PFI2015-00007 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2015-00007
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/26/2015
Parcel: SEG1292
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Adjacent to 13165 SW Ash Dr., replace bad underground primary conductor. SEG1292
Owner: FEES
Description Date Amount
PFI Permit Fee 01/22/2015 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
KRISTINE HENDRIX
10800 SW AVERY ST.
TUALATIN,OR 97062
PHONE: 503-209-0319
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 JVo7
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12015-00007
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
RECEIVED
City of Tigard ,IAN 2 0 2015
PUBLIC WORKS—ENGINEERING
Public Facility Improvement (PFI) PermieG
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one:�Putilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description ObLl'i_ (�r-dtr UL-Q-iff" ru— )finor work in right-of-way
(sidewalk repair,curb cut,street
E1EA'1 1��, opening,etc)requires:
•Application form,completed
and signed
-Submit one(1)copy of scaled sketch
Property address/location(s): 15110-1 5� of the proposed work to be done
•Submit one(1)copy of traffic
control plan
-OR-
L j ❑ Substantial project work requires
Applicants name: ILI above items and professional
Address: —�� engineered plans
for.
City/state: •Street wideningTUQQ �n �n p:
•Subdivision infrastructure
Phoneft?ki 1—� Email: 1 Gr.� �A►�Q Ilrl�m •Main utility line extension:
J v - Storm Drain,Sanitary—Tigard
T - Water—Tigard Water Service
Contractors name: `0 bL ddPpJ L[ Q bld . Area(includes Durham,King City
and a portion of unincorporated
CCB#: Expiration: Washington County)
Address:
DELIVER APPLICATION TO:
City/state: Zip:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
W A Tigard,OR 97223
Engineer's name:
Applications for"minor work in right-of-way's
Address: only may be emailed to:
City/state: Zip:
Phone: Email:
Case No.:?'I zol S_
Estimated value of work (within the public right-of-way): � '4 3
Application submittal fee: � 100
Is work related to a LAND-USE DECISION? ❑ Yes ,9-No App ccepted:
If so,please specify(MLP,SDR,SUB,etc.) case #: By: Date: 20 S
Is work related to a BUILDING PERMIT? ❑ Yes No Application reviewed:
If so,please specify(BUILDING PERMIT)case#: By: N (3 Date: l •Z t ��
Appliant notified:
By: _ Date: l
t:KuePu4%M/asMnUsnduseAPVdbtbns Rw.07/10MU
City of Tigard • 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-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
*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 hat may be attached to or imposed upon the subject pmp ems.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and litnitations 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.
SIGNATURES of each owner of the subject property required.
A plicant/ uthorized Agent's signature Print name Date
Owner's signature Print name Date
Owners signature Print name Date
Owner's signature Print name Date
F .yam PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SIN Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4
EBEAppPPROVED
Y DEVIATION FROM THIS DESIGN MUST WR CHECKLIST LEGEND
BY PGE PROJECT MANAGER TEM YES COMMENT
HOLEDIGGER
BOOM NEW PGE FACILITIES TO BE INSTALLED
A 564660 BACKHOE (UNLESS OTHERWISE SPECIFIED)
1 PGE TRENCH
M 05779 . 11111111 FACILITIES 70 BE In,
ABANDONED CABLE MUST
BE GROUNDED AT EACH LOCATES 1 11111111 FACILITIES TO BE ABANDONED
END PER LC22035-7 " STMiNc
' FUGGING x ________ INSTALL 1-22 AL-XLP JKT PRIMARY IN 2"PVC CONDUIT
A 50 6!
ii615 } 1, TREE'Pw PROVIDED d INSTALLED BY PGE-APPROVED CONTRACTOR
I n R
�1 PO 0577 r LANDSCAPE ABANDON PRIMARY CONDUCTOR
* p9 o EASNEM GROUND PER LC22035-7
R to S �+2 �' �°�.'s PERMITS X CITY OF TIGARD
3097 TRAFFIC PUN I ALL CONDUIT TO BE INSTALLED 36 INCHES(MON)BELOW FINAL GRADE
• �Q 6 �° 65-45 n CUTSHEET
ALL PGE CONDUCTORS TO BE INSTALLED IN GRAY,SCHEDULE 40,ELECTRICAL GRADE,
S� '� ♦AaQ W CIA.VFR PVC CONDUIT WITH NYLON PULL STRINGS((MIN.500 LBS.TEST).PGE TO DETERMINE
TRANSMISSION THE SIZE AND NUMBER OF CONDUITS REQUIRED.MAINTAIN 12 VERTICAL INCHES AND
'1 C` ; SHUTDOWN 24 HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES.ALL ELBOWS
CUSTOMER ALL
INCH 8 SMALLER TO BE 36 INCH RADIUS.ALL BENDS MUST BE FACTORY MADE.
