PFI2013-00036 y CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
_ COMMUNITY DEVELOPMENT Permit#: PFI2013-00036
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/16/2013
Parcel: 2S 111 CA08300
Jurisdiction: Tigard
Site address: 9925 SW KABLE ST
Subdivision: GULF SIDE ESTATES NO.2 A REPLAT OF" Lot: 27
Project: Hart Sidewalk Replacement
Project Description: Replace damaged sidewalk in front of 9925 SW Kable St.
Owner: FEES
Description Date Amount
PFI Permit Fee 09/16/2013 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
KEN HART
9925 SW KABLE ST.
TIGARD, OR 97224
PHONE:
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
CITY OF TIGARD RECEIPT
a
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 193078 - 09/16/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12013-00036 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
Check 842 TLEHRBACH 09/16/2013 $300.00
Payor: Kenneth and Patricia Hart
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
n City Of Tigard
Public Facility Improvement (PFI) Permit
General Information: '-I UU FOR STAFF USE ONLY
Property Address/Location(s): q%pp a2.5, .S, 0, klAyJe S/ ' Engineeri�1201 3—�0�_
Case No.:
1 Gear 09 97Z2-1KIg307�
Receipt No.:
� Date: 91,41 U 1 3
*Applicant's Name: 21.1 1F 11'Gt t Qr� Application Accepted By:
Address: 1,2,57 Revised 7/1/10
City/State: a R Zip: 9 72 1
Primary Contact: REQUIRED SUBMITTAL
INFORMATION
Phone: Far:
Professional Engineered Plans are required
// for:
Contractor's Name:.S/iauH Aae 6,,-yj IC,
V • Street Widening
CCB# Expiration: /k-/L; • Subdivision Infrastructure
Address:3lo�00 SElora�a Rd. • Nlain utility line extension:
City/State:-sh O!Y, 01E Zip: f70SS- 92,°S 0 Storm Drain,Sanitary-Tigard
0 Water-Tigard Water Service_Area
Phone:_ oFax: (includes Durham,Kung City and a
portion of unincorporated Washington
County)
Plans By:
I'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).
Description of work: I:curpin\master\land use application\PI-I app.docx
Estimated value of work(within the public right-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❑ 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.
li
Citti-of Tigard 1 13125 SW Hall Blvd.,Tigard, OR 97223 1 503-718-2464 1 www.tigard-or.gov 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.
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
SKETCH AREA:
� s
x ?
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 wxN�v.tigard-or.gov Page 4 of 4
SAMPLE SKETCH:
s«-
Edge of Pavement
IEIM
— Ditch
Streetlight I ------------ —C
Ran ---
Dom►szo a o
1
I I j
►� I ; d Existing House 1
aExisting
� I g
Driveway
�I I I 1
CI w I � :^•
IL l "'e
vl I I
o�
r
"I Cr I e 1
b� Existing Shop 1
I
Power ole I
95, 1
--------IrropertyLine------,----
iFire Hydrant(FH)
I j I
Scale: '1"=30'
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i I I
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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 SXX'Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 3 of 4