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PFI2018-00299 sn CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12018-00299 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/08/2018 Parcel: SEG313 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: SEG 313/294/ 11540 SW Glenwood Ct. Install conduit and underground cable. PGE Job M2167484 Owner: FEES Description Date Amount PFI Permit Fee 11/08/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: TOM COX 10800 SW AVERY STREET TUALATIN, OR 97062 PHONE: 503-464-7777 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: See application Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00299 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 of Tigard NOV 0 5 2018 PUBLIC WORKS —ENGINEERING i CIT": ,;►<�,`�?►�7 Public Fadhty Improvement PFI Per-' r _y i i4EERING TYPE OF WORK DESCRIPTION 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 Detailed description Install conduit and underround cable : and/or utility agency. ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2167484 Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation 11540 SW Glenwood Ct Property address/location(s): and/or repair :612) Tigard, OR 97223 • Sanitary sewer lateral installation and/or main line tap Applicant: Portland General Electric El 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: 503-464-7777 Email: preregcoord@pgn.com • Subdivisions or Partitions Contact name: Tom Cox Phone. 503-736-5419 • Street widening • Mainline installation for Sanitary Contractor: TBD– Permit needed for bid walk sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: Expiration: 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: NSA only may be emailed to: rowFermitsntiga�r.gov Address: City/state: Zip: Phone: Email: Case No.: DOOM Contact name: Application submittal fee(.007%of Engineer's Estimate) $ Estimated value of work is required(if over$5,000):$22,962.13 additional fees: $ �o (within the public right-of-way) Application accepted: By' Date: It Is work related to a LAND-USE DECISION? ❑ Yes Q,No Application reviewed: If so,please specify (MLP,SDR,SUB,etc.) case #: By: Date: Is work related to a BUILDING PERMIT? ❑ Yes VNo Applicant notified: If so,Pleasespecify(BUILDING PERMIT)case#: By: 6 Date: I I:\ENG\PermitApplications\pkapplication Rev.10/16/2017 City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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 required by the city*pursuant to TMC 15.041.140. w 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 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 APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject ro er . • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and sub)ect 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. Vinh D Nguyen, "I"llysi nedbyVinhD NguyePE PE Date:2018.11.01 12:50:14 -07'00' 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 BIEvdlE5+4Y.f ;�i3.'-*FM'r"+'R.Ya`iab=>;'.:k76S+Y4�+:=kiYA"-�"i'83c!.'Ctlka�riC'iY�.JK9H#llK..•,M11a�4mF3A.:tx..4Tc�t�E�aa^I36P`h3:k:4Sbl4w4€:s�+`,3=Co_eiCs1A' AIB,N:98a'::�. "...� - '''Fi'/MW. '.A PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of4 DEVELOPMENT ENGINEERING FEES FOR STAFF FSE' ONLY Public Facility Improvement(PFI)Permit: DETAILED _ APPLICATION FEE REQUIREMENTS 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/Partitions 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 2204) • 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 ❑ 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 Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc) ❑ Details Note. A cash/bond assurance maybe ❑ Traffic Sight Distance required per TMC 15.04.140. ❑ Signing and Striping (customer deposit) ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(pro)ect land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval ❑ Engineers Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of4 SAMPLE SKETCH: Edge of Pavement I I Ditch Streetlight I ■!■!■!.!■�■!■!.!r!■� Ram Draal � a ' Tl r pas d,SowerT'ne" � I T 1 � � Q0 .N I� r„1 . Existing House I I i I Existi n g 1 Driveway 01 �J a o CL, I co 0 Existing Shop C" ■ CD Poerpole I =� I I� 95! 1 Property L ne" � I . I I Fire Hydrant(FH) I � I � Scale: 1"=30' � � I � I I I I � I . � I I MINIMUM SKETCH REQUIREMENTS(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. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page 4 of4 WL 1 14750: LEGEND Install; ELBOW KIT.lICTD CABLE-#2AL i---- TENSION:117# REMOVE/ABANDON FACILITIES M INSTALL FACILITIES 10650 11595 TENSION:11041575 11555 INSTALL ADDITIONAL FACIL177ESIMODIFY FACILITIES W1 LUBE 11535 11605 gq 1� 1 WORK LOCATIONS CONDUCTORS ABANDON PRIMARY CABLE 11625 `1\�` 0 -GROUND ABANDONED CABLE PER LC22035-7 D LOOP r 30 INSTALL CO#2 AL EPR JKT-O PRIMARY 11645 2013 SW 14AZELWOO ; 1976 e_ - 'PROVIDED d INSTALLED BY PGE 115 1.2"CONDUIT PROVIDED d INSTALLED BYPGEAPPROVED 01 CONTRACTOR O 7' VT-14 ti EQUIPMENT _ m 1166` I ` INST SMALL FAULT INDICATORS)VAR TRIP 200 A I 30' 1 11600 C70 1149 76 1 80 cG0 11685 V + C1 1-346 11520 O 11610 LANDSCAPING NOTES WL1 VT-14750: 6so PRE-LANDSCAPE, 11570 � CLEAR IVY AT VAUL y 655 30'- 1976 480 ti 670 i 11530 30'-4 11660 I 976 I T- 11720 O �0., 1166° '10 Cu DX 50 17251 11460 cL 6?0 2 11475 ' 11. 0 5017267 11550 0 35 70 '41 140 a wL z VT-14751: 1474 Install: 11485 ELBOW KIT-JKTD CABLE-#2 AL N n _t 5 VT-1 7357 VT-124 C 12131 549 G PD-155 9� -1111:7'1 P__3505 C 167 17 C 108 4724 54 VT-17356 y G-�G C 75 733 L-350 124 0-29 Vr_12 PD 15134/33 623E BIP -3505 ASC 306 347W C 100 456 PL. so L-2895 C) Q, THINK PGE CONSTRUCTION DRAWING A 100 5 51 t3�161 C 25 77115 Pt.44 - AS-BUILT VERIFICATION 8 NESC VIOLATIONSCORRECTED —c 0-15030 Vr_1233 SAFETY „ ,«n �,... PD-15 P�' A 50 1lS2! VT-14E 52 PL-351 L75 56 Z P),-4512P Vr.12332 A P FIRST Foreman Date A FL-3514 '' D-1 1 100 3834 General Foreman: Date: L-3515” 19627 50 17151ORK IeA752 P (Signature on required for Ifeld construction changes) -15028 Cf1 172! C 1 1-34A SOPIWENG REVIEW SBUILT BY DESIGNER: P°-1 Pt-1 i Vr-146 NY DEVIATION FROM THIS DESIGN MUST VT-15 I 6/28/2018 1 in=60 ft 1070001 0000014628 M2167484 yr 14749 X11721 1 �0G +deet 75 3e REAPPROVED BY THE PGE PROJECT MANAGER REPLACE B/O#2 37 P-12150 50 17267 4748 O I CALL 811 BEFORE YOU DIG ` CI CUI SIZE PO-18 ATTENTION: PROGRESS ROBINSON 11 x 17 V7-1594 306 33 0 C" I� OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , �r LOCATION PL 12 51 -/ VT-14753 vr1 I BY THE OREGON UTILITY NOTIFICATION CENTER. / 11540 SW GLENWOOD,TIGARD,OR,97223 625 _ 0 C 50 1726! a 30" THOSE RULES ARE SET FORTH IN OAR 952-001-0010 ` DESCRIPTION B0 G THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF DESCRIPTION:REPLACE B/O#2 X-ING ON SW GLENWOOD CT SHEET V7-1503 -VT-1 G PGE THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS WDRKWITH NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) WASHINGTON C1134B 1 OF 1 DATE:06/28/2018 1S-1 W-34NW TO REQUEST UTILITY LOCATES CALL THE OREGON Kr&W Whets lbw. MEAVER70M DESIGN BY PHONE DRAWN BY UTILITY NOTIFICATION CENTER,811 AT LEAST Callbetoreyou dig. LINE CREW CENTER TOM COX I PATRICK DECASTRO DESCRIPTION:REPLACE BIO#2 ROAD CROSSING ON SW GLENWOOD CT 2 BUSINESS DAYS PRIOR TO EXCAVATION 'Iz T"'R°°" ©PORT ND G N RA L CTRIC CO.-ARIGHTS RESERVED Page 84 2011 Edition Stationary Lane Closure with Flagging Diagram 320 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 September 2016 m �— --------------------� No �^' �^ Single Flaer Operation '; N v m a v+to a a w w N�, M I (oprmrl m a a �, ggfor Low Volumes "WAR (Optional) o a Nm I (ADT<400) TMO srov can I o: n 0 0 L. o > I 7 I I BE � � FIAGOEA ONE LANE > I ROAD A v e c I PREPARED " W Y �° m I P► I� 1► 20 I TO STOP AHEAD r 0 0 0 o m >? c I r i'"M' i h n � Q �' I —► — — •1B®�•— — —�— I ROAD CD WORK 0 0 0 0 K o K s K a K A N I AHEAD s I "I I Q Prct@Cft V"11Id" N W I V#T"M-h 00-0 I N A B 1-- '------ ---------I 1 mile _I 4 TI r max. B I- ATT Buffer Protection Vehicle ROAD w/TMA(both Optional) WORK See Chapter 4 _0 !� AHEAD BE (p ONE LANE ROADPREPAREDTO Two Flagger Operation �. AHEAD m � U, (Optional) p vim, CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT !is COMMUNITY DEVELOPMENT Permit#: PF12018-00299 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/08/2018 Parcel: SEG313 Jurisdiction: Tigard Site address: PERMIT REPRINT Subdivision: Lot: ADDED CONTRACTOR Project: PGE Project Description: SEG 313/294!11540 SW Glenwood Ct. Install conduit and underground cable. PGE Job M2167484 Owner: FEES Description Date Amount PFI Permit Fee 11/08/2018 $300.00 PHONE: Contractor: LOY CLARK PIPELINE CO PO BOX 1369 TUALATIN,OR 97062 PHONE: 503-644-2137 FAX: Applicant: TOM COX 10800 SW AVERY STREET TUALATIN,OR 97062 PHONE: 