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PFI2018-00240 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT Is COMMUNITY DEVELOPMENT Permit#: PF12018-00240 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/17/2018 Parcel: SEG3789 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Install street light circuit, install conduit from pole 252 to pole 250. PGE Job M2593264. Owner: FEES Description Date Amount PFI Permit Fee 09/17/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RODRIGO SOLIS 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-464-7777 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. Permt plicant Sign 1a), Signature:ure: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00240 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 City Of Tigard RECEIVED SEP A I Z018 PUBLIC WORKS —ENGINEERING e CITY OF,TIGARD Public �ace e Improvement (PFI)p INEERING TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) TYPE 1–Franchise Utility Work Check one: V Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE and/or utility agency. Install street light circuit, install conduit from Detailed description: g pole 252 to pole 250 El TYPE 2_Sidewalk/Driveway/Sewer PGE Job M2593264 Work performed for the purpose of. • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): gee and/or repair SW Forrest Hollow St& SW Apple Grove Te, Tigard, OR 97140 • Sanitary sewer lateral installation and/or main line tap Portland General Electric EJ TYPE 3—Full scale Development Applicant: Work performed with Land use Address: 10800 SW Avery St Tualatin, OR 97062 approval which includes any of City/state: Tualatin, OR Zip: 97062 the following: Phone: 503-464-7777 Email: preregcoord@pgn.com • Subdivisions or Partitions Contact name: Rodrigo Solis Phone: 503-672-5417 • Street widening • Mainline installation for Sanitary Contractor: Portland General Electric sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: 103663 Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Zip: City of Tigard 503-464-7777 Planning/Engineering Phone: Email: 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" Eng'neer: N/A only may be emailed to: rowPermitsntigard-or.gov Address: FOR STAFF USE , City/state: Zip: Phone: Email: Case No.: O/ C Q Contact name: Application submittal fee(.007%of Engineer's Estimate) $ Estimated value of work is required(if over$5,000):$ Additional fees: $ 36e> (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 #: Application reviewed: / By: F 8 Date: Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date: �i I:\ENG\PermitApplications\pfi_application Rev.10/15/2017 City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of4 APPLICAN'T'S 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 owner's signature on the application BY SIGNING BELOW,THE APPLICAN'T'(S) SHALL CERTIFY"T14A'T': • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject prope • 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. Kevin D Muck 9/11/18 Applicant/Authorized Agent's signature Print name Date SIGNA'T'URES 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 PEES FOR STAFF 0 Public Facility Improvement(PFI)Permit: DETAILED APPLICATION FEE REQUIREMENTS 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 (including information below) Engineer's estimate X 2%Plan Review ❑ 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 22x34) • 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(pro)ect 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 SAMPLESKETCH: Edge.of'Payment r } p piT Ditch-- ` Streetlight I ■.!■i■i■!■!■.!■!■,:�.!.■i IRain.Drain a T� Fro ►os c!~Sewer Ine. N® �. I �;� � !Existing Hous:;. Existing 1 >t a Driveway . �t p ■ti ■.O CLI I � of-.-0 1 dd ° \> I. aI 04 o �Existi n g,Sto,p: li o ■ Powerpole e ° 76'p e rfi��ne- ® I I L � e II Fire Hydrant(FH) I I � � Scaler 1"=30' ■ I I i � � I . a 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 LIGHTING LEGEND "IT I INSTALL T-910 CU TX ST LT CIRCUPT M 1-2'SCH46 PVC ...... commr,Pwwiiia a tusTAuzo By cusTomEa SW FOREST HOLLOW ST TIE • "d 2589, i 55 tit PI A 252/250 CREW To INSTALL 160'1-1110 TX ST LT CIRCUIT 141EV61-, C N, 2'SCH40 PVC CONDUIT,30 AMP FASE, NECT @ 2 u 5 T9 IN IU-T, e�T 240V I IT SW SMADOW TIM ST A 25 INSTALL 30AMP FUSES IN SECONDARY PEDESTALS ORSEC ONDAiY VAULTS(WHICHEVER IS ST LT POINT OF ATTACHMENT)FOR EACH STREET LIGHT PER T&D CONSTRUCTION STANDARD LC-11550 CONSTRUCTION NOTES: SLCST I.CUSMAFR TO PROVIDE ALL TRENCHING V6 BACF(PPLUNG-JOINT VSE TRENCt. CALL 811 BEFORE YOU DIG ITH O'%E, TR=ACK '0 LE 15 WOHES DEEPAND 30 INCrEEVADE,WEAEURED FROM ATTENTION: FJNALCRAZOE. OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED pl, 2 ALL POE CONDUCT MS TO BE INSTALItED IN OFLIM,S�_41EMLE 10,ELECTROAL BY THE OREGON UTILITY NOTIFICATION CENTER. GRADE.F.t CONIOLIX411TH NYLON PIs,-STRINGS IIAIN.EW UIS.TEST)- POE TO DETERLWC-THE SIZEND W-%!E AF;t OF CONOUrTS,REQUIRED. THOSE RULES ARE SET FORTH IN OAR 952-007-0070 I.SAWTAIN I 2VFRrICAL INSHES AND 24 HOIRIZONMAL INCHES CLEARANCE SESTVIM THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF JUNCTION BOX INSTALLATIONS GASANO OTHER UTILITIES.ALL MAOWS 4 INOI A SMALLEITI,TO BE X tNOH RADV13t THE RULES BY CALLING THE OREGON UTILITY ALL SENDS LFJST BE FACTORY MADS.ALL ELISOVIII.LARGER T}M 4 INCH TO BE FOR STREET LIGHT ONLY 6a INCH RADIUS.RIGID STEP-OR OR PCIEAPPROVED.FIBERGLASS BENDS AREREWUNED NOTIFICATION CENTER ADMINISTRATION g (503-232-1987) FOR RUNS OF ISI FEET OR LOWER,OR FOR A14Y LENGTH RUN WITH MORE THAN OR CONTACT PGE FOR APPROVED MANUFACTURERS ;80 DECREES IN BENDS.PVC SCHEDULE 4C BENDS AREACCEPTAELE FOR RUNS OF- TO REQUEST UTILITY LOCATES CALL THE OREGON Know what's below. ED FEET OR LESS.rAE FAA"AUM TOTAL SENDS IN ANY CONDUIT RUN 15274 OFM REM. UTILITY NOTIFICATION CENTER,811 AT LEAST MAL CMIAD&W#AR:;!;UJHrACk(FLUM4; 1.ALLOONCAETE FOOTINGS NEED TOSE INSTALLED'.'.ITM'rOP OF BASE 2 BUSINESS DAYS PRIOR TO EXCAVATION- Call before you dig. M&C,I f.AD&If 5 CA'7 5 U74 A Ct FLUSH TO CUR3,SIOSWALK PGE CONSTRUCTION DRAWING 1�CVSTr.-AER RIESPONSTELE FOR ROAD CAOSSINGS.ALL CROSSINGS MUST EXTEND 9'af?"aw Roll FROM PROPERTY LINE M PROPERTY LINE_CROSSINGS 70 BE At OIBEP, ---TA-SBUILT BY DESIGNER: MEASURED FROIA FINA.LGRIADE, SDPMIENG REVIEW- 5,DIRECTIONAL EORINS REMAITIELEXIB:ELAM HOPE MIGH OENBrrY POLYETHELINEj DU--T CRSCHIEDU 40MIC*,fOTNAMECHMI--AL--QPZ4---rrOM-'CERTFH.CKORLIIEEPVEDHW:C.�L AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED PCE ou 7(C vp0 j UNT'I,rx� CONNEG7'OLE &IMAS.LE ON PR5EGILMST FROM PGr rFtOECr n 17EINIMly1nov REQUFEEM N P11ODUC0 ASAN ALTERNAW.EM HDPE DUCT HD SKALI MEET THE LO'X LATS Ox PCE SFECIFCATION _ IS., This document accurately represents FIELD construction. t EXTRLDE0 FWD MIPSIS OAKCH TS ASPESIFITIXTIONWOUFwAENT}MVZFREL TEST,- Foreman: Date: HOPE PIPE IS REQUIPMAFrEFt INS-EA LLATIQN WrTHFOE ENISPECTORPRFS, . 6,TRANSFWAER RAOSARE TO BE SET SO THAT THE TOP IS 2 MHES ABOVE GF: Date: rmjc_-�mmx FftA_'GRAD---CONDUITIS T09604TALLEOLNPADA3 INDICAMOIN MAIL H DATE: 917118 SCALE: WA JACCOUNT. AWO:100000460 JOB NO.M2593264 A.WTOEXTEND I WOHABI-i THE PAD. 18100 1 0 ALL PCE TRANSFO.-VISRSTO BE INSTALLED 9 FEET(LAIN!FROMANY C0043USTIELE TITLE WLOW,I%ALLOROVEP.-MCA.NI04=EUiL!Iti)FrtO%I.ANYFMKYDR&-4T. Polygon Northwest/River Terrace NW '5CH4 G#ff.YI'NCWi1AC1UJ1Y POE TRAN3FORLIER3 MUST BE WTAN IS FEETOFADIRNTABLEA"A 3' AL1VA'fS,%WNrAI-N 10 FE—E.CLEARANCE ISFRCVT OPAL TRANSFORMERS. CIRCUIT siz P'W?MAVIr 01aRfW:Off M_'fiW%tA-.!; 9.STEEL ILVIRIERPOST.ARE REQUIRED AROUND TRANSFORAZERS THAT. ARE EXPOSED SCROLLS FERRY-RAINBOW on fi-ciff.dy avriv.. TOVEHIrLES. I I 1x17 Top W&W 9.AS NEEDED:FRONT LOT PUBLIC UTILITY EASEIALICT iP.U.E.)TO BE 6 FEET(MV41, I GE LOCATION I C�FEET J'=RE _FIERRF��I. S W Forrest Hollow St&sw Apple Grove Ter Im"r&TAIT THINK 10.CIONSULTWITH FCA REFFIESEN-FATIVE.WEEKS DE-ORE STARTING I.VX4 PMER DESCRIPTION jj 160,1 iflo cu Tx st_t TRENCHING FOR APRE=NMUCTION CONFERENCE.NI_ta CLUOEV IN THIS CONFERENCE fight circuit in 1-2'Sch40 PVC conduit fmm PL#252 to PL 250.CONNECT @ 240V WILL BE EXCAVATE M PGE,TELCO,CMV,AND GAS. SAFETYIt.CLGT'O%C-R TRENCH AND ELPOW CONF13LRATIGNS,ALL 0ONDUrT,VAULTAND PAD COUNTY SECTION(S) WORK WITH d SHEET BE WASHINGTON OR PCE TO'NaPECT;&-­TiR INSTALLAITTION 15 COWLETE.CALL 83D-54,:�-9616 OR OF) MUrALLAMONS"UST INSPECTED BY PGE PRIOR TO EA-_K-ILLING.9%NEN YOU ARE C2106D READYPCR WILSONVILLE I FIRST! 3-e-313 IN THE PORTLAND AREA ALBA UP 70 2-,%%)RMNG DAVS FOR fMPECTON TO OCCUR, LINE CREW CENTER DESIGN BY PHONE L. (503) _�_­N BY .REFER TO THE PGE ELECTRIC SERVICE REQUIRDZENTS BOOKLET FOR SPECIFIC REQUIREMENTS. 9480 SW BOECKMAN RO RICO SOLIS 672-5417 1 RICO SOLIS 13.DESIGN IS BASED ON STANDARD UNOMROUNO SCUIPIAEF(T.NONI.TMMARD UNVER- I - - — CROUNO EQUIPAXENT MAY SE AN OPnON AFAN ADDMOXAL COSTTO THE CUSTOMFR WILSONVILLE,OR 97070 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED Lina Smith From: Prereq Coord <PreregCoord@pgn.com> Sent: Tuesday, September 11, 2018 9:32 AM To: ROW Permits Cc: Rodrigo Solis; Leontine Rawson; Prereq Coord Subject: URGENT New City of Tigard Permit Application, SW Forrest Hollow St & SW Apple Grove Ter, PGE Job M2593264 Attachments: M2593264 City of Tigard. Permit Application.pdf; M2593264 Sketch.pdf Categories: Routed for Eng. Review Good Morning. Attached is the City of Tigard Permit Application and Job Sketch for PGE Job M2593264. We appreciate you sending the approved permit as quickly as possible. This work is scheduled for 9/18/18. Please contact Rodrigo Solis at 503-672-5417 with any questions. Shanea Hardcastle P�E Pre-Requisite Coordination Administrative Assistant Direct: (503) 612-2945 1 Fax: (503) 612-6150 10800 SW Avery St.,Tualatin, OR 97062 1