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PFI2018-00226 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00226 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/29/2018 Parcel: 1 S 134DA00700 Jurisdiction: Tigard Site address: 11060 SW 106TH AVE Subdivision: NORTHERN PINE Lot: 9 Project: Bese Sewer Connection Project Description: Adjacent to 11060 SW 106th Ave. Replace residential sanitary sewer line up to top of city main. Owner: FEES Description Date Amount PFI Permit Fee 08/29/2018 $300.00 PHONE: Contractor: ROOT EXCAVATION 10824 E OAK ST MILWAUKIE, OR 97222 PHONE: 503-656-6610 FAX: 503-656-6625 Applicant: REBECCA FOX 10824 E OAK ST MILWAUKIE, OR 97222 PHONE: 503-656-6610 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 PF12018-00226 Type: Condition(dame: Status: SeverityL 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/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/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/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 Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov prior to work 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/[ 09-OTHER Applied Notice RECOVED � 4City ® TarAUG 2 8 2018 o PUBLIC WORKS —ENGINEERING CITY 4F TIGARD x Public Facil I rovement (PF]DATV�PJTTEERING TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ '1"Y1'E 1-F,'ranchisc.Utslin-Nr Fork Check one: Utiliacs ❑ Sidewalk/dnvewa�approach ❑Streennaprovements performed by 1�A<<?�i, PGF and/or utility agency. Detailed description: �j TYPE 2-Sidewalk;Driveway/Sewer Work performed for.the purpose of: o Sidewalk installation or repair. e Driveway approach installation Pro peml address/location(s): and/or repair • Sar11 ,n,sewer lateral installation and/or main line rap -PCX'.A54' V I A c -7 T in r Nbo_6k Rc6 ExMV60r) El TYPE 3-Full scale DevelopmentApplicant: \Fork performed Nvith Land use Address: 4 approval-which includes any of City"/state: d I 0 t q-7TITZip: the following: Plx�il �� I mail: Y° �� ° Subdivisions or Partitions Street widening Contact naive: &bPhonc7 . Mainline installation for Sanitary ContContractor: ?jWV �� (ayx. sewer, Storm se-,ver, Tigard water L�� and/or Tigard 'ater Service Area CCB#: �� Expiration: Address: 1070-14 5 � "� �r5M SUBMIT COMPLETED APPLi.CA'I'IQN'CD: City/state: ►,�t � 1 L_e Lip: 9-7 1- City of Tigard Phon- Email: tcjtand�ivir Planning/Engineering 13125)SW Hall Blvd. Cotltact name:?D GC-C Phone. Tigard,OR 97223 Applications,for"minor work tit rirhi oC ti as" Drily may be cfnailed to: Engineer: only Address: . �b. Cite/state: Gip: FIX! ::P�2,`°_ "a'-- f Phone: Email: Case No. +m l&—00Z Contact naive: Application submittal fee(07%of En s Estimate) . �! Estii^nated value of work-is required(if over$5,400):$. bb Additional fees: \vithin the public light-of-way) Application accepted: 09 BY: N, Date: Is work related to a LAND-USS:DECISION? ❑ Yes 0N If so,please specify'(N412,SDR, SU -Application-Application reti>ieured:B,etc.) case#: Bv:It, Dare: Is z:ork related to a BUILDINGPERi�'1IT? Yes ❑ 1\o Applicant notified: If so,please specie(lit)IL DING I'.E:Ri1H`I`}case#: By: ,�- Date: j �'a� l:\EhG\PermitApplications\pfi_application Effective 10/16/2017 ...,Ar.,. Petit& 4 uJ4tKw .543 RA, folLftw City of Tigard o 13127 SW Hall Blvd. ° "Tigard,nregorx 97223 ° ww%'k tigard-or.gov - 503-718-2421 0 .Page 1 of 4 APPLICANTS NOTE: Person specified as`Applicant" shall be designated"Pertn.ittee"and shall provide financial assurance for u-ork,if required by the city pursuant to T"NIC 15.041.140. With the e.Xceprion()f.1 utility operatingpursucuit to a valid franCHIC''With the(;ity ofTipard,when the owner and the applicant are different people,the applicant must be the purchaser of record ora lessee in posscssioti with written authorization from the owner or an.rent of the owner. The owners) must sigil this application irl the space providcd or submit a written authorization with this application. Fratichiscd Utihtics;arc not recltjired to obtaui the owner's signature on the applicatioai BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate anv, recorded deed restrictions that mai,-be attached to or imposed upon the subject property'. o If the application is granted,the applicant will exercise the tights 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,mals 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. :applicant/,hut oriz Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. ONvner's signature Print name Date Owner's signature Print name: Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 4 13125 SW Hall Blvd. ® Tigard,Oregon 97223 ° xv�x .tigard-ot.gov 503-718-2421 o Page 2 of 4 DEVELOPMENT ENGINEERING FEES FOR STAFF Ul','1`7 ONLY Public Facility Improvement(PFI)Permit•. DETAILED APPLICATION FEE REQUIRENIENTS Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND UTILITY Part 2: All non-water system iiCONNECTIONS,ETC.npravemciits (work in the right of way) Engineer's estimate X 5%(less$300.00 submitral fee) Engineer's estimate X 2%Plan Review Sketcb (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: All public water system improvements ❑ Street lame Engineer's estimate X 12% ❑ Site address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There will be no permit fee charged,or assurance required (Subdivisions/Partitions and Street Improvements)the fallowing types of work: • Sidewalk repair(less than 20 lineal feet) Design Plans • Relocate or replace mailbox (6 sets 24x36 or 22x34) • 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(duality,Facilities • 'fest 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) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street.Light Plan and Photometric ❑ Enginecrs 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,kpproval ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Bled. • 'Tigard,Oregon 97223 • w-wwtigard-or.gov 503-718-2421 • Page 3 of 4 11060 � �wt U IC poor KMUOF 11030 00 -i• d [] '7 7 it Noo a , 11.60 Tigard G-r1c�ccnrticrrw SeU-)fjLU vu 44*3 +4 QMt4Lmkya( &w%ch ss� aao l8 `�.v COn-S v. Ahead 5+'tyl August 29, 2018 1:500 0 0 0.01 0.02 mi 0 0.01 0.01 0,02 km Tigard GIS,Tigard,Cregon 1.