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PFI2015-00063 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00063 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/18/2015 Parcel: 1 S 133DA00900 Jurisdiction: Tigard Site address: 11080 SW SUMMER LAKE DR Subdivision: AMART SUMMER LAKE Lot: 31 Project: Replace Sidewalk Project Description: Two grinds to left of driveway, one grind on right of driveway&replace sidewalk 2 panels. Owner: FEES Description Date Amount PHONE: Contractor: JAY JACOB MILLER 8152 SW HALL BLVD#240 BEAVERTON. OR 97008 PHONE: 503-707-4725 FAX Applicant: JAY MILLER 8152 SW HALL BLVD#240 BEAVERTON, OR 97008 PHONE: 503-707-4725 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 Not Present Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00063 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/1 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/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/[ 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/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/[ 09-OTHER Applied Notice RECEIVED City of Tigard MAY 13 2015 e PUBLIC WORKS —ENGINEERING CITY OF TIGARD " G/ENGINEERING Public Facility Improvement (PFfMermit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: ❑ Utilities 'kSi ewalk/driveway approach ❑ S et imp vements ELEMENTS Detailed description: UL rlr1e� I or work in nigh[-of--way • (sidewalk repair,curb cut,street 1a r i nA aI Y opening,etc)requires: ' •Application form,completed and signed •Submit one(1)copy of scaled sketch perty ad re"ss/lo ation(s): of the proposed work to be done 'j'�jr •Submit one(1)copy of traffic control plan —OR— A Applicant's name:-I!) kfW ❑ Substantial project work requires PP �.1%W' above items and professional Address. engineered plans for: •Street widening City/sta r Gip: •Subdivision infrastructure Pho .mail: •Main utility line extension: - Storm Drain,Sanitary—Tigard - Water—Tigard Water Service Contractor's na _ Area(includes Durham,King City CCR#: Expiration: 1� and a portion of unincorporated Washington County) Address: City/stat tj ip: DELIVER APPLICATION TO: City of Tigard Phone: Email: Planning/Engineering 13125 SW Hall Blvd. Engineer's name: Tigard,OR 97223 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: Phone: Email: No.:Na: ��I Estimated value of work (within the public right-of-way): $ case CaseApplsubmittal fee: �1 Is work related to a LAND-USE DECISION? ❑ Ycs PgLNo Application accepted: I If so,please specify (MLI, SDR,SUB,etc.) case #: By: K. Date: l I Is work related to a BUILDING PERMIT? Application rev wed: ❑ les o By. Date: S 8 If so,please specify(BUILDING PERMIT)case#: Applicant odfied: By: hate: i:\cuePUNWasbn\Lvd use Appkmdons Rek 07/16/]014 Cityof Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • v wwtigard-ongov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for work. *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. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request dries not violate ani deed rest_ictions that ma be attached to or j=osed upon the subje,ctproper . • 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 statement~and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and the applicants so acknovdcdge that any permit issued,based on this application,may be ravoked 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. SIGN T/ES of soh owner of the subject proper required. v 41A r Ap t th Agent's signature Priv name I Date Owner's sign e Print name Date Owner's signature Print name Date Owner's signature Print name ate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW l IallBlvd. • 'Tigard,(-)regon 97223 • www.tigard-ongov 503-718-2421 • Page 2 of 4 Jay Miller From: Michael Edwards <michaeljoel.edwards@gmail.com> Sent Tuesday, May 12, 2015 2:18 PM To: Jay Miller Subject Re: Request for quote: Sidewalk repair in Summer Lake neighborhood - ONE MORE STEP Attachments: scan117.pdf Hi Jay, Sidewalk Repairs Specialist, Jay& Debbie Miller has my official permission to get a permit from the City of Tigard for the sidewalk repair to be done as specified on the attached quote (00426)at my home located as 11080 SW Summer Lake Dr., Tigard, OR 97223. Thank you and Best Regards, Michael Edwards 11080 SW Summer Lake Dr. Tigard, OR 97223 503.803.614LCell On Tue, May 12, 2015 at 1:09 PM, Jay Miller<sidewalkrepairs(&gmail.com>wrote: Hi Michael, The City of Tigard requires you to officially give me permission to get the permit for the work to be done. If you can email me a statement that you are giving Sidewalk Repairs Specialist,Jay& Debbie Miller,to get the permit at your home address (& specify that), then I can proceed. Thank you, Jay 43Z q)e66ie MiQer Sidewalk Repair Specialist 8152 SW Hall Blvd.#240 Beaverton, OR 97008 1 Sidewalk EST. NO. 00426 Repair PROPOSAL Specialist $152 SW Hall Blvd#240 sidewalkrepairs@gmail.com Phone:503-707-4725 CCBB 198613 Beaverton,OR 97008 http://www.sidewa[krepairs.net Fax:503-430-1553 Eliminate Trip Hazards Property owners are responsible for the repair and maintenance of the sidewalks adjacent to their property.Avoid the costs,dangers and hassles of being involved in a trip hazard lawsuit for personal injury. Your neighbors, children on bicycles or skateboards, new mothers with baby carriages,disabled people in wheelchairs and everyone else have one common need:A smooth,safe sidewalk. Let our experienced professionals grind out trip hazards or replace sidewalk sections as needed. Ctistorner Information Name: .e L E4 Wit�/ S Address: 114,76 5 W 56% La n� % W Phone: --6 Email: l o o - ky Y7 S Personalized Estimate 0 ID Grinding Subb*Ab W Areas: Est. L.Ft.: ` Other: 0 .g Total: �Q w q � � Q Sidewalk Replacement Areas: Est.L.Ft.: Est.Sq. Ft.: S 7d6 � �,� CT Other. SAW 4 IM estinxlte is vaW S VV Jt"rn"1 iL'A• e y Grinding Trip hazard area is sloped per ADA standards.Includes all labor,equipment and materials to complete the work as outlined above. Sidewalk Replacement Includes all labor, material and equipment to remove and dispose of existing concrete, prepare subsurface,remove existing tree roots in sidewalk(2 hr. labor maximum),provide.Install and finish surface of new concrete,permits and inspections per city or county requirements. Warranty Contractor warrants material and workmanship for a period of 1 year per Oregon Construction Contractors board requirements. Disclaimer **Newly ground concrete and newly replaced concrete will have a different appearance than your existing concrete(see: www.sidewnikrepairs.net).Contractor cannot be responsible for future soil movement from tree roots or other conditions beyond our control. Acceptance of Proposal a The above prices,specifications and conditions are hereby accepted.Sidewalk Repair Specialist is hereby authorized to perform the work as outlined above.Payment is due upon completion unless otherwise noted.Buyer agrees to pay all costs for collections,including court costs and legal fees. Payment may be made by check,cash(ask about discount),Visa,Mastercard,American Express or Discover Card. Buyer Signature: N. A Date: L� r Contractor Signature: Data / " J signer acknowledges receiving Consumer Protection Not, e,Notice ure,and the Information Notice to Owner INITIAL HERE: about construction liens per Oregon law requirements.