ®•� This document accurately represents FIELD Constivclion. _ D�IRI Foreman: Date: A 10 762 PL02902 MI oea General Foreman: Date: 1 p HD ne J-1-T— D- (Signature only required for field construction changes.) x SDPM'ENG REVIEW: ASBUILT BY DESIGNER: SI—I T-1—1- $ CONTACT SERVICE COORDINATOR DATE 7252016 SCALE: 1"=50• ACCOUNT: 7070001 AWO: 1000004594 108 No.M2778742 TP TOR TRENCH AND CONDUIT INSPECTION PRIOR TO IMCKFILL PGE WILL NOT INSTALL WIRE TITLE P-,k C°rpaMe cenw. 02902 UNTIL 1RENCH 15 I00%BACKFILLED. ` JACK BRAND SINGLE FAMILY EXTENTION O SERVICE COORDINATOR 1992-40 / \\\ Oaculr SIZE 503-736-5450 OR 503-463-4348(SALEM) DURHAM -BRIDGEPORT 11X17 nRyDn ellsi^ess Park aI e f ATTENTION: CALL 811 BEFORE YOU DIG PGE� LounoN sWM+lr«6ST ` OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ` y' 15660 SW 79TH AVE BY THE OREGON UTILITY NOTIFICATION CENTER. DESCRIPTION !RSlfO�LLeIweR £ F THINK THOSE RULES ARE SET FORTH IN OAR 952-001-MIO • 200A 720240 SERVICE WITH TEMP =AYwaLe THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF SAFETY COUNTY ECT ON(5) WORK WITH SNEE7 n THE RULES BY CALLING THE OREGON UTILITY BEAVERiON WASHINGTON C21-12C 7 OF 1 FIRST! NOTIFICATION CENTER ADMINISTRATION @ (503-232-7987) DES GN ev PHONE(503) DRAWN Br fiVBRMA ' LINE CREW CENTER A i0 REQUEST UTILITY LOCATES CALL THE OREGO PTD sw Is3Ro DR DORY ROANHORSE 672-5531 LANE WHITNEY Ai6n A UTILITY NOTIFICATION CENTER,817 AT LEAST K.whe,below. vAYERTON,oe P7We SW Durham Ad SW DurhwnRO, 2 BUSINESS DAYS PRIOR TO EXCAVATION. Cell before YDU dig. O PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 <Q Y2 C cc3 .o cts W CL Luo O O o� 1 Lu m � 1 O a Q m � — — ---- — I • ZS oa • I r i t I I EE :® g • • aE Z� ' "O I'. • j %- V I N 30k I I I • I LL-j Y r R I Aoo I co1 I >r � o � Yu I Sign Spacing and Buffer Lengths(feet) I 1 S c Posted S acin Between Signs BufferO Speed A B c Space z =d 0 20 50 I O 25 100 100 100 75 30 100 125 40 350 350 350 150 0 45 180 50 500 500 500 210 55 250 December 2011 Chapter 5