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PFI2016-00245 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT • COMMUNITY DEVELOPMENT Permit#: PF12016-00245 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/09/2016 Parcel: SEG1425 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Replace B/0 primary cable Owner: FEES Description Date Amount PFI Permit Fee 11/08/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: KENNETH ALLEMAN 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-936-6927 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: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00245 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 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 2 2016 City of Tigard ' PUBLIC WOR.I;S ---- I `NGINEERING CITY OF TIGARD :. ' PLANNING/ENGINEERING Public Facthty Improvement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ,_.j 'TYPE 1—Franchise Utility Work _ Check one: 1 Utilities ❑Sidewalk/driveway approach ❑Sueetimprove nests performed b.v NA1 NN, PGI:'. Detailed description: PGE JOB M1931601 and/or utility agency. Replace B/O Primary Cable - ❑ TYPE 2-Sidewalk/Driveway/Sewer Fork perfonned for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/locadori(s): _ _ and/or repair 13700 SW 115TH AVE, TIGARD, OR 9#23 • Sanitary sewer lateral installation and/or nrain line tap Portland General Electric ❑ TYPE 3—Pull state Development Applicant: Fork performed with Land use Address: 10800 SW Avery St. approval wluch uicludes any of Ciry/state: Tualatin, OR Zip: 97062 the following: 503-936-6927 Email: oord n.com ' Subdivisions or partitions Phone: Preren @,�cJ Contact name: Phone: 503-036-6927 • Street widening • Mainline installation for Simla,, Contractor: NIA sewer, Storm sewer,Tigard water and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Gip: City of Tigard Planning/Engineering Phone: Email: 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: Kenneth Alleman only may be ernailed to: rowpermitsCattigard-or.gov Address: 10800 SW Avery St. FOR STAFF USE ONLY City/state: Tualatin, OR Zip: 97062 Phone: 503-936-6927 Email: PreregCoord@pgn.com Case Contact name:Kenneth Alleman Application submittal fee: f 3 .00 Additional fees: Estimated value of work is required(if over$5,000):$ __ Application accepted: (within the public right-of-way) By: J Date: Application reviewed: Is work related to a LAND-USE DECISION? ❑ Yes I o �• 1 _ If so,please specify(N-ILP,SDR,SUB,etc.) case#: By: V%- 1'ISHl�.Date: 8 y 4 Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes No By:_Dare: If so,please specify(BUILDING PERMIT)case#: i_NtURPLN\Mastets',Lwd Use ADCucations Re,09/26/2016 S w t t S 4t-r— ('s V1 k�v Gv>- 57_'LE�LT_ 014 �-► L �/B City-of Tigard • 13125 SXR'Had Blvd. • Tigard,Oregon 97223 • xvwwtctigard-or.gov 503-718-2421 Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee''and shall protide financial assurance for work,if required by the city pursuant to TMC ?5.041.1 40. V ith the{.X cotiom ro a U611n,opts:umg liaiN'uat:t t,t,t valid tninciiisc will+the tate r f Tigard,when the owner and tile.applicant arc diffcreat pcopkt the applicant niltst lit:the l urciiaser of record ora lessee in possession with written