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PFI2016-00268 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00268 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/15/2016 Parcel: SEG754 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: B/O cable from PD-6921 to VT-12185 Owner: FEES Description Date Amount PFI Permit Fee 12/15/2016 $300.00 PHONE: Contractor: PHONE FAX: Applicant: TOM COX 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-867-0414 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: S�L& L-4-f)P C6 Issued By: i' Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00268 Type: Condition Name: Status: Severity: 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 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 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 Jonny Gish at 971-713-0281 of Jonny@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 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. RECEIVE® City of Tigard DEC 14 2016 PUBLIC WORKS—ENGINEERING CITY OF TIGARD Public Fadh Im rovement"M"Per tY PM 0 _ _. TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) 9 TYPE 1—Franchise Utility Work Check one: 9 Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE Detailed description: PGE JOB M2164660 and/or utility agency. B/O CABLE FROM PD-6921 TO VT-12185 ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. 11850 SW KATHERINE ST. TIGARD Property address/locauon(s): • Driveway approach installation and/or repair • Sanitary sewer lateral installation and/or main line tap Applicant: PORTLAND GENERAL ELECTRIC El TYPE 3—Fulscale 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: 503-867-0414 Email: PreregCoord@pgn.com • Subdi-6sions or Partitions Contact name: Tom Cox Phone: 503-867-0414 • Street widening • Mainline installation for Sanitary Contractor: N/A sewer, Storm sewer,Tigard water and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Zip: City of Tigard Phone: Email: Planning/Engineeting 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" En eer: Tom Cox only may be emailed to: � row*permitsCg�tiQard-or.Qov Address: 10800 SW Avery St. City/state: Tualatin,OR Lip: 97062 Phone: 503-867-0414 Email: PreregCoord@pgn.com Case P�� a � .: � � Contact name: Tom Cox Application submittal fee: Additional fees: Estimated value of work is required(if over$5,000):$ Application accepted: (within the public right-of-way) By: �_g Date: jolh4tll Application reviewed: Is work related to a LAND-USE DECISION? ❑ Yes W No By-J61:51,_ Date: a1fqb(, If so,please specify(MLP,SDR,SUB,etc.) case#: Applicant notified: Is work related to a BUILDING PERMIT? ❑ Yes W No By: L Date: If so,pleasespecify(BUILDING PERMI"l)case#: e\cunPui\M•s,nsW"duxAPdotro", se,.09/26/2016 City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page l 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 or a 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 owner's 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 propeerty. • 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. Brian Moore 12/14/16 Applicant/Auth rized 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 name Date Owner's signature Print name Date �, . :.. ,:..v:+ava s.y,ru..v.. .�+;r;rLxmr_e.e,,•.,uaa::::++.:.e 1,.v,..,.n:a�nu,;,��wce;�.:::tza.:mmr...ac:,s::zr:v:.s._u.w�w�,�a�w.mr: ..•xxa»,�::;rir�u a PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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 Part 2: All non-water system improvements CONNECTIONS,ETC. Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way) 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 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 22234) • Weep hole repair ❑ Cover—'ite,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) 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(f applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or:gov • 503-718-2421 • Page 3 of 4 SAMPLE SKETCH: jEdge of Pavement -d* — Ditch -0- Streetlight I A----•-------•— —C--- 1 /• R.Dna, T, � aSe+werTine Existing HouseExisting ': - Driveway� o� I > >� 1 i o Existing Shop I Power ole = °' �. I o l o I a 95' I — •--—-—-'Proper We —-—-—-—-—- I I IFire 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 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 WR CHECKLIST LEGEND WL 2 VT-12185: WL 1-2 Span: ITEM YES COMMENT INSTALL FACILITIES Install Install: HOLE DIGGER _INSTALL ADDITIONAL FACILITIESA9001FY FACILITIES ELBOW KIT-JKTD CABLE-#2AL (407')CO OF#2 AWG,AL,EPR,15 KV CONDUCTORS ,1-2"PVC CONDUIT BOOM ELBOW KIT-JKTD CABLE-#2AL Abandon: INSTALL C-PHASE#2 AL EPR JKT-O PRIMARY BACKHOE 'PROVIDED 6 INSTALLED BY PGE 07' """ 11860 71995 11945 11895 -- (4C)7')CO OF JKT#2AL -- 1-1-coND - _ 11855 11825 11795 PGE TRENCH PROVIDED E061NSTALLED BY PGE APPROVED CONTRACTOR ' - ,<•... _. _.. `.. CONTRACT BORE X 407' LOCATES X .. 112099 �> f 30'4 L 197D .. X 50' _. ROW sa:Y,a-,-`,=' SW KATHERINE ST -_- ______-„_c2AL 385' X TIGARD a 1CZP _,.m__.,m _. X .___12 C2P '.VT--7218 2 - ri/ TRAFFIC PLA C 50 35141` TENSION:61# PM921'CSO TENSION:61# CUTSHEET C1 1-34C D-6922 -- W/LUBE � 7 ., : UG CUR.VER. _ TRANSMISSION SHu TDOVVN nae0 i19s0 n65o CUSTOMER X 14 CUSTOMERS SHUTDOWN ? 11925 DOOR HANGAR CONTACT THINK N N� COMPANY SAFETY ..WL7 PO-6921 - PH# C# FIRST 'may Install:594-1P 7.2 240/120 PM SOKVA NTLB DATE TIME 9L •14CUSTOMERS 11965 �. •43.63 KVA 11990 ELBOW KIT-JKTD CABLE-#2AL NY DEVIATION FROM THIS DESIGN MUST 594.1 P 7.2 240/120 PM 50KVA NTLB 11965 BE APPROVED BY THE PGE PROJECT MANAGER 11880 •14 CUSTOMERS 17995 -43.63 KVA '. CALL 811 BEFORE YOU DIG 35 70 14 Feet - ATTENTION: I I 1 U I I..... s ,nom-.�I 12010 . !GEJ OREGON LAW REQUIRES YOU TO FOLLOW RUL£SADOPTED , BY THE OREGON UTILITY NOTIFICATION CENT ER. {g,� p�g �py}7n�N !HOSE RULES ARE SET FORTH IN OAR 951-007-0010 y `e -LINE DIAGRAM () THROUGH 951-001-0090 YOU MAY OBTAIN COPIES OF A UICIIIItjI Map PD 16963 THE RULES SYCAIUNG THE OREGON UTILITY >"`v f t NOTIFICATION CENTER ADMINISTRATION @(501-131-1987) 'T-I R E� KBOIN.nati below. I LT-12185- A 7D REQUEST UiIUTY LOCATES CALL THE OREGON C11-34C t 6922 C., 7 C PU-820 UTILITY NOTIFICATION CENTER,811 AT LEAST �llbefore y011dig. 'rk� ,� '- I C1 1 34C 2 BUSINESS DAYS PRIOR TO EXCAVATION VT-780 �'? � PGE CONSTRUCTION DRAWING AS BUILT VE r • RIFICATION ION CORRECTED&NESC VIOLAT _PD 7887 p.-._. „. ._..___ .. ......_ � kv” � " � ' �� ''" Foreman: Date: ARC yy.. g Br#0 PO-9$27 General Foreman: Date: sz C I (Signefurc oN requGetl for fieltl construclon then esJ O I PD 937 SDPMrENG REVIEW. ASBUILT BYDESIGNER: 'IBC DATE' SCALE: ACCOUNT A40 JOBNO PD-4529 ' 12/13/2016 160 ft 1070001 0000014628 M2164660 Ley' CS�*!',G�^!-,T-O` PD-9 -93J TITLE PD �.0 - B/O CABLE FROM PD-6921 TO VT-12185 NEED TO FIX FAULT PE).7881 ' C21_63?, F'7?-93A a:p CIRCUIT SIZE IpD_g3 �,/ PROGRESS-GREENBURG 11x17 X621-03B �z r /PGE, LOCATION pU y�� 11850 SW KATHERINE ST,TIGARD ' PCa32 ` DESCRIPTION 'r PD-7897 20D. I pp 930 RD S29 BIO CABLE FROM PD-6921 TO VT-12185 SHEET syr COUNTY SECTIONS WORK WITH r � "�+' - PD 928 WASHINGTON C21-03B 1 OF 1 PD-1527 1 a r'w4, xe —ru OESIGNBY PHONE DRAWN BY N - I pD-gam ,u PeN TOM COX 503-867-0414 HEIDI BOOMER .e : �snR eeav-Rioncx�,.nRnoA o,rca ®PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED �7'1Cp f�C�� - //850 .5. z�0. 7 Page 12 2011 Edition CHAPTER 2 — SETTING UP THE WORK ZONE This section provides guidelines and procedures for setting up work zone, special event, or incidence response. The use of additional devices, such as PCMS, arrow boards, and TMAs during set up and taking down of the work zone may be used to enhance worker safety. In developing and implementing the TCP, existing devices shall be maintained at an equivalent or better level than existed prior to project implementation. 2.1 Work Zone Components The work zone, as shown in Figure 2-1 below, consists of four parts and extends from the initial advance warning signs to the last temporary traffic control device or the END ROAD WORK sign(optional). Figure 2-1: Work Zone Components f� � 1 Termination Area Buffer Space (Optional) Vt t • Work Space Aclivky Area Buffer space (optional) Transitlon m I Area M• A ! M {! ♦—_T Advance B Warning �+ D V-4 Area V � 1 *4�— Initial Warning Sign Chapter 2 December 2011 Z�-