PFI2017-00016 a
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/02/2017
Parcel: SEG841
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to the intersection of SW Walnut Street and SW 135th Ave. 100A UG SVC to metered cabinet
for traffic signal. SEG 841 /876
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
CHRIS JEWETT
10800 SW AVERY STREET
TUALATIN, OR 97062
PHONE: 503-672-5481
Total $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: See application
Issued By: -------
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00016
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.
TRAFFIC RESTRICTION ON SW 135TH AND WALNUT ST: NO WORK BEFORE 9AM 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
RECEIVED
City of Tigard FEB 0 2 2017
PUBLIC WORKS — ENGINEERING CITY OF TIGARD
GINEERING
Public Facility Improvement (PM) "YMP
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
Q TYPE 1-Franchise Utility Work
Check one: 9 Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by N1ti N, PGE
Dand/or utility agency.
Detailed description:
100A UG SVC TO METERED CABINET FOR TRAFFIC SIGNAL ❑ TYPE2-Sidewalk thepulp.ose o Sidewalk-/Driveway/Sewer
Work performed for the propose of
• Sidewalk installation or repair.
h' y ' �77 r_ • Driveway approach installation
Property address/location(s): , —�_ 1 LP and/or repair
Intersection of SW Walnut St. and SW 135th Ave. • Sanitary sewer lateral installation
and/or main line tap
Portland General Electric ❑ TYPE 3-Full scale Development
Applicant: )Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Zip: 97062 the following:
Phone: 503-672-5481 Email: PreregCoord@pgn.com • Subdivisions or Partitions
Contact Warne: Phone:
•
• Mainline
widening
installation for Sanitary
sewer, Storm sewer,Tigard water
Contractor. N/A and/or Tigard Water Service Area
CCB#: Expiration.
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: 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: Chris Jewett only may be emailed to:
10800 SW Ave St. �rmits&jgard-or.Qov
Address: Avery
City/state: Tualatin, OR Zip: 97062
Phone: 503-672-5481 Email: PreregCoord@pgn.com Ca � .:'
Contact name: Chris Jewett Application submittal fee..
Additional fees:
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By: Date: 2,1 2 I 1-1
Application reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes 9 No
By: Z"N- Date: 2 Z
If so,please specify(MLP,SDR,SUB,etc.) case#:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes Er No By: LS Date:
If so,please specify(BUILDING PERMIT)case#: 1:\QJSPIN\Maabrzwnd Un AppiaWm Rov.0912612016
7`1r,4FF j e )zEsrQ/ctlo v : No ooRK oN i3s" o•- �JA�N�-T Sr
3 EFo i2E iAm SK- AM R 3 PM
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 wwwtigard-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 TMC 15.041.140.
+ With the exception of a utility operating pursuant to a valid franchise with die Citv of Tigard,when the owner and the applicant are different
people,the applicant must he the purchaser of record or a lessee in possession with written authorization from the ownet or an agent of the
owner. The owner(i)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:
• "lhe above request does not violate any recorded deed restrictions that may be attached to or imposed upon die subject
ro e
• 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.
—;u—��_.._ Brian Moore z\AX-1
Applicant/Aut orized Agent's signature Print name
Date
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name Date
Owners signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 S%X'Hall Blvd. • Tigard,Oregon 97223.• wwwtigard-or.gov 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
APPLICATION FEE RKSININIMI 0
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 59,o(less$300.00 submittal fee)
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-,vill be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (G 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 maybe 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
❑ Geoteclinical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 S\X'Ilall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-715-2421 • Page 3 of 4
SAMPLE SKETCH:
c'. c
Edge of Pavement
1 .40— Ditch —0'
