PFI2018-00159 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00159
P 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/25/2018
Parcel: SEG619
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: SEG 619. Replace vault lid on vault 86. PGE Job M2539886
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
PHIL MERRIMAN
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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00159
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
ECOVED
Cit- of Tigard JUN 21 2018
a PUBLIC WORKS —ENGINEERING
C1TV 4F TIGARD
Public Facihty Improvement ('VF1)3q0VVH?111E11NG
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work
Check one: Nf Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
Detailed description: Replace vault lid at vault 86 and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2539886 Work performed for the purpose of:
• Sidewalk installation or repair.
11495 SW Greenbu Rd
Property address/location(s): g . Driveway approach installation
and/or repair
C
Tigard, OR 97223 • Sanitary sewer lateral installation
and/or main line tap
Applicant- Portland General Electric [Submitted by Amy Sweany] ❑ TYPE 3—Full scale Development
pp Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Zip. 97062 the following: 01
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions
Contact name: Phil Merriman Phone: 503-963-6943 . Street widening
• Mainline installation for Sanitary
Contractor: TBD- Permit needed for bid walk sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: 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"
Engineer: N/A only may be emailed to:
g romTermits&tigard-or.gov
Address:
City/state: Zip: •
R STAFF US E ONLY
Phone: Email: Case No.:
Contact name: Application submittal fee(.007%a of
Engineer's Estimate) $.
Estimated value of work is required(if over$5,000):$ NSA Additional fees: $
(within the public right-of-way) Application.accepted:
/ By' f1 Date: t 11
Is work related to a LAND-USE DECISION? ❑ Yes No
Application reviewed:
If so,please specify (MLP,SDR,SUB, etc.) case #:
By Date:
Is work related to a BUILDING PERMIT? ❑ Yes Lf No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: Date:
I:\ENG\PermitApplications\pfi—application Rev.10/16/2017.
City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 ,vwti.t1gard-or.gov • 503-718-2421 Page 1 of4
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 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 anp recorded deed restrictions that may be attached to or imposed 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 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.
Vo n h D Digitally signed by Vinh D
Nguyen,
1 1 Nguyen,PE
S V g u ye n, P E -Date:2018.06.21 07:24:16
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 STAFF USE 1ONLY.
Public Facility Improvement(PFI)Permit:
DETAILED
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee$300.00 (minimum) FIZANCHISE U'T'ILITY ANIS SIDEWALK/
DRIVEWAY AND UTILI'T'Y
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 0.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 2x34).
• Relocate or replace mailbox ❑,Cover Site,Vicinity;
SAMPLE SKETCH:
y t
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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 • www.tigard-or.gov • 503-718-2421 • Page 4 of4
Page 106 2011 Edition
k®werseon onto a Contireu'ous �eft=Tur� Lane i gram,430
Diagram 430 shows work in the travel lane(s) next to a continuous two-way
left turn lane with one direction of traffic diverted into the continuous two-way
left turn lane.
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. When two or more travel lanes are reduced to a single lane before the
diversion, each lane shall be closed separately. Layout traffic control
according to ODOT Standard Drawing TM 852 for 5-lane sections.
4. A shifting taper(L/2) may be added in the diverted traffic direction
across the continuous two-way left turn lane (as shown). This option is
recommended when the speed is 45 mph or greater.
Sign Spacing and Buffer Lengths(feet)
PostedSpacmg BetweenSSag:ns Buffers
M Speed
PS,N w8wp Space
20 50
25 100 100 100 75
30 100
40 350 350 350 125
150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 107
=DAversaon lent® n lnuo- Left Turn Lane" a D agram 430
ROAD
WORK
AHEAD
CENMB lyt
LAMER
CLOSED
AHEAD
A
I
s
L/2 I ;I
•
Buffer
Protection Vehicle
w/TMA(both Optional)
See Chapter 4
m
Buffer
•
• L/2
•
•
•
L/2 lei A
lit B
y I ROAD
WORK
AHEAD
December 2011 Chapter 5
J
, 1145?37 ------
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11455 a30� 11467 REMOVE/ABANDO FACILITIES
INSTALL FAC
ILITIES1991 _..
1991 1145 INSTALL ADDITIONAL FACILITIES/MODIFY FACILITIESh o 11464
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WL 1 VT as: -- --I-------— EQUIPMENT
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CUSTOM ORDER-CONC.VT LID W/DUCTILE IRON DOORS 48"X80"X12" ® REPLACE VAULT LID
CUSTOM ORDER-CONC.VT LID RISER fi"THICK (CUSTOM ORDER-CONC.VT LID W/DUCTILE IRON DOORS 48"X60"X12"j
11465 (CUSTOM ORDER-CONC.VT LID RISER 6"THICK)
1991 Remove: _
(� SU39636-COVER,VAULT,CONCR,NONSUPDOUBLE DOOR(OVERSIZED 660VLT) 11500
NOTE:EXCAVATION CONTRACTOR TO REPLACE WITH CUSTOM ORDER VAULT RISER AND LID.
VT-87 P C2-
CONTRACTOR RESPONSIBLE FOR CONCRETE RESTORATION IN DRIVEWAY8SIDEWAI.K
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THINK PGE CONSTRUCTION DRAWING
SAFETY
AS-BUILT VERIFICATION 8 NESC VIOLATIONS CORRECTED
Thic FIELD C-0——
F Foreman: Date:
General Foreman: Date:
(Signature only required for field construction changes.)
SDPM/ENG REVIEW.' ASBUILT BY DESIGNER:
NY DEV,fATI
IN FROM THIS DESIGN MUST SCALE: ACCOUNT A WV: JOB NO.
5/23/2018 1 in=50 ft 1 5940001 3000000658 1 M2539886
BE APPROVED BY THE PGE PROJECT MANAGER TITLE
REPLACE B/O VT LID AT VT 86 C1135C
CALL 811 BEFORE YOU DIG CIRCUIT SIZE
TTENTION: TIGARD-13361 11 x 17
OREGON LAW REQUIRES YOU TO FOLLOW RULESADOPTED �i�;yvw w /pPG6LOCATION
BY THE OREGON UTILITY NOTIFICATION CENTER. I JE LOCATION
11495 SW GREENBURG RD,TIGARD,97223
THOSE RULES ARE SET FORTH IN OAR 952-001-0010 �,c� ' • DESCRIPTION
THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF REPLACE W/SPECIAL ORDER LID SHEET
THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS WL1RK WITH
NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) WASHINGTON C1135C 10F1
TO REQUEST UTILITY LOCATES CALL THE OREGON KnO-whanbelm BEAVERM"v DESIGNBY PHONE DRAWNBY
UTILITY NOTIFICATION CENTER,811 AT LEAST Call bef0leyoudig. L
INE CREWCERTER PHIL MERRIMAN 971-804-3579 TARA LEAKE
1 BUSINESS DAYS PRIOR TO EXCAVATION 2213 SW ®PORTND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
153RD OR
EAVERTON OR DT006