PFI2017-00277 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00277
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/19/2017
Parcel: SEG2813
Jurisdiction:
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Install circuitry for Opt. A lights
Owner: FEES
Description Date Amount
PHONE.
Contractor:
K&G CONSTRUCTION CO
26090 NW TIMBER CO
FOREST GROVE, OR 97116
PHONE 503-681-2370
FAX:
Applicant:
JOSE GRAJEDA
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-672-5602
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 PF12017-00277
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
City of Tigard
RECEIVE®
PUBLIC WORKS —ENGINEERING ��
w l_J E 1.�� 18 2017
Public FaciRty Improvement (PFI) J),.p 1 t
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work
Check one: gUtih6es ❑Sidewalk/driveway approach ❑ Street improvements performed by NV./N, PGE
Detailed description: and/or utility agency.
INSTALL CIRCUITRY FOR OPT A LIGHTS ❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2067602 Work performed for the purpose of:
• Sidewalk installation or repair.
Property address/locadon(s): 14033 SW Fern St Portland, OR 97223 • Driveway approach installationand/or repair
C7 zxg • Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric[Submitted by Amy Sweany] ❑ TYPE 3-Full scale Development
Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Zip: 97602 the following:
Phone: 503-612-2935 Finad: preregcoord@pgn.com - Subdivisions or Partitions
Contact name: Jose Grajeda Phone: 503-672-5602 - Street widening
- Mainline installation for Sanitary
Contractor: K& G EXCAVATING CO INC sewer, Storm sewer, Tigard water
CCB#: 28711 Expiration: $1912018 and/or Tigard Water Service Area
Address: 26090 NW TIMBER RD SUBMIT COMPLETED APPLICATION TO.
City/state: FOREST GROVE OR Zip: 97116 City of Tigard
Phone: 503-681-2370 Email: office@kgeonst.com Planning/Engineering
13125 SW Hall Blvd.
Contact name: Jon Wheelock Phone: 218-324-3344 Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: SR Design, LLC only may be emailed to:
Address:
8196 SW Hall Blvd., Suite 101 rowpermits(t_t�tigard-or.gov
FOR STAFF USE' ONLY
City/state: Beaverton, OR Zip: 97008
Phone: 503-469-1213 Email: stever@srdllc.com Case No.: R0/7FJ 912 d Oc
Contact name: Steve Roper Application submittal fee: $ - '
Additional fees:S
Estimated value of work is required(if over$5,000):$ 23,775.71 Application accepted:
(witlun the public right-of-way) By: SW Date: h-1117
,_,_,/ Application reviewed:
Is work related to a LAND-USE DECISION? LYf Yes ❑ No r ^
By: Date:
If so,please specify (MLP,SDR,SUB,etc.) case#: SUB2015-00016
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes No BY:
Date:
If so,please specify(BUILDING PERMIT)case#: I:\ENG\PermltAppllcations\pfl_applkatlon Rev.12/16/2016
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 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 APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the 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.
-- V��� �� - S,�,, \--�, rS �
-,
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property,if required.
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 Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4
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INSTALL 47W LED BRONZE CREE LIGHTING LEGEND
ON 30'DB FIBERGLASS POLE BRONZE(25'MTG HGT)
WITH S.
MAST ARM,CONNECT 240 VOLTS ........... INSTALL 1-k6 AL-TX ST LT CI R, IT
PD 175 PGE,to provide pole Stub for ,_ INSTALL 1.810 CU_TX ST LT CIRCUIT IN 1-1"SCH40 PVC
BS customer to install. ---- I CONDUIT,PROVIDED d INSTALLED BY CUSTOMER
17 144
30'-lnknow 30'-Unknow I I
2004 15' Non II
Q--——— �,11
––'� Ott -� CONSTRUCTION NOTES: SLCST
1. CUSTOMER TO PROVIDE ALL TRENCHING AND BACKFILLING.JOINT USE TRENCH
\\1 '
1',I I+ FINAL GRADE TRENCH TO BE 48 INCHES DEEPAND 30 INCHES WIDE,MEASURED FROM
VT-169
11111)
2.ALL POE CONDUCTORS TO BE INSTALLED IN GRAY,SCHEDULE 40,ELECTRICAL
1 111 GRADE,PVC CONDUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TEST).
