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PFI2018-00177 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00177 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Date Issued: 09/12/2018 Parcel: SEG1289 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: SEG 1289. Install light on power pole. PGE Job M2430415 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: RODRIGO SOLIS 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 l Signature: � v �I L.J�-% j LV Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00177 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. Call Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov 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 i JUL 12 2018 City of Tigard CITY OF TIGARD PUBLIC WORKS —ENGINEERING PLANNING/ENGINEERING l Public FacilityImprovement (PFI) Permit 7J 3�`...:....-.-..P_�-.J'�..�-,n.Jr.�-....�=�'..- xs --r.-xs-.rw.."c.%raxa�.,..r>6::r2er.N=�.:.�resn::-:•s.+.r.^a,�;�aEa:.ti,r TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) E TYPE 1—Franchise Utility Work ? Check one: q Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE Detailed description: Install light on power pole and/or utility agency. f ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2430415 Work performed for the purpose of: • Sidewalk installation or repair. Property address/location(s): 11564 SW Fonner St • Driveway approach installation and/or repair r z� Tigard, OR 97223 • Sanitary sewer lateral installation and/or main line tap Applicant: Portland General Electric[Submitted by Amy Sweany] ElTYPE 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.com • Subdivisions or Partitions Contact naive: Rodrigo Solis phone: 503-672-5417 • Streetwidening • Alainline installation for Sanitaly 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 Phone: 503-464-7777 Email: Planning/Engineering 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: NIA only tnay be emailed to: rompermits&ti,eard-or.gov Address: FOR STAFF I-ISE ONLY City/state: Zip: n Phone: Email: Case No.: f 12,Dr 1 Contact name: Application.subn-ittal fee(.007%of Engineerl s.Estimate) Estimated value of work is required(if over$5,000):$ NIA Additional fees:� (within the public right-of-way) Application accepted: By: Date: Is work related to a LAND-USE DECISION? ❑ Yes C�No Application revietve�: . If so,please specify (MLP,SDR,SUB,etc.) case #: By: ate: Is work related to a BUILDING PERMIT? ❑ Yes [�'No Applicant notified: :S. If so,please specify(BUILDING PERMIT)case#: By: Date: �12 J. I:\ENG\PegnitAppiications\pfi_application Rev.10/16/2017 City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 wX«vtigard-or.gov 503-715-2421 Page 1 of4 I 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. * %Vidi 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 APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any 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 litnitations of the approvaL • AU 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 r d the entire contents of the application,including the policies and criteria,and understands die requirements f a proving or denying the application. pplicant/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 Pint naive Date Owner's signature Punt name Date W_I�ae+r3�:+'.r4.'''4A:.•;.""_Y-s�3t-*i':�P'�:iiY!'�,.sRi-r��l�pQbVTu:.'�k:. - 'P.'..,:k7i�J PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • \«vxv.dgard-or.gov 503-718-2421 1 Page 2 of4 Page 118 2011 Edition Lane Closure at Intersection with Flagging Diagram 620 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 Spacing Between Signs Buffer Speed A B C Space 20 50 25 100 100 100 75 30 1 100 40 350 350 350 125 150 45 180 50 500 500 500 210 55 250 Chapter 5 December 2011 2011 Edition Page 119 Lane Closure at Intersection with Flagging Diagram 620 ROAD WORK AHEAD ON >C E AWE (OpliolleQ ROAD 1 1 AHEAD B BE PREPARED TO STOP !1 B A (Opbaw • • OFR AWE FIORD BE AHEAD 1001E Mex • tBB ROAD • WORK AHEAD A C Buffer.,\` 100 i<Ma. C B B A • T. ROAD BE } WORK PREPARED AHEAD M ST100&Mmc OP Tt A 1 (ten A Tf, B BE PREPAFVM TO BTDP B (opl-4 ROAD 1 1 C AHEAD ROAD WORK AHEAD December 2011 Chapter 5 L PR+<f t 1 t aPD-M10 ]D-aastt _, PL 2476 _ OPTION A tt7 ;.. V99e 1t)1Q 0 17!?e• 11'e'te • Myr ��.-�- t7!'!'y t„ ,ftaaes� 1NSTALL47WLED LEOTEKLIGHT(2S' LIGHTING LEGEND " »7 _� MTG HT),MASTARM 6'ON EXISTING t FRONTIER POLE,CONNECT AT 240V t7tM l l WSTAU 47W LEO LEOTEX WU V LlW f M'WrQ Nn MAST Am r, ON Ems rwa FRomnER OOiLF.c000mC T A T!IO lgJORtil.Rtt VOLTS telt as-a ttSt• � f � ttiSf6 �� f�]F�tBT � �`� 1 iota Uj ey CALL 811 BEFORE YOU DIG • ►(/� ATTENTION: , 3 r OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED BY THE OREGON UTILITY NOTIFICATION CENTER. , THOSE N OAR 952-001-0070 RULES I THROUGH952-001-0090.YOU MAY OBTAIN COPIES OF —`- — 0 p THE RULES BY CALLING THE OREGON UTILITY • L$ 11715 NOTIFICATION CENTER ADMINISTRATION Q (503-232-1987) tH* 13 l^-- TO REQUEST UTILITY LOCATES CALL THE OREGON le Know what's below. UTILITY NOTIFICATION CENTER,811 AT LEAST Cdore II before oudl 2 BUSINESS DAYS PRIOR TO EXCAVATION. r 9• PGE CONSTRUCTION DRAWING SDPANENG REVIEW: JASBUILT BY DESIGNER: AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED GROUNDING STREETLIGHTS ON DISTRIBUTION POLES This document accurately represents FIELD construction. NEW w,ND ROD W LED Foreman: Date: STRErrL#GHT GF: Date: BRACKET 4` STn}QNTRIAJTARM_._ DATE: X26/}8 SCALE: WA ACCOUNT: 18100 AWO: 1000004600 JOB NO.M2430415 —_PER Lc++sea TITLE Pacific Evergreen homes/City of Tirgard THE 2017 NESC REQUIRES WAS T A ELMS BE EFFECTIVELY BONDED y, i IF THE CLEARANCE BETWEEN THE BRACKET AND COMMUNICATION \ CIRCUIT Pacific Evergreen homes/City of Tlrgard 6orow Partition SIZE J COMPANYATTACHMENT POINT 1S LESS THAN 40 INCHES PGE\ 1 1X17 TO BOND AMAST ARM FOR NEW INSTALLATIONS AND RETF70FIrS LOCATION SW FONNER ST E UCrOR FROM GROUND WIPLE.IF THE GR0 D WIRE DO mec rA"WG COPPER NEUTRAL JL0W DER S THINK THE DESCRIPTION NOT EXIST THEN T}1f SERVICE NEUTRAL.USING AN ALl1MRYUM• Install 47W LED Leotek Grey,on existing frontier pole,with 6'MA,connect @ 240y SAFETY TO-COPPER PARALLEL GROOVE CLAMP TO THEMASTARM COUNTY ECTION(S) WORKWITIld SHEET USING A I RVCN GROUNDING CLAMP. BEAVERTON WASHINGTON C2103C M2369224 1 OF FIRST! LINE CREW CENTER DESIGN BY PHONE(503) DRAWN BY 2213 SW 153RD DR RICO SOLIS 672-5417 RICO SOLIS BEAVERTON,OR 97006 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED