PFI2022-00132 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12022-00132
13125 SW Hall Blvd.,Tigard OR 97223 503 718.2421 Date Issued: 04/12/2022
Parcel: 2S111 CB01748
Jurisdiction: Tigard
Site address: 10335 SW HOODVIEVVDR
Subdivision: HOOD VIEW NO.2 Lot: 44
Project: Grigg Encroachment Permit 2
Project Description: Temporary encroachment permit for a moving pod. Place 1 moving pod at curb in front of house.
Dimensions 16'x 8'x 8'. From April 20,2022-April 23,2022.
Class of Work: FEES
Type 2-Sidewalk/Driveway Approach Description Date Amount
Total
Owner:
REQUIRED INSPECTIONS
Call 503-639-4175 for the IVR inspection request line or visit the City of
PHONE: Tigard website at www.tiaardor.00v to schedule inspections online.
Contractor:
PHONE:
Applicant:
GORDON GRIGG
10335 SW HOODVIEW DR
TIGARD, OR 97224
PHONE:
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:
J 1
f' r
Issued By:
Special Conditions(See Atta/hed)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
PFI_Sidewalk/f 15-UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before
digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the
applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with
affected utility agencies.
PFI_Sidewalk/[ 16-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI_Sidewalk/f 17-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads, ditches,etc.)as may be necessary, as determined by
the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Sidewalk/[ 18-SEWER SYSTEM TEST Applied Notice
A sewer system air-test and/or DVD T.V.test report and one set of"As-Builts"shall be provided for review and approval.
PFI_Sidewalk/[ 19-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 20-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/[ 21 -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 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI_Sidewalk/t 23-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners,and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI—Sidewalk/1 24-VALIDATION OF MATERIAUCONSTRUCTION Applied Notice
The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI_Sidewalk/[ 25-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/t 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain
or provide for proof of right-of-entry or easements.
PFI_Sidewalk/f 27-PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI_Sidewalk/t 28-AS-BUILT DRAWING Applied Notice
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the
City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance).
PFI—Sidewalk/1 31 -OTHER Applied Notice
Other
City of Tigard Perlit#: ?02 2-oo
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ENGINEERING I PUBLIC WORKS
Encroachment Permit Recorddinturn g(ForgPermanneent�)
PROJECT INFORMATION
Project Name: r'1'� #.J
This Encroachment is for:,0 Furnishing ❑ Underground System ❑ Privately owned Structure L1 Hacdscape
•(See Tait Is16 for deanWom)
SITE INFORMATION(Inchrde:Sits aWras,pnpMW rue of sot-of-niaj,p%tiosul/ime fivme, conhnctorionuation,a d
reale drunrng of eirmiachment and its relationship t6 add'iamg profrertfer):
alarm l 1Oa5 �7o143Q- d'kl( ICT Curb 1+ltk(W? Gf heLtSL. ulnnSc t6 $� �8`
�r�M 2(p-Apr.?cL?2 t�,ro�gl Z�-Pv'�-�m22.
APPLICANT/ PROPERTY OWNER INFORMATION Is Applicant Same as Property Owoer? V' l Yes❑ No
Applicant Name:Goo {on G\rgiy:6f I6,i-y Property Owner.
Applicant Address: �� oadriew Qrie� Property Address:
City: ! ,o, State: o& Zip: qT224 City: State:_Zip:
Phone: 5[V--t i6-S4 1, Email: "����r�C/�a[ to Phone: Email:
THIS ENCROACHMENT PERMT IS SU�JECT TO THE PROVISIONS OF Tigard Municipal Code
Chapter 15.16. I certify that the information T;F in this application is true and correct to the best of my
knowledge. I have read,and i agree to be bound by Tigard Municipal Code Chapter 15.16.
Applicant Signature: Print Name of Applicant:
Property Owner Signature: Print Name of Property Owner.
IF INSURANCE IS REQUIRED BY CITY OF TIGARD:
Insurance Policy No. Policy Expiration Date:
Received by: Received Date: q r 2e— Permit fee:
Approved by Tl�iN f �- Approved date �ZI/ Add Fees:
City of Tigard 13125 SW Hall Blvd. • Tigurd Omgon 97223 • cwvwtiguri-or-gav • 503-718-2421
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