The URL can be used to link to this page

ROW2013-00077 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT\./ 1 INg 7 Request Permit Action i ��%��3 r I G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) V 1/111(3.1 Vnci 1 / VotnCA t Cm c-ruc-(-wv Mailing Address: (i9000 S. t helus t( U\LDI,i City/State/Zip: SGIY)C1 l 012- 4f'1055- Phone No.: S9 . bog . '3-�f PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): (` j CANCEL/VOID PERMIT APPLICATION. [ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). OD 09 ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). y y p REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: RCA-2013— CO:7]1 Site Address or Parcel #: Clelt SV\J tih[, .e/nZiG 1.-- Project Name: 5-. ft-rstInO Subdivision Name: Lot #: EXPLANATION: Perrnik *Wluc4 -for IVl err-Dr. Wprv- &rvi plaCci uhdet P-A 201 3-- vvv i3 Signature: 'VA ' 46.L.6-1- Date: 1012.4 I ( II Print Name: ''/ 1(s V-OV\J (CZ Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80%of the land use application fee for issued permits. d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80%of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte. toi ldmrn: Date/Vz By %. Refund Processed: Date Aj/ By I9. Invoice Processed: Date By Permit Canceled: Date //3 By„, . Parcel Tag Added: Date By Receipt# Date Method Amount$ I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012 From: 08/21 /2013 11 :48 #288 P.001 /003 City of Tigard :NI. " Application For Work In The Right-Of-Way TIGARD ROW Permit Pr erty Addre /Location(s):"1`1 05 au Fie Van z CC-51— FOR STAFF USE ONLY l l CI 0Q- Right-of-W . f s /6'30)3—O�D77 Case No.: /MI *Applicant's Name: Al a Ai iI& J 4 Ad. . Application Accepted:g/�7�/J7B /`�J _ 1-1 m�� iIriT1IIv yu1 . y' Address: j Application Reviewed:_ `b(Z) By: g Ciry/State, I 1 rI JA Zip: 'llt ` Application Fee DuelJOO,t.� y Primary t: , ' e to r , Applicant Notified: 112-1 13 -A-� • Phone: )Ca • Fax:' Y Receipt No.: Email:I"�,U,: ..� . , .'G 1 ;1'net 1a REQUIRED SUBMITTAL Contractor's Name:jil)o-ret 1 ftfl ct 'f o) ', D Q IRED S TION C:t:li#�/��Z/-`y7y�7� ` c�-�Expirati�on:�f�"/, 1� • Application form,completed and signed \c{dle5s. i�1LC�-lam ��)I,,r�� 1 ( v`�. • Submit one (1) copy of scaled sketch of City/StareQ( CV- Zip: Cl 1 the proposed work to be done Phone: --C_Q(Q . >,1 Fax: l ()COY % •• Submit one (1) copy of traffic control Email: r l�0\nei, e, �� %n e±- plan r Professional Engineered Plans are required Plans By: �n�m y\\-1 /+\c. /n�y� �,, µ�y� q ` for: .Address• --} / ) S J Vtt�Ul (fit t l VV( i\gyp ✓ I0D Widening 9 ` � � U V l� �/ • Street V�tdentng City/State:'_ £ . A l'/ Zip: • Subdivision Infrastructure Phone: C 1-AC-- ----1`7 11-AC-- ----1 lot ) Fax: • Main utility line extension Rev.6'24/2013 Ena11: I:curpin\muter* \land use applications\row app.docx Description of work:5rr rr � ChXeL1 polo-, ..tiv, (� 2.