PFI2017-00011 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00011
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/1
0/2017 Parcel: 2S 110BA010BA04000
Jurisdiction: Tigard
Site address: 14380 SW MCFARLAND BLVD
Subdivision: SHADOW HILLS Lot: 25
Project: Jenkins Driveway
Project Description: Adjacent to 14380 SW MacFarland Blvd. Concrete/aggregate driveway is being replaced with a new
concrete driveway. This will include replacing the driveway approach apron/sidewalk.
Owner: FEES
Description Date Amount
PFI Permit Fee 04/06/2017 $300.00
PHONE:
Contractor:
SUMMERS MASONRY INC
PO BOX 1263
GRESHAM. OR 97030
PHONE: 503-669-2417
FAX:
Applicant:
EBEN JENKINS
14380 SW MACFARLAND BLVD
TIGARD, OR 97224
PHONE: 503-639-5725
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
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00011
Type: Condition Name: Status: Severity:
PFI_Sidewalk/[ 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law, the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Sidewalk/[ 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. The
spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited
and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up
and suspension of work to accomplish clean-up.
PFI_Sidewalk/[ 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Sidewalk/[ 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI—Sidewalk/1 05-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/[ 06-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. call Jonny Gish @971-713-0281 or jonny@tigard-or.gov
PFI—Sidewalk/1 07-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/[ 08-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/[ 09-OTHER Applied Notice
RECEIVED
City of Tigard JAN 19 2017
PUBLIC WORKS —ENGINEERING CITY OF:TIG
ARD
Public Facility Improvement (PFI) ermit jEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑✓ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
Detailed description: Concrete / aggregate driveway is being and/or utility agency.
replaced with a new concrete driveway. This will include M TYPE 2—Sidewalk/Driveway/Sewer
Fork performed for the purpose of:
replacing the driveway approach apron / sidewalk. . Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s):
and/or
14380 SW McFarland Blvd. Ti ard, OR 97224
• Sanitary sewer lateral installation
2S 11D M o A 00D S 1JI�J�J and/or main line tap
Applicant: Eben Jenkins ❑ TYPE 3—Full scale Development
14380 SW McFarland Blvd. Work performed with Land use
Address: approval which includes any of
City/state: Tigard, OR Zip: 97224 the following:
Phone:
503 639 5725 Email: 1 eben. enkins@live.com • Subdivisions or Partitions
Contact name: Eben Jenkins Phone: Per above • Streetwidening
• Mainline installation for Sanitary
Contractor: Summers Masonry Inc. sewer, Storm sewer, Tigard water
CCB#:
#104047 Expiration: 12/31/2017 and/or Tigard Water Service Area
Address: PO Box 1263 SUBMIT COMPLETED APPLICATION TO:
City/state: Gresham, OR Zip: 97030 City of Tigard
Phone:503 669 2417 Email:summersmasonryinc@gmail.com Planning/Engineering
Ron Summers As above 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
N/A Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: rowpermitsatipard-or.gov
Address:
City/state: Zip:
Phone: Email: Case No.:Pf I V n– 00 01
Contact name: Application submittal fee: $ —260•00
Additional fees: $
Estimated value of work is required(if over$5,000):$ N/A Application accepted:
(within the public right-of-way) By: A'Y– Date: 2 y
Is work related to a LAND-USE DECISION? El Yes
reviewed:Yes V No 12
� k
If so,please specify (MLP, SDR,SUB, etc.) case #: By:j 4 i Sly Date:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes M No By:—�–9 Date:
If so,please specify(BUILDING PERMIT)case#: I:\ENG\Permit4plic tions\pfl application Rev.12/16/2016
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Person specified as "Applicant" shall be designated "Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
* With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,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 or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
prope
• 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 any 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.
R Eben Jenkins 10Jan 17
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
As above
Owner's signature Print name Date
Wendy Jenkins 10 Jan 17
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4
APPLICANTS
NOTE: Person silct-Ifed as \pplicalll" shall be dcsignatcd••Perming-"and ,hall provide Financia assurance Cor\v(A,if
required by the city-pursuant to 1'11( 1�.t111.1 111.
