PFI2018-00205 MTY OF TMARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COln]MUNFY DEVELOPMENT Permit#: PFI2018-00205
Date Issued: 08/27/2018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421
SQc��IR� Parcel: SEG3514
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: Shelby PFI
Project Description: SEG3514, associated with 13285 SW Bull Mountain Road. Tie existing septic system into municipal
sewer located on Alpine Crest Way.
Owner: FEES
Description Date Amount
PFI Permit Fee 08/27/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MATTHEW SHELBY
13285 SW BULL MOUNTAIN ROAD
TIGARD, OR 97223
PHONE: 503-310-8033
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:
Issued By: L't
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00205
hmL Condition Name: Status: Seven
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-PERMIDPLAN 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 AUG 0 2 2018
Pt—,B1—JC WOIU,..S -- l N G-I:N I ,E1-"INC_ :�;..
Facihtv
L.!,, G
ubdlc
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
U TYPE 1-- F'rancllise L,tIty\Vork
(_Aleck.onc: l? l t:ilit:ies ❑ ,i�1L��al ,i dri.�e��.a,, al�}��oacl� ElSheer-11 pro irtlYents l�e:rlori��eci l�ti y \ PGE
Det:-t_ilecland/or utditt-"IgelICA.
cle4crip tion: ��, ��s,,��J���.� '"����.�;
J 72J P t t L1i/`d f f 11", !- l' �i� Gt�( L f':: ✓I
IF ��{oi:k;.Berl) tiled for the purpos:of.
° Sidewalk.instaltttic.il or repair.
_ 4 D�1-e.%t-a}-�1p��r�<tclx install;�ttc�ll
Propert.�~ :�dclress/location -(d.>� ,��
�. �'s�� % �' Jtl
�• ail{:l/{3I:1>>p:ilr
u
° S-irittalAT sewer lateta.l Installat:6f)
,md/of.Ir).ain line tap
r ❑ TYPE 3-Full scale Detielopment:
pplicat� : - �
i 'k pe.r Eta+:nacci ui.l:l�L icl use
Address: v- approvaI Which includes any of
(,Yt: /stat.e: c, .7-k nz,,z ;/i'; c ��/ t tie c�ilL;u-r
—r,
I'l1one:<�v f c`J _ S I mail:�: e't(�:�, t Sic [�:! " �vi5'vi- c c�'�'( :�tlbc3iti t i{>I�s or1'tf.ttzis�ns
C011trtct name: f#.'��� �� � Plione:
° fainhne instalhtl.011 for Sariital')T
5c,«c.t. torill ,e«c r, Tir,�i d •t ate.r
Colarractor: v,4 � 4ivt1 c�� -`I` r"i i . �tjj 1 r 1
27ss,/or: l'i �rd ,,,xtcr et�1cc >ua
C;CT,#: _-`Z'.�4-( T�.zpiratio�: a
Address: jz�-��, cA�'.� SUIBMITCOMPLETED APPLICATION TO:
C.tt� tare: L�Qa�\S �ce� f,}p, City of Tigard
Planning/ngineer-ing
Phone: 52e) Email:
13125 Ste%lE-ia11 Bh-d.
Contact n.gtne: Thong.: Tigard,OR 97223
'1t7plicatlor)s for„animj1-cwork it1 right-ot-���a�-„
0111v 111'1v}7 i'::771R11c'C to:
roLvperniits atigard-or.gov
Address: �
Cita-/state: ZIP:
T.?lZone Email: C«S?\o. _j E -00 S
Col]tact nanac: t.ppl,c:Aaion sulmilat-t:"iI fec G07,.1;,of
E.nglllecr s Estinlate; S
v
I.stisr tre.cl-v-,.ltteof work (>vej $5,000). lddiuonal tccs� S
(Witl-lin t}�c pttl�lic t-ili ot. y) 1pplitation accepted.
f T _ _ _ T — t7�' _ _ _ Date:
Is work related to a T��`1l�lD-liSI--',D.FE ISIONr 0 yes I Fe4 o
If so, please specify. is\%l.L,l', SIDR, S(JB,ci.c.) case #: Application r=cele«-ccs:
B :� late:
Is\r(�r14 related to a l [!it-DING- P RI NfITr ❑ N Cs _ s� -pplic2int t��,�d icd:
If so,please specifi-(B UILDIN G PERTNU"I)case#: By: �, _Date:
I:\EftIG\PerrsitApplications\pfi_application Effective la/16/?Ct17
�C'i.ty of Tigard 131-2-)SVS'1-:1-A1 B1v(i. Iil,�xd C-)rc oto 3 ?3 ° �v�ti� ,u a.ru o..gov, r(3 3 i 8-2 2i � id�£' 1 4
APPLICANTS
NOTE: Person specified as, "_-kpj-)icanC" s'nall be designated"Per.nliCtee" and shat(provide financial assurance For work,if
requ FCC by the city piiJ._Stuant to FINIC '15.041.140.
