PFI2015-00157 VO I .
City of Tigard • COMMUNITY DrvELOI'M 1-N'f DEPARTMENT
m �
Request for Permit Action
® 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name: N/A
INVOICE TO: (13usinc,s or Individual)
Mailing Address: N/A
City/State/Zip: N/A
Phone No.: N/A
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMONT,/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: PF12015-00157
Site Address or Parcel#: 15233 SW 81"Ave.,Tigard, OR 97224
Project Name: PGE
Subdivision Name: N/A Lot #: N/A
EXPLANATION: Per Greg Berry in Engineering: This work was already covered in a previous
PFI permit (PF12015-00065), so this PPI permit is not necessary.
Signature: Date: 11/3/15
Print Name: Lina Smith
Refund Polic,
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. r1ll refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
' • ONLY,
Route to Sys Admin: Date By Route to Records: I Date / B
Refund Processed: Date N By Invoice Processed: Date B
Permit Canceled: Date // /s B arcel Tag Added: Date I By
1:ABuilding\Dorms\RcgPermiv\euon_0 231 .doc
RECEIVE® V
City of Tigard OCT 26 2015
PUBLIC WORKS —ENGINEERI CITY ORDER# M1684078
�LCANNING/ENGINEERIN
Public Facility Im p rovement PFI) Permit
a
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: 8 Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: Service to 10 Lot Partition ® Minor work in right-of-way
(sidewalk repair,curb cut,street
opening,etc.)requires:
•Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): 15233 SW 81 st Ave, Tigard of the proposed work to be done
• Submit one (1)cop),of traffic
Ste control plan
—OR—
Tsahai Anderson E] Substantial project work requires
Applicant's name: above items and professional
Address: 10800 SW Avery Street engineered plans for:
Tualatin, OR 97062 •Street widening
Cit}/state: Zip: •Subdivision infrastructure
Phone: 503-672-5466 Entail: T&DSupportAvery@pgn.com • Main utility line extension:
Storm Drain,Sanitary—Tigard
Water—Tigard\Mater Service
Contractors name: Area (includes Durham,King City
CCB#: Expiration: and a portion of unincorporated
Washington County)
Address:
City/state: Zip: LI
DEVER APPLICATION TO:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Engineers name:
Tod Shattuck Tigard,OR 97223
Address: 10800 SW Avery Street Applications for"minor work in right-of-way"
only may be emailed to:
City/state: Tualatin OR Gip: 97062 ronTermitsatigard-or.gov
Phone: 503-672-5466 Email:
Y�OR STkFF
J •
Case No.:
Estimated value of work (within the public right-of-way): $ Application submitral fee: , o'
Is work related to a LAND-USE DECISION? ❑ les W No Application accepted:
If so, please specify, (MLP, SDR, SUB, etc.) case #: By: LS Date: 6a, /S—
Is work related to a BUILDING PERMIT? ElYes R No Application reviewed:
!l•3•/S'
If so,please specify(BUILDING PERMII�case#: By:)Sh3 Date:
applicant notified: f a
,J�' o O'1�i�'►'1 C By: Z__!� _ Date: �/ J
!/ I:\CURPLN\Masters\Land Use Applications Rev.07/16/2014
City of Tigard • 13125 Sys/Hall Blvd. • Tigard,Oregon 97223 • «wutigard-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 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 owncr(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 mai,be attached to or imposed upon the subject proper
• 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 an},permit issued,based on this application,ma),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.
D gilally signed by TSAHAI ANDERSON
/ ANDERSON,TSAHAI ANDERSON& a-TSAHAIANDEERSONePGN
OOMUSm2015 10 26 09:1632-07'00' TSahal Anderson 10/26/15
Date-
Applicant/Authorized
Agent's signature Print name Date
Owners signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 2 of 4
i
i
Page 84 2011 Edition
Stationa LaneClosure;with'Fla Tin
rY
,..
