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PFI2016-00068 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12016-00068 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 03/30/2016 Parcel: SEG2956 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 10260 SW Hoodview Dr. Replace 545 ft bad order primary cable. Conduit to be installed by PGE approved contractor. Owner: FEES Description Date Amount PFI Permit Fee 03/30/2016 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: KATHRYN VANDERZANDEN 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-612-6136 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: Not Present Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12016-00068 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 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. Kenny Fisher at 503-816-6146 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 MAR 2 8 2016 City of Tigard CITY ■ PUBLIC WORKS—ENGINEERINJ?�ANNIN&JGINL! DER# M1939940 Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: N Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: I@ Minor work in right-of-way (sidewalk repair,curb cut,street Replace 545ft bad order primary cable opening,etc.)requires: Conduit to be installed by PGE approved contractor a Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 10260 SW Hoodview Dr of the proposed work to be done 5 e Submit one(1)copy of traffic control plan —OR— Applicant's Kathryn Vanderzanden for Phil Merriman E] Substantial project work requires PP s name: above items and professional Address: 10800 SW Avery St engineered plans for: Tualatin, OR 97062 a Street widening City/state: zip: e Subdivision infrastructure Phone: 503-612-6136 Email: T&DSuppoMvery@pgn.com a Main utility line extension: - Storm Drain,Sanitary—Tigard To be determined - Water—Tigard Water Service Contractor's name: Area(includes Durham,King City and a portion of unincorporated CCB#: Expiration: Washington County) Address: City/state: Zip: DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Engineer's name: Phil Merriman, PGE Service Design Project Mgr Tigard,OR 97223 3700 SW 17th Applications for"minor work in right-of-way' Address: only may be emailed to: City/state: Portland, OR Zip: 97202 ro"ermitsktigard-or.eov Phone: 503-963-6943 Email: phil.merriman@pgn.com Estimated value of work (within the public right-of-way): $ Case No.: Application submittal fee: co Is work related to a LAND-USE DECISION? ❑ Yes N No Application accepted: If so,please specify (MLP, SDR,SUB,etc.) case #: By:Lo Date: Is work related to a BUILDING PERMIT? ❑ Yes 8 No Applicata n r�_ e ewed: If so pleasespecify(BUILDING PERMIT)case#: By: Date: Appli tified: By: Date: 3 2 lACURPLN\Masten\land Use Applications Rev.07/16/2014 City of Tigard e 13125 SW Hall Blvd. a Tigard,Oregon 97223 a www.fiprd-or.gov a 503-718-2421 a 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 that may be attached to or im=osed upon the subject popery. • 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. SIGNATURES of each owner of the subject property required. DQ,.Uy s1g—by Kathryn VanEerra dw Kathryn DN'—K.Nry V-d.—Me -ftrwM General eme�ne.w=PGE. Kathryn Vanderzanden for Phil Merriman 3/28/16 Vanderzanden kathryn.251 D.3a 14 nM'n wm,FUS Date 2018.07.2510.75/�-0T00' 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 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI) Permit: Part 1: Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee = Part 2+ Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement I I - — Ditch ��► Streetlight I — ----------- —C--- ` /• a xal nridn k1� O � I d�5el�w'erTiHe" 1 I , Existing House I I WN I Existing 1 Driveway 01 cii I CL �I 0 I . o� co j wl I 0 Existing Shop Powerpole o 0 I 95 I�-------TrroPne"—.—......—. � I II Fire Hydrant(FH) Scale: '1"=30' � � I � I I I I � � I MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable): North arrow Property lines &dimension Slope of property Street& street name(s) Existing building, structures Utility&street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water, storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 Page 84 2011 Edition Stationary Lane Closure with Flagging Diagram 320 Diagram 320 covers total closure of one lane of a two-lane,two-way roadway. See the detail inset for the layout if using a single flagger to control both directions of traffic on low volume roads (less than 400 ADT)with good sight distance as discussed below. 1. Use truck-mounted flashing warning lights on work and protection vehicles. See Section 4.3—Lights and Lighted Signs for exceptions. 2. For added visibility, a truck-mounted arrow board or PCMS in caution mode may be used. 3. Flaggers at each approach are required if any of the following conditions exist: a. Night Operations. b. Work space is over 200 feet in length. c. Sight distance is less than 750 feet from each approach through the lane closure. d. Traffic volumes are greater than 400 ADT. 4. The length between the Flagger Ahead signs shall not exceed one mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one mile. 5. Cones should be used to outline the work space when curves or other roadway alignments prevent clear direction for the motorists to pass the work space safely. 6. Cones along the work space are recommended when posted speeds are 45 mph or greater, when working under heavy traffic or when travel lanes are narrower than 11 feet. 7. Extended queue signing (see Diagram 5-4)should be used when traffic queues extend beyond the initial advance warning sign. 8. When flagging near an intersection, the"Flagger Ahead" (CW23-2) sign should be visible to traffic entering from any side road. Additional advance warning and Flagger Ahead symbol signs may be placed on the side road(s). 9. Sign set-up and flagger placement shown may be used for intermittent full road closures of 20 minutes or less. 10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should be considered on high volume or high speed roads, or when extended queues are expected. Chapter 5 December 2011 o I------- ———— -----� Cl) n, O f7 (n(nAA W W NN I rh CD N N N a Single Fiagger Operation VV O I for Low olumes I (Optional) o a j o co'i+ o y °' (ADT<400) ' ro Born I O D . 0 0 o m IN 9 I FLAGOM I PREPARED ONE LANE Z c A .B H a t• t• I TO STOP r F I ♦ I • ROAD Flo r•0 WORK 0 0 o f7'm ° K e I B K B K� AHEAD EF 0 a "M y N j 189 I ,,., I • A B B C I------------------------I 3 I_ 1 mile _I Z1 r max. fu � • • • r• • • — — — — to • • Emig ® ••• K K K K Tt • e � Buffer Protection Vehicle ROAD .