PFI2015-00109 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12015-00109
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/10/2015
Parcel: SEG2376
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Summerfield Apartments
Project Description: Replace sidewalk panels adjacent to Summerfield Apartments along Summerfield Dr.
Owner: FEES
Description Date Amount
PFI Permit Fee 08/10/2015 $300.00
PHONE:
Contractor:
ROSE CITY CONCRETE
3300 NW 185TH AVE.#183
PORTLAND, OR 97229
PHONE: 503-232-9702
FAX:
Applicant:
MEGAN WINTER
4430 NW NESKOWIN AVE.
PORTLAND, OR 97229
PHONE: 503-890-9746
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 WORK ON PRIVATE PROPERTY
Conditions for PF12015-00109
Tvoe: Condition Name: Status: Sever&
PFI_Sidewalk/[ 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
RECEIVED
Y
el
City of Tigard AUG PA 7C1TMt
N PUBLIC WORKS — ENGINEERING PLANNe
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL.
Check one: ❑ Utilities P Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: S L.�41k t e.jrzf, •Minor work in right-of-way
(sidewalk repair,curb cut,street
Lj> h-sz,.els 61 r a �, n n opening,etc)requires:
/� '+ 1t •Application form,completed
ICV_1CAi%n tt tz', and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): » -j S" h _Icsd ��, ti �,�k of the proposed work to be done
•Submit one(1)copy of traffic
fir . 1 ;d AC . f w'. S > Sc�r✓tvhr /�Ln 1{ control plan
` -OR-
Applicant's name: ��C'cSa n �,.J t r�t C� ( ❑ Substantial project work requires
above items and professional
Address: !�U-<n engineered puns for:
City/state: J,r}j n n A C�{ , Zip: (f �_Z� •Street widening
+ •Subdivision infrastructure
Phone: Se; r 5o - g11f Email: rnt'c. •Main utility line extension:
c Storm Drain,Sanitary—Tigard
` - Water—Tigard Water Service
Contractor's name: 1�e:ti t• C : k.l C e"L)c (Z.1-Z Area(includes Durham,King City
d portion of unincorporated
ccB#: \�i H y.s Expiration: 2,/Z1 I 1 G acia p rl'
Washington County)
Address: 33 t.� Q t,> \�S F� �Jn.- '011'�3
City/state: ; fir_ �.r, l'!(, Zip: 1—(Z.2 cj DELIVER APPLICATION TO:
City of Tigard
Phone:-)& -'Z-3t"YICZEmad:_(C-5c dcc:\Le.e- (Jer :nL} Planning/Engineering
13125 SW Hall Blvd.
Tigard,OR 97223
Engineer's name:
Applications for"minor work in right-of-way"
Address: only may be emailed to:
City/state: Zip: r_�permits(g tigard-or.pov
Phone: Email:
Case No.:
Estimated value of work (within the public right-of-way): (a Ob nt Qhs
Application submittal fee:
Is work related to a LAND-USE DECISION? ❑ Yes No App accepted: o t
If so,please specify(MLP,SDR,SUB,etc.) case#: Ry irate: D 14
Is work related to a BUILDING PERMIT? ❑ Yes J4 No APPGcation reviewed:
If so,please specify(BUILDING PERMIT)case k By. Q'n T Dater `S I
App•c t totified:
By: Date: '11611 -5
IA WRPLN\Mesoen\Land Use Appllc rio Rex 07/16/2014
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 wwwtigard-or.gov 503-718-2421 Page 1 of 4
.._.._.__._.
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APPLICANTS
NOTE: Person specified as"_lipplicant"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 tris application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or iml2osed ikon the ct ' et pM= .
• 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 gbh pwner of a subject property required.
-e ( I
Applicant/Authorized A s signature Print nam Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 STV'Hall Blvd. • Tigard,Oregon 97223 • www.tigafd-or.gov 503-715-2421 Page 2 of 4
J
S
°.- RECEIVED a`
AUG 04 2015
CITY OF TIGARD 3 `�
PLANNING/ENGINEERING JX-v o
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eo�
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100, 100,
s
CURB JOINT
SEE STD
DETAIL NO. 146
5' MIN. SEE NOTE 5 ROW
I
�— 2
2" OF 3/4"-0" BASEROCK
COMPACTED SUBGRADE
SIDEWALK ADJACENT TO CURB
PLANTER 5' MIN. ROW
STRIP
— 2%
40
ROAD _ I IF
2" OF 3/4"-0"
COMPACTED SUBGRADE BASEROCK
SIDEWALK AWAY FROM CURB
NOTES
1. CONCRETE SHALL BE 3000 P.S.I. AFTER 28 DAYS.
2. PANELS TO BE 5 FEET LONG UNLESS OTHERWISE SPECIFIED.
3. EXPANSION JOINTS & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT
IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBRADE TO FINISH GRADE AND
PLACED AT SIDES OF DRIVEWAY APPROACHES, UTILITY VAULTS, WHEELCHAIR RAMPS AND AT
SPACING NOT TO EXCEED 45 FEET.
4. FOR SIDEWALK ADJACENT TO THE CURB AND POURED AT THE SAME TIME AS THE CURB,
THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN. 1/2" RADIUS.
5. SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED
OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY. OTHERWISE SIDEWALK SHALL HAVE
A MINIMUM THICKNESS OF 4 INCHES.
6. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3" DIAMETER
SCHEDULE 40 DWV (ABS OR PVC) PIPE AT 2% SLOPE. CONTRACTION JOINT TO BE PLACED
OVER PIPE.
7. CONCRETE SHALL HAVE A MEDIUM BROOM FINISH AND TROWELED ON ALL FOUR SIDES
CITY OF TIG ARD ED
APPROVBY: NO SCALE
OREGON MICHAEL A. STONE, P.E.
ENGINEERING DIVISION OTY aqlITR CONCRETE DWG. NO.
PURIJC WORKS DEPARTMENT
M- 01 TIG S.W. BLVD.
2013 SIDEWALK 120
TIGARD,OREGON 97223 JANUARY
VOICE:(503)6394171
Iw FAX: (503)684-7297 APPROVAL DATE
1