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PFI2013-00042 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT � N COMMUNITY DEVELOPMENT Ea Permit#: PF12013-00042 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 DateIssued: 11/14/2013 Parcel: 1S134DB12600 Jurisdiction: Tigard Site address: 11285 SW FOREST LN Subdivision: 2008-038 PARTITION PLAT Lot: 1 Project: Home Investment Services, LLC Project Description: PFI permit to relocated driveway from SW North Dakota Street to cul de sac on SW Forest Lane. Address reassigned from 11329 SW NORTH DAKOTA ST to 11285_ Forest Ln,reprinted 11/20/13 Owner: FEES Description Date Amount PFI Permit Fee 11/14/2013 $300.00 PHONE: COT Address Fee 11/14/2013 $50.00 Contractor: HOME RESOURCES UNLIMITED INC 294 NW 2ND AVE#412 CANBY, OR 97013 PHONE: 503-263-1976 FAX: 503-263-0067 Applicant: JOHN BRADEN 1102 N. SPRINGBROOK RD,#113 NEWBERG, OR 97132 PHONE: 503-816-8352 Total $350.00 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- Perm ittee/A pplicant ork.Permittee/Applicant Signature: Issued By: —7� Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT ss COMMUNITY DEVELOPMENT Permit#: PF12013-00042 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/14/2013 Parcel: 1 S134DB12600 Jurisdiction: Tigard Site address: 11329 SW NORTH DAKOTA ST Subdivision: 2008-038 PARTITION PLAT Lot: 1 Project: Home Investment Services, LLC Project Description: PFI permit to relocated driveway from SW North Dakota Street to cul de sac on SW Forest Lane. Owner: FEES Description Date Amount PFI Permit Fee 11/14/2013 $300.00 PHONE: COT Address Fee 11/14/2013 $50.00 Contractor: HOME RESOURCES UNLIMITED INC 294 NW 2ND AVE#412 CANBY, OR 97013 PHONE: 503-263-1976 FAX: 503-263-0067 Applicant: JOHN BRADEN 1102 N. SPRINGBROOK RD,#113 NEWBERG, OR 97132 PHONE: 503-816-8352 Total $350.00 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: V//*, 161A, Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY RECEWED City of Tigard OCT 2 9 Z013 Public Facility Improvement PLA,21-G Frigm p (PFI) Permit "EER�NQ General Information: FOR STAFF USE ONLY Property Address/Loccation(s): M NOMI I:�4k6n1 ,f Engineering TWO OP 41-7 TZ3 Case No2f 1 W13—c0 Q4Z Fee: 11300-co Receipt No.: 9 l *Applicant's Nam,^,e:`` �'(PM& IM ` Y(/.. LLL/ Date: 4 115 Address: 01 Iv V �1 J Application Accepted:? By:A� Cite/State: N Zip: 'lZ Primant Contact: TA, 17wie'1 REQUIRED SUBMITTAL ' �( � /� INFORMATION Phone: �J. (.7 LP- ��y�, ,, 2 Fax: ✓n�23--7(D.C WO I:-Mail: � �/�h�/�111 1C.1 t 1 rn(PS (wa w - Cpm Professional Engineered Plans are required for: 1�,_,,�,, ' I, • Street Widening Contractor's Name: 111 K/ �eSLU I CQS 1�1�YYI l�"C L Vl(/ . Subdivision Infrastructure CCB# 1c5LP ;5D1 Expiration: • Main utility line extension: F 0 Storm Drain,Sanitary–Tigard Address: 01� Nus N��G1 �^f/ ��I King Water–Tigard Water Service Area City/State: h 12- Zip: (includes Durham, ng City and a SCJ• portion of unincorporated Washington Phone: '/x/"!'!CJ 2 Fax: County) I **Note:See Engineered Plan Plans By: N 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: Fax: requirements and provided sketch area). Updated:6/24/2013 I:\CURPIN\Maste.9and Use ApplicanonsTublic I-acility �/ Intpwvctncntdmx Description of work: �Gl / d n V Pi��I l� Yl� V Y 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#: City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 1 www.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 Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.) BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT: ♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subject prope;U. ♦ 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 pen-nit 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 policies and criteria,and understands the requirements for approving or denying the application. SIGNATURES of each owner of the subject property. //�� r DATED this L[5 day of V��" 12 r App" ant/Authorized Agent's Signature ner's Signature Owner's Signature Owner's Signature City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigud-or.gov I Page 2 of 5 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Receipt Number: 193967 - 11/14/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12013-00042 COT Address Fee 100-0000-43113 $50.00 PF12013-00042 PFI Permit Fee 100-0000-43114 $300.00 Total: $350.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1054 TLEHRBACH 11/14/2013 $350.00 Payor: Home Investment Services, LLC Total Payments: $350.00 Balance Due: $0.00 Page 1 of 1 Caen e: C 9R00 $ 9E ee„+oo Z0 m FORES"T 12e .26 A 70, in w i r 10dQ'a a WFG National Title ~ Customer Service Department CWWRGNational Title Insurance Company 12909 SW 68th Pkwy#350 e a Williston Financial Group company Portland,OR 97223 w 4 r Phone:503.603.1700 Fax:888.833.6840 E-mail:cs@wfgnationaltitle.com s Parcel # : R2161851 / 1S134DB12600 IMU AL; �,` 70.07 e9.00 9300 $ Q 110.00 i�s,00 17 8 � 101.12 CC a 8200 600 0 9600 $ 9500 8 >t 6 2 9 60.00 20 : 19 9 94800 �Ir �L] qti V� 8.42 110.00 1M.00 � � / 70.04 89.00 42.5 e / 1 N �l N! SW re-74.91 LAND X85 1 700 12600 = N' 9 73.61 72.2914 AC .261AC �L , M G) °' 2 ^ . 000 7700 7800 V800 7900 4 C r �' 1 °' 8 3 4 m Nt \\\ '\\\\ o Q` 63.87 79.00 10&78 92 51 \\ \ \\?(b\\\\\\ e4 \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ +6 144'00 ��3?O �pp.87 a 4 99A7 6300 e•,y� •� 4Y 61300fj g 1 � 5200 ^ asw 'A Q 6400 42' 2300 2400 2500 :14 sq 50 a 1.23 AC a 1.59 AC 1.20 AC 99.911 g 93.65 7400 .56 AC 8 6500 24 � 5300_N 1 0 3 e�- 6 2 9 83.51 109.99 82.28 — �l S88-29-36W m 64.60 EASE 97-15486 !j VACATED ! 97-11558__ - 108.54 8 g 5400 .'.7500 3 o 0 2 � 7600 m�.N 0 6600 ^ � 3 :i N 4 9 This map is a copy of public record and is provided solely for informational purposes. WFG National Title assumes no liability for variations, if any, in dimensions, area or location of the premises or the location of improvements.