11' PGE TO DETERMINE THE S1ZE AND NUMBER OF CONDUITS REQUIRED.
MAINTAIN 12 VERTICAL INCHES AND 24 HORIZONTAL INCHES CLEARANCE BETWEEN
Ij II I I B 15 37921 ALL UTILITIES. L
SENDS MUST EFAC ORYMADE.�L ELAN RADIUS.
C 15 37923
BOWS URGER THAN 4 NCH TO BE
1 111 60 INCH RADIUS,RIGID STEEL OR PGE APPROVED.FIBERGLASS BENDS ARE REQUIRED
FOR RUNS OF 151 FEET OR LONGER,OR FOR ANY LENGTH RUN WITH MORE THAN
—py. 160 DEGREES IN BENDS.PVC SCHEDULE 40 BENDS ARE ACCEPTABLE FOR RUNS OF
La PD-8754 150 FEET OR LESS,THE MAXIMUM TOTAL BENDS IN ANY CONDUIT RUN IS 270 DEGREES.
3.ALL CONCRETE FOOTINGS NEED TO BE INSTALLED YNTH TOP OF BASE
1 FLUSH TO CURB I SIDEWALK
1 4. CUSTOMER RESPONSIBLE FOR ROAD CROSSINGS.ALL CROSSINGS MUST ECTEND
C2 1-04B I FROM PROPERTY LINE TO PROPERTY LINE.CROSSINGS TO BE 48 INCHES DEEP,
MEASURED FROM FINAL GRADE.
( DIRECTIONAL BORING REQUIREMENTS.BLACK HDPE(HIGH DENSITY POLYETHELINE)DUCT
1 OR SCHEDULE 40 PVC WITH AMECHANICAL CONNECTION(CERTA-LOK OR LIKE MECHANICAL
CONNECTION PRODUCT)AS AN ALTERNITNE TO HDPE DUCT.HDPE SHALL MEET THE
REQUIREMENTS OFPGE SPECIFICATION LC20515(AVAILABLE ON REQUEST FROM PGE PROJECT
1 EXTRUDED RED STRIPES(WHICH IS ASPECIFICATION REQUIREMENT).MANDREL TEST OF
1 HDPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT.
1
1 6.TRANSFORMER PADSARE TO BE SET SO THATTHE TOP IS 2INCHES ABOVE
1 FINAL GRADE.CONDUIT IS TO BE INSTALLED IN PAD AS INDICATED IN DETAIL
AND TO EXTEND 1 INCH ABOVE THE PAD.
1
_ 1 7.ALL PGE TRANSFORMERS TO BE INSTALLED 8 FEET(MIN)FROM ANY COMBUSTIBLE
1 BUILDING,WALL OR OVERHANG AND 4 FEET(MIN)FROM ANY FIRE HYDRANT.
' PGE TRANSFORMERS MUST BE WITHIN 15 FEET OF A DRNEABLE AREA.
2138 1 ALWAYS MAINTAIN 10 FEET CLEARANCE IN FRONT OF ALL TRANSFORMERS.
40'-4 I S. STEEL BARRIER POSTS ARE REQUIRED AROUND TRANSFORMERS THAT ARE EXPOSED
1971_ - - / TO VEHICLES
B 25 10341 / J1 9.AS NEEDED-FRONT LOT PUBLIC UTILITY EASEMENT(PITO BE 8 FEET(MIN),
I / 10 FEET(PREFERRED).
2137 / r f1
46-4 I 10.CONSULT WITH POE REPR ESENTATNE 2 WEEKS BEFORE STARTING MAIN POWER
l�e�. 1871 I TRENCHING FOR A PRECONSTRUCTION CONFERENCE.INCLUDED IN THIS CONFERENCE
11426 T vA 3g'-4 INSTALL 47W LED BRONZE CREE HALL BE EXCAVATOR.PGE.TELCO,CATV,AND GAS.
RN ST ON 35'CLASS 4 POLE 25'MTG HG
--- I�Dne ( T) '.CUSTOMER TRENCH AND ELBOW CONFIGURATIONS,ALL CONDUIT.VAULT AND PAD
� j WITH W MAST ARM,CONNECT 240 VOLTS INSTALLATIONS MUST BE INSPECTED BY PGE PRIOR TO BACKFILLING.WHEN YOU ARE
B 50 21310 jj- READY FOR PGE TO INSPECT(AFTER INSTALLATION IS COMPLETE)CALL 503-32}6700
SD, `� OR 503-4634148(SALEM AREA).ALLOW UP TO 2 WORKING DAYS FOR INSPECTION TO OCCUR.
12.REFER TO THE PGE ELECTRIC SERVICE REQUIREMENTS BOOKLET FOR SPECIFIC REQUIREMENTS.
DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPTMENT.NONSTANDARD UNDER-
GROUND EQUIPTMENT MAY BE AN OPTION AT AN ADDITIONAL COST TO THE CUSTOMER.
PGE CONSTRUCTION DRAWING
PIECE F19159GLA SS(COMPOSITP POLE
w� m
STREET LIGHTING NOTICE
I THINK THIS STREETLIGHT DESIGN BY OTHERS Foreman: Date:
PGE DOES NOT ACCEPT DESIGN RESPONS161LITY General Foreman: Date:
SAFETY
I INSTALL 30AMP FUSES IN SECONDARY PEDESTALS SDF�IWENG REVIEW5 °toe°" I" ped 10rT[ASBUILTBYDESIGNER'
then s.
FIRST OR SECONDARY VAULTS(WHICHEVER IS ST LT POINT CUNT JA—
UfL
OF ATTACHMENT)FOR EACH STREET LIGHT PER T&D 9/26/2017 1070001 1000004600 J M2067602
~ CONSTRUCTION STANDARD LCA 1 c TITLE
BOC LLC-CITY OF TIGARD
CALL 811 BEFORE YOU DIG CIRCUIT SIZE
ATTENTION:.... r..� TIGARD-13362 11 x 17
w.w.«....r� OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED 1 /PGE Ix,AI II N
BY THE OREGON UTILITY NOTIFICATION CENTER. SW 88TH AVE&SW GREENSWARD PKWY,TIGARD OR
THOSE RULES ARE SET FORTH IN OAR 952-001.00101 `, Descriptinll INSTALL CIRCUITRY 1-47W LED CREE ON 30'DB FG POLE
IOTTOBI
IPIECE POLE INSTALLATION THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF
THE RULES BY LALLING THE OREGON UTILITY Wilsonville COUNTY SECTIONS WORK WITH
"n....s.�... ...�.. NOTIFICATION CENTER ADMINISTRATION!(502-231-1987) LINE CREW CENTER I C2104B M2D67596 1 OF 1
+��•�—�-•�-' TO REQUEST UTILITY LOCATES CALL THE OREGON Knowwhaftbekm.
"n6osweoECKMAN SIGN BY PHONE(503)DRAWN BY
UTILITY NOTIFICATION CENTER,811 AT LEAST CaIlbefoteyoudig. •'JILSONVILLOR97070 SE GRAJEDA 572-5602 LANE WHITNEY
•'"•'•"�'"•"��" 2 BUSINESS DAYS PRIOR TO EXCAVATION I OPORTLAND GENERALELECTRIC CO.-ALL RIGHTS RESERVED