PFI2018-00189 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00189
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/06/2018
Parcel: 2S110BA01700
Jurisdiction: Tigard
Site address: 11754 SW GAARDE ST
Subdivision: None Lot: None
Project: Prophete Curb Cut
Project Description: Creating new curb cut with ADA 2%slope wings down to Driveway at 11754 SW Gaarde.Associated
with TRE2018-00056.
Owner: FEES
Description Date Amount
PFI Permit Fee 12/06/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
MARC PROPHETE
PO BOX 3421
TUALATIN, OR 97062
PHONE: 503-957-8717
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:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00189
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/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/[ 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/[ 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 at 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
City of Tigard RECEIVED
PUBLIC WORKS — ENGINEERING ,JUL 19 2018
Public FaciRty Improvement PFI Pere
,,� -I
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
Detailed description: C f 2F `(� �y � �J C-CJ Q-15 and/or utility agency.
C:�U_T i J) 1`-�� � 2 - ` � ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
V3/ L!p DRI G T�
K (� ( 1 LQ
20: LJA • Sidewalk installation or repair.
• Driveway approach installation
Property address/location(s): and/or repair
• Sanitary sewer lateral installation
and/or main line tap
Applicant: 2 C goP-&/e
❑ 'TYPE 3—Full scale Development
Work performed with Land use
Address: OeW -34� j approval which includes any of
City/state: Zip:R/ the following:
Phone: ��� r�A-0Q7/ Email:� D�p I���! 7 G4�ca C�%1w • Subdivisions or Partitions
Contact name: Phone: Street widening
• Mainline installation for Sanitary
Contractor: al kl`�16`/V A� i sewer, Storm sewer, Tigard water
and/or Tigard Water Service area
CCB#: Emiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
r Planning/Engineexrng
Phon 5 "'� Email: 13125 SW Hall Blvd.
Tigard,and
Contact name: Phone: g >OR 97223
Applications for"minor work in right-of-way"
Engineer: only may be emailed to:
rownermitsna,,,tigard-or.gov
Address:
City/state: Zip: LFOR STAFF USE, ONLY
Phone: Email: Case No.: Fflulbt,
- 00121
Contact name: application submittal fee(.007%of
Engineers Estimate) $ 3G1f).o 0
Estimated value of work is required(if over$5,000):$ additional fees: $
(within the public right-of-way) ApplicationDate:Is work related to a LAND-USE DECISION? El Yes El No SC By:
If so,please specify (MLP, SDR, SUB, etc.) case #: application reviewed:
By-7,Z--SL`,- Date:
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: Itz Date:
I:\ENG\PermitApplicatio ns\pfi—a ppl icat ion Rev.10/16/2017
•___ +�..���.tv.,.>_ s, :..r 4,.. -< � =td^"' "-^,y.�"..�A�r.�=� � _:*§qtr, .y_ _ _ - _ _ ._
City ofTigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of4
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 APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subict
proper
• 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.
Apphgant/Authorized Agent's signature Print name Date
SIGNAT RES of each owner of the subject property, if required.
,pl" 7//
Owne s signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 S`XI Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of4
DEVELOPMENT ENGINEERING FEES FOR STAFF USE ONLY
Public Facility Improvement(PFI) Permit:
DETAILED
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5% (less$300.00 minimum
submittal fee) Sketch
(including information below)
Engineer's estimate X 2%Plan Review
❑ Dimensions
WATER SYSTEM FEE ❑ Street Name
Part 3: All public water system improvements ❑ Site Address
Engineer's estimate X 12%
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements)
There will be no permit fee charged,or assurance required
for the following types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (4 sets,24x36 or 22x34)
• Relocate or replace mailbox ❑ Cover—Site,Vicinity,Abbreviation,Legend
• Ditch cleaning that does not involve regrading. ❑ General Notes(City,Water,Sewer,etc.)
• Weep hole repair ❑ Street(Plan,Profile)
• Curb repair or replacement(less than 20 lineal feet) ❑ Water,Storm and Sanitary(Plan Profile)
• Lawn sprinkler system installation or repair ❑ Water Quality Facilities
• Street tree pruning or planting ❑ Grading
• Planter strip landscape maintenance ❑ Landscaping/Tree Plan
• Test wells ❑ Composite Utility Plan(Electrical,Phone,Gas,
Storm,Sanitary,Water,Signage,Street Lights,etc)
❑ Details
Note: A cash/bond assurance maybe ❑ Traffic Sight Distance
required per TMC 15.04.140. ❑ Signing and Striping
(customer deposit) ❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
❑ Engineers Construction Estimate
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 Provider Approval
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of
a
SAMPLE SKETCH:
Edge of Pavement
I
I Ditch
Streetlight --•-------•—•---r---
f I f+ Ridn nnin
I ,o . a 1
1
I I
' T"'Fr o j�'aWcl elwre rT He—i 1
I r
w !
