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PFI2018-00119 - g s:A City of Tigard COTVI iUNITY DEVELOPMENT DEP �RT11 ENT �}f� Re nest for PerActi t onnz@� 13125 SW Hall Blvd. Tigard, Oregon 97223 ® 503-718-2439 www.tigard-ori TO: CITY OF TIGARD ]Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@@ard-or.gov FROM: ❑ Owner 01 Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE'T'AKE ACTION FOR THE ITEM(S) CHECKED (�): CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit Site Address or Parcel #: ,/.std'�) Project Name: {!/ Subdivision Name: Lot #: EXPLANATION: Tmvea cAo6ei(j No wk h d Signature: Date: Print Name: Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: o Any fee which was erroneously paid or collected. © Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. o Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. mo (s s M=0mly Route to Sys Admin: Date By Route to Records: Date d 4-- B Refund Processed: Date By Invoice Processed: Date B Permit Canceled: Date B Parcel Tag Added: Date B L•\Building\Forms\ReclPermitAction_) 2314fdoc From: Amy Dee Sweany <Amy.DeeSweany@pgn.com> Sent: Monday,June 4, 2018 12:10 PM To: Agnes Lindor Subject: RE: City of Tigard Permit PF12018-00119, 14750 SW 72nd Ave, PGE Job M2464029 Hi,Agnes. Go ahead and void the permit. Thanks for everything! Amy Sweany E Administrative Assistant, PSLD•503-612-2935•503-612-6150(f) 10800 SW Avery Street Tualatin, OR 97062 Portland General.corn• Follow us on social @PortlandGeneral From: Agnes Lindor [mailto:agnesl@tigard-or.gov] Sent: Monday, June 4, 2018 6:53 AM To: Prereq Coord Subject: RE: City of Tigard Permit PFI2018-00119, 14750 SW 72nd Ave, PGE Job M2464029 ***Please take care when opening links, attachments or responding to this email as it originated outside of PGE.*** Hi Amy- Would you like us to void the permit?Thanks, Agnes From: Prereq Coord <PreregCoord@pgn.com> Sent: Friday,June 1, 2018 8:53 AM To: ROW Permits<rowpermits@tigard-or.gov> Subject: FW: City of Tigard Permit PF12018-00119, 14750 SW 72nd Ave, PGE Job M2464029 Good morning, City of Tigard Team. I trust this finds you well. We have been notified that this job has been canceled. Thank you for all that you do. Amy Sweany PGE Administrative Assistant, PSLD o 503-612-2935 e 503-612-6150(f) / 10800 SW Avery Street Tualatin, OR 97062 PortlandGeneral.com o Follow us on social @PortlandGeneral From: ROW Permits [mailto:rowpermitsC&tigard-or.gov] Sent: Tuesday, May 29, 2018 10:00 AM To: Prereq Coord; ROW Permits Subject: RE: NEW City of Tigard Permit Application, 14750 SW 72nd Ave, PGE Job M2464029 ***Please take care When opening links, attachments or responding to this email as it originated outside of PGE.*** Attached is your permit. Thank you, City of Tigard Public Facility Improvement (PFI) Permits Phone: (503) 718-2421 E-mail: romTermitsgtigard-or.gov From: Prereq Coord <PreregCoord@pgn.com> Sent: Friday, May 18, 2018 9:40 AM To: ROW Permits<rowpermits@tigard-or.gov> Cc: Prereq Coord<PreregCoord@pgn.com> Subject: NEW City of Tigard Permit Application, 14750 SW 72nd Ave, PGE Job M2464029 Good morning. Attached is the City of Tigard Permit Application,Job Sketch, and TCP for PGE Job M2464029. Thank you for all that you do. Amy Sweany PPGE Administrative Assistant, PSLD -503-612-2935-503-612-6150(f) 10800 SW Avery Street Tualatin, OR 97062 Portland General.com• Follow us on social @Portland General DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00119 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/29/2018 Parcel: SEG2020 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 14750 SW 72nd Avenue. Move secondary out of the climbing space. