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PFI2014-00044 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12014-00044 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 08/04/2014 Parcel: 2S112BC05700 Jurisdiction: Tigard Site address: 8400 SW LA MANCHA CT Subdivision: LA MANCHA ESTATES Lot: 10 Project: Eastgate Project Description: Demo and replace 32 lineal feet of five foot sidewalk. No fee since homeowner is fixing a hazard. Owner: FEES SUSAN EASTGATE Description Date Amount 8400 SE LA MANCHA CT. TIGARD, OR 97224 PHONE: Contractor: PHONE: FAX: Applicant: SUE EASTGATE 8400 SW LA MANCHA CT. TIGARD, OR 97224 PHONE: 503-333-7733 Total $0.00 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: ,(�l� Issued By: C1JLC/1w�/LF',✓ Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY City of Tigard Public Facihty Improvement • (PFI) Permit General Information: FOR STAFF USE ONLY Property Address/Location(s): Engineering L400 � La'r\Acha_ 0 ,T Case No.: F OI�{ -0,>0 y�' Fee: Wr/�-t Va'e f7 Receipt No.: 7 4 A qr`LL a- ) *Applicant's Name: -amu 1=l,�:- Date: (f�2 Address: 34W SLO VWQAaa_ Application Accepted: Bv:W— Cinv/State:_T 1 In �� D � Zip: 41 7 PrimaryContact: REQUIRED SUBMITTAL Phone: � '3 333733Fax: INFORMATION �,�,[� �/ E-Mail: ��4D� T de kM, C0 r T , Professional Engineered Plans are required Ae vW)kdr Street WideningContractor's Name: . Subdixision Infrastructure CCB# Expiration: • Main utility line extension: 0 Storm Drain,Sanitan -Tigard Address: 0 Cater-Tigard Water Sen-ice.krea City/State: Zip: (includes Durham,Bing taty and a portion of unincorporated Washington Phone: Fax: portion .•Note:See Engineered Plan Plans Bv: � Submittal Checklist attached. ,address: For all other work:Submit scaled sketch of the CI"'/State: Zip: work to be done. (see attached minimum sketch requirements and provided sketch arca). Phone: Fax: l pda,ad 6 Is 2,111 I (Vitpl.\ Ata>,a I and 1pplwa,e•n> I'ublw I a Jm Re�p� � Impnnrr,xm c6K� Description of work. q PI) 5' 6 ide Sldk,*u lC Estimated value of work(within the public right-of-way): Is work related to a LAND-USE DECISION? YES FJ NO If so,please specify(MLP, SDR,SUB,etc.) case #: Is the work related to a BUILDING PERMIT? YES NO If so,please specify (BUILDING PERMIT) case#: Cityof Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 503-718-2464 1 www.dprd-ongov Page l of5 APPLICANTS: To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as descnbed on the front of this application in the"Required Submittal Elements"box. NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for Work. *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 on the back of this form or submit a written authorization with this application (Detailed Submittal Requirement Information sheets can be obtained,upon request,for all n•pes of Lind l'm. \pphcanons.) BY SIGNING BELOW,THE APPLICANT(S)SHALL CERTIFY THAT: ♦ The above request does not violate an}'deed restrictions that may be attached to or imposed upon the subject pro gem • 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 the 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. SIGNATURES of each owner of the subject property. DATED this f' day of"A 5r ,20—Lq— 9 ou, b4gx* Applicant/Authorized Agent's Signature Owner's Signature Owner's Signature Owner's Signature City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.dprd-or.gov PW2of5 n ' o � n x a w � rn Un to C tz C a gyro' w � W ' W _J N l 0 �b c°, ., 1476 �- {F tea. ' 141URTQUC. K 5T= �„ ,�,• 1418 Q .. 8390 8360 1I .. 833L1 d 'S 14820 � r -s co . 8.13 i 8 39 315 13860 Y '$ 4 7 0445 , "`� . v r LA NI A N " 14880 � r 4900 :. 8140F� l 'z0' 60 8 3d�. . 83za � `.� ' 8261 r r t� ?Q E IN P t F: k �. r 8Z56 187.38 ; Fee! Cheryl Caines From: Zen Dutson Sent: Monday, August 04, 2014 12:22 PM To: Cheryl Caines Cc: speedi40@yahoo.com; Eastgate, Susan Subject: RE: Sidewalk replacement permit Cheryl Please process the application with no fee, as the property owner is fixing a hazard in the sidewalk. Thanks, Zen From: Eastgate, Susan [mailto:Susan.Eastgate@centurylink.com] Sent: Monday, August 04, 2014 10:02 AM To: Cheryl Caines; Zen Dutson Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Also there is no contractor involved, I have hired the work to have the new sidewalk done. Of course it is being done by guys that know what they are doing O If this could be expedited for as soon as possible today that would be greatly appreciated. I will go in and pay the fee's online as soon as they are showing. Again...thanks for all your help on this I appreciate it. Sue Eastgate Support Analyst State of Oregon Team Centurylink 503-425-5386 (office)***PLEASE NOTE*** NEW NUMBER 503-585-2408 (fax) susan.eastgate@centurylink.com CenturyLink- Business From: Eastgate, Susan Sent: Monday, August 04, 2014 9:13 AM To: 'Cheryl Caines'; 'Zen Dutson' Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Cheryl, i I thought the only fee I had was the $300 for the Permit, what is the other $$ you mentioned for? I don't get it since it's the homeowners responsibility to fix the side walk, otherwise I could get sued if someone hurts themselves tripping on it because its raised up do to tree's that were planted there (not by me). The excavator is K Witt. Please let me know as this is getting to be a bigger financial burden then what I was expecting. I appreciate your help. Thanks! 5ue Eastgate Support Analyst 5tate of Oregon Team Centurylink 503-425-5386 (office)***PLEASE NOTE*** NEW NUMBER 503-585-2408 (fax) susan.eastgate@centurylink.com a r = CenturyLink- siness From: Cheryl Caines [ma iIto:cherylc tigard-or.gov] Sent: Monday, August 04, 2014 9:03 AM To: Eastgate, Susan; Zen Dutson Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Sue, More information—I do not know if the inspector's will be able to issue today. Without the permit the contractor should not be working in the right-of-way. Hopefully this can get done before the contractor is supposed to be there. Cheryl From: Cheryl Caines Sent: Monday, August 04, 2014 9:00 AM To: 'Eastgate, Susan'; Zen Dutson Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Sue, I spoke with the inspectors. They said that we cannot issue the permit until they have been able to review the permit, fees are paid, and assurances are collected for the work. The assurance is based on the amount of work and is held until after the work is complete. It will be refunded via check. 2 You can pay the fee ($300) and cash assurance (to be determined) on- line at this link: https://aca.accela.com/tigard/. Click on the Engineering tab at the top. Enter record number PF12014-00044. The fees will be listed under fees. We can let you know when the total is available to pay or you may stop by to pay the fees. I'm copying the inspection supervisor(Zen Dutson) as I am passing the paperwork onto the inspector's for review and determination of fees. One last question. They asked for contractor information. Will you please provide that? Thank you, Cheryl From: Eastgate, Susan rmailto:Susan.Eastgate(a)centurylink.com] Sent: Monday, August 04, 2014 7:49 AM To: Cheryl Caines Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Morning.. I found out last night he plans on being there this afternoon, so if I can get the permit in place by noon that would be super. Please let me know what needs to happen. I appreciate all your help. Thanks! Sue Eastgate Support Analyst State of Oregon Team Centurylink 503-425-5386 (office)***PLEASE NOTE*** NEW NUMBER 503-585-2408 (fax) susan.eastgate@centuCylink.com '1 �= CenturyLink- Business From: Cheryl Caines [mailto:cherylc(abtigard-or.gov] Sent: Monday, August 04, 2014 7:42 AM To: Eastgate, Susan Cc: 'speedi40@yahoo.com' Subject: RE: Sidewalk replacement permit Hi Sue, 3 I apologize. Our offices are closed on Fridays. I'm going to speak with the inspectors about this permit. Do you still have the contractor coming out this morning? Cheryl From: Eastgate, Susan [mailto:Susan.Eastgate@centurylink.com] Sent: Friday, August 01, 2014 7:54 AM To: Cheryl Caines Cc: 'speedi40@yahoo.com' Subject: Sidewalk replacement permit Importance: High Good Morning Cheryl, Attached is the application for the permit. I need to see if I can expedite this as I have the excavator scheduled for Monday morning, getting all the framing and prep work completed as its scheduled to be poured on Wed. If you have any questions, please feel free to call me. Below is my office number or my cell 503-333- 7733. I appreciate your help on this. Thanks! Sue Eastgate Support Analyst State of Oregon Team Centurylink 503-425-5386 (office) ***PLEASE NOTE*** NEW NUMBER 503-585-2408 (fax) susen.eastgate@centurylink.com CenturyLink- Business DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 4