= I 1
MI Existing House
Existi n I g
>-I Driveway .
01 I
CI R I • �•
Q
L ► , ' -
I !
01
a
>
� I 1
0I •
Existing Shop
Powerpole I I a
o • a
I I� 95,
-7roper' Line- - -
0
I I i
Fire Hydrant(FH)
I
I I I
Scale: 'I"=30'
� � I
I � �
' I I
I I
I I I
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 ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of
2011 Edition Page 81
Shoulder Work w/Minor Road Encroachment Diag. 300
ROAD
WORK I4
AHEAD 1
l
Initial A
Warning w
Sign
�3
(Optional)
I �
41
Protection Vehicle
w/TMA(both Optional)
See Chapter 4 Buffer
10,
minimum LJ3
A
- ROAD
NARROWS
(Optional)
B
ROAD
WORK
AHEAD
Initial
Warning
Sign
December 2011 Chapter 5
CURB JOINT
SEE STD
DETAIL N0. 146
5' MIN. SEE NOTE 5 ROW
ROAD :p• .,; a 1-.,
. III-III-III-I I 1=1 11= =1 I I-I 11=� '-
2" OF 3/4"-0" BASEROCK
COMPACTED SUBGRADE
SIDEWALK ADJACENT TO CURB
PLANTER Illo. .40 5' MIN. ROW
STRIP
6„
�--
2%
ROAD
I I 1=1 I I I I 1=1 11=1 I I i :l 1 Mi 1 1-1''
2$$ OF 3/4"-0"
COMPACTED SUBGRADE BASEROCK
SIDEWALK AWAY FROM CURB
N_
1. CONCRETE SHALL BE 3000 P.S.I. AFTER 28 DAYS.
2. PANELS TO BE 5 FEET LONG UNLESS OTHERWISE SPECIFIED.
3. EXPANSION JOINTS & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT
IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBRADE TO FINISH GRADE AND
PLACED AT SIDES OF DRIVEWAY APPROACHES, UTILITY VAULTS, WHEELCHAIR RAMPS AND AT
SPACING NOT TO EXCEED 45 FEET.
4. FOR SIDEWALK ADJACENT TO THE CURB AND POURED AT THE SAME TIME AS THE CURB,
THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN. 1/2" RADIUS.
5. SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED
OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY. OTHERWISE SIDEWALK SHALL HAVE
A MINIMUM THICKNESS OF 4 INCHES.
6. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3" DIAMETER
SCHEDULE 40 DWV (ABS OR PVC) PIPE AT 2% SLOPE. CONTRACTION JOINT TO BE PLACED
OVER PIPE.
7. CONCRETE SHALL HAVE A MEDIUM BROOM FINISH AND TROWELED ON ALL FOUR SIDES
CITY OF TIGARD APPROVED BY. NO SCALE
OREGON MICHAEL A. STONE, P.E.
ENGINEERING DIVISION CITY ENGINEER CONCRETE DWG. NO.
PUBLIC WORKS DEPARTMENT
S.W.HALL BLVD.
TIG 120
TIGARD,OREGON 97223 JANUARY 2013 SIDEWALK
VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE
EXISTING DRIVEWAY -
MATCH WIDTH & GRADE
A
R/W LINE
SEE NOTE 3
VARIES
27. SEE 2%
5' MIN 2% NOTE 3 SIDEWALK
SEE NOTE 2 A
30' MAX
6' 6'
10' MIN
PROJECTED TOP R/W �(
3/4 OF CURB 6"
2% MAX
STREET .
e °�O e4 cb00000 7 4:. : . st
d. o .d • o o•� O
�o . . ..
0 0p000
op 00 �'qY
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OC!O pOOOOe ep.De 000 O
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�O O p°°o°p eo°p aoo°e o8o oa 0900°o°o°o°°�Qo o°oo°o'°�c
O Q
000 0 0 0
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.
4. SEE STD DETAIL NO. 146
CITY OF TIGARD APPROVED BY. NO SCALE
OREGON MICHAEL A. STONE. P.E.
� ENGINEERING DIVISION aTY ENGINEER STANDARD DRIVEWAY DWG. NO.
PUBLIC WORKS DEPARTMENT
13125 S.W.TI ARD,OREGON 97223 JANUARY 2013 w/CURB-TIGHT SIDEWALK 142
VOICE:(503)6394171
FAX: (503)684-7297 APPROVAL DATE
3/4" R 6„ EDGE
G
6„ 5" �_ �— DRAINAGE BLOCKOUT
— 3" I.D. SCHEDULE 40
DWV (ABS OR PVC)
PIPE W/COUPLING
a °
°
a a
o 00 o p O
16"
O � O D 'Z�) °
0
O O O O o
o ° 0 0 ZI
o
° 0 00
a
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°
9„
COMPACTED SUBGRADE
NOTES:
1. EXPANSION JOINTS:
A. TO BE PROVIDED:
1) AT EACH POINT OF TANGENCY OF THE CURB.
2) AT EACH COLD JOINT.
3) AT EACH SIDE OF INLET STRUCTURES.
4) AT EACH END OF DRIVEWAYS.
5) AT LOCATIONS NECESSARY TO LIMIT SPACING TO 45 FEET.
2. TRAVERSE EXPANSION MATERIAL TO BE PRE—MOLDED NON—EXTRUDED MATERIAL
WITH A MINUMUM THICKNESS OF 1/2"AND SHALL COVER ENTIRE CROSS
SECTION OF CONCRETE.
3. TRAVERSE CONTRACTION JOINTS TO BE SPACED NOT MORE THAN 15 FEET APART
WITH A DEPTH OF AT LEAST ONE FOURTH OF THE CROSS SECTIONAL AREA.
4. CONCRETE BREAKING STRENGTH TO BE 3000 PSI AFTER 28 DAYS.
5. DRAINAGE ACCESS THROUGH NEW CURBS SHALL BE PLACED A MIN. OF 2 FEET
AND MAX. OF 3 FEET FROM PROPERTY LINES (SEE NOTE 5 STD DETAIL NO. 126
6. FOR SUBDIVISIONS AN "S" FOR SANITARY AND A "D" FOR STORM DRAIN SHALL
BE STAMPED ON THE TOP OF THE CURB ABOVE THE LATERAL
CITY OF TIGARD APPROVED BY. NO SCALE
ORI.GON MICHAEL A. STONE, P.E.
� ENGINEERING DIVISION a,Y ENaNM STANDARD M. NO.
PUBLIC WORKS DEPARTMENT
13125 S.W.HALL BLVD.
TIG
TIGARD,OREGON 97223 JANUARY 2013 CURB
: VOICE:(503)6394171 125
FAX: (503)684-7297 APPROVAL DATE
CURB JOINT
SEE STD
DETAIL N0. 146
5' MIN. SEE NOTE 5 ROW
�- 2%
ROAD ., 1 r' alrl el 1 I•1 ••11 T
. I I I-III-I I I-I I I-I I I- -I I I-III-�''
2" OF 3/4"-0" BASEROCK
COMPACTED SUBGRADE
SIDEWALK ADJACENT TO CURB
PLANTER 5' MIN. ROW
STRIP
6"
�-
2%
ROAD , - - -
. I I{-III-III-III-III- -III-I 11-��I-•
• I-1 I�- ��I=1 I I-1 I I-1�I- i_i i I-
21' OF 3/4"-0"
COMPACTED SUBGRADE BASEROCK
SIDEWALK AWAY FROM CURB
NOTES:
1. CONCRETE SHALL BE 3000 P.S.I. AFTER 28 DAYS.
2. PANELS TO BE 5 FEET LONG UNLESS OTHERWISE SPECIFIED.
3. EXPANSION JOINTS & CONTRACTION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT
IMPREGNATED MATERIAL OR EQUAL EXTENDING FROM SUBRADE TO FINISH GRADE AND
PLACED AT SIDES OF DRIVEWAY APPROACHES, UTILITY VAULTS, WHEELCHAIR RAMPS AND AT
SPACING NOT TO EXCEED 45 FEET.
4. FOR SIDEWALK ADJACENT TO THE CURB AND POURED AT THE SAME TIME AS THE CURB,
THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN. 1/2" RADIUS.
5. SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED
OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY. OTHERWISE SIDEWALK SHALL HAVE
A MINIMUM THICKNESS OF 4 INCHES.
6. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3" DIAMETER
SCHEDULE 40 DWV (ABS OR PVC) PIPE AT 2% SLOPE. CONTRACTION JOINT TO BE PLACED
OVER PIPE.
7. CONCRETE SHALL HAVE A MEDIUM BROOM FINISH AND TROWELED ON ALL FOUR SIDES
CITY OF TIGARD APPROVM BY. NO SCALE
OREGON MICHAEL A. STONE, P.E.
ENGINEERING DIVISION CITY ENONEER CONCRETE DWG. NO.
PUBLIC WORKS DEPARTMENT
S.W.HALL BLVD.
TIG 120
TIGARD,OREGON 97223 JANUARY 2013 SIDEWALK
VOICE:(503)639-4171
FAX: (503)684-7297 APPROVAL DATE
CITY OF TIGARD RECEIPT
S 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Prophete Curb Cut
Site Address: 11754 SW GAARDE ST
Receipt Number: 420649 - 12/06/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00189 PFI Permit Fee 640-0000-43114 $300.00
Total: $300.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 649 SCOPELAN 12/06/2018 $300.00
Payor: Marc Prophete
Total Payments: $300.00
Balance Due: $0.00
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