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PFI2018-00166 CITY OF TI ARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00166 s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/03/2018 Parcel: 2S 104AC 12800 Jurisdiction: Tigard Site address: 12660 SW 135TH AVE Subdivision: HANDY ACRES Lot: 32 Project: JTC Partners, LLC Project Description: Adjacent to 12660 SW 135th Ave. Replace sewer from house to main.Tap into sewer main on SW 134th Ave. Owner: FEES Description Date Amount PFI Permit Fee 07/02/2018 $300.00 PHONE: Contractor: REYNOLDS SEWERS INC 11954 NE GLISAN ST#233 PORLAND, OR 97220 PHONE: 503-913-2328 FAX: Applicant: KEITH REYNOLDS 11954 NE GLISAN ST#233 PORLAND, OR 97220 PHONE: 503-913-2328 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: �����C � Issued By: A/hw 44� Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00166 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/[ 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/l: 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 1 "'ECEIVED City ®f Tigard JUN 2 8 2013 +Ic PUBLIC WORKS —ENGINEERING CITY©1=TlGARD Public FacIty Improvement (PFf)-Ap& EERING M. TYPE OF WORK DESCRIP'T'ION OF WORK(in the right-of-way) ❑ TYPE 1—Franchise Utility Work Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑ Streetimprovements performed by NWN, PGE Detailed description: and/or utility agency. i. � �, El TYPE 2—Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): 6 66 and/or repair • Sanitary sewer lateral installation and/or main line tap Applicant: Re-' ys g. 5 5 e. � �i 5 '1y1(X ❑ TYPE 3—Full scale Development pp Work performed with Land use Address: lei'3C 7,3 3 approval which includes any of City/state: 0 if Zip: 9-7 Z,�� the following: X65 7/� �52G`Email: ,r �� � l�( • Subdivisions or Partitions Phone: � i t� Contact name: ���,�; Phone: 5Z53W25- • Street widening —Z�.�g • Mainline installation for Sanitary sewer, Storm sewer, Tigard water Contractor: �0� � .����--��5 .�f t.-es and/or Tigard Water Service Area CCB#: O/V I Expiration: 6 Address: 19 j- V iF d ?IN 33 SUBMIT COMPLETED APPLICATION TO: City/state: 0 V C Zip: 7 Z2_0 City of Tigard Phone: 56 ( Z Email: .. +tom Planting/Engineering 13125 SW Tull Blvd. Contact name: 1 `— Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" only may be emailed to: Engineer: royMermitsktigard-or.gov Address: FOR ONLY City/state: Zip: Phone: Email: Case No.: �I� 00/& Contact name: Application submittal fee(.007%of Engineer's Estimate) $ j Estimated value of work is required(if over$5,000):$ Additional fees: $ (within the public right-of-way) Application accepted: By: /�.�� Date: Is work related to a LAND-USE DECISION. ❑ Yes { f No If so,please specify (MLP,SDR,SUB, etc.) case #: Application reviewed: By-z—& Date: o� • Is work related to a BUILDING PERMIT? ❑ Yes 'Z"No Applicant notified: It If so,please specify(BUILDING PERMIT)case#: By: Date: I:\ENG\PermitApplications\pfi_application Rev.10/16/2017 City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.tigard-or.gov 503-71$-2421 Page 1 of4 c, T 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 owner's signature on the application BY SIGNING 1B]ELOW,THE AIPPLIGAIeT(S) SHALL CERTIFY THAT: o The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. o 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. o 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 ap roving or denying the application. Applint/Authorized Agent's AgnVure 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 ofTigard o 13125 SW Hall Blvd. , Tigard,Oregon 97223 o wwwtigard-or.gov 503-718-2421 o Page 2 of4 K � DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY Public Facility Improvement(PFI)Permit: DETAILEDSUBMITTAL REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 (minimum) FRANCHISEUTILITY AND SIDEWALK/ DRIVEWAY AND UTILITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5%(less$300.00 minimum submittal fee) Sketch Engineer's estimate X 2%Plan Review (including information below) ❑ Dimensions WATER SYSTEM FEE ❑ Street Name Part 3: All public water system improvements ❑ Site Address Engineer's estimate X 12% FULL SCALE,DEVELOPMENT PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements) There will be no permit fee charged,or assurance required for the following types of work: Design Plans • Sidewalk repair(less than 20 lineal feet) (6 sets;24x36 or 22x34) • Relocate or replace mailbox ❑ Cover-:Site,Vicinity,Abbreviation,Legend • Ditch cleaning that does not involve regrading. ❑ General Notes-(City,Water,:Sevwer,etc.) • Weep hole repair ❑ Street-(Plan;Profile) • Curb repair or replacement(less than 20 lineal feet) ❑. Water,Storm,and.-Sanitary`(Plan Profile) • Lawn sprinkler system installation or repair. ❑ .Water Quality Facilities • Street tree pruning or planting El Grading • Planter strip landscape maintenance 0, Landscaping/Tree Plan • Test wells El Composite UtilitSr:Plan(Electrical,.Phone,Gas,. Storm,Sanitary..Water;Signage,Street Lights,etc) ❑ Details.. Note: A cash/bond assurance maybe ❑ Traffic.Sight Distance required per TMG'15.04.140. ❑. Signing and Striping. (customer deposit) ❑ Street Light Plan and.Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision arid Plan l(cg-block,dates and sheet numbers.) Additional Submittals (per.Land Use conditions) El Traffic.Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report El Preliminary Access.Report(Sight Distance) E Proposed.Plat ❑ Pathway Design(if applicable) ❑ Water Department Approval ❑ Engineers.Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 0 www.tigard-or.gov 503-718-2421 Page.3 of4 SAMPLE SKE'T'CH. W -. �tt e c&P�aveinenj, Leitch R&kLirain fir I F v�1 - p oS_ 1"Iof 079" b '` Tian e j I ® Ee 't�ut ?1i1 b 1 a I t=mAi rub aii-we Firay 51LO I 1 �.I w • EL� b ID e 4 s I I r i 95014 Fire Hydrant(FH) Scale: 'I"=30' e l �w 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 FACILI'T'Y IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 4 of4 IN 0 fir.s c� -{rr ,§- .. �z'� 'y,' } w'e p, �'L•'a""'. as' v;r, L.' a e r 5 " yp �h ` a x x ' *a. , 0 'E 3 , Y IF r - r �- .,...,? c-. F - u7 i.K. ..,oM F ..: f.':,. ,... ;. ' ,.. �...:eM1`t ,. 'a��'7Sd� .�, :•t` 4 y'��: n a , , : n• ' t 3� , , a , y �± l� Hi r r .s,�' :..,,. u• .. '-1. 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'.- ... ., �., °' .ip -..:.'p'IaY:[�d M1. £.- n;yea..;.:. _ F+.✓ n - •,�. �.'x 5c:,�,#r,,Y 4" `��,� tt.p`ety's �'i ..�, " 1�; 4'% d::. i ff � 'cE t � .,.,.,�,. �. A y.j..'a �•�_ _." � ,t° a <,r 3" ! t; b ° a ,,- Y9x ,a .� `^ Lk "�.,'a`' :-. •�', - Az ,k9C c.. "'S.:. L S'k+`-(rpz#b ARAgs 0, . CITY OF TIGARD PLUMBING PERM COMMUNITY DEVELOPMENT ePe Imons` 041201800148 Dat®issued: 04003/2018 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Parcel: 2S104AC12800 Jurisdiction: Tig Site address: 12660 SW 135TH AVF Protect: JTC Partners Subdivision: HANDY ACRL3yE Project Description: 100 FT of sanitary sewer. No sewer reimbursement per Al Dickman. Contractor. REYNOLDS SEWERS INC Owner: JTC PARTNERS,LLC 11954 NE GLISAN ST#233 4505 SW FAIRVIEW 131 PORLAND,OR 97220 aD AOR$7222 PHONE: 503-913-2328 PHONE: 503-799-2546 FAX: FEES Quantity Description Date7Amount100 If Sanitary Sewer 04/03/2018Specifics: 1 12%State Surcharge- 04103/2018PlumbingType of Use: SF 10 ea Minimum Fee Adjustment- 04103!2018 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total Zp Required items and Reports(Conditions) ns permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other', piicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of :uance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon lity Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules direct questions to OUNC by caping 503. 2.1987 or 1.800.332.2344. ued By: "nature: � Call 603.639.4176 by 7:00 a.m.forth*next available inspec dab, e--4 This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each inspection. 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, %6" 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 muni d 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 c�lean�Vater Services DRAWING NO. 530 REVISED 12-16 As required in Off typical sections Street Streetof construction Area plans //--l ' T—cut see Surfacing note 1 Topsoil or as directed Base Material -a v O 0, U 0 i 0 > - -0 p -0 x i U _ x U � — w U C: N xa E C ) .C V) E N CD L- -0 0Q L Q 6" Min bedding fi 6 below outside of pipe bell 3/4' — p" MIN MIN crushed aggregate ' 0 o � 2' Min Trench foundation 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. iq ENGINEERING DIVISION aTY ENGINEER TRENCH DWG, NO. ® PUBLIC WORKS DEPARTMENT S.W.HALLBLVD, TIG 180 TIGARD,OREGON 97223 JANUARY 2013 BACKFILL VOICE:(503)639-4171 FAX: (503)684-7297 APPROVAL DATE CURB JOINT SEE STD DETAIL N0. 146 5' MIN. SEE NOTE 5 ROW �— 2% ROAD 4: h el 11 Pte, al 1°•I .e,,e., p1°• oma • e_,, ,. e • . _ —�—III- • . I—III—I I—III-1 I I— —III—I 11= ••" °' I—Ili- ��I_I I I—III �� - �—���- 2" OF 3/4"-0" BASEROCK COMPACTED SUBGRADE SIDEWALK ADJACENT TO CURB PLANTER 5' MIN. In ROW STRIP 6" ROAD 4 — — e> •._ . °. . °. _ •_ —III 71 III—III—I I I—I I I—I I I— —III—III-1 =I I�— 'I =1 I-1 I I=�i t r_11 2" OF 3/4"-0" COMPACTED SUBGRADE BASEROCK SIDEWALK AWAY FROM CURB 1. CONCRETE SHALL BE 3000 P.S.I. AFTER 28 DAYS. 2. PANELS TO BE 5 FEET LONG UNLESS OTHERWISE SPECIFIED. 3. EXPANSION JOINTS & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBRADE TO FINISH GRADE AND PLACED AT SIDES OF DRIVEWAY APPROACHES, UTILITY VAULTS, WHEELCHAIR RAMPS AND AT SPACING NOT TO EXCEED 45 FEET. 4. FOR SIDEWALK ADJACENT TO THE CURB AND POURED AT THE SAME TIME AS THE CURB, THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN. 1/2" RADIUS. 5. SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY. OTHERWISE SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 4 INCHES. 6. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3" DIAMETER SCHEDULE 40 DWV (ABS OR PVC) PIPE AT 2% SLOPE. CONTRACTION JOINT TO BE PLACED OVER PIPE. 7. CONCRETE SHALL HAVE A MEDIUM BROOM FINISH AND TROWELED ON ALL FOUR SIDES CITY Or TIGIM "NOVO BY: NO SCALE OREGON MICHAEL A. STONE, P.E. 14e ENGINEERING DIVISION pn ENaNEER CONCRETE DWG. NO. ®\ PUBLIC WORKS DEPARTMENT S.W.HALL BLVD. TIG TIGARD,OREGON 97223 JANUARY 2013 SIDEWALK ® VOICE:(503)639-4171 120 FAX: (503)684-7297 APPROVAL DATE