PFI2018-00184 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00184
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/18/2018
Parcel: SEG1703
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG 1703.Replace Pole 5092. PGE Job M2551937
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PORTLAND GENERAL ELECTRIC CO
121 SW SALMON ST C/O LEGAL DEPT
PORTLAND, OR 97204
PHONE: 503-464-8852
FAX:
Applicant:
JOSHUA DORNON
10800 SW AVERY STREET
TUALATIN, OR 972062
PHONE: 503-612-6150
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:
s\\
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00184
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-WORKSITE 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 Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov
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
tU1V
JUL. 17 2018
�)Ig ofTigard
�.��
CITY OF;E;�l iGAI_lrj
M PLANNING1C!N3�
PUBLIC WORKS ENGINEERING
y I M Public Facility Improvement (PFI) Permit
TYPE OF WORD
DIESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work
Check one: V Utilities ❑Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
p
Detailed description:
Replace Pole 5092 and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
PGE Job M2551937 o Sidewalk installation or repair.
° Driveway approach installation
14109 SW 93RD Ave
Property address/location(s)• and/or repair
® Tigard, OR 97224 o Sanitary sewer lateral installation
and/or main line tap
Applicant: PGE [Submitted by Shanea Hardeastle] ❑ TYPE 3—Full scale Development
pp Work performed with Land use
Address: 10800 SW Avery ST approval which includes any of
City/state: Tualatin, OR Zip. 97062 the following:
Phone: 503-612-6150 Email: PreregCoord@pgn.com o Subdivisions or Partitions
Contact name: Joshua Dornon Phone: 503-718-6343 ° Street widening
o Mainline installation for Sanitary
Contractor:
Portland General Electric sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: 103663 Expiration:
Address: SUBMIT COMPLETED APPLICA'T'ION TO:
City/state: Zip: City of Tigard
Phone: 503-464-7777 Email: Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: NSA romTermitsktigard-or.gov
Address:
City/state: Zip: gem�'�unOo`!��
Phone: Email: Case No.: (:Z01$ 00M
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ N/A Additional fees: $
(within the public right-of-way) Application accepted:
By: Date: ! I I I
Is work related to a LAND-USE DECISION? ❑ Yes No
If so,please specify (MLP,SDR, SUB, etc.) case #: App��li®®cacio reviewed: ,
By: ll�►1Ta5I,P./C-Date:'
Is work related to a BUILDING PERMIT? ❑ Yes 61 No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: 1�- Date: 77�
I:\ENG\Permit Applications\pfi_application Rev.10/16/2017
City ofTigard o 13125 SW Hall Blvd. o Tigard,Oregon 97223 www.tigard-or.gov o 503-718-2421 o 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 Cit}T 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 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 CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
prove
• 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.
V� 1 ® Digitally signed by Vinh D
Nguyen,PE
Date:2
Nguyen, P E 07'001
018.07.1615:58:07
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 name Date
PUBLIC FACILITTY IMPROVEMENT PERMIT
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 0 wwwtigard-ongov 503-718-2421 • Page 2 of4
DEVELOPMENT ENGINEERING FEES o . STAFF-U-J§E ONLY
Public Facility Improvement(PFI)Permit: TAIILI�® ,
APPLICATION FEE
Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$300.00 minimum
submittal fee) Sketch
Engineer's estimate X 2%Plan Review (including information below)
❑ Dimensions
WATER SYSTEM FEE ❑ Street Name
Part 3: All public water system improvements ❑ Site Address
Engineer's estimate X 12%
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: (Subdivisions/Pat 0.6 on s and Street Improvements)
There will be no permit fee charged,or assurance required
for the following types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (6 sets;24X36 or 22x34)
• Relocate or replace mailbox ❑ Cover—Site,Vicinity;Abbreviation,Legend
• Ditch cleaning that does not involve regrading. ❑ General Notes(City,Water;Sewer,etc.)
• Weep hole repair 0 Street(Plan,Profile)
• Curb repair or replacement(less than 20 lineal feet) ❑ Water;Storm:and Sanitary=(Plan Profile)
• Lawn sprinkler system installation or repair. ❑ Water Quality Facilities
• Street tree pruning or planting ❑ Grading
• Planter strip landscape maintenance ❑ Landscaping%Tree Plan
• Test wells ❑ Composite.Utili_t3=Plan(Electrical,Phone,Gas,.
