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PFI2017-00160 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12017-00160 13125 SW SEG1 Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 2017 Parcel: EG1351 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Delta Fire, Inc. Project Description: 4"service for fire sprinkler system starting at 6 x 4 wet tap Owner: FEES Description Date Amount Fire Service Connection-Base Fee 08/11/2017 $1,495.00 PHONE PFI Permit Fee 08/11/2017 $300.00 Contractor: DELTA FIRE INC 14795 SW 72ND AVE PORTLAND, OR 97224 PHONE: 503-620-4020 FAX: 503-620-1058 Applicant: DAVID ASCHBACHER 14795 SW 72ND AVE PORTLAND, OR 97224 PHONE: 503-620-4020 Tota l $1,795.00 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 `_ln Signature: ZJr.�i �1�pLlC� Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00160 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/[ 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 RECEIVE® City of Tigard AUG 0 9 2017 PUBLIC WORKS —ENGINEERING CITY OF TIGARD ■ P NNIN /ENGINEERING Public FacilitY Im P rovement (PFI) Permit TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1-Franchise Utility Work Check one: '�; Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE Detailed description: 4" Stvy•ieL -f-w P#&L and/or utility agency. S Y S1W STAA&n J 4r Ar (.x4 W LT TAP. ❑ TYPE 2-Sidewalk/Driveway/Sewer Work performed for the purpose of: • Sidewalk installation or repair. Property address/location(s): Z • Driveway approach installation �lt�-�t�►t X99 4 �-• and/or repair 7 D o aw �r S S*"-e-+. • Sanitary sewer lateral installation and/or main line tap Applicant: El TYPE 3-Full scale Development PP Work performed with Land use Address: approval which includes any of City/state: Zip: the following. Phone: Email: • Subdivisions or Partitions Contact name: Phone: • Street widening • Mainline installation for Sanitary Contractor: bF LTA rrt RL, 1 x1 e- sewer,Storm sewer,Tigard water and/or Tigard Water Service Area CCB#: CA 174 Expiration: Address: 14'?OLS S M/ 7 2 M 4 Xy t• SUBMITC01 MIMAPFUCATIONTO: City/state: Pi0.T i_" D OA, zip: At 7 2 214 -79 S 2. City of Tigard Phone:Sp3•G20.40ZOEmail: Planning/Engineering 13125 SW Hall Blvd. C o)nttac`tnaame: U/W l t A SOLI ir►e!ffR Phone: So3.9 l •9 2 os Tigard,OR 97223 L* 7 1 Ss.'Lb(2!, PP • y ^�� Applications for minor work in t-of-wa Engineer: 40N lact 0 only may be emailed to: rowgemaits(a�yp�-or��ov Address: City/state: Zip: Phone: Email: GWe No.r I -2 "r I tQCL 0 �. Contact name: Application submittal fiv S 3C6•O0 Additional fees:S �ygs oC7 Estimated value of work is required(if over$5,000):$ P11A Application accepted: (within the public right-of-way) Bjays .Date: Application reviewed: Is work related to a LAND-USE DECISION? ❑ Yes ❑ NoBy�G iS � Date: V110A 7 If so,please specify (MLP!,SDR,SUB,etc.) case#: Applicant notified: Is work related to a BUILDING PERMIT? 19 Yes ❑ No By. Date: If so,please specify(BUILDING PERMIT)case#:F PS 2017.0,0108 1:\f"G\ft"^""opPc•"6^s\pfi-apo•tiDn Rev.17/16/2016 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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 uti}ity 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 ownei s signature on the application BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject prop • 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. 4t^ a le-K64c.-i Ek 8-9-zmt-1 Applicant/Authorized Agent gnature Print name Date SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date 1 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 As required in Off typical sections Streetof construction Area Street plans 1 ' T—cut see Surfacing note 1 ) Topsoil or as directed Base Material a� 0 O a U O � In > I� -0 E N � U O 00 U C v Z M cn 0 x E N XE c Q) �° L- C: a� C: r p N C 0 �' C 0 0 Q 0 :2 N j a N a O N i o bA. a,o U Q � Q 6" Min bedding „ below outside of 6 6 pipe bell 3/4" — 0" MIN MIN crushed aggregate ' 2' Min Trench foundation \ \� \\ stabilization if required NOTE: 1. 1' T—CUT FOR PIPE ONLY PROJECTS. 2. JOINTS TO BE TACK AND SANDED. 3. SAWCUT SHALL BE TACK COATED WITH BITUMINUS ASPHALT EMULSION. CITE'<riF TIGARD APPROVED BY: NO SCALE OREGON MICHAEL A. STONE, P.E. ENGINEERING DIVISION TRENCH DWG. N0. PUBLIC WORKS DEPARTMENT qTY ENGINEER S.W.HALLBLVD. TIG A O TIGARD,OREGON 97223 JANUARY 2013 BACKFILL VOICE: VOICE:(503)639-4171 FAX: (503)684-7297 APPROVAL DAIS 0 mo ° 0000 ryry o 0 Fresh GRADE a-g-}{W ,r usr ww.],o fo. wsoosn u wsLoso aloes ,c eD Er w]so rAr owsuuQ, ° CLAS 52 EXIS1NG N ILE IROPIPE oES1G �u r•�o o M' wsowniw Mr uw)sas '�"' swDw wa.w nwosr aaat w wuwf.an NORTH SOUTH �t BUILDING e BUILDING , waw x YOKLfMr D ore osfa a! �->pwwn caa.A aEIDEo a. s wa 12 ° )IJY.1,/]•.]A-La.G D,w, b! DDD fW]1 M1411�tz ]. "]oss rK r+s Au"'KaMaaawYlsf riA.Ma nrr PlflalAf«,DD .tYc AM r. T.]n•.r Lac NOTES: fRR marc nla �'i ]Has.lala,It faLOlYi IwNUWi Rf,wYfLDYi MO fe•aAMD p ruK wi xor ro RST awMW wfs. {ur n[mwPDM.L,w/s www aRs)L 0— a avu,wc uawa.. ® GAL A NIZE ° a°�'Eo ­i rzsiNT O x.- �mrAEa rwa,sr wau.o*rw.r,m.rm unlw,m n mYe.aYa K�IW A MEI[UH[3 K ] DrVIIR R RiM YD MI } rwlL w w casxa au o c:,.lo.cmwuss. ])«MtEA vwK oo)or s.M aarfo"Wu arMc Ac.s roD amM.ma[ctwls K svo.s olcrsnra a AR«OP[R.MIR M ILDIIf y lD fOKAIEf,!HrM[IQT aAro Alf.cOWI[D L SUPPLY TO SOUTH �� ':Nni iocarr ro coos.°�DM,ao n''w'0Y rtrwi`sA"f�ij)Ma'w'o AuoYLcsliiaiww q wows>.•fasDc fv r— ) naso r sur p a,IrM If-«rf)RI AA« BUILDING TO BE ROUTED <olloca rAo AowAo VALK �—u—I wol]wK sur a oma tNw a rsxr wow � )irA,rp w M swaw rfowcxi °( .i alao.Mm�.'pAl[PrL ew pErAa r"spm mAef ). )JIDu wo�r amac ar.a]Yc+w a w+ls rua n[sLV as '//,IIIN` awNN IurAf wE1 aanc m.xs aaM M nn Dwaw arYL russc uY.« OVERHEAD THROUGH CONCRETE PAD owosr noon ME c]arc rtEr NORTH BUILDING ❑ (BY DELTA FIRE) -_•,' TYPVAL GAILs. .•' T