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PFI2018-00308 211 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00308 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 11/14/2018 Parcel: 25111 BCO2300 Jurisdiction: Tigard Site address: 14530 SW 103RD AVE Subdivision: TIGARDVILLE HEIGHTS Lot: 21 Project: Kozak Ringe Driveway Approach Project Description: 14530 SW 103rd Ave. Paving a driveway approach. Owner: FEES Description Date Amount PFI Permit Fee 11/14/2018 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: MARISSA KOZAK RINGE 14530 SW 103RD TIGARD, OR 97224 PHONE: 541-977-1794 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 See application Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00308 Type: Condition Name: Status: Severity: PFI—Sidewalk/1 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/1 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/1 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/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 RECEIVED City of Tigard N O V 14 2018 PUBLIC WORKS — ENGINEERING • � � Facility Public ,JGINEERING TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1—Franchise Utility Work Check one: ❑ Utilities �idewalk/driveway approach ❑Streetimprovements performed by NWN, PGE Detailed description: t \ �Crc: and/or utility agency. TYPE 2—Sidewalk/Driveway/Sewer ork performed for the purpose of: • Sidewalk installation or repair. Property address/location(s): 5 S ���t �..� Di' eway approach installation and or repair r.T,�, C) 1 P Sanitary sewer lateral installation and/or main line tap Applicant: l ARLS!P ,G� � �,��[ ❑ TYPE 3—Full scale Development Work performed with Land use Address: -)li 5 IF,© 6 i.13 j 03(ZA Are— approval which includes any of City/state: 71(-�A A fZ-C� Zip: the following Phone: S q I �l`1 11 q gEmail: IS Gt. ,� • Subdivisions or Partitions 21-L119 e Street widening Contact name: rY�1�1-15(� Phone: 5"-1 l �11 l 1 /`-, �;Iainline installarion for Sanitary sewer, Storm sewer, Tigard water Contractor: �B and/or Tigard Water Service Area CCB#: Expiration: Address: SUBMIT COMPLETED APPLICATION TO: City/state: Zip: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Contact name: Phone: Tigard,OR 97223 Applications for"minor work in right-of-way" only may be emailed to: Engineer: �-----------_-- ----------- ---- ---------------- row.PermitsCa)tigard-or.gov Address: WA City/state: Zip: kli= Phone: Email: Case No. RIVU-00309 Contact name: Application submittal fee(.07%of Engineer's Estimate) 0 0 Estimated value of work is required(if over$5,000):$ Additional fees: $ (witivn the public right-of-way) Application accepted: ��� ��✓�� Is work related to a LAND-USE DECISION? F-1Yes �VTo S� By: Date: If so,please specify (MLP,SDR, SUB, etc) case #: Application reviewed: Date- t> >W Is work related to a BUILDING PERMIT? ❑ Yes O�-No Applicant notified: If so,please specify(BUILDING PERMIT)case#: By: Date: I:\ENG\PermitApplications\pfi_application Effective 10/16/2017 City of Tigard • 13125 SW Hall 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 TMC 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 T. • 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 requiremen s for proving or deny the application. App ' t Auo d gent's signa re Print name Date SIG S of ea #Lowner of the subject property, if required. J2� kO-LAL EIM C-1 I I h3f O� is signa / -0 Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL 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 system improvements (work in the right of way) Engineer's estimate X 5%(less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Sketcb (including information below) WATER SYSTEM FEE 7 1 .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 (Subdivisions/Partitions and Street Improvements) for the following types of work: • 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 lineal feet) ❑ General Notes(City,Water,Sewer,etc.) • Lawn sprinkler system installation or repair ❑ Street(Plan,Profile) • Street tree pruning or planting ❑ Water,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) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Play and Photometric ❑ Engineers 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 ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hail Blvd. • Tigard,Oregon 97223 • www.figard-or.gov • 503-718-2421 • Page 3 of 4 FOUND 3/4" IRON PIPE. REFERENCED IN PARTITION PLAT NO. 2001-068 AND SET IN SURVEY NUMBER 10,723 I S 70'2446" E, 0.33' FROM CORNER NOT USED FOR LINE STAKING SW INEZ STREET o - FOUND AN FLAGGED /4" I IRON PIPE. REFEREN D I FO D AND AG ED 5 8" IRON FOD PAR T NO. WI RED P ST1C CAP SCRIBEo 2001 068 ND ET IN "CE TERLINE ONCEPTS C." SEv SUR Y NUMBE 10,7 PAR TION P T N0. 20 —068 000 --i O zW � W �� o I IW ® 1Q Q o Q � Vol" N 0 n O cr z n app N Q- cn p3- SW OAR 1453p C o 0 N CO f-- tet- 1— J tY U Q Q I FOUND AND FLAGGED 5/8" IRON ROD (0 O J WITH RED PLASTIC CAP INSCRIBEDX "CENTERLINE CONCEPTS INC." SET IN LO Q PARTITION PLAT NO. 2001-068 LEGEND `' • REPRESENTS A FOUND SURVEY y `c. REGISTERED MONUMENT THE PURPOSE OF THIS EXHIBIT IS TO PROFESSIONAL ■ REPRESENTS A WOODEN HUB WITH DEPICT SURVEY MONUMENTS FOUND LAN SUR OR LATH PLACED ON PROPERTY LINE. DURING A RETRACEMENT SURVEY PERFORMED ON 11/07/18. THE REFERENCE SURVEY FOR THE 0 RETRACEMENT WAS PARTITION PLAT NO. FEBRUARY o8, DE 2001-068. WOODED LATH WERE PLACED JOHN R. WADE ON THE PROPERTY LINE AS DEPICTED. 59999 LS EXPIRES.• 06/30/20 14530 SW 103RD AVE A PORTION OF LOT 20 AND LOT 21,TIGARDVILLE HEIGHTS, L"MIT SITUATED IN THE NORTHWEST 1/4 OF SECTION 11, TOWNSHIP 2 SOUTH, RANGE 1 VILEST,WILLAMETTE MERIDIAN, L R N O SURVEYORS CITY OF TIGAIRD, COUNTY OF WASHINGTON,STATE OF OREGON 12950 SW PACIFIC HIGHWAY, SUITE 255 TIGARD, OR 97223 AB NC' DATE PREPARED FM PHONE & FAX: 503.928.5589 998-280 111/08/18 1 ,, 1-.=40' MARISA KOZAK RINGE Cory, •Plotted: Nov 08, 2018.