PFI2022-00228 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
s COMMUNITY DEVELOPMENT Permit#: PF12022-00228
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/06/2022
Parcel: 2S114AC00600
Jurisdiction: Tigard
Site address: 16625 SW 92ND AVE
Subdivision: None Lot: None
Project: Davala Sidewalk Replacement
Project Description: New single family home on vacant lot-curb and sidewalk replacement
Class of Work: FEES
Type 2-Sidewalk/Driveway Approach Description Date Amount
TOWI
Owner:
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tigard-or.gov to schedule inspections online.
Contractor:
PHONE:
Applicant:
BRADLEE HERSEY
2000 SW 1 ST STE 420
PORTLAND, OR 97201
PHONE: 5039138811
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: See application
Issued By: &W�6—
�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12022-00228
Type: Condition Name: Status: Severity:
PFI_Sidewalk/[ 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—Sidewalk/1 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_Sidewalk/[ 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—Sidewalk/1 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—Sidewalk/1 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_Sidewalk/[ 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_Sidewalk/[ 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 8 Rescue)and to 503-962-8140(Tri-Met)and
503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI—Sidewalk/1 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at
each end of the construction area 72 hours(min.)before initiation of construction work.
PFI—Sidewalk/1 09-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_Sidewalk/[ 10-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_Sidewalk/[ 11 -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_Sidewalk/[ 12-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—Sidewalk/1 13- DRAINAGE CONTROL Applied Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property,public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Sidewalk/[ 14-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_Sidewalk/[ 15-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_Sidewalk/[ 16-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_Sidewalk/[ 17-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_Sidewalk/[ 18-SEWER SYSTEM TEST Applied Notice
A sewer system air-test and/or DVD T.V. test report and one set of"As-Builts"shall be provided for review and approval.
PFI_Sidewalk/[ 19-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_Sidewalk/[ 20-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_Sidewalk/[ 21 -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_Sidewalk/[ 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector.
PFI_Sidewalk/[ 23-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Sidewalk/[ 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice
The City's Inspector may,at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Sidewalk/[ 25-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_Sidewalk/[ 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements,shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain
or provide for proof of right-of-entry or easements.
PFI_Sidewalk/[ 27-PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI—Sidewalk/1 28-AS-BUILT DRAWING Applied Notice
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and,also,any improvement which may impact an existing public system or facility, shall be provided to the
City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance).
PFI_Sidewalk/[ 31 -OTHER Applied Notice
Other
DocuSign Envelope ID:297BI 163-EA04-4FE8-8408-8D60DF7A2782
City of Tigard PFI#: 2022-00228
= ENGINEERING DEPAIUnfENT
Public Facilities Improvement (PFI) Permit
PROJECT INFORMATION
� TYPE OF WORK
Project name: j/. O dA. // ❑ TYPE 7—Frmchi.c Ufi in Vork
Brief description of project: i' rr; perliormed by iv\V..i,PGI•:, or utiBty
a4cncy
IN TYPE2—RM Sidewalk/Driw%v y/ticNr cr
Worlrc performed for the parpov:of:
• Sidewalk installation or repair
• Driveivav approach installatiom and repai,
SITE INFORMATION • Saniran ,vi crlateral installation and
main line tap
Location (address if available): J&ZZT eW ❑ TYPE 3—I Ul Srtle Dccdopmcnt\t'ork
�� perfortned with land use approval which
includes any of the folk Wray;.
• Subdivi.,ms or Partitions
APPLICANT INFORMNATION • Street vvidemrig
/'✓ O . /rt �H • Mainline instilatiori for sanitary sewer,
Name:
n (''�,, /�- /, smnn .ewer- Tigard wax, mid 'Tigard
Mailing address: / /D _XN l J+ At, 1!/�/ti 7� wanr service area
City/State: zip: e- f zei4 ❑ TYPE 4-Small Cd 1'echnol(%
15W //3 e8Z( El TYPE S-'l i
Phone: gard Triangde
Email: A td/. sl'fhJfGGIIQ'./tt�+A Phone: NOTE: Type 1 and 2 apphcanfMs may be
k-11v I HAemailed to ri Nv nniln(U tigard-or.(..
Contact name: c( ,X! a
Phone: 7/7 23 72 Email: hire --a//lam
CONTRACTOR INFORMATION O Same as applicant
kc L
Name: & GSM Jtrcf
- M r)Slt r CL /khU J CCB Number:
1\Iailing address:am/ fflwkw-S ri.... ZL Cin/State: /-ate i-, 64- Zip:
Phone: �q �i`6(o MIL Email: m �i�in,Xartl� -LttiwrtP.ENGINEER INFORMATION
INFORMATION
Name:
Mailing address: City/State: Zip:
Phone: Email:
ADDITIONAL INFORMATION
Estimated value of work is required(if over$5,000):S (within the public right-of-wap)
Is work related to a LAND USE DECISION? O Yes W No Case number.
cit} of Tigard 13125 SWHall Blvd. • Tigard,Oregon 97223 • vmwtigard-orgov 503-718-2321 • Page 1 of 4
DocuSign Envelope ID:29701163-EA04-4FE8-8408-8D60DF7A2782
APPLICANTS
NOTE: Person specified as"applicant"shall be designated"Permittee"and shall protide financial assurance for
-work,if required by the tits pursuant to TMC 15.04.140.
' \X'ith rbc ehcepriim of a utilinoperafutg pursuant to a valid ftatulilsc nr finnsc kith the(:in•uf't'i}tanL rebut the•�ncncr and rbc applicant
arc different pcnple,the applicant must be the pureh:ucr of record or a lessee in possession with written authorization from the owner
or an agent of the owner. '[lie ouner must silm this application in the Space provided or 5ubrait a writte91 authurizarion with this
applicarion. Franchised or licensed Utilities arc not required to obtain the owner's silatatnrc of dic application.
I,the applicant,certify that:
• To the best of my knowledge,all the information provided within this application package is complete and
accurate.
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the
subject property.
• If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
Bradlee Hersey 5/31/2022
.\pplicant's or authorize �a��6J inure Print name Date
/�w
DdC•synod by: � � 1
1t- Steve Davala Laurie Davala 5/27/2022
- 022
'segeanxcsevars¢er's signatu 4r%T4PN m Print name IP"
STAFF USE ONLY
Case No: PF12022-00228 Permit fee: •r,- Received by: JCM Date: 5/31/2022
Approved by: -TY46irk B. Date: 4/to/zeizz Notified by: Date:
City of Tigard • 13125 Susi'Hall Blvd. • Tigard,Oregon 97223 • nuw.tigard-or.gov • 503-718-2421 • Purge 2 of 4
DocuSign Envelope ID:29781163-EA04-4FE8-8408-8D60DF7A2782
DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit:
INITIAL PFI PERMIT FEE
Part 1: Required submittal fee is 10'o of the Net PFI Permit Fee.See below for calculations. Minimum of$300.
NET PFI PERMIT FEE
Part 2: All non-water system improvements engineers estimate S 7°'n(less the initial PFI Pemrit Fee).
WATER LINE CONSTRUCTION FEE
Part 3: All public�N ater system improvements engineer's estimate Z 12'o.
FOR STAFF USE ONLY FOR STAFF USE ONLY
TYPE 4: SMALL WIRELESS
CHECKLIST REQUIREMENTS
Does applicant have a right-of-way license? ❑Yes ❑No TYPE 1 AND TYPE 2-Must include a sketch
showing:
Under the wireless facilities standards,is the proposal ❑ Dimensions
considered?(check all that apply): ❑SmallCell ❑Nlauo
❑ Street Varve
How many install sites are proposed as part of this permit ❑ Site Address
application?
TYPE 3-Must provide 4 sets of plans(sized 24 x 36
or 22 x 34)and an electronic version of all submittal
The proposed equipment is located on which of the following. items. The plans must that include:
❑Public Right-of-Wap ❑Private Property
❑ Cover—Sire,Vicinity,Abbreviation,Legend
If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.)
type&use: ❑ Street(Plan,Profile)
❑ Water,Storm and Sanitary(Plan Profile)
❑ Water Quality Facilities
❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,Storm,
Sanitary,Water,Signage,Street Lights,etc.)
❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheer label(project land use name,revision and plan
log block,dates and sheet numbers.)
❑ Engineers Construction Estimate
Additional Submittals
(per land use conditions,if applicable)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Georechnical Report
❑ PreliminaryAccess Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design
❑ Water Provider Approval
City of Tigard 1 i 125 SW I lall Bra. 1 igard,Oregon 97223 • w wwtigard-or goy • 503-718-3421 Page 3 of 4
DocuSign Envelope ID:297B1163-EA04-4FE8-8408-8D60DF7A2782
Q C�
jEdge of Pavement
I +_� Ditch�'►
�t ._.— — —C— —
4 A 1I
I
till
I ,� I Existing House �
1 ds I Existing 1
Driveway
1 ,i I 1
r
os
� 1 I
i Existing Shop j Ds
in 1
Powerpole i I o !a 1
la \\\\ 95 -------
I , O lfropeAy Line---
HytlraM(FH) 4
I
I I I Scale I"=30'
� I I
TYPE 1 AND TYPE 2:
MINIUM SKETCI I REQUIREMENTS (Put N/A if not appli"ible)
I i
i I
� I I
I j
I l
North arrow Property lines&dimensions Existing utilities locations
(sewer,storm,water)
Street&street names All existing structures
Proposed work Existing curb or edge of pavement Utility&street light poles
Existing S/W or D/W apron Slope of property Trees
City of Tigard 13125 S\%'Hall Blvd. • Tigard,Oregon 9722)3 • nww 6gard-ocgov • 503-718-2431 • Page 4 of 4
m
c
m
'RENAISSANCE
IiHOMES
GENERAL PROW MORI'IATION
517E ADDRESS- 16675 OW%PD AVE,TIGARD OR e..L.�.s, I �i�T�i11
M" Do
EXISTING AREA FOOTPRINT BSF-VAGbIi TOT
K a
CllLLHTi AREA FNTPRNT 7158665E 4 ♦via \ .aa.er �`
m
GROSS LOT SIM 6.31 ACRES W
Ml9
t LM/
7CNN5 Rl.S
A4 4
RIVERYIDOD LANE + a_
IHIFI qB ATEA C&C"710N! ,r,,. .- 4 / \ I. W
-_
-------- __s,,, ` / LOT 2 p
T3RVEWAY 6166E a rr mow' rry��y \ ,y .y
ROOF AREA NCLWM EAVES' 7)110 OF 140 � J�
TOTAL IMPERHCUS AREA 3166 5F
STOR1WATER 6DWTION' 1605E VEG RLTER STRIP REQ I i
mewm REQIED SEIBACK6
FRONT
GARAGE Nr=e' � �
a�yL
51GES 5-e' 16675 SW WV AVE,
I7! TIGAFD,OR S7714
REAR IS'-® ~ �m "Ln+rs TAX L0175114AC00650
R511331
'r' CITY OF SGARDI
nANIrLn NBGHT MT 3e'-e' LOT 14 I �..�L,a �•• WASHINGTON COAITY
— M
611E PLAN GENERAL NOTES ONO 510-0'WETLAND
C-ONSTRXT10N BUFFER
I.cONTWTOR TO vBOFY AND SPECIFY EXACT 4� IN
LOCATION OF ALL UTILTY CONNECTIONS CONTRACTOR
TO PROVIDE SEWER TAP,AND TO PROVIDE ELECTRIC,
NATURAL GA5,5BUER,WATER,AND DRY SERVICES PER
CITY AND LMLITY STANDARDS. CCNrRACTOR TO VERIFY r� •
TRENCH REOURENENT PRIOR TO EXCAVATION
CONTRACTOR TO VERI'Y 314'WATER MAIN,4'SANITARY <19 ND AREA
6Fb£R.NATURAL GAS,AND DRY U11WIE51N CITY YYY777 RvErED e 5 10 tv 6e
APPROVED BENCNED ACCE55 rRENCN VERFT E SCALE BAR•500'
LOCATION AND TYPE.PRES9UR7FD OR GRANNY WI
CITY,WEER
,'%INDICATES EJ65TR1G,REE TO BE REMOVED I� E PLAN— TREE REMOVAL
--
wwx,"ra NSrns"cEwr�LRrE eenRSRR _
ME NLw1 MFran[rmu U%ff rcNNsvNct TOAs T�KL AIWT,NWIaEEa"vert er:rsrc erwr oT.Rnnmrua®a DAVALJI MODIFIED Site Plan-Tree Removal/Replacement
aCemerl(
RENAISSANCE HOMES f gIL1 SEUL""4 roNAR B F NAB N6�LFnpEs M M»~"DN OFIEN%R �'
uwmollffADaamrnOaTNHx n,va.on TrR CEsiwnc.unc-xwrfs"oxruanncanin.-LT rmwkTellsrrtAURunFN VAUGHN
16771 BOONES FERRY ROAD ""rRNRR.SLi1ES Dr uNTo"Da rtxNaNT"mocD"unu. PrOjecimor bw RL044 b
LAKE OSWEGO,OR o RNN1�rcr""°a"°aam"s°ureuu,w„a'scasscama"'rano"w"NOLmR""'"'"uw'aavaeaeraN"" DMS- - 05-26-22 OSP-TREE
97 3S AW10•ImATrRroTNErawc.na,arcaaHNAmmor+NLnws s.Rw ML Terra"I c.R INvrcT~1 DH06a1swm 18615$w 92ND AVE. -..-_
Drr"u nua rDME srurtataarRcrux i.vAERroI"aoNB9vR,wE wtr®,tH:cartucronws roTNr vrwm4`r�R+aRTNp TIGARD OR Drawn OY _....._...K_MCCeII ____.
P:(503)636-5600 F:(5o3)635-8400 sTwrarsTNSLCTM NHDavueOrcrc BEWBIBmoN3 We coon NTEW%11tw W.aNwMW P MFS sNaxoaswll O -_ I Scale AS indceReo