PFI2022-00057 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
= COMMUNITY DEVELOPMENT Permit#: PF12022-00057
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/28/2022
Parcel: SEG132
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE Jobs#M3027227 and M2994998
Project Description: PGE to replace pole 2060 add new transformer. Contractor to install conduit underground to home. PGE to
pull wire through conduit and energize.
Class of Work: FEES
Description Date Amount
PFI Permit Fee 02128/2022 $300.00
Total $300.00
Owner:
REQUIRED INSPECTIONS
Call 503-6394175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.ligard-or.gov to schedule inspections online.
Contractor:
PHONE:
Applicant:
JOE VELASCO
2213 SW 153RD DR
BEAVERTON, OR 97003
PHONE: 5036725459
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.
Perm ltteelAppiicant
Signature: See permit application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12022-00057
Type: Condition Name: Status: Severity:
City of Tigard PH#: PF12022-00057
ENGINEERING DEPARTMENT
. Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
TYPE OF WORK
PGE Jobs# M3027227 and M2994998
Project name: 8 'TYPE 1—Franchise Utility Work
Brief description of project: PGE to replace pole 2060 add add performed byNWN,PGE, or utility
agency
new transformer. Contractor to install conduit underground ❑ TYPE2—ROW Sidewalk/Driveway/Sewer
to home. PGE to pull wire through conduit and energize. 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):
9655 SW 74th Ave main line tap
❑ TYPE 3—Full Scale Development Work
Tigard, OR 97223 performed with land use approval which
includes any of the following.
• Subdivisions or Partitions
APPLICANT INFORMATION • Street widening
Name: PGE [April Neale for Jose Velasco] • Mainline installation for sanitary sewer,
storm sewer, Tigard water, and Tigard
Mailing address: 2213 SW 153rd Dr. water service area
city/State: Beaverton, OR zip: 97003 ❑ TYPE 4—Small Cell Technology
Phone:
503-672-5459 ❑ TYPE 5-Tigard Triangle
Email: crewcoordination-western c@pgn.com Phone: 503-464-7777
NOTE: Type t and 2 applications may be
Contact name: Jose Velasco emailed to ro ermas tigard-or.gov.
Phone: 503-672-5454 Email: crewcoordination-western@pgn.com
CONTRACTOR INFORMATION ❑ Same as applicant
Name: Hals Construction Inc CCB Number: 34434
Mailing address: 20666 S HWY 213 City/State: Oregon City, OR zip: 97045
Phone: 503-793-1402 ask for Lee Email:
ENGINEER INFORMATION
Name:
Mailing address: City/State: Zip:
Phone: Email:
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000): $ tinder$5,000 (within the public right-
of-way) Is work related to a LAND USE DECIODN? Oyes 30 No Case number:
City of Tigard • 13125 SW Hall Blvd. • Tigard,Orcgon 9%223 • unuw.tigard-or.gov • 503-718-2421 • Pagel 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 Incensed 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.
48eAd/t,)"A April Neale 2/21/22
Applicant's or authorized agent's signature Print name Date
Property owner's signature (if required) Print name Dare
Case No: PF12022-00057 Permit f 3Oe-171100 2/22/2022
Received by: HPollarrl Date:
Approved by: Date: 2 2 Notified by: AL- Date:
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 9 wwwtigard-orgov • 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 ONLY • ' STAFF USE ONLY
SUBMITTALTYPE 4: SMALL WIRELESS FACILITY TYPE 1-3-DETAILED
CHECKLIST REQUIREMENTS
Does applicant have a right-of-way license? ❑Yes ❑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): ❑Small Cell ❑Macro ❑ Street Name
How many install sites are proposed as part of this permit ❑ Site Address
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:
❑Public Right-of-Way ❑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
sw )- " ':� I
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TYPE 1 AND TYPE 2:
MINIUM SKETCH REQUIREMENTS (Put N/A if
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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
Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 0 www.tigard-or.gov • 503-718-2421 Page 4 of 4
Page 118 2011 Edition
Lane Closure at Intersection with Flagging Diagram 620
Diagram 620 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging, traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance (see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. There should be one flagger for each approach. One flagger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections (fewer than 400
entering vehicles per day), one flagger may be used.
4. 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 may be expected.
Sian Spacing and Buffer Lengths(feet)
Prated SpodngBetweenSgro *Buffer"
Speed A 8 C Spam
20 50
25 100 100 100 75
30 100
35 350 350 350 12S
40 150
45 180
50 S00 500 500 210
55 250
60 28S
65 700 700 700 325
70 1 365
Chapter 5 September 2016
2011 Edition Page 119
Lane Closure at Intersection with Flagging Diagram 620
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