PFI2018-00059 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00059
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/14/2018
Parcel: SEG421
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG421, associated with 10735 SW 69th Ave. Replace wire in the fault behind building. Replace with
pad mounts, move vault out of the parking lot. PGE Job M2124325
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
TOM COX
TUALATIN, OR 97062
PHONE: 503-736-5419
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: J %► iQl LZC 1 Z �V
Llama
Issued By: L
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00059
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 12 2018
City of Tigard
CITY OF TIGARD
PUBLIC WORKS —ENGINEERING PLANNING/ENGINEERING
Q
Public Facility Improvement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work.
Check one: N�Utilities ❑ Sidewalk/driveway approach ❑ Streetimprovements performed by NWN, PGE
Detailed description: Replace wire in the fault behind building and/or utility agency.
Replace with pad mounts, move vault out of parking lot. ❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2124325 Work performed for the purpose of:
• Sidewalk installation or repair.
Property address/location(s): 10735 SW 69th Avenue • Driveway approach installation
and/or repair
Tigard, OR 97223 • Sanitary sewer lateral installation
t _y 1 i and/or main line tap
Portland General Electric Submitted b Am Swean ❑ TYPE 3–Full scale Development
Applicant: � Y y Y� Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Zip: 97062 the following:
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Ph
Contact name: one:
SDPM Tom Cox 503-736-5419 • Streetwidening
• Mainline installation for Sanitary
Contractor:
Portland General Electric sewer, Storm sewer,Tigard water
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"
N/A only lnay be emailed to:
Engineer; rowPermits@tigard-or.gov
Address:
City/state: Zip: O
R STAFF USE ONLYr
Phone: Email: Case No.: PFZ2,0l9_000S q
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ 16,870.29 Additional fees: $
(within the public right-of-way) Application accepted:
1 t
Is work related to a LAND-USE DECISION? ❑ Yes M No By: k Date:
If so,please specify (MLP,SDR,SUB,etc.) case #: Applic 'on reviewed:
Adl VBy: Date:
Is work related to a BUILDING PERMIT? ❑ Yes R No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By:
SC Date:
I:\ENG\PermltApplications\pfl_application Rev.10/16/2017
City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of4
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 authorisation with this application. 17ranchised
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 et .
• 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.
uV-s _ 3 241
Applicant/Authorized Agent's signature Punt 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
.....,.,ten:,. ^c:ems.,:"`
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www tigard-or.gov 503-718-2421 • Page 2 of 4
-�.
4-3 ._ >
.( Z1 FTZ C.
PLA,
2011 Edition Page 85
Stationary Lane Closure with Flagging Diagram 320
00
ro
L
W cu
'offCL
O Z Cr L
M
LL
0
LU
UJ
cc
• U O� � 2
I • L D_AtY
1 t
j
tA IE E
< I r •
3
I
c •
I o 0
I
I
o'3~ I s0-
-
LLJL Q w o
m ([
Uj
in 9 b3
I t �� i m
U) ,�°
---- m
Sign Spacing and Buffer Lengths(feet) o
