PFI2018-00057 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
= COMMUNITY DEVELOPMENT Permit#: PF12018-00057
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/08/2018
Parcel: SEG1609
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG1609, associated with address 12075 SW Rose Vista Drive. Install 320A 120/240V 1 PH
Underground service to new residence. PGE Job M2454736
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
CHRIS JEWETT
10800 SW AVERY ST.
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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00057
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.
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
MAR 0 6 2018
City of Tigard CITY OF TIGARD
PUBLIC WORKS --ENGINEERING PLANNING/ENGINEERING
Public FacilityImprovement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
9 TYPE 1—Francluse Utility Work
Check one: gUtilities ❑Sidewalk-/driveway approach ❑ Streetimprovements performed by N\UN, PGE
Detailed description: INSTALL 320A 120/240V 1 PH UNDERGROUND and/or utility agency.
SERVICE TO NEW RESIDENCE ❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2454736 Work performed for the purpose of
- Sidewalk installation or repair.
• Driveway approach installation
Property address 12075 SW Rose Vista Drive
P tY and/or repair
, 1661604 Tigard, OR 97223 • Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric[Submitted by Amy Sweany] ❑ TYPE 3—Full scale Development
PP Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Gip: 97062 the following:
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Contact naive: SDPM Chris Jewett Phone: 503-672-5481
• Street widening
- Mainline installation for Sanitary
Contractor: Full Bore Inc. sewer, Storm sewer, Tigard water
176691 I 6/8/19 and/.or Tigard Water Service Area
CCB#: Expiration:
Address: PO Box 1312 SUBMIT COMPLETED APPLICATION TO:
City/state: Silverton, OR Zip: 97381 City of Tigard
Phone: 503-269-4997 Email: shawn@fullboreinc.net Planning/Enbaineering
13125 SW Hall Blvd.
Contact name: Shawn Zander Phone: Tigard,OR 97223
Applications for"nunor work in right-of-way"
En ineer: N/A
only may be emailed to:
g rowpermits�ti�ard-Q�,gov
Address:
FOR STAFF USE ONLY
City/state: Zip: (7
Phone: Email: Case No.:
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ 7,219.31 Additional fees: $ V4—
(within the public right-of-way) Application accepted:
Is work related to a LAND-USE DECISION? ElYes Yr No By: J L Date: 3,64
If so,please specify (N4LP,SDR,SUB, etc.) case#: Application reviewed: 7
By: Date: `!
Is work related to a BUILDING PERMIT? ❑ Yes N(No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: 4Date: � �
I:\ENG\PermI tApplications\pfl application Rev.10/16/2017
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • w-ww igard-or.gov - 503-718-2421 • Page 1 of
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 die 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
proper
• 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 ackno-hedge 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.
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 naive Date
PUBLIC FACILITY IMPROVEMENT PERMIT
CityofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • -,vww tigard-or.gov 503-718-2421 • Page 2 of 4
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12082 12080 12078 12076 12074 SINGLE FAMILY LEGEND
NEW PGE FACILITIES TO BE INSTALLED
(UNLESS OTHERIMSE SPECIFIED)
WL 4-4 Span:
Abandon: PGEMICRO PAD PROVIDEDAND INSTALLED BYPGE,
(117)494-1-RUN OF 4/0 AL URD TX GRAVEL BASE PROVIDED d INSTALLED BYCUSTOMER
13760
055
12oas
FAULT INDICATOR
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INSTALL 1•p2 AL-XLP JKT PRIMARYIN 2"PVC CONDUIT
4 PROVIDED 6 INSTALLED BY CUSTOMER
25INSTALL 1-4,0 AL-TX C2 1-03C
;PD-35 PROVIDED d INSTALLED BY SECONDARY AVC CONDUIT
CUSTOMER
i
J
N TENSION:77#
a —► TENSION:S1#
I
W1 LUBE
' 12035 CONSTRUCTION NOTES: SFEXT
F
------------------ 1.CUSTOMER TO PROVIDE ALL TRENCHING AND BACKFILLING.JOINT USE TRENCH
L WITH GAS,TRENCH 70 BE 48 RICHES DEEP AND 30INCHES WIDE.MEASURED FROM
390'----------------- 'y WITH
FINA
NA 0 2.CONDUIT(IF NECESSARY)WILL BE GRAY.SCHEDULE 40.ELECTRICAL GRADE.
` N PVC CONDUIT WITH NYLON PULL STRINGS(MIN.500 LBS.TEST).
O PGE TO DETERMINE THE SIZE AND NUMBER OF CONDUITS REQUIRED.
13630 �, MAINTAIN 12 VERTICAL INCHES AND 24 HORIZONTAL INCHES CLEARANCE
BETWEEN GAS AND OTHER UTILITIES,ALL ELBOWS TO BE 36 INCH(MIN)RADIUS.
ALL BENDS MUST BE FACTORY MADE.RIGID STEEL OR PGE APPROVED FIBERGLASS
WL 2 PD-35 BENDS ARE REQUIRED FOR RUNS OF 151 FEET OR LONGER,OR FOR ANY LENGTH
A 25 82424 RUN WITH MORE THAN 150 DEGREES IN BENDS.PVC SCHEDULE 40 BENDS ARE
Install: `04� ACCEPTABLE FOR RUNS OF 150 FEET OR LESS,THE MAXIMUM TOTAL BENDS IN ANY
1 P 25KVA MP 120/240 7.2 NTLI3 CONDUIT RUN IS 270 DEGREES.
PD-5344 1 CUSTOMER RESPONSIBLE FOR ROAD CROSSINGS.USE ONLY GRAY.SCHEDULE 40,
i 0>() ELECTRICAL GRADE,PVC CONDUIT WITH NYLON PULL STRINGS(MIN.SW LBS.TEST).
1202 4. DIRECTIONAL BORING REQUIREMENTS.BLACK HDPE(HIGH DENSITY POLYETHELINE)DUCT
OR SCHEDULE 40 PVC WITH AMECHANICAL CONNECTION(CERTA-LOK OR LIKE MECHANICAL
12020 ¢ CONNECTION PRODUCT)ASAN ALTERNITIVE TO HDPE DUCT.HDPE SHALL MEETTHE
N REQUIREMENTS OF PGE SPECIFICATION LC20515(AVAILABLE ON REQUEST FROM PGE PROJECT
Q EXTRUDED RED STRIPES(WHICH IS ASPECIFICATION REQUIREMENT).MANDREL TEST OF
1 33'� 7�'� HDPE PIPE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOR PRESENT
S.SINGLE PRIMARY INSTALLAT'K)NSLON WIT TO EXTEND A MINIMUM OF 17 FROM
Road Side 24- SPoil TRANSFORMER PAD.
TYPK,( CONTACT SERVICE COORDINATOR 6.ALL PGE TRANSFORMERS TO BE INSTALLED 6 FEET(MIN)FROM ANY COMBUSTIBLE
FCIR TRENCH AND CONDUIT INSPECTION PRIOR BUILDING.WALL OR OVERHANG AND 4 FEET(MIN)FROM ANY FIRE HYDRANT.
1 Ln FNQ O BACKFILL.PGF WILL NOT INSTALL WIP,F PGE TRANSFORMERS MUST BE WITHIN 15 FEET OF A DRIVEABLE AREA.
THINK UNTO''I'NCH IS 100%BACKFILLED ALWAYS MAINTAIN 10 FEET CLEARANCE IN FRONT OF ALL TRANSFORMERS.
PGE Primary
so °�Secondary Cable SERVICE COORDINATOR
Min In.W.Duct 7.CUSTOMER TRENCH AND ELBOW CONFIGURATIONS MUST BE INSPECTED BY PGE PRIOR TO
TIM. Cover S A F E TY 503-323-6700 OR 503-463-4348(SALEM) BACKFILLING.WHEN YOU ARE READY FOR PGE TO INSPECT(AFTER INSTALLATION IS COMPLETE)
Trench 0 T.t—ICATV PLEASE CAL 503-323-6700 OR 503.4634348(SALEM AREA)
®SackRl' FIRST� ALLOW UP TO 2 WORKING DAYS FOR INSPECTION TO OCCUR.
O j e. DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT.NON-STANDARD
&A—Nd BackBe NY DEVIATION FROM THIS DESIGN MUST UNDERGROUND EOUIPMENT MAY BE AN OPTION AT AN ADDITIONAL COST TO THE CUSTOMER.
O Eseth rbed SEAPPROVED BY THE PGE PROJECT MANAGER
tr Mm PGE CONSTRUCTION DRAWING
AS-BUILT VERIFICATION&NESC VIOLATIO
Joint Use Trench W/O Gas Th.doc,r FIELD Conrt,uctnn
MICROP•PAD,CONDUfT DETAILATTENTION: CALL 811 BEFORE YOU DIG Foreman: Date:
nYwc.ul cI sDr :r OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED
sn,s s»t-ERs z-ABovE toss c]Eo tAVE. ,LS'O. F B General Foreman: Date:
BY THE OREGON UTILITY NOTIFICATION CENTER.
rcRo+Ha THOSE RULES ARE SET FORTH IN OAR 951-00I-0010 (Signairum an re used for held construction changes.)
'TM'r rwINSFOR"ER THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF SDPMiENG REVIEW JASBUILT BY DESIGNER:
ourslOa rO BYPGE
oursloB THE RULES BY CALLING THE OREGON UTI LfTY A SCALE: ACCOUNT AM JOB NO.
�C0N01'rrs NOTIFICATION CENTER ADMINISTRATION @(SO2-232-1987) 1/3112018 1 in:50 ft 1070001 1000004594 M2454736
TO REQUEST UTILITY LOCATES CALL THE OREGON Knowwhatrsbelow. TITLE
UTILITY NOTIFICATION CENTER,811 AT LEAST Call before you dig. HOLLMAN CO
2 BUSINESS DAYS PRIOR TO EXCAVATION CIRCUIT SIZE
TIGARD-TIGARD 13 11 x 17
/PGE/ LOCATION
`',; ORSFcavOAP RIGHT-OF-WAY PERMIT NOTICE: 1 12075 SW ROSE VISTA DR,TIGARD,OR,97223
c I' 10"ET`- A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY ` DESCRIPTION
WORK IN THE RIGHT-OF-WAY MAYBE PERFORMED. ONLY PGE APPROVED COUNTINSTALL 320A 120/240V 1 PH UG SRVC TO NEW RESIDENCE SHEET
CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL SEcnoNs WORK 1MTH
���\ WASHINGTON
INGTON C2103C 1 OF 1
R,c cORpu, \ AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. DESIGNBY PHONE(503)DRAWN BY
BYc"TOWIF \�
FTHE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS Chris Jewett 672-5481 Chris Jewett
OR PRIMARY \
BEFORE WORK 15 TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE. PORTLAND T -ALL RIGHTS