�4.1.ra PFZ?`�« Estimated value of work(within the public right-of-way): $ /6 I DOD p # •mss V Ay P44,,,,..4.1,74- „Ay) Is work related to a LAND-USE DECISION? YES n NO ,- "V If so, please specify(MLP,SDR,SUB,etc.)case#: 0114 -.' IT2L 13- U 0 io-7 5 iTE unuz-tom &tl->tPCtIZ a13— Is the work related to a BUILDING PERMIT? YES VI r.IN,. O If so, please specify (BUILDING PERMIT)case#: i 13--000-7Z 001?-7 Signature of A plicant/Permittee:�Xj .Q!t 4 Date• (U} IS Print Name: Wall.MO Title: P6ISkaillE Wyd-. 111r114 IX 4o el( K.harA. .. - '-- City of Tigard 1 131 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 f www.tigard-or.gov 1 �lr C�7(1 a_j_ ST- l• 4 &_____. ________. _ . . ._ _ _..._ ilLeit-i. i , ,sue . —p4 s. . 1 • O J C .L1 I\-'!C -ei4 e. S v vs-re 2`7��—z9Th Zv 3 .i _.__..-_ _ 4 c� • ; , ,z,, hi; ' 4 ' . ...._..., . • ;.,./\ 3loc -lrka e :-A ND • ry • O %n 0'41_ ! CO 4* 5 k) P PI-C__( F:!c .,,,, _----__.__ haw 0 O N r . CO o . .-.-. \ �\ \ LEGEND O CO \ >4/y/ / ``I '-�•"I Shah 0.PA:M _-.�s, _�_� O CI- \ ft/ d /i 4.••• \ e t, \\r ..��; , s1a�54,1,NMInE cJ6 x 0 -,_1, i ti 5.Q•c ° %/f� �r i\;;' S1 / e MIN ,.&Gm �■ ■ i 5.l y C\I x c >p \ /' • / 1 tI: , \ pet 4/ �a7Y DOESir[rA,tr TINE -.. ).--� 6 1� �,, rRI14 it \� ry \ te/ 4 E 1.ALL:l^:7 \ \ L +It la.r 4.4•Rf W. fill WA'U r.RE �-/Y-� N(IOU II 1111.,/ Rrv•nla \ `f © _ �' \ K ar• -`� r41IO IDL 1,I4 -•r-- a / ( /, m \ �� a /Vora yKAt D4 ' \\I R V / / ' /42/ r O .INI S•�11Arr r �.. \ • y /S( t L IralaaRO ro1�ul�- / / /, �•, f '.e \ a) -•4 OV[arlo rail WF -cn- // - t: ( )1 \� / / + , / .1 P. „•Oln..r Al ' / •1 r•Trl WEN © }1.Jt[ N �,-� • f a / / K.:a ,/ Yna Aswi[7 1'!� .,.. .i/ ,,,, i i/,, ', / O Daa c oils ® mY N0.1- ., ' \ rALr[MOON N A, 111.41i51 1.11f I IN am IY y' < , /� \ TIMMY!r[N 1,- --55• !;p �� / .12117({•Yi Q d, e�ykV LMI o sno itwoz S O ,� /i Or Nt•loot Ilr Nq as lrra soOOOOOsr/lsr�g / i �,'� ,L AI klkrom MOISat' • Ir f!Y:IA11'SttlO OttWUI ` miner,ak t>E r * t-1 IttLIM.Ii �. I 0 11 �+ 4.1621/1 - `''• 'in- Y/ \ A ■ !r►•rl.MY d sas «NN A I j tell al �At•lm, r j �4 RlO.la1• ` " vIr.• nen rp \ % � a .:.I�-�1. 1 J . .1/ /° / 1(.1112.0 t3\ �4 Nt as NIEL MN I:?� IUU A v •`j P[(yt r lar p}• Ir.,tE n - / t ono Y1M I woo / ,/.4P .: \ • ' �� P+"_" #• / / •A IF Ir SD �' � d•AOp6\ ' ' :.�4�4 c • � �' TER / J��MifiG]„ ...,,r.s'r :.,71,,.. m,�1' 1 Jl ^«I / ��' ��.�YI1L'l ::men :r I••:, RIY.,)G- I/� �, - / A ' D f� OE r te�r t RJra, I It•Imr) / �(I •r J��'w"!--:- `/Mf •. 160111} "O SO-e 5SA 0t 9f,• ,111 / . Il►v f ` /C,4:, ..r-. y_ err -i. -[ I I- t .I 'r - _[�1 O / .a•�~21:."0••;-•••••••1. -"' l..,..r- }r6112 ,1'* It-IC. te I�It iN-le)sl(er t[� / C nt 97,7,. �� D ..I „ A 1. a y ` I !`JT 1 : S ti r i 9sm A 1 ��/r� 21711,f 1r ao �� .t.:. Ir, O nn!ra A ( ':ALL �� , sso,n TA ED m ,� Yp TH 1 7l^., rtiiSti• s.DerT ]r 0 IMP la 4till '1�E, . �{ Rp U / AIJ•IRA .., - z _ �.- MOD.) , NURSEF 1621.91 -� ='CST 1 n V It 41 J r' M • fal ,a-'-^•1 i % J,2,,rrs r ,.' e , ALL( s71lf 1 40@PP u� '-r 4•IUSS � �.. ' CLASSRM' 1E.1 EEb 2 • Stamm i V�30 `_ sear � 11.7.111 '� D-i re JY6a r5 _ rr .DIY T i�I ' .�' FT..e - �{'✓ '\• " es i'm ,921 111_ 1�1 1' 2 if.41t rVr^'\ r.�t 7r' ,D 1.-.071.7 I " 1I4_n'y llla �1\ ! U snosD A trl ��s• �,-' a. - ,�^ 1 w ` X�ST. t1 L\ i EM[r.4 �,t� '•r S1A a... {,��y� � AKAOUIx / ,u,x_-- 1 '� 1 E 1 EU NN. Lr" 10-R rAarr�1 if rx•WU a" -,. 'I mil IIY sit �,f",• I VV.17A0 Itix•Ir7u(e.Yj �- '-�a.L' I h Ix..�u�ilillyW 10051.•1 y M0°U ,y �� Z ' I I[OR. IRIS[r 4) Ir CO, 16117 R' y ' SSRP11• a\ a 1 p .� �° M,ao�, , cva f ! ,W 1=`,. .,ON IN M1. YQ 1..„, ' -_I` 1 1 AA ar r a ��, 1 c\ 1 1•,...lc Mr Pe Fa RME(rtat TO ` f•V. 1 (`t��/y�'�11 . .T 'S- Ir.1A lXl•1N.t�'O1Mlr 1r1t ..I t• . :. (••* 1 Y1 i l �, GN ! _I f �• 1`"`. \ /�- .r- 11 K 'll f"ry�RC'• O�ellslCil E I ` i 111 .i- KEY CONSTRUCTION NOTES mimiceilrsw[xuAV mu of 7•lf, t u-,, 1' • Y t 1 1'1 ` • Cj 144141 r 4 11*44 10 AIp fit 11.3 40.6 ,0S (OxS1P I Mir WRx 0 ,p "�R con Roar,(O y�r ,{R' A$W.1:SQ OtTAIA 9Qi 7017 S/r OCw�SQI cl.a /;o,gi51AIL1 el V r ri,l SPAIIREA SERVitt VJJ U P y,�01sT IS RDr IM • -.11 5 �a 1 f A . Q,o rJIL0 41 cyA$„n eAi400.0 00114 11 r r• 1 _I1 I tI 4 t`` } o*1o.1 e•Dr:lt 01,70 X14(0(.Anfsac I 4C3W4 on PIOTtei DIS?IR S1Ofm 1INE SEi1I(F SH IIfP PU M 1114 1211110X5. . - ( 1 1 { 0 gF r1Ax 511Ei OIDA 0 _ 1 I I 1 .. 7.15.0,111 a7P In 4w tO LW CICT rJ 0[NN Yl1.t. Sri OF!M1NK 1 1 rf� _ - r 1 me 1 (1�RENO*7•379(cruel.Iw. I6+Aa 967.1.1.1 aA/F r,x l ID Q�rce afro.xA,ru. _- �1 Y' tt :. V ' 4 O RENO 040 61411E A.ih004 PMSR a 1S. J bets,MINT tAwwv(a ctbc (}0 0411*0L..o rA4rc 7.130lxc x94 ou,x Et AIL. - -� 1 t ` CONRAD,OI TD CMEINArl nrr'9.1:.17 lrOY13R AIULI-c rely,OlA7f aruslrE.n t (�a yr AKA sea FS r14Agte eat IxA W 4 I , IJ 1 S OFrO NC 61te.t ZAK ta}iML Mae,0 PRIMO 11te111PL ��IxJ1Att IxlOf[AIf AKA ONA.WC 117114' Incorporated {{ t l O c0*1 A^•0,10(JU101.YAf[YIM 7flLIT1 ma SNSr.I.DL t'S �/ I 1 Si 1)Y^r RAW 640114,31101.4111. U. :y■J,ere.'t"•1 w ••1 I i I 1 , Q x121 7rsrlNt 91121 swim 10 ANNDF �Q 5.a 0[,AU 0411 UT. rnartrn 711YFYANO ouM11 5.a'CT I+(•.Y•.4 rlMi2,+ L: - -.--_- 'E 1;1 t I ` l el o Fa orAKi C`'� 9617.'(';J w.-x2 e: � PP' 1', �, k 1 4 'I t `L.l •1 i, " Q7 60400 TO 0111 Y.Sim WNW_ 4 Wiwi[AMINE,b IN0l Sleety Volk r r@ [IR Q6-1,01 c( F 11511:1/la WOW A4fNIIY n 000 mph;Dltd 11X(1, I traxAt 621.12121. pF 4 I I 1 O PIA.Y S"uYU 6T-T Nnl1m'MEN em N\ q' �X�ST. F CES . mNEAU9Q7CIa F eM1K:Ir1ISSFJa Et,Ii0IP'IC1104 Ifi51 irSY_'O !`\' *.iRlt:'o V 1101679( 0 42 10 1044 11 SUP[10 AY kI Ol ry!'04)1 r Ir( lI4 0 4. pier ha 18 SPA I t ��1 ' 1 t !l AS"ALL FIR[}(YR�INT 0.4510. 3 .1.111'..1 0Y 1io IDI DIA:VIR SRYI[E r0.1SNi1(GOr WA IC ECt04PIP(1Mry' , O � 1j�!�`,x{[ 1 ------- Valenta Locum/1 ha.VI t; wNK.