Loading...
PFI2018-00221 CITY OF TI GA RD PUBLIC FACILITIES IMPROVEMENT PERMIT its COMMUNITY DEVELOPMENT Permit#: PF12018-00221 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/29/2018 Parcel: 2S115AD02300 Jurisdiction: Tigard Site address: 10534 SW TUALATIN DR Subdivision: DOVER LANDING Lot: 4 Project: Waddell Driveway Replacement Project Description: 10534 SW Tualatin Dr. Removal and replacement of sidewalk and driveway approach. Owner: FEES Description Date Amount PFI Permit Fee 08/28/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: MICHELLE WADDELL 10534 SW TUALATIN DR. TIGARD, OR 97224 PHONE: 503-869-0171 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 I Signature: iJ�'� Af P 7 0 lV r" Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00221 Type: Condition Name: Status: Severity: PFI—Sidewalk/l. 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/1 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/1 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. Boris 971-255-7724 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/1 09-OTHER Applied Notice w" NEC 9VED City ®f Tigard AUG 2 3 209 PUBLIC WORDS —ENGINEERING i CITY QF TIGARD ��� c FacilityI1� ®V� �� PFIP )Tl�,��,,r~1 1ifiNEERING TYPE OF WOE DESCRIPTION OF WORK(ire the right-of-way) ❑ TY)1'E 1-Franchise Utility Work Check one: ❑ Utilities Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE .and/orDetailed description: utility agency. Q, ��D�l '� �CQ,no 1�e,e,,me�n 11-- TYPE 2-Sidewalk/Driveway/Se`ver c� p���C, (i�.1 � c► f O C�.c Work performed for the purpose of: • Sidewalk installation or repair. • Driveway approach installation Property address/location(s): 1�3� SW T 1a1�Ln �. and/or repair ,/ • Sanitary sewer lateral installation and/or main line tap Applicant: �I L)n C-1 Ie, 4- �1 W Ck_aj" ❑ TYPE 3-Full scale Development pp Work performed with Land use Address: 1 ®S pp 'V G►,lc►.VkA Zca� approval which includes any of City/state: _TiiA C4tCl ®R Zip: q-7aol%4 the following: Phone: Email: 111 i Lbcl 1C"S. Wad CSI e.11 @. j mwI, • Subdivisions or Partitions • Contact name: M%L,�Nt ,lc. Phone: S03• 9 to r1• ®1 a1 I Street widening • Mainline installation for Sanitary sewer; Storm sewer, Tigard water Contractor: Fo u t- 5 euz�o rvm, and/or Tigard Water Service A-tea CCB#: a 0 3-7-r-7 Expiration: Z Address: �I3a5' N', 7rnbde.. �, d 3 SUBMIT.COMPLETED APPLICATION TO: City/state: I4 416bO{O "OK Zip: q-1 lc-�q City of Tigard Phone: 5_0S- 193 • (09-1-lEmail: Cuu r,,- Planning/Engineering 13125 SW Fall Blvd. Contact name: gas o Phone: 3•$ 8 • (09-1Tigard,OR 97223 Applications for"minor work in right-of-way' Engineer: only may be emailed to: rowpermitsktigard-or.gov Address: 0 :STAFF,11!SE City/state: Zip: n Phone: Email: Case No. F z 00 Contact name: Application'submittal fee(07%of Engineer's Estimate) $ Estimated value of work is required(i£over$5,000):$ ..q 00• Additional.fees: $ (within the public right-of-way) Application accepted: By: Sc Date: .� - Is work related to a LAND-USE DECISION? ❑ Yes No Application reviewed: If so, please specify (MLP, SDR, SUB, etc.) case #: �r� p By: Date: 4 Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date: 0/2 A 9) I:\ENG\PermitAppI ications\pfi_application Effective 10/16/2017 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-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. * 'Vith 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 CERTIFYTHAT: • The above request does not violate any recorded deed restrictions that maybe attached to or imposed upon the subject propert . • 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. lyck mi f)-) ,a,t I -UL", I-S Applicant/Authorized Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. amov) mo" Owner's signature Print name Date Jq,/ Owner's signa. e 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 FOR STAFF USE , NLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL REQUIREMENTS APPLICATION FEE Part 1: Required submittal fee$300.00 F4ANCHISE U'T'ILITY AND,SIDEWALK/ PERMIT FEE 'DRIVEWAYAND UTILITY Part 2: All non-water system improvements CNNEC' 'iONS,ETC (work in the right of way) Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketch (including information below) WATER S'Y'STEM FEE ❑;Dimensions Part 3: All public water system improvements ❑ Street Name 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/Partitions and Street lriiprovements) • Sidewalk repair(less than 20 lineal feet) Design Plans • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. (6 sets;24x36 or 22x34) • Weep hole repair ❑` Cover—Site,Vicinity;Abbreviation;Legend • Curb repair or replacement(less than 20 Iineal feet) ❑ Genera]Notes(City,Water,Sewer,etc:) . • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,Storm and Sanitary(Plan P.rofile). • Planter strip landscape maintenance ❑ Water Quality Facilities. • Test wells ❑ Grading 01 Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone;Gas; Note: A cash assurance may be required per Storm,Sanitary",WaterSignage,Street'Lights,etc) TNTC 15.04.140.(customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping Street Light Plan and Photometric El En .gineers'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 El Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-715-2421 • Page 3 of 4 ` A S-03.99plle� . V177 ` . 3LO s P J r� 5 ' 3( s C r � q, 3� SAMPLE SKETCH: 'll1,..x+• 1 f, " yam " n Edge of P al�vl'errient Ditch 4 Frr Tr I e � e � e 5 r ►�. 8 �>r E�istin� House r Existi n g >i Driveway I CL e • s ° WX I L B r 7 a e � Existing Shap,` `. � 731 0) CF4 •� s Powerpole i • 295, ■ ,::� •® m®e.�® —e®m oma.® - � `�aRert�`Line' e • Jay � I '.J Fire Hydrant(FH) Scale: 'I"=30' � o d • � � 1 • d p rg • � 6 � 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 r 13125 SW Hall Blvd. . Tigard,Oregon 97223 ® wwsmtigard-or.gov o 503-718-2421 . Page 4 of 4 � e i „ r SI�f IV y rV. .c y; A3, 4 tvop x d lg � •. ,�:;.; .,�* � • "`� ;. �, Google ~ 1 � R 4� Go.::gle Map: 10534 SW Tualatin Dr _�)o qj e Map data®2018 Google 10534 SW Tualatin Dr Tigard,OR 97224 Four Seasons Landscape & Construction Quote #2963 From Four Seasons Landscape& Construction Four Seasons (503)888-6977 Landscape.fVlaineance,LLC FourSeasonsLPM�gmail.com ' FourSeasonsLM.com 7325 NE Imbrie DR#332 Hillsboro,OR 97124 CCB#203777 Michelle Waddell Bill To 10534 SW Tualatin DR 10534 SW Tualatin DR Tigard,Oregon 97224 Tigard,Oregon 97224 Sent On 07/27/2018 Job Description Concrete Work Concrete sidewalk 70X5=350 1 $3,400.00 $3,400.00 Removal and disposal of existing Gravel Concrete Concrete apron 35X8=280 1 $3,400.00 $3,400.00 Included Removal and disposal of existing Gravel Concrete Total $65800000 This quote is valid for the next 30 days,after which values may be subject to change.