PFI2018-00169 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00169
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/12/2018
Parcel: SEG2623
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace car hit pole 90250
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
AMY SWEANY
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-612-2935
Total
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.
v
PermitteelApplicant
Signature:
Issued By: '
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00169
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 Jonny Glsh 971-713-0281 or Jonny@tigard-or.gov. **NO
WORK ON SW DURHAM RD PRIOR TO 9AM OR AFTER 3PM**
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 of Tigard JUL 0 3 2019
PUBLIC WORKS —ENGINEERING CIT` OF TIGARD
PLANNING/ENGINEERING
Public Fadhty Improvement PFI Permit
SPE of WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work
Check one: 9 Utilities ❑ Sidewalk/driveway approach ❑ Streetimprovenents performed by NWN, PGE
p
Detailed description: p car
Replace hit ole 90250 and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of-
PGE
fPGE Job M2550310 • Sidewalk installation or repair.
Property address/location(s): 7335 SW Durham Road Driveway approach installation
�y and/or repair
Tigard, OR 97224 �S' IPc5- Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric[Submitted by Amy Sweany] El 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: 97062 the following.
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Contact name: Rodrigo Solis Phone: 503-672-5417 • Street widening
• Mainline installation fox Sanitary
Portland General Electric sewer, Storm sewer, Tigard water
Contractor: and/or Tigard eater Service Area
CCB#: 103663 Expiration:
Address: SUBAUT COMPLETED APPLICATXON.TO:
City/state: Zip: City of Tigard
Phone: 503-464-7777 EmsPlanning/Englneen-4; 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
N/A only may be ern-ailed to:
Engineer: rowpermitsg,tigard-or_gov
Address:
FOR STAFF USE ONLY
City/state: Zip: y
Phone: Email: Case Nod ,/
Contact name: Application.submit fee(.000077]%of
Engineer s Estimate)
Estimated value of work is required(if over$5,000):$ 5,409.25 Additional fees
(within the public right-of-way) Application 2;- Aft*ed.
B �-'� Date: /
Is work related to a LAND-USE DECISION? F-1Yesd No y
application reviewed:
If so,please specify (MLP,SDR,SUB,etc.) case#: ! �d
By: Date: 8
Is work related to a BUILDING PERMIT? ❑ Yes [Y No Applicant notified::
If so,please specify(BUILDING PERMIT)case#: By: Date:
is\ENG\PermitAppllcations\pfi_application Rev.10/16/2017
CityofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 www.tigard-or.gov 503-718-2421 Page 1 of4
APPLICANTS
NO'T'E: 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 owners)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 APPLIC.ANT(S) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imgosed upon the subject
ro ei
• 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 exliibits 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 h -ead the entire contents of the application,including the policies and criteria,and understands the
requirement approving or denying the application.
pplicant/Authorized Age is 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 • wwwtigard-or.gov 503-718-2421 Page 2 of4
Page 96 2011 Edition
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Use Diagram 360 only on two-lane, two-way roads with a posted speed of 40
mph or less (unless not posted and speed governed by basic rule); and,
when there is sufficient lane and shoulder width to allow a minimum of 10
feet on each side of the work space.
1. When work vehicle(s) are in the work space, use truck-mounted
flashing lights on work and protection vehicles. Allow a sufficient
distance between the vehicle and work activity for safe run out if the
vehicle is struck.
2. Cones and signs shown are required.
3. A strobe or flashing warning light mounted on a Type II barricade may
be used just inside each end of the closed section.
4. The "Keep Right" (R4-7) symbol sign may be mounted on a portable
sign support or a barricade(if the sign-barricade combination has
passed NCHRP 350 or MASH crash testing criteria).
Sign Spacing and Buffer Lengths(feet)
PostetlSpacing4Between Si ns Buffer
�ry
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
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POLEa
POLE 90250
INSTALL NEW CONCRETE BASE
REPLACE CAR HIT ST LT POLE
WITH 30'ALUMINUM DOUBLE DAVIT POLE W/6' MAST ARMS
2—47W LED LEOTEK GRAY
CONNECT 240V
FUSE AT SOURCE IF POSSIBLE
NEED LOCATES, FLAGGERS, TCP, BOOM, VAC, GRAVEL FOR NEW BASE, POST LANDSCAPING POSSIBLY
***FOR QUESTIONS, PLEASE CONTACT LSDPM RICO SOLIS @ 503-672-5417***
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