PFI2018-00231 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00231
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/05/2018
Parcel: SEG1585
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replaced poles#6444 and#1032 and replaced BO transformer. PGE Job M2109717.
Owner: FEES
Description Date Amount
PFI Permit Fee 09/05/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
AMY SWEANY
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-612-2935
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: J>^,,
JV
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00231
Type: Condition Name: Status: Severi
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 of Tigard
SE F 0 4 201
PUBLIC WORKS —ENGINEERING _
• rX 1'�� OF TIGA1 D
�•a ir.-rn
Public Facility Improvemetn (Pniff);i a �! . _ 1NG
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TYPE OF WORK
DESCRIPTION OF WORD(in the right-of-way)
IV TYPE 1—Franchise Utility Work
Check one: V Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE
Detailed description: `Replaced poles#6444 Ј & and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
replaced 134 transformer
PGE Job M2109717 Work performed for the purpose of,
• Sidewalk installation or repair.
14765 SW Sunrise Lane ° Driveway approach installation
Property address/location(s): and/or repair
Tigard OR 97224 1
• Sanitary sewer lateral installation
and/or main line tap i
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 3
City/state: Tigard, OR Zip: 97062 the following:
503-612-2935 rere coord n.com • Subdivisions or Partitions r
Phone: Email: P q @P9
Contact name: Amy Sweany Phone: 503--612-2935 ° Street widening
• -Mainline installation for Sanitary
Contractor: Portland General Electric
server, Storm sewer, Tigard water
103fifi3 and/or Tigard Water Service Area y
CCB#: Expiration:
s
Address: $UBIMT COMPLETED APPLICATION 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 romTermitsntigard-or.gav
41
Address:
FOR STAFF USE ONLYa
City/state: Zip:
Phone: Email: Case No '
Contact name: Application submittal fee
,. t
Engineer's Es**) $
Estimated value of work is required(if over$5,000):$ N/A
ddttional fees:4
(wid-in the public right-of-way) pphcation accepted
By Date.
V h
Is work related to a LAND-USE DECISION? ❑ Yes Rf No :
Application reviewed
If so,please specify (1VILP,SDR,SUB,etc.) case#: Date - s
B}'
Is work related to a BUILDING PERMIT? ❑ Yes [Vj No ppl. irotified
If so,please specify(BUILDING PERMIT)case#: By Date
i
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l:\ENG\PermitApplications\pfi_applintion Rev 10/15J2017
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City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • ww-'-'�tigard-or.gov 503-718-2421 Page 1 of4 I
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APPLICANTS
NOTE: Person specified as`Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
a
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 ora 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 Mvritten authorization with this application. Franchised
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
proper
i
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all die
4. {
conditions and limitations of the approval.
• All of the above statements and die 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. 1
IAMardi Gilkey 9/4/18 h
applicant/Authorized Ageds signature Print name Date
5
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 SSV Iall Blvd. • Tigard,Oregon 97223 • ,Vwtiv.tigard-or.gov 503-718-2421 Page 2 of
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DEVELOPMENT ENGINEERING FEES
FOR
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTALREQUIREMENTS4
APPLICATION FEE
Part 1: Required submittal fee$300.00 (minimurn)
FRANCHISE UTILITY AND SIDEWALK/ ;
DRIVEWAYAND UTILITY
PERMIT FEE
CONNECTIONS,ETC
Part 2: All non-water system improvements 1,,work in the ght of%vay) F. �
Engineer's estimate X 5%(less$300.00 minimum
submittal fee) Sketch
(rncludui2 information below)
Engineer's estimate X 2%Plan Review
❑ Dimensions
i
WATER SYSTEM FEE ❑ Street Name
Part 3: All public water system improvements El Site Address
Engineer's estimate X 12%
FUEL SCALE DEVELOPMENT �
PFI Permit Fee Exemptions: (5ubdivi5t6n5/Parti.tions and Street Improvements)..
