PFI2012-00022 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12012-00022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/19/2012
Parcel: 1 S134CB03700
Jurisdiction: Tigard
Site address:
Subdivision: SUMMER HILLS PARK Lot: 35
Project: Driveway Approach Replacement in front of 12510 SW Summer Crest Drive
Project Description: Replace existing driveway approach in front of 12510 SW Summer Crest Drive
Owner: FEES
REYNOLDS FAMILY TRUST Description Date Amount
12510 SW SUMMER CREST DRIVE
TIGARD, OR 97223
PHONE:
Contractor:
PETER WARE CONSTRUCTION
8857 N.WILBUR AVENUE
PORTLAND, OR 97217
PHONE: 503-975-0141
FAX:
Applicant:
PETER WARE
PHONE:
Total $0.00
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 p4be�fowre—bening work.
Permittee/Applicant
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
J
Conditions for PF12012-00022
Type: Condition Name: Status: Severity:
RECEIVED
City of Tigard JUL 19 2012
�
Public Facility Improvement CITY OF TIGARDPLANNING/ENGINEERING(PFI) Permit
General Information: FOR STAFF USE ONLY
Property Address/Location(s): 1 2 5 Engineering n��r�/�+ Z�
Case No.: / L
`�yt l�ldf'1 P_ Cres T d� Receipt No:
7
Date: -1 b7 mi
*Applicant's Name: '\\ Application Accepted By: J
Address: Z'J5'/ d S CO cS ^^LA X4 o-1 Q� ( ,Y e_.1,��J✓ Revised 7/1/2011
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City/State: !yGcy p: `ZZZ
Primary Contact: IF REQUIRED SUBMITTAL
INFORMATION
Phone: /� Fax:
(D V AQ
E-Mail:�� r D 0 A rJ<P f U. � d l� Professional Engineered Plans are required
� p r for:
C�,��� lN� �- ( {�LI.C�I �Yl • Street Widening
Contractor's Name: l • Subdivision Infrastructure
CCB# / 74-7,95 Expiration: • Main utility line extension:
���7 l� W i G�GyV / wC, 0 Storm Drain,Sanitary-Tigard
Address:
` 0 Water-Tigard Water Service Area
City/State: �6yr� h� Zip: 2! (includes Durham,King City and a
portion of unincorporated Washington
Phog]B LI 7 S- Fax: County)
"Note:See Engineered Plan
Plans By: Submittal Checklist attached.
Address: For all other work:Submit scaled sketch of the
City/State: Zip: work to be done. (see attached minimum sketch
Phone: Fax: requirements and provided sketch area).
nn I:curprn\master\land use appGcatfon\PFI app.docx
Description of work: A21
Estimated value of work(within the public right-of-way): $
Is work related to a LAND-USE DECISION? YES F-] NO F4
If so,please specify(MLP,SDR, SUB,etc.) case#:
Is the work related to a BUILDING PERMIT? YES[] NO Rj
If so,please specify (BUILDING PERMIT)case #:
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 5
APPLICANTS:
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on
the front of this application in the"Required Submittal Elements"box.
NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
*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 on the
back of this form or submit a written authorization with this application
(Detailed Submittal Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.)
BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT:
♦ The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property.
♦ 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.
♦
All of the above statements and the statements in the 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
approving or denying the application.
SIGNATURES of each owner of the subject property.
DATED this I� day of 12 L�
Applicant/Authorized Agent's Signature er's Signature
Owner's Signature Owner's Signature
City of Tigard 1 13125 SW Hall Blvd.,Tigard, OR 97223 1 503-718-2464 1 www.dga.rd-or.gov I Page 2 of 5
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement (PFI) Permit:
Part 1: All non-water system improvements
Engineer's estimate X 5% (less $300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 2: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee= Part 1+ Part 2
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement(less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
2. Addressing Fee: The fee for this service is $50.00 per address.
SAMPLE,
Minimum Sketch Rec iremeants
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 of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations (sewer,water,storm)
City of Tigard 1 13125 S%X'Hall Blvd.,Tigard, OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 3 of 5
• SAMPLE SKETCH:
'91V SL
Edge of Pavement
I -00— Ditch ----W
Streetlight I ----•---•—•—•— —r—•—
fa
T' Rani Drain
iii Tr«�. � :a
I 1 o a 1
T-'rr±a'p'os d'S 'e rTi n e
1 - 1
W 1
v�
N Existing House
Existing
1
�i I g
aj Driveway
1 c0.
Li i i TT
v 1
0
o,
_�' I I t
"I � 1
a, I i
a
1 � 'Existing Shop 1
CA
Powerpole I I = 1 a 1
--------7roper- Line-----------
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I I Fire Hydrant(FH)
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Scale: 'I"=30'
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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 of Pavement Trees
Existing S/W or D/W Apron Existing Utility Locations (sewer,water,storm)
Cityof Tigard 1 13125 SW Hall Blvd.,Tigard, OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 4 of S
SKETCH AREA:
1w
r
� 2a!
Nye",���.n'
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 5 of 5
C line
l
Proposed 7'X
19'expansion
12510 S VV Summer C rest D
rd 00,
IIw
ik 4 20
Propbrty line
Existing porch Is 20'from property line -45'from centerline of road South side setback is Appx 6'and North setback is Appx 12'as measured at the corner of the principal building structure to existing
fences.
S.W. Corner
N Glen W. Sweet et ux
M Deed Book 339
Page 134
288.04 50
Az 19030, l
L.C.= S 09°aS.E 76.21
R = 226 cT F
Subject CD
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