PFI2017-00077 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00077
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/25/2017
Parcel: 2S110131306100
Jurisdiction: Tigard
Site address: 14111 SW 120TH PL
Subdivision: REDWOOD VISTA Lot: 3
Project: Henry Sanitary Sewer
Project Description: Located at 14111 SW 120th Place. Install new sewer lateral 4"saddle tap-HDDE. Lateral connection
with sheer ring fernco.
Owner: FEES
Description Date Amount
PFI Permit Fee 04/25/2017 $30000
PHONE:
Contractor:
SANITECH LLC
201 SHIRLEY ST
MOLALLA, OR 97038
PHONE: 503-803-1207
FAX: 503-303-8238
Applicant:
ERIC HEFLEY
201 SHIRLEY ST
MOLALLA, OR 97038
PHONE: 503-803-1207
Tota 1 $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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00077
Type: Condition Name: Status: Severity:
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/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/1 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 Jonny Gish at 971-713-0281 or Jonny@tigard-or.gov
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/[ 09-OTHER Applied Notice
R E C*E.It V E D
City of Tigard APR 2 4 2017
° PUBLIC WORKS—ENGINEERING CITY Orr-TIGARD
Public Facility Improvement (PFI) PerrMfENGINEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1–Franchise Utility Wort:
Check one: VUtifities ❑Sidewalk/driveway approach ❑Street improvements perfom-ied by NWN, PGP.
Detailed description:•�5f,o fLw awor UJI-c'L(.,1 and/or utility agency.
" t G � TYPE 2–Sidewalk/Driveway/Sewer
1 ,0lUtk twrO , ��F- A�l �
Mork performed for the purpose of:
1A�ia'h 51n r1�'lH �txncu
•
Sidewalk installation or repair.
j, t �l '�� Pkk�
Driveway approach installation
Property address/location(s): 1' i and/or repair
t `'}A-LC,t.- Sanitary-sewer lateral installation
and/or main line tap
❑ TYPE 3–Full scale D
evelopment
Applicant:
Work performed with Land use
Address: P0 P.)QX LAI approval which includes any of
City/state.
��l&AX-A, , Zip: 01-1 o 3g the following.
Phone:al 34411 r Email: • Subdivisions or partitions
Contact name: �2a l e i�.i Phone: C1_1V_8P1`3 k • Street widening
• Mainline installation for Sanitary
Contractor: C17f1.t Q(`I1 �.LCJ sewer,Storm sewer,Tigard water
and/or Tigard\ ater Service Area
CCB#: Expiration:
Address D PJU X 4_1 t� /1, SUBMIT COMPLETED APPLICATION TO:
City/state: 1"LIUIU.�LI, V�-- ` �L,i�p�: —t1Q3q "� City of Tigard
Phone: 211-x -1-15 Email• ��Q�(Ll__i-r�:V v��l7�Gt��o1-Y��C Pl125 SWEngineerin.
13125 SW Hall Blvd.
Contact name: FZAF AC, 1 WA Phone: Xb3-1aC7'7 Tigard,OR 97223
Applications for"minor work in right-of-was"
Engineer: only may be emailed to:
row�ermits dg-ard-or.gov
Address:
City/state Zip:
Phone: F ail: Case No.:?'Fl 201-000'1
Contact name: Application submittal fee: $ 30 -0 C1
Additional fees:S
Estimated value of work is r ed(if over$5,000):$ QV,�O Application accepted:
(within the public t-of--way) By: _Date:
Application reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No By 56 �� Dau:
If so,please specify(MLP,SDR,SUB,etc.)case#:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By: /19 Date:
If so,please specify(BUILDING PERMIT)case#: '`\E"G\Pe""`"°°"atWn\p1i'°°r"'t'°" Rm lv16/2016
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City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page I 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 Uty 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 APPLICANT(S)SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed urn the subject
r e •.
• 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.
F�.te- 1 e a 444; o 1
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property,if required.
Owner's signature Print name Date
Owners signature Print name Date
Owners signature Print name Date
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • vra wtigard-ongov 503-718-2421 • Page 2 of 4
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Sanitech
From: Kelly Hale <kekoha64@yahoo.com>
Sent: Friday, April 21, 2017 9:46 AM
To: Sanitech
Cc: Gary Henry; Ron Palermin
Subject: Re: 14111 SW 120th Place
To whom it may concern,
As president of the Redwood Vista Homeowners Association, I am writing to inform you we have a majority vote,
approved by our board to allow the home at 14111 SW 120th Place Tigard to install a sewer through three tracks to 119th
street to connect to the Tigard city main sewer line. We require copies of the required Permits, a timeline and a pre-
condition restoration of the streets. All costs associated with this work will be the responsibility of the homeowner.
Best regards,
Kelly Hale
President
Redwood Vista HOA
On Thursday, April 20, 2017 11:42 AM, Sanitech <sanitech@molalla.net> wrote:
Kelly,
Thank you for handling the HOA agreement. Per the request of the City of Tigard I need you to state
that 14111 SW 120th Place Tigard will be allowed to install a sewer through tracks to 119th to connect
to the city main. There are three tracks that need to be stated on the letter. Sanitech will not be
allowed to obtain the permits until we receive confirmation/approval from the HOA, we will send you
copies of the permits once we receive them. We are starting this job next Wednesday 4/26 so we
need to get this information into the city. If you have any further questions or concerns please call me
right away so we can get this handled immediately.
Thank you,
Eric
Sanitech LLC
Eric & Melissa Hefley
P.O. Box 47
Molalla, OR 97038
P: 503-213-4775
F: 503-303-8238
Eric cell: 503-803-1207 Melissa cell: 503-929-6751
Sanitech@molalla.net
• . PVC SADDLE (TEE)
STRAP RETAINER
RIDGES
RUBBER GASKET
CD
INSTALL PER
NOTE #7
STORM OR SANITARY STAINLESS STEEL
MAIN BAND
NOTES:
1. INDEXED PVC GASKETED SADDLE SHALL CONFORM TO ASTM 3034 SDR35.
2. PVC COMPOUNDS SHALL CONFORM TO ASTM D1784 WITH CELL CLASS OF 12454—B/C
OR 12364—C.
3. ALL ELASTOMERIC SEALS (RUBBER GASKETS) SHALL CONFORM TO ASTM F477.
4. INDEXED PVC GASKETED SADDLE SHALL BE INSTALLED WITH RUBBER GASKETS
APPROVED FOR THE SEWER MAIN WALL CONFIGURATION (PROFILE OR SMOOTH WALL).
5. STAINLESS STEEL BANDS SHALL BE 300 SERIES, 9(6" BAND WIDTH, CADMIUM PLATED,
CARBON STEEL, AND ATTACHED WITH HEX HEAD, SLOTTED SCREWS.
6. INSERTION HOLE SHALL BE CORE DRILLED.
7. INDEXED SADDLE SHALL BE INSERTED A MINIMUM OF Y4" FROM OUTSIDE WALL OF
HOST PIPE AND SHALL NOT PROTRUDE BEYOND THE INSIDE WALL OF THE HOST PIPE.
INDEXED PVC GASKETED
C1eanWate� Services
DRAWING N0. 540 REVISED 12-06 SADDLE our commitment is clear.
1 - Page 95
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