PFI2018-00182 �� PUBLIC FACILITIES IMPROVEMENT PERMIT
tC" OF TIGARD
COMMUNITY DEVELOPMENT Permit#: PF12018-00182
s
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/19/2018
Parcel: SEG1094
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG 1094. Install ground wire and ground rod. PGE Job M2459004
Owner: FEES
Description Date Amount
PFI Permit Fee 07/19/2018 $300.00
PHONE:
Contractor:
PORTLAND GENERAL ELECTRIC CO
121 SW SALMON ST C/O LEGAL DEPT
PORTLAND, OR 97204
PHONE: 503-464-8852
FAX:
Applicant:
MEAGHAN MILLER
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-612-2873
Total $300.00
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: e_ ��'([
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00182
Type: Condition Name: Conditions
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
JUL 16 2018
City of Tigard CITY OF 7;3A n
'a PUBLIC: WORXS—ENGINEEIZING ,:_ �-3 ,
PLAN N I N G,�s.��,I I� �R I N f
Public Facili Im rovement (I'FI) 1'er�
tY n�t
p
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) ,'
L`7 TYPE 1—Franchise Utility t111ork
Check one: gUtiEties ❑Sidewalk/driveway approach ❑Streetimprovements performed by N\VN, PGF'
Install round wire and round rod and/or utility agency.
Detailed description: g 9
❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2459004 Work performed for the purpose of:
• Sidewalk installation or repair.
13535 SW Fern Street • Driveway approach installation
Property address/location(.): and/or repair
6 06 Tigard, OR 97224 • Sanitary sewer lateral installation
and/or main line tap
Portland General Electric Submitted b El TYPE 3–Full scale Development
Applicant: Y Am y 5wean Y1 Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Lip: 97062 the following:
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Mea han Miller 5p3-612-2873 • Street widening
Contact name: 9 Phone:
• Alainline installation for Sanitary
Portland General Electric sewer, Storm sewer,Tigard water
Contractor: and/or Tigard Water Service Area
CCB#: 103663 Expiration:
Address: SUBMIT.COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
503-464-7777 Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work iut iigli-of-way"
only may be emailed to:
Engineer. N/A
� ro342erinits 4.ti,�a� r.� c1=or.gor
Address:
OR STAFF USE ONLY
City/state: Zip:
Phone: Email: Case No
Contact name: on'submittal fec{007%0 of
Api�licau
Engineer s Estimate)
Estimated value of work is required(if over$5,000): N/A Additional fees $_ �®
(«ntlun the public Eight-of-%vay) Application accepted
By .:Datc
Is work related to a LAND-USE DECISION? ❑ Yes Pf No
Application review
If so,please specify (MLP,SDR,SUIS,etc.) case#:
$y'' .: Date
'
Is work related to a BUILDING PERMIT? ❑ Yes EV No Applic,,tnt potlfied
If so, Tease specify(BUILDING PERMIT)case#: By � (- Date,
1. sP ,
I:\ENG\PermitAppiicauons\pfi_application Rev.20/16/2017..
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City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 «rnwtigard--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 or a lessee in possession with written authorization from the owner or all agent of the
owner. The owner(s)must sign thus application in the space prodded or submit a written authorization with this application. Franchised
Utilities arc not rcrlttired to obtain the owners sijmature cru the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that nnav be attached to or imposed ul)on the subject
to.ei:
• If the application is granted,the applicant will exercise the rights granted in accordance Xvith 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,
rng" 61 "ey
Applicant/Authorized Ifnes 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
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PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard • 13125 S\V I-Iall Blvd. • Tigard,Oregon 97223 • x%,\vNutigard-or.gov 503-718-2421 • Page 2 of4
DEVELOPMENT ENGINEERING FEES e5E ONLY
Public Facility Improvement(PFI)Permit:
MITTAL
APPLICATION FEE41
Part 1: Requited submittal fee$300.00(rnirvnrum) FRANCHISE UTILITY AND SIDEWALK/
DRIVE'%VAY AND UTILI�I`Y
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right oay)
Engineer's estimate X 5%(less$300.00 r iu u'nurn
submittal fee) Sketch
(including inforination below)
Engineer's estimate X 2%Plan Review
l Iauriensions
WATER SYSTEM FEE [] Street,Narne
Part 3: All.public hater system improvements L1 Site Address
Engineer's estirnatc X 12%
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: {Subcirvision5/Paitrtions and Six 1mprovcmcnEs)
There will be no perinit fee charged,or assurance required
for the following types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (G sets,2434 or 22x34)
• Relocate or replace mailbox 0;:Cover.7-Site, 'rcrnit};abbreviation,Legend
• Ditch cleaning that does not involve regrading. I� .General
lot
s(Cate,Water,Server,etc)
• Weep Bole repair ❑.Street(Plan,Profile):
• Curl)repair or replacement(less than 20 lineal feet) .:Water,Storhi and Sanitary(Plan Profile}
• Lawn sprinkler system installation or repair 0 .Natee(�ualiry Facilities
• Street tree pruning or planting L7.'Uradin9.
'
• Planter:strip landscape inaintenance El Landscaping/:Tree Plan
• Test wells ❑:.Composite Utiliq,Plan(Electrical,Phone,
Storni,Sanitary,\X ater,Signage,Street Lights,ere)
11.Details
Note: A cash/bond assurance may be ❑ `Traffic,Siglit Distance
required per TMC1S.04.140. C] Sighing and Striping.
(cusionzer deposit) ID Street,U&Plan and Photometric
[� Engineers seal/signature
❑ ;.Sheet.label(prolect,land use Warne,revision acid.
plan Ing block,dates and sheet numbe>.s.)
Additional Submittals
(perLand.Use conditions)
0 :TiafficReport
toi m:water Drainage Calculations
>Geotechnrcal Rcp6rt
Cl Rcport.(Sight Distance)
Pzoposed Plat
Patliivay Design(iE appltcat�le} q.
(1 .\Vater,DepzrfinentApproval
.Engineer's Construction Estimate.
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PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • t«v-w.tigard-or.gov 503-718-2421 Page 3 of4
SAMPLE SKETCH:
Edge afPavetneiit
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Powerpole
Ca n
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1
Fire Hydrant(FH)
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e
0 Scale: 'i"=30'
1 ' �
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MINIMUM SKETCH REQUIREMEN'T'S(Put"N/A"if Not Applicable):
North arrow Property lines&dimension Slope of property
Street &street name(s) Existing building,structures UdhtNy,&street light boles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
[a. "r T_ tt'�.+:.�F�A�_3'"rs?�."'r;.� ." .._.-....-•- �a�..�'Sim:�.'aLesS_._.�':�a�..�_.�..�.Y?.:=i7-Ld�8i1';CT_':.NP'�'E�"-_QCs..-e @-?]'ti.'ext" -""".,.+F-.1��v..TL'�: -`n'�L..�-e.�:.."..:.<�Lih'„t'=Kr.Ck..-St::h'a..'"F:j1�1
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard - 13125 SSV I.1all BIvd. • Tigard,Oregon 97223 ° wwwtigard-or.gov • 503-718-2121 • Purge 4 of 4
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Diagram 620 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging, traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance (see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. `there should be one flagger for each approach. One flogger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections (fewer than 400
entering vehicles per day), one flagger may be used.
4. The "ONE LADE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues may be expected.
Sign Spacing and Buffer Lengths (feet)
� ... �. ��..��.c1ng� e,�tw effLsig is w
�,3 � E�\RATA e
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:oDOT Traffic-Raodway
50 500 500 500 210 Section
55 250
Signs Spacing and Suffer Lengths (feet) Supplement
--s
S e+ x 3 ms's'
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05 700 700 700 325
70
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12 ii5 3554 30'-4 ;� 1`
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43665
13925 05 C2104B 2128 1953
2267 L.
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1980 � � 3555 2159
B 28 19184 N 42 40 3 5-1
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-- -- _ 12700 Q
SW FERN ST 552
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