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PFI2019-00251 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 0 1 111 MI Request for Permit Action %/3/s zogr,,f TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ZrCity Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): EL CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: 00?5 Site Address or Parcel#: G 1.Y7 8 Project Name: PG Subdivision Name: Lot#: EXPLANATION: D p tc'-4C P•1 V — OV 0_,.b�.- Signature: LA►�l�I oYL/ Date: (5/ iq Print Name: A7(/-76(?0CS Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date /0,3 /, By if Refund Processed: Date /v'/4.. By . ' Invoice Processed: Date By Permit Canceled: Date fp By,cp9j.— Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1ZOS .doc \ Q I . RECEIVED O City of Tigard AUG 0 5 2019 PFI#:201q-CO2S-I ENGINEERING DEPARTMENT CITY OF TIGARD TIGARDPublic FacilitiePs'lft 'diT ent (PFI) Permit PROJECT INFORMATION PGE Job # M2753594 TYPE OF WORK Project name: B TYPE 1—Franchise Utility Work Brief description of project: Repair underground fault & conduct performed by NWN,PGE, or utility agency post-landscape (concrete repairs) ❑ TYPE 2—ROW Sidewalk/I)riveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 10985 SW MIRA CT, TIGARD, OR, 97223 main line tap ❑ TYPE 3—Full Scale Development Work S 131S performed with land use approval which I includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: PGE [Submitted by Amy Sweany] • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 10800 SW Avery Street water service area City/State: Tualatin, OR Zip: 97062 ❑ TYPE 4—Small Cell Technology Phone: 503-612-2935 ❑ TYPE 5—Tigard Triangle Email: preregcoord@pgn.com Phone: NOTE: Type 1 and 2 applications may be emailed to rowpermits n,tigard-or.gov. Contact name: Phone: Email: CONTRACTOR INFORMATION El Same as applicant Name: Portland General Electric CCB Number: Mailing address: 10800 SW Avery Street City/state: Tualatin, OR Zip: 97062 Phone: 503464-7777 Email: preregcoord@pgn.com ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? DYes ❑r No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 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 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license 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 must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I, the applicant,certify that: • To the best of my knowledge, all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. /94o.5'u„ea.,u, Amy Sweany for PGE 7/18/19 Applicant's or autCorized age is signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY Case No: pFI2OIG 1 )25/ Permit fee:# . Received by: Dater Approved by: ISrady Date: ( Notified by: Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee.See below for calculations. Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? ❑Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): 0 Small Cell 0 Macro ❑ Street Name ❑ Site Address How many install sites are proposed as part of this permit application? TYPE 3-Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: 0 Public Right-of-Way 0 Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 sly " -- '• F i Edge of Pavement . Ditch ----10"0 —•—•—•—•—•—•-r •— r• ,'; — •I 7. IIE roh • .1 I • ' T--Propos!dVel-TenWrr-- 1 hi.= I I CD ill I . Existing House ti 1 Existing 1 d >I • Driveway ml OP 1 1 Cl H I ' E • irl • a i 1 n1 m ' o� •J1 ! 1 1 Existing Shop i J L Powerpole ! I = a 1 �. 'o 0 •, 1a 95' I � I ---- ---------- I 1 r-1— -ProperlyLine \ I1 Fire Hydrant(FH) 1 1 iI Scale: 'I"=30' I I I I I I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer, storm,water) Street& street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4 '1 1 SW Derry Dell Ct .. 85011774 -- 11.15 _ 10331 7 PI 3551 i 0 sties 11026 \ ge., ,/,, = T. / g ,---- __....._ SW Park ST SW Park ST Baq` Q \ 5298 f SW 4/ ` 10985 Southwest F nr�s ,�,o,i I � GARD_,r� ,.. i Mira Court 1 ,0320 h FaUlt ,l7 ,o3Bo sw MIIac 1 7011774 13226rS\*iLyi.�;.• •,, SW Cock In i 71 I H f - l f i s 13355 . '.. \-- --- M. .y I Fe SW Fairhaven St SW Fairhaven St ' •'* _ /� - - - 1. Winterbo Quilts Q Tigard Anima 10985 SW Mira Ct err'- Repair underground fault & conduct post- POE CONSTRUCTION DRAWING landscape Foreman: Date (concrete General Foreman Date (Signature only required tor field construction changes./ repair) SDEANENG REVIEW LE ACCOUNT IASBUILT BY DDESIGNER JOB NO 7/18/19 M2753594 TITLE Portland General Electric CIRCUIT SIZE ATTENTION: CALL 811 BEFORE YOU DIG 11 x17 OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED 47PGE- LOCATION BY THE OREGON UTILITY NOTIFICATIONCENTER. 10985 SW MIRA CT,TIGARD,OR,97223 THOSE RULES ARE SET FORTH IN OAR 952-001-0010 AHINI\ ` DESCRIPTION THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF RIGHT-OF-WAY PERMIT NOTICE: Repair underground fault&conduct post-landsca a(concrete reE�8�y.) �� SAFETY A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRE,BEFORE ANY WORK Qwv%T THE RULES BY CALLING THE OREGON UTILITY IN THE RIGHT-OF-WAY MAY BE PERFORMED.ONLY PGE APPROVED COUNTY SECTIONS WORK WITH NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL Washington C2103D 1OF1 TO REQUEST UTILITY LOCATES CALL THE OREGON \FIRS j AGREEMENTS WITH PGE 1"°l BE ALLOWED TO WORK UNDER PGEs PERFIrt. tt110W What's below THE CONTRACTOR MUST NOTIFY THE LOCK JURISDICTION 48 HOURS eEAVERrax DESIGN BY PHONE DRAWN BY UTILITY NOTIFICATION CENTER,811 AT LEAST Caw=1 BEFORE WORN IS TO BEGIN.A COPY of THE PERMIT MUST BE ON SITE. N LME CREW CENTER Amy Sweanv 503-612-2935 2 BUSINESS DAYS PRIOR TO EXCAVATION oRvcoN clrr oa orw,'0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED Page 54 2011 Edition Pedestrian Accommodation Diagrams See Diagrams 5-7 and 5-8, below, for pedestrian accommodations in work zones. Pedestrian Accommodation Principles: 1. If the work impacts the sidewalk or pedestrian facility, provide a safe, accessible path, where practical, in accordance with the requirements of the ADA. 2. If not practical to match the width of the existing pedestrian facilities, maintain a 4-ft minimum width. 3. Unless a reasonably safe route can be provided through the work space, pedestrians should be appropriately directed with advance signing to cross the road. Do not divert pedestrians into travel lanes. 4. Install pedestrian closure or detour signing on Type II barricades. Make every practical effort to satisfy the following: • If work closes a sidewalk or sidewalk ramp, close sidewalks at a point where an alternate crossing point or route can be provided. Minimize the amount of out-of-direction travel for pedestrians. • Use a combination of"SIDEWALK CLOSED" (R9-9), "SIDEWALK CLOSED USE OTHER SIDE" (R9-10), "SIDEWALK CLOSED AHEAD CROSS HERE" (R9-11), and "SIDEWALK CLOSED CROSS HERE" (R9-11 a) signing to direct pedestrians to an alternate facility. • Where there are business destinations between the nearest crosswalk and the work area, close the sidewalk at the business access nearest the work area, where practical using the SIDEWALK CLOSED sign. Include the SIDEWALK CLOSED AHEAD CROSS HERE sign at the a nearest crosswalk prior to the closure. (73Q H Chapter 5 September 2016 2011 Edition Page 55 Pedestrian Accommodation, Mid-Block Diagram 5-7 The sidewalk should be closed at the nearest intersection on each side of the work area when a safe, ADA-compliant path through the work area is not available. SIDEWALK CLOSED SIDEWALK CLOSED AHEAD or CROSS HERE CROSS HERE 24x12 Type"W1" 24x18 (Mount on B(II)L) Type'W1' SIDEWALK CLOSED 24x12 Type'W1" (Mount on B(II)LR) (2 Reqd.) _ D O CD SIDEWALK CLOSED 0) SIDEWALK CLOSED AHEAD 4- or CROSS HERE --- CROSS HERE 24x12 24x18 Type"W1' (Mount on B(II)R) Type"W1" 12. September 2016 Chapter 5 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 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 /o\ o Wo 0 o) CO m Wa * $ 1 0 O � maU Q c • U O • � • �*el.- 1, ` • „,;(4,,, C L • �gm 1.. E16, -E I. (a_ amco illi II: j•, •O .�— Yr• Q o 1 V w 25 a. c_'o 1 vm °\cici�' 1 1r � o 1 03 Sign Spacing and Buffer Lengths(feet} $ t V 4-.9 \Posted Spacing Between Signs "Buffer” CSpeed A B C Space V\ O 20 50 V ZiO0c25 100 100 100 75 I 30 100 35 125 350 350 35040 150 p Y 9 45 180 0 0= 50 500 500 500 210 CC Q , 55 250 60 285 65 700 700 700 325 70 365 September 2016 Chapter 5 RECEIVED /0'3/‘ q City of Tigard AUG 05 2019 PFI#:Zoi�i-�2S I :• ENGINEERING DEPARTMENT AUG OF TIGARD TIGARD Public FacilitiePs'ATtti b'iF€' ent (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: PGE Job # M2753594 i TYPE t—Franchise utility Work Brief description of project: Repair underground fault & conduct performed by NWN,PGE, or utility agency post-landscape (concrete repairs) ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 10985 SW MIRA CT, TIGARD, OR, 97223 mainlnetap ❑ TYPE 3—Full Scale Development Work S 1 ej 131 R performed with land use approval which W includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening PGE [Submitted byAmySweany] • Mainline installation for sanitary sewer, Name: storm sewer, Tigard water, and Tigard Mailing address: 10800 SW Avery Street water service area City/State: Tualatin, OR Zip: 97062 ❑ TYPE a—Small Cell Technology Phone: 503 612 2935 ❑ TYPE 5—Tigard Triangle Email: preregcoord@pgn.com phone. NOTE: Type 1 and 2 applications may be emailed to rowpermits(rt).tigard-or.gov. Contact name: Phone: Email: CONTRACTOR INFORMATION ID Same as applicant Name: Portland General Electric CCB Number: Mailing address: 10800 SW Avery Street City/State: Tualatin, OR Zip: 97062 Phone: 503-464-7777 Email: preregcoord@pgn.com ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? ❑Yes 0 No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4 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 15.04.140. With the exception of a utility operating pursuant to a valid franchise or license 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 must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I,the applicant,certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. stp Amy Sweany for PGE 7/18/19 ApplicaKt's's or aut45orized as signature Print name Date Property owner's signature (if required) Print name Date Case No: pFIzolq-coZ$-/ Permit fee:if 360 Received by: A- Datc:15 1�"l Approved by: UrUdY Date: (K(71201 Notified by: Date: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PH Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PEI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? 0 Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): 0 Small Cell 0 Macro ❑ Street Name ❑ Site Address How many install sites are proposed as part of this permit application? TYPE 3-Must provide 4 sets of plans(sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: 0 Public Right-of-Way D Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) O Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details O Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) O Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat O Pathway Design O Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-otgov • 503-718-2421 • Page3 of 4 Q sw ,-1. .• S 1 Edge of Pavement �� Ditch —OP- Streetlight —•---•—•—•- -r—•— I R�ara' =/'�'��� ; 1Ii - .. i I • T -Pro'pos•irgewrnine —{ I I NI 1 Existing House I ii ! dr/ 1 ini a I `-1 .s0" 1 :� I i o >I \1 o . Shop Powee I I = 1`■ is 95- Fro a Line L -- • I • I I Fire Hydrant(FH) I i II Scale: 'I"=30' I I I I • TYPE 1 AND TYPE 2: 11I N 11'n1 SKETCH 121?QI'iRENII;NTS (Put N/A if not appFcable) North arrow Property lines&dimensions Existing utilities locations (sewer, storm,water) Street& street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-ocgov • 503-718-2421 • Page 4 of 4 • 17 S -� Mtn — _ N. B 5011Td I IOW Y/OHO ON' — • /Cal \ 7 e \\\\\ p' RIFT YYY > litS . - r_i - ) W *IG al — _ SW Pa�Y St SW ParkG, S. ` ''4 `L 11' s •10985 Southwest s m_Mof1 \ Iszas �,� 3 Mira Court r]N' a WS i i `1 tNW n SWMirap n aol/na 'I AL .-. SW CDT*to , WPC ` f L u" Jr > 5 Fa 1Me o — =ra r SW FahNRvm S SW rairNaVM SI 1 • WInterto Quilts Tigard Anirnz a i _-. - 10985 SW Mira CI 1 r,¢ III . .,d` 11 1 / _ y R, f :A - -ri. Repair underground fault & conduct post- POE CONSTRUCTION DRAWING AS-BUILT VERIFICATION 8 w ES®VIOLATIONS CORRECTED landscape Foreman: Date: (concrete General Foreman Date (Swakn oAl rsAAlirerd lot Reid analruibn aV .) repair) SDPM'ENG REVIEW IASB(NLT BY DESIGNER: DATE- 3OALE ACCOUNT AWO' NO 7/18/19 I M2753594 III LE \ Portland General Electric ATTENTION: CALL 812 BEFORE YOU DIG CIRCUIT SIZE OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED a t'GE LOCATION BY THE OREGON UTILITY NOTIFICATION CFNTFR. oal' �HIN\ 10985 SW MIRA CT.TIGARD.OR 97223 THOSE RULES ARE SET FORTH IN OAR 952003-0010 8 Yl 1, / DESCRIPTION THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF ' RIGLITOFWAY