authorization from the owner err an agent of the owner. The awner(s)mutt.ign this application in the slntce protidcd or subm.ir a written atltho[lZation 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 abc>-e request docs not rio'atc any recorded decd restrictions that may be attachcd to or irZ on sed upon the subject propexts:. • If the application is granted,the applicant will exercise the tights 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. -�— �,t,---- Brian Moore tt E„e , Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. Owners signature Print name Date Owner's signature Print nanie Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 Ste'Ball Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEESFOR STAFFUSE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REIQUIREMENTS APPLICKHON FEE Part I: Required submittal tree$300.0x1 FRANCHISE UTILITY AND SIDEWALKj PERMIT FEE DRIVEWAYAND UTILITY CONNECTIONS,ETC. Part 2: A11 non-water system improvements (woxk.in the right of way) Engineer's estimate X 5%(less$300.00 submittal fee) F-rr irieer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: All public water system improvements ❑ Street dame 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 lmprorements) for the following types of work: • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Des Plans • Ditch cleaning that does not involve regrading. (6 setss,,24x36 or 22x34) ri • Vleep hole.repair ❑ Cover–Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Fater,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pinning or planting ❑ dater,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 City of Tigard 13125 SW I fall Blvd. • Tigard,Oregon 97223 • www.tigard-ongov 503-718-2421 Page 3 of 4 SAMPLE SKETC11: Y ; �- Edge ofPwvemert No D—Itch Streetlight —,--,— - ---- `— }' 1 P*jx DxAbA n I I ' ' 7_'P1T_Fas cf•�e�iu'e�m ee 1 Q.) I 1 vii Existing House t Existing i Driveway 1 v >I V 1 U ' Existing Shop Ponrerpole i 1 0 a 1 I --------776pertyline----------- I I •� iFire Hydrant(FH) I � 1 Scale: 1"=30' I i � I I I I I I � � 1 MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable): Nordi arrow Property- lines &dimension Slope of property Street &street name(s) Existing bi ulding,structures Utility&street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/NV apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 Ski'Hall Blvd. • Tigard,Oregon 97.223 • wwwtigard-or.gov • 503-715-2421 • Page 4 of 4 PV LEGEND C To. C 50 71255 z if THINK 7.'G!.40Y- .LG,Urr�S INS L Llir:S A'UNK SAFETY !0875 20r4—.1 - g2 FIRST IN3MI.LADDITJONAL s"ACXrrIES'VOO1FYFACILIT`CS !' 3 1974 90100 , 9B• 1 ....,..... 33 `2� 502 1 s CNDUCTORS z�„ c ANYDEVY4770AIFROAI THI5DESIGNMUST g2Al VT-7896 �!,•,•„••••»» hYST.iLL42A7 AL TX JitT-FFR PRs11kRYlN REAPPROVED BS THE PGE PROJECTMANAGfR rxrsnvc i avr,rcxr..,fr .r - - --- ..... ...._._. 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NOTIFICATIONCENTERADMINISMANOND1502.732-19H/f 503-323-6700 OR 503.463.434BjSALEM) �__..-._.._.I FR�w wl..ts below. k - fO� TO RECUESr[,.fU. t'.ATF5 CAt THE OP.rGO+`" 4 NO7,FiCA.OA'L£NT R RIk ArlFA4r Ca1111Cf01@YO@di1J. 28US7A•ESS OAFS PRIOR 0fXX.AVArE0N �� I 6 r I�� i A•UNI «..,.� t` .F L' I ( I 1 T I �ti..)W ._ _.... _.. PD-53 i SW FAIRNAVEN ST A 50 243820 - 97 WRCNECKLzS f r — x CEkI YES COMMENT ia r L q 17&'2)1 425-t-RUN OF 21000AWG.AL,TRIPLEX.EPR.15KV,(15FEET) ' 2 --- JOB SITE' 19 B (765ll-IRUN 0FR2AWG,AL•TRIPLEXEDEPR,iSKV,(1600FEEI) ;,,E:T'2i.N"H w— :_ ..._..._............................ _ vT 0$1 STAKING VICINITY MAP', X ............. .. _.............._ PGECONSTRUC77ONDRAWING C 10 17195 + 2 "s1•`� to �'. rt e hfL" fi5•BUlLT4 Ndfi 1i TtOh X•NESC VtOiArtOhS CORRFC r'FD I :...__..._ ... 2'-41 A4- f � 4127 r, 1 ,{ L V 3 ' Foreman: Date: 40'4 L ;ns:f; Y TIGARD `1958 i 13)ELBOW KIT-JKTD CABLE-92NAL —�Y•" General FOf@Tan: Date: (3MNDICATOR LARGE FAULT VAR TRIP 200 A MINIMUM TIME RESET TR%'.'"(;%+L%'." } I - N' Jt ... .. SDPM•ENG REVIEW. KEN ALLEMAN ASBUILTBYDESIGNER 13)ELBO W KIT-JKTD CABLE N2AL '— 1 ` I 3 K .� DATE: ACCOUNT All C 1 •� 20.-Ullik lowil _-----._----- 11/022015 1'=70' 1070001 10000014628 M1931601 TLE 3 ,,, REPLACE 00 PRIM CABLE • ...._ ...____............ TI Al C ' Z �' rP GRCUIT SIZE ._. ... TIGARD-TIGARD 13 11X17 A C 50 1261 6624 G4 : L 1_.� -.J - E t N 13700 SW 115TH AVE.,TIGARD.OR 217-4 �•F.. L _9... ` CRIP ION r 'FAIRVIEWLN x N, 0 1972... '� G '' - REPLACE BO PRIM CABLE SHEET F ` - )N-• T __ BEAVERTONCOUNTY 1E11Rro K WITH " WASHINGTON C2103D LINE CENTER J I PGE 04 +N' ...___ —. .._ ... DESIGN BY PHONE 1507 C RAWNBY loll P{q 2213VN153RDDR KEN ALLEMAN 963-6921 HUGO MEJIA www.invarion.com DEVICE SPACING: � .�., Northwest Trak Control c TAPER: 20' z Portland (503)262-6500 TANGENT.' 20' Vancouver (360)604-5655 Fax (503)262-0357 Toll Free (800)783-9733 0 p O Q � min 00= �� �3Q a > < vAULT#00033 !f- too•N� ►}a too•+ 101.4 -oo•w--��o•� SW 115 AVE l + too•+i 0-}a 1i00'+i• ►}a roo•+i-s{ 100'+/. �S/ 100•+1 11 I7 ymD 'a A L yyc X, OmC 0 F m a v m � ROAD m c ? WORK 100'+1 m 1n EA N H BE 0~ PREPARED TO STOP ROAD WORK 100'+/ HEA ODOT PERMIT# SUMMARY OF DEVICES: OWNER: PROJECT/JOB NUMBER: 4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601 PROJECT NUMBER I LOCATION: 3 X BE PREPARED TO STOP TIGARD OR 13485 SW GENESIS LOOP 3 X FLAGGER SYM PRIME CONTRACTOR TRAFFIC CONTROL CONTRACTOR: PGE CONTACT NAME 1 NUMBER: E MAIL: 20 X CONES Ken Apeman 503-963-6927 PREPARED BV: Nathan Burris NOTE:All signs and devices SHALL conform to the MUTCD/OTTCH E MAIL: Will adjust to field conditions Plan NOT to scale FILE DATE:10/0112015 www.invarion.com DEVICE SPACING: .�,, Northwest Traffic Control „ c TAPER: 20' Z Portland (503)262-6500 TANGENT.' 20r Vancouver (360)604-5655 Fax (503)262-0357 Toll Free (800)783-9733 v3Hv 1001+1- muoM avoa y d01S Ol 09NW311d �r 38 S 1001+1- ¢o I" maH a w � n0 °a 0 W &3Q too•+/- VAULT#00034 •k too+i._-- Y- aoa+✓-JJ.0 100•+i- 1.1.0 0•.100• SW I15AVE 00+ � m. too•+t. >T s m =fa om i•I m DA°y o iROAD WORK AHEA ODOT PERMIT# SUMMARY OF DEVICES: OWNER. PROJECTIJOB NUMBER: 4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601 PROJECT NUMBER/LOCATION: CITY: 3 X BE PREPARED TO STOP 13485 SW GENESIS LOOP TIGARD,OR 3 X FLAGGER SYM PRIME CONTRACTOR: TRAFFIC CONTROL CONTRACTOR: PGE CONTACT NAME/NUMBER: E MAIL: 20 X CONES Ken Alleman 503-963-6927 PREPARED BY: Nathan Burris NOTE:All signs and devices SHALL conform to the MUTCD/OTTCH E MAIL: Will adjust to field conditions Plan NOT to scale FILE DATE:1010112015