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PFI2015-00195 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00195 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 12/30/2015 Parcel: SEG1096 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: Warren Sidewalk Repair Project Description: Remove and replace broken sidewalk,driveway, and approach Owner: FEES Description Date Amount PHONE: PFI Permit Fee 12/30/2015 $300.00 Contractor: PHONE: FAX: Applicant: TAMIKO\NARREN 5460 NMRIMINO AVE PORTLAND, OR 97229 PHONE: 503-515-9293 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 PF12015-00195 Type: Condition Name: Status: Severity: PFI_Sidewalk/[ 02-WORK SITE AREA Not Met 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/[ 06-NOTICE TO COMMENCE WORK Not Met 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—Sidewalk/1 09-OTHER Not Met Notice PFI—Sidewalk/1 05-PRECONSTRUCTION MEETING Not Met 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/1 07-PERMIT/PLAN ON SITE Not Met 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/1 04-WORK SITE REPAIRS Not Met 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/[ 01 -WORK SITE REQUIREMENTS Not Met 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/[ 03-WORK SITE EROSION CONTROL Not Met 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/[ 08-EMERGENCY CONTACTS Not Met 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. RECEIVED City of Tigard DEC 3 0 2015 � PtlKl_l(: WORKS— FINGINI?I"RING ■ F TIGARD Public FacilityImprovement (PFI) P �ENGINEERING DESCRIPTION OF WORK(in the right-of-way) TYPE OF WORK f Check one: ❑ Utility Connection ❑ TYPE 1-Franchise Utility\Xorl, --`14 Sidewalk/drivcu:iy approach Work performed by N\XW'N,PGL ❑ Street improvements and/or utility agency. Detailed description- -/AraLZG 6 ��c4 a��o k6h '-sTYPE 2-Sidewalk/Driveway/Scwcr i io�c l Work performed for the purpose of: S. D F w AL k, b r iJ 6 NM /{a - • Sidewalk installation or repair. • Driveway approach installation ���U ��(�t-} 12g� 70\ and/or repair Property address/location(s): — • Sanitary sewer lateral installation and/or main line tap �` ❑ TYPE 3-Full scale Development Applicant: /C //�o �� �� Work performed with Land use ', 29r1 c '`� - approval which includes any of Address: S � �' N� �2«� --7 � ���- the following. City/state: ';?,o1Z ©B- lip: q7 ZZ 2 • Subdivisions or Partitions Phone:� 55��_�Email. b 4 ' IClYYC 1L' �$ ` Street widening Contact name: Q K° Phon Nlainhne installation for Sanitary sewer,Storm sewer,Tigard water and/or Tigard Water Service Area • Contractor: �4 D 5 <.OhS�.,�c.�;a� G G L CCB#: /e.ti 7,7-6- Expiration: 6'S' Z o/b sUBMrr COMPLETED APPLICATION TO: Address: Z 9 Y S• /S"/ 54 City of Tigard City/state: S 9 7 oS' / Planning/Engineering 1161e- S,� E�e� j1P= 13125 SW Hall Blvd. Phone: .SoS-tel -9ao� Email: /h;��G�►e/E✓. •,c,��.,A,l.�oi"c Tigard,OR 97223 Contact name: /lliGL+��I l.�E✓c/ir-,I Phone: -5'0,3 -10/-D103 Applications for"minor work in right-of-way" only may lx emailed to: CO rmitsktigar -or. Engineer: Address: City/state: zip: n Phone: Finail' Case No.: Contact name: Pi' A lication submittal fee: c '> Additional fees: Estimated value of work is required(if over$5,000):$ Application accepted: ? (within the public right-of-way) By:�--�_ Date: licatio ed: Is work related to a LAND-USE DECISION? ❑ Yes No App If so,please specify (MLP, SDR,SUB,etc.) case#: By' Date'AS �/5 Applicant notified: Is work related to a BUILDING PFRMIT? ❑ Yes ❑ No By: L-S Date: �9 .3� If so,please specify(BUILDING PERMIT)case#: e\a,artN\---\-d—Apple wm ar,071o9/2ots City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 www ti 4ard-or.gov 503-718-2421 • Page 1 of 4 Conditions for PF12015-00195 Type: Condition Name: Status: Severity: PFI_Sidewalk/[ 02-WORK SITE AREA Not fMet 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/[ 06- NOTICE TO COMMENCE WORK Not fMet Notice The applicant shall notify the City's Inspector Nventy-four(24)hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI Sidewalk/[ 09-OTHER Not Met Notice PFI Side',valk/[ 05-PRECONSTRUCTION MEETING Not Me, 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/[ 07-PERMiT/PLAN ON SITE Not Met 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_Side\,valk/[ 04-WORK SITE REPAIRS Not Met 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/[ 01 -WORK SITE REQUIREMENTS Not Met Notice Applicant must comply with all applicable provisions of federal and slate 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/[ 03-WORK SITE EROSION CONTROL Not Met Notice Prior to starting work, effective and approved erosion control devices muse 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/[ 08-EMERGENCY CONTACTS Not Met Notice Provide to the City inspector, in writing, the names and 24 hour emergency telephone number of Nvo,(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 noti7y the City Inspector, in writing: of any/all assignment changes.