Storni;Sanitary;Water,Signage,Street Lights,etc)
❑ Details
Note: A cash/bond assurance may be ❑ Traffic Sight Distance
required per TMC 15.04.140. 0 Signing,and Striping
(customer deposit) ❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
planlog block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
El Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
El Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
❑ Engineers Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page.3 of4
SAMPLE SKE'T'CH:
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[ Ditch
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MINIMUM SKETCH REQUIREMENT'S(Put"N/A"if Not Applicable):
North arrow Property lines &dimension Slope of property
Street &street name(s) Existing building, structures Utility&street light poles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. a Tigard,Oregon 97223 • NvwuTtigard-ongov • 503-718-2421 . Page 4 of4
Page 84 2011 Edition
its �®nary aye Ca®sure weth �S:a`Jga g r,: ®.1 gr 3-2-0
Diagram 320 covers total closure of one lane of a two-lane, two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads (less than 400 ADT)with good
sight distance as discussed below.
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 PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater,when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4) should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the"Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD" (W20-4)sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
————————————————— —————CD
o, I 1 O
Single Flagger Operation4=Z,
for Low Volumesy PREPARED .
N W N a ( (ADT<400) ro sroPROAD
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L a H A I� I� TO STOP AHEAD a
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ROAD
w/TMA(both Optional)
WORK See Chapter 4
AHEAD ��'`
BE
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AHEAD TO STOP Ya,.
CD N' CD
00
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-- — 1 'b2 OVERHEAD LEGEND
WL 1 PL-5092;FTR OWNED POLE 67
Install: #34115 30'-Unknown
PL 45'-3 200 SW HILLVIEW CT REMOVE/ABANDON FACILITIES=INSTALL FACILITIES
4'SOUTH INSTALL ADDITIONAL.FACfL JT1ES/MODIFY FACILITIES
1 P 50KVA OH 1201240 72 NT1 C8 ,RMV 2 PRI X
11 ACCOUNTS _RMV 2'SEC -- B 350 At -
22.33 KW RMV 2'SEC I P 52 r.
142 C/O F10T UG TERM 9295 PD-53
3422
Al(EXISTING)-L24'-10,363# '�'`) 35'-4 ` - ---- — 1 WORK LOCATIONS
G16-PRI-3,766# `;`..-'\j+L 0
G16-SEC-3,148# C2 1-02D 9 24
(2)2-IN PVC CONDUIT UNIT ANEW 2-PRI i -------' SURVEY GRID BOUNDARY
2AN PVC COND UNIT W/12"BKTS CHEW 2-SEC W `� 9252-- 9206
Remove: NEW 2'SEC
PL40'-4 '
1P 50KVA OH 120/240 7.2 NT1CB >
142 C/O F10T UG TERM ='I POLES
G16 x ! �—POLE CLASS(1,2,3,4,H1,H2,S)
(2)2-IN PVC CONDUIT UNIT B 15 42611 VT-78- ---_
----. HT CL
1_ ;
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ITEMP TRANSFER COMM(S), 35'-U own POLE HEIGHT
PGEPULLED 2006
❑TOPPED TO COMM(S) e..R 142>40 .,.® ,,,,, „d��+.�.....,,.�.�..�...�..._...�..
TELCO TO PULL 5091 SW MCDONALD ST
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PGE CONSTRUCTION DRAWING
AS-BUILT VERIFICATION B NESC VIOLATIONS CORRECTED
Th,dowmenl acw at,Iy represents FIELD Cn
Foreman: Date:
THINK General Foreman: Date:
SAFETY (Signature only required for field construction changes)
SDPM/ENG REVIEW.' ASBUILT BYDESIGNER:
NY DEVL4TION FROM THIS DESIGN MUST FIRST 7/10/2018 1 n�=70 ft A 1070001 A 000004545 J M2551937
BE APPROVED BY THE PGE PROJECT MANAGER TITLE
Replace PGE pole 5092(ASAP)for M2335934
CALL 811 BEFORE YOU DIG CIRCUIT SIZE
ATTENTION: TIGARD-13337 17 x 11
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED �� ��� LOCATION
BY THE OREGON UTILITY NOTIFICATION CENTER. � 14109 SW 93RD AVE,TIGARD,97224
THOSE RULES ARE SET FORTH IN OAR 952-001-0010 k". DESCRIPTION
THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF a e ` Replace B/O Pole SHEET
THE RULES BY CALLING THE OREGON UTILITY t COUNTYSECTIONS WORK W17H
NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) WASHINGTON C2111A 1 OF 1
TO REQUEST UTILITY LOCATES CALL THE OREGON KnOW Whaftbeklm wxsoRw, DESIGNBY PHONE DRAWNBY
UTILITY NOTIFICATION CENTER,811 AT LEAST Call befOfeywft -CR—CENTER JOSH DORNON 971.338.3703 STEPHANIE MCKENZIE
2 BUSINESS DAYS PRIOR TO EXCAVATION WL SN90ECKNANRD m PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED