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PFI2014-00061 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT q s COMMUNITY DEVELOPMENT Permit#: PF12014-00061 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/21/2014 Parcel: 2S109AD03100 Jurisdiction: Tigard Site address: 14605 SW 130TH AVE Subdivision: WOODFORD ESTATES Lot: 23 Project: White Storm Connection Project Description: Connect french drain system to storm/sewer system at 14605 SW 130th Avenue. Owner: FEES Description Date Amount PFI Permit Fee 08/20/2014 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: RANDY WHITE 14605 SW 130TH AVENUE TIGARD, OR 97224 PHONE: 503-784-0053 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 0+ QregC^— Signature: i Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY 1 RECEIVED AUG 1 9 X014 City of Tigard CITY OF TIGARD ■ Public Facility Improvement PLANNING/ENGINEERING (PFI) Permit Gem"I.bMM"u.: FM In"ME QN11 Psopeny AMww/I�oci.�aa(.�: 14 b 45 SW 130 "Aw .�j Z� cow 2�t4-cx�ocQ •moo N 1 Dn Addrm- 7V%01-52 5,JV Ave Chy/s AIL q-77-7-y pr axQumwwjsunnw�n�►roav T.&L iunq room S03--714- 66 F= i T<ta.� rGtn�l� z itis, IT i m • Sam°r'ufaling CC" 101-5,ol 2,a1 q • K. E Yat OY o s�nr,K s..�,-rid ddmmO Water-z1W Wrier Sa w Am Ciel/sate: ter c —7o �668 Dv&kk King city-0 r Phone wt Cp ni Cd }} �...Br _ submied Cl,ektir+r rtasdiea. SW '36 t" submit WSW skewh of dw �/ d q�Z Z`l woo a be d�(ate as ndsed aalidwros shw9b Pkoae suktz 577 _ —00 g.Y. r+a�drraoean and pro.ided sba A tett}. u,i+.kvwsa Ci L1WMN5lir+�1�++�L�Appae�rYfflat�i4 Ift - e looted wahm btwwk(with"dae PoUk dO""� '� ?.44 Ig WO&rchMd to s LAND-USE DBOSION? YES© No 5a It ao,Nere epee*0".SDR.SUB,ew-)aye L&t wcw c whwd so a►BUILDING 1NG YESW NID [] Plum2o14-w26q 4 If. ,N� ( City of TSprd 1 13125 SW Hd Biwa.7 jgwd,OR 97223 1 503-716-2464 I www.4pvd-ocWw I AW 1 of I& SCa, APPLICANTS: To crwaider ao appbcatwws complete,yon will need lo submit AL1.of the RE hm as deocrlbed eta► rbe(toot of thn applacatioe m the"Regtired Subotiud Ektaaser"box_ Nt7M: Persoo■pccff"as"Appbcant"shall be dt•iijsarcd"Pexnince"and shd provide finaonid a mmatoe for w a& OWben the owaet and dw mpphcaal are drgtrrrtt people,dee app hcx t mmw be the purchaser of record or■leasee in puwaeasioo With wlinea au"timaaoo 61t dw owner or as ajest of the owner. The o.rwet(a)must sip dhM application is the VmV powded on the back of tbar lona or quits written autbrxisatkm wilt delis AI"caana pr aW t infummu rts 1(Xcft 4sf1 he otrsrmd,upon mquest,for al types of Isad Use Appi ks6om-', BY SIGNING BELOW,THE APPUCANI'(S)SHALL,CERTWY THAT: s �.ili�4 nnoo the aubjttrtF�I = • 1f rhe appbmnm is granted,rhe apphcLnt will ammsr the rq+L-gamed in r_cordancc wtth 4e etxras and sutioc-to dl the vurxiorrm and hautauoar of kill spacuval • Al of the sbwe smtnmrrs sad the simwmc tb in till OA plan,attachmm s, and exhibits tmsaattkcl herewuh,arc Mar, std the appirarsts w aektsva.{�edAe that aa!pcmrt troxrk+�bated tx�tfus rpphcatson,row bt tnvl¢d rf rt a fuwd rise aar such sntesnrnta ate tiala:. • I1sc■pplam"has and dx surlier contests of the appicaback it�the Palkiesstd mcens,and UVA-mama s the mxPjfternenrs for apprc.VW cx dnrying the tp*StilxL SIGNATURES of=cb owam dthe wbim ll rmFmmtj- ah � DATED thea of A 11 a V � .21) Appicaat/Awboeistd AC-6 S gmwle Owsm%S*Mattae VLkk)' Owner'.Si jallume - - '+ SlRsaaoaa Ory of Tigud 1 13125 SW Hall Blvd,T'igtled,OR 97223 I 503-7111-20A I v►nrrw.eigarrl or-gw Page 2 ofd S��Qe a hoc V. Scale; y hale dfaiv% Z, yr,sall 303y clrathg9,� ?;Pp (3'' 79. voile or, bo-,h Sibs tV% r6h Shfla kjNj 910vt r ' proof d � pt°""A3, Shaw �rAi� 75' L( r I r �yM+1 1 r V2 pr n�f k / I a, Zen Dutson Subject: PFI 14-00061 Attachments: Zen Dutson.vcf Application approved.Applicant to call 503-718-2472 for inspection prior to backfilling pipe connection to catch basin. Zen Dutson „ City of Tigard Public Works Engineering Inspection Supervisor (503)71.8-2472 (503)572-5917 Cell zen@tigard-or.gov 13125 SW Hall Blvd. Tigard,OR 97223 wwwAigard-or.gov 1