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: AMY SWEANY 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-612-2935 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 PF12018-00119 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 City g of°Ti and MAY 13 2018 n PUBLIC WORKS —ENGINEERING LIN OF TIGARD PLANNING/ENGI INIEERNG Public FacihtyImprovement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ,,.., ,{ � TYPE 1—Franchise Utility Work Check one: 21 Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE Detailed description: Move secondary out of the climbing space and/or utility agency. ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2464029 Work performed for the purpose of: • Sidewalk installation or repair. �, • Driveway approach installation Property address/location(s): 14750 SW 72nd Avenue and/or repair Tigard,OR 97224 • Sanitary server lateral installation and/or main line tap Portland General Electric Submitted b Am Swear ❑ TYPE 3—Bull 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 Contact name: Amy Sweany Phone: 503-612-2935 • Street widening • Mainline installation for Sanitary Contractor: Portland General Electric sewer, Storm sewer,Tigard water CCB#: 103663Expiration: axed/or Tigard Water Service Area 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" Engineer: N/A only may be emailed to: romVermitslr,dgard-or.gov Address: FOR STAF171TSE ONLY City/state: Zip: Phone: Email: Case No Contact name: application submittal fee(,007%of Engineer's Estimate).$ Estimated value of work is required(if over$5,000): NIA Additional fees: (within the public right-of-way) Application accepted; By: �� Date.. h Is work related to a LAND-USE DECISION? ❑ Yes Ga` No If so,please specify (MLP,SDR,SUB,etc.) case#: ApplicaOo hykwed: By: Date: Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified: ,� p If so,please specify(BUILDING PERMIT)case#: By: Date: I:\ENG\PermitApplltatiom\pfi_appllcation 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 requited by the city pursuant to TRIC 15.041.140. ,r With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and die applicant are different people,the applicant must be the purchaser of record ora lessee in possession with written authorization frons 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 CER'T'IFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or unposed upon the subject ro er . • 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 inany 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. 'Aa"tV/�4��- j444(Z Q( �i L 156-Y Applicant/Authorized Agents 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 ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • -,vwwtigard-or.gov 503-718-2421 Page 2 of 4 c •, CD 3 Q 3378 3G 750 AL ABO 555 AAC WR CHECKLIST �f y N4/0 AAC 5 ^4F = ITEM YES COMMENT y Ct' 13.2s 3 HOLEDIGGER _ 5; X43 3 3 MAN CREW TO BOOM X 068 Y MOVE MOVE BACKHOE ? PGE TRENCH - SECONDARY 81GVAC x u 4 gw u HANSEN LOCATES LN g Y y OUT OF STAKING FLAGGING y w sr cAI:n,Nal LN sHaKesal CLIMBING TREETRIM LANDSCAPE SPACE EASEMENT PERMITS XCilyogTlgard CC �9 TRAFFIC PLAN 0 f a sw a CVTSHEET Q Z a) E ovD Ya UG CIR.VER. Lir r���0 TRAN DOWON SHUN l CUSTOMER x SHUTDOWN DOOR HANGER SW KABLE 4 CONTACT COMPANY PH= C,+ DA?E TIME Cj� Marriott Portland 0� SW Bonita Rd Bonita Rd BATTENTION: CALL 811 