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PFI2021-00302 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT ■ Permit#: PFI2021-00302 COMMUNITY DEVELOPMENT Date Issued: 08/24/2021 T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG573 Jurisdiction: Tigard Site address: Lot: Subdivision: Project: PGE PFI job M2969013 Project Description: PGE to install reconductor for 21 poles and install avian guards FEES Class of Work: Date Amount Description Type 1 -Utilities(gas, electric, data) PFI Permit Fee 08/24/2021 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tioard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: KEN MALONE 2213 SW 153RD DRIVE BEAVERTON,OR PHONE: 5034634335 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. PermitteelApplicant Signature: See application Issued By: I t l c-tfr 16‘7)60 iki Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2021-00302 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 The work area and approach roads shall be maintained in a clean condition,free from obstructioplied ns and hazards.Notice Thespreading 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 oce Prior to starting work, effective and approved erosion control devices must be installed and maintained meetingtthe 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 Noce 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 ied Applicant shall provide traffic control according to the current edition of the"Manual on Uniform TrafficControl D vtices [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 Applid Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at thelce 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 Public roadway shall not be closed to traffic, at any time,without obtaining written approvalAppliedfro PublicNotice the City The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, rges dents 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 ADVANCE WARNING ied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours (min.) before initiation of construction work. PFI_Utilities 09-TRAFFIC CONTROL PROPERTY ACCESS Alied Notice Access to existing properties shall be maintained at all times, including normal delivery sere ce and mail service. Obtain City approval of any access closures. PFI_Utilities 10-TRAFFIC CONTROL WORK HOURS Applied Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized byotice the City. PFI_Utilities 11 -TRAFFIC CONTROL LIMITED WORK HOURS Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m.l unlessd authorizedlce 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 12-TRAFFIC CONTROL MODIFICATION Aplied The City reserves the right to add to or modify traffic control requirements as necessary to effectively control trafficrce and to assure public safety. PFI_Utilities 13-DRAINAGE CONTROL Aice Drainage shall be controlled within the work site and shall not adversely affect adjacent privateppro ert lied pprope the receiving system. The City may at any time order corrective action and suspension of work to accomplish effect ve and drainage control. PFI_Utilities 14- UTILITY NOTIFICATION Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said lied rules are set forth inc 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 15-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. Notice PFI_Utilities 16-TEMPORARY PATCH Applied 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. Applied Notice PFI_Utilities 17 -REPAIR OF EXISTING FACILITIES 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 19-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Trent Brickey>at <971-228-9269>,to establish a preconstruction meeting. Work hours on Pfaffie and Hall Blvd are 9:OOam-3:00pm Applied Notice PEI_Utilities 20-NOTICE TO COMMENCE WORK 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. Applied Notice PFI_Utilities 21 -PERMIT/PLAN ON SITE 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. 