PFI2014-00013 q CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
• COMMUNITY DEVELOPMENT Permit#: PF12014-00013
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/18/2014
Parcel: 1 S 134AD03800
Jurisdiction: Tigard
Site address: 10910 SW 108TH AVE
Subdivision: BLACK BULL PARK Lot: 8
Project: Pearson Driveway
Project Description: Permit for a new driveway approach located at 10910 SW 108th Avenue.
Owner: FEES
Description Date Amount
PFI Permit Fee 05/05/2014 $30000
PHONE:
Contractor:
TUALATIN VALLEY CONCRETE CORP
8950 SW LOCUST STREET
TIGARD, OR 97223
PHONE: 503-891-0955
FAX:
Applicant:
BRUCE PEARSON
10910 SW 108TH AVE
TIGARD, OR 97223
PHONE: 503-686-3364
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 p
Signature: I V
Issued By: C
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12014-00013
ems: Condition Name: Status: Severity:
RECEIVED
City of Tigard MAY 0 5 2014
Public Facility Improvement CITY OF TIGARD
(PFI) Permit PLANNING/ENGINEERING
General Information: J q� FOR STAFF USE ONLY
/
Prop Address/Location(s): Q�l 10 �y & 7 Engineering
Case No.•
C Fee: 3ty,t O
Receipt No.: i- 1 Sajoq
*Applicant's Name: bale'e, ��r�-'1 Date: 5.5. 14
Address: C_ 40 sol 144" Application Accepted:5.5. By:
City/State: r _ Zip: a 7 Z2-_
Primary Contact: REQUIRED SUBMITTAL
INFORMATION
Phone: ��X� Fax:
E-Mail: Professional Engineered Plans are required
for:
/ J
Contractor's Name: �i",b.�r; �i'1 14Llp_�/ /�c/G7�. : Street Widening
Subdivision Infrastructure
CCB#_ 7� Expiration: • Main utility line extension:
Address: .s 0 Storm Drain,Sanitary—Tigard
0 Water—Tigard Water Service Area
City/State: J ice
Zip: ?Z Z _3 (includes Durham,King City and a
PhoneF� / 62-1 r9— Fax: portion nuty of unincorporated Washington
tY)
**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).
Updated:6/18/2013
l:\CURPLN\Masters\Land Use Applications\Public Facility
t Improvemern.docx
Description ofwork:�G.l!` �f�(lJ �' 4�4,01— i
Estimated value of work(within the public right-of-way): ,
Is work related to a LAND-USE DECISION? YES F� NO
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 #:
City of Tigard 1 13125 SVS'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"Applicane'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 propel.
♦ 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 day of / // ,20�<�
Applicant/Authorized Agent's Signature Owner's Signature BBQ r/C f D •j�F,�SON
So3 6 96-3344
Owner's Signature Owner's Signature
City of Tigard 1 13125 SAX'Hall Blvd.,Tigard,OR 97223 503-718-2464 1 www.tigard-or.gov I Page 2 of 5
A
r
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 Requirements
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 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 3 of 5
SAMPLE SKETCH:
Edge of Pavement
Ditch tet`
Streetlight I —•---•---•-----r---
• ° RiUn Dricin
, o
I 1
►, I �, Existing House
I I �� I Existing 1
`� I �� • Driveway
IL
C, w I • ..1J1
0 I .
oa.�
t
o�
Existing Shop 1
Powerpole I I I 1
�. o • o
I a 95, 1
-- -lsioperiy Line
------ ------_---
I �
� I
II Fire Hydrant(FH)
I i I
Scale: 'I"=30'
I
� I
I I
� I
� I I
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)
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 4 of 5
SKETCH AREA:
N
I �
20
City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 www.tigard-or.gov Page 5 of 5
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