BEFORE YOU DIG , v OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED McMenamins Cr Hunt CIL THINK BY THE OREGON UTILITY NOTIFICATION CENTER. c1 THOSE RULES ARE SET FORTH IN OAR 952-001-0010 John Barleycorns SAFETY THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF THE RULES BY CALLING THE OREGON UTILITY FIRSTI NOTIFICATION CENTER ADMINISTRATION @ (503-232-1987) TO REQUEST UTILITY LOCATES CALL THE OREGON Know what's below. Trader Joe's UTILITY NOTIFICATION CENTER,811 AT LEAST Call before oudi 14750 Southwest 2 BUSINESS DAYS PRIOR TO EXCAVATION. Y 9• 172nd Avenue PGE CONSTRUCTION DRAWING SDPMIENG REVIEW: ASBUILT BY DESIGNER: g AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED V 'hi, -c fely represents FIELD construcrlon. N Burma Rd Foreman: Date: G D GF: Date: DATE: 5/16/18 SCALE: WA ACCOUNT: 5930001 AWO 1000001400 JOB NO.M2464029 Sweet Tomatoes-Tigard TITLE SW Cardinal Ln � ` Portland General Electric CIRCUIT SIZE PGE 11X1 LOCATION 14750 SW 72nd Ave Tigard, OR 97224 t ` DESCRIPTION 3 MAN CREW TO MOVE MOVE SECONDARY OUT OF CLIMBING SPACE © RIGHT-OF WAY PERMIT NOTICE. A PERMIT FROM THE LOCAL JURISDICTION IS REOWREO BEFORE ANY COUNTY SECTION(S) WORK WITH SHEET v woRKINTHfprGHr-OF-WAYMAYREPERrORMEO ONLY PGE APPROVED BEAVERTON Washington C2112A 1 OF1 N Pacific Corporate Center CONTRACTORSANO CONTRACTORS WHO HAVE MADE OTHER SPECIAL LINE CREW CENTER PHONE AGREEMFNTSWTTH PGf WNL RE ALLOWED TO WORM UNDFR PGE'S PERMIT DESIGN BY (503) DRAWN BY ,. THE CONTRACTOR MUST NOTIFY THE LOCAL)VitWICTION b HOURS 2213 SW 153RD DR Amy Sweany 503-612-2935 Amy Sweany BEFORE WORK IS TO BEGIN A COMOF THE PERMIT MUS!RE ON SR If. BEAVERTON,OR 97006 10 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED www,invarion.com -c.-a' ..wc.,. y "`u r -` ,tt +as •,, -:rc i3':v- �u"i_; a"-> W •ra' {, ys u>+AM:,: ru N ie'': i ':-a.. t;,: M a.k,,..s"ra =,.3•,., 1 ,x's�,:se.* '4'.-.w�'Y`Y4-,ky.'s` 73`^1. Lift Diagram 430 shows work in the travel lane(s) next to a continuous two-way left turn lane with one direction of traffic diverted into the continuous two-way left turn lane. 1. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3 — Lights and Lighted Signs for exceptions. 2. For added visibility, a truck-mounted arrow board or PCIVIS in caution mode may be used. 3. When two or more travel lanes are reduced to a single lane before the diversion, each lane shall be closed separately. Layout traffic control according to MOT Standard Drawing TM 852 for 5-lane sections. 4.A shifting taper (L12) may be added in the diverted traffic direction across the continuous two-way left turn lane (as shown). This option is recommended when the speed is 45 mph or greater. Sign Spacing and Buffer Lengths (feet) ce •'r.- � ed�-_:A .lF .�l ..�',.�_;°i. 20 50 25 100 100 100 75 Supplement Table 30 100 35 350 350 350 125 Updated:February 12, 40 150 2016 45 180 By:MOT Traffic-Raodway 50 500 540 500 210 Section 55 250 Signs Spacing and Buffer Lengths (feet) Supplement #.l � ��, K3"tr�'?°''� 42°''o"t"' .f.�X+�''>r" ^' i�s'i� ;a�,� J�'nx�`�✓r„v_:ls•.kk'� �.arm. ixtCfiflN�'4 '1 RIN �52y wj��.` }+�'-P',,-w'f:vs'y� 4 ;.w■(*.s` -�.,'• 4+n a���.iKe u� .tr`�._`-t"",S a.:J.'. __;�,..,_....s....twm�i..x...ii_::.':..5-:x:.:., ui"+•,,.ix.?'_�_.a-xn'Y fr,.._wY.,,,,�...?.1:�•�?4s';3 60 285 65 700 700 700 325 70 365 www.invadon.com .,,,,€ ROA® WORK HEA® B t CENTER LANE CLOSED HEJAD A O Lf2 0 0 0 Buffer Protection Vehicle w TMA(both Optional) See Chapter 4 C A Buffer 0 0 U2 0 0 0 U2 o A 0 o ROAD WORK HEA