` With dIC etcepti.oi�).Of a uLilitV,operating purstla"it to a vatid franchise the CIty rpt Ilg2ard,�vlicn the owner xid the applicant different
jvoph-,`I?.f'<!ppl1c:11it:ilit.u�,t 1)(1,011;' or 7.(_.c l:d of ;1 .11 Willi .0 nt'cs_n ,iv1Thw`ii.2cI0II tr n.1 did f1wmer ol,;lil.11 cnr of r!le
G.)Cl'1) i:. lX!C iJCtI ( l must sign -chl's'appli atlon In dic space..pam'ded or submic a WaLten ::1La11G)fl/1tiot1 With Cllr appllcai:i()1).
l_iaiit t s .tc rlcai r
BY
to obts3,11 �.t.!..t�t<<n �f- stg-r aIn u-nn t is-,Ipp Ac-aLii
n.
BY SIGNING BELOW,THE A.PPL.ICANTT(S) SHALL CERTIFY THAT:
• The alhovc.request sloes not vic)latc.any recorded clued.restrictions that nla�be attach d to or 1-mi-)osed upon the subject
-P ler
" U.'ffie application'1s o antC'd the applicant\xil.l exercise the L'hts granted 1n accordan.ce with the Cerins and subjeo-to all d1c,
concli6ons and limitations of the approval.
All of the;rbovc:stateinents and the statements in an) plot plaza,atiachrrients,and exhibits transmitted here,vith, are true;and
the applicants so ackno\vledgc that any permit issued,based on this application,ria,. be r-e�Tokcd if it is found.that any such
statements are false.
'11:a.e has read the ent:i?:-e cf:3ntetars of the application, tilc policies and crAccia, at.id understatads the
requirements for approving or den-,Ing die application.
pplicant/1=\zlthori:�e€� ;er Si atT� Trim.naive I�)a-e
SIGNATURES of each fin-aer of the subject ptoperty, if required..
tivne s Siu1aiu1e 1'rtt3t t1a111e Iia.r.
owri.d'l s si.gniif_i:i.re P.rl'rnt namc l D:Cc
Owner's signature Print name � Date
PUBLIC FA TL.ITY IMPROVEMENT PERMIT
City �).Tilyard 1.X125 S�,�,'Hail.blvd. i1,),aril,��fe�i�n. 1, ?3 tv�, xk—I,.anal-G�t c:�ti' �()3-:"E -�1` i. ,, 0J
S 09A 100
t kL 4-} 4 La 1'.�Y iI a YY• t'._�r
n
{t �''�i� r d - y
�'�zt',>�'a='uas•'.r ..c:a?r a r ..-,.. „, -,a,•---r"r�-�.•..•-.^'�'t, � - pl
i
X
Mx [
�ti �i � 330
o' {, •/7h.. � ` ''tt' : �t
•: X4101
, 4 n 91.
V fsP:. �'k4 c 'SS.ua+r' „�3 3 i - -•�, n ;Asa
a x 3
f a, -�, iia. X8,, �'�34r. e I _ � yfy •y*..q
rrJ`.£_-, � i .i:� .nom, a=5: ;,', ..� �"�•._- >' �� � �5m,,.�,� T �j
s1« A - `�.-xl <- `� •15+, i eqg J{Y' h"�`-+,x
•-�,xfi ro� '�eaY" r �F r3sTM 'f�' >z "vY - � S` 'rS���'
r++'� V ' '! ;Y �.* ' wk'.hs• vC.'
IS,
OF
144
%
An
-ug,sT.
€
� � u z j a rib
>k �.'.C T
:
ICA
4m
� #'.t
9'
x
A _ ✓V.. .. .'1 � f "`` �? „{, {y'r �c�^ x �� � � �of.
2y„ trra
SIP,,
S d d
�� u.€.
t „F A ," 4>:At
q •i'�i."i4`•2t'e�� "a 3 .',. *:.
w'k , k
RM
ml
"�� �'� �` :��F� ,� . C���x�,�;. •t fill"€ °���r��r �;; � ��\4��.r��ti� �- ', #
�•, ��r: '��*"��- �' +:,._ z'" r � �. G.�.. its �- ,•� �_.'� �£`�� �`�, � -'� � .a.
!� rv; .. a _ r� t., 'q+�`+ _'' Cf �t,t• +� ;�`A'. "`3 •' " I. s• y M1,i -,,, ,' t3.� - '
_ >a Y
�•u: r ,n� +�. "' �7 t4 `c'w4
.+ ", •r°rr•�y "''a.� ,. �: N p t..r
x What '_, t - r a r a t.-
NIP—I
'1?� r�?`7 Cit" `•.. yr ;:.�".M��.. € v - (! �'
e`x ` .4 e f y. ?.. 45 ,jk ;' !A
Ell
g 40
In
OF
u> ,,' �,,+ '�'�i � ��.a: ��;}.�§,�?� ,, ,t•���' 7 +xfim-.F.., Z.
>� s�r,* si?.. �. `EA �4.3�.�� �7.✓..'. - �p4 _;�'� �`� �•'
�,sx kx,:�• .,a3 ;,,�y1'� ,.� a��� .' fS M .9&.,.. -' F � a"✓, p ;;{ f.'` � .e 9 _.9 .�.".. z`�'
� • .n3'4if'�.+�; �,�'�`., ' r
Olt
zfr' 3., z;'.; "'. f `r s•' -x_t. �„-�i �'$!s "b. •'.,.H' �''y �,yer� qr �3
Ile,
WE
!i_- t v$3 #a -r _ x ., .. `'•7�: 1
`t•., Y E=���d'P'apc; '§ � S�� f������P� �;� �� �. �h 'A Hs"y?';r�.�g ��
l $ $�" =`,' YJ a. t<• � +a' xa.'sa� Yca;, �'i w y�'��r't &�f
'"! i•- �•��#`,,, -,'_Y ,.: E-. 1k, v1 .i z. `7 r. _� m r�dP .tis5 iV.•' �7yrs
�x° YR w ^°vim/.-?':�r:' c•
�..t�����f� e �.. :� �T •A'4i`��'+t'i-' :y�'��
n i ! Y
fl
..- ; ,.a' ;v t " zc,, " a -,c"yrs �^ L:`:" M+;...;u `'. !,fit.• a�-e `. ?�,'l>,F,c'.a:ii` ,;y'� r,r�',.r' -'.. y
'- T
xY"..
¢�,
:'v'., -n, ,+
.si Stw mom';.!• r, J
. ,#F,q,�S}i9*' ,.
m -�y,`5;,' -:<u+..' ✓e+� .M ��i'
Y
A'' , i°:n - z ,•a si �" .n'�i� •Y F.K.e .,k '{S,6 r a• •�
`a .'f i• .�'� "��� r';u ��-''6'� i1.. �' "`+, ^',r-`•r'"t �a„���1`�'.F.S�'t-:. '�+��. �'k �rt�: 2- s �";
t�.�;"gK � -s;r� -A 1.�+•.p.,.t �.:�- - .�h�.r
_ ; �•� ,k�' w° �" 3 3�F �j (( i >r�-.� t'^k`t� ,.s a -+v., a W_� ' �L,si-•3'`.
_- U
�� �� � c:
r �
Wo�r
30 S
31 33 34
29
2a 32 H rz
sw 01 12M LANEW
x � 13
� � 1s
1 14
Li
22 z
26
25v` Z4 Alh ST 3TARM EW DRIVE
st 21 r
`w 'Ir
MAX20
Prop as,ed -Pater of FIECIMMINc
seer if
�a
ti
_.
t.istj fimanho9 G
`a 17
v
Fente
P c�
Existir�sewer§n
and septic tank ,
House
sw w
rco
4 RECISZEREO
PROFESSIONAL
5 u, La
17 UA 08. 2000
` JOHN R, WADE
� 59999 LS
NCffm
THE OF ALWOMO NOTM MMMM AM ars+M ON WAMMOTM cmNw REccm of aummv mjmsm 7wma.
FROMIPITY ANNEXATION EXHIBIT
T1�II�T A6 DE's P>�1®vn ND.ao1 soo�stlr
AMATM M TME wo"Eow 106 OFa4"3I4 94
OWN TMM MP S GOL"K RAN=1 WORT.INLLAMME N UMM.
LAND 0 U R V!V O A B W111l�iip�idl�i�lQL/�/rY.CNIS M
42!90 sw PRGFIG HcmAy.swiE 256 jum nMg%OR 97MPHME dt FM- 503.028.59@9 A w WS 1,=1w MAMII=W IgHIELW
,bhn, Platted: Apr 15. 2018 — 3:14pm. P:\998-261 SW 801 Int Rd Anne a`dwg\Mops,99B-261—Yfark.dwg