PFI2014-00056 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12014-00056
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/18/2014Parcel: 2S102CC04400
Jurisdiction: Tigard
Site address: 13765 SW ASH AVE
Subdivision: BEREA Lot: 5
Project: Bruner
Project Description: Remove 18'section of sidewalk and replace with new driveway approach.
Owner: FEES
Description Date Amount
PFI Permit Fee 08/14/2014 $300.00
PHONE:
Contractor:
FINE LINE CONCRETE CUTTING INC
PO BOX 66742
PORTLAND, OR 97290
PHONE: 503-793-1506
FAX:
Applicant:
IAN BRUNER
13765 SW ASH AVE.
TIGARD, OR 97223
PHONE: 503-475-0745
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: hf (t LlC.t.( Jam( p\v
Issued By: �lu-1_".tj lil (�D�l.✓��
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PFI2014-00056
Type: Condition Name: Status: Severity:
ROW APPROACH STANDARDS Not Met
The new approach must be 6 feet from the side property line, 10 feet wide(minimum)and must be 30 feet from adjacent
driveways.
ROW ADA Compliant Not Met
The new apron must comply with ADA,which will necessitate sloping the sidewalk on each side to fit.
Zen Dutson
Attachments: Zen Dutson.vcf
OK w/ Engineering
The new apron must comply with ADA, which will necessitate sloping the sidewalk on
each side to fit.The new approach must be 6'from the property line, 10' min width, &
30' between driveways.
Zen Dutson
City of Tigard
Public Works
Engineering Inspection Supervisor
(503)718-2472 ';
(503)572-5917 Cell
zen@tigard-or.gov
13125 SW Hall Blvd.
Tigard, OR 97223
wvAv.tigard-or.gov
i
RECEIVED
City of Tigard AUG 14 2014
y Public Facility Improvement CITY OF TIGARD
(PFI) Permit PLANNING/ENGINEERING
General Information: ``11 FOR STAFF USE ONLY
Property Address/Location(s): l 19�t- � fT � Cae' cerin'PE,U Iy_00o%
o.
Fee: -4-3w.00
'' Receipt o.
*Applicant's Name:_ k 4 N t✓� Date: Il'I I
Address: 117(eS— 5W 1%" ?1ya Application Accepted: 19 Byu
y:
City/State: 'll G A" (Z' Zip: 9-71—Z3
Primary Contact: 14 tJ REQUIRED SUBMITTAL
INFORMATION
Phone: 5-13 - �Z-d'7 q� Fax: fb7-<-2-q-2113
E-\'Tail: `lam brlgY►ej-_v1tA w,I71 nProfessional Engineered Plans are required
for:
• Street Widening
Contractor's Name: t-IN F_(r(/y)� [�N(R.F� U4TiN(� Subdivision Infrastructure
CCB#—. -tt i, I t 1 I�- �Z'7 R�l Expiration: • Main utility line extension:
�-rrr- 'L- 1 �
0 Storm Drain,Sanitary-Tigard
Address: �'� 3-C91 (0� Z.— 0 Water—Tigard Water Service.Area
Cite/State: IQJ'IL 'Lip: 7 Z9 (includes Durham,Bing City and a
�--__ portion of unincorporated Washington
Phone: 0 . -7gi 3—I'50J� Fax: County)
' "Note:See Engineered Plan
Plans By: l A'/J Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
Cit-/State: Zip: work to be done. (see attached minimum sketch
requirements and provided sketch area
Phone: Fax: 4 P )
Updated:6/24/2013
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Description of work: -A9& AM11 - --� �10�-
1 LkL&- S,R C,1Wff4 d S 1091 t.r Az-K 71- E-06- t"01'71ak M- Pw�f
&L& MOT— ►S A-L_?S— -1 71 Wz4_P, .
Estimated value of work(within the public tight-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 1 503-718-2464 1 www.tigard-or.gov I Pagel 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 property.
♦ 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 policies and criteria,and understands the requirements for
approving or denying the application.
SIGNATURES of each owner of the subject property.
DATED this day of ,20
App'cant/Authorized Agent's Signature Owner'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.tigard-or.gov I Page 2 of 5
CITY OF TIGARD RECEIPT
i
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 197225 - 08/14/2014
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12014-00056 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 015907 TLEHRBACH 08/14/2014 $300.00
Payor: Ian M Bruner
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
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