PFI2013-00009 y n CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12013-00009
• 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 04/18/2013
Parcel: 2S111 DCO2600
Jurisdiction: Tigard
Site address: 15725 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 473
Project: Walbert Sidewalk Replacement
Project Description: Adjacent to 15725 SW Alderbrook Circle, remove and replace sidewalk and curb.
Owner: FEES
Description Date Amount
PFI Permit Fee 04/18/2013 $300.00
PHONE:
Contractor:
FETTIG COMMERCIAL CONSTRUCTION, INC.
P.O. BOX 1381
TUALATIN,OR 97062
PHONE: 503-209-8250
FAX:
Applicant:
CHARLES WALBERT
15725 SW ALDERBROOK CIR.
TIGARD, OR 97224
PHONE: 503-624-6494
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 O�\ I
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
City of Tigard
Public Facility Improvement (PFI) Permit
General Information: FOR STAFF USE ONLY
Property Address/Location(s): Engineering-+ Q
C C-1�.� �� `Z 1 Z Z� Case No.: -I"F� 2,���--�C��
Receipt No.: 111103 1
Date: q I�� �-0� s*Applicant's Name: C & , f✓3t Application Accepted By:
Address: L S -T ZS Cie, Revised 7/1/10
City/State: Zip: Ci 1 2--2cj
Primary Contact: REQUIRED SUBMITTAL
Phone:
-3L/g `62`l_&Q Q Fax: INFORMATION
Professional Enboineered Plans are required
__ for:
Contractor's Name: r7i l I G, C�t�c-cc��
• Street Widening
CCB# Expiration:
• Subdivision Infrastructure
Address: • Main utility line extension:
0 Storm Drain,Sanitary—Tigard
City/State: �P 0 Water—Tigard Water Service Area
Phone: Fax: (includes Durham,Bing City•and a
portion of unincorporated Washington
County)
Plans By:
**Note:See Engineered Plan
Address: Submittal Checklist attached.
City/State: Zip: For all other work:Submit scaled sketch of the
Phone: Fax: work to be done.(see attached minimum sketch
requirements and provided sketch area).
�/3 il�CC C&\�.Lw I:cucptn\master\land use application\PFiapp.doee
Description of work: Y CSA
Estimated value of work(within the public right-of-way): $ J5 C_W-G
Is work related to a LAND-USE DECISION? YES ❑ NO
If so,please specify(MLP,SDR,SUB,etc.) case#:
Is the work related to a BUILDING PERMIT? YES❑ NO E
If so,please specify (BUILDING PERMIT)case#:
*NOTE:Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for the work.
City of Tigard 1 13125 SXX'Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 «vwrw.tigard-or.gov I Page 1 of 4
4CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 191032 - 04/18/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12013-00009 PFI Permit Fee 100-0000-43114 $300.00
Total: $300.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1321 TLEHRBACH 04/18/2013 $300.00
Payor: The Walbert Living Trust,Charles G.Walbert Trustee
Total Payments: $300.00
Balance Due: $0.00
Page 1 of 1
Page 1 of 1
fwTTIG HOMEOWNER JOB PROPOSAL & ESTIMATE
r DATE: 4/12/2013
Concrete Specialists Since 1991
OR CCB#18E99f]
PLAN: N/A(site visit)
CUSTOMER: CHUCK WALBERT CONTACT: Chuck 5G3-624-6494
15725 SW ALDERBROOK CIRCLE
TIGARD JOB LOCATION: same
EMAIL- cgwalbertCdgmaiI.corn
ITEM MEASUREMENTS QTY UNITS RATE TOTAL
R&R PcrchiErlry, 5.25'X 27'-broemed finish 135 ft, (4'1 $ 7,00 S 945.00
R&R Driveway 18'X 15'-trcorr,ed finish 2-70 ft'(4'1 5 7.00 S 1,290..0
Driveway Addition 1.75 X 15'-broomed firish 2625 P(4") S 3.00 S 7x.75
R&R Citfvalk 4'X 28'-broomed finish 112 1-2(4--) S TCO S 784.CG
R&R Approach 4'X 22'-broomed finish 88 P,=(61 S 9.00 S 792.00
Full Height Curb R&R Sa v cut,remove&replace cab only 23 P S 18.00 S 504-CO
Apprcach Curb R&R S&a, cut remove&replace=rb only 22 ft S 12.00 5 264.00
VAre flesh Ccncrete Reinforcement 531.25 ft'(4'1 S 0.E0 S 378.75
JOB TOTAL S 5,626.50
Pleaso NOW:Terns:Pn;m4n payrrcr t^required:1:2 of s;tlmatad balani pdor to ah star.,balm ce cite In ILA upon crxnpL^ltin
A:l amensicrm are approx!mam and meas;jements have heen rcurded off:c L.c nearest tact of 1!4 cube yard.Q,:otc
O,:ote Ices not tz!uce=maned rock for frit,dirt crcurb 4aulefl unless rated shove.Any a erution or dcviat:sn frcr:l ahcve
specizGcat3crz invciwg extra=sh.,viii bee;_r.2 an extra_targe over and atcve tho estinato. All at reemems srtinsan;
urn sleka3,accidents-wcatfu r,arc=tier =slays!:cyan=cur=nboi.CM:r.er to carry Hr_,tornado and i or caner
ne,?ssa:y insurance upn atova crk.'Afc-kmen.'s Componsatir-n and put=C:nillry insurance on abcvu w:rk to L--taken
out by Fealg Conslrucbar,Ina.
FerJg CcnsCu:ion,b1G'MO snpiete me nr-rc desc:lbcd Jlla prap=el in manner and to erduatry alarrards.
brlark:s g:ra wl—d to be kvWh;n the 3Lmdars set by the Comtr udcn Cct=elms 2card for the starew-at Or-son and;cr
Washing;-'a t year from dale cr omFiel;on. C.acka Wass tar.VS irci v=Ucal:ecarader or Issa:han 114 iron hcracrbt
wpa-aaticn arc mthrn InCustrystana:rds or tic's Icb.
ACCEPTANCE OF PROPOSAL
The atove prices,spedncations and condflicrs are satisf:,ctor�and are hereby accepted. Fettig Constriction,lnc.is authcrized
to do the vicrt as specifled above. Payment vA be made as outlined abcve.
SigratLre: Date:
If there are any questicns please tail: Mark Bailey @(503)209-8250
https:Hdocs.google.com/viewer?attid=0.1&pid=gmail&thid=13e002ad8ead6844&url=https... 4/12/2013
PROPRIETARY&CONFIDENTIAL
15725 SW ALDERBROOK CIR. SITE PLAN
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TIGARD, OR 97224 DIAGRAM NOT TO SCALE
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