Loading...
PFI2018-00242 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT r E' COMMUNITY DEVELOPMENT Permit#: PF12018-00242 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/19/2018 Parcel: SEG1932 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Jack Howk Plumbing/Rescue Rooter Project Description: Adjacent to 8995 SW Pinebrook St. Exterior sewer replacement on property in ROW. Dig at street side of curb. Owner: FEES Description Date Amount PFI Permit Fee 09/17/2018 5300.00 PHONE: Contractor: JACK HOWK PLUMBING/RESCUE ROOTER PO BOX 2830 CLACKAMAS, OR 97015 PHONE: 503-850-3100 FAX: 503-491-2932 Applicant: JOYCE DENNIS PO BOX 2830 C LAC KAMAS, OR 97015 PHONE: 503-850-3100 Total S300.00 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 PF12018-00242 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/[ 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. 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/1 09-OTHER Applied Notice RECEIVED City of Tigard SEP X 1 2018 PUBLIC WORKS -- I;NGJNUER1NG CITY OF TIGA RC s • -NIG3INE'RING Pubhc Facile Improvement (PFI) Permit TYPE. OF WORK DESCRIPTION OF WORK(in the right-of V El '"PE 1—Franchise L.ttlin• Work Check Unc: ElUtilitics �k��-ilk/�iri�eaa� at-) 1ch tiniprovements perfomied be N\Y\, PGI; Detailed descri tion: and/or utiliti a€?cncr Jot ❑ TYPE 2—Sidc«,aik/Doi cv.•a%./k,,vcr r Work performed for the purpose ot: • Side,.valk installation or repair. U4je_4t?> - DriVC,,%*a} approach Installation Proper - address/location(s): and/or rcpait Lq6--� • Sanitary sewer lateral installation and/or main line tap d�y 'YPE 3—Ful!scale Deti clopmcnt CW pwr%l l y ^�i__.o• r Work performed with Land use Address- approval which includes an\ of City/state: _ Lip: L(5: the following: P Email: or Partitions � � Strcct widening Contact name Phone: j� Mainline installation for Sanitar\• (/ sewer, Storm scwcr, Tig-Lrd w-atcr Contractor: and/or Tigard\\pater Service arca CCB 4: 1;�l�ir�iti�t Address: �T' SUBMIT COMPLETED APPLICATIONTO: City/state: zip: City of Tigard Phone: Email: Plan Ring/Engin eeri ng 13125 SW Haii Blvd. Contact name: Phone: Tigard,OR 97223 Alpplications for"minor work in right-of-way" I:nginccr: only mai he unaikrl VE rowpermit��tiga rd-os.�ov Address: cirti-/state: zip: Phone: Email: Case No.: F162 CIA '—"� Contact name: Apphcation submittal fee(.071X of l-nWncer's}=stimatc) 5 Estimated value of work-is required(if over$5,000)-S '�/4" Additional fccs:S 3©d («ithin the public right-of-way) Application accepted: Is work related to a I,AND-USI: DI• By: Application O Yes �c� .Application reviewed: If so, please specify (NILP,SDR, SUIT,ctc.) case #: By: 400 Date: Is work related to a BUILDING PERMIT? KNIcs No Applicant notified: If so,please specify(BUILDING PERS-IIT)case#: T3 By: Dare: asa I i1ENGlptmrcAp�iitati0ns apotia�on Effective 10/1.6/2017 Ciryof Tigard • 13125 S% Hall Bled. • Tigard,Oregon 97223 • w,xx•vxaigard-or.go • 503-718-2421 - Page 1 of 4 A-PPLICANITS NOTE: Pcrson specified as ":applicant"shall be designated"PerniMec"and shall provide financial a.,sttriancc fur work.if rcqLlirc(i by the CitV pursuant to TNIC 1.5.0-11.140. 1 1 W Eli the e.-,occpdon of a Wlk-,%4"xmdzig jiur,.i t:-.t r.!i ti-did franchise nidi the Cr.-,-,L:'f i.prcl,ashen the o-.%tier wid The applicant arc(Iii-rert.,fic people,Eli-,applicMir rnua he the purchnser a Ics-ee in jv,)<'e4<jf)l Wi7h wriuen auchorizatirm from die owntj or an aunt the r),AnLr. Thc owner:s nna;t sip this ar)pk-i6-n in t space prm ikizrri or�uhniit a%t riucn audinrization with t1h15 appjk;uirm. Fratichi;-_d L!filifics arc not required E0 Cjhtii.