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Encroachment Permit City of Tigard Permit#: 1111 ENGINEERING I PUBLIC WORKS Return to City of Tigard After TIGARD Encroachment Permit Recording(For Permanent Only) PROJECT INFORMATION Project Name: This Encroachment is for: ❑ Furnishing ❑ Underground System ❑ Privately owned Structure ❑ Hardscape *(See TMC 15.16 for definitions) SITE INFORMATION (Include:Site address,proposed use of right-of-way,proposed time frame, contractor information, and scale drawing of encroachment and its relationship to adjoining properties): APPLICANT / PROPERTY OWNER INFORMATION I Is Applicant Same as Property Owner? ❑ Yes ❑ No Applicant Name: Property Owner: Applicant Address: Property Address: City: State: Zip: City: State: Zip: Phone: Email: Phone: Email: THIS ENCROACHMENT PERMIT IS SUBJECT TO THE PROVISIONS OF Tigard Municipal Code Chapter 15.16. I certify that the information provided in this application is true and correct to the best of my knowledge. I have read, and I agree to be bound by Tigard Municipal Code Chapter 15.16. Applicant Signature: Print Name of Applicant: Property Owner Signature: _ _ Print Name of Property Owner: IF INSURANCE IS REQUIRED BY CITY OF TIGARD: Insurance Policy No. Policy Expiration Date: STAFF USE ONLY Received by: Received Date: Permit fee: Approved by: Approved date: Add. Fees: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 TIGARD MUNICIPAL CODE 15.16 ENCROACHMENT PERMITS Standards for Approval: 1.The proposed encroachment is 2. Furnishings must identify the name expressly authorized by the Tigard Community and address of the owner on the exterior of the Development Code or is otherwise in the public object,as well as an emergency contact number. interest and consistent with the City's Public Improvement Design Standards. 3. Furnishings must maintain a weather proof or weather resistant quality. 2.The proposed encroachment does not interfere with the existing or future 4.Furnishings must be designed to be stable and self-supporting under a wind load of at transportation system or the provision of public utilities. least 20 pounds without attachment to the pavement or other object. 3.The proposed encroachment does not impede vision clearance or sight distance, pursuant to Tigard Community Development Code Chapter 18.920 or the current AASHTO publication, "A Geometric Design of Highways and Streets,"whichever is more restrictive. 4.The proposed encroachment does not prevent access to, cover,or block the flow of water to or into catch basins,ditches,or swales, and does not otherwise alter the natural drainage patterns in a manner that adversely affects other property. 5.The proposed encroachment maintains minimum applicable vertical clearance for encroachments within the right-of-way,as provided in the Tigard Community Development Code or Manual on Uniform Traffic Control Devices. 6.The proposed encroachment must meet minimum horizontal clearance from public facilities,such as manholes and fire hydrants,as set by the relevant service provider. B. Standards of Approval for Furnishings: In addition to the standards provided in Section 15.16.050.A,approval of furnishings as encroachments must meet the following additional standards: 1. Furnishings may not be chained, bolted,or otherwise attached to any fixture,tree, or item located in the right-of-way,nor attached to the surface of any right-of-way.