PFI2018-00135 _ aq UTY OF TOGA 3D PUBLIC FACILITIES IMPROVEMENT PERMIT
COfi�ilb�li1UNFY DEVELOPMENT Permit#: PF12018-00135
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/08/2018
m� Parcel: SEG301
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Lennar Northwest, Inc.
Project Description: Tap into waterline main in SW Oak St. Work will consist of AC sawcut,waterline install, hot tap, trench
backfill, and AC patch.
Owner: FEES
Description Date Amount
PFI Permit Fee 06/08/2018 $300.00
PHONE:
Contractor:
PHONE.
FAX:
Applicant:
DYLAN GARDNER
PHONE: 360-258-7905
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: ��- -�-- -i
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORE(ON PRIVATE PROPERTY
Conditions for PF12018-00135
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/[ 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.
Contact Ken fisher at 503 816 6146 or Kenny@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/[ 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
Oak Street is a collector.Work only between 9 a.m. to 3 p.m. Contractor shall coordinate with Oak Street Apartments
Superintendent to complete work prior to road construction.
RECEIVED
... ... ....
City of Tigard JUN 0 5 2018
PUBLIC `FORKS ENGINEERING
C IT Vii` t •. L
)
Public Fac* Improvement �TIFTA�'P&fiiiiftY
TYPE'OF WORD
DESCRIPTION OF WORD(in the right-of-way)
❑ TYPE 1-Franchise Utilinr`Fork
Check one: ❑ Utilities ❑ Sidewalk-/driveway approach E.S tree t imp rovements performed by IMAX,, PGE
�/ and/or utility agency=.
Detailed description: /� cJ to +0 #'Oo c..�afef 1--ne, main
J�� TYPE 2-Sidewalk/Driveway/Sewer
+Yl �W OQ K 5�: V�Of�C �f C( eonsi S� a� �C�QwCu4, �akf IYtiL Work-performed for the purpose o£
r Yt �u 1�, %')U _ _�` �. -fir G nC hQ L a�'t "LI+, Sidewalk installation or repair.
-� 3g�y S 1 35/� • Driveway=approach installation
Property address/location(s): Ia,)c _Q L 0�1 �Ioi`,a j and/or repair
:54t 4- S W C K5+,, S E o E 51nJ 90 yhi4y�r SCLA tf SW (Oa K k t Sanitary sewer lateral installation
and/or main line tap
e.
Applicant: L mr?a --- El TYPE 3-Full scale Development
ay- Nortj t�ve5 E, L>n
Work performed with Land use
Address: I9g
Io7 NEE ��� S+�SJP�� 1 170 approval which includes any of
City/state: Vail C C Uje't(`,, WA ! Zip: q,56�2 the following:
Phone: 366-9�S-�q�5 Emil: Jr GLf Jnn 1 e-yi noa-co n • Subdivisions or Partitions
• Street widening
Contact name: QV/441 2� _ Phone: 364 025 -7905
• Mainline installation for Sanitary
sewer, Storm sewer, Tigard water
Contractor: � � Coo�ngo-nr5 0nfjol� �-nc-
and/or Tigard Water Service Area
CCB#: Iq 56 5�3 l Expiration:
Address: ��(� �LP'1GZ.I1 a�pa�1 Ln /V SUBMIT COMPLETED APPLICATION IO:
City/State: Woo a J)C.ym{ 0/? Zip: q 70 71 City of Tigard
Phone: 971-�I6-005o Email: o)(P eff6Dnf iraJ6f5•C0M Planning/Engineering
13125 SW Hall Blvd.
Contact name: 0011110 (zx Phone: 503`3qq"7_17()3 Tigard,OR 97223
}( J ' Applications for"minor work ul right-of-way"
1 I S YI r i 10��3�r LLG only may be etia,,uled to:
Engineer: cj
rowpermitstigard-or.gov
Address: >'a 6�, Pit/�1P,�rman ,��� �a 16o
G FOR ONLY
Cite/state: Zip: l'l E?02
Phone: 503-563-6/51 Email: br0.t1a+6GtX:5-&fm•corn Case-Nod l =" �
Contact name: grm � lrf l s., Pell Applicariori submittal fee 07°'0 of
Engirleer's'Estirrlate) $ '
Estimated value of work is required(if over X5,000): ,, Additional fees $
(within the public right-of-wad-) catior accepted
By Date
Is work related to a LAND-USE DECISION? El Ye No '
Application reviewed
If so,please specify (MLP, SDR, SUB, etc.) case #:
By: Date. U<,
Is work related to a BUILDING PER1\41T? ElYes ® No kp licant noed
If so,please specify(BUILDING PERMIT)case#: B\ Date
I•\ENG\PermitApphcations\pfi application Effective l0/16/2017
b ,Z A C-7mp PAs-Ccs 4T 4 0=�,40, 4v }
City of Tigard 13125 S`ti'Hall Blvd. • Tigard,Oregon 97223 -,v,,,7-\vtigard-or.gov • 503-718-2421 Page 1 of 4
APPLICANTS
NOTE: Person specified as`Applicant"shall be designated'Tcrnh ttee"and shall provide financial assurance for work,if
required b},the city pursuant to TiVIC 15.041.110.