^,the vkvner's si,-,:mzurc on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: - The d0CS 110t Violate any recorded degd restrictions that aw.I)c attached to or imposed Lipaaihc-,t41!jgct 9 If the application is granted,the applicant will vxcrcise the rightz.granted in accurclance with the terms and subject E0 all the conditions and 11111iMions of the approval. - All of the above statcincrits and the statements in any plot plan,attachments,and exhibits transmitted here-with,arc true;and the applicants so acknowledge that any permit BSUCd,based on this application,inai-be revoked if it is found that any Stich statcinents,are false. - The applicant has mad the entire contents of the application,including the policies and criteria,and understands the M.]Llirenicnts for approving or denying the application. D � �j �D g Applicant' ,AtZori/ed Agent's, sign-.11`1.117C Print nam Date SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Ou-ner"s signature Print nanic Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13123 S\\ Hall Blvd. - Tigard,Oregon 97223 - www6gard-or.go-, 30.3) 18-2421 - Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improt-ement (PFI) Permit: APPLICATION FEE Part 1: Required suE)mi(tal ttc j300,111) -�* �.�,t �-_•.•�,. .,,::., ,{,-_ r,_..., , t ., . FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE D IVEWAYAND UTILITY Part 2: AH non-water s}-stem imhroveuients CONIJECTIONS,ETC. - (wf-►rk in!the right of xk l nninecr's estimate t 3°,I0(less S100.00 suhmitcal fee) i ngineer's estimate l- 2°4 Plan Rei IOV Sketch (including inforci'idoal3tlotc•) WATER SYSTEM FEE D Dimensions Part 3: Ml public water st-steni improvemcntti [� Street-Name, I"JiDneer's estimate\ 12°r, ❑ Site Address PF1 Permit Fee Exemptions: FULL SCALE DEVELOPMENT There%rill be no hermit fee charged,or assuaanec rcqui:ccl for the following tj•hes of-,vorh: (Subdiiisions/Partitions and Strect Improvemenrs) • Sidewalk repair(less than 20 lineal feet) Design Plans, • Relocate or replace mailbox • Ditch cleaning that cines not involve regrading. (6 sets,24 36 or 2204) • 1C'cep holt repair ❑ Cover-;Site;Vicinity,Abbr6iation,Legend • Curb repair or replacement(less than 20 lineal feet) ❑General Notes(Crty,Wa er,Sc«•er,eic.) • I.a«•n sprinkler system installation or repair ❑ Stxeet.(Plan;Profile); • Street tree pruning or planting; Cl VCrat+cr;Storm kind Sanitary(Plan Profile) Planter strip landscape maintenance ❑ Water Quality Facilities • Test we is ❑ Grading ❑ L.andscaping/Trec Plan ❑ Composite Utility-Plan(Electrical,Phone,Gas, Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,crc) TMC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight_Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(proj&i land use name,revision and plan log block,dates and sheet numbers) Additional Strbmittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Prdiminaq Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Departrnent.Approval ❑ E4neees Constriction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13123 S%V Hall l3l%-d. • Tigard,Orcgon 9 7223 • wwwtigard-or.gov • 503-7l&2421 • Page 3 of 4 . - . . �'ADT�/���� • �.r'tis.i�:��se �� ----_.__ _T.w`a .. ._..• •-•- -__ "'�"7r"__`-. „`cz.,e4ue�'Y.!`��»-'•li�i��'s=?_�.`�_='_S:rti•._--- sxETCH MMA: DATE: l�t �� KESS: "! PROJECT ADDRESS: , i "0.0 i Ll r , PROVIDED BY: ARS dba Jack Flowk/Rescue Rooter, P.O. BOK 2830, Clackamas, DR 97015, Phone: 503-850-310O Fax: 503-491-293 � SKETCH MILA:,/ �y DATE: PROJECT ADDRESS: BE-'REPARED D TO OP Q a ui 0 a vl O i a0 cc gr0 � 0 3 a D ao ^x' 0 D O m oxv o ti A m d ...rte PROVIDED BY: ARS dba Jack Hovvk/Rescue Rooter, P.O. BOX 2830, Clackamas, OR 97015, Phone: 503-850-3100 Fwt: 503-4.9i-2932