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ROW2013-00022
CITY OF TIGARD RIGHT OF WAY PERMIT 1111111- r �+ Permit#: ROW2013-00022 COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/24/2013 • TIGARD Parcel: SEG849 Jurisdiction: Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 7500 SW Dartmouth.St. Provide 120/240V-1PH-3W UG 100A Svc to signal meter. Owner: FEES Description Date Amount ROW Permit Fee 06/24/2013 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RALPH REISBECK 9480 SW BOECKMAN RD • WILSONVILLE, OR 97070 PHONE: 503-570-4409 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: n p - Issued By: .1.. A 414.1 " Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2013-00022 Type: Condition Name: Status: Severity: ROW 01-CUSTOM CONDITION Applied Notice <Custom Condition goes here> ROW 02-PERMIT& PLAN REQ ON SITE Applied Notice A copy of the permit and all attachments, and a copy of the approved construction plan and all amendments shall be 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 the aforesaid must be approved by the City, in advance of work performance. ROW 03-TRAF CTRL-SPECIF(CITY) Applied Notice The City's standard specification for traffic control is"Manual on Uniform Traffic Control Devices for Streets and Highways", U.S. Dept. of Transportation, F.H.A., 1988 Ed. ROW 04-TRAF CTRL-CONTR RESPON FOR Applied Notice Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in accordance with a City (job specific)approved traffic control plan.A copy of the approved traffic control plan shall be available at the work area. ROW 05-TRAF CTRL-ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without having first obtained written approval from the City Engineer. The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide Emergency Services(Tigard Police Dept.,Tualatin Fire&Rescue)and to Tri-Met and Tigard School District. ROW 06-TRAF CTRL-ADVANCE WARNING Applied Notice Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. ROW 07-TRAF CTRL-PRIV PROP ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not, shall be cause for work stoppage until effective access is established. ROW 08-TRAF CTRL-DEVICES IN PLACE Applied Notice Traffic control devices,flagpersons,etc., shall be in place prior to initiation of construction work and shall be effectively maintained. ROW 09-TRAF/NOISE CTRL-WORK HRS Applied Notice No work will be permitted during the hours of darkness, nor between 9:00 p.m.to 7:00 a.m. Monday through Friday, nor between 9:00 p.m. to 8:00 a.m. Saturday, nor between 9:00 p.m. to 9:00 a.m. Sunday. ROW 10-TRAF CTRL-MIN LANE WIDTH Applied Notice Minimum travel lane width shall be eleven(11)feet; pedestrian travel shall also be provided for. ROW 11-TRAF CTRL-CITY CAN MODIFY Applied Notice The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic and to assure public safety. ROW 12-INSP 24 HR NOTICE REQUIRED Applied Notice The permit holder or his contractor shall notify the City's inspector Kenny Fisher at 503-816-6146 or email at kenny @tigard-or.gov, twenty-four(24) hours prior to commencing work,twenty-four(24) hours prior to any staged inspection, and after completing work covered by the permit. ROW 13-HAZARDS-CERT OF INS Applied Notice Maintenance of the work area and approach roads is the responsibility of the permit holder.The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards.A copy of the permit holders Certificate of Insurance shall be available at the work area. ROW 14-DEBRIS-MATERIALS Applied Notice • 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 cleanup and stoppage of work to accomplish cleanup. ROW 15-EROSION CTRL REQ Applied Notice Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q. requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion control. ROW 16-REPAIRS-LIKE MATERIALS REQ Applied Notice Property disturbed by construction activity shall be seeded with a standard grass mix;shrubs,flowers, barkdust, existing signs, pavement markings, mailboxes, etc., shall be reestablished, reinstalled or replaced,with like kind and material. ROW 17-DRAINAGE CONTROL REQ Applied Notice Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent private property, public property and the receiving system is not adversely impacted.The City may, at any time, order • corrective action and stoppage of work to accomplish effective drainage control. ROW 18-UTILITIES PRELOCATION REQ Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. Copies of the rules may be obtained from the Center by calling(503)232-1987. If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders expense. ROW 19-UTILITY LOCATIONAL CONFLICT Applied Notice Contractor 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 permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall coordinate the work with affected utility agencies. ROW 20-TRENCH-PATCH/SAFETY/LBILITY Applied Notice A temporary hard-surface patch(Cold mix A.C. or Hot mix A.C. base paving) shall be placed on trenches within roadways at the end of each day's work. No trench,on site or off site,shall be left at any time in an unsafe condition.The permit holder is responsible for and is liable for hazards or damage resulting from the work. ROW 21-REPAIRS REQ-INSPTR OPINION Applied Notice Work provided for under the permit shall include repair of existing facilities(roads,ditches,etc.)as may be necessary, in the City Inspectors opinion, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the permit holders expense. ROW 22-AS-BUILT/ENGR CERTIF REQ Applied Notice At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public right-of-way shall submit complete"as-built"drawings 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 engineers certification of installation compliance(form attached). ROW 23-DAILY INSP REPORTS REQ Applied Notice The permit holders Engineer/Inspector shall submit daily inspection reports,on a weekly basis,to the City's Inspector. (see Developer-Engineer Agreement note#5). ROW 24-TESTS/REPTS TO VALIDT CLMS Applied Notice The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's engineer or contractor to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the permit holder's expense. ROW 25-RELEASE-WAIVER REQ Applied Notice The permit holder shall provide a copy of a properly executed Release&Waiver document to the City for each ownership disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction. ROW 26-MONUMENT PROTECTION REQ Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders expense. ROW 27-PROB SOLVING-RESPON PARTY Applied Notice The permit holder shall 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 an emergency.The permit holder shall notify the City Inspector, in writing, of any/all assignment changes. ROW 28-CONSTR SAFETY-RESPON PARTY Applied Notice The permit holder shall cause his contractor to provide to the City Inspector, in writing,the name and 24 hr emergency telephone number of a designated"Competent Person"responsible for construction safety as per OR-OSHA, Chap.437, Div. 3 Construction, Subdivision P-Excavations.The contractor shall notify the City Inspector of any/all assignment changes. ROW 29-ESMT/RT OF ENTRY-RESPON Applied Notice It is the sole responsibility of the permit holder to provide for proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry, or properly executed easements,shall be provided to the City.The City shall in no way be construed to be liable for the permit holder's failure to obtain or provide for proof of right-of-entry or easements. APPLICATION FOR RECD 1111 WORK IN RIGHT-OF-WAY (ROW) PERMI1 AR 07 201 • CITY OF TIGA F J( A R D Development Engineering PLANNING/ENGIN 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 FAX (503) 624-0752 FOR STAFF USE ONLY General Information: WR 703897 S�( 49 Right-of-Wa Property Address/Location(s): 7500 SW DARTMOUTH ST Case No.: 'g-UW2M I ;— Receipt No.: 'C:71 d OS *Applicant's Name: Portland General Electric Date: 3 113 Address: 9480 SW Boeckman Rd A....l:...+:.... A........+..,+ Q.,. AY/ REQUIRED SUBMITTAL INFORMATION City/State: Wilsonville OR Zip: 97070 ;1 Z �Dr = 3.13. ,3 Primary Contact: RALPH REISBECK Phone: (503) 570-4409 Fax: (503) 570-4420 Submit a scaled sketch of the proposed work to be done Contractor's Name: N/A CCB# Expiration: Professional Engineered Plans are Address: required for: City/State: Zip: • Street Widening Phone: Fax: • Subdivision Infrastructure • Main utility line extension: Plans By: Address: City/State: Zip: Phone: Fax: Description of work: PROVIDE 120/240V— 1 PH-3W UG 100A SVC TO SIGNAL METER Estimated value of work (within the public right-of-way): $ Is work related to a LAND-USE DECISION? YES III NO If so, please specify (MLP, SDR, SUB, etc.) case#: Is the work related to a BUILDING PERMIT? YES NO ■ If so, please specify (BUILDING PERMIT) case#: *NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide financial assurance for the work. c:\users\agnesk\appdataUocalMicrosolt\windows\temporary internet files\content.outlook\qo3xtgbo\wr 703897 city of tigard permit.docx WINCO STORE COMMERCIAL LEGEND 7501 SW DARTMOUTH PAD $00094 INSTALL �'P�;7200V NEW PGE FACILITIES TO BE INSTALLED 1- •O-PAD E:I M0240V (UNLESS OTHERWISE SPEORED) 2.1/0 Co So 0 900 KWH ETD . PGE INGO PAD SE PROVIDE ED AND 9 0 e'r M XLP 01546- 3 KW DMD ESTD 00052/ O _ PL 00017 z-)/ FAULT INDICATOR 00017 I 1.4 Cu 83pLP ---._ Q 01545- 1994-25 IS1V D41?1 Wo PAST a INSTALLED 1- PVC COTOLo 00051/ PL 00016 INSTALL 1..00 AL-TX N 07 1-.T.PVC 1007 CONDUIT .000016....... .._. 36C 36 ` FRONDED P.PETALED BY CLGTOMER 1995-25 ....... ....1 B 1 A ........ .._.................... T46240V A 25 I =m PD 00094 ABC 300 I 0s 5,50300 AFC P_ 1 325' 1-T,0 A- J5 .' I P;, 00044 IA-2 AL XLP JKT-C1 TX- _ 1j L 00201 O _ 2-350 a!-OX-O CDND"u]T ]-4'SPARE / 2002-251 10 CU-TX G. 15-3.SPARE 01814-I I V7 a - 00070/1 I w042 1 �6WODIa7. /' PL00201 y 1 RETAIL 2 �• . 7500 SW DARTMOUTH ST l 1 I„4 N� u '�. IPP- I 1 j I1 MC DONALD all `—'m°' I 655-GS BONRA CNRY AAP j LEGEND m- EGe / My `-'•Bassasry Celle I Loo,' 1..... j ° r`Ie''r° '��/Telco i T r ®maim j i WR CHECKLIST CONSTRUCTION NOTES: CMOEE 0Mee BaatEll I BEM YES COMMENT I / I 1IC( L CIaro.ER R@OIB0E FOR ALL 70004 CO SDIIIT.100611 PADS AID d'\Q em v 1 1 ens I MN ROAD COSSAS 1 lam v.l 70404057 Lao ar ( 04.1010E x ALL CaNEfI ro E IE7Att10 N NoC PvOeeav wat taWOE L ME 5501 6 AL NE 1»10103074 7O RE 11700010 N ONT•EMMA!400 E1707a0 6 GRAD:PC COM TTY INN NMON PILL 1M2OS 901600 0811570 I ROE ro O[7EAEE ra Jiff 100 MAWR OF CONDUM 110(2170. I I LOG16 MAW. O 411170017 OM AND 24 NOffiON0AL EOn t]WAN2 BENIGN I SNIG 051 A0 OnR wan=ALL 191°16 1 NOI 6 SLUM ro RE F6 NOS NL1i RE WALMART STORES INC 6IL 00 50047 E ID VIES MR POE WOW11M�1724 .0*A ro 21/1176 I 0 II101 NOSE Ma R LO d eQ NOR ANT rl®Ni51 elan M7 RI MAN 7600 SW DARTMOUTH I '7 00 Rua r m�r oR tDI 20 a ion AM rn aN 07 FRITH A Off 107 b0 D N 001 PVC IDma0.0 101 7.E 00021001E IM RING OP INfSPAPE p0 MIT oR MSSn*WaIfW TOTAL SIMS N AM CONDUIT RN a x10 DEGREES ( / I £401071 A AIL I@ 7 000(0 a ro E N 10(210 B 161 000 ROY AM 10MEanR! II.EE [ 117000 BMEON0.WALL OR Ow1AO AO 1 757 904 FROM ANT w7 111010011. ilpTK R.BN MR M EC:PO RS WIT 0 WIn04 a MT OF A 0701 6E AREA O3B05 AVIAN IMA MN 10 MT OEN.=N FRONT OF AL 710 019 5 0 0 1956-40 6 700300700 PADS AE ro E Er 50 MAT 176 Tor a 7 100 WM • 16 Met O FNat MR.DP 1000121 a TO R?N11AU10 N PAD N 0001CA11D N 1711E r 60 00!0 ro 5710 I NOI ABODE LIE FAO. — I i 417.'015 r 00040 6.IIM 750161 ras7s AE WOWED MO00 7RAWONE9 MAT AE CVO i 0773'JIIN ro 00008 oawoM ! 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CONTR.OpE 114051 87ALSi A W WE 1111E 7300 6 100 7010 THE CON4IS We11 617 WIL 11 THE LOC f0 WOE 074 47 HOU 16012. 7EF RE IDOP0 OI OI 81 IN.09'THE LOP 17 E PE MITI MU 48 HOURS 1 / IBOE IYOE a iQ 61:11 A CbIY OF 7140 911512 M18T E ON SITE /' I 1 I 1 ANY DEVIATION FROM THIS DESIGN MUST BE APPROVED BY PGE PROJECT MANAGER 9 . 1 I I CONTACT GENERAL FOREMAN .'T 00041 1 I ANDOR CONDUIT INPECTOR 7 TO IO WORKING DAYS PPJOR I I TO ERCAYATION.CONDUIT 114020077012 REQUIRED PRIOR TV 000901 PYE WILL NOT PETALL WIRE UML 109202 E 0013 sACCHUED. ED BURNS KEN=EOM A B 25 75% / �jE��-� /4 I 1 GIMBAL FORMAN 0N01IT INSPECTOR /�r 1 I PHONE:56L57W401 CI150-840-0670 WOPM:503-940-19(4 Co A 0 r I I I 03470 1 3511X105 FRO=64014005*Rif SIDG1E00 ABC-2 AL XLP JKT-D _ 1 I 1994-45 ! PNmE503-/70-4404 ®L:0DSa9a6A8 103471 I AT8IF110FE CALL 8B 19601E YOU DIG a� 4 Y 1 1981-45 I 01814- 0lro4N LAW 2EOLIM YOU TD FOLLOW R1ES 00001711, ABC 75 30906 x ;70N-2 FL0203470 TTHOSE 0836 AE 01101N DI OAR 937-001.0010 ACSR J 1740060.11 951001-0090.YOU WY 010514 CONES OP ..may 01814- `-- THE RUES eY CAL NG 1140 OREGON UNSTY 0001 B/ NO7WCATION®4701 ADAEOTRATTON© (301-x31912) Iii O PL00072 04 /01815- Res�1•..,-�2008-30 10 EOU6T 1ThiCATLOWS ,SIA LEGON 3eeE��LxI� I 00004/r UTe17Y MS DAYS Pa/CI4MR,6TI 1,1£asf I-O x BUa1/M5S GAYS PMOR TO FXGYA170N �B belela 1210�/• Ou 910 0 0 3 8 110$ 1 I PGE CONSTRUCTION DRAWING �, 2008-30 SW f .��� YT oo0i1 I HERM() A t /i AS-BUILT VERIFICATION 8 NESC VIOLATIONS CORRECTED PD 00035 111 6mA I ,� i AY TAY 00140.70011°ROAM epwwm FLED U+-5••- Z !! FN02103. Dale: 1-350 AL-00-I j '� 1 Soon 25 59292 Genlma Foreman: _ - Dale: 1-4'SPARE E 1 I f-� ■, VT 0001 TaAD (SiBnllhne only regldnd Na7 field 1DOInniN 003 9481Ret) SDPA919NC REVIEW: IASBUILT BY DESIGNER: W ZW 02024 730200 PNH r oo''...:1070001 I"W'0 7000001931 r B NO'703897 O I a f ` OTY OF 11GARD-WALMART STORES INC TRAFFIC LGNAL @ WINCO EU I 1 Q j �PORTLAND-73ND I 7.22 43� PG� 10040101 �'�_ c = ' °zooi 30 1 �� THiNg 7s00 s3 wRrMOUrN sr 7900010 Oo SAFETY ` PRROOVI E 10240V IPN-3W 110 1000 TRAFFIC SIGNAL METER . t3, FIRSTI W.lDNEM wWASHIINGTON cn-340 I"°E`IM I�7 U 620 OR M 1 00 a.B! PNOPE pay WN 1 m RALPH REABEOI 570-4409 160GAN1E Q 2402187*A� ®IORTLVID 005006 FOCTRIC Co.-AIL 119773 MEWED CITY OF TIGARD RECEIPT II q g. 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 191905 - 06/24/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2013-00022 ROW Permit Fee 100-0000-43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 037790 AKOWACZ 06/24/2013 $300.00 Payor: Susan Oliver-PGE Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1