Permit CITY TIGARD SEWER CONNECTION PERMIT
PE
�l�'� DEVELOPMENT SERVICE S9'-4 1 r 1N M E ISSUEDRMIT #: S 11/W24/1999 R1999 - 00107
13125 SW Hall Blvd., Tigard, OR 97223 (50 6
SITE ADDRESS; 09985 SW WALNUT ST PARCEL: 2S102BD -00904
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: R -12
BLOCK: LOT: 006 JURISDICTION: TIG
TENANT NAME: NATION, KURT
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 2
TYPE OF USE: MF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Duplex - 9985 & 9987 SW Walnut St.
Owner:
FEES
NATION, KURT
6003 SW CORBETT AVE Type By Date Amount Receipt
PORTLAND, OR 97201 PRMT GEO 11/24/199E $4,600.00 99- 320017
INSP GEO 11/24/199E $70.00 99- 320017
Phone: Total $4,670.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not •
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of -e rule or direct questions to OUNC by calling (503) 246 -1987.
Issued by: % Permittee Signature:
Call 503 639 -4175 by 7:00 P.M. for an inspection needed the next busi e�f s da
Call ( 503) Y p day
— 1)€.T'T. COPY —
CITY TIGARD PERM T #: ENG2000
�+so' DEVELOPMENT SERVICES PRIM. PERMIT #: ENG2000 -00011
��II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/11/2000
SITE ADDRESS: 09985 SW WALNUT ST PARCEL: 2S102BD -00904
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: R -12
BLOCK: LOT: 006 JURISDICTION: TIG
PERMIT TYPE: SOP PUBLIC IMPRV QUANTITY LIN FT VALUE
AGREEMENT DATE: GRA/EROS:
ASSURANCE EXPIRATION STREET:
PERFORMANCE: SAN SEW:
STM SEW:
MAINTENANCE:
PATHWAYS:
ALL OTHER: ` *`* $800.00
TOTAL: $800.00
Remarks: STREET OPENING, TO INSTALL A SIDE SANITARY SEWER SERVICE LATERAL.
FEES
Owner:
PAXMAN, SUSAN + Type By Date Amount Receipt
NATION, KURT OPEN JSH 04/05/2000 $150.00 0001131
6003 SW CORBETT AVE BOND GEO 04/11/2000 $800.00 0001326
PORTLAND, OR 97201 Total $950.00
Phone:
Engineer:
Phone: REQUIRED INSPECTIONS
STM /SAN SEWER STREET
Permittee / Applicant: MN/CB/CO CRB LINE & GRADE
KURT NATION PIPE LN & GRD SUBGRADE
6003 S.W. CORBETT AVE. BCKFLL & CMPCT BASE ROCK
PORTLAND, OR 97201 AIR & TV TEST LEVEL COURSE
WEARING COURSE
Phone: GRADING TRAFF & PED CONT
CONTOURS MONUMENTATION
DRAINAGE STREETLIGHTING
Permittee/ EROSION CNTL. WALK/APRON /RAMP
Applicant ,410
Signature: Y
REPR'S /ADJ'S PATHWAYS
Issued By 4 '4/ _
/ FOR INSPECTIONS, CONTACT THE CITY OF TIGARD,
SPECIAL CONDITIONS: (SEE ATTACHED) ENGINEERING DEPARTMENT, AT: (503) 639 -4171
CITY OF TIGARD
•
GENERAL CONDITIONS
1) TRAF CONTRL- SPECIF (CITY) -- The City's standard specification for traffic control is "manual on
Uniform Traffic Control Devices for Streets and Highways -, U.S. Dept. of Transportation. F.H.A.,
1988 Ed.
2) TRAP CONTRL- CONTR RESPON FOR -- Traffic control shall be provided for by the contractor in
accordance with the City's standard specification and, also, in accordance with a City (job
specific) approved traffic control plan. A copy of the approved traffic control plan shall be
available at the work area.
11 TRAP CONTRL - ROAD CLOSURE -- Public roadway shall not be closed to traffic, at any time, without
having first obtained written approval from the City Engineer. The permit holder is responsible for
provision of timely notification of traffic flow disruptions to area wide Emergency Services
(Tigard Police Dept., Tualatin Fire 4 Rescue) and to Tri -Met and Tigard School District.
41 TRAP CONTRL - PRIV PROP ACCESS -- Access to existing properties shall be maintained at all times,
including normal delivery service and mail service and if not, shall be cause for work stoppage
until effective access is established.
S) TRAP CONTRL - DEVICES IN PLACE -- Traffic control devices, flagpersons, etc.. shall be in place
prior to initiation of construction work and shall be effectively maintained.
6) TRAP /NOISE CONTROL - RORK MRS -- No work will be permitted during the hours of darkness, nor
between 9:00 p.m. to 7 :00 a.m. Monday through Friday nor between 9:00 p.m. to 6 :00 a.m. Saturday,
nor between 9:00 p.m. to 9:00 a.m. Sunday.