99 . 9 s` Diagram320
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads(less than 400 ADT)with good
sight distance as discussed below.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater,when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection, the"Flagger Ahead" (CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
is
2011 Edition Page 85
$tationary;LaneClosure;with`:Flag'ging;;::%:', ;:-..,' Diagram 320,
off¢ o
w
g J O �i O
o O¢ s 4I �-
W �
m
1>"n�
1 1 LLO
i
c
•• m c
-- ----------- • v osf
$ I •' m CLI
g� I • wog
I • oot
IE 2 2 coo
I I rE M� aH
«r •
aE I •
02g
�•. I •
I (D>>"
X30 � I
� r- o
L wa
I Np m I ¢O
m a w
I = j t r e l m Qo
Cl) I a
----------r------ m
Sign Spacing and Buffer Lengths(feet) 1 t W cu
Postedy zt;:S acin Between S' ns;f -Buffer„ o o
iSpeedr =:'A's,r ;B': C:$ ;Space{' o x
20 50
25 100 100 100 75
30 100
35 125
40 350 350 350 150 O O
45 180
50 500 500 500 210
55 250
December 2011 Chapter 5
5_7'�z
SAMPLE SKETCH:
S-`ajt Z' S t
Edge of Pavement
Ditch so
n Streetlight I -- ----------- —r—•—
a Rain Drain
1 I � Fir Trcx: � a
r GasO 9
1 0 1
� 1
' T��ro'p'os cf'Seliw'er WF-- 1
I _
vs i 1
N Existing House 1
I I
�e 1 Existing
g
: Driveway
CI ^ I ' �•
10
1 �' � i map rl
ap 1
0
o�
aI I I
NCOcfa
01 1
I
I Existing Shop �
�
Powerpole 1� o
0
I� I
I 95•
------- ----------
I -property Line
I Q I Fire Hydrant(FH)
� � I
Scale: 'I"=30'
� I I
� I I
� 1 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
Cityof Tigard • 13123 SW Hall Blvd. • Tigard,Oregon 97223 • uni,wtigard-or.gov • 303-718-2421 Page 4 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part 1: Required submittal fee$300.00
Part 2: All non-water system unprovements
Engineer's estimate X 5% (less $300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2 + Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair (less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SSV Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 3 of 4
IDPZ-AO s-oo 1 s'7
`S 33
U?Y r'}I �i IIl—.��= SUBDMSION LEGEND
L743 �1 J NEW
PL03108T PGE FACILITIES 70 BE INSTALLED
310Iy. I vr—: ;I MM1Es,Drrrffw„E fIFDf fDl
I IAO Y00}68 J 41 mn,,u f.[wnfs
INSTALL T200V1 L �,e,trua wortrovu rwunEs
8116 IB PAD IT 25 Bf3120240V 'U 6I�J,�,� s=� GI �rMr4t.pMpNu f.ci,nrzs
IFN,3w LY,✓� I� [�my n
_ 6GE yr
3 L 44-P 1 r`�� +u L racunifs
VAULT naawA 5 LOTS DII. - !L ILOB SDE w
Noerw PBLOB b, � _ PEAK DEMAND TS0-0,11
ro ro n 19925 I Is°aa a L^ r.onav s.¢vum nuneswrs msroe mr
'VT 00267CIN r'^^•'^u�'vrs^
x O I l u I �v ` �Lot
� w.oeN n ice.wnweo n.vnwr
pr r. J:p sa.c...s. I I, rw.rr,�oxns - mxoLn
O e e p p ro rolF a I I>] I ro opae, Lor i„' I ro wn ,s. 4/0 TXr 15045
JW0215-91
Lor
le I le—_-_ roroaef °dnr �. _2 AL-GB Nee„,.eaa,s,er,an raw,gs,n,•
15033
EOLE rt, -
wn.0 rD,rou _-- -_-Y. CONSTRUCTION NOTES:
uGnrNmG N - I e -- NwN CON$IRUCTON NOTES. NAV NATURAL �.."a'q•.�a w Lo r��...f..”`-.e.
Lore
I ro.�.�rtN.Nrom ate. a
n I I� � ,SF5 � Na�fxnv r�wn. mnel��m n.asx• a°„�s,d� s
sw eoss srI r Lor r
LOT ro.'.,.. rake.rws,:rsives •.,. ..�'...,o'_•.,.,'. .
.on.�.I ���e ro code, � • •u•a•,.r.a•. .„r s.a....nwq..n.o-.i+.v
8200
_m r PAD YOOZ)d
I nr ,�cPo-S INnnu 7200'
PAD IT so BB IaD�.ov
15160 LPH,—
T I GN du-PGE VI TH[NK
15160 a LOTS
PEAK DE-0;40 SAFETY
II I �IlL ry,f n ew.vAUlin�muur TEWLDUCIS r,.a
FIRSTI
C.
IND
IEI
-,- ; o svueE nwe e • p.",,, rwmu.n.n.
I � ssarJxI' - CE+OrsNEr,WEnnoN7
OD 0 /{ a•rt„wm.ron-mu,n ew
0' h�•a• RdJolfo,IN°D Mul wA,Aoo[n rD aDD,H
Ef
D
ro AS--BUILT VERIFIURON NESC VOLATONS CORRECTED -
\F'G/
VO I
City of Tigard • COMMUNITY Drvr:LOPMENT DEPARTMENT
0 Request for Permit Action
"map
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigird-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name: N/A
INVOICE TO: (Business...lndividual)
Mailing Address: N/A
City/State/Zip: N/A
Phone No.: N/A
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: PFI2015-00157
Site Address or Parcel#: 15233 SW 81"Ave.,Tigard, OR 97224
Pro)ect Name: PGE
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Per Greg Berry in Engineering: This work was already covered in a previous
PFI permit (PFI2015-00065), so this PFI permit is not necessary.
Signature: Date: 11/3/15
Print Name: Lina Smith
Refund Poliu
1. The cites Community Development Director,Building Official or Cin,Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the origiunal payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
• ' OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: IDate / B
Refund Processed: Date N B Invoice Processed: Date B
Permit Canceled: I t-lacel Tar Added: Date B
1:ABuilding\forms\Req PcrinitAction_0 231 .doc
RECEIVED
City Of Tigard
OCT 26 205
aA CITY VGKOAAWK ORDER# M 1684078
PUBLIC WOKKS —ENGINEERI
�LcA
tYp NNING/ENGINEERIN
Public Facih IM
rovement (PFI) Permit
•
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: ® Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: Service to 10 Lot Partition R Minor work in right-of-way
(sidewalk repair,curb cut,street
opening,etc.)requires:
•Application form,completed
and signed
• Submit one(1)copy of scaled sketch
Property address/location(s): 15233 SW 81 st Ave, Tigard of the proposed work to be done
�a�Ca •Submit one(1)copy of traffic
control plan
—OR—
Tsahai Anderson ❑ Substantial project work requires
Applicant's name: above items and professional
Address: 10800 SW Avery Street engineered plans for:
Tualatin, OR 97062 •Street widening
Ci /state: Zip: •Subdivision infrastructure
Phone: 503-672-5466 Email: T&DSupportAvery@pgn.com •Main utility line extension:
- Storm Drain,Sanitary—Tigard
Water—Tigard Water Service
Contractor's name: Area (includes Durham,King City
CCB#: Expiration: and a portion of unincorporated
Washington County)
Address:
City/state: Zip: DELIVER APPLICATION TO:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Engineers name:
Tod Shattuck Tigard,OR 97223
Address: 10800 SW Avery Street Applications for"minor work in right-of-way"
only may be cmailcd to:
City/state: Tualatin OR Gip: 97062 rowpermits(ktigard-or.gov
Phone: 503-672-5466 Email:
® 14�STJ IGSE�oNL
CaseNo.:
Estimated value of work (within the public right-of-way): o�
Applicatiom submittal fee:
Is work related to a LAND-USE DECISION? ❑ Yes N No Application accepted:
If so, please specify (MLP, SDR, SUB, etc.) case #: By: LS Date: IS—
ewed:
Is work related to a BUILDING PERMIT? [I Yes ® No
Application revi
!l•3•/�
If so,
�please
_specify(BUILDING PERMITS case#: By:��� Date:
Applicant notified:
By: ,L_.J Date:
I:\CURPLN\Masters\Land Use Applications Rev.07/16/2011
City of Tigard 13125 SW Hall Blvd. Tigard,Oregon 97223 www.tigard-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 the applicant arc 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 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 required.
Digitally signed by TSAHAI ANDERSON
TSAHAI ANDERSON°m "Tsq„A".ANOERso°@P=NGoM:'_G5 TSahal Anderson 10/26/15
� Date'2015 10 26 09 16 32-07'00'
Applicant/Authorized agent's signature Print name Date
Owner's signature Print name Date
Owners signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 S\\/Hall Blvd. • Tigard,Oregon 97223 • xv,,vwagard-or.gov 503-718-2421 Page 2 of 4
i
Page 84 2011 Edition
F1`St ;Dia`"yam 3 0:afionary:;L;ane,,Closure,. nth;,.:agging::�'�;�,:":.� -��`�:......._ z....
