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PFI2017-00107 a CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12017-00107 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/19/2017 Parcel: SEG775 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Baker Project Description: Adjacent to 11720 and 11750 SW 72nd Ave. Perform three 6 inch diameter road cores in the North bound lane of SW 72nd Ave within the property boundaries to access pavement and base rock thickness and subgrade strength SEG 775 Owner: FEES Description Date Amount PFI Permit Fee 06/19/2017 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: MICHAEL BAKER 14835 SW 72ND AVE TIGARD, OR 97224 PHONE: 503-598-8445 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 PF12017-00107 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/[ 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 Jonny Gish 971-713-0281 or Jonny@tigard-or.gov PFI_Sidewalk/f 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 City of Tigard JUN 14 2017 ~ PUBLIC WORKS — ENGINEERING C Public Facility Improvement (PFI) Perrnit;INC, TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) [] TYPE 1–Franchise Utility Work Check one: El Utilities ElSidewalk/driveway approach �treetimprovements perfonned by NWN, PGE Detailed description: Pet 6M 3 s/x t*A � ,d "0'" and/or utility agency. Aawebfr� roa ./ TYPE 2-Sidewalk/Driveway/Sewer h IZ►C �►.K,b.►..,��«.+t iF S1J 7a� 4,.�..i �ic D�O�''�• Work performed for the purpose of: ie l'x'� '��` 0411 Sidnvalk installation or repair. Driveway approach installation Property a ddress/location(s): )17&10 I I SU SW 7"_ &C and/or repair Sanitary sewer lateral installation and/or main line tap El TYPE 3-Full scale Development Applicant: /U,cA,6 tj T6-Le- - CT tr �a ,, Fiis i•o«n. v— d Work performed with Land use Address: 14 0 s 50 _'7,1,j 04,ye approval which includes any of city/statc: Pa"H - 0& Zip: 19.141f the following. Phone:SV _S19 KV%T Email esP,Un • Subdivisions or Partitions Contact name: /4'_kr- d,key Phone: 'I1 d`16 elodo • Street widening - • Mainline installation for Sanitary Contractor: �r.t_ sewer, Storm sewer, Tigard water and/or Tigard Water Service Area CCB#: Expiration: -- Address: SUBMIT COMPLETED APPLICATION TO: City/state: - - _ Zip: City of Tigard Phone: E mail: Planning/Enginrering - --- --- -—- -- - 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-,of-%%ay" Engineer: only may be cmailed to: row erinhs(gltigard_or.gov Address: City/state: -__-- -- _ Zip: - Phone: Email: Case No.: f Contact name: Application submittal fee: $ L300.00 Additional fees:$ Estimated value of work is required(if over$5,000):S_ Application accepted: ''"" (within the public right-of-way) By:-�� WDate: I __ Is work related to a LAND-USE DECISION? ElYes [I No reviewed:No G 114117 If so,please specify(INILP,SDR,SUB, etc.) case #: By �. g.ts __Date: Applican�notifed: Is work related to a BUILDING PERM �}IT? es ❑ No B3':—� Date: If so,please specify(BUILDING PERMIT)case#: f it c owib-UVB 7 L4NG1PannaAppkadont\pR_applcadon Wv.12/16/2016 Cityof Tigard • 13125 SVC Hall Blvd. • Tigard,Oregon 97223 9 «-A w.tigard-or.gov 9 503-718-2421 • Page l 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 TAMC 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 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 owners)must sign this application in the space provided or submit a written authorization with this application. Franchised utilities are not required to obtain the owner's signature ori the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The alx)� request docs snot violate any.recorded deed restrictions that tna)•br attached to or impuascd 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 any plot plan,attachments,and exlvbits transmitted herewith,are true;and the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is Bund 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. Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. 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 9 13125 SW Hall Blvd. • Tigard,Oregon 97223 • Am-Ax.tigard-or.gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAIT DS17 ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL APPLICATION FEE REQUIREMENTS Part 1: Required submittal fee$300.00 FRANCHISE UTILI'T'Y AND SIDEWALK/ DRIVEWAY AND UTILITY" PERMIT FEE Part 2: All non-water system improvements CONNECTIONS,ETC. Engineer's estimate X 5'%(less 3300.00 submittal fee) (work in the right of way) Engineer's estimate 12%Plan Review Sketch (including information below) WATER SYS'T'EM FEE ❑ Dimensions Part 3: All public water system improvements ❑ Street Name Engineer's estimate 1 1211% ❑ 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 (6 sets,2406 or 2204) • Ditch cleaning that does not involve regrading. • 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) IMC 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(if applicable) ❑ Water Department Approval PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13'125 SW I fall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 14835 SW 72nd Avenue SITE PLAN AND PROPOSED GeePaciiic Portland, Oregon 97224 Tel: (503)598-8445 Fax:(503)941-9281 EXPLORATION LOCATIONS BaylorSW kv. 1110- Elio, E 7 GIH i (`? Y, 1; 11680 • / � 7130 OP30 6,4 Ilor RC-2 // Sy ,X f : / North Legend Date: 6.13 2017 Drawn by. MTB RC-1 g Road Core Desi nation 0 50' and Approximate Location ��Site Boundary APPROXIMATE SCALE 1"=50' Project: 72nd Avenue Apartments Project No. 17-4626 Tigard , Oregon 2011 Edition Page 85 Stationary Lane Closure with Flagging Diagram 320 gQo a 1 1 U. c i -------------- — I •• �ov •• >Q m , V I • 3 I I : I • 1 ,,�� O :® � I • m I ma E I� I • �021 jv I Q'3~ I • —j I y` I C~ I Y. � X\- jr j t tr o i CO) , x �' a 5 I n t hs /•ned SW n serwee"slow eufee \\ o 1p"d C �� 0 25 100 Soo 100 75 O 30 100 do 350 350 350 250 p Y�< 45 180 Qp _ 50 Soo S00 Soo 210 K SS 250 60 2!S 65 700 700 700 R5 70 365 September 2016 Chapter 5