PFI2018-00217 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00217
13125 SW Date Issued: 08/22/2018 Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S104AD00100
Jurisdiction: Tigard
Site address: 12600 SW 128TH AVE
Subdivision: BELLWOOD Lot: 14
Project: Bode
Project Description: Adjacent 12600 SW 128th Ave. Prune 2 sweetgum trees to reduce weight by 25%due to breaking
branches-safety hazard.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
MOUNTAIN VIEW TREE SERVICE
PO BOX 80805
PORTLAND, OR 97280
PHONE: 503-830-1468
FAX.
Applicant:
JUANITA BODE
12600 SW 128TH DRIVE
TIGARD, OR 97223
PHONE: 503-747-5688
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: See application
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00217
Type: Condition Name: Status: Severity:
PFI_Sidewalk/[ 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/[ 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/1 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/1 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.
Contact Ken Fisher at 503 816 6146 or Kenny@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/1 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
City of Tigard AUG 20 2018
N PUBLIC WORKS—ENGINEERING CITY OF TIGARD
Public Facihty Improvement (PFI) PI&YffiftGNEERING
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
❑ TYPE 1—Franchise Utility Work
Check one: ❑ Utilities ❑Sidewalk/driveway approach ❑Street improvements performed by NWN, PGE
Detailed description: I&WE& and/or utility agency.
D010El TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of
�. Sidewalk installation or repair.
Property address/location(s): • r---- Driveway installationa(eOV ��/� and/orrepair
ALIT • Sanitary sewer lateral installation
and/or main line tap
--// -- ❑ TYPE 3—Full scale Development
Applicant:/ �� 7�f' �.��%� Work performed with Land use
Address: lol if TA approval which includes any of
City/State: Zip: the following:
Phone-_S50 7? Email: bad& Z CornG�Sr.N67- • Subdivisions or Partitions
Contact name: Phone: • Street widening
ni
j • Mainline installation for Satary
Contractor: ///D!w'r7E-r� �Ej,C1 /1E��S��/l�G sewer, Storm sewer,Tigard water
and/or Tigard Water Service Area
CCB#: /7 Q9:2 S Expiration:
�j �j
Address: /.Q, ed 0 0 6 p a ! SUBMIT COMPLETED APPLICATION TO:
City/state: L Zip: ZjR 4F6 City of Tigard
Phone-
p�X S'n 197 41mail: Planning/Engineering
O '�C� AITi/TO12�aJ. l°o�c— 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer. only may be emailed to:
Address: rowPermitsntigard-or.gov
City/state: Zip: RINUFM
Phone: Email: Case No.: P1?._0 l 8- ooll-?
Contact name: Application submittal fee(.07%of
Engineers Estimate) $ Q'o
Estimated value of work is required(if over$5,000):$ Additional fees: $
(within the public right-of-way) Applicationaccepted:
� � l
Is work related to a LAND-USE DECISION? [J Yes El No \
By: T
If so,please specify(MLP,SDR,SUB,etc.) case#: Application reviewed:
By Date: Z I"16
Is work related to a BUILDING PERMIT? ❑ Yes ❑ No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: -S Date:
1;\ENG\PermitAMkatiom\Pfi_application Effective 10/16/2017
City of Tigard • 13125 SW Hatt Blvd. • Tigard,Oregon 97223 • www.tigard-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.
* With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,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 APPLICANT(S)SHALT.CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
ro r.
• 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.
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property,if required.
3s
AJ
Cavy is signature Print name Date
uc�y� - id"AlAv- C �-( q I I g,
Own si ture Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SSG'Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 • Page 2 of 4
Schedule date/time: PO Box 80805
Line drop: No
Portland,OR 97280 Proposal # c-15554
MtV EW
TREE SERVICE Date: 8/14/2018
Grinder: N/A TREE SEPhone: 855-878-8733
Email: office@mtvtreeoregon.com
Truck: BT#3 Website: www.mtvtreeoregon.com
Locate utilities: No Customer Phone: 503-747-5688
Customer Alt.Phone:
Name/ Billina Address Job Address
Juanita Bode Juanita Bode
12600 SW 128th Ave. 12600 SW 128th Ave.
Tigard,OR 97223 Tigard,OR 97223
Health
Chip I Remove Remove N/A No
Description Qty Rate Total
Risk Mitigation Pruning: 525.00 525.00
(2)Sweetgum(20, 18"DBH)In ROW-Reduce weight by 25%,focusing on removing secondary limbs,
with a goal of reducing risk of limb failure.
------------------------------------------
Maintenance Pruning:
(1)Horsechestnut(8/4/6/7/4"DBH)Front left yard-Raise canopy for 8-9 feet of ground clearance,remove 75.00 75.00
sprouts from lowest 10 feet of trunk,remove deadwood.
(1)Southern Magnolia(25"DBH)Back right yard-Raise canopy for 10 feet of ground clearance over 175.00 175.00
neighbors property,7 feet ground clearance over clients property,remove deadwood 1 inch diameter and
larger.
(1)Norway Maple(25"DBH)Back left yard-Raise canopy over clients property for 7 feet of ground 75.00 75.00
clearance,prune for 3 feet of Star Magnolia clearance.
-Chip and remove all debris and wood.
------------------------------------------
Subtotal: 850.00
------------------------------------------
SenioT Discount: -5.00% -42.50
Customer Note:A Right Of Way permit is required prior to.Right 12785 SW Marie Ct and back 12775
SW Marie Ct neighbor waivers for magnolia pruning.
OPTIONAL:The following items are priced for Mountain View staff to facilitate the permit process:
Non-refundable ROW permit application fee: 0 300.00 0.00
Administrative fee to complete application process: 0 50.00 0.00
ESTIMATE IS GOOD FOR 90 DAYS -Customer is responsible for marking private lines,details below. Total $807.50
After 90 days Mountain View Tree Service LLC may choose to honor the estimate or provide the customer with a new proposal. Mountain View Tree Service LLC
will provide all labor and materials necessary to complete the above proposal.Customer agrees to pay cost of this bid upon completion of the written work order to
agreed expectation.By law and for your protection,we are licensed CCB#179875,Bonded and Insured.This means we carry full liability and workman's comp.Ins.
Certificates of Verification are available upon request.
Note:It is the responsibility of the customer to inform Mountain View of any property lines that could be crossed.Mountain View will contact corporate/city owned
utilities necessary to be marked.These will include communication,water,sewer,and power.These will be marked with paint,and homeowner is requested to not
remove paint until grinding is complete.Mountain View is responsible for damage to these corporately/city owned utilities.Homeowner is to inform Mountain
View of all privately owned lines such as sprinkler lines,septic lines,outdoor drain tiles,underground pet fences,or any other privately owned underground lines.If
any of the underground hazards listed above are under stump or grinding area,the above listed grinding depth will need to be altered and Mountain View cannot be
held responsible for damage to these privately owned lines.Other hazards that could affect grinding depth would include but are not limited to:metal/steel or
excessive rock. Contractor Mountain View Tree Service LLC
Customers Signature: n+ji. I Rep JV
Signature: By Marvin Klopfenstein, Member
For Questions or concerns please call Marvin Klopfenstein 503-830-1468;Stump grinding please 503-363-0991;Billing Dept:503-619-9153
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