Loading...
ROW2013-00064 p CITY OF TIGARD RIGHT OF WAY PERMIT III I COMMUNITY DEVELOPMENT Permit #: ROW2013 -00064 — fe_pf TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 07/31/2013 Parcel: SEG150 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 9350 SW Lehman Street. Relocate 45' pole for street improvement. SEG150 Owner: FEES Description Date Amount ROW Permit Fee 07/31/2013 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: LORRAINE KATZ 9480 SW BOEKMAN RD WILSONVILLE, OR 97070 PHONE: 503 - 570 -4407 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 ll Signature: __ �T • f -Sen+ fir g Issued By: C0 / f A , � t� / /� -Po( A OWAG . Special Conditions (See Attached) l Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY e n CITY OF TIGARD RIGHT OF WAY PERMIT 11 11 COMMUNITY DEVELOPMENT Permit #: ROW2013 -00064 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 07/31/2013 TIGARD 13125 SEG150 Jurisdiction: Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 9350 SW Lehman Street. Relocate 45' pole for street improvement. SEG150 Owner: FEES Description Date Amount ROW Permit Fee 07/31/2013 $300 00 PHONE: Contractor: PHONE: FAX: Applicant: LORRAINE KATZ 9480 SW BOEKMAN RD WILSONVILLE, OR 97070 PHONE: 503 - 570 -4407 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. ttue /Applicant Sign n� Signature: Issued By: Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2013 -00064 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 inspectorKe nny 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 REC9VED IT I City of Tigard JUL 3 a 2013 Application For Work In The RigF � ".,NG TIGAR.D ROW Permit Property Address /Location(s): g350 SW Le. l'i y 'Yv h <9. FOR STAFF USE ONLY // �� //�� (P Right -of -Way_ U n ' � Case No.: 1013 ' ovo(4 *Applicant's Name: Q' 6 1 > C Application Accepted: By: f 'A� Address: g - Q O SW 3oeck YYla 1 iert Application Reviewed: )I3 By: GJ R Cit l d} I I `50 iii ((O. 612 Zip: 707( I Application Fee Dues Primary Contact: i--e'v rC. Ka45 ✓ Applicant Notified: 7-3 Email: l..lJ�/VCC I h P . T C� —/5 Phone: .'5b 3- .5 /20 - LI if 7 Fax: ! 2a b ��`1 K a f PGN &� '- Receipt No.: , 7. 3v�i 3 1 � REQUIRED SUBMITTAL Contractor's Name: INFORMATION CCB# Expiration: • Application form, completed and signed Address: • Submit one (1) copy of scaled sketch of City/State: Zip: the proposed work to be done Phone: Fax: • Submit one (1) copy of traffic control plan Email: Professional Engineered Plans are required Plans By: for: Address: • Street Widening City/State: Zip: • Subdivision Infrastructure Phone: Fax: • Main utility line extension Email: Rev. 6/24/2013 1 I.curpin \masters \land use applications \tow app.docv Description of work: �CvC ZLe 45 ' pore. 164/^ (sho t / . Inte,oven(' • . wv '7a i6o 78 Estimated value of work (within the public right -of -way): $ Is work related to a LAND -USE DECISION? YES n NO ❑ If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES n NO E If so, please specify (BUILDING PERMIT) case #: Signature of Applicant /Permittee: A6. 4_t471V p(77 E Date: 7/. Print Name: ,(.t 3/AN /k V1.-/If Title: .� /) b PvF tsd ilia Lead City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503 - 718 -2464 I www.tigard - or.gov I III CITY OF TIGARD RECEIPT > g 7 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 TIGARD Receipt Number: 192464 - 07/31/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID R0W2013 - 00064 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 053700 AKOWACZ 07/31/2013 $300.00 Payor: Susan Oliver Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1 7,1 1 -26� -1 1 -28D _ SW NANA C7 a' i PD 00101 -1 � 9445 9475 9355 I PLO 'S 4/0 Tx _ 2 AL -DB • iI � __ 5 Q o • 1 142 1 142 ,0 Q Z 6 +- F6T F10T 01508- /.-) IQ 4i. , ' 18232 it L05916 'L05064 • J O 27881 03110/ / -- . ( — - _ 1985-35 O \ 0 PL05915 _ _ _ D5915 Q 2 I • 1980 -45 h C-4 CU 1-2 AL- - - -- - -- - -- - 4.....1. .1 N 2 ACSR C 5 12623 SW LEHMAN P L05 : 2a 1 -2 AAC 1 2 AAC 2 1/0 AL • •r •`r I El 1 0,256# .7: A - AL XLP JKT - D 2-4/0 AL(SPUN) \ I - - _._ • � lw.� .. � ri � _. —. — — _ — — .— • A 2 ACSR a i L. P S•R► li 90 1 - 42 — i . I F100T 10 27434 01509- F3 001t30 • F OT 05064 01509{ 050L5 O 04100/ i - II 1 g - 53 . r. 5 2006 -45 041 O A \ 1950 -45 PL 05915 0 • 1 953 15 PL 100/ F On?', PLO 6 ti / 05916 05854 3 a q - AL XLP JKT PD 00050 y 1 L' A 50 1 2 1I 0 0 AY Os PD e R[ z9 ball A 25 84 7 04 1W0 r -- —_ • I 100 -ISS FO 51 - + P0�000521 R . - - At -TX-A 4 06605 Li GC: -'-i • • • • L_ i ¢ E� i 1980 -45 O,' 600 KVAR PO C 01 32 UL u d ! PL06605 a co 1 8 7 6 5 (V NV 01509- a _N ! / 00 4600 P00005/ 200A - --- - - - - -- 1 9 1/D AL -Tx - 55 -4 8 A 15 16481 pL -05915 p1. -05824 OVERHEAD LEGEND EXTG PRI OH GUY REPLACE 8 RELOCATE 25' EAST, 2' NORTH REMOVE FACIUTIES INSTALL FACILITIES 12 L M INSTALL ADDITIONAL FACILITIES /MODIFY FACILITIES 4r� m MI 6.505# POLES G20 TRANSFER EXTG PRI OH GUY, SEC 23,315N AND 2 - #2 TX SVCS rPOLE CLASS (1, 2, 3, 4, HI, H2, S) • TOP POLE FOR TELCO TO PULL I- -POLE HEIGHT (FEET) POST LANDSCAPING TRANSFER STREETLIGHT REPAIR GRASS @ x ANCHOR ANCHORS i t • § e - o ...c. coo ei©©rato GUYING i i i= u 10 u WR CHECKLIST .e� O O O O C C c ITEM YES COMMENT `^ // m►rY HOLADIGGER X I GUY ©C®ifiii BOOM 2 GUYS mmE/®�<�eMr1<E� PGE TRENCH 3 GUYS M�mLIGIMI®I�GL CREW CENTER DESIGN RI � � PGE C ONSTRUCTION DRAWING 6 LOCATES AS -BUILT VERIFICATIO & NE VIOLA TIO NS CORRECTED STAKING x DO WITH RSDEV WR# 718412 This document accurately represents FIELD eon,n� :, y repr • � � ■ �r- FLAGGING Foreman: Date: J General Foreman , Date: LA DSCP7 x POST (Signature only required for (field construction changes.) CON TACT G ENERAL FORE SDPM'ENG RE VIEW: �ASBUILT BY DESIGNER: L___ II I PRIM f$ U T ARD ANDOR CONDUIT INSPECTOR 3 TO 5 W D AYS PRIOR a__________ I� DA T E: 7.21.2013 sue: T - =6D. IACCOUNr: 10700D1 � Aw o: 7000001929 �OB NO 7716TH • I ip,U p (µ TO EXCAVATIO CONDUR INSPECTION REQUI PRIOR TO RACEI POE W NOT INST ALL WIRE UNTIL TRENCH IS 100% BACKFILLED. TITLE ^` r - C(1f5OR. G AL FOR ` GRECO ESTATES - DOR / L. L UG DR. VER. GENERAL FOREMAN CIRCUIT SITS I - TRANSMRSION CELL 503 - 793 - 8321 PROGRESS - GREENBURG 17s22 SW H EM LO CK ST SHUTDO W w T HINK E S DMERN x OREGON ATTENTION: CALL 811 BEFORE YOU DIG PGE/ Lou0K �� � rj. . / < LAW REQUIRES YOU TO FOLLOW RULES ADOPTE[■ 9 SC SW LEHMAN ST, TIGARD i L�R __J1 / � SAFETY DOOR /WIDER BY THE OREGON UTILITY NOTIFICATION CENTER. 8 \ \174,6 oE dFTro THOSE RULES ARE SET FORTH IN OAR 952-001-0010 R EL OCAT E N POLE FOR STREET IMPROVEMENT t i JOB SITE � � �� ° z FIRST! CONTACT THROUGH 952-001-0090. YOU MAY OBTAIN COPIES OF � „ sHEf1 __ 2. CO MPA NY THE R ULES BY CALLING THE OREGON UTILITY COUNTY [TI[ML(S wORR WITH o . - WASHINGTON r01-26D _ NOTIFICATION CENTER ADMINISTRATION &D (503 - 232 -1987' wILSONVILLE I of I LOCUST ST 1 T� Ii PHA Cr CANE PHONE (503) �� I I i 3 TO REQUEST UTILITY LOCATES CALL THE OREGON ,� DATE TIME Know what's below. LORRAINE KATZ 570-4407 I DRAWN BY BRIGANTE VICINITY MAP 2 BUSINESS NOTIFICATION CENTER, C AT LEAST Call b you dl wRSO nnlr. 05 croro 2 BUSINESS DAYS PRIOR TO EXCAVATION. Y 9 O PORTLAND GENERAL ELECTRIC CO. - ALL RIGHTS RESERVED