PFI2018-00117 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
Is COMMUNITY DEVELOPMENT Permit#: PF12018-00117
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/22/2018
Parcel: 1 S135DBO5602
Jurisdiction: Tigard
Site address: 11425 SW 94TH AVE
Subdivision: MILLERS'ADDITION TO HILLSBORO, ORE( Lot: None
Project: Root Excavation
Project Description: Separate shared party"wye"from 11385-open the road tap the main-angle branch (as per Jonny Gish)
within the same road opening as 11385(Branches appr. 3' apart).
Owner: FEES
Description Date Amount
PFI Permit Fee 05/22/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX
Applicant:
REBECCA SCHOENBORN
10824 SE OAK ST
#322
MILWAUKIE, OR 97222
PHONE: 503-656-6610
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: See application
Issued By:
Special Conditions Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00117
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/1 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/[ 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/[ 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
REC "#I
E."
City of Tigard MAY 17 2018
°
PIF"WORKS —I:NGINI-II?RING C�T�,
_.. Public Fadhty Improvement PFI) Permit "VG
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1—Franchise Utility\�brk
Check one: El Utilities Sidewalk/driveway approach ❑Streetimprovements performed by NAX_ , PGE
Detailed description n(i 1 ' ' r'1 xd/or utility agency.
l-3e5 _ • TYPE 2-Sidewalk/
Cs V brk performed for the purpose of:
t Gi t0i4h in 5-.trn e .n 1
• Sidewalk installation or repair.
n • p "`� • Driveway approach installation
Property address/location(s): L. Al 1 and/or repair
• Sanitary sewer lateral installation
and/or main line tap
Applicant: El TYPE 3—Full scale Development
PP6114 � Work performed with Land use I
Address: 1. 0 �� approval which includes any of
City/state: t-I l I VV i� • DK 1.ip: 9the following.
Phone•
IiD' 10 H=ail: CA Le.a.r i robinuom • Subdivisions or Partitions
�,.� !��� Street widening
Contaname:
ct Y Phone• Y�f
• Mainline installation for Sanitary
sewer, Storm sewer, Tigard water
Contractor: kqc� e�C C Cl�L'+�(��
C,CB#: Expiration:
and/or'Tigard Water Service Area
��SJ��CII I� �-- l�
Address: 1 �'T � _ 0 Ct i1 - i SIL 5UBMIT COMPLETED APPLICATION TO:
City/state:l ` I I I W&A 11f, 1 0 zil :cl-I ET I L City of Tigard
Phone l ?r, i1: (�, �' '1C. �jnL;�, Planning/Engineering
13125 SW Hall Blvd.
Contact name. effi Phone Tigard,OR 97223
Applications for"minor work in right-of--way"
I�.nguieer: only may be emailed to:
rAnzwrmits g.titgard-or.gov
Address:
City/state: lip: _1 p
Phone: F'm �ail: Case No.: � Z ld�0
Contact name: Application submittal fee(.070/10 of
Engineer's Estimate) $504•
Estimated value of work is required(if over$5,000):$_.2, i 0 .additional fees: $
(within the public right-of-way) Application accepted:
By: )L —
Date:
Is work related to a LAND-USI:DECISION? ❑ Yes No
Application reviewed:
If so,please specify (IMLP,SDR,SUB,etc.) case#: i ^G
1, By ;$ Date:
:_v '
Is work related to a BUILDING PI-IMMIT? Ves No Applicant notified:
If so,pleases ecify(BUILDING PERMI'I�case#: _ Bv- Date:
1 �-1 I:\ENG\OermitA lications L a ication Effective 10/26/2017
�' Gil t
r
City of Tigard 13125 SW 1 M 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'IAT IC 15.041.140.
" With the exception of a utility operating pursuant to a valid franchise with the O at}•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
I Ttiiities 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 mU be attached to or=oSed upon the subject
propem
• 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.
• 71e 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
Applicant/Authorized 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
City of Tigard 13125 SW 1 Tall Blvd. • 'Tigard,Oregon 97223 • www.dgard-or.gov 503-718-2421 Page 2 of 4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED SUBMITTAL
APPLICATION FEE REQUIREMENTS
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.
(work-in the right of way)
Engineer's estimate X 5°'o(less$300.00 submittal fee)
l?ngineer's estimate X 2°46 Plan Review Sketch
(including information below)
WATER SYSTEM FEE ❑ Dimensions
Part 3: All public Rater system improvements ❑ Street Name
Engineer's estimate X 12°o ❑ 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. (G sets,22406 or 2.2x34)
• 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 ❑ Fater,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)
El 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 I.and Use conditions)
❑ "Traffic Report
❑ Storm water Drainage Calculations
❑ Geotechnical Report
❑ Preliminary Access Report(Sight Distance)
❑ Proposed Plat
❑ Pathway Design(if applicable)
❑ Water Department Approval
❑ Engineers Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW hall Blvd. • Tigard,Oregon 97223 • wvcwvtigard-ongov • 503-718-2421 Page 3 of 4
FAK:505-656-6625
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NOTES:
1. ALL INSERTA-TEE HOLES SHALL BE MACHINE DRILLED AND CORED.
2.INSERTA-TEES ARE NOT ALLOWED IN NEWLY CONSTRUCTED SEWER MAINS WITH AN INSIDE
DIAMETER (I.D.) OF 10 INCHES OR SMALLER.
3. SEWER MAIN SHALL BE TWO SIZES (NOMINAL I.D.) LARGER THAN THE INSERTA-TEE.
INSERTA TEE �
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DRAWING NO. 530 REVISED 12-16
As required in
Off typical sections
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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.
CITY OF TIGARD APPROVED BY. NO SCALE
OREGON MICHAEL A. STONE. P.E.
ENGINEERING DIVISION aTM ENaNR TRENCH DWG. NO.
PUBLIC WORKS DEPARTMENT
S.W.HALL BLVD.
TIG O
TIGARD,OREGON 97223 JANUARY 2013 BACKFILL18
VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE