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PFI2015-00005 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT p COMMUNITY DEVELOPMENT Permit#: PF12015-00005 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/15/2015 Parcel: SEG660 Jurisdiction: Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 9254 SW North Dakota-install pole anchor in public right-of-way. Overhead service. WR#756154/M#1433190 Owner: FEES Description Date Amount PHONE. Contractor: PHONE: FAX: Applicant: TIMOTHY BELL 10800 SW AVERY ST. TUALATIN, OR 97062 PHONE: 503-612-6138 Total $0.00 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: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00005 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 Applied Notice The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. 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 clean-up and suspension of work to accomplish clean-up. PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the 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 Notice 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 Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [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 Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the 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 Applied Notice Public roadway shall not be closed to traffic,at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents 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 PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City approval of any access closures. PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized 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 11 -TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in 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 13-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. PFI_Utilities 14-TEMPORARY PATCH Applied Notice 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. PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice 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 16-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>,to establish a preconstruction meeting. PFI—Utilities 17-NOTICE TO COMMENCE WORK Applied Notice The applicant 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, prior to any staged inspection,and after completing work covered by the permit. PFI—Utilities 18-PERMIT/PLAN ON SITE Applied Notice 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. 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 these must be approved by the City, in advance of work performance. PFI—Utilities 19-MONUMENT PROTECTION Applied Notice Existing monuments, property corners,and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI—Utilities 20-EMERGENCY CONTACTS Applied Notice 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 any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI Utilities 21 -OTHER Applied Notice �?�E Q-e V-e r-c r c -e NZ/ City of Tigard W R#_ -1 ( 1 S4/ M:w- 14-3319 O PUBLIC WORKS—ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one:10,Utilities ❑ Sidewalk/drivewayapproach ❑ Street imptovements ELEMENTS Detailed description: 6.-SA-461s+ O0" OF � A Minor work in right-of-way ` ( (sidewalk repair,curb cut,street %V\ U b Ie Tr opening,etc.)requires: O •` �'-e •Application form,completed and signed •Submit one(1)copy of scaled sketch er Pro ty address/location(s): 72-E+ Wt �0 r of the proposed work to be done ' r� o •Submit one(1)copy of traffic control plan -OR- A Applicant's name:' _T1 M o+ 1�/ I T�1- L rw i n•e A f2 11 Substantial project work requires PP {_. above items and professional Address: e- W900 SW V S'�Y.e�t engineered plans for: -';T- g70G2 Streetwidening v0. 1 Subdivision infrastructure Phone: 5v4a- Email: u @ •Main utility line extension: �I 2� - Storm Drain,Sanitary-Tigard DC7 �/� �� p - Water-Tigard Water Service Contractor's name: Area(includes Durham,King City CCB#: Expiration: and a portion of unincorporated Washington County) Address: City/state: Zip: DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. • Engineer's name: Tigard,OR 97223 o r-rm 1 h-e-_ � :t Applications for"minor work in right-of-way" Address: -S E -e only may be emailed to: City/state Zip: r�ermitsra)"gard-o_gma)'gard-orgm Phone: Email: Estimated value of work(within the public right-of-wap): $ II I 0 00 0.00 Case Na: Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes OK No Applicaur accepted: If so,please specify(MLP,SDR,SUB,etc.) case#: By ,( Date: Is work related toa BUILDING PERMIT? ❑ Yes 0(No Application reviewed: If so,please specify(BUILDING PERMIT)case#: App otified C� By Date: 1 k%GJRK 4tiamrsW"d Un APPSMUMU an 07/16/X14 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-oLgov • 503-718-2421 • Page I of 4 r APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. *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(s)must sign this application in the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed iwon the subject Qper4. • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are false. • The applicant has read the entire contents of the application,including the policies and criteria,and understands the requirements for approving or denying the application. SIGN TU S of o r o t o u j ct property required. Tr M n—t�r F 'f' t3 E LL o 1 13 2a 15 A2"nt/Ae A4-rent's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or:gov 503-718-2421 • Page 2 of 4 OVERHEAD LEGEND 12234 05880 05881 1974 -45 O 19 5 4 -4 5 1954 -45 O REMOVE FACILITIES = INSTALL FACILITIES BN -2 A CSR - - - - - - - - INSTALL 1-#2 AL-TX OH SECONDARY 1 -210 AL -TX EASEMENT FOR OVERHEAD WIRE SW NORTH DAKOTA ST VT 00089 B 25 61325 9254 B 15 32003 NORTH Q WR CHECKLIST DAKOTA U 25 27718 ITEM YES COMMENT SHOP B 2 5 87316 HOLEDIGGER X 200A BOOM 12KW EXISTING LOAD BACKHOE ` PGE TRENCH 9322 1201'240V PGE ADDED LOAD 2ooAMP ` 32.3 TOTAL NEW LOAD 2.24%VD 45' I 1.55%FLKR LOCATES X 3,803A AFC STAKING X UG CIR.VER. L -T X-D FLAGGING 0 5131 112�o TREETRIM 1950 -4 5 1 _2 AL-TX T X_` � LANDSCAPE x Z EASEMENT X ANCHORS w x-U Z U, PERMITS X CITY OF TIGARD = 2 a PL-5131 P�" y J y W a TRAFFIC PLAN 30'L 11285 1 "2 > Ai LEAD ) CUTSHEET Al 5'014# 1 ANCHOR CODE Al A3 AS A7 A8 TRANSMISSION G16 SECONDARY 5,014# U C3 \�q SHUTDOWN CUSTOMER Z T SHUTDOWN z N DOOR HANGER m GUYING o = o z CONTACT o o 0 11300 Gl6 (POS.-LBS.) z ^ S COMPANY - 3 PH* C# v 1 GUY GI G4 G7 G10 G16 DATE TIME SW SHADY LANE eFq` PGE CONSTRUCTION DRAWING Fq RIGHT-OF-WAY PERMIT NOTICE: TQti, —BUILT VERIFICATION & NESC VIOLATIONS CORRECTED A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY AS TCiq WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED This document accurately represents FIELD Construction. CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL Foreman: Date: ti AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. 8m o yyr THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS General Foreman: Date: bBEFORE WORK IS TO BEGIN. A COPY OF THE PERMIT MUST BE ON SITE. (Signature Only required for field construction changes.) CP° THINK CONTACT GENERAL FOREMAN SDPM/ENG REVIEW: ASBUILT BY DESIGNER: v ANDOR CONDUIT INSPECTOR 3 TO 5 WORKING DAYS PRIOR Q & SAFETY TO EXCAVATION. CONDUIT INS?ECTION REQUIRED PRIOR TO BACKFILL. DATE: 11/17/2014 SCALE: 1" 40' ACCOUNT: 1070001 AwO 1000004599 JOB 756154 SW NORTH DAKOTA ST FIRSTI PGE WILL NOT INSTALL WIRE UNTIL TRENCH IS 100% BACKFILLED. TITLE JAYDEE PICKERILL ` KYLE KRAITER GENERAL FOREMAN //P CIRCUIT SIZE £3 CELL:503-849-6742 TIGARD - 13336 11x17 �� CALL 811 BEFORE YOU DIG PGE LOCATION Q JOB ITE ATTENTION: , 9254 SW NORTH DAKOTA p OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ` DESCRIPTION C7 Q , BY THE OREGON UTILITY NOTIFICATION CENTER. , a an d THOSE RULES ARE SET FORTH IN OAR 952-001-0010 � OH SVC TO NEW SHOP (M1433190) v N THROUGH 952-001-0090.YOU MAY OBTA114 COPIES OF COUNTY SECTIONS) WORK WITH SHEET N a THE RULES BY CALLING THE OREGON UTILITY BEAVERTON THE C71- 35D t OF 1 b C3 0 3rNOTIFICATION CENTER ADMINISTRATION @ (503-232-1987) � LINE CREW CENTER DESIGN BY PHONE (503) DRAWN BY Ln TO REQUEST UTILITY LOCATES CALL THE OREGON Know what's be 2213 SW 153RD OR LORRAINE KATZ 672-5484 LANE WHITNEY THOMAS GUIDE D❑ low. 6EAVERTON,OR 97006 UTILITY NOTIFICATION CENTER.811 AT LEAST Call before you dig. ©PORTLAND GENERAL ELECTRIC CO.- ALL RIGHTS RESERVED 655—E3 VICINITY MAP 2 BUSINESS DAYS PRIOR TO EXCAVATION.