PFI2017-00213 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00213
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 10/10/2017
Parcel: 25111 CC14600
Jurisdiction: Tigard
Site address: 10155 SW HIGHLAND DR
Subdivision: SUMMERFIELD NOA Lot: 197
Project: Christensen
Project Description: Repair and replace driveway apron and approach
Owner: FEES
Description Date Amount
PFI Permit Fee 10/10/2017 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRIAN CHRISTENSEN
PHONE: 909-838-9912
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.
Perm itteelApplicant �'u
Signature: ee
Issued By: ` ' 13-11
(o Lo��
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00213
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.
PH 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.
PH 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/[ 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.
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/[
erformance.PFISidewalk/[ 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
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Christensen
Site Address: 10155 SW HIGHLAND DR
Receipt Number: 413253 - 10/10/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12017-00213 PFI Permit Fee 100-0000-43114 $300.00
Total: $300.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1237 MBILODEAU 10/10/2017 $300.00
Payor: Brian Chistensen
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
City o,f Tigard RECEIVED
q PUBLIC WORKS — ENGINEERING OCT 02 2017
Public Facility Imrovement (I �
p
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
El TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ® Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE
Detailed description: and/or utility agency.
TYPE 2—Sidewalk/Driveway/Sewer
/ Work performed for the purpose of:
• Sidewalk installation or repair.
Property address/location(s):
• Driveway approach installation
_ 1 n � �.� and/or repair
-S•t��. 1 G j/" '2> _19_7'/kh R b D I's • Sanitary sewer lateral installation
and/or main line tap
❑ TYPE 3—Full scale Development
Applicant: �f2 i,4:v c.;r/iP[s--77ew,'sI-Al Work performed with Land use
Address: I D/ .5S ,l rJ t1/«i�,v D approval which includes any of
City/state: 7-16 A R 8 6 Zip: q 2 Z 2 y the following:
Phone:-76 q / Email: tcC h e-ct.h • Subdivisions or Partitions
• Street widening
Contact name: �110.'Ve &R iRk[Ay Phone: ��d' �`�� I
• Mainline installation for Sanitary
Contractor: G0,VCF'Te R i-4 _,r LLC. sewer, Storm sewer, Tigard water
CCB#: D n 7.5-2 Expiration: and/or Tigard Water Service Area
Address: �2 3 q3 AJ f 5 & je, d k 7-1-A*v D ZA' SUBMIT COMPLETED APPLICATION TO:
City/state:r7 l`� ti'7 ^ Zip: 72.. 3 3 City of Tigard
Phone: /�' �'�� mail: Planning/Engineering
13125 SW Hall Blvd.
Contact name: Phone: yz Og Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer: only may be emailed to:
Address: roMTermitsau ard-or.gov
City/state: Zip:
Phone: Email: Case No. f e C.42
� Q13
Contact name: ..ea
Application submittal fee: $
Additional fees: $
Estimated value of work is required(if over$5,000):$ Application accepted:
(within the public right-of-way) By: ///-S Date:
Applicati n reviewed:
Is work related to a LAND-USE DECISION? ❑ Yes ❑ No
y: D
If so,please specify (MLP, SDR,SUB, etc.) case #: Bate:
Applicant notified:
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No By: Date:
If so,please specify(BUILDING PERMIT)case#: l:\ENG\Permitapplications\pfi_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 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
12rol2eM.
• 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.
CA
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
JgIA % 13R/ � Gf1iS'�5�7 ai r-�v `7 "Z
Owner's signature Print name Date
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
DEVELOPMENT ENGINEERING FEES 1`011 STAFF USL ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00
FRANCHISE UTILITY AND SIDEWALK/
PERMIT FEE DRIVEWAYAND 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) f
Engineer's estimate X 2%Plan Review Sketch
y (ncluding information below))
WATER SYSTEM FEE ! ❑ Dimensions
Part 3: All public water system improvements ❑ Street Naive
Engineer's estimate X 12%
❑ Site Address
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required ;
for the following types of work: (Subdivisions%Partitiorls'and Street Improvements)
• Sidewalk repair(less than 20 lineal feet) 4
• Relocate or replace mailbox r Design Plans
• Ditch cleaning that does not involve regrading. (6 sets,24x36 or 2204)
• Weep hole repair ❑.Cover.-Site,Vicin ty,Abbreviation,"Legend
• Curb repair or replacement(less than 20 lineal feet) ❑ General Dotes(City,.Water,Sewer,etc.) .
• Lawn sprinkler system installation or repair ; ❑ Street(flan,Profile)
• Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan Profile)
• Planter strip landscape maintenance ❑:Water Quality Facilities
• Test wells ❑ oa:ading
❑ 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) El Details
❑ Traffic.Sight Distance
❑ Signing and Striping
Street Light Playa 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
SAMPLE SKETCH:
Edge of Pavement
—' Ditch
Streetlight I .!■:.l w 1.l w l w l w_rwoo-w�
a
FW
Drain
I � I Tri
� D
I r Gia ueler 1
4
1
I I _ •
Existing 1
' I N Driveway01
IL
w
IWO
! � 1
rl •
�I
Powerpole I I m a 1
� o w
9 �_-.-.-. .-.
�opeity Lme
I
1 I
iI Fire Hydrant(FH)
I I I
Scale: 'I"=30'
I I
I
� I 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 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 • wwwtigard-or.gov • 503-718-2421 • Page 4 of 4
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RECEIVED
OCT 02 2017
CITY OF TIGARD
PLANNING/ENGINEERING
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EXISTING DRIVEWAY —
MATCH WIDTH & GRADE
A
R/W LINE
VARIES SEE NOTE 3
2% SEE 2%
5' MIN 2� NOTE 3 SIDEWALK
SEE NOTE 2 A
30' MAX
6' 6'
10' MIN
og( G
owdEA .�cc�L3
-ares/ W
P�
PROJECTED TOP R/W �{
3/4>> OF CURB 6"
0
2% MAX
STREET •.
a 'a OR
a°goo°°°�g�°�° �. ! . ° +Y
O 00 0 0 f.
O pOao°moo°o o°o`co�°�o8o oaa 000°o°o o�°oa�<o a°o °
0000 00
2" OF AGGREGATE
SECTION A—A (3/4"-0") COMPACTED
1. CONCRETE COMPRESSIVE STRENGTH SHALL BE A MINUMUM OF 3000 PSI AFTER 28 DAYS.
2. CURB JOINT SHALL BE TROWELED WITH A MIN 1/2" RADIUS ALONG BACK OF CURB.
3. EXPANSION & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT IMPREGNATED
MATERIAL OR EQUAL EXTENDING FROM SUBGRADE TO FINISH GRADE.
4. SEE STD DETAIL NO. 146
CITY OF TIGARD APPROVM BY. NO SCALE
mp" OREGON MICHAEL A. STONE, P.E.
ENGINEERING DIVISION aTY ENGINEER STANDARD DRIVEWAY DWG. NO.
PUBLIC WORKS DEPARTMENT
2a TIGSARD,OREGON 97223 JANUARY 2013 w/CURB—TIGHT SIDEWALK 142
VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE