PFI2017-00075 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00075
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/24/2017
Parcel: SEG1133
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Single family line extension; provide backbone for new three-lot partition
Owner: FEES
Description Date Amount
PFI Permit Fee 04/24/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX.
Applicant:
CHRIS JEWETT
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-672-5481
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00075
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 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
RECEIVE®
City of Tigard APR 2 0 2017
PUBLIC WORKS —ENGINEERING
■ CITY OF TIGARD
Public Facility Improvement (PIFITYM�ifflf-RING
i
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
D( TYPE 1—Franchise Utility Work
Check one: ]SI Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE
Detailed description: M2091239 Single Family Line Extension and/or utility agency.
Provide Backbone for New 3 Lot Partition ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
Sidewalk installation or repair.
Property address/location(s): 13230 SW Walnut St • Driveway approach installation
and/or repair
C/S SW 133rd Ave 1133 • Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric El TYPE 3-Full scale Development
PP Work performed with Land use
Address: 10800 SW Avery St approval which includes any of
City/state: Tualatin, OR Zip: 97062 the following-
Phone:
ollowingPhone: 503-672-5481 Ems: preregcoord@pgn.com - Subdivisions or Partitions
Contact name: Chris Jewett,SDPM Phone: 503-672-5481 - Street widening
- Mainline installation for Sanitary
sewer, Storm sewer, Tigard water
Contractor. 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 in right-of-way"
Engineer: Chris Jewett only may be emailed to:
Address: 10800 SW Avery St t�permitsaltigard-or.gov
City/state: Tualatin, OR Zip: 97062
Phone: 503-672-5481 Email: preregcoord@pgn.com Case No.: /—Tl MY
Contact name: Chris Jewett Application submittal fee: ;3t��Oy
Additional fees:;
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By: �S Date:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No Application reviewed:
By;.� �.�Date: y/2t /1-7
If so,please specify(MLP,SDR,SUB,etc.) case#:
Applic t notified:
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By: Date: 2 l
If so,please specify(BUILDING PERMIT)case#: I:\ENG\PermitApplkatlons\pfl_application Rev.12/16/2016
,aa .seaewe.ewe.,aua.�.o„aerv..»am,.sae..,wa.,.vdarw
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wu 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 TMC 15.041.140.
With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different
people,the applicant must be the purchaser of record ora lessee in possession with written authorization from the owner or an agent of the
owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owners signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
12mpe
• 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.
c�),� _S�-2 e 14 v v-S�VN Zo zo l —7
Applicant/Authorized 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
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigaid-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
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 X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: .111 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/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. (6 sets,24x36 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 may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
77dC 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 Hall Blvd. • Tigard,Oregon 97223 • w•wwtigard-or-gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
Ditch 10
Streetlight 1 — ----------- —r—•-
1 x�nna.
I 1 GnO 0 o I
' T–�ro'pos d''Sejw'er'Cine" �
i y i ,i Existing House
Existin
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'1 1 1
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rl
40 I
a v
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- 1 Existing Shop
I "J 'J
Power ole I
�. I o l 2
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-------7roper Line-------_----
,
� I �
iQ 1 Fire Hydrant(FH)
I i 1
1 Scale: 1
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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/fix'apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard - 13125 S\X'Hall Blvd. - Tigard,Oregon 97223 - www tigard-or.gov - 503-718-2421 - Page 4 of 4
A2AL A 12759 ABC 750 AL ,211 SINGLE FAMILY LEGEND
C 2/0 AL VT-78 24
VT26804 2510-- _ NEW PGE FACILITIES TO BE INSTALLED
WL 4:PDA 61 NNLESS OTHERVNSE SPECIFIED)
Install:
1201240v 3X7=21KWTOTAL DEMAND 605-SECONDARY JUNCTION PEDESTAL SW WALNUT ST JU 644-PGEPADMOUNT VAULT,WITH 64.332P-212—GE TOP
---___ PRONGED d INSTALLED BYCUSTOMER
200AMP
HPIAC:4TON .� PF 300 SECONDARY PEDESTAL
1.4 %VD PROVIDED BY PGE d INSTALLED BY CUSTOMER
1.7 %FLKR -
6411 A AFC
2832 CUSTOMER TO INSTALL 3"PVC CONDUITS STUB-UP
tea°.A PEY781
9 FOR FUTURE 1-4A0 AL-TX SERWCE
WL 3:PD-160 _ 21 ______ INSTALL D&IN AL-TX SECONDSTOM 1-3-PVC CONDUIT
Install:
t4�14r, PROVIDEDdINSTALLED By CUSTOMER
805-SECONDARY JUNCTION PEDESTAL
3230
0 13090
CONSTRUCTION NOTES: SFEJIT
2844 0 1. CUSTOMER TO PROVIDE ALL TRENCHING AND BACKFILLING.JOINT USE TRENCH
PD-160
C2 1-04A _ _ _ _ _ _ j THINK WT H GAS.TRENCH TO BE 48INCHES DEEP AND 301NCHE5 WIDE MEASURED FROM
FlNAL GRADE.
SAFETY 2 PUC CONDUIT NECESSARY)
WITH NYLON PULL STRINGS(MINE GRAY D500LW.LEEST).CAL GRADE
- — FIRST POE TO DETERMINE THE SQEAND NUMBER OF CONDUITS REQUIRED.
26 MAINTAIN 12 VERTICAL INCHESAND 24 HORRONTAI INCHES CLEARANCE
1. - BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS TO BE 36 INCH)MIN)RADIUS.
3 b-133 ALL BENDS MUST SE FACTORY MADE.RIGID STEEL OR PGE APPROVED FIBERGLASS
_. BENDSARE REQUIRED FOR RUNS OF 151 FEET OR LONGER,OR FOR ANY LENGTH
RUN VMTH MORE THAN 1B0 DEGREES IN BENpS.PVC SCHEDULE 40 BENDS APE
7287 A2 L ACCEPTABLE FOR RUNS OF 150 FEET OR LESS,THE MAXIMUM TOTAL BENDS IN ANY
CONDUIT RUN IS 270 DEGREES.
W L 2:PD-133 1 65 161 3.CUSTOMER RESPONSIBLE FOR ROAD CROSSINGS.USE ONLY GRAY,SCHEDULE 40,
n stall: 45'-3 ELECTRICAL GRADE.PMC CONDUIT WITH NYLON PULL STRRGS OAR.S00 LBS.TEST).
42 6
- SU1613-BUSHING CAP,INSU,LOADBRK,ISKV 3075 13055 4 OR SCHEDULE 440NAL RING PVC LMH ARE ENTS MECHANK:ALLCONECTION ICERTK HOPE IHIGH MLOK OTY R LIKEELINE�DUCT
MECHAHICAL
395-ELBOW KIT-JKTD CABLE-#2AL 2552 CONNECTION PRODUCT)AS AN ALTERNITNE TO HDPE DUCT HDPE SHALL MEET THE
644VT PM Transformer GroundingKit REQUIREMENTS OF PCE SPECIFICATION LC20515IAVAILABLE ON REOUEST FROM PGE PROJECT
EXTRUDED RED STR IPES(WHICH ISA SPECIFICATION REQUIREMENT).MANDREL TEST OF
593-1 P 7.2 240/120 PM 25KVA NTLB TRANSFORMER HOFF PIPE IS REOUIREDAFTER INSTALLATION WITH PGE INSPECTOR PRESENT.
5. SINGLE PRIMARY INSTALLATIONS-CONDUIT TO EXTEND A MINIMUM OF IB FROM
TRANSFORMER PAD.
12845 SW HAMPTON CT WL 1:PL-2161
2892 —
N� Install: e.ALL POE TRANSFORMERSOVERHANG
G INSTALLED(IN],FR MANY FIAN Y COMBUSTIBLE
BUEOINO,WALL OR OVERHANG AND 4 FEET ITIFROM ANY FIRE HYDRANT.