\\lilt Ilu rcrcjainn of..Mill" ulnr.,tutr 1,111-suanl h,a%,IIId ti.uttIli,, %kill,Iltc(.il, tit I iL:ud,%ahem tilt(mlivr aunt the al,l,licant arc difltrcnt
I)tnl%lc,the.q,plicuu nota I,c the I,urtl,.,<cr of w(,ird tit.,It;;ct in l,nsst. inli%,lilt,triton authu,Vati,)it fr.,nt IIx ImIit-I I I an agcnl of the
mIitI. 'Ili( o%%ncr(s; moa sign this al,phcation in iltc shaft l,rn itictl or submit :,%%,titin .tit hon/.III n with this apl,lit-mi,III. Ir.1IIC cd
I'tilitics a,i-not rctluircd In obtain tilt ov:nct's sigmattm nn the aphlicatinn
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• 'llte above request does not violate ant-recorded deed resn-ictiom that ilia) be attached to or imposed tuxtn the subject
pro pert-.
• if the application is granted, rhe applicant mill exercise Iltc rights granicd tit accordance-with the terms and subject to all the
conditions and limitations of the approval.
• All of tilt•above slatements and the statements in an\-plot plan,attachments,and exhibits transmitted heret.-ith,are true•;and
the applicants so ac•knomcle•dge that anepermit issurd,based on this application,ma\-be revoked if it is found that am such
statements are false.
• 'llu•applicant has read the entire contents of the application,including the policies and criteria,and understands tilt•
requirements for approving or denvIng the application.
R Eben Jenkins 14Jan17
\pphC:tIll Attthrn-rzcd :\gent's silmature Print name Datc
SIGNATURES of each ommer of the subject property, if required.
As above
Ownees sig-naturc Print name Date
Wendy 10 Jan 1 �
Oxvncr's si rc U print name late
Owner's signature Print name Date
PUBLIC FAC11,11N IMPROVEMENT PERMIT
Cite of Tigard 13 123 S\\ l lall Blvd. • 'I igard,Orcr on 9-"3 • wwwtihard-or.gov 303--18-2421 • Page 2 of 4
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DEVELOPMENT ENGINEERING FEES
Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
Part 2: All non-water system improvements CONNECTIONS,ETC.
Engineer's estimate X 5°6(less$300.00 submittal fee) (work in the right of way)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE
❑ Dimensions
Part 3: All public water system improvements ❑ Street Name
Engineer's estimate X 12% ❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(Subdivisions/Partitions and Street Improvements)
for the following types of work:
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,24x36 or 22x34)
• Weep hole repair ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.)
• Lawn sprinkler system installation or repair ❑ Street(Plan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑ Water Quality Facilities
• Test wells ❑ Grading
❑ Landscaping/Tree Plan
❑ Composite Utility Plan(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Street Lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight Distance
❑ Signing and Striping
❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
❑ Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department.Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
Cityof Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I Ditch
Streetlight -
- —•-----•—•— —r—•—
� R,j,,r
I ILr
'
' cfSeeilr,ri '
I - 1
►� i1 Existing House 1
r� I Existing
�1 II • Driveway 1
'� I 1
al V
CI � I ' �/y•
a
�I �0 i
C
j I i
o •
Existing Shop
C" �
Powerpole
I a 95'
I -------767per Line—-—-—-—-—-
II Fire Hydrant(FH)
I
Scale: 'I"=30'
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 Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4
Storm Sewer
................ - —. - - - - - - -
Sanitary
- - RSanitary Sewer
v
c
J
T
t
N
Proposed Project to replace
Existing D/W Apron with new
Concrete apron @ 14380 SW o
McFarland Blvd. Ln rz
� r
Legend CL
N
N
Existing
n
f/ r Existing Driveway i • f
Existing Apron •
Dim. A= 19' 0"
Dim. B = 26' 8"
xrs►ng r ew xistingr ew_4
Existing Curb Edge Existing Curb E—��-'--- �
®_ Sanitary Sewer
SW McFarland Blvd
.......................................................................................................................................................................
Storm Sewer
Streetlight `~