PFI2017-00078 Y „ CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PFI2017-00078
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/16/2017
Parcel: 2S 111 BA02300
Jurisdiction: Tigard
Site address: 14320 SW 100TH AVE
Subdivision: TIGARDVILLE HEIGHTS Lot: 29
Project: Hiatt
Project Description: Repair/replace gravel areas on north and south sides of property
Owner: FEES
Description Date Amount
PFI Permit Fee 04/26/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
JEFF HIATT
14320 SW 100TH AVE
TIGARD,OR 97224
PHONE: 503-334-6791
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
See application
Signature:
Issued By: --�
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00078
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/1 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/[ 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. Jonny Gish at 503-718-2467 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/1 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/1 09-OTHER Applied Notice
RECEIVED
City of Tigard APR 2 5 2017
PUBLIC WORKS — ENGINEERING
ITY OF TIGARD
Public FacilitNT improvement (PFAT ' CI7 ING
J
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1-Franchise Utility Work
Check one: ❑ Utilities NZ Sidewalk/driveway approach ❑Street improvements performed by NVG'N, PGE
�► ,1 0` � t kt„�„� ,5'd� and/or utility agency.
Detailed description: ,`,,,,w"'� k j
TYPE 2-Sidewalk/Driveway/Sewer
—l�t ✓� NL4
�
Work performed for the purpose of:
• Sidewalk installation or repair.
i � Driveway approach installation
Property address/location(s): IJo� IV and/or repair
�e
'I • Sanitary sewer lateral installation
arid/or main line tap
Applicant: El Work
3-Full scale Development
- Work performed with Land use
Address: 43 b 4kA approval which includes any of
City/state: uK r `Zip: � the following:
Phone `� Email: '1 til Ce� ( "^ • Subdivisions or Partitions
Contact name: Phone: • Street widening
• Mainline installation for Sanitary
Contractor: sewer, Storm sewer, Tigard water
- and/or Tigard\k'atcr Service Arca
CCB#: I?xpiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Planning/Engineering
Phone: Email: -- 13125 SW Hall Blvd.
Contact name: Phone: _ Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: only may be emailed to:
rowpermits&tjgard-or.
Address:
FSTAFF USE ONLY
OR
City/state: Zip: -�} 7
Phone: Email: Case No.: AtiOCD1-T` CIM�8
Contact name: Application submittal fee: S
Additional fees: $ 1
Estimated value of work is required(if over$5,000):$ NJ& Application accepted:
(within the public right-of-way) By: Date:
Is work related to a I:.AND-USE DECISION? ElYes El No) Application reviewed:
s,
If so,please specify (M.LP,SDR,SUB,etc.) case#: By: W.1ro Date:
Applicant notified:
Is work related to a BUILDING PER NIM El Yes ❑ No By: L_s Date:
If so,please specify(BUILDING PERMIT)case#: 1.\ENe\PermitwplKation5\vf-apoicatfan Re".12/16/2016
City of Tigard 13125 SVG'I lall Blvd. • Tigard,Oregon 97223 • wnvw.tigard-ongov • 503-718-2421 • Page 1 of 4
DEVELOPMENT ENGINEERING FEESFOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
REQUIREMENTS
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAY AND UTILITY
CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$300.00 submittal fee)
I?ngineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Pan 3: All public water system improvements ❑ Street Name
I?ngineer's estimate X 12°.0 ❑ 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)
lace mailbox Design Plans
• Relocate or replace (6 sets,2406 or 2204)
• Ditch cleaning that does not involve regrading.
• \X'eep hole repair ❑ Cover—Site,XTicinity,Abbreviation,Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,Water,Sewer,etc.)
• Lawm 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
El Landscaping/'free Plan
❑ Composite t'tility Plan{Electrical,Phone,Cas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Silmage,Street Lights,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ 'fraffic 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
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 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 utilih-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 imposes{upon the subject
rope
• 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.
Applicant/Authorized Agent's signature Print name Date
SIGNATU S eac owner of the subject property, if required.
- 'A W "W - qlX51
Own i e Print name Dat
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
Before
O
F
•mom• �:. -,�r '1
` 14320 SW 100th
jor
�a
T ,
SW View Terr
After
6 '
• 25' x 45' = 1125 sq ft on property
• Remove raised bed garden (825 Sq Ft) '
• 4" thick 1.5" Minus Compacted Gravel �; {� �
Sign Moved 20' south
n
• 17'x14' Gravel drive
• Remove barkdust
4 thick x 1.5 Minus Compacted Gravel
• +2" thick x 3/4" minus overlay 4320 SW 100th
i
4S t� Lo CTO
SW View Terr