- 12:02pm, P:\998-280 14530 SW 103rd Ave\dwg\Mops\998-280_Exhibit.dwg FOUND 3/4" IRON PIPE. REFERENCED IN PARTITION PLAT NO. 2001-068 AND SET IN SURVEY NUMBER 10,723 I S 70'24'46" E, 0.33' FROM CORNER NOT USED FOR LINE STAKING SW INEZ STREET o Ec k o _ r 14 - ► ,��1-S h-e� FOUND AN FLAGGED /4" IRON PIPE. REFEREN D I FO D AND AG ED 5 8" IRON NOD � PAR ON T N0. WI RED P STIC CAP SCRIBED O 2001 068 ND ET IN "CE TERLINE ONCEPTS C." SEY IN SUR Y NUMBE 10,7 PAR TION P T NO. 20 -068 .- 00- W W < J O 0 � I O Iw ® . 1 � Q > n- N Q �. O Iz z 0 23a� N Q_ IZ cn �A SW 1 O3FZ z aj p o cNI coo �— U O CLQ FOUND AND FLAGGED 5/8" IRON ROD WITH RED PLASTIC CAP INSCRIBED IZ X "CENTERLINE CONCEPTS INC." SET IN Q PARTITION PLAT NO. 2001-068 LEGEND {`� • REPRESENTS A FOUND SURVEY REGISTERED MONUMENT THE PURPOSE OF THIS EXHIBIT IS TO PROFESSIONAL i REPRESENTS A WOODEN HUB WITH LAN SUR OR LATH PLACED ON PROPERTY LINE. DEPICT SURVEY MONUMENTS FOUND DURING A RETRACEMENT SURVEY PERFORMED ON 11/07/18. THE REFERENCE SURVEY FOR THE ON RETRACEMENT WAS PARTITION PLAT NO. FEB ARY 08, 2000 2001-088. WOODED LATH WERE PLACED JOHN R. WADE ON THE PROPERTY LINE AS DEPICTED. 59999 LS EXP/RES: 06/30/20 14530 SW 103RD AVE A PORTION OF LOT 20 AND LOT 21,TIGARDVILLE HEIGHTS, SUMMIT SITUATED IN THE NORTHWEST 1/4 OF SECTION 11, SHIP 2 SOUTH, RANGE 1 WEST, WILLAMETTE MERIDIAN, 1 LAND 8 V P,V E Y O R s CITY OF TIGA 4D, COUNTY OF WASHINGTON, STATE OF OREGON 12950 SW PACIFIC HIGHWAY, SUITE 255 TIGARD, OR 97223 JOB N0' DATE ` PREPARED FOR: PHONE & FAX: 503.928.5589 1998-280 111/08/18 -'� 1"=40' MARISA KOZAK RINGE Cory, kPiotted: Nov 08, 2018. - 12:02pm, P:\998-280 14530 SW 103rd Ave\dwg\Maps\998-280-Exhibit.dwg EXISTING DRIVEWAY — MATCH WIDTH & GRADE A R/W LINE VARIES SEE NOTE 3 5' MIN 2% SIDEWALK 1 :71 SEE LANDSCAPE SEE NOTE 2 NOTE 3 LANDSCAPE STRIP STRIP A 30' MAX 3' 3' 10' MIN PLAN R W 3/4" PROJECTED TOP OF CURB MAX STREET / d °° °°°— II F 0 0°00000 b o°p DOo°o�8 d 6 DO d o °o 0000 ° ...................... o o °° °° 00oo o 0 0 °o°°°°000 0 °°°°° °° opo 00 o 0 0 o I;,III; li 1 I 11 1=1 1=1 I� �I 11—'I I 2" OF AGGREGATE SECTION A—A (3/4"-0") COMPACTED NOTES: 1. CONCRETE COMPRESSIVE STRENGTH SHALL BE A MINUMUM OF 3000 PSI AFTER 28 DAYS. 2. CURB JOINT SHALL BE TROWELED WITH A MIN 1/2" RADIUS ALONG BACK OF CURB. 3. EXPANSION & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBGRADE TO FINISH GRADE. CITY OF TIGARD APPROVED BY. NO SCALE OREGON LORI FAHA, P.E. ri ENGINEERING DIVISION CITY ENGINEER STANDARD DRIVEWAY DWG. N0. PUBLIC WORKS DEPARTMENT 13125 S.W.HALL TIGARD, REGOBN 92 23 JANUARY 2016 w/LANDSCAPE STRIPS 141 ` VOICE:(503)639-4171 FAX: (503)684-7297 APPROVAL DATE ■ b q'i q-,l.41 r�-: o F)>U G w oUtTl x m PROP. PROP. PROP. c �oLINE LINE LINE -LowaC z � H � � n s a 4 s R/W w CURB •"' CURB R/W JOINT ACCESS \l� 30' MIN. BETWEEN DRIVEWAY (AGREEMENT} ;uAPPROACHES ON SAME PROPERTY 30' MIN. BETWEEN 6' MIN. BETWEEN ADJACENT INTERSECTING STREET PROPERTY LINE AND R/W & DRIVEWAY n DRIVEWAY APRROACH APPPROACH. r O D O NOTE: Z DRIVEWAYS LOCATED ON OR ADJACENT TO ARTERIAL OR N COLLECTOR STREETS SHALL MEET 18.705.030 42 o cnn OZ r o m