PFI2013-00039 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12013-00039
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/08/2013
Parcel: 1 S 135BD00500
Jurisdiction: TIGARD
Site address: 10855 SW 95TH AVE
Subdivision: MEADOW VIEW Lot: 8
Project: Gertz Fine Homes
Project Description: Adjacent to 10855 SW 95th Ave., install catch basin and culvert at street.
Owner: FEES
Description Date Amount
PFI Permit Fee 10/08/2013 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
KEN GERTZ
19200 SW 46TH AVE.
TUALATIN, OR 97062
PHONE: 503-692-3390
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: AQ l �I t l�Ol.1 U r I
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
RECEIVED
city of Tigard OCT p g 2013
Public Facility Improvement ,Janet TIGARD
(PFI) Permit -1LANNING/4=1NG-INEERING
General Information: IFOR STAFF USE ONLY
Property Address/Location(s): / Engineering I _ 39
Case No.:
Fee: If-3 D o.oQ
Receipt No.: 3HOH
*Applicants/Name: �Z— �`t Date:
Address: L �L �w -u Application Accepted: 10 BN:
/S � f ��� 2—
City .'tate: // i � ��-_ Zip:.. L
Primary Contact: /(l°9.1 �-e,-6 REQUIRED SUBMITTAL
INFORMATION
Phone:* 3 -6!E2- ` C) rax: t�3- �QZ -S X33
E-Mail: 6_ s: Professional Engineered Plans are required
• titrec•t Widening Name: f O /�✓"' • Subdivision Infrastructure
CCB# -3 Expiranon:Ty • \lain utility line extension:
,Sb
Address: /" cz y 0 Storm Drain,sanitary—Tigard
` 0 Water—Tigard\Fater Service Area
City/State; (M_ Lip: E 2 (includes Durham,king Cin'and a
Phone: 50 3 _ / `3 lax: SC — � 2 3. portion of unincorporated Washington
N3� County)
Plans By: e "dote:See Engineered Plan
w-�� r e-1° /1'_�� Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
City/State: Zip: work to be done. (see attached minimum sketch
Phone: rax: requirements and provided sketch area).
Vptiated:6,24,2j 113
L`.ta'RI I\'M1tastcn land l°sc:\pplicannns\Puldtc faciliq•
�j -- /f Impreninxnt.dncx
Description of work:
Estimated value of work(within the public right-of-way): $ ! -
Is work related to a LAND-USE DECISION? YES F� 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#:
City of Tigard 1 13125 SW 14all Blvd.,'Tigard,OR 9-7223 503-718-2464 .v\vw.tigard-or,gov Page 1 of 5
APPLICANTS:
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on
the front of this application in the"Required Submittal Elements"box.
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
*When the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with
written authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided on the
back of this form or submit a written authorization with this application
(Detailed Submittal Itcquirement InfOrmation sheets can Inc(6wned,alum rcyucst, ti r all i�pes ut l;.ux1 l'sc Applications.)
BY SIGNING BELOW,THE APPLICANTS)SHALL CERTIFY THAT:
♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subjectprogerty
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions
and limitations of the approval.
♦ All of the above statements and the statements in the plot plan, attachments, and exhibits transmitted herewith, are true; and the
applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are
false.
• The applicant has read the entire contents of the application,including the p►tlicics and criteria,and understands the requirements for
approving or denying the application,
SIGNATURES of each owner of the subject property.
DATED this -- d:►} of 20 /— S
Applint/Authorized Agent's Signature Owner's Signature
Owner's Signature Owner's Signature
City of Tigard 13125 SW Mall Blvd.,"Tigard,OR 97223 503--18-2464 1 anvw.tigard-ongov I Page 2 of 5
CITY OF TIGARD RECEIPT
It 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
' e
Receipt Number: 193404 - 10/08/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12013-00039 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 17528 TLEHRBACH 10/08/2013 $300.00
Payor: Gertz Construction Company, Inc.
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
1
SEE ANDMO DRAINING N0. OR
J2p FI �y
FRAME AND COVFA. I
A
AA I —I
./r;L',yr
`°� °"' SECTION A—A
1
1 I 1 �YP
PLAN VIEW RECESSED CURB INLETS I I 1 PLAN
TO BE REINFORCED
CONCRETE ININ
ACCORDANCECE WN MTH
6 CURB DRAMNG NO 310
PAVEMENT I 1 Y ani. 1n'1uT GAAa
• - 3'WE
HO I I 11
1
I 21• �e I ■ I ■ 1 d F alas 6aAc
i T4 � 6 � an•�
6'FOR POURED N
6'M1N ma I I 1
gp1.FORCONENT /
FOR PRECAST 11' .• B• I ■ ■ 1
I 1
SECTION A—A SECTION B—B I 1 ,/I•A ^" PLAN ^P�BaM
NO CASHALL BE BASW BE CONSTRUCTED IN AC—DANCE MTH ASTM C-4M ■ ■ ■ '"'°'"` r6•n.0 SECTION B-132. MSIALL STEPS-EN DISTANCE FROM TOP OF CRATE TO FLOW UNE OF PB{IS GREATEN TNAN Ae SEE STANDARD
DRAMNG NO 100.SET FIRST STEP 12'FROM TOP O�GRAM
] INSTAR STPUCNRE ON MINIMUM OF e'OF N'-0'COMPACTED BASE MATDBA'_
..
REN'OgCEMENT FOR PRE CAST CATCH 13AS01 SHAL BE REBAF YEEIWC ASIY A-615 GRADE BO GR WQOEO ARE
MEERNO ASN A—NS). I I NOTE_
5 ALL POURED INPLAfE CONCRETE SHALL HAW A 28 DAY SiRENI T OF 3000 PSI.AND A S—P OF 2'TO.'. TTTAME AND GRAZE TO BE NEW STRUCTURAL ASTM A-36 FLAT BAR SrWL OR APPROVED EQUAL.
6 CHANNEL RE ED IN FLOW THRWOM APPUCATIOHS,AS APPFOWD.ALL OTHER A—ADWS IIEOJRC AN TB'SUW I 1 ADOITIONAL THIXNESS AAO RWORCE EIR 5HAL BE REOLMM FOR STATE HIGHWAY APPjCATONS.
BELOW LOWEST PIPE INVERT. LOCATED
) NLLG U TTEERR�&DT BC U R B IN DEWAIN RAMPS GR PAW WN6
CATCH BASIN
INLET CATCH BASIN 1 o ATTACH DRIVEWAY TO STREET WITH ASPHALT
/�//�-� a..W,e.,?"ervices NEW PROPERTY LINE FRAME AND GRATE (CG-2) C3eanWatTs ServEces
DRAWING NO. 300 CV-2 REMST_D 12-06 oPc..amTm.A I,cI., I I 1 ■ec c.mmamaABMAuc.
DRAWING NO. 320
lf')
EXI TING DITCH LINE AN OUT DITCH LINE or INSTALL 3034 CULVERT
NEW 12" C-900 CULVERT EW G-2 CATCHBASIN
END OF 12" CULVERT
EXTEND TO CB _
REMOVE EXISTING CULVERT
10855 SW 95TH AVE � AND GRAVEL APPROACH
- --�� -
o --
C EDGE OF PAVEMENT
M Q
CL
,0m'&ER9f--7 CONSTRUCTION
COMPANY INC. -
BUILDING
CUSTOM HOMES SINCE 1977
(503)692-3390