PFI2012-00026 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12012-00026
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued:
Parcel: 2S111AD13200
Jurisdiction: Tigard
Site address: 8930 SW Refiling
Subdivision: SCHECKLA PARK ESTATES Lot: 27
Project: Kronsteiner Driveway Replacement
Project Description: Replace Driveway Apron
Owner: FEES
Description Date Amount
PFI Permit Fee 08/22/2012 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MARK KRONSTEINER
8305 SW REILING ST
TIGARD, OR 97224
PHONE: 503-753-8153
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:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12012-00026
Type: Condition Name: Status: Severity:
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 188099 - 08/22/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12012-00026 PFI Permit Fee 100-0000-43114 $300.00
Total: $300.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 02245B HWATKINS 08/22/2012 $300.00
Payor: Mark Kronsteiner
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
d[ZCity of Tigard
Public Facility Improvement (PFI) Permit
General Information: FOR STAFF USE ONLY
Property s/Location s
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Receipt No.:
Date: z
*Applican 's Name: Application Accepted By:
Address 5(,e/ Revised 7/1/10 t
City/State:
Primary Contact: REQUIRED SUBMITTAL
INFORMATION
Phone: 6 ) " 7�� 15 x: S D .�^S &!- e4
Professional Engineered Plans are required
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Contractor's Name: rr
• Street Widening
CCB# - %_11— �� 7 Expir tiion: • Subdivision Infrastructure
Address: TT • blain utility line extension:
City/State: Zi 0 Storm Drain,Sanitary-Tigard
P 0 Water-Tigard Water Service Area
Phone: -" Fax: D; - L/013 2 (includes Durham,Kung City and a
portion of unincorporated Washington
/ County)
Plans By: /�/
**Note:See Engineered Plan
Address: Submittal Checklist attached.
City/State: Zip: For all other work:Submit scaled sketch of the
Phone: Fax: work to be done.(see attached minimum sketch
requirements and provided sketch area).
P
Description of work: C
curpin\master\land use application\13F1 app.docx
Estimated value of work(within the public tight-of-way): $ ./
Is work related to a LAND-USE DECISION? YES NO
If so,please specify(MLP, SDR, SUB,etc.)case#:
Is the work related to a BUILDING PERMIT? YES NOsZ
If so,please specify (BUILDING PERMIT)case#:
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for the work.
City of Tigard 1 13125 SAY'Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI)Permit:
Part 1: All non-water system improvements
Engineer's estimate X 5% (less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 2: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 1+ Part 2
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
II
• Test wells
2. Addressing Fee: The fee for this service is$50.00 per address.
h
SAMPLE
Minimum Sketch Requirements
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 of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations (sewer,water,storm)
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 2 of 4