PFI2012-00028 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2012-00028
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/30/2012
Parcel: 2S 102AA
Jurisdiction: Tigard
Site address: 12215 SW Main ST
Subdivision: Lot: 05500
Project: Woo Yong Choi
Project Description: Replace sidewalk and driveway drop(code compliance case)
Owner: FEES
Description Date Amount
PFI Permit Fee 08/30/2012 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
WOO CHOI
2323 NE 165TH DRIVE
PORTLAND, OR 97230
PHONE: 503-251-2700
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 PF12012-00028
Type: Condition Name: Status: Severity:
CITY OF TIGARD RECEIPT
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■ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 188203 - 08/30/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12012-00028 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 03098C GPAGENSTECHE 08/30/2012 $300.00
Payor Manja Choi
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
RECEIVED
AUG 3 0 2012
Ci O Tigard d CITY OF TIGARD
�' g PLANNING/ENGINEERING
Public Facility Improvement (PFI) Permit
General Information: // FOR STAFF USE ONLY
Property Address/Location(s): Z22 lJ \5 4) /����' Sf Engineering z�) Z –UCr Z
C' Case No.:
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? � I G Z A /1G�'S 00 Receipt No.: SV2032,�
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*Applicant's Name: fill P ,7, DiVL� 4 Application Accepted By: �9 �
Address:�i�;�� 1/.5 D Revised 7/1/10
City/State:r44: /D /f.Zip: 9,,u�3 �
Primary Contact: REQUIRED SUBMITTAL
INFORMATION
Phone: Fax:
Professional Engineered Plans are required
for:
Contractor's Name:
• Street Widening
CCB# Expiration: • Subdivision Infrastructure
Address: • Main utility line extension:
City/State: Zip: 0 Storm Drain,Sanitary–Tigard
0 Water–Tigard Water Service Area
Phone: Fax: (includes Durham,King 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
J y, L/ �j requirements and provided sketch area).
Description of work: 13--z rk e-n aLL4-L- I:curpin\master\land use application\PFI app.docx
S5 z L24Y-k S
Estimated value of work(within the public right-of-way): $
Is work related to a LA?4� DECISION? YES NO
If so,please specify(MLP,SDR, SUB,etc.) case #: ZU L ^ �' ITT
Is the work related to a BUILDING PERMIT? YES NO
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 SW 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
• Test wells
2. Addressing Fee: The fee for this service is$50.00 per address.
AMPLE
W''T"ISTetch 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
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SAMPLE SKETCH:
Edge of Pavement
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Streetlight I ------------- —r---
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Powerpole
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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 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 3 of 4