* Vitlt the exception of a utility operating purstiant to n vtlid franchise Willa the City of Tigard,when the oNvner and the applicant are different
people,the applicant must be the purchaser of record or a lessee in possession with written nutliorizatim from the owner or an agent of the
owner. The chwner(s)nxtst sipt this application ire tlhe space provided or summit a written authorization with this application. franchised
Utilirics are not required u)obtain the owner's si}ntature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
'1'lhe shove request does not violate:any,recorded deed restrictions that may be attached to or imposed upon the subject
properr.
If the.:application is gs inrcd,the applicant will exercise the rights granted in accordance with the tert-ris and subject to all the
conditions and liinitatlons of the approval.
a !lll of the:abo\7e statemetats and the statetnents in any plot plan,:attaclhments,and exhibits transnlitted herewith,are true;and
tlhe applicants so acknowledge that any permit issued,based oil this application,may be revoked if it is found that any such
stateine.nts:are false.
The applicant has read the entire contents of the application,including the policies and criteria,rand understands the
requirements for[approving or denying the application.
f�
�Pvt� 5/1U120i?
Appli crit%-luthorized Agent's -ij;nature Print ianze Date
SIG 1CIRE of 2eacla r�er of the subject property,if required.
Owner's signature Print name Date
Owner's signature Print name DaCe
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Owner's signattate Print name Date
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PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13'l25 S\V 1 I:all Bl%,d. a "Tigard,Oregon 97223 Y wwN�:tigard-or.gov 503-718-2421 Prtge 2 of 4
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DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI)Permit:
DETAILED.
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 sjTs tem improvements («Dili in the light of way)
Engineer's estimate X 5°%0 (less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review Sketch
(including information below)
WATER SYSTEM FEE
❑ Dimensions
Part 3: All public water system improvements ❑ Street-Name
Engineer's estimate X12% El
Site_-address
PFI Permit Fee Exemptions:
FI.ULL SCALE DEVELOPMENT
There will be no permit fee charged,or assurance required
(SiibdlVi i
for the following types of`work:
]ns/Pa.rtttions and Street Imp.'ements)"
• Sidewalk repair(less than 20 lineal feet) Design Plans
• Relocate or replace mailbox
(6 sets,24kU or 22 34)
• Ditch cleaning that does not involve regrading.
• \Veep hole repair .Cover Site,VicinityA
, bbreviation,Legend
,
• Curb repair or replacement(less than 20 lineal feet) ❑ General Notes(City,`�titer,Se«-er,etc.)
• Lawn sprinkler system installation or repair D Street'(Plah,Profile)
• Street tree pruning or planting ❑ `Vater,Storm and Sanitary(Pl'ti Profile)
2 .
• Planter strip landscape maintenance ❑ Water Quality Facilities`
• Test wells EJ Grading
❑ Landscaping/Tree Plan
Composite Utility Plan,(Electrical,Phone,Gas,
Note: A cash assurance may be required per Storm;Sarutar�,`eater,S gnage,:Street Liglits,etc)
TMC 15.04.140.(customer deposit) ❑ Details
❑ Traffic Sight'Distance
❑ Signing and Striping
❑- Street Light Plan and Photometric
❑ ;Engineers seal/signature
❑ Sheet label(project land use name;reN-ision and
plan log block;dates and sheet numbers.)
Additional Submittals
(per`Land.Use coitio.ns)
0 Traffic Report
❑, Storm water Drainage'Calculations
❑ Geotechnical Report
Pr&dminarV Access`R66rt(Sight Distance)
Proposed Plat
❑ Pathway Design(if applicable)
❑ ��ater.Department��pproval
[] Engineer's Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SW Hall Blvd. • Tigard.,Oregon 97223 • wwwti19ard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
W Y t
Edge of Pavement
I
Ii Ditch
Streetlight I .1.�.�.�• l.i.�.,lr�.�
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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 Udhtty locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97/223 • -,N;Avwtigard-or.gov • 503-718-2421 Page 4 of 4
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-- j:v' ES SHON ARE DAUNDERGROUND UTILITY LOCATE
i MARKINGS AS FRONDED BY OTHERS,ROV[DED PER LITY
1!-I
LOCATE TICKET NUMBERS 17263036,172630.77,AND 17263040. ¢
SW OAK WAY THE SURVEYOR MAKES NO GUARANTEE THAT THE UNDERGROUND
$!
LOCATES REPRESENT THE ONLY UTILITIES IN THE MEA i
-- -- __ _- - CONTRACTORS ARE RESPONSIBLE FOR VERIFYING ALL EXISTING .
N8923'25•E 137.01-1 CONOIRONS POOR TO BEGINNING CONSTRUCTION. _g z
2 FIELD WORK WAS CONDUCTED OCTOBER 17-18,AND NOVEMBER ID, o z
• '\i - ,EX Sim Go 2017.
EX STN CB \ 180- {1 RIM:179.03 N z
RIM i I IE OUT:176.37(B-S) 3. VERTICAL DATUM:ELEVATIONS ARE BASED ON WASHINGTON
IE OUT:176.72(8'S) Ex$M NH STM MH 1 I SUMP.174.69 COUNTY BENCHMARK NO.921.ELEVATION-169.82 FEET(NM
SUMP:175.18 Im;_179.86 179 4 29
\_\ I IIID RIM:-.93 i } �
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4. THIS uM DOES NOT coNmtuTE A PROPERTY BounoMr SURVEY.
�✓ P 5. SURVEY IS ONLY VALID M11H 6URKYOR•S STAMP AND 9KRhNRE,
Ill-,,,,- 6. OTHERWISE
FOOTPRINTS ARE MEASURED WITH TO STING UNLESS NOTED
BUILDING
5E CONTACT SJRI4:YCR WITH QUESTIONS REGPNgNG
{ � TAX LOT 3707 BIIIDINC nFs. 0�^
L_J TAX MAP IS 135AA 0 3
7. CONTOUR INTERVAL IS 1 FOOT.
B W
L I TREES MATH DAWETER OF 6•AND GREATER ARE 9HOON.TREE L
DIAMETERS WERE DETERMINED BY VISUAL INSPECTION.TREE N 0
INFORMATION IS SUBJECT TO CHANGE UPON ARBORST
TAX LOT 3902 TAX LOT 3900 x �I' I I wsPEC oN. L p�
' TAX MAP 1s 1 35AA Cy
fAX YAP 15 136.0.0
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• �X SIMIAN"� ! P Icl
RIM:17863 cl
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1 RIM:177.38
IF OUT:-yNABKE TO j U
P 1 MEASUREI(CUT W)^ I I I ill- EX STM w Q
11 RIM:177.71
E OUT:176.25(3•W)
SUMP:175.99 1 �K
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} IE IN:165.48("N) �, I EX 5111 MH E OUT:176.43(3•S) Vi
10084 RIM: \EE IE IN:185.46 W) SUMP:176.09
IE OUi�H69.40(e•E) � 1 i (� A RIM:176.14
/� IX sne w IE air:16s.>s e's)�r TAX LOT 3701 _
RIM:17.53 �/ TAX LOT 3703 n
s I IE IXIT:'UNwUE TD -,�0� 101,1*1 // I TAX MAP IS 1 35AA TAX MAP 1S 1 3SAA
CITY
p/'`K 4(�f�[�H /�
v A'• '` MEASURE(OUT S)` _ - /O-N. i' III, BUILTNNC C 1 1 ! O� T!E�. Ai 1 D V
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MEASURE(OUT E)- f//� p
SUMP:171.82 V/
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EX STM MH RI:177.9 S.6I \ }� RIM:175.78 p
RIM:179.28 IE IN:171. (36' IE W:1 9. (W) n I;(_ \\ „,y- •-.� IE IN:171.64(12 W)
alis 171. 1. ;� MI6 _ FF IE IN:171.57(12•N)
I I i'II I\ EX STM MH IF OUT:171.74(12'S)
BUILDING 1 I _ OVM92ED SUMP:167.54
1 _ I WO MH WmLTERS
1 > I RIM:176.31
RIM:17.91 107 RI STM.3 oEvoin Br. BDT
EX STM CB RIM:169.39 ORAMi ar AC
RIN:172.17 IC OJT:169.39(0•)
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IE_T.171272.17(O•) SUMP:169.39 Dco¢o 1m ANN
•/ •3 I _ .:� SUMP:172.17 AS NOTED
-- TAIL 1/12/2018
HAL
REGISTERED
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m TDSDRV
SW OAK STREET "'°•, \ --\"-s\--
MICHM Y S.io16
____ MICHAEL S.KALIU
-EX5M NH - I-- EX STm MH
- -- - RIM:177.80 RIIM.116.30 (12'N)
IT N:16269(8•W)
8 IE OUT:152.67(8•E) IE WT:169.18(12•E)
EX SAN MH JOB NUMBER
RIM:176.95 6279
IE IN:163.20(8•N) SCALE:1'=20 FEET
u I IE IN:16262(8• .I ® ^SHEET
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