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Home My Public Portal About12-0017 City of Tybee_1of3City ot Jee Island • Community Develo,__rient Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 ii" mask INTERNATIONAL CODE COUNCIL MEMBER Permit No. 17--_. Date Requested Z/l /.Z Owner's Name �I,_' u F k -t �c�.. Date Needed A 1 Z Gen. Contractor ! -{4-T .4 G.1+ ,),,-1L-" Subcontractor Contact Information Project Address i J ■JU+.) Scope of Work te20>A . Inspector 71=i Date of Inspection 1 1 Inspection -1 J ,\.)( 1 Pass Fail El Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass Fail El Fee Inspection Pass ❑ Fail ❑ Fee City of _ Jee Island • Community Develop._.ent Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 Permit No. I o - 001 is a INTERNATIONAL CODE COUNCIL MEMBER Date Requested Owner's Name Zi , ,Or X76' E Date Needed Gen. Contractor i4 c r 10 r (!O►') Subcontractor Contact Information B r v C 2J 234- ap 00 (05-5-- Co 9 30 Project Address 5) 0 7) p rlf2_5 Ave.... Scope of Work /" /JJ ,42).D f Inspector '7, Date of Inspection Inspection / - / Pass Inspection Pass Ej Fee Inspection Pass ID Fail El Fee Inspection Pass ❑ Fail ❑ Fee Dianne Otto From: Dianne Otto Sent: Monday, April 30, 2012 2:38 PM To: Jimmy C. Brown Subject: RE: Fianl Inspection Permit 12 -0017 I put the AmericGas form with the file on Ray's desk. I'll make a copy of the final inspection report for you when Ray passes the file back to me to close. That should be tomorrow. Dianne K. Otto, CFM City of Tybee Island phone 912.786.4573 ext. 136 fax 912.786.9539 From: Jimmy C. Brown Sent: Monday, April 30, 2012 2:29 PM To: Dianne Otto Subject: Fianl Inspection Diane, I spoke with Ray earlier 5the Fire Station Bay addition passed the electrical , would you place a copy of the final inspection in by box. Also placed in your box located at the entrance door a gas cylinder inspection for the Fire Bay. Thanks! 1 itzMeriGaSe AmeriGas - Savanr, America's Propane Company Work Order Summary 400041r �9 RECEIVED Scheduled Date/Time 04/02/2012 15:59:29 Notification: 3000555497 Sales Order: 25630193 WORK ORDER DESCRIPTION Planner Group: 001 Planner Group -5424 hook up Plant: 5424 Customer: 201004897 CUSTOMER` SITE NAME, ADDRESS Assigned to 82647 SAVA_T1_LARSON WATTS TYBEE ISLAND FIRE DEPT 101057893 Grid #: SLJCF8 Zone: 512 JONES ST TYBEE ISLAND GA 31328 Material: TANK -120 Owner: C Subtanks: N Equipment ID: 5001499326 AmeriGas ID: 5001098734 Manufacturer Serial #: 1A80797 COMMENTS * 03/29/2012 15:40:13 Jennifer Rivera (RIVERAJE) * ready to be hooke back up. OPERATIONS SUMMARY FOR THIS WORK ORDER OP# Description Status Work Center Completed Duration Actual 0010 Connect Tank DSPT 82647 SAVA_T1_LARSON WATTS 1.0 0.0 DO T /za DOT ASME AMG:SerialID Manufacturer SR Manufacturer Year /MO Work Performed Result. RIN REGULATOR MFG Date Condition Manufacturer Model Vent Position How Protected FIRST ST SECOND ST Integral 2 ST System Testing,, Prior to Appliance Testing PRESSURE TEST (AIR / INSERT GAS ONLY). Comments: Start Pressure End Pressure Time held System OK PSIG PSIG Integral Two stage (Piggyback) System LEAK CHECK (PROPANE ONLY) OPERATING SYSTEM TESTS Start Pressure End Pressure Time held System OK Flow Pressure Lock -Up Pressure 9- G PSIG C. /' PSIG vc- MIN 7 LC 7 `,-- -.--.- IN WC IN WC MIN IN WC IN WC Two Stage Sys LEAK CHECK (PROPANE ONLY) OPERATING SYSTEM TESTS 1st Stage Start Pressure End Pressure Time held System OK Flow Pressure Lock -Up Pressure PSIG PSIG MIN PSIG PSIC 2nd Stage Start Pressure End Pressure Time held System OK Flow Pressure Lock -Up Pressure IN WC IN WC MIN IN WC IN WC APPLIANCE INFORMATION Name Misc Central Heat Space Heat Water Heat Range Clothes Dry Manufacturer Model # Serial # Control Valve # Pilot Safety Venting System Proper Combustion Red Tag Customer Care: I YIN YIN Code Requirements Tank shutoff showed to customer? Odor Test Performed? Line Depth Tank Location Customer knows propane smell? Deficiencies and /or corrections explained? Shutoffs where required Regulators Installed Correctly? Consumer Ed Safety material reviewed? Customer Satisfied with work? Line Material Sediment Traps where required Customer's Signature (if required) _ /_ /_ Service Person's Signature (if required) — / —/_ Permit No. City of',.,oee Island • Community Develoi,.. ent Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 Owner's Name Gen. Contractor { f. tt) .1111 * INTERNATIONAL CODE COUNCIL MEMBER Date Requested Date Needed e Subcontractor Contact Information . . 2,C/ • Gv G S � _;D Project Address i 16., -)4-5 Scope of Work Inspector r° Inspection .- %? . `,, Pass i1 i I Fee Date of Inspection Inspection Pass ❑ Fail ® eej Inspection Pass Fail; Fee Inspection i,f (, t ►J - Pass ❑ Fail �ItJCg I�� City of Tv,,ee Island • Community Develop►._Int Dept. Inspection Report 403 Butler Ave. • P.Q. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 INTERNATIONAL CODE COUNCIL MEMBER Permit No. 1 Date Requested `T I 1 ° I L Owner's Name Date Needed Subcontractor Gen. Contractor > >> Contact Information > >k_ _; ,� , L ` z ( > Project Address �' > )6. Scope of Work � `6 �� .4- Inspector ^ o `� v Date of Inspection" Inspection Pass Foil El Fee Inspection Pass Fail Fee Inspection Pass Fail Fee Inspection Pass ❑ Fail ❑ Fee }PaoNE ►- 858 - 748 -6543 'press ►�' ex4. 3 2 IS'Sor 32850 RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND FOR . FAX TO: 9-37 Pho Ejeorg;a looW¢r- / 9 FAX: 1— S8T- 25"l -4'+ i 3..t, -291,-_ Location Address: Type of Release: Temporary ermanent Subd Name: Electrician: Owner/Builder: Ty$ri ��1 v oore.S Lot # Release Date: O �4 l 3iJ Electrician Phone Number: 2f 7-1 & /(p 9/, -11q Phone Number: kS -- 43D Location Address: Type of Release: Temporary Electrician: Lot # Release Date: Permanent Subd Name: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Type of Release: Temporary Electrician: Lot # Release Date: Permanent Subd Name: Owner /Builder: Electrician Phone Number: Phone Number: TX Result Report P 1 04/12/2012 12:30 Serial N0. CM35228060004 TC: 328374 Destination Start Time Time Prints Result Note 18888514411 04 -12 12:25 00:00:46 000 /001 Cont 18888514411 04 -12 12:29 00:00:58 001 /001 OK Note TMR: Timer TX. POL: Polling. ORG: Original Size Setting. FME: Frame Erase TX. MIX: Mixed Original TX. CALL: Manual TX. CSRC: CSRC. FWD: Forward, PC: PC -Fax, BND: Double -Sided Binding Direction. SP: Special original. FCODE: F -code. RTX: Re -TX. RLY: Relay. MBX: Confidential. BUL: Bulletin. SIP: SIP Fax. IPADR: IP Address Fax. I -FAX: Internet Fax Result OK: Communication OK, S -OK: Stop Communication, PW -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M- Full:Memory Full, LOVR:Receiving length Over, POVER:Receiving page Over, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. IC) f1aNE IOW `• /- 8538- 74e -foS4 �, -pc- - Ss lI ex-F. 3 2 S'5s -w- �/� 3'ZS Sto -.1Ctr RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND cj r FAX l O: 7�- - ----- ?7 Pho r@o'-U e 1� O iYe T vo VA NC r I - 4388 -95t - .44-ii Location Address: V/5re--1. :-v..� Lot # Release Date: 4j/4 Type of Release: Temporary ¢rmaaent Subd Name: Electrician: Owner/13uilder: 14.3 Electrician Phone Number: 8 /{0 9/4.0 Phone Number: Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: ■wner/Builder: Electrician Phone Number: Phone Number: Permit No. City of 1 403 Butler Phone yoee Island • Community Develop►._ nt Dept. Inspection Report Ave. • P.O. Box 2749 • Tybee Island, GA 31328 912.786.4573 ext. 114 • Fax 912.786.9539 /7 - 00/-7 Owner's Name L7/ Gen. Contractor Contact Information Project Address INTERNATIONAL CODE COUNCIL' MEMBER Date Requested Date Needed 7/3/2`. Subcontractor l Scope of Work /4,0/). Inspector Date of Inspection Inspection - Inspection Inspection Inspection Pass Fee Pass ❑ Fail ❑ Fee Pass Fail ❑ Fee Pass ❑ Fail ❑ Fee cox TERMS r'E & PEST CONTROL L.' SAVANNAH, INC. 4 BRYCE INDUSTRIAL DR. PH (912) 236 -2503 FAX (912) 236 -0509 SAVANNAH, GEORGIA 31405 0057 DATE j s : % 41, AM AM PM PM TIME IN (circle) TIME OUTlcircle) ACCOUNT NO. IZONE NAME G -hKit (0, fie r Le L - f 6' ,— /I y r.. 1 ''. 1 r. -1/-r• �I, 4. ACCOUNT ❑ RESIDENTIAL TYPE ❑ COMMERCIAL ❑ SCHOOL ADDRESS i f/ ` `t r /, f I P FREQUENCY ❑ E.O.M. ❑ FOLLOW UP ❑ QUARTERLY ❑ CLEAN OUT ❑ INITIAL SERVICE ❑ INSPECTION ONLY CITY, STATE, ZIP CODE 'T-' O ) /r 17 f/ / 1' .4.— Sl t'f�J'i C4 Z4-` 1 ❑ 90 DAY ❑ MONTHLY PHONE # SUBDIVISION ❑ WEEKLY PRODUCT(S) USED AMOUNT oz., grams, gal; lb. TARGET`PES . (see codes) METHOD OF APPLICATION - SITE APPLICATION AREA (S) (see codes on reverse) 1 ADVION ROACH BAIT ❑ 0.6% 2 ARILON 0 0.05% ❑ 0.10% 3 CYPER TC ❑ 0.25% ❑ 0.50% ❑ 0.1% 4 DELTA DUST ❑ 0.05% 5 DEMAND CS O - 0.015% ❑ 0.03% ❑ 0.06% 6 EXCITER 0 0.55% 7 GENERATION BLUE MAX ❑ 0.0025% 8 MAXFORCE FC SELECT ❑ 0.01% 9 NYLAR IGR.' , O: 015 /° . 10 ONSLAUGHT 0, .'0:025% ❑ 0.050% 11 PHANTOM 0: 0.5% 12 PRECOR 2000 ❑ 3.735% 13 SUSPEND SC ❑ 0.03% ❑ 0.06% 14 TEMPO SC ❑ 0.025% ❑ 0.05% 15 TEMPRID SC ❑ 0.075% 16 TERMIDOR SC ❑ 0.06% ❑ 0.125% PP /,2.4. _I 1-.L Ti., � -u ' ii_tqf.tb w 5 lid. ft, k...rr %.2, 1f 1 /I f4', /, 6 vt- j f SERVICE CHARGE , TE IC AN IGNATURt 1! I ( ) ADDITIONAL CHARGES CUSTOMER SIGNATURE ) t T/ PRECAUTIONS KEEP CHILDREN AND PETS OUT OF TREATMENT AREA. DO NOT TAMPER WITH RODENTICIDE PLACEMENTS. DO NOT COME IN CONTACT WITH TREATED AREAS UNTIL DRY. FOR FLEA TREATMENTS REMAIN OFF TREATED AREA UNTIL DRY. THOROUGHLY WASH DISHES; UTENSILS, FOOD PREPARATION /PROCESSING EQUIPMENT AND SURFACES WITH AN EFFECTIVE CLEANING COMPOUND AND RINSE WITH CLEAN WATER, IF NOT REMOVED OR COVERED DURING TREATMENT. THE AREA SHOULD BE ODOR FREE BEFORE FOOD PRODUCTS ARE PLACED IN THE AREA. TOTAL I -2 } i ft / , lid ❑ CASH AMOUNT PAID ❑ CHECK # 0 CREDIT CARD White Copy - Company Yellow Copy - Customer WHITAKER LABORATORY, INC, P.O. Box 7078 2.500 Tremont Road Savannah, Georgia 31418 (912) 234-0696 Fax (912) 233-5061 Email info whitakerlab.net ka,Atvi wh!takeriati ne7 FIELD COMPACTIC9N/ PERMIT # \20 Project E. Location: 5\0/511- )es kJe- 14C(' c'elf5('■)C-V.kci-\ FOOTINGS: EARING REPORT Date: -1 - ( 250() All tests have achieved a minailm of 95% standard/modified density All tests have not achieved a minimum of 95% standard/modified density All tests have achieved a minimum of a* lest SUBGRADE: PSF All tests have achieved a minimum of 93% standard,modiried density All tests have not achieved a minimum of 95% standard/codified density PITMARECjz: Lt)r.- N.)P /4 Se CO f1S4, 0 im c0 ,7071t1,-; the 7E1D. (7 net-4'V') signed TiTSP7.CTn: 0_ 0 k ifrj City of , ,ee Island • Community Develop, .nt Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 INTERNATIONAL CODE COUNCIL MEMBER Permit No. t 2- o (T I-1 Date Requested 2 I t 2 Owner's Name , t C b Date Needed ' 1 �- Gen. Contractor asb O r 0 1(154.'• • Subcontractor { r ( , � M Contact Information r-J Project Address Scope of Work Inspector - Q (0oQ c10 "-QrszS Ave,. GS &4'3LD f: re) s +A..or, k0.od4 , Date of Inspection Inspection r 00 piu r,n b n GZ Pass on Fee Inspection Pass ❑ Fail ® Fee Inspection Pass ❑ Fail El Fee Inspection Pass ❑ Fail ❑ Fee City of I ._Jee Island • Community Development Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 Permit No. j/ Date Requested / Owner's Name ,.., , Date Needed / Gen. Contractor / ), Subcontractor u ▪ snalk hTEPNATIONAL CODE COUNCIL MEMBER Contact Information ' Project Address Scope of Work / Inspector Date of Inspection Inspection Pass D Fail 11 Fee Inspection Pass El Fail El Fee Inspection Pass El Fail Fee Inspection Pass Fail Fee TX Result Report P 1 01/30/2012 12:21 Serial No. CM35228060004 TC: 312537 Destination Start Time Time Prints Result Note Georgia Power 01 -30 12:20 00:00:48 001/001 OK Note TMR: Timer TX. POL: Polling. ORG: Original Size Setting. FME: Frame Erase TX. MIX: Mixed Original TX. CALL: Manual TX. CSRC: CSRC. FWD: Forward. PC: PC -Fax. BND: Double -Sided Binding Direction. SP: Special original. FCODE: F -code. RTX: Re -TX. RLY: Relay. MBX: Confidential. BUL: Bulletin. SIP: SIP Fax. IPADR: IP Address Fax. I -FAX: Internet Fax Result OK: Communication OK, S -OK: Stop Communication, PW -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M- Full:Memory Full, LOUR:Receiving length Over, POVER:Receiving page Over, FIL :File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND FOR _ FAX TO: Lynn Brennan yn 97 Phone 912- - r'q Leo rg:a �oartr 3OGe -4�Le 9 33e.&.-.213,c).5— i2 � ea+-t. 3.aa- z ,..as _f Location Address: ��,�.� ��,¢w ,cam- i -A�zh� Lot t/ Release Date: Type of Release: ../ "I'eznporary Permanent Subd Name: Electrician: �/ --1-� v�'► r� 6 Electrician Phone Number: 2c, 7_ .i $.r {P Owaier/Builder: /1l r y " -,,f Phone Number: 6347/..— s1 s5 Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Lot # Release Date: Type of Release: Temporary Permanent Subd Name: Electrician: OwnerBuildcr: Electrician Phone Number: Phone Number: RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND FOR . FAX TO: Lynn Brennan 9-1:2444=3:537 Phone 912=3 it _4eori;a'iPou+er 30(o -2�y� .. 3 °6-Z8os Co. -1-11 308- 2 b2 S Location Address: Type of Release: Rio aJ3- Temporary Electrician: �}�,,,�5 Lot # Release Date: Permanent Subd Name: Owner/Builder: /i y OF Y ht 0 VEZ 1.040i> Electrician Phone Number: 2S7_ 9 $j 4 Phone Number: glob- 116-5-* Location Address: Type of Release: Electrician: Lot # Release Date: Temporary Permanent Subd Name: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Lot # Release Date: Type of Release: Temporary Permanent Subd Name: Electrician: Owner/Builder: Electrician Phone Number: Phone Number: DATE ISSUED: 01 -12 -2012 WORK DESCRIPTION CITY OF TYBEE ISLAND BUILDING PERMIT ADD TO COMMERCIAL BLDG WORK LOCATION 510 JONES OWNER NAME CITY OF TYBEE ADDRESS PO BOX 2749 CITY, ST, ZIP TYBEE ISLAND GA 31328 -2749 PHONE NUMBER CONTRACTOR NAME HARBOR CONSTRUCTION ADDRESS 1481 DEAN FOREST ROAD CITY STATE ZIP SAVANNAH GA 31401 FLOOD ZONE BUILDING VALUATION SQUARE FOOTAGE 900 OCCUPANCY TYPE P TOTAL FEES CHARGED $ 0.00 PROPERTY IDENTIFICATION # PROJECT VALUATION $104,700.00 PERMIT #: 120017 TOTAL BALANCE DUE: $ 0.00 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of ssuance. Signature of Building Inspector or Authorized Agent: P. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 (912) 786 -4573 - FAX (912) 786 -9539 www.cityoftybee.org City of Tybee Island — Community Development Department BUILDING PERMIT Permit Number: Imo. 0 ill Issued Date: i a // it, Job Address: ,J /0 JfrE 5 Ave itAA6002. e tri lair riftrEe i Wig '°. ' egod 4)7 Job Name: Type of Work: Mood Zone (if applicable): To avoid penalty this placard must be posted and visible from the street until completion of the project. TO SCHEDULE AN INSPECTION call (912) 786 -4573, extension 114, by 4:00 pm the clay before you need an inspection. V2 -o p(.1 CITY OF TYBEE ISLAND, GEORGIA APPLICATION FOR BUILDING PERMIT Location: 5 I T; b.Lt NAME ADDRESS 2 se-1• plans PIN# /4- Ccc9- ZI •cam TELEPHONE Owner L,i-,--YUr '-log,,-.1:i(e: A-.1*-- 4((21 ,4 S 13 Architect or Engineer J$c,�,. ,t'.e „i, v,er s 3c- Q7 ,,,-,,„,0_ S'd C—It_ Zc.c- �c:�.r - czx . --5( (-to f2- l�tcC° Scl Building Contractor u (-time C 4.4 ;x,,tQ Cc,An,�cli,,-1 LL(- lit° i \(.ems - - v.K -.A. S S2- Swv - fin, _ (`t65 q(7-734-06 cuu (C$ ( -et 3o (Check all that apply) ❑ Repair ❑ Renovation ❑ Minor Addition Substantial Addition ❑ Other Details of Project: 1't-C't vp� ❑ Residential ❑ Single Family ❑ Duplex ❑ Multi- Family Rf ommercial of- (oo F Footprint Changes ❑ Discovery ❑ Demolition Estimated Cost of Construction: $ /04( .7C0 r Construction Type (Enter appropriate number) (1) Wood Frame (4) Masonry (6) Other (please specify) (2) Wood & Masonry (5) Steel & Masonry (3) Brick Veneer Proposed use: j (re S Remarks: ATTACH A COPY OF THE CERTIFIED ELEVATION SURVEY OF LOT and complete the following information based on the construction drawings and site plan: # Units '`(� # Bedrooms A1,4 # Bathrooms •164 Lot Area Lia,Li - space4 talsq_ft.) (S- $c (0 a # Off - street parking spaces 11,E SQ Trees located & listed on site plan )/j4 Access: Driveway 30 (ft.) With culvert? With swale? Setbacks: Front Rear Sides (L) (R) # Stories I Height (6 ' Vertical distance measured from the average adjacent grade of the building to the extreme high point of the building, exclusive of chimneys, heating units, ventilation ducts, air conditioning units, elevators, and similar appurtances. During construction: On -site restroom facilities will be provided through Tc�..(s Sc>v . i • On -site waste and debris containers will be provided by AAwk&:c ,r— • Construction debris will be disposed byj,0 /i;kio.,t . by means of `0c.L,,,.Psk� I understand that I must comply with zoning, flood damage control, building, fire, shore protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations. I understand that the lot must be staked out and that the stakes will be inspected to ensure that the setback requirements are met. I understand also that a certified plot plan showing elevation must be attached to this application and that an as -built elevation certification is due as soon as the habitable floor level is established. Drainage: I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way adversely a ected. I accept responsibility for any corrective action that may be necessary to re - e dra e impaired by this permitted construction. Date: a-16 —16 —11 Signature of Applicant: Note: A permit normally takes 7 to 10 days to process. The following is to be completed by City personnel: Zoning certification Approved rezoning/variance? NFIP Flood Zone Street address and number: New Is it in compliance with City map? If not, has street name and/or number been reported to MPC? FEMA Certification attached State Energy Code Affidavit attached Utilities and Public Works: Describe any unusual finding(s) Existing Access to building site Distance to water main tap site Distance to sewer stub site Water meter size Storm drainage Approvals: Zoning Administrator Code Enforcement Office Water /Sewer Storm/Drainage Inspections City Manager • ature FEES SeA cv Permit Inspections Water Tap Sewer Stub Aid to Const. TOTAL LEAD -BASED PAINT Adapted from http: / /www.epa.gov/lead /pubs /renovation.htm. Please use that site to access the following information. Information for Property Owners of Rental Housing, Child- Occupied Facilities Property owners who renovate, repair, or prepare surfaces for painting in pre -1978 rental housing or space rented by child -care facilities must, before beginning work, provide tenants with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools. Owners of these rental properties must document compliance with this requirement. EPA's sample pre- renovation disclosure form may be used for this purpose. After April 22, 2010, property owners who perform these projects in pre -1978 rental housing or space rented by child-care facilities must be certified and follow the lead -safe work practices required by EPA's Renovation, Repair and Remodeling rule. To become certified, property owners must submit an application for firm certification and fee payment to EPA. The Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application. Property owners who perform renovation, repairs, and painting jobs in rental property should also: • Take training to learn how to perform lead -safe work practices. • Learn the lead laws that apply regarding certification and lead -safe work practices beginning in April 2010. • Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead - safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeepinq checklist that EPA has developed to help contractors comply with the renovation recordkeeping requirements that took effect April 2010. Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right. Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting. Information for Homeowners Working at Home If you are a homeowner performing renovation, repair, or painting work in your own home, EPA's RRP rule does not cover your project. However, you have the ultimate responsibility for the safety of your family or children in your care. If you are living in a pre -1978 home and planning to do painting or repairs, please read a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools lead hazard information pamphlet. You may also want to call the National Lead Information Center at 1 -800- 424 -LEAD (5323) and ask for more information on how to work safely in a home with lead -based paint. Information for Tenants and Families of Children under Age 6 in Child Care Facilities and Schools As a tenant or a parent or guardian of children in a child care facility or school, you should know your rights when a renovation job is performed in your home, or in the child care facility or school that your child attends. • Before starting a renovation in residential buildings built before 1978, the contractor or property owner is required to have tenants sign a pre- renovation disclosure form, which indicates that the tenant received the Renovate Right lead hazard information pamphlet. Beginning in December 2008, the contractor must also make renovation information available to the parents or guardians of children under age six that attend child care facilities and schools, and to provide to owners and administrators of pre -1978 child care facilities and schools to be renovated a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools lead hazard information pamphlet. Information for Contractors As a contractor, you play an important role in helping to prevent lead exposure. Ordinary renovation and maintenance activities can create dust that contains lead. By following the lead -safe work practices, you can prevent lead hazards. Contractors who perform renovation, repairs, and painting jobs in pre -1978 housing and child- occupied facilities must, before beginning work, provide owners, tenants, and child -care facilities with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools. Contractors must document compliance with this requirement. EPA's pre- renovation disclosure form may be used for this purpose. Understand that after April 22, 2010, federal law will require you to be certified and to use lead -safe work practices. To become certified, renovation contractors must submit an application and fee payment to EPA. See: Application for firm certification. The Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application. Contractors who perform renovation, repairs, and painting jobs should also: Take training to learn how to perform lead -safe work practices. • Find a training provider that has been accredited by EPA to provide training for renovators under EPA's Renovation, Repair, and Painting (RRP) Program. Please note that if you previously completed an eligible renovation training course you may take the 4 -hour refresher course instead of the 8 -hour initial course from an accredited training provider to become a certified renovator. Click here for a list of eligible courses. • Provide a copy of your EPA or state lead training certificate to your client. • Tell your client what lead -safe methods you will use to perform the job. • Learn the lead laws that apply to you regarding certification and lead -safe work practices beginning in April 2010. • Ask your client to share the results of any previously conducted lead tests. • Provide your client with references from at least three recent jobs involving homes built before 1978. • Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead - safe work practtc s on the job. To make recordkeeping easier, you may use the sample recordkeepinq checklist that EPA has dev• • •ed t. e contractors comply with the renovation recordkeeping requirements. • R-ad .bou ho to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right. • re• abo •w to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting. IF YOU'RE NOT f.,D SA•f (fRi•ifl .DISTURBING JUST SIX SQUARE FEET "COULD COST YOU .BIG TIME. Signatyce, Date I7c Printed Name Permit Acknowledgement of Asbestos /Environmental Notification to Georgia EPD for Projects Involving Demolition, Wrecking, or Renovation The undersigned hereby acknowledges that the issuance of this permit does not in any way grant permission to the owner, owner's representative, or permit holder to proceed with demolition, wrecking, or renovation of a structure prior to the filing of any required ten (10) day "Project Notification for Asbestos Renovation Encapsulation or Demolition" form in accordance with the Georgia Asbestos Rules. The Georgia Environmental Protection Division administers the rules. In most cases, the rules require both the owner and the involved contractors to assure the portion of the building involved in the project is thoroughly inspected by an Accredited Asbestos Inspector for materials that contain asbestos; and the removal of the asbestos before renovation, wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed demolition notification from be submitted 10 workings days in advance even if no asbestos is present in the building. Further guidance for regulatory compliance and contact telephone numbers are provided by the brochures entitled Asbestos & Renovation and Asbestos and Demolition. Other environmental issues such as asbestos removal techniques, lead abatement, ground contaminatioor unusual site conditions may have EPD regulations that could affect the project. J� Undersigned mkt -6 Printed Name AA 12 —(6-1( Date Office Use Only: Project Address: Permit Number: REQUIRED FOR: Building Permits Relocation Permits Sign Permits Demolition Permits Land Clearing, Disturbance or Excavation Permits Tree Removal Permits Relocation Permits Special Review Permits Site Plan Approval Subdivision of Land Sketch Plan Approval Preliminary Plan Approval Final Plat Approval Minor Subdivision Plat Approval Major Subdivision Plat Approval In addition to specific requirements for the above permits and approvals, applicants must demonstrate that they are in compliance with the City of Tybee Island Storm Water Management requirements as outlined in Chapter 5 -4, Code of Ordinances. Section 5 -4 -9 Prohibition provides, in part, as follows: (4.) It is unlawful for any person to cause or permit any storm water to flow from their property onto the property of another person, unless such storm water naturally flowed thereon prior to any development activity. (5.) It is unlawful for any person to interrupt the flow of any storm water runoff from adjacent property onto their property by any development activity. As part of the City's approval process applicants must illustrate how these storm water management prohibitions will be met, including a showing of how storm water naturally flowed on the affected property (prior to any development activity), and what changes in storm water flow have occurred or are expected to occur, as attachments to this form. The City's approval or permit does not guarantee that the applicant's plans will result in meeting requirements. The final product must actually meet the City Ordinance requirements. Applicant name: '?A &C re- fltitAC er Project I.D.: Attachments approved by: Date: LL June 30, 2010 The following deficiencies have reached an unacceptable level on the projects in the City of Tybee Island. While the deficiencies are not necessarily the fault of the Owner or his agent, they are their responsibilities. The two areas of deficiencies are in the two most basic and common BMPs on local projects. They are: Co — Construction Exit Sdl — Sediment Barrier Correct installation information can be found not only in the "Green Book" but in the Field Manual for Erosion and Sediment Control in Georgia, Fourth Edition 2002, 4310 Lexington Road, P.O. Box 8024, Athens, GA 30603, telephone 706.542.3065, www.gaswcc.org, Georgia Soil and Water Conservation Commission; http: / /www.gaswcc.org /docs/ field_manual_4ed.pdf. Problems with the Co is not limited to the installation, but to the material. Specifically, the job site personnel are telling me the stone delivered is the 1.5 " -3.5" stone they requested. I have experienced on my own projects suppliers not adhering to the specs they are given with the orders. While I regret this situation, I will no longer be accepting any deviation from the State requirements. The stone will be a representation of 1.5 " -3.5" stone or larger. Gradations that are obviously smaller will no longer be tolerated. The smaller stone allows for a smoother surface with smaller voids, thereby reducing the function of the construction exit. Similarly, I am finding Type A sediment barriers installed where Type C is required and shown on the permit drawings. I have attempted to work with the Owners through increased inspections, additional backup BMPs, etc. This has evidently become common knowledge based on the installations I am finding. Where two rows are called for they will be installed with a separation that allows for the first one to fail (fall over) without impacting the second one. The complete assembly and installation must be compliant; steel or wood posts, post spacing, Type C or A. There has been no discharge into state waters due to previous occasional deficiencies. However, the increased frequency has created unnecessary exposure to: 1) Sediment discharge into nearby waters of the State, 2) Increased maintenance efforts by the DPW on downstream lines. 3) Due to #2, higher cost to island taxpayers. I will be adhering strictly to the manual on all BMPs and not just these two. Downer Davis City of Tybee Isl nsulting Engineer Signature of Owner /Contractor Chatham County Board of Assessors: 2 (111 Property Record Card 4- 0004 -21 -001 2011 Chatham County Board of Assessors Property Record Card APPRAISER LAST INSP APPR ZONE vmmccuen 07/23/1996 000008 Page 1 of 4- 0004 -21 -001 506 JONES AVE TYBEE ISLANE PUBLIC PARK TYBEE TYBEE ISLAND CITY OF TOWN HALL PO BOX 2749 TYBEE ISLAND GA 31328 SALES BOOK / INS VI QU RSN PRICE PAGE PERMITS TYPE DATE AMOUNT 07 -0413 24 Sep Issued 22,675 2007 07 -0233 RN 23 May Issued 2007 07 -0188 EL 26 Apr Issued 1 2007 06 -0384 RF 10 Jul Issued 24,000 2006 06 -0264 03 May Issued 35,000 2006 05 -0327 EL 15 Jul Issued 2005 040177 CM 20 Apr Issued 2004 97 -00255 01 Jan Comp 50,000 1998 COMMENTS: 22 May 2003 2003, LAND REVIEW. Picture Unavailable [Click for larger picture] .``'tff: Chatham County t!! ) Tax Commissioner 0,, ■.� F'r.p =rt, T. Itit=nent CAMA ASMT 3,805,500 56,670 LAND 2 363,000 BLDG 0 OBXF 0 3,805,500 419,670 OVERRIDE CODES PROPERTY 0002 COMMERCIAL USE UTA NBHD 0004 Tybee Island 020500.00 T500 TYBEE TO BULL R EXEMPTIONS El COMMCATEG 7000 Recreational LAND ID# USE DESC 109251 RECREATIONAL 300 592 177,690.00 -SF 35.00 R2B 109252 RECREATIONAL 100 200 20,000.00 -SF 35.00 R2B FRONT DEPTH UNITS / TYPE HISTORY LAND IMPR TOTAL 2011 56,670 363,000 2010 56,670 363,000 2009 56,670 363,000 2008 56,670 363,000 2007 56,670 363,000 2006 56,670 363,000 2005 56,670 363,000 2004 56,670 363,000 2003 56,670 363,000 2002 56,670 363,000 2001 56,670 363,000 2000 56,670 363,000 1999 56,670 363,000 1998 56,670 363,000 1997 56,670 363,000 1996 56,670 363,000 1995 56,670 363,000 1994 56,670 363,000 1993 56,670 363,000 1992 56,670 363,000 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 419,670 Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove Ove PRICE ZONING LCTN TOPO OTHER ADJ1 ADJ2 ADJ3 ADJ4 MKT VALUE SZ -50 SZ -50 3420500 385000 http: // boa. chathamcounty. org /DesktopModules/ ChathamCounty / BoardofAssessors /PropertyRecordCard.asp... 2/19/20] RFP # 2011 -624 CITY OF TYBEE ISLAND TYBEE ISLAND, GEORGIA IS ISSUING THIS REQUEST FOR PROPOSAL FOR FURNISHING THE SERVICES DESCRIBED HEREIN: The City of Tybee Island is requesting proposals for COMPONENT OF PUBLIC SAFETY FACILITY - FIRE STATION BAY ADDITION. This is a component of the Public Safety facility. Bidders shall offer services and materials which may be upgraded with optional services and materials which may not be purchased at time of bid award. Bidder shall specify in the proposal the delivery schedule for the products and services from time of notification of award of bid. BIDS ARE TO BE RETURNED NO LATER THAN WEDNESDAY OCTOBER 19, 2011 AT 10:00AM BIDS WILL BE OPENED ON THURSDAY OCTOBER 20 AT 10:OOAM AT CITY HALL A PREBID MEETING WILL BE HELD WEDNESDAY OCTOBER 12, 2011 AT 10:00 A.M. ON SITE AT 510 JONES AVENUE (TYBEE ISLAND FIRE STATION) TO DISCUSS SPECIFICS I. Scope of Work • Size 60'X14' • Erosion and Sedimentation Control compliance is required. • Remove existing electrical, phone utilities and relocate them on the new exterior wall • Relocate existing propane tank to the outside of the new exterior wall, the tank must be anchored to FEMA Standards( See FEMA 348 page 3.2 -8) • Install and connect to the City Sewer system 2 floor drains of adequate size. • Install approximately 70 yards or more of fill dirt for new foundation, front and rear pads • Layout, form and pour new 6" concrete foundation, front and rear ramp all to be completed with 5000 psi concrete as requested. New interior floor and ramps poured and Page 1 of 11 finished to match existing floor and ramps. Contractor is to provide concrete testing cylinders and 28 day break results from a certified testing lab. • Approximate size of new Ramps: Front 30'X14' Rear 20' X 14' • Install new metal columns, beams and metal girt to match existing building. • Lay new block wall to match existing. • Tybee Island is situated in a Coastal 130 mph wind zone. • Install 2 new 14'X12' overhead doors with operators to match existing doors. • Install 2 new 3'0 "X6'8" doors with frames equally spaced in new exterior walls matching existing doors and hardware. • Paint new exterior walls to match existing exterior walls. • Install roofing, gutters and downspouts to match existing. • Install interior and exterior lights to match existing. • Two sets of Plans must be drawn and accepted by The City of Tybee Island Planning & Zoning Department, a permit must be issued before any work may begin. (No Charge for Permit)The words "Component of Public Safety Facility — Fire Station Bay Addition" must appear on each set of plans submitted. • Engineering may be required. • All construction must be in compliance with all Building Codes Adopted and enforced by the City of Tybee Island. • A dumpster with a cover for debris is required on site. • Toilet Facilities shall be provided for construction workers and such facilities shall be maintained in a sanitary condition. • Proposal is to include all labor and materials to complete the job as specified II. Administrator Jimmy Brown will be the Contractor Administrator for this project. III. Submission Requirements A. Submission Deadline and Location: Proposals must be submitted to the City to The address listed below by 10 o'clock a.m. on October 19, 2011: City of Tybee Island Fire Dept Bay Addition RFP #2012 -624 ATTN: Melissa Freeman Page 2 of 11 403 Butler Ave. P.O. Box 2749 Tybee Island, GA 31328 Inquiries or other need for clarification in this document should be submitted by October 12, 2011. Questions to: Jimmy Brown Office 912 - 786 -4573 X 112 Cell (912) 844 -3503 Email: jbrownacityoftybee.org B. All submissions must be accompanied by copies of the necessary licenses of the parties making the proposals. C. All persons wishing to submit proposals shall submit one (1) original proposal and five (5) complete copies in an 8 %z" by 11" format and one (1) original contract that is consistent with the proposal. D. Required Information: Please submit the following information in the order requested. 1. Name, address, phone number, fax number, and e-mail address of the person or firm submitting the proposal. Provide the name of the contact person and person authorized to contract for the firm. 2. The proposer's qualifications to meet the City's objectives and perform tasks listed in the proposal. This shall include the size of the firm, office location from which the service is being performed and nature of staff and equipment to be employed. Job descriptions and pay classifications of the proposer's positions and employees shall also be included. 3. Bids and all required or requested supplemental materials in compliance with this Request for Proposal shall be submitted to Melissa Freeman at City Hall (see address above). Supplemental materials will not be accepted after the Proposals have been opened unless requested by the City. 4. All materials proposed on this Project must be purchased from U.S. based companies with preference given to those located within the state of Georgia. All products are intended to achieve higher energy efficiency of buildings located within Memorial Park and product specifications and descriptions are required as a part of the Proposal submittal. IV. Limitations Page 3 of 11 A. This Request does not commit the City to the award of a contract or to pay any costs incurred in the preparation for a response to this Request. B. The City may or may not require the prospective proposer to participate in negotiations and to submit additional technical information or other revisions to their Proposal as may result from the negotiations. C. The City reserves the right to reject any or all Proposals, to waive informalities, to request additional information, and to award a contract deemed most advantageous for the City. V. Minimum Requirements for a Proposer A. Proposals shall be considered only from firms normally engaged in performing the type of work specified with the Request for Proposal. In the determination of the evidence of responsibility and ability to perform the required services by the proposer, the representatives of the City shall determine whether the evidence of responsibility and ability to perform is satisfactory. The representatives of the City reserve the right to reject any or all proposals. B. Previous experience in the performance of projects of a similar nature to ensure timely and efficient completion. C. The individual /firm warrants that he /she is fully qualified, with adequate personnel and experience to undertake the services required within a reasonable time. D. The proposer shall be an equal employment opportunity employer and shall adhere to any applicable local, state, or federal affirmative action requirements. E. The proposer shall provide bonds which shall remain in effect for the full term of the subsequent contract. Upon activation of the contract, the successful contractor shall provide Performance and Payment Bonds. VI. Criteria for Evaluation and Award The successful Proposer will be selected based upon the best response offered to the City. Proposers may be requested to give an oral presentation after submission of responses should the City find it necessary to determine which is best received. Evaluation Criteria: Submitted proposals will be evaluated and scored based upon the following criteria: Criteria Points Assigned Page 4 of 11 Credentials 10 Expertise of Designated Staff 10 Past Performance 20 Managerial Capabilities 10 References 15 Capability to Perform SOW 15 Price Proposals 20 VII. Incurred Expenses The City is not responsible for any expenses which proposers may incur in the preparation and submittal of proposals requested by this RFP, including but not limited to, costs with travel, accommodations, interviews, or presentation of proposals. Page 5 of 11 City of Tybee Island TERMS AND CONDITIONS DEFINITIONS - As used herein, the following terms shall have the meanings set forth below, whether or not capitalized. (a) "Purchase Order" or "Order" means this purchase order. (b) "Buyer" means The City of Tybee Island. (c) "Seller" or "Vendor" means the party furnishing the supplies under this order. (d) "Supplies" means what the Seller furnishes the Buyer under this order and includes with limitation, the following; (1) the work; materials; articles; deliverable items, items, data and services, whether tangible or intangible or any combination thereof; and (2) what is leased or licensed, pursuant to the lease(s) or license(s) signed by both the Buyer and the lesser or licensor if attached to and made a part of this order. (e) "Loss" means any or all the following: claims, liabilities, damages, losses, costs, or expenses (including reasonable attorneys' fees and expenses and other legal costs). ACCEPTANCE - This order constitutes an offer which shall become a binding contract upon the terms and conditions herein set forth upon acceptance by Seller either by acknowledgement of this order or commencement of performance. Buyer objects to any difference, conflicting or additional terms proposed by Seller in the acceptance of this order, and no such terms shall be effective unless expressly accepted by Buyer in writing. Each shipment received by Buyer from Seller shall be deemed to be only upon the terms and conditions contained in this order, except by such written instrument modifying the order, signed by Buyer, notwithstanding any terms and conditions that may be contained in any acknowledgment, invoice, or other form issued by Seller and notwithstanding Buyer's act of accepting or paying for any shipment, or similar act by Buyer. PRICES - Seller represents that the prices, terms, warranties, and benefits contained in this order are comparable to or better than those offered to any other customer of Seller for items which are the same or substantially similar. Buyer shall receive the benefit prospectively or retrospectively if Seller offers any item or service included in this order to any other customer at a lower price, more favorable terms, more favorable warranties, or more favorable benefits up to one year after completion of this order. DELIVERY - Any delivery schedule made a part of this order is an important, material condition; time is of the essence of the order. Unless otherwise agreed to in writing. Seller shall not make material commitments or production arrangements in excess of the amount or in advance of the time necessary to meet Buyer's delivery schedule. It is Seller's responsibility to comply with this schedule, but not to anticipate Buyer's requirements. In addition to any other rights or remedies, Buyer may cancel all or any part of this order for Seller's failure to deliver in strict accordance with the delivery terms set forth herein. Seller shall promptly notify Buyer of any anticipated delay in the delivery date and Buyer may require Seller to ship by alternate means in order to expedite delivery. Any additional costs shall be paid by Seller and Seller shall be liable for all resulting damages to Buyer occasioned by the delay. Delivery shall not be deemed to be complete until the items have been received and accepted by Buyer. Advance and excess shipments may at Buyer's option be rejected and returned to Seller at Seller's expense. TRANSPORTATION - Except as otherwise provided on the face of this order, transportation charges on Supplies shall be f.o.b. destination, at Seller's sole cost and expense. Risk of loss Page 6 of 11 from any casualty to supplies ordered hereunder, regardless of cause, shall be Seller's responsibility until goods have been delivered to Buyer's designated delivery post. No insurance or premium transportation costs beyond the price listed in this order will be allowed unless authorized by Buyer in writing. If Seller does not comply with Buyer's delivery schedule, Buyer may, in addition to any other rights that Buyer may have under this order, require delivery by fastest way, and charges resulting from the premium transportation must be fully prepaid and absorbed by Seller. WARRANTY - Seller warrants that all supplies delivered pursuant to this order shall strictly conform to the applicable specifications (including without limitation information or functional performance, material content, size, appearance, response time, etc.), shall be free from all defects and workmanship in materials including latent defects, shall be free from defects in design and suitable for their intended purpose, and shall be free from all claims, encumbrances, and liens. This warranty shall survive inspection, delivery and payments shall run to Buyer, its successors, assigns and the users of the items and shall not be deemed to be exclusive. Seller agrees to indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent, harmless from all damages, including consequential and incidental damages, incurred or sustained by Buyer by reason of any breach of any warranty with respect to the supplies purchased. Buyer shall be promptly reimbursed for all expenses incurred in the handling, inspection and return of defective items, and Seller shall bear the risk of loss on all such items. If any of the supplies are found at any time prior to acceptance to be defective in material or workmanship, or otherwise not in conformity with the requirements of this order, Buyer (in addition to any other rights which it may have under warranties or otherwise) may at its option (1) correct or have corrected the nonconformity at Seller's expense, or (2) reject and return such supplies or other deliverable items at Seller's expense, such supplies or other deliverable items not to be replaced without suitable written authorization from Buyer. CHANGES - Buyer may at any time request in writing changes to this order in the specifications, packing, shipment, quantities, delivery schedules, and other matters. If any such change causes an increase or decrease in the costs of or the time required for performance, Seller shall immediately notify Buyer. Any request for an equitable adjustment must be made in writing with 30 days from the date of the written request for the change. No additional charge or change in the specifications, packing, shipment, quantities, delivery schedules, and other matters will be allowed unless authorized by Buyer in writing. TAXES - The Buyer, a municipality in the State of Georgia, is exempt from Georgia Sales Tax under the Sales and Use Tax ID # 302 526 178. All sales and use tax due on materials purchased by the city for installation by the seller under this contract are the responsibility of the contractor. ASSIGNMENT - Neither this order nor any interest herein may be assigned, in whole or in part, by Seller without the prior written consent of Buyer. Notwithstanding the above, Seller may assign any monies due or to become due to him hereunder, provided that such assignment shall not be binding upon Buyer until receipt of a copy of the assignment agreement is acknowledged and approved by Buyer in writing. SUBCONTRACTING - Seller shall not enter into a subcontract for any part of this order, including completed or substantially completed items or major components thereof, without Buyer's written consent. Nothing in this order shall be seen as prohibiting Seller's purchase of Page 7 of 11 standard commercial articles, raw materials, or other supplies specified in this order if these are typically purchased by Seller in the normal course of business. TERMINATION - Buyer may terminate or suspend performance under this order in whole or in part from time to time by sending written notice to Seller. Upon receiving notice of such action by Buyer, Seller shall immediately comply with its terms and take all reasonable steps to avoid incurring any additional costs under this order. Buyer's sole liability to Seller shall be for items completed and delivered to Buyer in accordance with this order and for Seller's reasonable costs to the date of termination, such costs being solely attributable to this order and not being recoverable from other sources. INDEMNIFICATION - Seller agrees to indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent harmless from (1) any and all claims and liabilities for injuries or death of persons or damages to or destruction of property; (2) any other Loss caused by or resulting from the acts or omissions of Seller, its agents, subcontractors, suppliers or employees in the performance of this order; (3) any Loss caused by or resulting from the supplies purchased under this order, (4) any intended use of products or materials provided by Seller; (5) any defective products or materials provided by Seller, including without limitation the use or disposal of hazardous and/or toxic materials, such materials to include at minimum all materials recognized by the Environmental Protection Agency as hazardous; or (6) any breach by Seller of any express or implied warranties. If Seller's work hereunder involves operations by Seller's agents, subcontractors, suppliers or employees on Buyer's premises or any place where Buyer conducts operations, Seller shall take all necessary precautions to prevent the occurrence of any injury or damage to persons or property during the progress of such work. Further, Seller shall indemnify, defend and hold Buyer, Buyer's employees, and those for whom Buyer may act as agent harmless for any injuries occurring to Seller's agents, subcontractors, suppliers or employees and Seller shall maintain public liability, property damage and employee's liability and compensation insurance sufficient to protect Buyer from any claims under any applicable law, statute, or regulation. MODIFICATION; WAIVER- No waiver or modification of this order shall be effective unless in writing and signed by both of the parties hereto. Failure of either party to enforce its rights under this order shall not constitute a waiver of such rights or any other rights. ENTIRE AGREEMENT- This order is intended by the parties as a final expression of their agreement and also as a complete and exclusive statement of the terms thereof, any prior or contemporaneous oral or written agreements as to the same subject matter notwithstanding. INVALIDITY- In the event that any provision of this order is declared invalid, illegal, or otherwise unenforceable by any tribunal or law, the remainder of the provisions shall not be affected thereby, and each term and provision not declared invalid, illegal or unenforceable shall be valid and shall be enforced to the fullest extent permitted by law. DRUG FREE WORKPLACE- By accepting this order, the Seller certifies that he shall provide a drug free workplace for his employees in accordance with the laws of the State of Georgia. SPECIFICATIONS, PROPOSALS, BID DOCUMENTS- The documents which form the basis for this order shall include the plans and specifications and bid documents as attached hereto, together with any other documents so listed and enumerated, if any, and it is expressly Page 8 of 11 understood that any special conditions listed and attached hereto are specifically made a part of this contract. APPLICABLE LAW -The provisions and performance of this purchase order shall be governed by the laws of the State of Georgia and applicable federal law. Seller agrees to bring any and all actions relating to this purchase order only in the state and federal courts located within Chatham County in the State of Georgia. APPROPRIATION- Notwithstanding, any other provision hereof, this agreement shall terminate at the end of each calendar year without liability or obligation on the part of the city in any calendar year where the City has not appropriated funds for the obligations hereunder for the next calendar year. PROTEST POLICY - Any bidder who is aggrieved in connection with a solicitation or award of a contract may protest to the Purchasing Agent. The protest shall be made to the purchasing office having responsibility for initiating the solicitation. The protest must be submitted in writing within 7 calendar days after knowledge of the facts and occurrences giving rise to the protest. The protest shall: include the name and address of the protestant; include the solicitation number, contain a statement of the grounds for protest; and specify the ruling requested from the purchasing office. Awards will be held at bay until the protests are resolved. INSURANCE REQUIREMENTS Contractor shall provide a Certificate of Insurance naming the City of Tybee Island as also insured, a 30 day cancellation notice, indicating the following minimum coverage: Comprehensive General Liability Automobile Public Liability $2,000,000.00 $2,000,000.00 A performance bond will be required in an amount equal to the bid amount plus at least ten percent (10 %) of the total bid amount for the completed work. Workman's Compensation Insurance equal to the statutory requirements. Page 9 of 11 QUOTATION SHEET A. Description: $ Quotation Expiration date: TOTAL COST: $ Page l0 of 11 Form W -9 (Rev. October 2004) Department of the Treeeuty Internal Revenue Service Request for Taxpayer Identification Number and Certification Give form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Name (as reported on your income tax return) Business name, if different from above Individual/ Check appropriate box: ❑ Solo proprietor ❑ Corporation ❑ Partnership ❑ Other I* Exempt backup Address (number, street, and apt. or suite no.) Requester's name and address (optional) City, state. and ZIP code List account numbers) here (optional) Part 1 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number {SSN). However, for a resident alien. sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part 11 Social security number II -1 I -[ III or Employer identification number Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Here Signature of U.S. person ► Date ► City of Tybee Island, PO Box 2749, Tybee Island, GA 31328 912 - 786 -45731 (fax) 912-786-9465 What products /services do you provide to the City of Tybee Island: To whom shall we direct the Purchase Order? Sales Contact: Email: Phone #_ Fax# Location: To whom shall we direct Payment? A/R Contact: Email: Phone# Fax# Remittance Address: Our terms are Net 30. Page 11 of 11