There will be no permit fee charged,or assurance required
for the following types of work: Design Plans
(6 sets 24x36 or 22x30
• Sidewalk repair(less than 20 lineal feet) '
• Relocate or replace mailbox ❑ Cover-Site,1Ticinity,Abbreviation,Legend a
• Ditch cleaning that does not involve regrading. ❑ `General Notes.(City,Water,Se�ver,etc.)
• Weep hole repair ❑ S treet.(Plan,Profile)
• I
Curb repair or replacement(less than 20 lineal feet) ❑ lX ater Storm and Saruta (Plan Profile `
• Lawn sprinkler system installation or repair ❑ Nater Quality Facilities
• Street tree pruning or planting ❑ Grading ,
l
• Planter strip landscape maintenance ❑ Landscaping/Tree Pian
• Test wells C7 Composite Utility Plan(Electrical,Phone,Gas,
Storm,Sanitary,Nater,Signage,Street Lights,etc) 3
11 Details
Note: A cash/band assurance n2ay he ❑ Traffic Sight Distance
required per TMC 15.04.140. ❑ Signing and Striping.
(customer deposit) ❑ Street Light Plan and Photometric.
❑`E.ngineers seal/signature
❑ Sheet label(protect land use name,revision anal
Plan log block,dates.and sheet numbers)
b.
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AdditionalSubmittals. i
(per Land Use conditions)
❑ Traffic Report
❑ Storm xvater Drainage Calculations
❑ 'GeotechnicalReport
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat`.
❑ Pathlvay.Design{1f applkahle)
ElWatei Department Approval.
El Engineer's Construction Estimate t
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PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SSV Hall Blvd. Tigard,Oregon 97223 ,v,,v,.vtigard-or.gov 503-718-2421 • Fage 3 of4
SAMPLE SKETCH:
Edge of Pavement
Ditch
Strebtlight a =me!. a EMEN!a:.EM.. . .._r......�
Rain Drain
a
1 4 r
8
1 j
os cf'Sewer ine��
Jnr Ei€�st�n� House
Existing
>I 0 Driveway
751
;
a _ lk
41F
OL
39 I
• a 3
CL i
t
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(U•
>I
I.. Existing ShoF
•
r
Powerpole
C)
• o m �
— -------Fr opertjLni e- .-—-—-
---
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I Fire Hydrant(FH)
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Scale: 'I''=30'
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MINIMUM SKETCH REQUIREMENTS(Put"N/A"if Not Applicable):
North arrow Property lines &dimension Slope of property
F
Street &street names) Existing building,structures Utility&street light poles i
i
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (seNver,water,storm)
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PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 S`V Hall Blvd. Tigard,Oregon 97223 v wkv.tigard-or.gov 503--718-2421 Page 4 of 4
1
79 2 OF 170 y 11 Date 8/311201r,
14735 380 13815 13825 5 lr e23 - L0'-4 M2109717, outage 70366
1996 1996 g
2001 Replaced Poles#6444 8#1032
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1 0 1 1993 36 31
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`, 1 inch=96 FT
it ( 1993
14170 fi t 1408
0 37.5 A 150 225
1 Y I Feet
33
Y�. 25'a N Dan Discbr
-
VQ PGE date and poduM we far idormatoml purposes arty and may
1; gid 14 ¢ not have been prepared for lag*L engineedngor s rvsyhg pe pteas.
�1. Thera d the hF. ban should nvi.w or corout the prmary dots
- 1495 1 and informabo n s au ices to s saefta h the usability of th.tela nnNion'
P .a.d (� PGE Ias.t Geo Data ra ted survey accurate aM Is not intended fer
ED '' 4� 1i dos pts pu rpoa.s.The data rtaY co ata in PGE secure inMmeEon
14190 � 85 bat the user needs to be m complanoe with FERC ragulatum.
14210 / p 4 // 141 r5 Th.Dan may rot be ah.,.d.sold or given away beyondth e
J.,r-.� I N recipients oRice and operebons.My quesbons,plea se cor Kt
// Good Ibrs*N*bon,GIS su p.M.or.Ph on.507.736.5501.'
30 -4
5'4 1 93 m COPYRIGHT PORTLAND GENERAL ELECTRIC
14727 14719 14711 ALL RIGHTS RESERVED
993
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