503-464-7777 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: <y(:7Q_ to I t Issued By: A6W &zL Special Conditions{See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00299 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 worm 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_Ublities 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_Utilibes 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-PERMITIPLAN 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 anylall assignment changes. PFI—Utilities 21 -OTHER Applied Notice AM Cwi-tyada2_ City of Tigard N PUBLIC WORKS — ENGINEERING Public FacilityImprovement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) TYPE 1—Franchise Utility Work Check one: Vutilities ❑ Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE Detailed description. Install conduit and underground cable and/or utility agency. ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of- -Job M2167484 • Sidewalk installation or repair. Property address/location(s): 11540 SW Glenwood Court • Driveway approach installation and/or repair Tigard, OR 97223 • Sanitary sewer lateral installation and/or main line tap PGE Submitted b Am Swean for Tom Cox ❑ TYPE 3—Full scale Development Applicant: � 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: Tom Cox Phone: 503-736-5419 • Street widening • Mainline installation for Sanitary Y p Contractor: LO Clark Pipeline sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: 52281 Expiration: 1/28/2020 Address: 19020 A SW Cipole Road SUBMIT COMPLETED APPLICATION TO: City/state: Tualatin, OR Zip: 97062 City of Tigard Phone: 503-644-2137 Email: ben.jurgensmeier@loyclark.com Planning/Engineering 13125 SW Hall Blvd. Contact name: Ben Jurgensmeier Phone. 503-720-9003 Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: NIA only may be emailed to: rg=ermits(&_jjgard-or.gov Address: City/state: Zip: imlis 10i_ Phone: Email: Case No.: RE12D) Contact name: Application submittal fee(.007%of Engineer's Estimate) $ Estimated value of work is required(if over$5,000):$ Additional fees: $ (within the public right-of-way) application accepted: Is work related to a LAND-USE DECISION? ❑ Yes VNo By: Date: If so,please specify (MLP,SDR,SUB,etc.) case #: Application reviewed: By: Date: Is work related to a BUILDING PERMIT? ❑ Yes VNo Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date: I:\ENG\PennitApplications\pfi—application Rev.10/16/2017 FJ.4 ,.._.._...,iYias[=,iHRE: .. - x. +.• +...xw-...a _ •—- TS .. - _ _ l3t4 Jit"�+:"Y-.s_=n>,N;v,. a....,,r.•ti,ery ln:. .:...y...c ;.,.,,. .:.s,..:.. :... :;..'. x^6.ri7F.u'Y�+'r'.- _�W�}10.^sF�Rtl '$ �tW"i5`d9Aff _ _ _ City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-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 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 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 owners signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that mays be attached to or imposed upon the subject 12101M • 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. 15&41¢.0t, (f rz4wlli Steve Hursh 12/14/2018 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 FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tlgard-or.gov 503-718-2421 • Page 2 of4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONIN Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REQUIREMENTS 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 120/o FULL SCALE DEVELOPMENT PFI Permit Fee Exemptions: (Subdivisions/Partitions 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 ❑ 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 Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc) ❑ Details Note. A cash/bond assurance maybe ❑ Traffic Sight Distance required per TMC 15.04.140. ❑ Signing and Striping (customer deposit) ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of SAMPLE SKETCH: Edge of Pavement I I — Ditch — ' Streetlight I .—.—.—.—.— .--.—.—r—•— Rain rmizi I I . ' T ' 'io jos cl"SeweiTne , I Q.) Existing House Existing 1 I >i Driveway . al I �i l 1 CI R I 01U-) LI I 01 I I I "I ' > ;I i 1 0 N� Existing Shap � Powerpole • a I� ■ -gape t Line- I 0 Fire Hydrant(FH) I � I Scale: "I"=30' � I � I I I I I I . I I I MINIMUM SKETCH REQUIREMENTS (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. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4