- w/TMA(both Optional) WORK I1■'+ See Chapter 4 AHEAD BE ONELANE PREPARED m ROAD TO STOP Two Flagger Operation 3 w M v, (Optional) 00 WL 3 VT-5789 NEEDS POST LANDCAPE L 10324 2B� 1p1T3 W 1 VT-5276 LEGEND Install: WL 1-3 Span III Install: RsovewAlnONARIauTra wsuu PACAlILa SU39627 CONC.VAULT COVER PADMOUNT TRF 48"x48"x6" lam Abandon (6)6-POSITION BUS SUBMERSIBLE wsr ANwSKNAL fACR01lSAIOOFYIiAC1U1lF 1P 7.2 240/120 PM 75KVA NTLB (545')A-PHASE OF JKT#2 AL Remove: ELBOW KIT-JKTD CABLE-#2AL mm IP 7.2 120/240 SU 50KVA NTLB CONDUCTORS Remove: REMOVE CONCRETE VAULT-VT5276 A-PHASE RAL EPR JKY�D PRIMARY I 7.2120/240 SU 75KVA NTLB WL1-2 Span: _______ .PRONDEDANDINSTALLEDBYPGE. I-2-CONDUIT Install: NOTE:CONTRACTOR TO RETURN TO -PROMED s wsTAUED BY POE APPRpv>=D CONTRACTOR (10)2-RUNS AL 350KCM TX REMOVE VT-5276 AFTER PGE CREW -------- FMAL TXSECAINRYN f-J'PW -- -(10')2-3"PVC CONDUIT ICLEARS ALL PGE EQUIPMENT FROM VAULT ABANDON RAL GROUND ABANDONED CARIE PER lC22006T 1005 10.155 10185EQUIPMENT 10135 107061 'T 1NAI F LTww.—VANRo . 1 ?m �i s PAO(Uo16NT) 10102'0 PRD�DfD.HDIHSTALL_BYP,SFAPPRPVf c— QPROVINTMNS.FsTAufO eYPNecRE LL0(SOswn) w Vicinity Map ' t 3 SWHOODNEWDR 1 + _____________ LL------------------ - �' - TENSION:82-R " "$Q 39514 X A•UNK sqq� +D+� JOB SITE E tA E d Po-BAA 5o p 1 . S 10410 10100 1tI5A tOi1O / •••o„ 7 1031 1021,la 10250 AUNxrx cUsr E 1maD .oaN..M ^^M'u••, TEVE CHWIRK EMI TAKAHASH u „ m.... 5036207777 1 5034436434 j ETER GUDEKUNS 503.598.9685 503.860.2117 sit tot N � PGE 1086 WL 2-3 Span: WL 2 PD-94: Install Install:10316 (5ONE-LINE DIAGRAM TV ' 10775 10755 45')A-PHASE OF#2 AWG,AL.EPR,15 KV SU39684-PAD TRANSFORMER CONCRETE 42"x50k6 ' " - 1 (545')1-2"PVC CONDUIT 0114 1P 7.2 24WI20 PM 50KVA NTLB _ — .�,,.a.I•^ �D 1 1 ICIM5 SMALL FAULT INDICATOR VAR TRIP 200A (2)ELBOW KIT-JKTD CABLE-02AL JOB SITE 0< 30 60 120 Fed ar NOTE:SPLICE ALL SECONDARIES AND ROUTE TO PD-1 x 02. PGE `OL � i A7AL RIGHT-OF-WAY PERMIT NOTICE: - _ I ZY TI A PERMIT FROM THE LOCAL JURISDICTION 15 REQUIRED Of FORE ANY A CO TRACTORS AND CONTRSBACTOWHO AVE MADE OTHER OVCD SPECIAL ` D R.wvAOxf AGREEMENTS WITH PGE Wit SF ALLOWED TO WORK UNDRPGE'SPERMIT pgylyp sI.E ME CONTMCTOR MUST NOTIFY RE LOCAL JURISDICTION AB HOURS \ BEFORE WORK 15 TO BEGIN.ACOPYDFTHEPRMITMUSTSEONSITE. AICU i rnfIs NNGwnD LANDSCAPING NOTES EED POST LANDSCAPI Q WL 3 VT-5789 -- PGE WR ESCO�'EE'T eRFNTION: NOnfu . YDU P IG OREGON LAW Rf0UIMf5O )OwRUFRS AOVD 1 oLEoicGER TNOsU—sARfsRFORTHw rom—CONES THINK THKNUGN ss.11I NSTEFO MAY ar N confs Or SAFETY •RAMS LING.WfTRAION OF(10 TY SINOLE-PHASE TRANSFORMER PA6 p,�K xOO REQUESCENTERYLOCATMI DILL THE FIRST CONDUIT CONRGURATION TO REQUEST UTILITYLOCATESCEN[ALL IMF OREGON IY=d1rR�a 545 FT UTILITY NOTIFICATION CFNRR 711 AT LEAST �111ft17�« PD 94 2 RUfINESf DAYS IRIOR TO fkGVATION _TCB x POE CONSTRUC TION DRA WING x r...�,.........._...., _2RN SCOHFECTFP R RIM PERMIT MAP x POST FPTwotn OMe General Foremen Do* PERM' x TIGARD ib 1Ytlmiw'�" SW HOODVIEW DR FOC 31' ROW 50' F x SOPMEAG SEW TSYDESIGNERODE : ur 3222016 1.6011 1070001 0000014628 M7939940 vr52T59 5 cR PD01 .vER. \ PGE-REPL BED PRIM CABLE-545 FT ■ ooxl 5DURHAMS17ATTLER 17 R 22 onon 10260 10200 X 20ACCOUNTS �; L102cA60 SW MOODVIEW DR.,TIGARD,OR DEsc wnoN PGE-REPL BIO PRIM CABLE-545 FT y�T WS`H sfc s ,1031,MTH DATE:02/04/2016 1/4 SECTION:2S-1VV-11SE NNSINGTON c21-t1c 1aF1 MPFNY --BY FMON3-MARKBY DESCRIPTION:INSTALL MICRO-PAD °�•° PHILMERRIMAN =3— S1_ R IECi CO-N1 RKaliB RE