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PFI2017-00111 „ CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT = COMMUNITY DEVELOPMENT Permit#: PF12017-00111 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/29/2017 Parcel: 1 S 134AB02000 Jurisdiction: Tigard Site address: 11325 SW BASSWOOD CT Subdivision: ENGLEWOOD Lot: 77 Project: Bryant Sewer Project Description: Adjacent to 11325 SW Basswood Court. Install new 4”sanitary sewer lateral via pipe burst from leftside of the drive to main in cul de sac. SEG Owner: FEES Description Date Amount PFI Permit Fee 06/29/2017 $300.00 PHONE: Contractor: TCJ CONSTRUCTION 19750 SW PAGE CT BEAVERTON, OR 97007 PHONE: 503-320-7831 FAX: 503-259-2432 Applicant: TROY JEWELL 19750 SW PAGE CT BEAVERTON, OR 97007 PHONE: 503-320-7831 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 a Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12017-00111 Type: Condition Name: Status: Severity: PFI—Sidewalk/1 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_Sidewalk/[ 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—Sidewalk/1 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—Sidewalk/1 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_Sidewalk/[ 05-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_Sidewalk/[ 06-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. call Jonny Gish 971-713-0281 or Jonny@tigard-or.gov PFI—Sidewalk/1 07-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_Sidewalk/[ 08-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—Sidewalk/1 09-OTHER Applied Notice RECEIvED JUN 26 2017 d • City of Tigan �ri:r>u�G L mem ig PuB1.1_c:�IoR�—� YpV e public F acilit�, Imp ra—s of Woo Work ❑ TYPE I_Franchise Utilin' PGE WORK(in the right-of-way) performed by DESCRIPTION OF p end/or Utilin agency. ❑Streetim toren1ents Dewar•a roach Driveway/mer Utilities 0 sideualkl�' PP� It nl� � TyP1✓2–Sidewalk/ Check one: LL ose of: Detailed description: V work per for the puT F #1L 4 N.) ,,,t • Sidewalk installation 0r rCPair- v-jr DC i T • Driveway approach installation 4-10 and/or repair 6j-"- lns}: • Sanitary sewer lateral installation Property address/ ocatioand/or main line cap S TYPE 3—full scale Development G ... Gp, �N►C� Work performed"i"ith rand use Applicant: t''t appro�'al which includes any of O a~ Cr the following: Address: zip: �� Sor partitions nn�� . ubdirisions� !';ry/gate: 1�� �y'QIL�! •� 0 1`631 t;mail:rt-�-� • Go �n�«w:�,....:.,� Phon` Mainline installation for Sanitary Contact name7D7��� L— Pho sewer, Storm sewer,Tigard water : s p''Y`�' A*s A gV and/or Tigard Contractor \Fater Service urea CCB#: ' F.tipiration: rUBm rcnUPI.FTEDAPPLICATIONTO: Address: City of Tigard City/state: 71p: Planning/Engineering Phone: _ Email: 13125 SW Hall Blvd. Contact name Phone: Tigard,OR 97223 Applications for"minor work in right-of—" only may be emailed to: Engineer: rowyermits(dti�ar -ot.gov Address: City/state: Zip: '(�-- n� Phone: T?mail: Case No.: ' Contact name: Application submittal fee:$ 04 Additional fees: $ Estimated value of work is required(if over 55,000): Application accepted (within the public right-of-wa}) B�: Date: 12iel n - (10 Application re%dewed: Is work related to a LAND-USE DECISION? ❑ yes 1\0 B4.J6 Date: G�a7 /7 If so,please specify (MLP,SDR, SUB,ctc.) case #: nppl;e t nc,tifird: Is work related to a BUILDING PERMIT? ❑ Yes; � No By: a Date: If so,please specify(BUILDING PI?RMIT)case#: AENG\v.rm@Apa1k.Mi \1Ni aonracw„ P., tsnme City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www6gard-or.gov 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.041.140. * nith the exception of a utility operating pursuant to a valid franchise with the City of TGard,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 or submit a written authorization with this application. Franchised Utilities are not required to obtain the owner's signature on the application BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that maT-be attached to or imposed upon the subject l?roplgrz% • 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 any 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. -A , - (,(I . IQ 7fL P�q 076../45 L-L, Ap 'can gutho zed Agent's signature Print name Date SIGNATURES of each owner of the subject property, if required. Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT Cityof Tigard • 13125 SW'Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4 6/25/2017 11325 SW Basswood Ct-Google Maps 11325 SW Basswood Ct101,A AJ � *w Image ©2017 Google,Map data 02017 Google 10 ft _ . AT�n� v l y" toy PG Y r afi W T r 11325 SW Basswood Ct Tigard,OR 97223 WOO 'w https://www.go(>gle.com/maps/place/11325+SW+Basswood+Ct,+Tigard,+OR+97223/@45.4442759,-122.7910005,30m/data=!3m1!1 e3!4m5!3m4!1 sOx5... 1/1 JEFF MARSHALL BILLING ADDRESS Scheduling: 503-998-3212 195 Springtree Lane Sewertechnw4grnail.com West Linn, Or 97068 r CCBM204338 Billing:503-927-8883 CLIENT NAME: �Qt�Q� r✓'L'F(t't ST 1'n`'J 9[s DATE: I�- PROPERTY ADDRESS: AGENT: nvt�-�l �'tla►��s v� SCOPE OF WORK:This is a sl+e.•Lilry insert riot of the sanmary sewer line Isom rhe prol.rrty idd—oboes ro nc,main:fry•/county sewer connection or septic tank.Our inspecnon of the sanitary sewer line cont,mcd from our available access point(mored below)to the roam city/county sr wee connrctusn or optic rank.No orb"Areas of the smeary seem line were inspected.and all of our continents below arc stnaly bawl on the portion of the unitary,ower line that was iusprctrd.Client understands that this company docs not oflrr any tyle of warranty on the forum operation and/or condition of the sanitary sewer line.-Ibe findings on this in.apeirihm report and video arc basal solely on the opuuoas amt cducanon of the inspector.This is a sub*rive inspection and our comments Mow reflect our ky,iniott of the condition discovered at the tonic of this inspr;mon only. Access point: Exterior C/0 ❑Basement C/0 ❑Crawlspace C/0 ❑Vent on Roof ❑Toilet ❑Other Main Waste Line Size: 03" ❑8" Other Total Footage: 5e. Waste Material Type(s): ,( yC�Cast ImOd--ncrete ❑Transits(Asbestos cement) ❑Clay ❑Orangeburg E11 B8 ❑PVC /34 ❑HOPE ❑Other Evidence of Party Sewer Line: ❑Yes JNo ❑Not Known El Further Evaluation with City is Advised r it Easement: ❑Yes)gNo ❑Not Known Line: ❑Sewer line functioning ❑Sewer line working but draining slowly El Recommend Jet/clean line and call for a rescoping of line I�AcZewer"spot repairs"needed El Sewer"line replacement'needed ❑Unable to scope entirety of line,Add/locate cleanout(s) and call for a rescoping of the line ! f I Inspection Findings: ( e,l o►J t'1t Q'6tt s i[cJ T-�c,�rLc�/ /• `T AISC k`t E CTr rra�i TO fn,,-,-Tec-4— (T- fizz � Loa's Rte} >✓ � rrr*- TtstE �.�wE t S f•J \t2 - U%�U p GerK-Ot.T+oYJ �1� �-\,�.--(c�-ru-I r•v� ,��- -�{-c s �.�•,t.-F. �e Recommend Replacement of Line: Wes ❑yTt�` � 1� ��„�_ i Inspector(s)Signature: Rough Sketch of Sewer line: Client Contact email and phone N: `JC,6�Q.tci`t I S �ttitPlt�/ Fee of Sewer Inspection:$ Late Charge after 30 days:$35.00 Check ❑Credit Card ❑Gash ❑Invoiced ❑Paid with Home Inspection Service Collected by LIMITATIONS OF LIABILITY.By paying for rhis report the Client understands and agrw ees that Secr Tech NW is noran in.eurtr and that ncurnAr �upccat.and repo a. c not inrended rn be,or construed as,a guarantee or warranty o4e adequacy,performance Pr condrttoat of any structure,ucm.or sgsrent at the properta•address.lie s19tamg beloo. the cusromer hereby releases and exempts Sewer Tech N W at{d its agents and employees hom all liability and responsibility tsr the cost of retvtring or replacing ant tun ep,n tc.l def cr or deficiency and for any conwqurncial damage,properlty damage or personal injury of any namor.In the nrnr that Scsaer T—h N\\'.ntd-%r,n a.genes a o taund h.ddc due to breach of contract, breach of warranry,negligm,:e,negligent misrepresentrtion,negligent hiring or any other theory of Lability,dun the hal+den,tel lien ci Ic,h N\% cud its agents and employees shall be limited to the amount of S 115.0p. I As required in Off typical sections Streetof construction Street plans Area 1 ' T—cut see Surfacing note 1 ) Topsoil or as directed Base Material U U o 0- C) O Of � > -0 E -0 o a U E5 Z cin ° �C x 0 C w U � o U X (n C) (!l E a O N C O Q C N 0 a_ :2 N Q) a N cin U ,� Q) i QI Q a- < 6" Min bedding 6 6 " " below outside of f pipe bell 3/4" — 0" MIN MIN crushed aggregate 2' Min Trench \\i\moi\\ foundation stabilization if required NOTE: 1. 1' T—CUT FOR PIPE ONLY PROJECTS. 2. JOINTS TO BE TACK AND SANDED. 3. SAWCUT SHALL BE TACK COATED WITH BITUMINUS ASPHALT EMULSION. CI"I'Y OF TIGARD APPROVED BY: NO SCALE OI LGON MICHAEL A. STONE, P.E. ENGINEERING DIVISION TRENCH DWG. N0. PUBLIC WORKS DEPARTMENT CITY ENGINEER S.W.HALL.BLVD. TIG /�O TIGARD,OREGON 97223 JANUARY 2013 BACKFILL VOICE:(503)639-4171 1jv( FAX: (503)68¢7297 APPROVAL DATE