PERMIT ROWE THE RULES BY CALLING THE OREGON UTILITY {I SAFETY ADMIT FROM THE LOCAL ILRVJORp1 IS REQUIRED BEFORE ANY Wpta Repair undenround fault 8 conduct post-landsca oconorete repeOr a1 TIE RIGM#WAY FLAY PE PERFORMED.IRM PGE APPROVED COUNTY SECTIONS WITH NOTIFICATION TREQUEST TER ADMINISTRATIONOA THEOREGON "b CONTRACTOPS\FIRS j AmmonsiµD CONTRACTORS BEA WMam TO WORE OTHER SPECIAL �`�r Y Washington 1C2103D I OF 1 i0 REgUESi UTILITY LOCATES CALL OREGON wrtN NA WAS RE ALLOA®To WORK UL9l POEM rEwln, DT OR tlaG Call below DESIGN BY PHONE DRAWN BY UTILITY NOTIFICATION CENTER,811 AT LEAST Callt,etm you BEFORE RE WORKIISTDMM.A COPY CR TEMPER IRM N 2 BUSINESS OATS PRIOR TO EXCAVATION RNME WGWIsmeBN.AlGW anRlaLar ERnTSDN SIZE AV WARMER MW CFMER Amv Sweeny 503-612-2935 f as C PORTLAND GENERAL FI ECTRIG CO.ALL RIGHTS RESERVED Page 54 2011 Edition Pedestrian Accommodation Diagrams See Diagrams 5-7 and 5-8, below, for pedestrian accommodations in work zones. Pedestrian Accommodation Principles: 1. If the work impacts the sidewalk or pedestrian facility, provide a safe, accessible path, where practical, in accordance with the requirements of the ADA. 2. If not practical to match the width of the existing pedestrian facilities, maintain a 4-ft minimum width. 3. Unless a reasonably safe route can be provided through the work space, pedestrians should be appropriately directed with advance signing to cross the road. Do not divert pedestrians into travel lanes. 4. Install pedestrian closure or detour signing on Type II barricades. Make every practical effort to satisfy the following: • If work closes a sidewalk or sidewalk ramp, close sidewalks at a point where an alternate crossing point or route can be provided. Minimize the amount of out-of-direction travel for pedestrians. • Use a combination of"SIDEWALK CLOSED" (R9-9), "SIDEWALK CLOSED USE OTHER SIDE" (R9-10), "SIDEWALK CLOSED AHEAD CROSS HERE" (R9-11), and"SIDEWALK CLOSED CROSS HERE" (R9-11 a) signing to direct pedestrians to an alternate facility. • Where there are business destinations between the nearest crosswalk and the work area, close the sidewalk at the business access nearest the work area, where practical using the SIDEWALK CLOSED sign. Include the SIDEWALK CLOSED AHEAD CROSS HERE sign at the nearest crosswalk prior to the closure. Co a - Chapter 5 September 2016 2011 Edition Page 55 Pedestrian Accommodation, Mid-Block Diagram 5-7 The sidewalk should be closed at the nearest intersection on each side of the work area when a safe, ADA-compliant path through the work area is not available. SIDEWALK CLOSED SIDEWNK CLOSED Or AHEAD CROSS RIME ► CROSS HERE 24x12 ----- Type'W1" 24x18 -- (Mount on B(II)L) Type'W1' j�.... SIDEWALK CLOSED 24x12 YYY"` Type'W1' (Mount on B(II)LR) (2 Regd.) J � SIDEWALK CLOSED SIDEWALK CLOSED or AREAD ~— CROSS HERE CROSS HERE 24x12 24x18 Type"W1' Typel'W1' (Mount on BOOR) September 2016 Chapter 5 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 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 a ,. k 0 I �O 0 w c / 09 Q m rn !W • 4 t m o as ' ct ,4 . . CD CD C •• U O sr q t'a • irL • c p to O L I• d o ;: 1D6 • Ca • E : II • m6-g L! • 4 • L .J - Y• `+� _• O � f. c j tY Q�t ,i Sign Spacing and Buffer Lengths(feet) 4 y Posted Spacing Between Signs 'Buffer' 071Speed B B C Space \ O 20 50 �• O25 100 100 100 75 30 100 40 350 350 350 150 QY 245 180 0 0= 50 500 500 500 210 tr 3 Q 55 250 60 285 _65 700 700 700 325 70 365 September 2016 Chapter 5 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT v N Request for Permit Action /°/3/9- T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPemlits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ZiCity Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE �(attach �case fee schedule and provide explanation below). Permit#: P't�12-o -- O0-2.5 Site Address or Parcel#: SG 3'7 S Project Name: PG e Subdivision Name: Lot#: EXPLANATION: a,t n[�C� Signature: V � � Date: I`�j/ 101 Print Name: j(yI, LI v p y2i ` Refund Policy ``��JJ 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date By Route to Records: Date /p 3 /`' By .1 Refund Processed: Date /V/,. By .41Z 1C Invoice Processed: Date By Permit Canceled: Date f �z c/ By Parcel Tag Added: Date By I:\Building\Forms\RecPcmutAction_1Zh .doc