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PFI2018-00085 14 9 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00085 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/17/2018 Parcel: SEG1580 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: SEG 1580. Adjacent to 14960 SW Sunrise Lane. Install 47W LED light on pole 2847. Crew will put out cones around area. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: JOSE GRAJEDA 10800 SW AVERY STREET TUALATIN, OR 97062 PHONE: 503-672-5602 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 I `�` , Signature: Set AfeLIC41ZV1� Issued By: ^4 _� Special Conditions(See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00085 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. 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 A P R 1 1 2018 City of Tigard PUBLIC WORKS —ENGINEERING CITY OF TIGARD � ='I-,I Public FaciRty Improvement PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) [X TYPE 1—Franchise Utility fork Check one: KUtilities ❑Sidewalk/diiveway approach ❑Street improvements performed by NWN, PGE Detailed description: Install 47W LED Light on Pole 2847. Crew will and/or utility agency. put out cones around area. ❑ TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. Property address/location(s): 14960 SW Sunrise Ln • Driveway approach installation and/or repair • Sanitary sewer lateral installation and/or main line tap Applicant: PGE(Submitted by Linda Saddler) [I TWE 3–Full scale Development pp Work performed with Land use Address: 10800 SW Avery St approval which includes any of City/state: Tualatin OR Zip: 97062 the following: Phone: Email: PreregCoord@pgn.com • Subdivisions or Partitions Phone: (503 Contact name: Jose Graeda 672-5602 • Street widening ) • Mainline installation for Sanitary Contractor: NSA sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: E j City/state: Zip: City of Tigard Planning/Engineering Phone: Email: 13125 SW Hall Blvd:. i Contact name: Phone: Tigard,OR 97223 Apphcations for"minor work in right-of-way" Engineer: only may be emailed to: roLvpermitsnu.tigard-or.gov Address: f FOR STAFF USE ONLY City/state: Zip: MM + Phone: Email: Case No.: VU�5 Contact name: Application submittal fee(007%of 1 1 Engineer's Estimate) $ i Estimated value of work is required(if over$5,000):$ Additional fees: $ '" (-\vithin the public right-of-way) Application accepted: By: Date: 1 Is work related to a I..AND-USE DECISION? ❑ Yes No If so,please specify (NELP,SDR, SUB, etc.) case #: Applic tion r e 000-1 By: -Dd:ate: Is work related to a BUILDING PERMIT? ❑ Yes L No Applicant notified: + If so,please specify(BUILDING PERMIT)case#: By: Date: I:\ENG`,PermltApplfcatIons\pQ_applIca Hon Rev.10/16/2017 E'�:�-=?ss3P5e::T�'rllGr_ .:?..rrs'+'t+�93..:..,.P:.-`�•..,r^-c+:�rL' .'C'_--F_-��'R.F�.37m^�;...- -: �..... City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 wwwtigard-or.gov • 503-718-2421 • Page 1 of APPLICANTS NOTE: Person specified as"applicant"shall be designated"Permittee"and shall provide financial assurance for Nvork,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 Tigard,when the owner and die applicant are different people,the applicant must be the purchaser of record or a lessee in possession witli written authorization from die owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written authortuation 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 above request does not violate any recorded deed restrictions that may be attached to or iiuposed upon die subject ro et • 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 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 requit:empnts for approving or denying die application. Applicant/Autho ized Agent's signature Print naive 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 CityofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • -,v.v-,vtigard-or.gov 503-718-2421 • Page Z of4 INSTALL 47W LED LEOTEK W 6'MA ON POLE 2847 (25'MH) CONNECT@ 240V U Q v M 2848 5055 40'-4 1951 C2 1-05D 2849 40'-4 2847 2846 1954 (HN) 45'-3 40'-4 J 2006 1957 J B 2 ACSR B 25 71701 N 2 ACSR B 25 16834 1'1(!p! SW SUNRISE LN 3958 2s-1 1957 C) U Q z Q m = Q 149ro IC2 -08A 3 H 0 20 40 80 Feet I I I I I I I I I PGE PGE CONSTRUCTION DRAWING 1---t,,merely no,Ps>m=F ELn co_'1I-, Foreman: Date: General Foreman: Date: (Slgnah7re only required for field construction changes.) SDPM/ENG REVIEW JASBUILT BY DESIGNER: DATE. SCALE ACCOUNT GROUNDING STREETLIGHTS ON DISTRIBUTION POLES 3/26/2018 1 in:39 ft 1070001 1000004600 M2501752 WIND ROD NEW LED STREETLIGHT City of Tigard BRACKETLOCATION T_7_T-H-Et20 �ASTARM ` i SCHOLLS FERRY-ROY ROGERS 11 x 17 360 ��E NESC REQUIRES MASTARMS BE EFFECTIVELY BONDED P 14960 SW SUNRISE LN,TIGARD OR 97224 THINK EARANCE BETWEEN THE BRACKET ANO COMMVNICATIOM ATTA CHMEN T POINT IS LESS THAN 40 INCHESSAFETY AMASTARMFORNEWINSTALLATIONSANDRETROFITS, Install 47W LED LQOIeK On 6'MA Connect@ 240V SHEET A&AWG COPPER NEUTRAL JUMPER CONDUCTOR FROM COUNTY ECTIONS WORK THE POLE GROUND WIRE,IF THE GROUND WIRE DOES W A G`O C 210 5 D 1 OF NOT DUST THEN THE SERVICE NEUTRAL,USING AN ALUMINUM- F I RS TTO-CDPPER PARALLEL GROOVE CLAMP TO THE MAST ARM EAVERTON O (503)DRAWN BY VSMGA2MCH GRDUNDMC CLAMP. LINE CREW CENTER Jose Gra eda 672-5602 JG 2217 SW 133RD DP. BEAVERTON,OR P7006 ®PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED