.13 Property Owner Notification of Tree Removal (M-689) SAMPLE.pdf
PDF 269 KB Posted
- Attached to
- Tree Trimming & Stump Removal Services
- Solicitation number
- 6100065337
- Issued by
- Fayette County, Pennsylvania
About this file
This document is a Property Owner Notification of Tree Removal form (M-689) issued by the Pennsylvania Department of Transportation (PennDOT) to inform abutting property owners of tree work occurring within PennDOT's right-of-way. The form serves as a notification mechanism for tree trimming and stump removal services performed by contractors under PennDOT's authority across state routes and departmental facilities. The notification requests property owner information including name, address, county, state route, and segment location, and inquires whether the property owner wishes to receive resulting wood materials, wood chips, or allow chip blowing on their property. The form requires property owner signature and contact information, though the signature does not constitute agreement or disagreement with the work being performed. Contact information for PennDOT District Roadside Units across all 12 districts is provided for property owners requiring additional information.
This is a sample form created for Pennsylvania's Small Business Procurement Initiative, which restricts bidding and award eligibility to DGS-certified small businesses only. All bids must be submitted electronically through the PA Supplier Portal at www.pasupplierportal.state.pa.us. The related contract opportunity covers tree trimming and stump removal services for Fayette County, encompassing all state routes and PennDOT facilities within the county's jurisdiction. Waste materials including chips, mulch, leaves, and branches are primarily hauled away and disposed of by contractors, though fly chipping may be required with specific instructions provided by PennDOT upon project notification. Bidders experiencing technical difficulties may contact the Supplier Service Center at (877) 435-7363, option #1.
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Text version
This notification is to inform you, the abutting property owner, of the tree work that will take place within the PennDOT
Right-of-Way. If you should require additional information, please contact the PennDOT Roadside Unit indicated at the bottom of this form.
This work will be performed by Contractor: _______________________________________________________ .
Property Information:
Owner Name:_ ______________________________________________ County:________________________
Address:_ __________________________________________________ State Route:_ ___________________
__________________________________________________________ Segment:_____________ Left or Right
Telephone:__________________________________________________
1. Do you want the resulting wood?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
2. Do you want a load of wood chips if any are available?. . . . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
3. May the resulting wood chips be blown on your property?. . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
* Property Owner Signature:_________________________________________ Date:_______________
Contact Person:_ _________________________________________________ Date:_______________
* The property owner's signature does not imply that he or she agrees or disagrees with the work being performed.
PennDOT District Roadside Units
WHITE - PennDOT YELLOW - Contact Person PINK - Property Owner
M-689 (8-08) Sample
ProPerty owner notification of tree removal PleaSe tyPe or Print in blue or black ink all information o District 1-0 • (814) 678-7147 o District 2-0 • (814) 205-1192 o District 3-0 • (570) 368-4224 o District 4-0 • (570) 963-4048 o District 5-0 • (610) 871-4139 o District 6-0 • (610) 205-6753 o District 8-0 • (717) 787-7600 o District 9-0 • (814) 696-7226 o District 10-0 • (724) 357-2833 o District 11-0 • (412) 429-4954 o District 12-0 • (724) 439-7374
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