PFI2012-00037 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
a COMMUNITY DEVELOPMENT Permits¢:: PF12012-00037
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/29/2012
Parcel: 1 SI134CD_0740.0
Jurisdiction: Tigard
Site address: 11680 SW TIGARD DR
'Subdivision: BURLWOOD NO3, Lot: PTS 33&34
Project: Fink Driveway Approach
Project Description: Expand driveway approach-by 13'to replace existing damaged sidewalk.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
_ PHONE:
FAX:
Applicant:
HEIDI•FINK
11680 SW TIGARD DR.
TIGARD, OR 97223
PHONE: 503-810-6624
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 parties before beginning work.
Permittee/Applicant
Signature:
lAtf W,
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON;PRIVATE PROPERTY
Conditions for PF12012-00037
Type: Condition Name: Status: Severity:
RECEIVED
OCT 2 9 2012
City of Tigard CITY OF TIGARD
PLANNING/ENGINEERING
P
Public FacilityImprovement 'I) Permit
General Information: FOR STAFF USE ONLY
Property Address/Location(s): 116560 SW 7iV,rd Dr, Engineering�
Case No. I-1011—P003-7 ZO2`X003'1
Receipt No.: r1 a,
7 Date: I O Z4 I Z
*Applicant's Name: Kral I Vj %- Oe1p 1-t Application Accepted By:
Address: 1(WE ID 5 e(P-0 �) Revised 7/1/10
City/State: k -Li A44_ 0 ILS Zip: 7
Primary Contact W REQUIRED SUBMITTAL
Phone: S(3—k�O fol Fax: INFORMATION
Professional Engineered Plans are required
Contractor's Name: q. a&P ,-t;F for.
• Street Widening
. Subdivision Infrastructure
tt�vr • Main utility line extension:
0 Storm Drain,Sanitary—Tigard
City/State:qm�• DSU �/` Zip: � �2
0 Water—Tigard Water Service Area
Phone: ���b1 ���-7 Fax: (includes Durham,King City and a
portion of unincorporated Washington
County)
Plans By: l.`w ''Ce7
**Note:See Engineered Plan
Address: Submittal Checklist attached.
City/State: Zip: For all other work:Submit scaled sketch of the
Phone: Fax: work to be done.(see attached minimum sketch
oA �j�/J requirements and provided sketch area).
Description of work: �` V v` A9 �N`S�� 'curpin\master\land use application\PFI app.docr
I� Dt •1.� �S�'I� l �l �—
Estimated value of work(within the public right-of-way): $ 6(30
Is work related to a LAND-USE DECISION? YES [] NOZ
If so,please specify(MLP,SDR,SUB,etc.) case#:
Is the work related to a BUILDING PERMIT? YES❑ NO
If so,please specify(BUILDING PERMIT) case#: 1211**
*NOTE:Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for the work.
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.dgard-or.gov I Page 1 of 4
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:
(__o_;?Idewalk 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 Requirements
North-Arrow J 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 (se wer,-water,,storm)
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 2 of 4
SKETCH AREA:
Il �
Cityof Tigard 13125 SW Hall Blvd„Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page,4 of 4