Q� 410-2-IN PVC CONDUIT UNIT ALWAYS MAINTAIN
CLE WITHIN IS FRONT OF ALL T LEAREA.
N0
SU3204-FUSE LINK-T 6 AMP ALWAYS MNNTAIN 10 FEET CLEARANCE IN FRONT OF ALL TRANSFORMERS.
am 13080 SU3752-SIGN FUSE SIZE F-6-T 7.CUSTOMER TRENCHAND ELEOWCONFIGURATIONS MUST BE INSPECTED BY FIDE PRIOR TO
439-UG PRI POLE#2AL JKT 1 P-142 C/O BACKFILLING.WHEN YOU ARE READY FOR PGE TO INSPECT(AFTER INSTALLATION IS COMPLETE)
PLEASE CAL 5013218700 OR S0 14348(SALEM AREA)
12902 13 70 1306 ALLOW UP TD 2 WORKING DAYS FOR INSPECTION TO MCUR.
_. 6. DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT.NON-STANDARD
12885 UNDERGROUN D EQUIPMENT MAY BEAN OPTION AT AN ADDITIONAL COST TO THE CUSTOMER.
PGE CONSTRUCTION DRAWING
AS-BUILT ! 6NESC VIOLATIONS CORRECTED
CONTACT SERVICE COORDINATOR &4W'*'ATKW "XER"'D r.S. „—E
FOR TRFNCH AND CONDUIT INSPECTION PRIOR Foreman: Date:
TO BACKFILL.PGE WILL NOT INSTALL WIRE
UNTILTRENCH15100%BACKFILLED. of nur CURSMZNRroN. General Foreman: Date:
SERVICE COORDINATORrNP,-ty.e ulLed ro[Rem con3t—h-then s
503-323-6700 OR 503.463-4348(SALEM) �,'",."",,,',�`•" LA.NCArfARfA SINWIG REVIEW JASBUILT BY DESIGNER:
OVNI JA_
JOB NO.
_ 3/22/2017 1 in:52 ft 1070001 1000004594 M2091239
Y1EIR ION FROM THIS DESIGN MUST + 4� oma„^~ g°DD I L
SIZE
0
TAMAS JAKO
EfNcoLoaroH4 UIT
ISE APPROVED BYTHE PGE PROIECTMANAGER M TIGARD-13362 11X17
O T /�E LOCATION
QU"11 BEFORE G/ 13230 SW WALNUT ST,TIGARD,97223
INGO111-1o.AW RFgUIRfS OU
RIGHT-OF-WAY PERMIT NOTICE: ` IPnoN
R[GONNAYTID FOLLOW RULES AOWTfO
11—ORNo —CENTERAPERMITFROM THE _ PROVIDE BACKBONE FOR NEW 3 LOT PARTITION SHEET
FGONUULIiY . DICTIOII 1111,11,11111, Y
8110IAN .wu.cRvmP
HOSE RULES ARE SET ro 1—OAR 952x01 m10 WORK IN THE RIGHT-OF-WAY MAY SE PERFORMED. ONLY PGE APPROVED COUNTY S CTION WO K W1TH
THROUGH 952�a111- roMMA.UINIcoP)Fs of CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL � ` WASHINGTON C2 04A 10F
NFRULESMGLLINGTN UMNYNUNITY
NOTIFKATIONCENrER AOMLNISrRATLON�ISOSS322%>) AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. DESIGNBY PHONEI503)DRAm BY
TOREQUEST UTIL I TY LOCATES CALL THE OREGONTHE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS 1r�'�"'•�"`-"' 1"' '� C.hfl$JeWetl 672-5481 CH RISJEWETT
UTILITY NOTIFICATION CENTER,811 AT LEAST CIr MrBn18VA{ BEFORE WORK 15 TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE.
2 BUSINESS DAYS PRIOR TO EXCAVATION -A T
2011 Edition Page 85
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December 2011 Chapter 5