Streetlight •I ---•---.—•--- -C---
a Raai r>raati
1 l d`
' T—'lTioj�os cl"Sej�w'er'Cirie" �
1 int Existing House
I I l 1 Existing
gra - Driveway
0. I .
1
>� I 1
a
Existing Shop
f 1
4i,
Powerpole I 12 1
�� 0 o
I I a 95'
.—.—.'PiopertyLine —.—.—.i---
! I
Fire
ir Hydrant(FH)
� 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 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
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-ox gov • 503-718-2421 • Page 4 of 4
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
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Speed A B C Space z¢rd
20 50
25 100 100 100 75
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35 125
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40 350 350 350 150
45 180
50 500 500 500 210
55 250
December 2011 Chapter 5
12058 12045 1333
GR N ELD 275
L AGE 301-6 1201240V THINK
12070 12067 0 26917 'Q 1971 100AMP
s rn 33S 127 /vD SAFETY
x 101 nT C75838t_ PD_9169 1< %FLKR FIRST
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12169 12 U _ m r < 30'8 --
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0 1971 P.�!- 13350
20'-a a o6. sfie 35 c6 CONSTRUCTION NOTES: CMDEV
1987
A2 AL1989 -
C 25 50393,3 D_95 1 CUSTOMER IS RESPONSIBLE FOR ALL TRENCH.CONDUIT VAULTS.PADS 2 C 4/0 13431 AND ROAD CROSSINGS.
ALG 4 CU 13405 13330
2O'-4 __ 959 2 FALL ROM FINAL GR DE INSTALLED WITH 30 INCHES(MIN)COVER AT TOP OF CONDUIT
1342 FROM FINAL GRADE.
1987 35' 1379
9 13439 2p' 3. ALL PGE CONDUCTORS TO BE INSTALLED IN GRAY,SCHEDULE 4O ELECTRICAL
GRADE,PVC CONDUIT WITH NYLON PULL STRINGS(MIN.S REQUIRED.TEST).
12254 232 Q 1985 PGE TO DETERMINE THE SIZE AND NUMBER OF CONDUITS REWIRED.
8 2 AL MAINTAIN 12 VERTICAL INCHES AND 24 HORIZONTAL INCHES CLEARANCE BETWEEN
12218 _ U B 50 27027 GAS AND OTHER UTILITIES.ALL ELBOWS 4INCH 6 SMALLER TO BE 36 INCH RADIUS.
1 ALL BENDS MUST BE FACTORY MADE.ALL ELBOWS LARGER THAN 4 INCH TO BE
VT- 595
PO-91 C 75 6467 9 444 B 5 7 SO INCH RADIUS.RIGID STEEL OR PGEAPPROVED.FIBERGLASS BENDS ARE REQUIRED
FOR RUNS OF 151 FEET OR LONGER,OR FOR ANY LENGTH RUN WITH MORE THAN
25 4 Y SIT, 8.10 CU DX LBO DEGREES IN BENDS.PJC SCHEDULE 40 BENDS ARE ACCEPTABLE FOR RUNS OF
C21-04B FORNWsunwnMi 1196 SC P 150 FEET
ORLE56THE MAXIMUM TOTAL BENDS INANY CONDUIT RUN IS270DEGREES,
C21-04A o
SW WALNUT ST ry\oP m 2 d DIRECTIONAL BORING REQUIREMENTS BLACK HDPE(HIGH DENSITY POR LIKE
ELINE)DUCT
ABC 2/0 AL G 134,',5 2 ORSCHEDULE d0PVCT)ASAMECHANICAL CONNECTION L(CERTAESH LL LIKE MECHANICAL
} PO 2 _ CONNEC MEN PRODUCT,AS CI ACATIO LCC 51 HOPE DUCT.HDPE SHALL MEET THE
71 t REQUIREMENTS OF PGE SPECIFICATION IS A S LCIFICA(AVAILABLE ON REQUEST FROM PGE PROJECT
25'< P� is so,� 1966 EXTRUDED RED STRIPES(WHICH ISASPECIFICATON REQUIREMENT)MANDREL TEST OF
1995 72 >\0 m 1342 207 HDPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT
13733 1372125'-4
G �Swla>+MN?r4adL wur.
13755 13689 13665 1995 a 0.,+xNrscaeob Rvc cpbXnT 1 8 1985 5. ALL PGE TRANSFORMERSOVERHANG
G INSTALLED FROM)ANY FI EHNY COMBUSTIBLE
137 BUILDING.WALL OR S MUST BE AND 4 FEET(MIN)FROM ANY FIRE HYDRANT
PGE TRANSFORMERS MUST BE WITHIN 15 FEET OF A DRIVEABLE AREA
A U HCl\ Open 36 ALWAYS MAINTAIN 10 FEET CLEARANCE IN FRONT OF ALL TRANSFORMERS.
A2AL NK 1527 6. TRANSFORMER PADSARE TOSESETSOTKATTHETOPIS2INCHESABOVE
112 '9( FINAL GRADE.CONDUIT IS TO BE INSTALLED IN PAD AS INDICATED IN DETAIL
20-4 20-4 AND TO EXTEND I INCH ABOVE THE PAD.
78 0 199
CGISW UD1996A 13CU TX
S 1331 7. STEELBARRIER POSTS ARE REQUIRED MOUND TRANSFORMERSTMATARE EXPOSED
R A5D4035 3611VT-58 TOVEHICLES
5062565 73 TC( B. ALL SWITCH VAULTS TO BE SET AT FINAL GRADE WITH 6 INCH GRAVEL BASE AND
-q 20-4 25'-4 `�.} CONUDITS ALIGNED TO ENTER THE VAULT END LOWER KNOCKOUTS(TERM-ADUCTS).
4- 1996 3599 1995 (SEE DETAIL ON SKETCH)
lA
J 1 1y';5 7T -9 1'401 9 PGE TO BE NOTIFIED AND INSPECT ALL CONDUIT.VAULT AND PAD INSTALLATIONS.
115 "�� BEFORE BACKFILL ALL NEW VAULT d PAD LOCATIONS TO BE FIELD VERIFIED
20 a
13762 13740 13728 135+ �7 1 ' WITH PGE AND CUSTOMER REPRESENTATIVE
13796 1996C 50 627" 10. REFER TO PGE ELECTRICAL SERVICE REQUIREMENTS BOOK FOR FURTHER DETIALS
9G 350 n( 8 SPECIFIC REQUIREMENTS.LINK T0IMNN PORTLANDGENERALCOM
0 50 100 200 Feet 13620 116 ?�\ 2S �C 0.7 11 DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPTMENT NONSTANDARD
31 137153 I 1373( I }372r.T I , +�5'9 13592 20� „`~ 1991 13 UNDERGROUND EQUIRTMENT MAY BEM OPTION ATAN ADDITIONAL COSTTO
PGE THE CUSTOMER.
ITEMrE5 COMMEHT 12 THE POINT OF DELIVERY AND DIVISION OF OWNERSHIP BETWEEN THE CUSTOMER AND
ATTENTION' CALL 811 BEFORE YOU DIG ,ANY DEVL477ON FROM THIS DESIGN MUST WI
YR1 CHECKUST PGE WILL BEAT THE LINE SIDE OF THE NEW CUSTOMER PROVIDED SWITCH GEAR
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED
BY THE OREGON UTILITY NOTIFICATION CENTER. I BEAVPROVED BY THE PGE PROJECT MANAGER Es
THOSE RULES ARE SET FORTH IN OAR 952-001-0010
THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF _CE PGE CONSTRUCTION DRAWING
THE RULES BY CALLING THE OREGON UTILITY E TRENCH
NOTIFICATION CENTER ADMINISTRATION!(502-231-1987)
TO REQUEST UTILITY LOCATES CALL THE OREGON it—wnafs below.
UTILITY NOTIFICATION CENTER,811 AT LEAST Coll before you ft ocATEs Foreman: Date:
1 BUSINESS DAYS PRIOR TO EXCAVATION rnKi General Foreman: Date:
EETBIN SI am- u-e ar rrea corturucnort Inert eb.
ANDscAPF SDPMIENG REVIEW SBUILT BYDESIGNER:
N -11. SCALEccou
Vicinity Map X TIGARD 11/28/2016 1in:99R 1070001 M2172328
x MILE WASHINGTON COUNTY
C1R.vEB. ` IRCut MURRAYHILL-MURRAYHILL 13 511 x 17
wN E/ IZELOCAnON
INTERSEC OF SW WALNUT STAND SW 135TH AVE,TIGARD,972223
DESCRIPTION
"yc; ^+ 100A UG SVC TO METERED CABINET FOR TRAFFIC SIGNAL SHee-
OU CIONS WORK WITH
ONTACT R WASHINGTON C21D4A 1 OF
^U�* QANY DESIGN BY PHONE(503)
BY
, Chris Jewett 572-5481 C JEAETT