PFI2018-00024 City of Tigard * COMMUNITY DEVELOPMENT DEPARTMENT
■
Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARDV I
Building Division
13125 SW SW Hall Blvd.,Tigard,OR 97223 / / ��'/✓
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: PFI2018-00024
Site Address or Parccl #: SEG 1396
Project Name: PGE
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Per Engineering, new service poles are not permitted in public right-of-way.
Therefore,permit should not have been approved, and should be voided. Applicant has been
notified. /l/0
Date: 2/15/18
Signature: —�-
Print Name: Lina Smith
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date B
Refund Processed: Date N "q� B Invoice Processed: Date B
Permit Canceled: Date B Parcel Tag Added: Date B
I:\Building\Forms\RegPermittkction_09231 .doc
9CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00024
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/12/2018
1
Parcel: SEG1396
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG 1396/9725 SW Frewing Street. Install service pole(lift pole needed). M2332921.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRANDON HADLEY
10800 SW AVERY STREET
TUALATIN, OR 97062
PHONE: 503-612-2935
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: L�
� II
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00024
Type: Condition Name: Status: Severity:
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
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.
RECEIVED
City of Tigard FEB 0 5 2018
PUBLIC WORKS —ENGINEERING CITY OF TlGgRD
Public Facility Improvement (PF"'P1fftftjtERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1-Franchise Utility Work
Check one: Pf Utilities ❑Sidewalk/driveway approach ❑ Street improvements performed by N1VN, PGE
Detailed description: Install Service Pole (Lift Pole Needed) and/or utility agency.
sot N, 2-33 Z") -1 ❑ TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of-
- Sidewalk installation or repair.
Property address/location(s): 9725 SW Frewing Street • Driveway approach installation
and/or repair
jCQ Tigard, OR 97223 • Sanitary sewer lateral installation
and/or main line tap
Portland General Electric Submitted b El TYPE 3-Full scale Development
Applicant: Y Amy Swean y� Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Lip: 97062 the following:
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Contact name: SDPM Brandon Hadley Phone: 503-844-5412
• Sheet widening
• Mainline installation for Sanitary
Contractor: N/A sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Phone: Ercall: Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
N/A only may be em:uled to:
Engineer: ro3ypermits_.tigard-or.gov
Address:
City/state: Zip:
Phone: Email: Case No.:?F�2-C)o-OoOZy
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ N/A Additional fees: $
(within the public right-of-way) Application accepted:
5 1
Is work related to a LAND-USE DECISION? ElYes lvf No By: AL--Date:
If so,please specify (MLP,SDR,SUB,etc.) case#: Applicain reviewed:
VBy: Date: •' •�
Is work related to a BUILDING PERMIT? ❑ Yes M'No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: Date: Z-
I:\ENG\PermitApplications\pfi_application Rev.10/16/2017
City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • wwwtigard-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,if
required by the city pursuant to TMC 15.041.140.
* With the exception of a utility operating pursuant to a valid franchise with the City of Figard,when the owner and the applicant arc different
people,the applicant must be the purchaser of record or a lessee in possession with written authorization frons the owner or an agent of the
owner. The owner(s)must sign tlus application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owner's signature oil the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or iunposed upon the subject
ro er
• 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 any plot plan,attachments,and exl-bits transmitted here,,with,are true;and
die 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.
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print naive Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SSU HallBlvd. • Tigard,Oregon 97223 • -,«vw tigard-or.gov 503-718-2421 • Page 2 of4
OVERHEADLEGEND
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AS-BUILT VERIFICATION B NESC VIOLATIONS CORRECTED
in,•acmeni ac.l,a.N..�•eurr!a FI FI f"
Foreman. Date:
THINK General Foreman: Date
SAFETY (Signature required lorrield construction changes)
SDPMIENG REVIEW ASBUILT BY DESIGNER:
NYDEVIATION FROM THIS DESIGN MUST FIRST 1/23/2018 1 in TE SCALE=30 ft 1070001 D000017443 M2332921
BEAPPROVED BY THE PGE PROJECT MANAGER TITLE
2016 OH FITNES-INSTALL SERVICE POLE
CALL 811 BEFORE YOU DIG CIRCUIT 412E
ATTENTION: ` TIGARD-TIGARD 13 17 x 11
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , LOCATION
/pG G
BY THE OREGON UTILITY NOTIFICATION CENTER. / 9720 SW FREWING ST,TIGARD,OR,97223
THOSE RULES ARE SET FORTH IN OAR 952-001-0010 / DESCRIPTION
THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF ` INSTALL SERVICE POLE SHEET
THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS Wt7RKWITH
NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) 3. 1 WASHINGTON C2102C 1 1 OF 1
'0 REQUEST UTILITY LOCATES CALL THE OREGON K�wwwhat"ahe1�W w1111001-c DESIGNBYPHONE DRAWNBY
UTILITY NOTIFICATION CENTER,811 AT LEAST Callbefompudlg. cwewcr�eR BRANDON HADLEY 503.758.6436 KYLE LEMPINEN
2 BUSINESS DAYS PRIOR TO EXCAVATIONI weo sw eoecxMwRo
®11RTLAND GENE RAL ELECTRICCO.-A L RIGHTS RESERV D 71
Page 118 2011 Edition
Lane Closure at Intersection with Flagging Diagram"62'
20
Diagram 620 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging, traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance (see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. There should be one flagger for each approach. One flagger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections(fewer than 400
entering vehicles per day), one flagger may be used.
4. 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 may be expected.
Sign Spacing and Buffer Lengths(feet)
Posted Spadng Between Signs "Buffer"
Speed A B C Space
20 SO
25 100 100 100 75
30 1 100
35 350 350 350 125
40 150
45 180
50 S00 500 500 210
55 250
60 285
65 700 700 700 325
70 365
Chapter 5 September 2016
2011 Edition Page 119
Lane Closure at Intersection with Flagging Diagram 620
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September 2016 Chapter 5