ERRATA: Posted S acing Between Signs Buffer w O z a.
Speed A B c Space o a p
20 50
Supplement Table 25 100 100 100 75
30 100
Y¢0
Updated:February 12, 35 125 350 350 350 150 O cc w
2016 40 cc 3�
8y:OROT1rjMc-Headway 45 186
Section 50 500 500 500 210
55 250
Si n S anti Buffer len the feet Su)p eme It
December 2411 Posted Spacing Between Signs "Buffer" Chapter 5
S geed A [3 C space
60 285
65 700 7030 700 325
70 365
106W LEGEND
WL2VT-6984: VVL 1 PL-5843: REMOVE/ABANDONFACiLITIES_INSTALL FACEFTIES
Install: �`� install: INSTALL ADDITIONAL F4CILlTIESMODIFY FACILITIES
1P 7.2 2401120 PM 75KVA NTLB2 UG PRI POLE#2AL(JKT)1P-142 C/O F25T UG TAP CONDUCTORS
16 ACCOUNTS 39 2005 '-emovf
SU39627-CONC.VAULT LID PADMOUNT TRF 48"x48"x6" 3a-4 UG PRI POLE#2AL(JKT)1P-142 C/O F40T N PROVIDED&INSTASTALL LLED OYPOE EPR JKT4D PRIMARY
ELBOW KIT-JKTD CABLE-#2AL 1994 1-2-CONDUIT
'PRONDD&INSTALLED BYPOEAPPROVED CONTRACTOR
SMALL FAULT INDICATOR VAR TRIP 200 A
12- MSTALL f-RUNAL 350RCM TXC-PHASE
U• ________ 'PROVIDED&INSTALLED BYPGE
1P 7.2 1201240 5U 75KVA NTLB X18 a" NEw2 RRtc. '•PROV DEDT&INSTALLED BY PDE APPROVED CONTRACTOR
d ` o1M4PY CABLE
CZ �(i�y,� .�ROUNO ABANDONED CABLE PER LC220157
i 1
� EQUIPMENT
10881 C7 FUSE 257
'IAD IPDMT TRNF 1P PAD UNIT RADIAL CONCRETE PADI
TENSION:SON
—�TENSION:38N C 25 79838
WI LUBE 1
5843
2 1--_____---_-_-C2AL_��iC2AL- -_-_ __-q,.�'L 5a-2 Q ABC 112569
75 3971 i N -- 218' 142 25 T 2005 A P614705 -
C 7 VT2984 - _-
50'ROW 70
501-2
SNQ0a1k 2OD5
-,
�t>a5\�� w 600 A
8189
111.77
�1 1P�g
1
I b
I 10735 3
I y
�I 174992-_ A1C
1
SU-2 1994 1513�
C 50 12407 vl 2005
c N
V'r-ew 3-142107.ped
r'iP0.34 42 15 T
3 C 50 199525
r�
ry
TIE 71 V7-72
c 600 A
9561
I2 ABC 750 qL 3X eC1
ABC 112 736 V PNap
-P0.17498 199432 VV
11 so; �1F1G H`t�
-t-o
WL 3 VT-6985-
Install:
T-6985 Install:
1 P 7.2 240/120 PM 50KVA NTLB
y�
6ACCOUNTSE��J''Q°a`'�, ryP�
SU39627-CONC.VAULT LID PADMOUNT TRF 48"x48"x6" eF`Oe°�v°s P0°
ELBOW KIT-JKTD CABLE-#2AL ,e5
Remove:
1 P 7.2 120/240 SU 50KVA NTLB
NOTE:LOCATE NEW PADMOUNT XFMR IN GRASS 6'BEYOND PARKING
EXTEND SECONDARIES FROM NEW XFMR TO VT-6985
x
n136560 7
0 20 40 80 Feet ®1 DF1R
I I I I 1 I 1 1 I
10900
Vaso
THINK PGE CONSTRUCTION DRAWNG
SAFETY ,.. .....,.,��.�1, SC
FIRST Foremen Date:
General Foremen: Date:
LANDSCAPING NOTESLB �l
SDPM.fJ+FG REVIEW ASBUlLT 8Y DESIGNER:
NY DEV1477ON FROM THIS DESIGN MUST
I DATE SCALE CLEAR 10' SWATH 180 BE APPROVED BY THE PCF PROJECT MANAGERI 3n2o16 1 aon 1070001 000001as26 Mz12a3zs
WIRE NEEDS REPLACED 1967 YEAR FAULT IN BEHIND BUILDING
DEGREES STREETSIDE CALL 811 BEFORE YOU DIG ` CSI SIZE
nENnON: WEST PORTLAND-NORTH 17 x 22
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTEDr�iG 8 !1/_'G' LOCA ON
AROUND POLE BY THE OREGON UTILITY NOTIFICATION CENTER. 10735 SW 69TH AVE,TIGARD OR 97223
THOSE RULES ARE SET FORTH IN OAR 952-001-0010 OES IPTION
THROUGH 952-Doi-0090 YOU MAY OBTAIN COPIES OF REPLACE PRI 02DB FRM POLE 5843 TO VT 6984 8 VT 6985 -F17
THE RULES BY CALLING THE OREGON UTILITY COLMTv SEC TIONS Ni1RM IM TN
NOTIFICATION CENTER ADMINISTRATION@(502-232-2987) WASHINGTON C1136A IOFI
TO REQUEST UTILITY LOCATES CALL THE OREGON Know�NIe111 "A�r"Te" sI v PHONE LnA�nMBy
UTILITY NOTIFICATION CENTER,811 AT LEAST Calbefinepoldig. urw<c"^''�"^"" TOM COX 503;67 O414 CHRISTOPHER SMITH
2 BUSINESS DAYS PRIOR TO EXCAVATION OP N G N RA TRIC Rr4fTS RESERVE[)