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Parks & Recreation

Healthy Parks, Healthy Portland

Phone: 503-823-PLAY (7529)

Fax: 503-823-6007

1120 SW Fifth Ave., Suite 1302, Portland, OR 97204

Non-Park Use Permit Application
Please read the application information on the previous page before completing this form. You must provide information in fields marked with an asterisk *.

APPLICANT INFORMATION

Company
Contact Person
Address
City
State
Zip
Phone
Fax
Cell
Pager
Email

On-Site Project Manager

Name*
Title
Phone
Cell*
Pager

Person authorized to sign binding legal documents

This person will be required to sign the completed permit.
Name*
Title*

CONTRACTOR INFORMATION

No contractor is authorized to work unless specifically named in the permit or a formal amendment.
Company
Contact Person
Address
City
State
Zip
Phone
Cell
Pager
Email

On-Site Project Manager

Name
Title
Phone
Cell
Pager

Person authorized to sign binding legal documents

Name

PROJECT SUMMARY

Project Location (park name and specific location within park)
Property ID/Tax ID#
Description of proposed use, activity or facility (include whether proposed use will be public, private or commercial)
Is this part of a larger project? If yes, please describe.
Do you have existing authority (easement, etc.) to operate on this parcel of PP&R property? If yes, please describe and provide a copy or a reference number for the relevant documentation.
Will this project require permanent installation of equipment on (or above or below) PP&R property? If yes, please describe.
When would you prefer to start work?
How long will the work take?
Beyond the construction period, will applicant require ongoing access for operations or repairs? Please describe frequency, duration, and nature of ongoing needs.
Why is the project needed?
Who is the facility intended to serve?
What alternatives are available to the applicant, other than using PP&R property?

CONSTRUCTION INFORMATION

Description of construction methods to be used (e.g., trenching, boring, etc.)
Description of all equipment to be used
Anticipated impact on park land, facilities or users resulting from applicant’s use or construction
Description of proposed mitigating measures to minimize impact on park land
Description of site restoration plans and methods
Description of any enhancement to park property resulting from project
If utility or roadway, what is the usual width of right-of-way required for construction? For maintenance?

SUPPORTING DOCUMENTATION

Use the following field boxes to upload maps, insurance certificates, site photos, product specifications sheets or other documents. Submit these materials now - or you can send them in by email, fax or regular mail later.
Supporting Documents #1
(Maximum file size: 30MB)
Supporting Documents #2
(Maximum file size: 30MB)
Supporting Documents #3
(Maximum file size: 30MB)

COMMENTS

Please include any other instructions or notes related to your application.
* Required Field