SHUTDOWN ALL ELBOWS LARGER THAN 4 INCH TO BE 60 INCH RADIUS.RIGID STEEL OR PGE
APPROVED.FIBERGLASS BENDS ARE REQUIRED FOR RUNS Of 151 FEET OR LONGER,
380' LLMVGER
A OR FOR ANY LENGTH RUN WITH MORE THAN 180 DEGREES IN BENDS.PVC SCHEDULE
4` /1B BI�0/ DDDR x
1 ,w 40 BENDS ARE ACCEPTABLE FOR RUNS OF ISO FEET OR LESS.THE MAXIMUM TOTAL
INSTALL �,It' ; COMAC7 BENDS M ANY CONDUCT RUN 6 270 DEGREES.
_ OPE , • ,L. COMPANY -'-TIONAL BORING REOUIREMENTS:BLACK HDPE`HIGH DENSITY POLYETHYLENE)DUCT
P 277 (� 1• F.j �j• PNM PH4 C4 SCHEDULE 40 PVC WITH A MECHANICAL CONNECTION (CERTA-LOK OR LIKE MECHANICAL
PROPOSED qq11�� .:ONNECTION PRODUCT)AS AN ALTERNATIVE TO HDPE DUCT.HDPE SHALL MEET THE
1 REMOVE r ROA„ DATE RMF REQUIREMENTS OF PGE SPECIFICATION L22501(AVAILABLE ON REQUEST FROM PGE PROJECT
OPE - —GERI.FOR SAFETY REASONS THE DUCT SHALL BE BLACK WITH THREE EQUALLY SPACE
' 7 EKTRUDED RED STRIPES(WHICH IS A SPECIFICATION REQUIREMENTT77.MANDRft TEST Or
AITa HOPE PTFE IS REQUIRED AFTER INSTALLATION WITH PGE INSPECTOF PRESENT.
PGE TO BE NOTIFIED AND MSIECT ALL CONOW..VAULT AND PAD INSTALLATIONS
05277 BEFORE BACKFILL ALL NEW VAULT B PAD LOCATIONS TO BE FIELD VERIFIED
I WITH PGE AND CUSTOMER REPRESENTATWF
/ REFER TO PGE ELECTRICAL SERVICE REQUIREMENTS BOOK FOR FURTHER DETAILS
A 64620 f e , * THINK B SPECIFIC REQUIREMENTS.LINK TO WW"^A Pnen Aunnxureu rnM.RFnROnr
i SAFETY DESIGN IS BASED ON STANDARD UNDERGROUND EQUIPMENT NON-STANDARD
Y ,
THE RGROUND CUSTOMER EQUIPMENT MAY BE AN OPTION AT AN ADDITIONAL COST TO
P a FI RST!
RIM-2 ,
wsi-43 IP ' WINS 715447
4�.
+ L,
G ice" Q 1 VI67I5 CONDUIT/CABLE PATH WAS MODIFIED. NOTE ADDED.
A N
REV* DATE DESCRIPTION
REVISIONS
�+ FUE CONSTRUCTION DRAWING
RIGHT-OF-WAY PERMIT NOTICE: AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
A PERMIT FROM THE LOCAL JURISDICTION 15 REQUIRED BEFORE ANY This document accurately mpresents FIELD Construction.
- WORK IN THE RIGHT-OF-WAY MAY BE PERFORMED. ONLY PGE APPROVED
i" Foreman: DDM:
CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL
�C AGREEMENTS WITH RISE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. General Foreman: Date:
THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS
3 BEFORE WORK 15 TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE. (Signature only required for field construction changes.)
SDPMIENG REVIEW: JASBUILT BY DESIGNER:
DATE: 123043 SCALE: I'm AccaR+T: 1070001 A f 1000004545 Joe NO.M1409518
�y
REPLACE B9 UG PRIMARY CABLE
41 CALL 811 BEFORE YOU DIG CIRCUIT slzE
\1 OREGOATTENTN
TIGARD-TIGARD 13 11x17
'�. � Y� v ,RSI OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED '
r
THOSEBY OREGON RULES ARE SETFORTHITY TIN OAR 952-001-NIO /FICATION CENTER. PGE LOGTRON
` / 13163 SW ASH DR,TIGARD
�(. THE RULEUGH 952-00LING YOU MAY OBTAIN COPIES OF DESCRIPTION
THE RULES BY CALLING THE OREGON UTILITY
NOTIFICATION CENTER ADMINISTRATION �y f50}277-1987) REPLACE BU UG PRIMARY CABLE
TO REQUEST UTILITY LOCATES CALL THE OREGONKCOUNTY (S) WORK WITH SHEET
now whaYs below.
UTILITY NOTIFICATION CENTER.BTI AT LEAST �OII hllor! oO d1 BEAVER WASHINGTON C71-02C ) of 1
Sw Mc uDOlBia 2 BUSINESS DAYS PRIOR TO EXCAVATION. T B LINE CREW CENTER
.us GUIDE -" --- DESIGN/Y PHONE(425) DRAWN BY
m1 sw ISRKD DP HASSAN AMAN 32D-0319 K MIERAS
65545 -` VICINITY MAP REAw.1-.DR 9—
0►PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED