The URL can be used to link to this page

PFI2015-00099 a CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permits: PF12015-00099 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/28/2015 Parcel: 2S 111 AB03200 Jurisdiction: Tigard Site address: 9330 SW MCDONALD ST Subdivision: ELROSE TERRACE Lot: 27 Project: Frontier Communications Project Description: Repair to residential driveway apron at 9330 SW McDonald St. Damaged driveway is on SW 93rd Ave. Remove broken concrete and repour driveway. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX: Applicant: JOHN COUSINEAU 4155 SW CEDAR HILLS BLVD BEAVERTON, OR 97005 PHONE: 503-643-0371 Total $0.00 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: Not Present Issued By: C Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00099 Type: Condition Name: Status: Severity: PFI—Sidewalk/1 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/1 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 Kenny Fisher at 503-816-6146 or email at kenny@tigard-or.gov twenty-four (24)hours prior to commencing work, prior to any staged inspection,and after completing work covered by the permit. PFI_Sidewalk/[ 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/1 09-OTHER Applied Notice PFI_Sidewalk/[ 01 -WORK SITE REQUIREMENTS Applied Nonce 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. City of Tigard RECEIVED PUBLIC WORKS — ENGINEERING JUL 2 2 2015 Public Facility Improvement (PFIUNIRING DESCRIPTION OF WORK (in the right-of-way) REQUIRED SUBMITTAL Check one: Utilities ELEMENTS ❑ ® Sidewalk/driveway approach ❑ Street unprovements Detailed description: Repair to residential driveway apron at ❑ Minor work in right-of-way (sidewalk repair,curb cut,street 9330 SW McDonald St. Damaged driveway is on SW 93rd Ave. opening,etc.)requires: Remove broken concrete and repour driveway •Application form,completed and signed •Submit one(1)copy of scaled sketch Property address/location(s): 9330 SW McDonald St. _ of the proposed work to be done •Submit one(1)copy of traffic control plan –OR– licant's name: Frontier Communications/Cousineau ❑ Substantial project work requires Applicant's above items and professional Address: 4155 SW Cedar Hills Blvd, engineered plans for: •Street widening City/state: Beaverton Zip: 97005 •Subdivision infrastructure Phone: 503-643-0371 Email: iohn_cousineauQftr_com •Main utility line extension: ' e - Storm Drain,Sanitary—Tigard - Water—Tigard Water Service Contractors name: Sonieom Area(includes Durham,King City CCB#: 188116 Expiration: 3/24/2016 and a portion of unincorporated Washington County) Address: 1275 S Kodiak Circle City/state: Comelius Zip: 97113 DELIVER APPLICATION TO: City of Tigard Phone:503-710-2972 Email:matt shore(ftonicom.com Planning/Engineering 13125 SW Hall Blvd. Engineers name: John Cousineau Tigard,OR 97223 Applications for"minor work in right-of-way" Address: 4155 SW Cedar Hills Rlvd_ only may be emailed to: City/state: Beaverton Zip: 97005 1=rmlitsnaetig&W-or.gov Phone: 503-643-0371 Email:john.cousineauAr.eom Case No.: Al�o� eo9'g Estimated value of work (within the public right-of-way): $2.000 Application submittal fee: O Is work related to a LAND-USE DECISION? ❑ Yes ® No Application accepted: If so, plekse specify (MLP, SDR, SUB,etc.) case #: By, Date: as bS Is work related to a BUILDING PERMIT? ❑ Yes ® No Application reviewed: If so,please specify(BUILDING PERMIT)case#: By:b{Pi Date: 7.2 A- 4s Applicant notified: By: _ Date: kXwa►uiW NtMYMW ua nppi aftm aw.0711GA014 City Of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.figard-or.gov • 503-718-2421 • Page 1 Of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. *When the owner and die applicant are different people,die applicant must be the purchaser of record or a lessee in possession with written authorization from die 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 APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed Canon the subject propc • 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 required. John Cousineau 06/17/15 Applicant/Authorized Agent's signature Print name Date Owners signature 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 9 503-718-2421 • Page 2 of 4 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 210 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 SAMPLE SKETCH: jEdge of Pavement Ditch -00- Streetlight - I _-_-_-_-----_ —r--- e R.Dram I I —_rof os a Selwer'Liine— 21_ ! Existing House o: I Existing �I i �r Driveway Cir I Lf). ILON dl i �' 4 1 oar 1 Y o� ! i I � Existing Shop � Powerpole I I l a 1 I a 95' --------7ropertyl_ine----------- I l 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 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4 � \ 7000-84733 �In PIYIICORNER86/220 46 Yv - h � 9 ✓V�\/'1\LL *� 90.00 90.00 a' < W DAMAGE D900 800 ' Z 5 4 W $ 3200 > p .88 AC • \•v, NE CORNER 437/787 r I 3300 2.27 ACw 1000 I p \` M i ;< 3100 $ 90.00 27 g SW ELRQSE CT 140.17 71.18 f»r 3000 8n 1800 0' 0 ' 26 14 2 17(