PFI2018-00033 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00033
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/26/2018
Parcel: SEG2407
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Clean Water Services
Project Description: Applicant will be applying bark dust along Durham Road and 85th Avenue, and will be blocking the
sidewalk and bike lanes for scope of work.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
DENNIS KRAMER
PHONE: 503-866-4065
Total $0.00
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: �� G ��;�( Y�..
Issued By: v v
1
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00033
Type: Condition Name: Status: Severity:
PFI_Utilities 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_Utilities 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_Utilities 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_Utilities 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_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition, American Traffic Safety Services
Association [ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services. 503-629-0111 (Tigard Police Dept., Tualatin Fire& Rescue)and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m.to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole
before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at
the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI Utilities 14-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI—Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads, ditches, etc.)as may be necessary, as determined by
the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Utilities 16-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_Utilities 17-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—Utilities 18-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—Utilities 19-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 20-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_Utilities 21 -OTHER Applied Notice
RECEIVED
City of Tigard FEB 0 8 2018
�
PUBLIC WORKS —ENGINEERING CITY OF TIGARD
PLA;`IN ING/Ei1GINEE€Jt,!r
Public Facility Improvement (PFI) Permit
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1–Franchise Utility Work
Check one: ❑ Utilities X§idev&/drive,,vay approach ❑Streetimprovements performed by i\�V\T, PGE
Detailed description: At' ILLI L411v ftp 641t� and/or utility agency.
❑ TYPE 2-Sidewalk/Driveway/Sewer
Work performed for the purpose of:
Sidewalk installation or repair.
Driveway approach installation
Property address/location(s): l t✓� L'`•`-` `� and/or repair
V�'1 �4/0� •*T l(i ` 4 G)� 4f 4-� Sanitary sewer lateral installation
and/or maim line tap
Applicant: C41 A60 Lt1.41 FJt S F Nl L rk Ll TYPE 3-Full scale Development
` with Land use
Address: (o i) L83 :`�{�•. �� Work perfortned wapproval which includes any of
City/state: 7 (G/-t h :J A- Zip: 1 77-1-Y the following.
- Subdivisions Subdivisions or Partitions +
Phone: clek,
c
j e11 1- • Street widening
Contact name: -hems % K/t-tM t✓' Phone: ��
S 3 1r-Lrt. fr b,5" • mainline installation for Sanitary
` sewer, Storm sex-ver,Tigard .eater
Contractor: NGS SV.-_Le-eve A ` r'T and/or Tigard Water Service.-lrea
CCB#: ` �*� Expiration:
Address: SUBMIT:GOMfPI. APPi.1CA'I'IONTO:_
City/state: Zip: City of Tigard
Phone: Email: Planning/Engineering
131125 SAX/Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor wort:in right-oflx ay"
Engineer: l only may be emailed to: +
ronpecmitsCatigard-ongov
Address:
City/state: Zip: ;
Phone: Email: Case No.,. fj
1
Contact name: ' Application submittal fee(:Q?%off_
Engincet's Estimate) $
Estimated value of work is required(if over 55,000):S U .U,'SgZ Krldd;donal fees $
(within the public right-of-way) application accspted,
Is work related to a LAND-USE DECISION? ❑ Yes [ No By Dare:
Appkc 'on t ved:
If so,please specify(MLP,SDR,SUIT,etc.) case#:
Date:
Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified
If so,please specify(BUILDING PEnfl'f)case#: By- 1�� Date:
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City of Tigard 13125 SVI Hall Blvd. Tigard,Oregon 97223 ww\%aigard-or.gov 503-718-2421 Page 1 of 4
APPLICANTS
NOTE: Person specified as`Applicant"shall be'designated"Pertnittee"and shall provide financial assurance for work,if
required by the city pursuant to Ti\-fC 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
roe •.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terns 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.
• Tlie applicant has read die entire contents of the application,including the policies and criteria,and understands the
requirements for approving or nying the application.
C Ir
Ap c Authori Agent's signature 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
PUBLIC FACILITY IMPROVEMENT PERMIT
L
City of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • urww 6gard-or.gov 503-718-2421 • Purge 2 of 4
i
DEVELOPMENT ENGINEERING FEES FOR STAFF I ISE ONLY
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
Part 1: Required submittal fee$300.00 _
F1�A Iew$jj UTILITY ANI)SIDEWALK/
PERMIT FEE DRn,- U 'ILIT- x` ,
C4NS B a a t
Pat 2. illl non-water system unpro� nts moo.
_10- -
Engqi}tleer s estimate X 5%(less$300.00 submittal feel
Engineer's estimate X 2%Plan Review Sl�retfb j "� '
(inclu infoiiziation�beloty� _'�,�}��k= �•.��rs;;.*��>�:, �
'r
WATER SYSTEM FEE - �'•�������••� �,;�-h.'-•-
�,ravC+T<r': L itj,s3' 1S :;i� ri rim te,:
Q D]3DCt t1iis �Y�Si r 3 `<LF��-( 1'_� ,h...
Part 3: All public water system improvements ns�,
4� Street) $ltle z ,X.s yrs x , 7st' i
Engineer's estimate X 12% ❑ Site Address �z���4. -::t"� ~`
t r:n•rc�(v3k^?�i2�'c'Y c "fir.�•na:'._.bt .C ti L rit tr� is
PFI Permit Fee Exemptions: ' r •�� - - � ;-z
FULL, AL �$VLLOPMENT
There will be no permit fee charged,or assurance required
(SubdiMrti
siosis/Pations and Street Improvements) i
for the following types of work: _
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailbox Design Plant
(G sets2406 or 22x34)
• Ditch cleaning that does not involve regrading.
• Weep hole repair _Q Cgver Srte,V10",Abli�re��ation'Legend r„
• Curb repair or replacement(less than 20 lineal feet) .0 Gc�ttl�Alotes`(City, \rater,Sewer,etc)
U
• Lawn sprinkler system installation or repair ❑ Street �q file) , - .a}
Street tree pruning or planting ❑ W er,siQ and Sanitary(Plan Profit) y';
• lanter strip landscape maintenance ❑ Wotcr Q!'allt}'Faalstres >r.c
• Test wells g
Grad1I7
♦ L
CJ Lantlsc piW Tree an
D Composite I7aty Plan(Electrical Phone,Gas,
Note: A cash assurance may be required per Storm,Sanitary,Water,Signage,Stt� . g its,etc)
❑ ,:;:
pCta#15 C�
TMC 15.04.140.(custarner deposit) s
D T4*Si6i istance .l
❑ Sigi*and Striping
�.:.
U Street'Ught P.1ia and Photon etrtc
] ttineers silmature
D Sl cetlabel(pioject land use naine,recision and
plan log block,dates and sheet numbers) f
AdditronaI.Submittals
(per Lan A16 conditions).
_Traffic Report_, , .._'r♦ _, ' +s °r ` t, .�.
0 Storm water Drainage 096ulatlons
❑ Geotechnical Report
D Preliminary Access Report(Sight Dishy i-
❑ Proposed Plat '
❑ Pathxay Design(f gppkcable)
❑ Nater Departrnent.rlpprav�al
❑ Engineer's Construction N:stimate =
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SSU Hall Blvd. • Tigard,Oregon 97223 • w\vw igard-or.gov 503-718-2421 Page 3 of 4
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MINIMUM SKETCH REQUIREMENTS (Put'IN/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 `frees
Existing S/W or of pavement Existing utility locations
i
D/W apron (sewer,�trater,storin)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigatd 13125 SW Hall Blvd. • Tigard,Oregon 97223 • ,igatd-or.gov • 503-715-2421 Page 4 of 4
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City of Tigard • C'OMWINITY DEVELOPMENT DEPARTMENT
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Request Permit Action
► 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 www.tar -o . ov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
(check one)
REFUND OR Name:
INVOICE T O: (business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓}:
CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: FfA 2A)N r U,
Site Address or Parcel #: Z—l
Project Name:
Subdivision Name: Lot#:
EXPLANATION: « +`4 PF I Zi)IS ` WO--� aj
Signature: Date: 2
r
Print Name: f-'� LIVIe og-
Refund Policy
1. 'rhe Director or Building;Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 800 o of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80',o of the land use application fee for issued pemvts.
d) not more than 80°.o of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80("o of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment Nvas received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date B 37 Rte to Bldg Admin: Date B
Refund Processed: Date By Invoice Processed: Date B
Permit Canceled: Date (r /P B Parcel Tag lidded: Date By
Receipt# Date Method amount$
1:\Building\l,orms\RcgPcnnitiction.doc Rev 05/25/2012
RECEWL I
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FEB 2 12013
City of f Tigard CITY 0,=IIGAQ 0
LANNI* PUBLIC WORKS—ENGINEERING €
Public Facility Improvement (PFI) Permit
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TYPE oV WORK• —
DESCRIPTION OF WORK(in the tight-of-way)
❑ TYPE I—Franchise Utility 1Vark
Check one: ❑ Utilities Sidewalk/driveNvayapproach ❑Street improvements performed by IANN, PGE
/,1 .r ls enc
Detailed description: A -ICATIO c`-t--# �►1a- l and/or uttry agency.
y.
A i-�}N ��j �.i ^ n ❑ TYPE 2—Sidewalk/Drivei��ay/Suver
�H At f lN� Work,performed for the purpose of:
Sidewalk installation or repair.
` U ��� � ,. ,• Driveway approach installation
Property address/location(s): and/or repair
-T l G AA o Z ` 49LZ Sanitary sewer lateral installation
and/or main line tap
Applicant: C L / �U ��" /Z `- ��:L��l Lr ❑ TYPE 3---Full scale Development
lip Work performed with Land use
Address: 0 JL4,► == ilk �� approval which includes any of
City/state: "T i&4L p - Zip: -1 7uA the folio wing:
5-V S �"�'rr oto(yspmail: l�% tit r + e1 k W • Subdivisions or Partitions
Phone: 1 �. � C -L �- G
4 eS r �i • Street widening
Contact name: n+ttJ Phone: • l•laintine installation for Sanitary
sewer, Storm sewer,Tigard water
Contractor: N G'� S V L6_:C.T c� `��7`
CCB# and/or Tigard Water Scrvicc arca
`�`�, � _ Expiration:
Address: _=;:�UBbiITCA1IQ!I.ETBDAFPI.ICA'IEONTQ:; :',`
Cit}/state: Zip: City of Tigard
Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"ininor work in right of-way"
Engineer: only may be emailed to:
�= rawpermits&ggrd_or,gov
.Address:
FOR STAFF I'SE1 ONLY
City/state: Zip: >.
Phone: Email: Casc No,-
Contact
o Contact name: tian scrbtr►t#tal fee(.07%of
Engineer's Estimate)
Estimated value of work is required(i£over$5,000):S if .'uf� Z K► Additional(sees:$
(within the public right-of-way) pplzcatson-accepred
r
BY t Bate:
g. �.
Is work related to a LAND-USE DECISION? ❑ Yes No
If so,please specify(MLP,SDR,SUB,etc.) case#: :1ppLca 1e
BYE.."
Is work related to a BUILDING PERMIT? ❑ Yes ANO AppU6 nt notified. .:::;:..;
If so,please specify(BUILDING PEItMI'I)case#: By
::�.cltnclAern►�pprcattonslpta;�pp�ct�on.:E�r«�sieyiW�otf�;':=:.:
i
I 72 , ' - r. -7 4
Cit? of Tigard 13125 S\� Hall Blvd. Tigard,Oregon 9 ..23 �vwu.hgard o gov 503 18-2121 Page 1 of
i
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APPLICANTS
NOTE: Person specified as`:applicant"shall be'designated"Permittee"and shall provide financial assurance for work,if
required by the cite pursuant to TIIC 15.041.140.
,: Vvith the exception of a utilih•orwrating piLrsuant to a valid franchise\6th die City of'11Kud,when die 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 flus application in die space pro-%tided or submit a written authorization wide this application. Franchised
Utilities are not rcyuircd 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
r i r
• If the application is granted,the applicant will exercise the rights granted in accordance witli the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements un 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.
• 'I1ne applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or d nying the application.
Applicant/Audhori Agent's signature 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
PUBLIC FACILITY IMPROVEMENT PERMIT
Cite of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2.121 Page 2 of 4
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DEVELOPMENT ENGINEERING FEES
FOR STAFF USE, ONLY
Public Facility Improvement(PFI)Permit:
APPLICATION FEE
Part 1: Required submittal fee$300.00
FRANCHISE UTILITYAND SIDEWALK/
DRIVBW�IY A►N�I`UTILITY
PERMIT FEE
-• ; -.. _
' CQNEC�'iUTS,ET�,
Part 2: All non-water system improvements �.-
(W0'&sn the dA
Engineer's estimate X 5%(less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
{including information below)
WATER SYSTEM FEE ❑ Dimensions S
Part 3: All public water system improvements
❑ Street Arne
Engineer's estimate X 12/0 ❑ SlteAddress
PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
for the following types of work: ($ubdrgiatons/Farattoris sad Street Improvements)
• Sidewalk repair(less than 20 lineal feet)
• Relocate or replace mailboxsigtttPYatu _
• Ditch cleaning that does not involve regraduig.
• Weep hole repair :_Corer-.Ste NTicunt��:�li}afeviatiaa;:_hegend
• Curb repair or replacement aess than 20 lineal feet ❑ GeaelAlores Water Sewn etc.
• Lawn sprinkler system installation or repair ' Street.... _.a.:,P
Street tree pruning or planting ❑ rater,Stour aAs Sanitary(PiaciP�cofle);;
Planter strip landscape a maintenance ❑ ��rater QuaGtlFaulitics
_ E
• Test wells 0 ..............G
❑ Iandsca m ::::......:::...
.p g/TreePlsn.
❑ Corn s - _. . .
pc� tc Utilitg Planlectuca,.>,Phone,Gas,
Note: A cash assurance may be requiredper StQcm,Sanitary,Qi7ater:Signage,Sheet Lghs;,etc
TMC 15.04.140,(customer deposit)
❑ 'Txtc Sight Distance
.. .
❑ Si run as Lim
g $
❑ Street Ial1t:Plsr: rtd Phofoiiictic - ........
❑ ;Engineers seal/signature
❑ 5hcetL be1(p�colect?a, use-1riatu 4;ewsion
piaci lob blt�cl�datesrcd sheet
..... ...... ..:.:
AddidiW S►eliir ;t 4s: _
ct ImiUs :corditiois
Storm water U sage Calculatiaits:`......:.
❑;.P r::.,..___:....Access:R ort S htDistance
[ Proposed Plat
PaD4stgi(f applicalc)
Q �l`IaGer Depaxtment ilpProa1
❑:::$ttgineer's Cs11 tcuGtoti l~stitnate _
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • \v«%atigard-or.gov 503-718-2421 Page 3 of 4
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