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PFI2015-00159 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00159 p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/04/2015 Parcel: SEG885, 3624, 3428 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 12115 SW 124th Ave. Repl BP primary UG wire 320 feet 3 phase from VT 6340 to VT 6341. Owner: FEES Description Date Amount PFI Permit Fee 11/04/2015 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: TSAHAIANDERSON 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-612-6106 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 Not Present Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00159 Tv pe: 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 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 41 City of Tigard OCT 2 7 2015 PUBLIC WORKS —ENGINEERING PGE WORK ORDER# M1450077 ITY OF TIGARD , , . Public FacilityLA ��ent (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: REPL BP PRIMARY UG WIRE 320 FT ® 1\4inorwork in right-of-way (sideN3 PHASE FROM VT 6340 TO VT 6341 opens ngg,,alk repair,curb cut,street opening,etc.)requires: •Application form,completed and signed • Submit one(1)copy of scaled sketch Property address/location(s): 12115 SW 124TH AVE, TIGARD of the proposed work to be done � � )• •Submit one(1)copy of traffic (�(Ci control plan OR— Applicant's name: TSAHAI ANDERSON E] Substantial project work requires PP above items and professional Address: 10800 SW AVERY STREET engineered plans for: TUALATIN OR Zi 97062 •Street widening City/state: p •Subdivision infrastructure Phone: 503-612-6106 ]-mail: T&DSupportAvery@pgn.eom •t\lain utility line extension: Storm Drain,Sanitary—Tigard TBD \Meter—Tigard Water Service Contractor's Hanle: Area (includes Durham,King City CCB#: Expiration: and a portion of unincorporated \Mlshington Count),) Address: Cite/state: Zip: DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Tigard,OR 97223 Engineers name: TOM COX ' 3700 SE 17TH AVE Applications for"Honor work in right-of-way" Address: onlv m:n•be cnlailcd to: City/state: PORTLAND OR Zip: 97202 rowpermitsa tigard-oror.gov Phone: 503-867-0414 Email: • • /�1.../��� ���� Estimated value of work (within the public right-of-way): � � Case No.: Application submittal fee: 308 Is work related to a LAND-USE DECISION? ❑ Yes ❑p No Application accepted: If so, please specify (1\7 1-P, SDR, SUB, etc.) case #: By: L J Date: Is work related to a BUILDING PER 41T? ❑ Yes ® No Application reviewed: . ��•3• �S If so,please specify(BUILDING PEIA211)case#: By: �� Dare: Applicant notified: By: Ls Date: I:\CURPLN\Masters\land Use Applications R-07/16/2014 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • w1-,w 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. Wheli the owner and the applicant are different people,the applicant must be the purchaser of record ora 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 anv deed restrictions that may be attached to or imposed upon the subject propern • If the application is granted, the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and linutations of the approval. • AD 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 tivs 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 tlne requirements for approving or denying the application. SIGNATURES of each owner of the subject property required. Digitally signetl by TSAHAI ANDERSON TSAHAI ANDERSON 10/27/15 TSAHAI ANDERSON 11=TAHAIANNDERSO@ RGNDOMucPUS Date.2015.10 27 15 28 N-07'00' Applicant/Authorized Agent'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 S\V Hall Blvd. • Tigard,Oregon 97223 • m1vxvtigard-or.gov • 503-718-2421 • Page 2 of 4 123?5 j WR CHECKLIST OVERHEAD LEGEND t_-�_ -WL ITEM ITEM YES COMMENT ` 1 •(3)ELBOW KIT-JKTD CABLE.#2AL i I U J 0 REMOVE FACILITIES ©REMOVE FACILITIES�.• 12495 1 L..._ t t _ < HOLEDIGGER BOOM 6 '1 7" I jBACKHOE --_---- 73 � �� � V I Q INSTALL ADDITIONAL FACILITIESIMODIFY FACILITIES y 65 I �f ,�j45^ � -- •-_�,,,_,_ 5 ( 6653 -., 8032 mv PGE TRENCH 20 CONDUCTORS2--12497\„ 201I2b,-Unknow 197 a -225 BORE X 320 FT INSTALL nknown 2012 LOCATES _ X PROVIDEDBY6 INSTALLED BYPGE-APPROVED CONTRACTOR �r X10 CU DX STAKING ' FLAGGING X REMOVE o SW KATH INE ST 'M C G SW KATHERINE ST TREETRIM �C3, — k LANDSCAPE EQUIPMENT IY EASEMENT 03 G'G .T-"` F--- -� l FAULT INDICATOR r-- H PERMITS X TIGARD 80 — ; 1 — I I TRAFFIC PLAI, X l L_1 360j 1 1 y 50 I CUTSHEET 5 12111 2 106 2B4B I I U C.3 ( J 7- UG CIR.VER. ....-,.--..�.m-.._s.,....- ...__ t Q WL 1-2 Spen: TRANSMISSION p- -Install; I SHUTDOWN j I"`-'-"�2-F- j 1 I {�)! �� '(305')1-RUN OF 02 AWG,AL,TRIPLEX EPR,I SKV RECEIVED pa 1i 15 ` Q + 'CONTRACT BORING CUSTOMER tI _ B ®� Abantlon: `�� eee77/ 1 18- I 1 •305'1RUN-2AL CTX SHUTDOWN i {S1 j F,, I a a 12120 I DOOR HANGAR 1 -a CONTACT OCT 27 2015 COMPANY k l VT 311-WL 1: lSj( t W W f(� Install: PH# C# /'`'"�O TIW® U) 1 48. {i ' ~AJ '(3)INDICATOR SMALL FAULT VAR TRIP 200AMINIIIUM TIME 1ZATE TIME � V��N ����s i � < 1 t 6855 �I ISO '(3)ELBOW KIT•JKTD CABLE.#2AL 1 I 120.4 I I rL 4 7 3760 1 168, 112165n C2P 1 0 —'37.5 75 150 Feet I f 12n0 I I I I PGE I CONTACT GENERAL FOREMAN THINK AND/OR CONDUIT INSPECTOR 7 TO 10 WORKING DAYS PRIOR TO EXCAVATION.CONDUIT INSPECTION REQUIRED PRIOR TO BACKFILL. SAFETY PGE WILL NOT INSTALL WIRE U NTIL DUANE 15 100% CMCM I�WH TETE TOR FIRST EMAN CONDUI 503-84-353 CELL- -72-75 8 PHONE:503-849-3538 k ewrti.coan�nw � x. a :JOB SITE NY DEM 77ON FROM THI5 DESIGN MUST t' 1bBEAPPROVEDBYTHEPGEPROIECTMANAGER PGE CONSTRUCTION DRAWING F y� AS-BUILT VERIFICATION&NESC VIOLATIONS CORRECTED •sy 2 RIGHT-OF-WAY PERMIT NOTICE: �� �+ r- •FSP= h A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY Foreman: Date: y H WORK IN THE RIGHT-OF-WAY MAYBE PERFORMED. ONLY PGE APPROVED -4 CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL General Foremen: Date: SW KATHERINBST aC AGREEMENTS WITH PGE WILL BE ALLOWED TO WORK UNDER PGE'S PERMIT. SDPANENG REV/EW. nfv ASBUILT BYDESIGNER. mlunaRJlcax C lmri THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 48 HOURS .�} L ACCOUNT, AWO: JOB NO. C nBEFORE WORK IS TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE. 09/10/2015 1'=70' 1070001 14628 M1450077 S WIWILLS PC ,tS ~ TITLE BORE JOB-REPL BO PRI UG WIRE-320 FT-3 PHASE bCALL 811 BEFORE YOU DIG CIRCUIT SIZE _ y ATTENTION. TIGARD-13362 1107 "SW RNAL,, )- OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED LOCATION BY THE OREGON UTILITY NOTIFICATION CENTER. PGE 12115 SW 124TH AVE.,TIGARD,OR V SNI I&REN ST THOSE RULES ARE SET FORTH IN OAR 951.001-0010 D SCRIPTION THROUGH 951-001.0090 YOU MAY OBTAIN COPIES OF 11 REPL BO PRI UG WIRE 320 FT-3 PHASE FROM VT6340 TO VT6341 JSHWTP( THE RULE58Y CALLING THE OREGON UTILITY F BEAVERTON COUNTYSECTIONS I H NOTIFICATION CENTER ADMINISTRATION @(502.131-1987) LINECENTER WASHINGTON C2103B i+ SWQ/;�OK CT VICINITY MAP• PGE: TO REQUEST UTILITY LOCATES CALL THE OREGON xlmrurinla�below• DESIGNev PHONE(503DRAWN BY UTILITY NOTIFICATION CENTER,811 AT LEAST Callbefampomg. 2213SW 153RD OR TO COX 867-0414 HUGO MEJIA 2 BUSINESS DAYS PRIOR TO EXCAVATION NEKTON,OR 97006 control aevice or ine cNu KUAU vvuNr\ sign toponal). figure 2-1 : Work Zane Components I . .•• _ Term inaflon Area • Buffer space . (optlonan • Work Space r I Buffer sRECEIVED pace (options OCT 21 2015 ® CI cis-rlcaR ( • PLANNINGiENGINEERING • Transtdon ' Area • I • e A V4Advance B Warning �► V—t Area c f Inildol Warning Sign Chapter 2 December 2011