PFI2018-00290 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00290
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/24/2018
Parcel: SEG2010
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE PFI
Project Description: Replacement Pole at 14995 SW Leslie Ct.
Owner: FEES
Description Date Amount
PFI Permit Fee 10/24/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
RODRIGO SOLIS
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-672-5417
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.
Permittee/Applicant
Signature: 1,
Issued By:
Y
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00290
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
ermit.PFIUtilities 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 OCT 2 2 2018
a PUBLIC WORKS —ENGINEERING _
GARD
Public FacihtY mp lt�Irovement (PFI) Perm 'NEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) TYPE 1–Franchise Utility Work
Check one: VUtilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE
Detailed description: Replace pole PL#80160 and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
PGE Job M2604906 Work performed for the purpose of.
• Sidewalk installation or repair.
Property address/locadon(s): 14995 SW Leslie Ct • Driveway approach installation
and/or repair
Tigard, OR 97224 • Sanitary sewer lateral installation
S499 2,010 and/or main line tap
Portland General Electric ❑ TYPE 3—Full scale Development
Applicant: Work performed with Land use
Address: 10800 SW Avery ST
approval which includes any of
City/state: Tualatin 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
103663 and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Planning/Engine ening
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: NIA only may be emailed to:
ro ermits_tigao rd-or g
Address:
City/state: Zip:
Phone: Email: Case No.: 13 "Q 2 C-1 d
Contact name: Application submittal fee(.007%of
Engineer's Estimate) $
Estimated value of work is required(if over$5,000):$ Additional fees: $ 300
(within the public right-of-way) Application accepted:
Is work related to a LAND-USE DECISION? 0 Yes No By: M(� Date: 23
If so,please specify (MLP,SDR,SUB,etc.) case #: Application reviewed:
By: $g Date: t0
Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified: JA4
If so,please specify(BUILDING PERMIT)case#: By: Date: t
I:\ENG\PermitApplications\pfi—application Rev.10/16/2017
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 Page 1 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 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 authorisation with this application. Franchised
Utilities are not required to obtain the owners 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 e
• 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 10/22/18
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 of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFFUSI: ONLY
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
APPLICATION FEE REQUJIZEMENTS
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) (G 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(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
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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 Pavement
I — Ditch
Streetlight .—.—.---.—.—E4 .E r—E�
xadn nradn
1 01 �I I .
T 'Propos d�Sowerriine
T'
I WI 1
NI Existing House
Existing
I
g
1 I >1 i Driveway .
aI 01 1
C 1 � •
�!
ap
of
CL
13
I w 1
'I
Q. Existing Shop
Poerpole
• o
I 95 1
'------- ------ -—-
� "�operiy L ni e" —
� 0
I i
Fire Hydrant(FH)
I
I � �
Scale: 'I"=30'
� � I
I � �
1 I �
� 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 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4
RECENED
0 C 2 3 2018
CiT'•,0,F If'f;DARD
Pi.ANNING;ENGINEERING
Page 54 2011 Edition
Pedestrian Accommodation Diagrams
See Diagrams 5-7 and 5-8, below, for pedestrian accommodations in work
zones.
Pedestrian Accommodation Principles:
1. If the work impacts the sidewalk or pedestrian facility, provide a safe,
accessible path, where practical, in accordance with the requirements
of the ADA.
2. If not practical to match the width of the existing pedestrian facilities,
maintain a 4-ft minimum width.
3. Unless a reasonably safe route can be provided through the work
space, pedestrians should be appropriately directed with advance
signing to cross the road. Do not divert pedestrians into travel lanes.
4. Install pedestrian closure or detour signing on Type II barricades.
Make every practical effort to satisfy the following:
• If work closes a sidewalk or sidewalk ramp, close sidewalks at a point
where an alternate crossing point or route can be provided. Minimize
the amount of out-of-direction travel for pedestrians.
• Use a combination of"SIDEWALK CLOSED" (R9-9), "SIDEWALK
CLOSED USE OTHER SIDE" (R9-10), "SIDEWALK CLOSED AHEAD
CROSS HERE" (R9-11), and "SIDEWALK CLOSED CROSS HERE"
(R9-11a) signing to direct pedestrians to an alternate facility.
• Where there are business destinations between the nearest crosswalk
and the work area, close the sidewalk at the business access nearest
the work area, where practical using the SIDEWALK CLOSED sign.
Include the SIDEWALK CLOSED AHEAD CROSS HERE sign at the
nearest crosswalk prior to the closure.
Chapter 5 December 2011
2011 Edition Page 55
Pedestrian Accommodation, Mid-Block Diagram 5-7
The sidewalk should be closed at the nearest intersection on each side of the
work area when a safe,ADA-compliant path through the work area of is not
available.
�♦ or
aaoss►E �♦
arose r�
24x12
Type"W1' 24x18
................ ,.. ::.:.::....... ......,.... (Mount on B(II)L) Type'W1"
............... .......... ...........
..... .......... ...........
.................... ... ................. .I.,.........
_. ..... ......... ..........
.................. ..........
SIDEWALK
CLOSED
24x12
Type'W1'
(Mount on B(II)LR)
(2 Reqd.)
siotwNx aoem
eo IWALKCROSS HERE I
aneeo
or
c�+oss r�RF
24x12 24x18
Type"W1" Type"W1"
(Mount on B(II)R)
December 2011 Chapter 5
RECEIVED
OCT 232018
CITY �:� iaARD
PLAN NIN( , ;1\: ,%INEERING
2011 Edition Page 79
Work on Shoulder Diagram 210
1 t
•
•
•
(OptiMonal)
• ` Protection Vehicle
w/TMA(both Optional)
See Chapter 4
•
• Buffer
•
•
•
• 0
•
A
ROAD SHOULDER
WORK OR WORK
AHEAD AHEAD
i
Initial Warning Sign
I t
*Use as appropriate-see Table 5-2
December 2011 Chapter 5
Page 80 2011 Edition
5.3 Two-Lane, Two-Way Roads
Shoulder Work w/ Minor Road Encroachment Diag. 300
Use this detail for non-freeway work which extends into a travel lane and
maintains a minimum 10 foot travel lane. If a minimum 10 foot travel lane
can not be maintained, or when traffic can not safely pass by in both lanes
simultaneously, use the appropriate lane closure diagrams—for example,
Diagrams 310 through 350.
A lane closure may be appropriate for conditions such as high traffic
volumes, high speeds, and inadequate approach sight distance to the work
space, or heavy equipment adjacent to the travel 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. Cones shall be placed along the entire length of the work space. If a
protection vehicle is used and work is in place one hour or less, the
taper and tangent devices may be omitted.
4. If the speed is 45 mph or higher, volumes exceed 2000 ADT, or there
is limited sight distance, consider placing cones or tubular markers on
centerline.
5. An arrow board in caution mode or truck-mounted PCMS with
"SHOULDER WORK" or other appropriate message may be used for
higher visibility.
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
3L5_� 125
40 350 350 350 150
45 180
50 500 500 500 210
55 250
Chapter 5 December 2011
` OPTION A
� &_ LIGHTING LEGEND
INSTALL 45W LED TOWN 8 COUNTRY LIGHT ON 20'2PC DB
- r+' FIBERGLASS DB BLACK POLE,FUSE AT SOURCE,
SW LESLIE CT .�' . CONNECT AT 240 VOL TS
Uj SOW
r.+r <
Q ''sj�
25
14r*M z R 1 r t
ry
^4 51� �1r
• Q,
PL 0 80160
,
•
INSTALL 45W LED TOWN B COUNTRY ON 20 I 3 '
Is�ta ., ts�M
2-PC FIBERGLASS DB BLACK POLE. FUSE AT
SOURCE, CONNECT @ 240V • '" �-
ism
ISMS W-4 I s war g I�
VAMP
INSTALL 304 MP FUSES IN SECONDARY PEDESTALS OR SECONDARY
VAULTS(WHICHEVER 15 ST LT POINT OF AT74CHMENT)FOR EACH
17"f' El"LIGHT PER T&D Cly i'`rRUCTION STAB,',",ARD LC-11550
ATTENTION: CALL 811 BEFORE YOU DIG
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED
BY THE OREGON UTILITY NOTIFICATION CENTER. ,
THOSE RULES ARE SET FORTH IN OAR 952-001-0010
THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF
THE RULES BY CALLING THE OREGON UTILITY
NOTIFICATION CENTER ADMINISTRATION @ (503-232-1987)
2 PIECE FIBERGLASS(COMPOSITE)POLE TO REQUEST UTILITY LOCATES CALL THE OREGON Know what's below.
AA Maw I I_ — � UTILITY NOTIFICATION CENTER, 811 AT LEAST
�u -- I I — "'g''� 2 BUSINESS DAYS PRIOR TO EXCAVATION. Coll before you dig.
r' of LLrY:if �I
I 1PGE CONSTRUCTION DRAWING
"wey"'� I SDP/WENG REVIEW: JASBUILT BY DESIGNER:
41.E Z.
AS—BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
spoorW`ry This document accurately represents FIELD construction.
....a,u..r
—:..,.F,.. Foreman: Date:
GF: Date:
DATE: 1011118 SCALE: WA ACCOUNT: 18100 AWO: 1000004600 JOB NO. M2604906
{ r b„ LA q_sr TITLE City of Tigard EOL Pl # 80160
• "•��°'~^' CIRCUIT SIZE
DURHAM-SATTLER
1 1x17
PGE LOCATION
= ., , .,•. ., - 14995 SW Leslie Ct
THINK BOTTOMPIECE POLE Inls rALLAnOnr
''"r DESCRIPTION
= ir�a. Replace EOL Laminated wood pole w/20'FG DB 2 PC black,45W LED T&C,30amp fuse,connect @ 240v
f Ti.nyrW SVncfl mrt.ta nN.N.A rocfl
SAFETY m r.rg", ranr,,r.
,,,,��,�.;�.�,,,,,, ,,,,ff�.., COUNTY SECTION(S) WORK WITH SHEET
pnww WILSONVILLE WASHINGTON C2111 D
r,raw:'-0rW*1rmrr.-r.m I I I OF 1
FIRST! IPU 01M w'S.-0 Woeprowl,0.'"1w LINE CREW CENTER DESIGN BY PHONE (503) DRAWN BY
rxt.h!k 0,ove'f,Leow"d pub roR
9480 SW BOECKMAN RD Rico Solis 672-5417 Rico Solis
WILSONVILLE,OR 97070FE)PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED