12055 SW ANN STREET-1 FILE NO.
ANN STREET - 12055 STR. OPN. PERMIT
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APPLICATION — STREET IMPRO LENT/EXrp VAT►ON COPY TO:
ORDINH;4%,E NO. / ' ;4 >19WH I TE)-F I LE
{YELLOW)-INSP.
(INSTRUC-(IONS ON SEPARATF.SHEET) U (PINK)-OTHER AGENCY
BLUE)-APPLICANT
APPROVED APPLICATION NO.: 39
NOT APPROVED CITY OF TIGARD, OREGON FEL AMT.. S--------
PENDING
—_PENDING FEE. PMT, Ll CITY HALL RECEIP �o Z
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY DATE �� /Z'I�_
PENU'NG AGENCY "C K" ❑ kpplication and Progress Record –
MAINTENANCE BOND/M
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION As REou1RE `D --'�
ANNUAL
PENDING VARIANCE ❑ EXPIRATI N DATE:
PERMIT NODATE ISSUED: /U /Z4/ vim. , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICAN f �LLZJ�—S�-�' — '_ ?. 0 I�1J ��A_ �R. �Z-- �'33___jj
NA�AE ADDRE! -- "T CIT PHONE
CONTRAC OR --
A E
CITY - PHONE
PLANS B`(.�
AME ADORE69 CITY PHONE
C:+C7
ESTIMATED IMPP.OVEMENT TOTAI. VALUATION ( COST): E ZUU
DOLLARS
FOR OFFICE USE: e
(2) EXCAVATION DATA 'u _ :_ "^'N
-- 0.04 x = 2 UG> , _
STREET DESCRIPTION —� PROGRESS & INSPECTION :;TATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM_ 4 QUANTITY
STREET
OPENED
_ Jl ll, _ 1 INSP
Iq TION
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ESTIMATIEI 'TREET OPENING DATE �< � t��/ S --
ESTIMATED STREET CLOSING DATE — f / T
- E
(3) SECURITY NO. _ SFCURI TY AMT: S 2GC�. STREET
CLOSE
SURETY CO. _ FINAL u /�
cERTIFIcbcrlv.cK T7 •ONbr_ INSPEC. If- .:• v f� ICVC � .V).
j4) PLOT PLAN INDICATE SITE PERTINENT PH rSICAL SPECIAL PROVISIONS /CONDITIONS:
FEAT RES; EXCAVATION LICATI[jN AND EXTENT.
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(5) NOTE THE CITY OF TIGARS'i DOES NOT, HEREBY. GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDI:.TION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT .AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THF. CITY AND
EMPLOYEE, AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
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APPLICANTS SIGNATURE �._ l� �^ � � DATE / - /
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24' — 0" MAX. 12' 0" MIN_.
DRIVEWAY R/W LINE
-'�-„
w CONTRACTION OINT OPTIONAL
cr SIDEWALK
> LOCATION
B SIDEWALK EXPANSION JOINT B
EXPANSION JOINT
CURB JOINT
A
L:3�_ " 6'-0" MIN. 12' "0" MAX. 6' - 0" MIN. 12'• 0" MAX. 3'-4" 7
FACE Of CURB
SIDEWALK ADJACEN'f TO CURB SIDEWALK AWAY FROM CURB
FLAN
11/2" EXPOSURE
USE EXISTIr4 EX^ANSION
JOINT OR SAWCUT AND
ELEVATION B-S PLACE COLD JOINT.
SEE DWG. NO. CS-306.
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01IMPACT0 919GRAT \ 2" OF 3/4" MINUS
SECTION A—A,
NOTES
I. CONCRETE SHALL HAVC A MiNIMtIM BREAKING STRENGTH OF "%COO PS.I.
AFTER 26 DAY$ , 6 SACK MIX.
2. CURB JOINT 514ALL BE A TROWELED JOINT WITH A MINIMUM W." RAOILIS
ALONG BACK OF CURB.
3. EXPANSION JOYmT9 SHALL BE 1/2" PREMOL.DCD ASPHALT IMPREGNATED
MATERIAL OR EQUAL , EXTENDING F9QM SUBGRADE 1'0 FINISHED GRACE .
4. SEE DWG. NO. CS-30C AND NO. C;1-305. I
WASHINGTON COUNTY Y
DEPARTMENT OF LAND USERESP� �
DEN f l AL DRIVEWAY
AND TRANSPO'R1 ATION
DA'Z'E CIVIL I IINEIFR ORAWN APWA NO. WASK COUNTY Na
17
.dEa fol" [\!'clNh D1N"""' 200
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CITY OF TIGARD - RECEIPT GF F'PgVMENT REC NO: 00105802
CHEC4' APIOUNT 208.00
NAME. MARTIN CLARK CONSTRUCTION CASH AMOUNT , 0U
ADDRESS: PO FOX 168 PAYMENT DATE 1U-24-89 I
AURORA. OF., 97002 BLOU:. NO/AL-DF':
12-055 SW ANN ST.
P'URP'OSE OF PAYMENT AMOUNT PAID TURPSE OF PAYMENT ANOUdT PAID
-•______________...---_-.___ _____.__ ___ ____.____...__.__----.----•--_----.__ --------___- i
CUSTOMER' DEPOS I ( 10-22000 _ 200.00 FUEL T I; I MPROVEM ( 10-4.4600 8.U0
ST'F:EET OPEN I 1dG F ERM I T # 7,49-139
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THAN'. YOU
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TOTAL AMOUNT PAID
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�1tx.WMfhwtvwu.w;' ti�Nkk4fef��E3i11�3�ixy:ESQ,i!1+}litl{.iliWti+1:`w.u:.cK 4' .rr ,t+r. '
REMITTANCE ADVICE - 96651
��— 1232
MAR"TIN CI ARI( CON'JI RUCTION, INC. — _ _ -- 9220
P.O Box 166 _
AURORA,I)RfGr1N 97002 -- - - —
TELEPHONE(503)678-1139
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PAY _ --DOLLARS
m
TIM ORDER
Of -------- — —
FIRST NATIONAL BANK of Oregon
CANBY.OREW11 97013
11'009 2 2011' 1: L 2 3 206 S LGII: 709 00W 3 L011"r
C ITY V T167ARD
EXPENDITI RE REIMBURSEMENT REQUF„;T
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u Thic form is a multi-use form. Where appropriate rea.eipts must be attached.
Documentation is important: for all 1;-,�rposes. Staple di.cumentation to form.
VENDOR N0: �- DATE: 1919139
PAYAB).E TO: Mav 'tun s,��f�c �uv�s r�.ct�o+tI vAc. Reque:;ted by:
lcaena arza!!er•.esc rza r..res-cacmr_=c.acv ac esrzme_.raa:z r_rs.r-.c.c r_r:ecars sa::eeaccrsc.caevmmrcrzzmmcrr es
MISCELLANEOUS (parking, books, subscriptioais, dues, membershipv, etc.) :
jDateDescription _ Account No. _ Amount
Qi�4sd�, '�, t 0- zzdoo zon
m.masnmr•!lmmlmrmwlmeamrnna as ur_vr r_r_aaeaar.----------- vvonu!..lama emmsr mmmu+ama♦
GENERAL MEAL EXPENSE:
-Date Description _ - Amount
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Account Number to be c,iarged: Total
grin-meal amamemmvea cec ae -..�-s-men -c aaasac c-c._a�=e_ccr..a'-aces r_.n r..aeinlur_caacnc.or�caa lm
MILEAGE:
Date Description: (Include erd/start readinLs and total miles) Amount
Account Number: _ Total mile;: x$.7.1 b
!m!m!!lmmmOlmm!Om6RR6lOCSS<•Caaa4 CMC�C.II__Lt=aC��t23F'aaGea .aMr'tlCr p^�p.CRtZCC�I1`iq 2SaOrt♦aR!
APPROPRIATION BALANCE: - Ar OF: Sign.9Curr_
APPROVALS (if. $25.00 or under rriy be reimbursed through petty cash) :
GP to =500.00)Sectivn Manager i _ Pirch. Agent
($500.01-$5,000.00)Dept. He!011 —ch. Agent y--'-_ -
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