Loading...
PFI2018-00328 n CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00328 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/10/2018 Parcel: SEG709 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Replace pole PL4668 Owner: FEES Description Date Amount PFI Permit Fee 12/07/2018 $300.00 PHONE: Contractor: PHONE: FAX Applicant: TEAGAN WISE 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-951-0528 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 41 Signature: SCZ GAD12(tCC- t-1 Issued By: 4d —, Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00328 Type: Condition Name: Status: Severity: 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. Contact 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 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. RECEIVED City of Tigard DEC 0 3 2018 N PUBLIC WORKS — ENGINEERING IT"Y - FIC3APD ;Nn111G Public FacilityImprovement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) VTYPE 1—Franchise Utility Work Check one: V Utilities ❑ Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE Detailed description. Replace pole PL4668 and/or utility agency. ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2420882 Work performed for the purpose of- - Sidewalk installation or repair. 6610 SW Baylor St SEG 7(2q - Driveway approach installation Property address/location(s): Y / and/or repair Tigard, OR 97223 - Sanitary sewer lateral installation 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, OR Zip: 97062 the following: Phone: 503-464-7777 Email: preregcoord@pgn.com - Subdivisions or Partitions Contact name: Teagen Wise Phone: 503-951-0528 - Street widening - Mainline installation for Sanitary Contractor: Portland General Electric sewer, Storm sewer, 'Tigard water 503-464-7777 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: rowpermits jjga^ rd-or.gov Address: i��� ommi City/state: Gip: Phone: Email: Case No.: PF/20 /$' U 3c� Contact name: Application submittal fee(.007%of Engineer's Estimate) $ , 0V-CPO Estimated value of work is required(if over$5,000):$13,201.52 Additional fees: $ (within the public right-of-way) Application accepted: By: lJ tt/ Date: Is work related to a LAND-USE DECISION? ❑ Yes 91No If so,please specify (MLP,SDR,SUB, etc.) case #: Application reviewed: By: S Date: 114b Is work related to a BUILDING PERMIT? ❑ Yes V No Applicant notified: 7 ,///`Jf w If so,please specify(BUILDING PERMIT)case#: By: Date: IL-61 I:\ENG\PennitApplications\pkapplication Rev.10/16/2017 City ofTigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-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 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 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. Vi n h D Nguyen, Digitally signed by Vinh D Nguyen,PE PE Date:2018.12.0313:55:56-08'00' 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 • wwwtigard-or.gov 503-718-2421 Page 2 of4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL 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 (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,2406 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.tlgard-or.gov • 503-718-2421 Page 3 of4 SAMPLE SKETCH: Y ,• l Edge of Pavement I Ditch Streetlight .—.—.—.—.—.—.—.—r—.— • Rain Drain � a T�"l�rWj�os d-bow er'Tiirie'� 1 Existing House 1 a� I Existing 1 I Driveway . 1 ai( VI C Et • t IL I 1 .. I I �• al I I I f I ' > I 1 0I Existing Shop 1 CA •J • Powerpole I a .►.� a o I 95, --------7rroperiyLine------- --- I I go Fire Hydrant(FH) I I Scale: 'I"=30' I � � I � 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 Mall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 4 of4 www.invarion.com Lane Closure at Intersection with Flagging Diagram 620 ROAD WORK AHEA l t >C (Optional) ONE LANEROAD AHEAD B BE PREPARED TO STOP • B A 0 0 100 ft.Max. O O Buffer O 4 O O O O O NOW O cl � \� O O 100 ft.Max. C B B A O ROAD BE WORK PREPARED O 100 ft.Max. AHEA TO STOP • It ONE LANE ROAD AHEAD (Optional) A • B BE PREPARED TO STOP B (Optional) ONE LANE I t ROAD AHEAD C ROAD WORK AHEAD www.invarion.com Lane Closure at Intersection with Flagging Diagram fi20 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 ERRATA: 20 50 25 100 100 100 75 Supplement Table 30 100 35 40 350 350 350 �25 Updated: February 12, 50 2016 45 180 By:ODOT Traffic-Raodway 50 500 500 500 210 Section 55 250 Signs Spacing and Buffer Lengths (feet) Supplement Posted Spacing Between Signs "Buffer" Speed A B C Space 60 285 65 700 700 700 325 70 365 C 1050105 OVERHEAD LEGEND O 3-142 142 10T SD H1 DFIR REMOVE ABAhbvN FA�1�l TIL S INSTALL FACILITIES _INSTALL ADDITIONAL FACIUTIES/MODIFY FACILITIES ABC 150 150 1 WORK LOCATIONS PD-15 POLES POLE CLASS(1,2,3,4,H1,H2,S) g POLE HEIGHT 0- aFRAMING TRANSMISSION&DISTRIBUTION(SEE CODES BELOW) a� _FRAME TRANSMISSION-LC10754,WMS MU 1012 3 T3 TVS,BANDED POLE TOP BRKT(NON-TANGENT) YFRAME DISTRIBUTION-LC10730,MU 0044 6 D44—(3PH 1OFT SGL LT,ANG,POST) n a FRAME DISTRIBUTION-LC10711,MU 0251 = _ D251 (3PH 1OFT HVY,ALLEY,TANG) EQUIPMENT Q PROPOSED ADD SECONDARY VAULT[JUNCTION BOX 1730,UNFUSED] QQU :¢;U ANCHORS O x XLli Z_ _ = Q ZO lWu m v = F a'Z (LEAD A (LBS) b b N Anchor Code I At I A31 A51 A7 I A8 n h GUYING O =O d = d p c7 O o 0 — io io to P06 1"f N 1 GUY G1 CA G7 G1 G1 G1 2 GUYS G2 G5 G8 G11 Gi 3 GUYS G3 G6 G9 G1 G1 C21 17308 45-1 1983 A50 17642 208, B 50 15560 TREE TRIMMING NOTE A6AL-TX 1 C 50 17643 CLEARAREA SW BAk0OR ST A 50 AROUND POLE �C 556 AAC B 50 N 410 AAC C 50 4ABC,556 AAC N 4/0 AAC i 4668 75 H3 OFIR A WL 1 PL-4668: VT-150 Install:PL 75'-H3ZEAST T3(TVS) E' D44(NORTH/SOUTH) D251(EAST/WEST) (2)WILDLIFE PHASE COVER 3-IN PVC COND UNIT W/12"BKTS JUNCTION BOX 1730,UNFUSED M (3)1P 50KVA OH 120/240 7.2 NT1CB 1 CELC ACCOUNT VD=0.62% 58kW Al-L 15'-6,517# Q G16-PRI-3,987# Transfer: ro STREETLIGHT 10 rrlln vr: 3 PL75'-2 h T3(NS) 11675 D44 D251 (2)3-IN PVC COND UNIT W/12"BKTS 11700 (3)1P 50KVACH 1201240 7.2 NT1CB ¢U¢' TEMP TRANSFER COMM(S),. U PGE TO PULL �•QQQ TOPPED TO COMM(S) dip PGE TO PULL 00 ¢Z 6656 75 2 DFI 600 A 6674 UQ. ¢0 N lf1 ,U 7 0 25 50 100 Feet a,z l I I I l 1 1 1 1 N PGE CONSTRUCTION DRAWING AS-BUILT VERIFICATION Q NESC VIOLATIONS CORRECTED TRK EOcumpnla¢uralely rppesenh F�ELC�^-•"..- Foreman Date: THINK General Foreman: Date SAFETY (Signature on required for field construction changes) SDPM/ENG REVIEW. ASBUILT BY DESIGNER. J0 NO NY DEVIATION FROM THIS DESIGN MUST FIRST 8/30/2018 1 in=50 ft 1070001 TE SCALE ACCOUNT 1A 1000004545 M2420882 BE APPROVED BY THE PGE PROJECT MANAGER TITLE TRANSMISSION SHERWOOD-WEST PORTLAND 115K-REP e/O PL 4668 CALL 811 BEFORE YOU DIG CIRCUIT S¢E ArATTENTION: WESSTT PORTLAND-WEST PORTLAND 13 17 x 11 OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED , /PGE LOCATION BY THE OREGON UTILITY NOTIFICATION CENTER. r v`; 6610 SW BAYLOR ST,TIGARD,OR,97223 THOSE RULES ARE SET FORTH IN OAR 951-001-0010 DESCRIPTION THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF ` REPLACE PL4668 SHEET THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS WORK WITH NOTIFICATION CENTER ADMINISTRATION @(501-132-1987) WASHINGTON C1136D 1 OF 1 TO REQUEST UTILITY LOCATES CALL THE OREGON K"0W Wlratt below. 1 ILSONVILLE DESIGN BY PHONE DRAWN BY UTILITY NOTIFICATION CENTER,811 AT LEAST Call before you dig LINE CREWCEN7ER TEAGEN WISE 503-951-0528 TARALEAKE 1 BUSINESS DAYS PRIOR TO EXCAVATION WWSW00ECNN4 WLSOWL OR P70I0 ©PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 Request for Permit Action 311 , -- 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tig;grd-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓): ® CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: PFI2018-00328 Site Address or Parcel #: SEG709 Project Name: PGE Subdivision Name: N/A Lot#: N/A EXPLANATION: Per Engineering,applicant never completed the work and permit has expired.Please void.Applicant has not requested refund. 2/12/2020 Date: Signature: --ti- �%�jzG� Print Name: Lina Smith Refund Policy 1. "fhe city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date B Route to Records: DaB Refund Processed: Date A114' B Invoice Processed: Date B Permit Canceled: Date3 /fi 2 o B Parcel Tag lidded: Date B 1\Building\Forms\RegPem9nleuon_1192314.doc CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT • COMMUNITY DEVELOPMENT Permit#: PF12018-00328 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/10/2018Parcel: SEG709 Jurisdiction: Tigard Site address: Subdivision: Lot: ,6"® R r Project: PGE �` �, , Project Description: Replace pole PL4668 �//�//� Owner: FEES Description Date Amount PFI Permit Fee 12/07/2018 $300.00 PHONE Contractor: PHONE: FAX Applicant: TEAGAN WISE 10800 SW AVERY ST TUALATIN, OR 97062 PHONE 503-951-0528 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 a Signature: &i 77�ICaA Issued By: 46;, Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00328 Type: Condition Name: Status: Severity: 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_Utilifies 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 verity 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 Contact Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov. PF] 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 anylall assignment changes. PFI_Utilities 21 -OTHER Applied Notice 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. iV Y City of Tigard /3 lgl2v Ar- PUBLIC WORKS —ENGINEERING >= Public Facility Improvement (PFI) Permit , TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) TYPE l—Franchise Utility Work Check one: it Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGI i Detailed description: Replace pole PL4668 and/or utility agency. ❑ TYPE 2—Sidewalk/Driveway/Sewer PGE Job M2420882 Work performed for the purpose of: • Sidewalk installation or repair. St for S EG 70 a Driveway approach installation Property address/location(s): 6610 SW Baylor 9 and/or repair Tigard, OR 97223 • Sanitary sewer lateral installation and/or main line tap Portland General Electric ❑ TYPE 3—Full scale Development Applicant: Work performed with Iand use Address: 10800 SW Avery St 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: Teagen Wise Phone: 503-951-0528 • Street widening • Mainline installation for Sanitary Contractor. Portland General Electric sewer, Storm sewer, Tigard water 503-464-7777 and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Gip: 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 he emailed to: Engineer: N/A roc¢permits� ard-or.eov Address: City/state: 'Lip: Phone: Email: Case No.: Ft 1.2o /8— L Contact name: Application submittal fee(.007%of Engineces Estimate) S •f!!7 Estimated value of work is required(if over$5,000):$13,201.52 Additional fees: $ (within the public right-of-way) Application accepted: Is work related to a LAND-USE DECISION? ❑ Yes Q1No By: 'iU l Date:TLS If so,please specify (MLP,SDR,SUB,etc.) case#: Application reviewed: ' By:9 .A4EkkL Date: ►NCr 1/� Is work related to a BUILDING PERMIT? ❑ Yes 4KNo Applicant notified: � If so,please specify(BUILDING PERMIT)case#: By: te: I I:\ENG\Pert"ppkatio \pfl appbtlm Nrv.10/16/3017 City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 PVc I04 DEVELOPMENT ENGINEERING FEES FOR STAFFUSE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL 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 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 Lngineer'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: Desrgn Plane • Sidewalk repair(less than 20 lineal feet) (6 sets,2436 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 Tacilities • 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.) AddidonrlSubmittala (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 ❑ Engineef s Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 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. 4 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 APPLICANTS)SHALL CERTIFY THAT: • The above request does not violate any'recorded deed restrictions that may be attached to or imposed upon the subject To . • 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. Vinh D Nguyen, Digitally signed byvtnhD P E Nguym PE Date:2016.12A3 13:55:56-06'00' Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. Owners 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 of4 SAMPLE SKETCH: Edge of Pavement Ditch ---- StreetlightI — — •—•—•—•—•— —�—•— I °• x,in vela, r p I � i I 1 I N Existing House I r1 I Existing ; ,. d+ is Driveway 31 r I I I Ni 0-1 H rl a, fl c • i aj I I j Existing Shop FE Powerpole o � - 95' 1 I .L. •�iopei %Lme—•--- -- I Fir a Hydrant(FH) Scale: 1"=30' � I 1 � I I j 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 of4 www.invaric)n.com Lane Closure at Intersection with Flagging Diagram 620 ROAD WORK AHEA ONE LANE C 1 t (Optional) ROAD AHEAD B BE PREPARED TO STOP B A 100 Il.Max 1 I Buffer mm K K K 100 ft.Max. C B B q ROAD BE WORKPREPARED 100ft Max. AHEA TO STOP O ONE EANE ROAD C AHEAD It (Optional) A B BE PREPARED TO STOP B (Optional) ONE LANE l t ROAD AHEAD C ROAD WORK AHEA www.invarion.com Lane Closure at Intersection with Flagging Diagram 220 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 ERRATA: 20 50 25 100 100 100 75 Supplement Table 30 100 35 125 Updated: February 12, 350 350 350 40 150 2016 45 180 By: ODOT Traffic•Raodway 50 500 500 500 210 section 55 250 Signs Spacing and Buffer Lengths (feet) Supplement Posted S acing Between Signs "Buffer" Speed A B C Space 60 285 65 %00 700 700 325 70 365 C 10 50105 OVERHEAD LEGEND 3-14210T® 80H1 DFIR RLAgj AI ASe ,h F A-r,r,L S_INS T41 L TACII TES _IN$,ALI X00Ii1LWIl FA[IUNEYYODIFv fAGLlrlE3 ABC 150150 1 WORK LOCATIONS P 15 POLES POLE CLASS f7,2,3,4,H7,H2,S) i POLE HEIGHT FRAMING TRANSMISSLON4 DISTRISUTRINI3EE CODES BELOWI E-:p _FRAME TRANSMISSION-LC10754,WMS MU 1012 TV$,BANDED POLE TOP BRKT(NON-TANGENT) 4 FRAME DISTRIBUTION 1010730,MU 0044 1,4` -(]PH 10"SGL LT,ANG.POST) _FRAME DISTRIBUTION-LC70711,MU 0251 (3PH 10FT HVY,,ALLEY TANG) EQUIPMENT L�y Q PROPOSED ADD SECONDARY VAULT(JUNCTION BOX I7T9.UVFUSEO] ANCHORS �•g ALcty Cab A, A3 AS A7 AB 0 b G WMG U S E H E R U,. c1 G4 c7 curs G2 m m Gt wmm 17308 45'-1 19M 50 17642 200, 8 50 15560 REE TRIMMING NOTE C 50 17613 Ae AlrTk t CLEAR AREA SW BAYLOR ST A 50 AROUND POLE B 50 NNVp�C � C 50 ABC-SSB AAC N"AAC WL1 PL 466D _ Vi.15 b, PL' SI PL 75'-H3 2'EAST T3(TVS) D44(NORTHISOUT ) n 650 D251(EASTANEST) (2)WILDLIFE PHASE COVER 11N PVC GOND UNIT W112'81CTS AINCTION BOX 1730,UNFUSED 4F, (3)IF SOKVAOH 12=407.2 NT1C8 1 CELO ACCOUNT VD+062', 56kW Al-LIS'-5.6171 t 019-FIR-3OB70 Tlansre,. Ap STREETLIGHT PL 7F-2 T3(TVS) 11675 D44 D251 (L)}IN PVC COND UNIT WH2'BKTS 11700 (3)1P 5OKVA ON 12084072 NT1 C8 1EMP TRANSFER COMMIS) • 1 POE TO Put t TOPPED TO COMMES) POE TO PULL IL I%56 75 2 DIP 11 600 A qq6674 Oil n35D YI L 0 25 60 1DOFOM l I L I 1 1 I I 1 N POE CONSTRUCTION DRAWING IL7 VERIrICAtIONS NESC VIOLATIONSCORRECTED THINK cBIFmBmBR Date SAFETY SOFMENG REVIEW. UILT BYDESICNER .,ANY DEV14770N FROM TM DESIGN MUST F(RST gl30/2018 lin=50 N 1070001 JAI 1111v 1000004545 M2420882 BE APPROVED BY THE PGE PROJECT MANAGER'I TELL RANSMISSION SHERWDOD-WEST PORTLAND 115KV-REP BIO PL 45188 CALL 831 BEFORE YOU OIG Cwtczkr mm�QN_ \ WEST PORTLAND-WEST PORTLAND 13 11 k 11 REGONLAW REQUIRES YOU TO FOLLOW RULES ADOPTED /P�IEl I N BY THE OREGON UTILITY NOTIFICATION CENTER. 6610 SW BAYLOR SL TIGARD,OR,97223 THOSE RULES ARE SET FORTH IN OAR 952 WI-0010 " . DESCRIPTION THAOU6HOS1-0040090 YOU MAY OBTAIN COPIES W \ REPLACE PL4668 SHEET THE RULES BY CALLING THE OAE60N UTILITY COON SEC1i0N3 KN1H NOTIFICATION CENTER ADMINISTRATION @ IS02.232-1987) WASHINGTON Clnlo D 1 OF 1 TO REQUEST UTILITY LOCATE,CALL THE OREGON B1aL41BMfb�IM. MYTVM'iIL DES16NOY PHONEDRAWIIBY UTILITYNOnFICATION CENTER,351Ar LEAST Iia�1I818 I� IneeAiw uNRX TEAGEN WISE 503-951-0528 TARA LEAKE 2 BUSINESS DAYS PRIOR TOEACAVATION rAo.: onw� POFMNOGENERAL ELECTRICCO. LRIGHTS SRV