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PFI2015-00069 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12015-00069 13125 SW Hall Blvd . Tigard OR 97223 503.718.2421 Date Issued: 08/05/2015Parcel: 1 S135BB00700 Jurisdiction: Tigard Site address: 10685 SW GREENBURG RD Subdivision: OAKBURG Lot: 27 Project: Ewing Lot Line Adjustment Project Description: Sidewalk, curb ramp and driveway approach widening to Cascade Avenue as shown on the development plans. Owner: FEES Description Date Amount Erosion Control Only-Eng 07/21/2015 $472.80 PHONE: PFI Permit Fee 07/21/2015 $1,232.00 Customer Deposit 07/21/2015 $17,600.00 Contractor: PARKWAY CONSTRUCTION 1000 CIVIC CIRCLE LEWISVILLE, TX 75067 PHONE: 972-221-1979 FAX: Applicant: KEN KELLY 3441 E HARBOUR DRIVE PHOENIX, AZ 85034 PHONE: 602-437-9530 Total $19,304.80 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 PF12015-00069 Type: Condition Name: Status: Severi : PFI—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 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—Street Imp 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI—Street Imp 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area. Traffic control devices,flag persons,etc., shall be in place prior to initiation of construction work and shall be effectively maintained. PFI—Street Imp 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire& Rescue)and to 503-962-8140(Tri-Met) and 503-431-2345(Tigard School District)and other service providers impacted by such closure. PFI—Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI—Street Imp 11 -TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m.to 9:00 a.m. unless authorized by the City Engineer. PFI—Street Imp 12-TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI—Street Imp 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI—Street Imp 14-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules,contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense. PFI—Street Imp 15-UTILITY LOCATION CONFLICT Applied Notice Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI—Street Imp 16-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI—Street Imp 17 - REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities (roads, ditches, etc.)as may be necessary, as determined by the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI—Street Imp 18 - SEWER SYSTEM TEST Applied Notice A sewer system air-test and/or DVD T.V. test report and one set of"As-Builts"shall be provided for review and approval. PFI—Street Imp 19 - 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—Street Imp 20-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. PFI—Street Imp 21 -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—Street Imp 22 - DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector. PFI—Street Imp 23 - MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI—Street Imp 24 -VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI—Street Imp 25 - 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—Street Imp 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI—Street Imp 27 - PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreements]from the owner for each private property disturbed by construction activity. PFI—Street Imp 28 -AS-BUILT DRAWING Applied Notice One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). PFI—Street Imp 29-PRIVATE WATER QUALITY FACILITY Applied Notice The Developer shall maintain the water quality facility and correct any defective work, and shall perform all scheduled maintenance to assure proper functioning of the facility. PFI Street Imp 30-PUBLIC WATER QUALITY FACILITY Applied Notice The Developer shall create and provide to the City a schedule for periodic(quarterly)maintenance of the water quality facility. The Developer shall maintain said facility for a period of three(3)years from the date of City Conditional Acceptance of the public improvements. On October 1 st of each year during this three(3)years period,the Developer shall report, in writing, maintenance activities to the Director of Public Works. City crews should monitor proper removal and disposal of silt and debris. Prior to City final acceptance of the facility, the Developer shall provide a written evaluation of the operation and maintenance needs of the facility and correct any deficiencies identified in the evaluation. PFI—Street Imp 31 -OTHER Applied Notice oe e � City of Tigard January 21, 2016 Parkway Construction &Associates Attn: Ethan Mabe 1000 Civic Circle Lewisville,TZ 75067 Re: Permit No. PFI2015-00069 Dear Applicant: The City of Tigard has processed a refund for the deposit of fees on the above referenced permit for the following: Site Address: 10685 SW Greenburg Rd Project Name: I-Fly Job No.: N/A Refund: ® Check#219881 in the amount of$17,600.00. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Refund 100% of cash assurance deposit paid before submitting a bond. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. i I 13125 SW Hall Blvd. • Tigard, Ore • g Oregon 97223 503.639.4171 C TTY Relay: 503.684.2772 • www.tigard-or.gov I c City of Tigard Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request forPetwidAc•tion form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: parkway Construction cl',--Assc DATE: 1/14/2016 Attn: Ethan tilabe 1000 Civic Circle REQUESTED BY: Dianna Howse Lewisville,TZ 75067 AD TRANSACTION INFORMATION: Receipt#: 201738 Case#: PF12015-00069 Date: 7/21/2015 Address/Parcel: 10685 SW GreenburgRd Pay Method: Check Project Name: I-Fly EXPLANATION: Refund 100°o of cash assurance deposit paid before submitting a bond. _ RNIATION: - -- - _ - - - - - REFUND INFO - M1 ....fiin'd Fee`Descri non"Fzom Recei 't - Revenue Account No:r'.'.-_.<,_. :r ...,_ -.,Re - P, -- - - - o unf Ani ''o=y - `Ie�= 300 000 43 0 =Esarric '$ �Esam'le'`Build�n�Permit Feed - - - Customer Deposit 100-0000-22000 $17,600.00 TOTAL REFUND: $17,600.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager �J If under$50,000 City Manager Hover$50,000 Local Contract Review Board :-FOR TIDEMARK:SYSTEM°ADMINISTRATION:USE-ONL Case Refund Processed: Date: B 1:\Building\Refunds\RefundRequest.doc s 09/01/2010 City oj -tgard • COMMUNITY DEVELOPMEIN_ DEPARTMENT Request for Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO•• (Business or Individual) Mailing Address: L• , �r City/State/Zip: 1�,�/��// � 1—_767' Phone No.: 1� _ T 4 j?_• 1�'7 Gr PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: I +,�G/11 /tel r � 6J Site Address or Parcel #: 16/.-Is-gqgQQ�[�3 Project Name: 1+A Z,,t,�j� Lj Subdivision Name: — Lot#: EXP ATION• O 00 , ev Signature: Date: Print Name: Refund Poliev 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE tTSE ONLY Route to Sys Admin: Date By Route to Records: Date By - Refund Processed: Date / / b B Invoice Processed: Date B Permit Canceled: Date B Parcel Tag ridded: Date B I:\Building\Forms\RegPemnitAction_092314.doc l