PFI2017-00090 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00090
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/17/2017
Parcel: SEG1396
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Pro Fleet NW, Inc.
Project Description: Open asphalt in street to tap city sewer main and patch
Owner: FEES
Description Date Amount
PFI Permit Fee 05/17/2017 $300.00
PHONE:
Contractor:
PRO PLUMB
4125 SE 102ND AVE
PORTLAND, OR 97266
PHONE: 503-867-5042
FAX:
Applicant:
JENNIFER KETTNER
4125 SE 102ND AVE
PORTLAND, OR 97266
PHONE: 503-867-5042
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00090
Type: Condition Name: Status: Severity_
PFI—Sidewalk/1 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/1 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/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. Ken Fisher 503-816-6146
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/1 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
RECEIVED
MAY 16 2017
City of Tigard CITY OF TIGARD
PLANNING/ENGINEERING
1"V131,1C WORK.i -- L",61-M Lkl\(,
Rio Public Facility Improvement (PSI) Permit
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) ❑ T)PF 1—Franclwc I it"',
per orm
Check one: Ej Vulides cd by NW\. 1"(d
utilim
Detailed dcscription: tq�, n CL S Qb,•A In, A lyli
-Vn 1-7 A _1t 1i AAC�1 , ^ Z��n Work putorrned 1*(o:-the
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i�uryH>sc of:
_1d,:v%1!k inst:illatjor or repair.
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Pr()percv address;IOCIAUO"i'�,- Lt —11 r rep,fir
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TX, ,1jNn1L,nt
Applicant: �R F
v� tr c :wk perfoimcd Nvith Land-w
Address: 4-11 Ls- 1, AnY(4
firol 1,�-vving-.
Citoo/state: 5' A-ArA v\ lip: 6i:12
• bdv,lon�w,P..rumnis
Phone: <LZ_ �02A_T)411161: qltl-)a:bLL�Ci/'I1j, (,; 42Y:L"PLUkltz&",�{C -N "' i '.m�
Contact name:de�LA.4 4.or /Ilhonc: ((-,,I o a, -/t'
"obifflAIL 111Zral"Alik'13 f(,r Sanutary
owr, Srni *c .r, *111 rd VVAL-r
Contractor A_, it 111d Tig ;
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SUfpM1-1' N IPLETED APPLICATION TO:
Address-. —L-4 I 111c'.4
City of Tigard
Citv,,"starc! -A ..............
�1, PlanninglEngineering
Phone: i(J-1 2114111ail�� 11- 16 t-"L�,N, L j) 13125 SW hall
Blvd.
Contacinamc: LAI 11.tLl Li_4U; L N11- Tigard,OR 97211
"H;W.4 11`,ti,,-kw m„df od
Engi ncer:
Address:
City/state: Zip:
Phone: Ernall: Case No).:
vJ700 a -
Contact name- ................................... Applicaficon submittal fcc: S__k0_L.cAp
Additional fee,,:
F,stirnated value of wt irk is reau'rco over Si-,000 :S D Aropficittion accepted:
(within the public righc-of-way`
L
Is work related to a 1..1\D-}_.SI:.DI%CIS1(1)\:, 7
bv: 14
If so,,plead specify M.P,SDR_St*B. ctc.-, case:
Is work related to BUIIDI\TG PFRMIT-P -vj�N El lio.. me rLic:
If so,please specify(BUILDING PFRMITcase�:
Cita of 13123AX HAIMM1 ),,ard,0m_,o-I' Page I of'4
p4 Qt* 6, uT-
0 t- M4 cLt �s(4--r'-f 411 t d G1,4,4v_tT- )).Jlxq
APPLICANTS
NA)TE: Pc""n speu I mw -\ppIkanf' Q A!be designated-Terri-im cc" and shall pi-t-Nidc Linaracialforwork,if
!%-(juived by the city 1, ii, : TNN:- 1.14(1,
kkilh I!1v ev'cj)U1 M 4 ,t,ldw, rt I'k k%lit!fraticrise wt1h 6w(%nhTWm1Kv;A-n ihe and The applicant are dirfercnt
ollsf.w,. illi yw.jvhmcrf,t in wrim'g, wto sigk:vioftl-,
,),Anvr Tli�, 11MM 7111 M dw Twe OwAy 1w shma I w I oym= wd,M. qTwamm. I'Mmm"-i
I At am m i wqwmd w Omw Vc mm&"Wmwm an rk Vp%wn
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFYTI-JAT:
• -n,,c h,)%, reek�t(II)C,11r)k J(ihuc ml,% recorded decd restrictions that 11MV be attached ,t)or w,,j1os,:ti upon the sublvcr
• If the application is granted.the applicant. will exercise the rights granted in accordance NAITII the terms and subject to all the
conditimi,,and.limitations of the approval.
• All of the thcstatcmcnts in any plot pian,arra6rricnts,and c-x1hibits [ransn-iiacd hcrcwith, trc true;and
Jic applicants so ackv(,v-1cdgc that any permit issued,based on this applicatim ma v he rcv,lcd if itis Gnind that any such
rtatcments are false.
• J licapplicam has read the cnAL convents(d be alVllimbm,inclubrig AL IwAlus.rand crit it mid undcrmands the
reqwmmerim Or approvimy or denying dicapplicavion.
Y—
Agcnt'� s-.gnature Print natne Date'
SIGNATURES t)f each owncr of the subject property, if required.
...........
hviler's signature Prim nmr;,- barc
.................
Oxvncr's signature Print narvic Dare
..........-
0. ,vller,s signarurc Pint name Dare
PUBLIC FACILMAMPROVEMENT PERNIFF
City of Tigard 13125 SNS 1461 IM - Tgnd,Oregon 9'223 - %t-,v-,v.ugard - • 503-718-242 1 . Page 2 of 4
Lina Smith
From: Jennifer Kettner <jontiveros@proplumbnw.com>
Sent: Tuesday, May 16, 2017 3:01 PM
To: ROW Permits
Subject: Re: ROW 9780 SW FREWING
Attachments: 9780SWFrewing.pdf
Please see the attached photo. We will be drilling the sewer line, so the work in the street is just a patch.
Jennifer Kettner
c 503.867.5042
f 503.719.6304
fJPR0P'LU1AE;NW
On Tue, May 16, 2017 at 2:33 PM, ROW Permits <rowpermitsgti arg d_or.gov> wrote:
Hi Jennifer,
Please provide a sketch of the work. Please see the example sketch on page 4: http://www.tigard-
or.gov/document center/PublicWorks/Engineering/pft application.pdf.
City of Tigard
Public Facility Improvement (PFI) Permits
Phone: (503) 718-2421
E-mail: roLvpermits@tigard-or.gov
From: Jennifer Kettner [ma iIto:jontiverosCabproplumbnw.com]
Sent: Monday, May 15, 2017 12:17 PM
To: ROW Permits
Subject: ROW 9780 SW FREWING
1
Jennifer Kettner
c 503.867.5042
f 503.719.6304
f7i PR0P!`-JJ E;NW
DISCLAIMER E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
rr ay be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by tP;e City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule,"
2
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Sand And Seal
Machine Mill The Paving Joints With
12 Area For A 1-1/2" Hot Paving Grade
Exst/ng12, Min Blanket Inlay Oil (pg 64-22 Or
Min Equivalent)
Asphaltic * See Notes Be/ow
moo
Concrete l
Exsting
Road •+ ` �'`
Base '✓ �J�`— ✓
Non—Compressible
Bockfill—Cement Slurry
(for Major Roods Or As• ( l
Undisturbed
Asphaltic Concrete Pavement _I - Specified) I,! I I_ Ground
7" Patch, 6` Thick Or Match —_
Existing Pavement (whichever is
Greater) Up To The Level Of
Original Pavement. ij—
Crushed Aggregate
Or Granular Pipe
Ione Backfill
!—I ! Material I—I
-1�1- SII =
E�
ea
z
o Trench Width
Per Plan or
*Notes: As Specified
o�
m�
0 Blanket Patches To Be Constructed With Level 2, 1/2 Inch, Dense, Pg-64-22
o� Hmoc In Dry Pavement Conditions, Where Existing Pavement /s At Least 60' F
And Rising.
Tock All Pavement To Be lnloid With Emulsified Asphalt.
(� The City Engineer Shall Determine the Final Width and Length of the Inlay Patch
c e v to Best Fit Travel Patterns.
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CAPITAL CONSTRUCTION AND
City of Tigard FIGURE
TRANSPORTATION DIVISION
EjMW*W.T1G4RO-OR.GOV
"125 S.W. tAU BLVD. Blanket Inlay TUTR
AG4RD, OREGON 97223
_ VOICE: 503-639-4171
FAX 503-624-0752 FILE NO
'�` Detail n/a