PFI2016-00245 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
• COMMUNITY DEVELOPMENT Permit#: PF12016-00245
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/09/2016
Parcel: SEG1425
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace B/0 primary cable
Owner: FEES
Description Date Amount
PFI Permit Fee 11/08/2016 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
KENNETH ALLEMAN
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-936-6927
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 PF12016-00245
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 twenty-four(24) hours prior to commencing work,prior to any staged
inspection, and after completing work covered by the permit. Call Ken fisher at 503-816-6146 or Kenny@tigard-or.gov
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
NOV 0 2 2016
City of Tigard
' PUBLIC WOR.I;S ---- I `NGINEERING CITY OF TIGARD
:. ' PLANNING/ENGINEERING
Public Facthty Improvement (PFI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
,_.j 'TYPE 1—Franchise Utility Work
_
Check one: 1 Utilities ❑Sidewalk/driveway approach ❑Sueetimprove nests performed b.v NA1 NN, PGI:'.
Detailed description: PGE JOB M1931601 and/or utility agency.
Replace B/O Primary Cable - ❑ TYPE 2-Sidewalk/Driveway/Sewer
Fork perfonned for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Property address/locadori(s): _ _ and/or repair
13700 SW 115TH AVE, TIGARD, OR 9#23 • Sanitary sewer lateral installation
and/or nrain line tap
Portland General Electric ❑ TYPE 3—Pull state Development
Applicant: Fork performed with Land use
Address: 10800 SW Avery St. approval wluch uicludes any of
Ciry/state: Tualatin, OR Zip: 97062 the following:
503-936-6927 Email: oord n.com ' Subdivisions or partitions
Phone: Preren @,�cJ
Contact name: Phone: 503-036-6927 • Street widening
• Mainline installation for Simla,,
Contractor: NIA sewer, Storm sewer,Tigard water
and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Gip: City of Tigard
Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: Kenneth Alleman only may be ernailed to:
rowpermitsCattigard-or.gov
Address: 10800 SW Avery St. FOR STAFF USE ONLY
City/state: Tualatin, OR Zip: 97062
Phone: 503-936-6927 Email: PreregCoord@pgn.com Case
Contact name:Kenneth Alleman Application submittal fee: f 3 .00
Additional fees:
Estimated value of work is required(if over$5,000):$ __ Application accepted:
(within the public right-of-way) By:
J Date:
Application reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes I o �• 1 _
If so,please specify(N-ILP,SDR,SUB,etc.) case#: By: V%- 1'ISHl�.Date: 8 y 4
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes No By:_Dare:
If so,please specify(BUILDING PERMIT)case#: i_NtURPLN\Mastets',Lwd Use ADCucations Re,09/26/2016
S w t t S 4t-r— ('s V1 k�v Gv>- 57_'LE�LT_ 014 �-► L �/B
City-of Tigard • 13125 SXR'Had Blvd. • Tigard,Oregon 97223 • xvwwtctigard-or.gov 503-718-2421 Page 1 of 4
APPLICANTS
NOTE: Person specified as"Applicant"shall be designated"Permittee''and shall protide financial assurance for work,if
required by the city pursuant to TMC ?5.041.1 40.
V ith the{.X cotiom ro a U611n,opts:umg liaiN'uat:t t,t,t valid tninciiisc will+the tate r f Tigard,when the owner and tile.applicant arc diffcreat
pcopkt the applicant niltst lit:the l urciiaser of record ora lessee in possession with written authorization from the owner err an agent of the
owner. The awner(s)mutt.ign this application in the slntce protidcd or subm.ir a written atltho[lZation with this application. Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS)SHALL CERTIFY THAT:
• The abc>-e request docs not rio'atc any recorded decd restrictions that may be attachcd to or irZ on sed upon the subject
propexts:.
• If the application is granted,the applicant will exercise the tights 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 any 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.
-�— �,t,---- Brian Moore tt E„e ,
Applicant/Authorized Agent's signature Print name
Date
SIGNATURES of each owner of the subject property, if required.
Owners signature Print name Date
Owner's signature Print nanie Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 Ste'Ball Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEESFOR STAFFUSE ONLY
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
REIQUIREMENTS
APPLICKHON FEE
Part I: Required submittal tree$300.0x1
FRANCHISE UTILITY AND SIDEWALKj
PERMIT FEE DRIVEWAYAND UTILITY
CONNECTIONS,ETC.
Part 2: A11 non-water system improvements (woxk.in the right of way)
Engineer's estimate X 5%(less$300.00 submittal fee)
F-rr irieer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public water system improvements ❑ Street dame
Engineer's estimate X 12% ❑ Site address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required (Subdivisions/Partitions and Street lmprorements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Des Plans
• Ditch cleaning that does not involve regrading. (6 setss,,24x36 or 22x34)
ri
• Vleep hole.repair ❑ Cover–Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Fater,Sewer,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pinning or planting ❑ dater,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW I fall Blvd. • Tigard,Oregon 97223 • www.tigard-ongov 503-718-2421 Page 3 of 4
SAMPLE SKETC11:
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Existing S/W or of pavement Existing utility locations
D/NV apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard • 13125 Ski'Hall Blvd. • Tigard,Oregon 97.223 • wwwtigard-or.gov • 503-715-2421 • Page 4 of 4
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SUMMARY OF DEVICES: OWNER: PROJECT/JOB NUMBER:
4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601
PROJECT NUMBER I LOCATION:
3 X BE PREPARED TO STOP TIGARD OR
13485 SW GENESIS LOOP
3 X FLAGGER SYM PRIME CONTRACTOR TRAFFIC CONTROL CONTRACTOR:
PGE
CONTACT NAME 1 NUMBER: E MAIL:
20 X CONES Ken Apeman 503-963-6927
PREPARED BV:
Nathan Burris
NOTE:All signs and devices SHALL conform to the MUTCD/OTTCH E MAIL:
Will adjust to field conditions
Plan NOT to scale
FILE DATE:10/0112015
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SUMMARY OF DEVICES: OWNER. PROJECTIJOB NUMBER:
4 X ROAD WORK AHEAD PGE(Beaverton line crew center) M1931601
PROJECT NUMBER/LOCATION: CITY:
3 X BE PREPARED TO STOP 13485 SW GENESIS LOOP TIGARD,OR
3 X FLAGGER SYM PRIME CONTRACTOR: TRAFFIC CONTROL CONTRACTOR:
PGE
CONTACT NAME/NUMBER: E MAIL:
20 X CONES Ken Alleman 503-963-6927
PREPARED BY:
Nathan Burris
NOTE:All signs and devices SHALL conform to the MUTCD/OTTCH E MAIL:
Will adjust to field conditions
Plan NOT to scale
FILE DATE:1010112015