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PFI2014-00102
CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFI2014-00102 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/04/2014 Parcel: 1 S125DC03500 Jurisdiction: Tigard Site address: 7071 SW BARBARA LN Subdivision: RAZBERRY PATCH,THE Lot: 28 Project: Jackson Project Description: Replace existing sidewalk, driveway approach,and gutter. Owner: FEES Description Date Amount PFI Permit Fee 11/04/2014 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: SCOTTJACKSON 7071 SW BARBARA LN TIGARD, OR 97223 PHONE: 503-977-9029 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 O ON PRIVATE PROPERTY l Conditions for PF12014-00102 TvDe: Condition Name: Status: Severity: PFI—Sidewalk/1 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code,and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Sidewalk/[ 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The spreading of mud or debris or storage of materials or equipment 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 suspension of work to accomplish clean-up. PFI_Sidewalk/[ 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Sidewalk/[ 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs,pavement markings, mailboxes, etc. shall be reinstalled or replaced,with like kind of material. Obtain City approval of restoration work. PFI_Sidewalk/[ 05-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>,to establish a preconstruction meeting. PFI_Sidewalk/[ 06-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work,prior to any staged inspection, and after completing work covered by the permit. PFI—Sidewalk/1 07-PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance, and all attachments,and a copy of the approved construction plan and all amendments shall be readily 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 these must be approved by the City, in advance of work performance. PFI_Sidewalk/[ 08-EMERGENCY CONTACTS Applied Notice Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Sidewalk/[ 09-OTHER Applied Notice 9 EJ M } EO E b � S QJ EJ b CJ I � T Q tb 1T EJ 1 ■ ci KEYNOTE LEGEND R rn (D NEW TRENCH DRAM: SOURCE 1DRAINAGE SIE-GLVCH TRENCH i DRIVEVAY CHANNEL W EJ GALVANIZED STEEL GRATE,OR EQUAL O CONNECT NEW TRENCH DRAIN TO EXISTING STORM DRAIN STUB I VENT rn ALIGN NEW CONIC WLLK WRN EXISTING 61 DECK STAIRS IO NEW CONC DRIVE: = f THICK 3,000 PSI;SM10 WAR; OYER t MIN.OF COMPACTED 311 Ll- 5 MINUS BASE.FINISH SHALL BE EXPOSED AGGREGATE(PEA GRAVEL) O T OW PVC CONDUIT W CAP AT EACH A J-1 END EXTEND 11 BEYOND EDGE OF CONIC BLABci . © EXISTING STORM DRAIN I VENT T Ol r H X C W CONCRETE CURB W 1 R' RADIUS EDGES 3 / NEW CONCRETE DRIVE APRON PER CRY STANDARDS ri NEW CONCRETE SIDEWALK CURB AND GUTTER PER CRY STANDARDS ® REMOVE,SALVAGE AND REINSTALL EXISTING MAILBOX AND POST. O EXISTING WATER METER TO REMAIN. Lj I JACKSON RESIDENCE 7071 SW BARBARA LANE TIGARD, OR City of Tigard ■ PUBLIC WORKS— ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check-one: ❑ Utilities Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: or work in right-0f--way (sidewalk repair,curb cut,street opening,etc.)requires: •Application form,completed and signed •Submit one(1)copy of scaled sketch �7/ SW, � �1�)� LJ,/ of the proposed work to be done Property address/lOCatiOn(S): 7 ��— •Submit one(1)copy of trnffic control plan –OR- 0 name: Sc�?'r.1�c},_Y>j�l ❑ Substantial project work requires Applicant's above items and professional Address: 7_z1 .5W engineered plans for. •Street widening City/state: T(��-L;, Zip: 27 Z Z •Subdivision infrastructure Phone: 67�9Finail: .Sm \ate k.5oet 57 a a►m�1��,�� •Main utility line extension: - Storm Drain,Sanitary—Tigard X - Water—Tigard Water Service Contractors name: /Yl/�_Hj�j��, �lS��/T Area(includes Durham,King City CCB#: e_'.21(9 Z?J Expiration: and a portion of unincorporated Washington County) Address: �7T lJ �, _ 1.c/ City/state: C�JQ�./�-r_jc1 6,32— Zip: 97�// 3 DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning&nginmHng 13125 SW Hall Blvd. Engineer's name: Tigard,OR 97223 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: rQm=rmitsj tig&W-oror gav Phone: Email: Estimated value of work (within the public right-of-way): $� Case No.: PF 1 o20 I-4 – 001 o X Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes O/No Application accepted: If so,please specify (MLP, SDR,SUB,etc.) case #: By: Date: Is work related to a BUILDING PERMIT? ❑ Yes Q/No Application reviewed: If so,please specify(BUILDING PERMIT)case#: By: Date: Applicant notified: By: Date: 1:1aMKNVANW8U&W uw MWk V" ate.o7/1Wmu City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4 1 APPLICANTS 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 or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that mai•be attached to or imps d upQn the subject pip. • 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 gull owner of the subject property required((. ;App4licttho ' ed gent's signature Print name Da e�= —4L47-Z.511- — tu a Print name Date Owners signature Print name Date Owners signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-715-2421 • Page 2 of 4 10 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part 1: Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee=Part 2+Part 3 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 PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 1 SAMPLE SKETCH: Edge of Pavement +— Ditch Streetlight - I — ----------- —r--- I " Rain Drain D I I ' d'Selw'erTine— I qa I Nt I 1 ►� I gin= . Existing House I Q Existin;i I g Driveway I 75' I 1 a I i i �A r� 0 I . o� I Iy 1 4, p1 Existing Shop � � J L Powerpole o I a 95' I --------groper i Line—-—-—-—-—- , ( � '� II Fire Hydrant(FH) I � I Scale: 1"=30' I I I I i I � I I � � I 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 Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-or.gov - 503-718-2421 - Page 4 of 4 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Receipt Number: 198261 - 11/04/2014 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12014-00102 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 004798 CCAINES 11/04/2014 $300.00 Payor: Scott M Jackson Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1