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PFI2018-00100
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00100 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/01/2018 Parcel: SEG3786 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: SEG 3786/Adjacent to 1331 SW Pumpkin Valley Terrace. Replace damaged pedestal with carson box. Owner: FEES Description Date Amount PHONE: Contractor: PORTLAND GENERAL ELECTRIC CO 121 SW SALMON ST C/O LEGAL DEPT PORTLAND, OR 97204 PHONE: 503-464-8852 FAX: Applicant: TOM COX 10800 SW AVERY STREET TIGARD, OR 97223 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: 12 J2 'T Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00100 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 City of Tigard APR 3 0 2018 • PUBLIC WORKS — ENGINEERING � CITY OF TIGARD Public Facili tY Imp rovement (PFI) _� INEERING TIGARD TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ,�.�/ L�1 TYPE 1—Franchise Utility Work Check one: LJ Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE Detailed description: REPLACE DAMAGED PEDESTAL and/or utility agency. WITH CARSON BOX ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2492270 Work performed for the purpose of: • Sidewalk installation or repair. 13331 SW Pumpkin Valle Terrace • Driveway approach installation Property address/location(s): p y and/or repair SIEG 3_76W Beaverton, OR 97007 • Sanitary sewer lateral installation and/or main line tap Applicant: Portland General Electric[Submitted by Amy Sweany] ❑ TYPE 3—Full scale Development Work performed with Land use Address: 10800 SW Avery Street approval which includes any of City/state: Tualatin, OR Zip: 97062 the following: Phone: 503-612-2935 Email: preregcoord@pgn.cpm • Subdivisions or Partitions Contact name: Tom Cox Phone: 503-736-5419 • Street widening • Mainline installation for Sanitary Portland General Electric sewer, Storm sewer,Tigard water Contractor: and/or Tigard Water Service Area CCB#: 103663 Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Zip: 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" only may be emailed to: Engineer: NIA romMerrnits aktiga�gov Address: City/state: Zip: �p Phone: Email: CaseNo.: Contact name: Application submittal fee(.007%of Engineer's Estimate) $ Estimated value of work is required(if over$5,000):$ N/A Additional fees: $ 1�--• (within the public right-of-way) Application accepted: By: Date: Is work related to a LAND-USE DECISION? ❑ Yes No If so,please specify (MLP,SDR, SUB, etc.) case ##: Applica'on reviewed: By: Date: Is work related to a BUILDING PERMIT? ❑ Yes Yr No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date:✓�' I:\ENG\PermWplications\pkapplication Rev.10/16/2017 City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page I of4 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 Cit} of Tigard,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. Franchised Utilities are not required to obtain the owners signature on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject proper . • 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 requirements for approving or denying the application. Gohar Shafiq 04-27-2018 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 name Date PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of4 DEVELOPMENT ENGINEERING FEES FOR s,rAFF USE' ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/ DRIVEWAY AND UTILITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5%(less$300.00 minimum submittal fee) Sketch Engineer's estimate X 2%Plan Review (including information below) ❑ Dimensions WATER SYSTEM FEE ❑ Street Name Part 3: All public water system improvements ❑ Site Address Engineer's estimate X 12% FULL SCALE DEVELOPMENT PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements) There will be no permit fee charged,or assurance required for the following types of work: Design Plans • Sidewalk repair(less than 20 lineal feet) (6 sets,24x36 or 2204) • Relocate or replace mailbox ❑ Cover—Site,Vicinity,Abbreviation,Legend • Ditch cleaning that does not involve regrading. ❑ General Notes(City,Water,Sewer,etc.) • Weep hole repair ❑ Street(Plan,Profile) • Curb repair or replacement(less than 20 lineal feet) ❑ Water,Storm and Sanitary(Plan Profile) • Lawn sprinkler system installation or repair ❑ Water Quality Facilities • Street tree pruning or planting ❑ Grading • Planter strip landscape maintenance ❑ Landscaping/Tree Plan • Test wells ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc) ❑ Details Note: A cash/bond assurance maybe ❑ Traffic Sight Distance required per TMC 15.04.140. ❑ Signing and Striping (customer deposit) ❑ 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 ❑ Engineers Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of4 SAMPLE SKETCH: Edge of P aventew I etch Streetlight I . . •�■�■! .i••�•�� ■ /+ l,i.fLL /i aJLl I I , • rtopo' cf''Se�wei'rne" 1 I I 1 � I rs • I iI Existing House 1 I Existing01 • I I I 1 �I I �1 0 1 I 1 > I • I Exisfin g Shop 1 _ � 1 1 J Ptr4Verpole I 95' 1 I I -,-.-. ---I rr oper 1:e'------�_—_ I I I i . 1 Fire Hydrant(FH) I I � I Scale- 'I"=30' � I � 1 I 1 I I I I 1 ' 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 ofTigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-or.gov - 503-718-2421 - Page 4 of4 1-LINE DIAGRAM C2'-06BLj vT_115 C2 1`-06A x314• WL1 PD-397 CONTACT PGE ABC 556 AAC ABC 79 .PL'-1491 PL-287APGE 1730 SPLICE BOX FOR APPROVED nL4/o1�Ac_- 'a MANUFACTURERS c O , ' PL 2876 POLYMER COVER II VT 434 ABC H ELECTRIC MARKED V>f 5 PD 379110-012 p p3 PD 358 ELECTRIC' CONDUIT I PD 381 PC�-002 MARKER PLAN i y } D 378 VT 555 F VT SSfi - ' PD391 PD-421' PD-011 ' t 1 �k 2'ABOVE FINAL GRAD r 4 X15'+ r ? I $ ❑r Q, r❑ d {t UNLESS M SIDEWALK FINAL GRADE i W RADIUS I • 36•RADIUS scH 40 3'TO I FOR PERM SVC Q1: %q VT 554 CVT CONDUITS OFF TRANSFORMER MARK CAP 6 INSTALL I I 557 PD-08;: .• 2•MAX. 6'WELL COMPACTED - 20'OF 500 PULL STRING PD 373PD,-3 I�L 18 s PD-802 �PD 367. 8'GROUND I Y4"MINUS BACKFILL GROUN , II - 601 - PD MIR__ AROUND AND UNDER - I A 7 ❑A SD 12101 ❑ ' rt RODercusr p 1 a* N I � SPLICE 80X TRENCH �, a tl Y' .Y,PD-45PD-0 PD 392 D 388 Ttf x 341R' s I -B I *"P.D 36opD-37 ' . Cl ❑PD 599 D. � -�❑❑' - i_s/e. sTLT •N t i I r,PDd23pD-0� OPTIONAL Pi 1 .� ❑ L 48-TRENCH DUCT TO SERVICE ' TOP VIEW F` �'+ -' - f SIDE VIEW MARK CAP 6 INSTALL a t o Vr59 P._D-81 + PD 596110-328 STLr 2o'OF500#PULL STRING PD 598 PD 3 i PD 2 g 56] PTIONAL OPD 362❑; ❑ F�59 �❑n .�, I I . .®r' r 'I {PD 279 SO 1210aSCaulioii 2,F odars B 559 d I r. ALL SECONDARYVAULTS(1730)TO BE INSTALLED ON PROPERTY LINES WITHIN THE UT7LITYEASEMENT a tr 59 r♦ .�, r s �.• A i�, r,y-' ANO AT FINAL GRADE.ALTERNATE LOCATIONS MUST BE APPROVED BY PGE AND WILL BE NOTED c i PD-8689,` t PD 363 ` PD-437 x- ON THE SKETCH. 25 4 V*U v 3 39 0.364 THE COST FOR RELOCATION OR ADJUSTMENT OFA 1730 VAULT WILL BE THE RESPONSIBILITY OF a I t pD-0 THE BUILDER OR DEVELOPER REQUESTING THE MOVE.PGE APPROVALS OF THE INSTALLATION WILL BE BASED VT-045 t < C SO'12082 PD89 ON FINAL GRADE AND LOCATION CRITERIA SET BY THE DEVELOPER AND HIS OR HER AGENT. C2 1066 ""ta. -) 4 C2 9�-U6� VPD-007t PD 37 ff r f . * r, 15, r PD-031 PD 396 3 Ia88 Y 3 v I.� I PD-008❑.'� '`❑-.PD 3ffi�SPD-026 '? �spi PD120991 5671 ., c PC3 V75891r 4 t s r ,+, x I r ,yxVT 588" 58277 38 4. j 110-433 p 334 Vi`� ` 1563 PD 327 i =yr-583V 45o � '.; = NYDEVl477ON FROM THIS DESIGN MUST 562 PD 365 pD 39 ORK " 06 465 BEAPPROVED BY THE PGE PROJECT MANAGER ;5¢41'v AREA vr-58 pD-371 CALL 811 BEFORE YOU DIG CI"I ,50 12D67 pD-010 PD-00 ATTENTION: _` OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED t -) 75 55521 r ` THINK BY THE OREGON UTILITY NOTIFICATION CENTER. 