PFI2018-00320 A CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00320
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/28/2018
Parcel: SEG1939
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG 1939, associated with 10585 SW Murdock. Need permit for traffic control only. Excavation to occur
on private property.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
AMY SWEANY
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-612-2935
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/A ppl i cant S'U
Signature: A U lL T Z 0 *1U
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00320
Type: Condition Name: Status: Severity:
PFI_Sidewalk/[ 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_Sidewalk/[ 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—Sidewalk/1 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_Sidewalk/[ 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_Sidewalk/[ 05 -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_Sidewalk/[ 06 - 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_Sidewalk/[ 07- 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 Sidewalk/[ 08 -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 Sidewalk/[ 09 -OTHER Applied Notice
RECEIVED
City g of Tigard NOV 2 7 2018
CITY :)�T"CP,PD
a PUBLIC WORKS —ENGINEERING pI_.AN;�fs ii'1.+,1);VEERING
Public Facility Improvement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) 5/TYPE 1–Franchise Utility Work-
Check
orkCheck one: V Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
Detailed description: Need permit for traffic control only. and/or utility agency.
Excavation to occur on private property El TYPE 2—Sidewalk-/Driveway/Sewer
PGE Job M2630783 Work performed for the purpose of-
-
f- Sidewalk installation or repair.
10585 SW M U R DOCK ST - Driveway approach installation
Property address/location(s): and/or repair
TIGARD, OR 97224 - Sanitary sewer lateral installation
and/or main line tap
A licant: Amy Sweany for PGE El TYPE 3—Full scale Development
pp 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: Phone: - Street widening
- Mainline installation for Sanitary
Contractor: Portland General Electric sewer, Storm sewer, Tigard water
CCB#: 103663 Expiration: 12/21/18 and/or Tigard Water Service Area
Address: 10800 SW Avery Street SUBMIT COMPLETED APPLICATION TO:
City/state: Tualatin, OR Zip: 97062 City of Tigard
Phone: 503-464-7777 Email: Prere coord@P9n.com Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: N/A only may be emailed to:
rowDermits@iigard-or.gov
Address: =00i
City/state: Zip:
VE22difa-DdAPhone: Email: Case No.: —
Contact name: Application submittal fee(.007%of
Engineers Estimate) $
Estimated value of work is required(if over$5,000):$ Additional fees: $
(within the public right-of-way) ApplicB :�r Date: IS
—
If
ted:
.�Z�_
Is work related to a LAND-USE DECISION? ❑ Yes V'No y
so,please specify (MLP,SDR,SUB,etc.) case #: Application reviewed:
fy: 6-9 Date: 11-27-18
Is work related to a BUILDING PERMIT? ❑ Yes /No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: L Date:_11-d-A —
I:\ENG\PertnitApplications\pri_application Rev.10/16/2017
City ofTigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-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 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
12K012CM.
• 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.
Steve H u rsh 11/27/2018
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.tigard-or.gov • 503-718-2421 • Page Z of4
DEVELOPMENT ENGINEERING FEES FOR STAFF UISE ONLN
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
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
(including information below)
Engineer's estimate X 2%,Plan Review
❑ 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) (G sets,24x3G 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 may be ❑ Traffic Sight Distance
required per TMC IS.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 • wwwtigard-or.gov • 503-718-2421 • Page 3 of4
SAMPLE SKETCH:
Edge of Pavement
I
Ditch
Streetlight I .—.—.—.—.—.—.—.-r—.—
• Rain Drain
I I
a
T—�rop'os' d'SSwerTine'"
I '
Existing House
Existing
a� I g
>1 Driveway
01
WI ! 1
of I •
CL
a
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>I ! 1
°. I Existing Shop 1
� •J -
I
Powerpole I = I a 1
o - o
I I 95' 1
I -PrropertyLine
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Fire Hydrant(FH)
I I I
' I .
! Scale:
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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
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DATE TIME
ATTENTION: CALL 811 BEFORE YOU DIG
Permit needed for OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ,
THINK BY THE OREGON UTILITY NOTIFICATION CENTER.
THOSE RULES ARE SET FORTH IN OAR 952-001-0010
traffic control. SAFETY THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF
THE RULES BY CALLING THE OREGON UTILITY
Excavation to FIRSTI NOTIFICATION CENTER ADMINISTRATION (503-232-1987)
TO REQUEST UTILITY LOCATES CALL THE OREGON Know whcWs below.
UTILITY NOTIFICATION CENTER,811 AT LEAST Call before ou dl
re p i a r bad order 2 BUSINESS DAYS PRIOR TO EXCAVATION. rg.
PGE CONSTRUCTION DRAWING
underground wiII SDPWNG REVIEW: ASBUILT BY DESIGNER:
occur on private AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
This document accurately represents FIELD construction.
propeproperty• Foreman: Date:
rty.1 GF: Date:
DATE: 11127118 SCALE: N/A ACCOUNT:5940001 AWO:3000000658 JOB NO.M2630783
/// TITLE Portland General Electric
CIRCUIT KING CITY-BULL MOUNTAIN SIZE
1 1x17
PGE
/ LourloN Across from 10585 SW MURDOCK ST, TIGARD,OR,97224
DESCRIPTION
Permit needed for traffic confrof.Excavation to repair underground pnmery to occur on private property
RIGHT-OF-WAY PERMIT NOTICE,
A PERMIT FROM TOE LOCAL JURISDICTION IS REOUIREO BEFORE ANY COUNTY SECTION($) WORK WITH SHEET
WORK HV FWX"FOf-OfBE PERFORMED. ONLY PGE APPROYEU BEAVERTON Washington C2110A
CON TKAC TORS AND CON rRAC 10R3 WHO MAW MADE OrHER SPECUI r OF I
AGREEMENTS W?O PGE WILL Of ALLOWED r0 WLNM UNOER FGE'S PERMIT. UNE CREW CENTER DESIGN BY PHONE IS037DRAWN BY
THE CONTRACTOR MUST NOTIFY THE LOCAL JURLSOICTION 4S HOURS 2213 SW 153RD OR Amy Sweany 503-612-2935 Amy Sweany
Bf FORF WORK is TO BEGLN A COPY OF THE RERM/T MUST BE ON SIR.
BEAVERTON,OR 97006 p PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS 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
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