7962 SW CHURCHILL WAY-1 r
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APPLICAMILI EkREET IMPROVEMENT/EXCAVATION . \ COPY TO:
ORDINANCE NO.NO74-14 -" J X) (WI-ITE)-FILE
OR 10 199 '`�, ® (YELLOW)-INSP.
INSTRUCTIONS ON SEPARATE SHEET) / ��'�"® (PINK)-OTI-iER AGENCY-bidg
\ w (BLUE)-APPLICANT
COMMUNITY DEVELOPhij
APPROVED
APPLICATION NO.: 455
NOT APPROVED Li C11 11' OF 7IGARU, OREGON FEC AMT.: = 4#/OO
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT N43.! 91-21_1743
PENDING SECURITY ❑ PUBLIC WORKS U£PARTMENT 0Y ---UA61 DA� _ r _TE 4 t 8 / g-
1
PENGtNG AGENCY ''OK^ C3 _Application and Progress Record ` Z - - - " -
MAINTENANCE
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIREL) 2LL
ANNU.-.L p
PENDING VARIANCE 13EXPIR 4TION DA-,E: 011e�9aC
PERMIT NO. 410-01 D
ISSUE
DATE
- --- -- - 4 yl 91 —
BY
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL Cot1CCO�:e Sidewalk ���
& DC Y2Wfty Apron,__ -_ AS DESCRIBED 4EREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT Tiny & Co. Cement 6129 NE Skidmore Fort-lanJ, OR 972:18 # 281-1981
NAMEDRE � --- _.- - CITY --- -E
CONTRACTOR
AODR[ CITU-_ --__---_---- O
PLAN") BY.---_ �Lk+_�a^�eI �_ K�SpiRC111CRt
NAME
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): : 1,2W.00
— nOLLARS
(2) EXCAVATION DATA: Fps OFFICE usE MIN. -`
,.Ga X $
1_.200.00 _ f 4E.00
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT Cl, CU-1 MATERIAL INSTALLED
TYPIZ LENGTH WIDTH DEPTH ITEM AI QUANTITY ITEM DATE REMARKS/TYPE LAY
STREET -'
PEN D
SW Church 11 Way (sea atta hed) INSP C-
R TION
E
Q
U _
ESTIMATED Sl REET OPENING DATE: E
ESTIMATED STREET CLOSING DATE: L / T -
E
13) SECURITY NO. _ SECURITY AMT.: S 1,200.00. _ CSTREET
LOSED
SURETY CO.: _._Alyn_ Bautrer jC m _ FINAL -`-
'_ rwxS CHECK 6 CASH ❑ — IOND '� •��ceEC.
(�I PLU l' PLAN: INDICATE SITE PERTINENT PHYSICAL - SPECIAL PROVISIONS/CONDITIONS:
FE'kTURES; EXCAVATION LOCATION AND EXTENT. N 1. Notify City Inspector, Carl
I
prior to starting work; also 1
1 '
prior to pouring canc_ete.
2. Excavator must cult 1y weth ORS
SRH - '
CHURCEiHiLL WAY 1 757.541-.571 p—re- location of
.. .- -
.•---_- utilities, etc. ;.
1
3. All work shall conform to City
_ P -
I I standards t 21VICifications.
l 1 ) ( work Site I I 4. Traffic IS Pedestrian safeL•y must
1 , (:hi. I be provided for by the contractor.
,rchl 1way I
Ch�. : .
ISI NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICT'ON IS 1'+AAT OF WASHINGTON COUNTY OR THE STA1-E OF OREGON.
THE APPLICANT AGREES TO DEPOSI- THE REQUIRED SECURITIES, TO COMPLY WITH ALL 't�RTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WhICH MAY RESULT FROM APPLICANTS ACTIONS,
APPLICANTS SIGNATURE , 5 S DATE
[wenn i s Ross CC13# 71767
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INS^--',TION NOTICE
City of Tigard Building Department
12420 S.W.Main St.
Tigard,Oregon 97223
Phonr 639-4171
lype of Inspection
Date Requested _^ Time �A.M. P.M.
���Address {GA Permit
Owner —' `°'"""-`— _ _ Lot # _
Builder
The following Building Code deficiencies are required to be corrected:
Presented to ,._ i—_— t-Zpproved
Inspector U Disapproved
Data
CALL FOR REIMPFCTION
O Yr1S O NO
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tilyrd,Gregor 97223
Phone: 639-e j 71
Type of Inspection
Date Requested A.M. P.M.
77
Address � Permit
Owner Lot
Builder
The following Building Code deficiencies are ,-squired to be corr..,,ted:
=Loa
g-
-T
Presented to Approved
Inspector
0 Disapproved
Date
CALL FOR REINSP CTION
YES 7NO
BUILDING PERMITAPPLICATION TIGARD DATE_ MAY 16 I985 5384
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED E UILDER PHONE 692-3615
OR AµSHOWN AND APP90VED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. C WNER PHONE
OWNER JAX i 11er JOB ADDRESS r, - Y LOT NO.
�_ 796Z ,�_ 1lurchil. .. -- 1, .
ARCHITECT
BUILDER -- ar3tw _ADDRESS P.O. box 23291 ENGINEEDESIGNER
STRUCTURE NE R M DEL ❑ ADDITION ❑ REPAIR _ ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
Q] 00810 NOit ❑ EDL}COJI AL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB(:] FENCE
OCCUPANCY P�3 LAND USE ZONE k"1 BLDG.TYPE — Sd -FIRE ZONE PLAN CHECK BY WR HEAT G9ti
WuStfuct-sLigle xL.nily dwelling w/attached garage.
Re-Issue of Permit 04672 -
- - 2 bathroom 3 Bedroom —
SEWERPERMITN 2U427 _ Garage 472
OCC.LOAD FLOOR LOAD 40 HEIGHT 12• _110.STORIES ! AREA 1344 NO DEBEDROOMS -_3 VALJ_E 0 19U00.
BUILDING PARTMENT SETBACKS FRONT � � _ --
[U REAR ?I LEFT SIDE j RIGHT SIDE
Permit 316.00 ------ = - -_— -- _
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS l ONTAINED IN THE BUILDING CODE, ZONING
Plan Check 4 U.W REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREL v AGREED THAT THE
WIDRK TH A1LLLA PE.CABLE CODES ANDDONE IN NCE WITH THE PLANS ORDINANCES. THE ISSUANCEND ECIFICATIONS AND IN OF THIS PERMIT DOES NOTWIANCE
AIVESub-total 356.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACEORS TO HAVE CURRENT CITY BUSINESS
State Tax 12.64 Tf?OENSE.S ATE PERMITS REQUIRED FOR SEWER,PLUMBINC 4ND HEATING.
.: .0
Total 3(y8,F4 SDC— $.5000UU
By �! 2M TI $150.U0APPLId_AANTORAb_
- CL
Approved _— BCk _ I Receipt No. _
—.J ADDRESS LL PHONE
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DATE IIN5P.I TYPE INSPECTION I'
-- REMARKS II — PLUMB(N6 DATE
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Fina -
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9 SEWER �- I
Final I I
DRIVtWAY
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Dr-.1n)Final
Curb Sire-t Final
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SLOG. DEPT.FINAL TEMPORARY CE;;T IFICATE OCCUPANCY
^CERTTICATC OCCUP::":,
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