Diagram 320 covers total closure of one lane of a two-lane,two-way
roadway. See the detail inset for the layout if using a single flagger to control
both directions of traffic on low volume roads(less than 400 ADT)with good
sight distance as discussed below.
1. Use truck-mounted flashing warning lights on work and protection
vehicles. See Section 4.3—Lights and Lighted Signs for exceptions.
2. For added visibility, a truck-mounted arrow board or PCMS in caution
mode may be used.
3. Flaggers at each approach are required if any of the following
conditions exist:
a. Night Operations.
b. Work space is over 200 feet in length.
c. Sight distance is less than 750 feet from each approach
through the lane closure.
d. Traffic volumes are greater than 400 ADT.
4. The length between the Flagger Ahead signs shall not exceed one
mile. Use Diagram 340—Lane Closure with Pilot Car if exceeding one
mile.
5. Cones should be used to outline the work space when curves or other
roadway alignments prevent clear direction for the motorists to pass
the work space safely.
6. Cones along the work space are recommended when posted speeds
are 45 mph or greater,when working under heavy traffic or when travel
lanes are narrower than 11 feet.
7. Extended queue signing (see Diagram 5-4)should be used when
traffic queues extend beyond the initial advance warning sign.
8. When flagging near an intersection,the"Flagger Ahead"(CW23-2)
sign should be visible to traffic entering from any side road. Additional
advance warning and Flagger Ahead symbol signs may be placed on
the side road(s).
9. Sign set-up and flagger placement shown may be used for intermittent
full road closures of 20 minutes or less.
10. The"ONE LANE ROAD AHEAD"(W20-4)sign is optional and should
be considered on high volume or high speed roads, or when extended
queues are expected.
Chapter 5 December 2011
|------------------------1 �
| | �
� | S�Q� | �
, Vo
for lumes (Optional) -M
—. '-~'
� M / FLAGGM ONE LANE
tTt
A
/ =
ROAD
10 TO STO
AHEAD
ROAD
WORK
< T
-_-
� mile
~ e
Buffer
Protection Vehicle
ROAD w/TMA(both Optionao
See Chapter 4
WORK
AHEAD
BE
NE LANE PREPARE
0 ROAD
~ ��
Two F—""— OperationAHEAD TO STO
� (Opti"naV 00
10 f���l S--Oo l S 7
SAMPLE SKETCH:
SW Y " St
Edge of Pavement
I -4— Ditch i'W
Streetlight I •— ---•—•—•—•— —r—•—
I a Rain Dom►
I =o 6
' T'�ro'pos cP"5e1werTiifie�' i
j ws i I
.i1 Existing House
e I Existing 1
Q >e Driveway
ai I Ue I 1
CI I • qhs
� I
"I al s 1
�'
o
i � I Existing Shop 0
1 •J 1
L
4
Powerpole I I 1
�. i5 • o
Imo- 95° 1
I ------- ----------
• ( -property Line-
I I '.
II Fire Hydrant(FH)
i I I
Scale: 1"=30'
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 • ,vxxvtigard-or.gov • 503-718-2421 Page 4 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$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2+ Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SN Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 Page 3 of 4
IDRTAvrS-001,97
SZ 3 3 sw �s/S'` v r-
U¢9> JI I SUBDIVISION LEGEND
NEW PGE FACILRIE$TO BE INSTALLED
PL0NoT
o8 I F PAO.00166 �)))1 I •�I w5iui f¢Wsrti sf f.fOf4q
8776 3 rNSTAII 1300- r� }_ALAI LIQ €I
�(�l]� n' jll. �r„s:w.00nrorvu aKmm�
s e vAD Mr�1s Bo
ON"—GE
ou raro�rtMltT nairoe 5 LOTS =^�� f.,ljoe SIZE r
NOfm _ PE DI—D.25 xW � -
19925 Iq I I ^c l�I �w1 I�I�I� � •a,o wr.u...0✓ee..a rr
roVT 00167 / I I ro awes nm 655-F1 �'� I )�NCINITY raw r n�a n amara -msra w
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