111 work amendmentshallonform and to the City to the rmit terms,rcconditions and provisions and to the City approved permit plans, and approved p specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work performance. Applied Notice PFI_Utilities 22-DAILY INSPECTION REPORTS Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. Applied Notice PFI_Utilities 24-VALIDATION OF MATERIAL/CONSTRUCTION pp The City's Inspector may, at his discretion, require tests and or reports from the applicant to evaense.valide claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant'sApplied Notice PFI_Utilities 25 EMERGENCY CONTACTS arsons who have Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)p 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. Notice Applied PFI_Utilities 26-RIGHT OF ENTRY/EASEMENTS Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properlyexecuted easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. Applied Notice PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Provide the City a copy of an executed agreement[sj from the owner for each private property disturbed by construction activity. Applied Notice PFI Utilities 28-AS-BUILT DRAWING 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also,any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements,including any revision made to the previously approved construction plans and,also, any improvement which may impact an existing public system or facility,shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI_Utilities 31 -OTHER Other Applied Notice INCity of Tigard PFI#: 2021-00302 i. _ ENGINEERING DEPARTMENT TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: PGE Job # M2969013 la TYPE 1—Franchise Utility Work Brief description of project: PGE to install reconductor for performed by NWN,PGE, or utilityagency ❑ TYPE 2—ROW Sidewalk/Driveway/Sewer 21 poles and install avian guards Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair • Sanitary sewer lateral installation and SITE INFORMATION p a t ne main line Location (address if available): 7701 SW PFAFFLE ST, Tigard ❑ TYPE i ScaleDevelopment Work performed with land use approval which SEG 573, 593, 575, 577includes any of the following: • Subdivisions or Partitions • Sreetwidening APPLICANT INFORMATION . StreetwiMainline installation for sanitary sewer, Name: PGE [Briana Fogh for Ken Malone] storm sewer, Tigard water, and Tigard Ma water service area mailing address: g 2213 SW 153rd Dr 97003 ❑ TYPE 4—Small Cell Technology City/$fate: Beaverton Zip. ❑ TYPE 5—Tigard Triangle Phone: 503.463.4335 Crewcoordination-western@pgn.com Phone: NOTE: Type 1 and 2 applications may be Email: emailed to rowpermits(a�tigard-or.¢ov. Contact name: Ken Malone Phone: 503.736.5469 Email: ken.malone@pgn.com CONTRACTOR INFORMATION 0 Same as applicant CCB Number: Name: Mailing address: City/State: Zip: Phone: Email: 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? QYes ONo 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. Briana Fogh 8/12/2021 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date viar I", hou,rS or, P+r- F'P(e- SI- ►tee 9� 3'a Case No: PFI2021 000302 Permit fee: 30(> qb Received by: Date: 8/12/21 Approved by: 7'�,_ Date: gi//9/ .OZj Notified by: 1 �} \' `' Date: 31 2-Li 212)7-4 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 •..ect.... . ,._. * Ili e>o,.., „. ywxwr .,, d mu KK.y9x L1 a _ WLZFL-»SS: x- - -• • Install: ty. ,,,, Aft-) _ n� -H.R._ _. _«.na DIPS-LINE SOWN :, E _- _ tn.,' MIS-SUCKFAST • ,..,. w T see,.!/bwr Rw T N-L 2Y-2E 2swi soUTH ,om NpPxwne N9 GTi-PRI.102399 N ' G19-NEVi•3,ee9A _ N-L 25'-51,3909 WEST ea S ••w w-r -. -a '• G23-PRI-211059 • witm In y� PRI.21.]OS3 hone. • w GIS-NE111-9.233N "WLE PLSNS'. • (3)142 GP F100T d1 TAP-EAST $ ImIMI. damove; re ' - ::, Gmr ff q aNAN GUARDRe 039 F1.„ y4 # M2 CID F35TWTAP-TAPLINE TO NORTH DP9-EAST ; .,..r ••'7.. pwx++ EXISII l lSllO2O DOWNOUYH AND ANCHOR-WEST ...ACM (3)CUTOUTSNED FUSES TO NEW FARM _Y ..r ..-... QI1430(O F100T OH TAP-FAST -1 ,.: ]D TAP TO SOUTH F -:.: (i1115 CT MOT OM TAP 1 a •j... < ",. Remo.e: OW F F ' l4S UP NORTH B -:..: 4 1N Dro FM'U6U R • ... .._ " rl i WL]PLSI]F: I er. �. wLrs PL-wo: YILTPLA3l$', m 1.w(wc Inf MAN GUARD ' •,'• NNW ,fo IInaMX :o:er:F l 1 AVM OUARO AVIAN GUARD HORN ewRFNa '•` .,T1�. :., awns .. „LN �i:r. _ Sw Cr IMP 105 211 R 153' 0 a t50 wr I49' wnWIFEn 210' ' ,r»•S • S 5' i wLEPLd1A0' I- k^-' Matte t8 „„ Install 2 < • AWN GUARD MIL SeLA3Et: F ar N-L'A-2L293RNORTN Ay2VNS1ARD x R9� 9 aeR G 3' •q' GI).PRI-ID,z39E g 3r ♦ SIG-NEUT.]A]4p �s1 Trend*, 4 WL a PL�NO: / 1 CUTOUTS AND FUSES TO NEW FRAMING WLe ML I3 PLJ: !y Remove: 0103-NORTH M9N. Wa 4 MAN WARD (2)0103-NONTHMI0500N •. two D30 .s33y... -T Rem.. • cnnwo,F{J�--+� 0103-PORCELAN (21 DIM•PORCELAIN f. RIGHT-OF-WAY PERMIT NOTICE: O0°r' `� :c—_ ., wry RF BMW p„r cw rMx A9e9Ew1wN la E ac,mur� A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY �a•x E WORK IN THTE RIGNTAF-WAYMAV BE PERFORMED. ONLY PGEAPPROVED '~ C 4 n._ 5 CONTRACTORSAND CONTRACTORSWLLBWW3H TOE MADE UNDERER SPECIAL PL AGREEMTRACTO H PGE WILL BE ALLOWED WORK AGE'S PERMIT $ THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS _ BEFORE WORK IS TO BEGIN A COPY OF THE PERMIT MUST BE ON SITE. 'rte'NYDEWA17ON FROM THIS DESIGN MUST l I�HEAPPROVED BY THE PGE PROJECT MANAGER A VICINITY MAP 3 _ Ann*roN: CALL 811 BEFORE YOU WS OREGON UW R[CUIRES IVU IOFIXIO RVIF IM �� L"l? M P AD Alm\ eYMFMEDONUNLIn NOrIfIfANDR ENTER ? ,.1,-Eali� \ iXOSE RVIf3 ARF PETfORA 1N WR9331VIC010 i HawNmme VillSv OVERHEAD LEGEND rXmuex nl-mlmw rou M.rvwM coPNs vF „AP, R T npemmnita U.;,elLf.eaDNS SAFEI ( / TXe RULESwuLLws TNLaREe eA vmm PFMOPEh0U LI A'DTltRESTORTE'ER ITR ORE51RAr1OLLTHE 233-19eT1 i WORK AREA TALL EPORI .'rn+,•=ACNmE] \IRS j TO TUITY eT UTILITY LOCATES CADDIE FS E9 re Call Y,ee ymu' UOLM NOTHICATON CENTER,All AT LEAST dig ,prl nt. cuPEIc - - ,,- CONDUCTORS IBUSINESS OATS RID*TO EXCAVATION FRAMING mANSMIssDNA DISrRBDTpN10110EE,U PP POE CONSTRUCTION DRAWING Apartment. ©P s Nerd P�94 / Ot —FRAME g9TR6URr*!-LG10110.MU PPP SmM FDDdse onse / (IPH rsso.RM NMTALLIN.a9LYDRRIIMRTI<RBDNIN ISY AS-BUILT VERIFICATION SNESCV10ArIONs CORRECTED WpeN4N*SIOePs Car ICILY F FRAME LISTRSIInOR.LC11/10.MU Noe I11 411,.19,I ANC CRINVENF1 FOrtm]R. wN: i IlYQU Tryerdv DR —IIPHSGL OE.POLY) pSIRO Foremen: Gel Wes!sHe CMis3Ene V= High 511001 _FRAME SACK SPNSS OE,PO2,WOt03 gENJVEY[OIAp.SRTRMO MEUIMI Ipmw^°rh091138 rd NN tP*nKKT e.g., a l;n9tG(l GasQ 2 5 O1S FRAMEACN SPAN SCL OE,POLY) ORR m CU IPININv ERO R ACIa Went L SD°MENG RE4EN• �ASBUNTBVCEHM,hER: AC4TMMIT {YlDE ND D1m�� EILT 0910€. 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RIGHT-OF-WAY PERMIT NOTICE: =O1"• ITW m•,V.. n mown.So C&WU anvils INNO ARpWC WW • 4 A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY WORK IN THE HIGHTOF-WAY MAY BE PERFORMED ONLY PGE APPROVED CONTRACTORS" OTHER SPECIAL 'Le AGREEMENTS W�POE WILL BE ALLOWED TO WO CONTRACTORS WHO HAVE RK UNDER PGE5 PERMIT THE BEFORE TRACTOR MUST WORKIS ro BEGIN AIFY COPY OFTHE PER LOCAL MIT MTUST SE ON SITE VICINITY MAP Rack Attack''5.1 ��Y""" 9 IRNY DEVIATION FROM THIS DESIGN MUST l %s© £ ( 9EAPPROVED BY THE POE PROJECT MANAGERji R 9 F.�I O Q d mxrrox. FAIL 311 BEFORE YOV DIE NeWlne.ne vill PefONREWIRESg/F MOWN YRut[s.WP DT WORK aaannemGrP. 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