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PFI2019-00057 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PFl2019-00057 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/14/2019 TIGARD 13125 2S112CC03800 Jurisdiction: Tigard Site address: 8010 SW CHURCHILL CT Subdivision: BOND PARK NO.3 Lot: 66 Project: Deck Sidewalk Replacement Project Description: Sidewalk replacement and fix curb. Owner: FEES Description Date Amount PHONE: Contractor: BULL MOUNTAIN CONSTRUCTION 973 SW TOMAHAWK PLACE DUNDEE, OR PHONE: 503-330-0149 FAX: Applicant: DENNIS DECK 8010 SW CHURCHILL COURT TIGARD, OR 97224 PHONE: 503-639-8149 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 PFI2019-00057 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/[ 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. PFI_Sidewalk/[ 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/[ 09-OTHER Applied Notice . . RECEIVED City ofTigard FEB 14 2019 iiii '� PUBLIC WORKS —ENGINEERING CITY OF TIGARD _ PLANNING/ENGINEERING Public FacilityImprovement (PFI) Permit TIGARD TYPE OF WORK DESCRIPTION OF WORK(in the right-of-way) ❑ TYPE 1-Franchise Utility Work Check one: ❑ Utilities ❑Sidewalk/driveway approach ❑ Streetimprovements performed by NWN, PGE / Detailed description: �'�_ ,,a4J /nd or utilityagency. (.....643,:.4,444,_� 'TYPE 2-Sidewalk/Driveway/Sewer Work performed for the purpose of: C-4-e2 G .�j- tem a.- l e LL — lie j iv 0-6 •V ) ai//" • Sidewalk installation or repair. /, • Driveway approach installation Property address/location(s): g0C0 ?) .� l A and/or repair / !7-1.44 U SSG � T • Sanitary sewer lateral installation and/or main line tap ;� ❑ TYPE 3-Full scale Development Applicant: `/P11 vl L5 w Work performed with Land use Address: fp, 5 LU C alal (- t _ approval which includes anyof C pp City/state: 1/1 GV`(/1 0,E Zip: / 2--c( the following: Phone: 4- 3 4'` �'�t 1tmail: Yl V61�,RA,dad-:‘'6).gl'YICr.i��C • Subdivisions or Partitions • Street widening Contact name: 9_,74,14.64- Phone: 903.- 6'jy-5).4'Io • Mainline installation for Sanitary sewer, Storm sewer, Tigard water Contractor: /5c{Jk /47 4'71 <<z and/or Tigard Water Service Area CCB#: `7c Expiration: Address: • :•ri. < i . /ll 44,c,"trpictv: SUBMIT COMPLETED APPLICATION TO: . City/state: tL1q,-A e Q CC Zip: C1`7/ J- City of Tigard Planning/Engineering Phone: (?7—3 3D`0E4( mail: I-70 3 ---- 30 - v/4E17 13125 SW Hall Blvd. Contact name: .' 11L (/-tl. Phone: T-©3--336- 0/41 Tigard,OR 97223 Applications for"minor work in right-of-way" only may be emailed to: Engineer: rowpermits@u,tigard-or.gov Address: mit S'1':A1 1: t SI. ONLY City/state: Zip: Phone: Email: Case No.: fF1 Zo 141 000 Contact name: Application submittal fee(.007%of Engineer's Estimate) $ Estimated value of work is required(if over$5,000):$ 2-f-5 Additional fees: $ - (within the public right-of-way) Application accepted:E By: �- Date: 2. ((Hi Is work related to a LAND-USE DECISION? 0 Yes "No If so,please specify (MLP,SDR,SUB,etc.) case#: Application reviewed: By: 643 Date: 21/4//? 9 Is work related to a BUILDING PERMIT? ❑ Yes 171><o Applicant notified: If so,please specify(BUILDING PERMI case#: By: h.g Date: 4/4)/ 9 P fY� � I:\ENG\PermitApplications\pfi_application Rev.10/16/2017 City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of4 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) SHALL CERTIFY THAT: • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • 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. Lvt�c Two De(T(L -2/(3//1 Applicant/Authorized Agents signature Print name Date SI ATURES of each owner of the subject property, if required. 1 acb..12 c ec13 Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES F()R STAFF ISE ONLY Public Facility Improvement(PFI)Permit: DETAILED SUBMITTAL APPLICATION FEE REQUIREMENTS Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/ DRIVEWAY AND UTILITY PERMIT FEE CONNECTIONS,ETC. Part 2: All non-water system improvements (work in the right of way) Engineer's estimate X 5%(less$300.00 minimum submittal fee) Sketch Engineer's estimate X 2%Plan Review (including information below) ❑ Dimensions WATER SYSTEM FEE ❑ Street Name Part 3: All public water system improvements ❑ Site Address Engineer's estimate X 12% FULL SCALE DEVELOPMENT PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements) There will be no permit fee charged,or assurance required for the following types of work: Design Plans • Sidewalk repair(less than 20 lineal feet) (4 sets,24x36 or 22x34) • Relocate or replace mailbox ❑ Cover—Site,Vicinity,Abbreviation,Legend • Ditch cleaning that does not involve regrading. ❑ General Notes(City,Water,Sewer,etc.) • Weep hole repair ❑ Street(Plan,Profile) • Curb repair or replacement(less than 20 lineal feet) ❑ Water,Storm and Sanitary(Plan Profile) • Lawn sprinkler system installation or repair ❑ Water Quality Facilities • Street tree pruning or planting ❑ Grading • Planter strip landscape maintenance 0 Landscaping/Tree Plan • Test wells ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm,Sanitary,Water,Signage,Street Lights,etc) ❑ Details Note: A cash/bond assurance may be ❑ Traffic Sight Distance required per TMC 15.04.140. ❑ Signing and Striping (customer deposit) ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Provider Approval PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 3 of 1 , r SAMPLE SKETCH: z v- '• y " i Edge of Pavement Ditch — " lop"1-t16\ Streetlight .-----•—•—•—•---r—•— i / f j•T - Rain Drain l/r/;i rJ D r~ �r� ,t.'r'•,• / Ott I -t . of i4 1 T-,Tiopp'osrirSel�w'ei' tine" 1 , I 1 �t 0 I Existing House 1 t : 1 Existing 1 ,! �1 • Driveway 1-I 3. 1op 1 0 1 ii,>< p• 1 e :I-gi I I rI 01 t I Ci a .4 1 C5 4. 0. 9 i 11/4...\.. Existing Shop I Powerpole I I 5 I a '" lc" 951 i 1 r:).-------15747tilTrie"— I 0 . Fire Hydrant(FH) i I • IScale: .1"=30' • I I I I I I 1 I MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable): North arrow Property lines &dimension Slope of property Street &street name(s) Existing building, structures Utility&street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 4 of4 Vicinity Map _land 8010 S W Beaverton Churchill Tigard — City of Tigard, Oregon • Tualatin -7114CrAl-- " k9( TG� 04144" '--/icAA .4 cet-(4-7C'' „Lt. 10 410 -� Date is derived from multiple sources.The City of Tigard makes no warranty,representation,or guarantee as to the content,accuracy,timeliness or completeness of any of the date provided herein.The City of Tigard shell essume o liability for any errors,omissions,or ins Ccurecies in the information provided regardless of how caused. Scale: 0.00 Miles City of Tigard 13125 SW Hall Blvd Tigard, OR 97223 11 MapCreated: (503) 639-4171 15735 02/13/2019 www.tigard-or.gov T�� ,�� Dennis Deck,8010 SW Churchill Ct,Tigard ,,k s a -int i',p,kr�., " n s. Ft '. F" K of q, i` fiLid f My k`. " _ s , . From driveway looking south R f 11. kt. 44 t : ,,,:,.tor,,,,,....:j 4441...,,,„7:. - '- - - - - - '''' ,;:j'SbY ,1: *" .. T 'V 4 2 Looking North toward driveway BID MEMO BID NO. 25 DATE: 2/6/2018 JOB Dennis Deck Side Walk Replace LOCATION Sidewalk in front of Deck Residence FIRM PREPARED BY Matt Dalton ADDRESS 8010 SW Church Hill Court APPROVED BY Matt Dalton City/State/Zip Tigard OR 97224 Bull Mountain Construction LLC TYPE OF WORK Tear out and replace sidewalk PHONE 503 330-0149 WORK INCLUDED AMOUNT OF BID 5x30 area of sidewalk tearout. 150.00 sq feet.5.00 per sq.foot 750.00 Cut out and remove any roots impacting sidewalk.3 hour minimum at 75.00 per hour 225.00 Use 3/4 minus gravel to compact in sidewalk area for good subgrade.150.00 sq.foot.3.00 per square foot 450.00 Place and Pour 4000 PSI concrete in brush finish. 150 sq.feet.6.00 per sq.foot 900.00 Permit Fee.100.00 100.00 TOTAL BID 2,425.00 EXCLUSIONS AND QUALIFICATIONS If Root excavation exceeds minimum hours time will be billed hourly at 35.00 per hour. ACKNOWLEDGEMENT OF ADDENDA TAX DELIVERY EXCLUDED INCLUDED RECEIVED BY • • - - • • Driveway Lens Cap is about 1.7" ) (efaiit .42 624 t �� co-6 71--/t4p -65a-e- 6c 74,/, is;ie gze - //a4sPao in ?4-L:t .-e^5 6) 5 . 611,1;e. 1(4"(461 t-2e e9k? Itiva-Yed 71-4-fiz.e.Dines Pec o&Lnia d.diQc ,o 3-6 3 (t-