PFI2018-00334 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00334
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/11/2018
Parcel: 2S 101 AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project: Compass Oncology Sewer Connection
Project Description: Connect new 6"sewer line to existing public sanitary sewer line at back of right of way.
Owner: FEES
Description Date Amount
PFI Permit Fee 12/11/2018 $300.00
PHONE:
Contractor:
WEITMAN EXCAVATION, INC
11225 SW CLAY ST
SHERWOOD, OR 97140
PHONE: 503-682-3322
FAX:
Applicant:
PATRICK DOHERTY
11225 SW CLAY ST
SHERWOOD, OR 97140
PHONE: 503-682-3322
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 `(� A
�������To
Signature: �,
10
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00334
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.
PH 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.
PH 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.
PH 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.
Contact Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov
PFI—Sidewalk/1 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
City of Tigard RECEIVED
g
PUBLIC: WORKS — ENGINEERING DEC 10 2018
�
TIGARD
Public Facile y Im rovement PFI P TYj"fGN IEERINC
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1-Franchise Utility Work
Check one: N Utilities ❑Sidext-alk/driveway approach ❑Srreet improvements performed by NWN, PGE
Detailed description: Connect new 6"sewer line to existing public sanitary line and,/or utility agency.
at back of right of way. ® TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of:
• Sidewalk installation or repair.
Property- address/location(s): 12123 SW 69th Ave Tigard Oregon • Driveway approach installation
and/or repair
• Sanitary sewer lateral installation
and/or main line tap
El TYPE 3—Full scale Development
Applicant: Weitm_an Excavation, Inc.
Work performed with I-and use
Address: 11225 SW Clay Street approval which includes any of
City/state: Sherwood, Oregon Zip: 97140 the following:
Phone: 503.682.3322 Email: gdoherty@weitmanexcavation.com • Subdivisions or Partitions
Contact name: Patrick Doherty Phone: 503.941.8390 • Street widening
• Mainline installation for Sanitary
Weitman Excavation Inc. sewer, Storm sewer, Tigard water
Contractor: � and/or Tigard`'Fater Service Area
CCB#: 217837 Expiration: 11/27/19
Address: 11225 SW Clay Street SUBMIT COMPLETED APPLICATION TO:
City/state: Sherwood, Oregon Zip: 97140 City of Tigard
Phone: 503.682.3322 Email: pdoheMaweitmanexcavation.com Planning/Engineering
13125 SW Hall Blvd.
Contact name: Patrick Doherty Phone: 503.941.8390 Tigard,OR 97223
Applications for"miner work in right-of--way"
Engineer: only may be emailed to.
rowpermits&tigard-ot,gov
Address:
City/state: Lip:
Phone: Email: Case NoRRU16`MjJ23
Contact name: Application submittal fee(07%of
Engineers Estimate)
Estimated value of work is required(if over$5,000):$ 4,342.00 Additional fees: $
(within the public right-of-way) Application accepted:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No
By: AL- Date:
If so,please specify (MLP, SDR, SUB,etc.) case #: Application reviewed:
By:K•6 ate:
:Is work related to a BUILDING PERMIT? X Yes ❑ No Applicant notified:
If so,please specify(BU.ILDING PERMIT)case#: BUP2018-00242 By: Date:
I;\ENG\PermitAppliations\pA appikation ENe4th+e 10/16/2017
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigrard-or.gov 0 503-718-2421 0 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 city pursuant to TMC: 15,041.140,
* With the exception of a utility operating pursuant ti)a valid franchise with the City of Tigard,when the owner and the applicant are different
people,the applicant trust be the purchaser of record or a lessee in possession with written authorir,ation from the owner or an agent of the
owner. 'rhe owner(s) must sign this application in the space priwided or submit a written authorization with this application, Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The aboyg request ,recorded dped restrictis�n� that inal,be attached to or imposed upon the subject
• 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.
• ,U- of the above statements and the statements in any plot plan,attachments,and exhibits transmitted herewith,are true,and
the applicants so acknowledge that an),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.
Applicant/Authorized Agent's sigAature Print name Dat
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 • 13125 5W Hall Blvd. • Tigard,Oregon 97223 • www.dgard-or.gov 503-718-2421 • Page 2 of 4
Compass Oncology Building Sewer Tie In To Public Sewer
12123 SW 69th Ave Tigard Oregon
)uth St S'vv Dartmouth St SW Dartmouth St
cr
0-0
cn
rr�
CONNECT TO CITY S WER
LATERAL IN SIDEWA K
NEW 6" BLDG S.S. LINE
a
�n
#'
Google
1 aYlTrmn BBUE SCR PEANrta®01
- ISSUES
`_-(E)4'STS TO REMAN
A REVISIONS
A•SANUP 4'SAN UP
r UP
UP TO WALL CYAN OUT rVUP
rSAN UP-� 1-17VUP 3'SAN UP -
r SMI UP
r SAN UP `f ----
UP TO CLEAN OUT
r SAN UP ♦EPS F S
2 SAN
UP TO WALL CLEAN OUT �r
TYUP �r
r SANUP J O&I MI S
1
a•SAN UP
1-17 YUP
''s"°IU' TI PACKAGE
Z"SAN UP
W �
UP TO WALL CLEAN OUT w
H }
a
1-11YYUPUP
j O
UP TO FS-1 m J
SANUP 2'SAN UP � w WQ Q
' 1.17 V UP� 1 1J <�' U
2'VUP UP TOWALL CLEAN OUT U m� Q
�O
0 'O0 a
2'SAN UP� ISAN UP
,SAN UP V 0
r SAN w � � � r0
1
7 V UP 4'SAN UP U
r VUP 71M UP V Q
/ 1"SAN UPJ
a•SAN LR J
a r SAN UP /
r SAN W l
u
N UP TO WALL CLEAN OUT KETPLAN
C
2
a
B A
UP TO WALL
j CLEAN OUT
i "'AN
UP UP TO WALL CLEAN OUT
I
PLUMBING
SAN UP 2'SAN UP 75AN UP `1•SAN UP UNDERGROUND
PLAN—LEVEL 1
SEGMENT A
(E)4'STS TO REMAIN (EW STS TO REMAIN
tg1CTr9PJ6T.e�GEftR Y Y�� JOB ProjectNumbE
DATE 08/17/2018
c KO ASM UNOEbiPLOORPIAN LEVEL^SEGMENTA SHEET
r� P02-00P
Compass Oncology Building Sewer Tie In To Public Sewer
12123 SW 69th Ave Tigard Oregon
7uth St SW Dartmouth St SW Dartmouth St
c�
s
m
tica
CONNECT TO CITY S WER
LATERAL IN SIDEWA K
NEW 6" BLDG S.S. LINE
m
<..
a�rrrc rrrrrr��
TIN
m
4
� • so i
Google
1{WtirzOte 08UE lOR IERMRIBIODi
(E�4-ITS TO REMAIN
IiEVISIONS
4•SAN UP
4'SAN UP
2'VUP
W TO WALL CLEAN OUT Y V UP
r SAN UPS 1-1 R•V UP3'SAN UP
r SAN uv
rSAN UP \
`UP TO CLEAN OUT
Y SAN UPf ♦ �f�p,
Y SAN UP f
UP TO WALL CLEAN OUT �Y r
YVUP
z•S N UPT", 08/17/2018
41 SAN UP 1-112'V UP
4'SANUP TI PACKAGE
2'SAN UP
Ui
ofUP TO WALL CLEAN OUT !2
^ W
U)
1112'V UP 3'SAN UP 2*SAN VP V
UP TO FS-1 a
I'SAN UP 2'SAN UP � w m m Q
-,rrvuP I IJ am U
:•V UP UP TO WALL CLEAN OUT UU �p Z
go! C)
c1l)
:'SAN UP� YSAN UP W ✓�+� a
4'SAN UP V
41 SAN UP /
O
:�T. YVUP NUP Z
\
rSAN UP 4'S ^ Z
rVUP / C')
/ 4•SAN UP
J �/
4•SAN LIP J
Y SAN UP
Z,SAN UP
w
UP TO WALL CLEAN OUT NEYPLAN
C
z
B A
o UP TO WALL r SAN UP
j Cl6AN OUT �Y UP TO WALLCLEAN OUT
z
PLUMBING
--- rsANUP
..Up
rsANUP `2•SANUP I UNDERGROUND
-- - - - - PLAN-LEVEL 1
SEGMENT A
.-..--.- (E)4•STS TO REMAw1
fAIIITT9H9.LT.Fl9ElHIQR `�lEH'srs TO REMAIN
JOB Project Numb(
DATE 08/17/2018
PLLlAbING UenEMLOOR KM-AEVr*I$*QA ENT A SHEET
vi•=V.T
a
P02-00P
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit*; BUP201MO242
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2018
Parcel: 2S101AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Project: Compass Oncology Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Descriptlon: Interior demolition of existing building,then tenant improvement shall be interior construction for new women's
cancer treatment center.
Contractor: TURNER CONSTRUCTION CO Owner: MCKESSON SPECIALITY HEALTH
375 HUDSON ST 10101 WOODLANDS FOREST DR
NEW YORK, NY 10014 THE WOODLANDS,TX 77380
PHONE: 503-226-9825 PHONE: 281-863-4723
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Permit Fee-Additions,Alterations, 10/15/2018 $23,016.95
Class of Work: ALT Type of Const: IIB Demolition
Occupancy Grp: B Occupancy Load: 403 12%State Surcharge-Building 10/15/2018 $2,762.03
Dwelling Units: 0 Plan Review 09/10/2018 $14,961.02
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 10/15/2018 $388.00
Bedrooms: 0 Bathrooms: 0 Plan Review Addi-Fire Life Safety 10/15/2018 $1.00
Value: $6,000,000 Info Process/Archiving-Lg$2.00(over 10/15/2018 $294.00
11x17)
Metro Const.Excise Tax 10/1512018 $7,200.00
Floor Areas:
Total Area: 0
Accessory Structs 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $48,623.00
Required: Required Items and Reports(Conditions)
Fire Sprinkler. Parapet: 1 Special Inspection(see plans)
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Pairking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification CeZor/.83.332.2344.se rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You mayobtaina copy of the rules or direct questions to OUNC bycalling 503.232.1
Issued By: /37� ee Signature:
Call b0 9. s by 7:00 a.m.for the next available Inspection date.
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.
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00 FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
(work in the right of way)
Engineer's estimate X 5%(less$300.00 submittal tee)
Engineer's estimate X 20/o Plan Review Sketcb
(including information below)
WATER SYSTEM FEE
D Dimensions
Part 3: All public water system improvements
El Street Name
Engineer's estimate X 121'/4 ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
Where will be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following types of work:
• 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 D 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 D Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water(duality Facilities
• Test wells ❑ Grading
❑ Landscaping/'free 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
❑ Engineers seal/signature
D 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
❑ Engineer's Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SVG'full Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-7113-2429 • Page 3 of 4