110;436 pp-0 THOSE RULES ARE SET FORTH IN OAR 952-001-0010 -` THROUGH 951-001-0090 YOU MAY OBTAIN COPIES OF a 1 ^.' PD416 f SAFETY D 398 VT;584 THE RULES 8Y CALLING THE OREGON UTILITY 58 NOTIFICATION i s '� 110.375 �, FIRST�°a71 NOTIFICATION CENTER ADMINISTRATION @(502-231-1987) ' RDIf,387 I If� TO REQUEST UTILITY LOCATES CALL THE OREGON K��aft below.ABC 30010S2b °' g"'U QI 09" VT 57 0.3 UTILITY NOTIFICATION CENTER,811 AT LEAST Call before you d1% '" PD 35 f xl 25 83417 u 1 BUSINESS DAYS PRIOR TO EXCAVATION !s 8 VT57 PD *; PGE CONSTRUCTION DRAWING `,e uT 576 AS-BUILT VERIFICATION&1eNESC VIOLATIONS CORRECTED 0 75 150 300 Feet VT571 .'t PGE`: N Foreman: Date: General Foreman: Date: (Signature only required for field constntction changes.) SDPIWENG REVIEW. ASBUILT BYDESIGNER: DATE: SCALE: ACCOUNT.: AWO: J08 NO. 3/9/2018 1 in=50 ft 1070001 1000004547 M2492270 TITLE REPLACE DAMAGED PEDESTAL WITH CARSON BOX CIRCUIT SIZE /� SCHOLLS FERRY-ROY ROGERS 11 x 17 POCATION GE/� 13331 SW PUMPKIN VALLEY TER,TIGARD,OR,97007 DESCRIPTION DAMAGED PEDESTAL;REPLACE W/1730 JBOX IN FRONT OF 13331 SHEET COUNTY SECTIONS WORK WITH WASHINGTON C2106D 1 2 OF 2 SEAVERroN DESIGN BY PHONE DRAWN BY LINE CREW CENTER TOM COX 503-867-0414 HEIDI BOOMER 1113 SW 153RD OR BEAVERTON,OR 97006 ® OR ND GENERAL ELECTRICCO. RIGHTS RESERVED 1 ' LEGEND _--� -- ---------- REMOVE/ABANDON FACILITIES INSTALL FACILITIES ti INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIES VT-450 ( r 1 C 410 AL—Tx WORK LOCATIONS � � f 81 I 66 220 i VT s63 EQUIPMENT Pending Retag: 16r-Unknown Pending Retag: 2017 INSTALL NEW 1730)BOX 7/C2106D-365 used I �I ---- C2106D-397 used '854-JUNCTION BOX 1730 UNFUSED <-1—:,to-be C2106D-95 �� \-t --� � © REMOVE SECONDARY PEDESTAL VT-3970 805•SECONDARY JUNCTION PEDESTAL PD-397 — ----... _ III"""°°°I x -.__- 80 67 1 U � x �t H U, 79 68 ¢o LANDSCAPING NOTES --— i POST-LANDSCAPING ---2211 161-unknown BARK DUST PD-4 20;17 WL 1 PD-397: C 75 55 I Install: 854-JUNCTION BOX 1730 UNFUSED 78 69 Remove: R 805-SECONDARY JUNCTION PEDESTAL � a , NOTE:PENDING RETAG:C2106D-397 USED i TO BE C2106D-95 — Pondfdg Retag: ` 0 15 30 60 Feet PD-432 \!C2106D-432 used I j" I I I I I I I I I to be C2106D-96 : N i T HI IN K PGE CONSTRUCTION DRAWING OAFETV AS-BUILT VERIFICATION 8 NESC VIOLATIONS CORRECTED ITIS d-,—,l accut",ep,,—FIELD Cnn Rlnrciron FIRST Foreman: Date: General Foreman: Date: (Signature oN required for field construction changes. SDPM/ENG REVIEW ASBUILT BYDESIGNER: NYDEVL4TION FROM THIS DESIGN MUSTDATE SCALE ACCOUNT.. Jo o. 3/9/2018 1 in=30 ft 1070001 1000004547 M2492270 SE APPROVED BY THE PGE PROJECT MANAGER TITLE REPLACE DAMAGED PEDESTAL WITH CARSON BOX CALL 811 BEFORE YOU DIG CIRCUIT S1zE rr£NnoN: r SCROLLS FERRY-ROY ROGERS 11 x 17 OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED �� PV LOCATION BY THE OREGON UTILITY NOTIFICATION CENTER. GE 13331 SW PUMPKIN VALLEY TER,TIGARD,OR,97007 THOSE RULES ARE SET FORTH IN OAR 952-001-0010DESCRIPTION THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF ` DAMAGED PEDESTAL;REPLACE W/1730 JBOX IN FRONT OF 13331 SHEET THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS WORK WITH NOTIFICATION CENTER ADMINISTRATION @(501-132-1987) WASHINGTON I C2106D 1 OF 2 TO REQUEST UTILITY LOCATES CALL THE OREGON KnowwhMbLgOHk BEAVERTON DESIGNBY PHONE DRAWNBY UTILITY NOTIFICATION CENTER,811 AT LEAST CellbetmeyouLlig LINE CREW CENTER TOM COX 503-867-0414 HEIDI BOOMER 2 BUSINESS DAYS PRIOR TO EXCAVATION 221)SW 15JROOR O PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED