PFI2017-00082 94 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12017-00082
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 05/05/2017
Parcel: 2S104AB11400
Jurisdiction: Tigard
Site address: 12341 SW MORNING HILL DR
Subdivision: MORNING HILL NO.6 Lot: 143
Project: Habre Sidewalk Repair
Project Description: Repair sidewalk along 12341 SW Morning Hill Drive. Replace 4'4"x 5'of sidewalk.
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 See application
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12017-00082
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. 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
City of Tigard MAY 0 2 2017
~ PUBLIC: )VORKS -- I NGINEERING
CITY OF TIGARD
p
Public Facility Im rovement (PF1)L+Aef_TtjWEERING
DESCRIPTION OF WORK (in the right-of-way) nTE OF WORK
(;httk ones ❑ LT alit}'(:onnection ❑ TYPE 1—Franehisc Utility Work
Sidcwalk'drncwa% xppntach
Work perfortncd by NWN,PGE
F-1 Strect imp • mcnt> t f( and/or uultn'agency.
Details descriptit 19 ' 'PE 2—Sidewalk/Driveway/Sewer
\Vi,rk performed for the purpose of:
• Sidewalk installation or repair.
• Driveway approach installation
Prt Bert\ a dress/location ): Alland/or repair
• Sanitan•sewer lateral installation
and/or main line tap
❑ TYPE 3—Full scale Development
Applicant:
Work,performed with land use
approval which includes any of
Address-
the follovtinl;.
City/state: Zip: • Suhdivisions or Partitions
Phone: Emai : • Street widening
Contact name: Phone: • Mainline installation for Samoan
sewer,Storm sewer,Tigard wate•i
Contractor- and/or Tigard%Fater Service 4rc.i
C.CB#: 'A Iration: �� SUBMIT COMPLETED APPLICATION TO:
Address: City of Tigard
Ci ry/state: zip: I'la etring/E»gincering
13125 SW Hall Blvd.
Phan :mn l m Tigud,OR 97223
Contact nantc: Phan \pphcaaons for "minor work in right-of-u-m"
only may be emailed to:
Engineer:
Address:
City/state: Zip:
Phone: Ismail: Case Na: f`�F I2-0 1I
Contact name: Application submittal tee:
�} Additional fees:
Estimated value of work is required (if over S5,(XX)):$ 7 t Application accepted: _
(within the public fight-of-way) By:--fflo�—= mm
Application reviewed:
Is work related to a I-AND-LISI DECISION? ❑ Yrn, S�Nu
By: J 6-3 l-,__ Date: 5 S !
If so, please specify (MLP, SDR, SUB, etc.) case #:
Applicant notified:
Is work related to a BUIi.DING PERMIT: ❑ 1•cs 9 N By Dare:
If so ,please specih•(BUILDING PERMIT)case#: 1'%(.UNI-t"\M&"to. ou d""'"t'tKwmm
Cityof Tigard • 13125 SSV l lall Blvd. • Tigard,Orcgtm 97221 • www.tigard-or.gov • 503-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Person specified a_s"Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
lt('hcn the oN'ner and the applicant are different people,the applicant must be the purchaser of record or a Iessec to possession with written
authonrnuon from the owner or an agent of the owner. The ownet(s,must sign this applicanon in&,c space proxided or submit a u-nnen
authonzanon with this applicauon
BY SIGNING BELOW, THE APPLICANT(S) SHALL_CERTIFY THAT:
• The above mqucst docs not violate am feed tcstnctons that mat be art-ached w ur imp s• I upon the subj c r tpcM.
• if the application is granted, the applicant will exercise the nghts granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All(if the abovc statements and the statements to the plot plat,attachments,and exhibits transmitted herewith,arc true;and
the applicants sit acknowledge that anV permit issued,based on this application, may be revoked if it is found that any such
statements arc 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 A
URES of each owner of the subject property required. ✓ I
• 1 �` f
\Ppli g is signaturePrint nam N Datc
'
qAu
A 0
Owner's s g aturc Printoanle Date
t)wner's signature Print name Date
()uncr's signature Pnnt name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard 13125 SQL' Flall Blvd. • Tigard,Oregon 97223 • www.ngard or.gov 503-718-2421 • Page 2 0(4
Jay Miller
From: Jshabre <jshabre@gmail.com>
Sent: Tuesday, May 2, 2017 8:55 AM
To: Jay Miller
Subject Re. Sidewalk trip hazard
Yes, let's get started. Thank you Jay!
Sent from my iPhone
>On May 2, 2017, at 8:15 AM, Jay Miller<sidewalkrepairs@gmail.com>wrote:
>Jared, Will take a few days to get the permit from the city of
>Tigard. I could get removed and it set up next week but it likely
>will be the week after before I can get it grouped with others concrete pours to complete it.
> If that works for you I will get the paperwork started.
>Thank you,
>Jay& Debbie Miller
>Sidewalk Repair Specialist
>8152 SW Hall Blvd.#240
>Beaverton, OR 97008
>Call or Text: 503-707-4725
>SideWalkRepairs@gmail.com
>www.sidewalkrepairs.net
>
>-----Original Message-----
• From:Jshabre imailto:jshabre@gmail.com)
>Sent: Monday, May 1, 2017 12:15 PM
>To: Jay Miller <sidewalkrepairs@gmail.com>
>Subject: Re: Sidewalk trip hazard
>Hi Jay. Thanks for getting back to me. We would like to go ahead with
>the repair/replacement. Would you be available Friday or this weekend
>to begin work? If not, what is your availability?Thank you.
>Jared
> 50.750.4462
>Sent from my iPhone
>>On Apr 30, 2017, at 7:04 PM,Jay Miller<sidewalkrepairs@gmail.com>wrote.
>>Jared, I attach your estimate. We handle permits and inspections as
>well as root cutting. The trip hazard is too large to qualify for
>grinding.. Please feel free to call or email any questions you may have.
1
f Sidewalk EST. NO.
epair PROPOSAL
pecialist
6152 5W nail i3ivd 9240 i?honw'S33-'107-4112 5
CCB# 198613 Beaverton,OR 97008 htto:Uwww.sidewalkreparrs.net
Eliminate Trip Hazards
Property owners are responsible for the repair and maintenance of the sidewalks adjacent to cneir 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 babv carriages disabled Deoole in wheelchairs and evervone else have one common need:A smooth,safe sidewalk.
Let our experienced professionals grind out trip hazards or replace sidewalk sections as needed.
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Disclaimer
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cannot be rpstinosihie for future sai movement fmm tree roots or otner conaiuons oevona our contror Ire sonnkiers.drain ones.caole fins)
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The above onces soecrfrcations and conditions are herein accented.Sidewalk Repair Soeciarrst is herebv authorized to oerform the work as outlined above Payment.s
due ut>7r.comcilPtion unless otberorrse noted Suver ac-e-es tD oaa all ants`or cotlectreris tnctudrna court cost5 and Jena!fees
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Buyer Signature:! Date-
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Signer ackixywieckg recemrig Consumer kotection Notker e: Prrxeoure ILthe rnfornvatron Nuri c tri •'.wi�r INITIAL HERE:
trout cor.sb,,rcbcn liens per 7egnr.law,burr�r-t.