7) TRAP CONTRL - MIN LANE WIDTH -- Minimun travel lane width shall be twelve (12) feet: pedestrian
travel shall also be provided for.
6) TRAP CONTRL - CITY CAN MODIFY -- The City reserves the right to add to or modify traffic control_
requirements as may be necessary to effectively control traffic and to assure'public safety.
Li l ITISP 24 iIOTI0? - The permit holder or his contractor shall notify the City's inspector
F ' 1 9 1 . 4 / IZ ) '// at 6619 -4171 twenty -four (24) hours Prior to commencing
work, twenty -four (24) hours prior to any staged inspection and after completing work covered by
the permit.
10) PERMIT 4 PLAN REQ ON SITE -- A copy of the permit and all attachments, and a copy of the approved
construction plan and all amendments shall be 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 the aforsaid swot be approved by the City, in advance of work performance.
. .11) HAZARDS - CERT OF INS -- Maintenance of the work area and approach roads is the responcibility of
the permit holder. The work area and approach roads shall be maintained in a clean condition, free
from obstructions and hazards. A copy of the permit holders - Certificate of Insurance shall be
available at the work area. •
12) ' DEBRIS - MATERIALS -- The spreading of mud or debris or storage of materials or equiptment 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 stoppage of work
to accomplish cleanup.;
111 EROSION CONTRL REQ -- Effective erosion control is required. Erosion control devices most be
installed and maintained meeting D.E.Q. requirements. The City may at any time order corrective
action and stoppage of work to accomplish effective erosion control.;
14) REPAIRS - LIKE MATERIALS REQ -- Property disturbed by construction activity shall be seeded with a
standard grass mix; shrubs, flowers, barkdust, existing signs, pavement markings, mailboxs, etc.,
shall be reestablished, reinstalled or replaced, with like kind and material.
IS) DRAINAGE CONIRL REQ -- Effective drainage control is required. Drainage shall be controlled within
the work site and shall be so routed that adjacent private property, public property and the
receiving system is not adversely impacted. The City may at any time order corrective action and
stoppage of work to accomplish effective drainage control.
16) UTILITIES PRELOCATION REQ -- Oregon law requires following the rules adopted by the Oregon Utility
Notification Center. Said rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0080. Copies
of the rules may be obtained from the Center by calling (503) 246 -1987. If you have questions about
the rules, contact the Center. NOTE: Damage to utilities shall becorrected at the permit holders
expense.
17) UTILITY LOCATIONAL CONFLICTS -- Contractor 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 permit holders expense. Changes must be approved by the City in advance of work performance.
Contractor shall coordinate the work with affected utility agencies.
18) TRENCH - PATCH /SAFETY /LIABILITY -- A temporary hard - surface patch (Cold mix A.C. or Hot mix A.C.
base paving) shall be placed on trenchs within roadways at the end of each days work. No trench,
on site or off site, shall be left at any time in an unsafe condition. The permit holder is
responcible for and is liable for hazards or damage resulting from the prosecution of the work.
19) REPAIRS REQ - INSPECTORS OPINION -- Work provided for under the permit shall include repair of
existing facilities (roads, ditchs, etc.) as may be necessary, in the City Inspectors opinion, to
overcome deterioration or damage which occured in conjunction with the work authorized by the
permit. Corrective work shall be done at the permit holders expense.
20) TESTS /REPT'S TO VALIDATE CLAIMS -- The City's Inspector may, at their discretion, require provision
of tests and or reports the permit holder, permit holders engineer or contractor to validate
claims of material or construction adequacy/compliance. Such tests /reports shall be provided at the
permit holders expense.
21) RELEASE - WAIVER REQ -- The permit holder shall provide a copy of a properly executed Release &
Waiver document to the City for each ownership disturbed by construction activity, as evidence of
disturbance resolution and owner satisfaction.
22) MONUMENT PROTECTION REQ -- Existing monuments, property corners, and survey markers shall be
protected. Replacement shall be at the permit holders expense.
23) PROBLEM SOLVING - RESPON PARTY -- The permit holder shall provide to the City Inspector, in
writing, the names and 24 hr emergency telephone number of two (2) persona who have authority to
resolve problems, take corrective action and, in general, will be responsible in case of an
emergency. The permit holder shall notify the City Inspector, in writing, of any /all assignment
changes.
24) CONSTR SAFETY - RESPON PARTY -- The permit holder shall cause his contractor to provide to the City
Inspector, in writing, the name and 24 hr emergency telephone number of a designated Competent
Person* responsible for construction safety as per OR -OSHA, Chap. 417, Div. 3 Construction,
Subdivision P - Excavations. The contractor shall notify the City Inspector of any /all assignment
changes.
2S) ESMT /RT OF ENTRY - RESFON -- It is the sole responsibility of the permit holder to provide for
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 permit holders failure to obtain or provide for proof of right -of -entry or
easements.
• r
26) SEWER CONN PERMIT -REQ -- A sewer connection permit is required to be obtained, from (the City.s
Building Department) (Unified Sewerage Agency of Washington County). prior to connecting any
structures to the sanitary sewer system.
•