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PFI2017-00062 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT n pT COMMUNITY DEVELOPMENT Permit#: PF12017-00062 9 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 25/022017 Parcel: S102BA02300 Jurisdiction: Tigard Site address: 10005 SW JOHNSON ST A Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 15 Project: Young Driveway PFI Project Description: New driveway approach Owner: FEES Description Date Amount PFI Permit Fee 04/18/2017 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: BRAD YOUNG 13430 SW HILLSHIRE DR TIGARD, OR 97223 PHONE: 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: t Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00062 Type: Condition Name: Status: Severi : 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/1 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. call ken fisher at 503-816-6146 or Kenny@tigard-or.gov 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/1 09-OTHER Applied Notice RECENED City of Tigard APR 12 201 * PUBLIC WORKS — ENGINEERING TIGARD Public Facility Improvement (PFI); PernEER►NG A�!1' `w./ t. lfji6/( DESCRIPTION OF WORK(in the right-of-way) Y t ❑ TYPE 1-Franchise Utility Work Check one: ❑ Utilities Sidewalk/driveway approach ❑Streetimprolveements performed by NWN, PGE �.E'/UE�:�ty si�/�/E'Q.�il' S Detailed description: and/or utility agency. TYPE 2-Sidewalk/Driveway/Sewer Work performed for the purpose of - Sidewalk installation or repair. er Pro address/location(s): Mk90 I �AA dy N,�e�n/ - Driveway approach installation Property ..� 6 and/or repair AA,c, ZQ J L - Sanitary sewer lateral installation and/or main line tap Applicant: ` iPiQ© Vo/myC-) ❑ TYPE 3-Full scale Development " ^ /� Work performed with Land use Address: � `f`w f�� ���(/ �''7�/t.��/�/,Q 2� !J/� approval which includes any of City/state: Zip: the following- Phone-f' ollowingPhone-f' b %, yam-s~Email: s�P,�/>_ yc��%°7l'/ 4i'LACI�/'✓/Cv Subdivisions or Partitions Contact name: Phone: - Street widening - Mainline installation for Sanitary T-f� �� sewer, Storm sewer, Tigard water Contractor: _��aC'f� lyti�, f,E'V�TIJ� and/or Tigard Water Service Area CCB#: 2057-3' Expiration: Address: J eOX 5'77 SUBMrrC.OMPLETEDAPPUCAnONTO: City/state:44011A c_ ''- Zip: 00 v7 City of Tigard �✓3� -'� S�' Email: Planning/Engineering Phone: �-- 13125 SW Hall Blvd. Contact name: Phone:�J,7—.gS L Tigard,OR 97223 Applications for"minor work in right-of-way" Engineer: only may be emailed to: rowpermitsaa tigard-orgov Address: City/state: Zip: Phone: Email: Case No: � � �- Contact name: Application submittal fee: Additional fees:$ Estimated value of work is required(if over$5,000):$ Application accepted: (within the public right-of-way) By: M 0 Date: 4112417 Is work related to a LAND-USE DECISION? j]i Yes ❑ No Application reviewed: If so,please specify (MLP, SDR,SUB, etc.) case #: i4©,>`2yf - � By:J 66 t-- Date: LI t'-I Applicant notified: Is work related to a BUILDING PERMIT? )6 Yes ❑ No By: Date: If so,please specify(BUILDING PERMIT)case#: o/7-c.I ':\ENG\Perm tAppliat ons\pfi_apDlKation Rev,12/16/2016 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,if required by the city pursuant to TMC 15.041.140. * With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,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. Franchised Utilities are not required to obtain the owners signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject ro . • 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 any 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. Applic t A thorized A sign ture Print name Da SIGNATURES of each owner of the subject property, if required. Owner' si ature Print name ate 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 • www.tigard-or.gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water system improvements CONNECTIONS,ETC. Engineer's estimate X 5%(less$300.00 submittal fee) (work in the right of way) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: All public water system improvements ❑ Street Name Engineer's estimate X 12% ❑ Site Address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required for the following types of work: ! (Subdivisions/Partitions and Street Improvements) • Sidewalk repair(less than 20 lineal feet) • Relocate or replace mailbox Design Plans • Ditch cleaning that does not involve regrading. (6 sets,24x36 or 2204) • Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(f applicable) ❑ Water Department Approval 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 —� Streetlight I •— !•-----------r •— e Rain Dom. tUA ef& B � O ' T—�rop'os d•S�rver'Cine-- Existing House N� r� I Existing I _N-e Driveway 01 I in' ,d.l CL tl � a� I i 0 Existing Shop j • t I� Powerpole �` I • 0 1 I 95' 1 --------7roperf)L7e ------ • I II Fire Hydrant(FH) I � I Scale: '1"=30' I � I I 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 a 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 LEGEND SITE PLAN 0 FOUND SURVEY MONUMENT FOR BRADLEY AND REBECCA YOUNG SF SQUARE FEET 10025 SW JOHNSON STREET, TIGARD, OREGON f ASPHALT ;8";15'c IN THE NW 1/4 OF SECTION 2, T25, R1 W, WM CURB DROP ' ` WASHINGTON COUNTY, OREGON to",35'C /4, 36".60'C SURVEYED OCTOBER 7, 2016 DECIDUOUS TREE ;o MAP 2S1 2BA TAX LOT 2300 4� Eu, ELECTRIC METER 41 12".20'C �v Z. 12".15'C EVERGREEN TREE 2 14",20'C ",15'C c, `' FIRE HYDRANT GAS METER 10",20'C CJP JOINT POLE / R ROOF DRAIN ' 0 WATER VALVE WATER METER 6",12'C' PARKING CONCRETE 11";20'e ' 31",40'C GRAVEL k 12 J 2'C BUILDING DEED DOCUMENT 4 s' NO. 2015-083554g.- ( )s"1z'c 18",50'C I �ryj (2)6' 25'�k I 10",35'C 10 35'C x C DECK; DEED DOCUMENT NO. 97122298 / �—PROPERTY LINE SHED Q oa 7" 12 Cry KEYSTONE HOUSE �o HOUSE q z� SCALE 1 "=30' v REGISTERED PROFESSIONAL tiNSO�\ c r ' �G�" _;�� LAND SURVEYOR f ST e/v RFFT oF IWO, SOOR/T of 0 ON o JULY 25, 1995 0\; ` 13',t ROBERT ALAN JOHNSON t t,G; #2725 22",40'f /yti EXPIRES 6/30/17 ry° JOHNSON UNO SUrt!/EY/NG; /NC. gTFR J 10185 SW HOODVIEW DR, TIGARD, OR 97224 3P ".. 503-407-9966 jsurveyOfrontier.com jlsurvey.com EXISTING DRIVEWAY — MATCH WIDTH & GRADE A R/W LINE SEE NOTE 3 VARIES �2% SEE 12% 5' MIN 2% SEE 3 11 SIDEWALK SEE NOTE 2 A 30' MAX 6' 6' 10' MIN PLAN 3/4" PROJECTED TOP R/W P� / / OF CURB 6" 2% MAX STREET :a 4. o o o qY i OO OO O O o 0 0.0 0080„ o D o e 2" OF AGGREGATE SECTION A—A (3/4"-0") COMPACTED NOTES: 1. CONCRETE COMPRESSIVE STRENGTH SHALL BE A MINUMUM OF 3000 PSI AFTER 28 DAYS. 2. CURB JOINT SHALL BE TROWELED WITH A MIN 112" RADIUS ALONG BACK OF CURB. 3. EXPANSION & CONTRACTION JOINTS SHALL BE 112" PREMOLDED ASPHALT IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBGRADE TO FINISH GRADE. 4. SEE STD DETAIL NO. 146 CITY OF TIGARD APPROVED BY. NO SCALE oRFIcc)N MICHAEL A. STONE, P.E. ENGINEERING DIVISION STANDARD DRIVEWAY � PUBLIC WORKS DEPARTMENT13125 S.W. CITY ENGINEER DWG. N0. TIGARD,OREGON 97M JANUARY 2013 w/CURB-TIGHT SIDEWALK 142 VOICE:(503)6394171 FAX: (503)684-7297 APPROVAL DATE