PFI2017-00258 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00258
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/27/2017
Parcel: 1 S125DA05702
Jurisdiction: Tigard
Site address: 6700 SW ALFRED ST
Subdivision: KINGS VIEW Lot: 43
Project: Sanitech
Project Description: Adjacent to 6700 SW Alfred St, Tax Lot ID 1 S125DA05702. Replace sewer from cast iron to city main
via drive.
Owner: FEES
Description Date Amount
PFI Permit Fee 11/27/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
ERIC HEFLEY
PO BOX 47
MOLALLA, OR 97038
PHONE: 503-213-4775
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: �� yQ/}II
Issued By: (44�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00258
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/[ 05-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity, the applicant shall coordinate with the City's inspector, <Insert Names 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/[ 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 N O V 2 0 2017
PUBLIC WORKS —ENGINEERING
CITY OF TICARD
f
, ay,kFacityimprovement �NGI
UEERINO
Public errnt
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1-Franchise LTtility\Y/ork
Check one: Utilities ❑Sidewalk/driveway approach ❑titreetimprovements perfom-jcd h1- NTW�1, PGF
Detailed description: and/or utility agencj,.
cy'Po .�-r, v* V,• 2rTYPE 2-Sidewalk/Drivc�vay/Suver
I t� Work performed for the purpose of:
• Sidewalk installation or repair.
•
Propert}, address/19cation(s): 6100 S �� S- lllicewav approach installation
I S i Lb DA Ow- and/or repair
• Sanitary sewer lateral installation
and/or main line tap
❑ TYPE 3—Full scale Development
Applicant: � �Yl��,(�,�/1 LLQ P
Adess' 4-1
, Work performed with Land use
— `--t approval which includes any of
City/state: -ko LU-4- zip: the follawin
Phone: �I��j1 Email: SGL�1.a{ c�1 d (1l(,�,(,��'1,r'�f� • Suhdi��isians or partitions
Contact name: 1�1/1�(', v -:L1�e,r.( � Phone:�I S-L- -1 r}C---) • Street widening
• �'\•Iainline installation for Sanitai:y
Contractor:
sewer, Storm sewer,Tigard mater
and/or Tigard Water Service Area
CCB#: l O�LD C31 q ] "�} Expiration:
address: f pC) &D x `-I r SUBMIT COMPLETED APPLICATION TO:
Citi-/state: City of Tigard
Phone:t, --_�- N-I-7t Is Email: " U -E Planning/Engineering
13125 SW Hall Blvd.
Contact name. Phone: Tigard,OR 97223
:Applications for"tninor work in right-of-way"
Engineer: M-di.may lx-emailed to:
Address. tan:pc its@ rd-or_gov
City/state: Gip:
Phone: Email: Case No.:
Contact name: Application submittal fee:
Additional fees:
Estimated value of work is required(if over$5,000):$ Application accepted:
(Xvithin the public night-of-ova}r) By.--Sc Dare: I Z� 1?,
,�/ application retgiexved:
Is�-ork related to a LAND-USE DI�CISION? El Yes LrJ Ido
B}r J G�S Date:
If so, please specif,(i`ILP, SDR,SUB,etc.) case#:
-Applicant notified: 1
�� D
1s work-related to a BUILDING PERl�1i1'r f�'1'es Q No By ate:
If so,please specify(BUILDING PERMIT)case#: I:\ENG\permitApp"tions\pflapplication Rev.12J16/2016
City of Tigard 13125 Ste%Hall Blvd. Tigard,Orcgon 9722-1 wwwtigard-ongov 503-715-2421 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 cit},pursuant to"IT'IC 15.041.140.
* Vlith the exception of it utility operating pursuant to a valid franchise with the City of'figard.%x-hen the owner and the applicant are different
people,the applicant must be the purchaser of record or a lessee in possession%%ith written authorization from the owner or an agent of the
mvner. The owner(s)must sign this application in the space provided or submit a written authorizarion with this application. franchised
Utilities are not required to obtain the owner,sibmature 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 iinposed upon the subject
ro e
• If the application is granted,the applicant will exercise the rights granted in accordance n7th the terns 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
die applicants so ackno\vledge 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.
IA.
,Tp icant/Authorized 1 nt's si ature Pru-it name Date
SIGNATURES of each o,,�vnier 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 13125 SW Hall Blvd. • Tigard,Oregon 97223 • m7\v%6gard-or.yot, 503-718-2421 • mage 2 of 4
2011 Edition Page 95
Self-Regulating Lane Closure Diagram 350
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Office 503-213-4775 Eric Celi' 503-803-1207
Customer Site locataore
Thomas Jung
5225 SE 18th Ave 6700 SW Alfred
Porldand,OR 37282 Tigard,OR
Phone: 503.766.2229
Work to be performed as follows:
*Replace sewer from cast iron to city main via directional drill.70 ft.in length 12' in depth
*Excavate a 3 x 5 ft. hole street to access sewer line.
*Excavate a 3x5 hole in side of driveway to access sewer line. 6 ft. depth
*4-inch hdpe,abs,and 3034-sewer line.
*Sanitech connect to existing line.
*t0aterial in roadway to be hauled off and replaced with 4 minus rock per city standards
*Material on property will be used for backfill.
*All material will have firm bedding and installed per city standards or better.
*Asphalt removal and replacement included in price.
f�,i
� � Q G
1. PVC HUB SHALL CONFORM TO ASTM 3034, SDR 35 DRIVE INTO CENTER OF
RUBBER SLEEVE AFTER SLEEVE IS PLACED IN HOLE.
2. STAINLESS STEEL BAND SECURES UPPER HALF OF RUBBER SLEEVE TO THE
PVC HUB. STAINLESS STEEL BAND SHALL BE 300 SERIES, 9/16" BAND WIDTH,
CADMIUM PLATED CARBON STEEL, AND ATTACHED WITH HEX HEAD SLOTTED
SCREW.
3. COMPLETE RUBBER SLEEVE INCLUDES A MOLDED SEGMENT THAT HOLDS IT IN
PLACE.
1
3
2
nuuui
t
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NOTES:
1. ALL INSERTA-TEE HOLES SHALL BE MACHINE DRILLED AND CORED.
2.INSERTA-TEES ARE NOT ALLOWED IN NEWLY CONSTRUCTED SEWER MAINS WITH AN INSIDE
DIAMETER (I.D.) OF 10 INCHES OR SMALLER.
3.SEWER MAIN SHALL BE TWO SIZES (NOMINAL I.D.) LARGER THAN THE INSERTA-TEE.
INSERTA - TEE
CleanWater Services
DRAWING NO. 530 REVISED 12-16
As required in
Off typical sections
Street Street of construction
Area plans
1 ' T—cut see
Surfacing note 1
Topsoil or as
directed Base Material
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6" Min bedding y-
below
"outside of 6
pipe bell 3/4" — 0" MIN MIN
crushed aggregate
a ,
a , o
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2' Min Trench
foundation i\\\� i\iN \\�
stabilization
if required
NOTE:
1. 1' T-CUT FOR PIPE ONLY PROJECTS.
2. JOINTS TO BE TACK AND SANDED.
3. SAWCUT SHALL BE TACK COATED WITH BITUMINUS ASPHALT EMULSION.
CITY OF TIGARD APPROVED BY: NO SCALE
OREGON MICHAEL A. STONE, P.E.
ENGINEERING DIVISION CITY ENGINEER TRENCH DWG. NO.
PUBLIC WORKS DEPARTMENT
S.W.HALL BLVD.
TIG 180
TIGARD,OREGON 97223 JANUARY 2013 6ACKFI LL
VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE