8870 SW EDGEWOOD STREET FILE NO. 432 -R
EDGEAWD ST. - $8'10 STR. OPN. PERMIT
f i
CM OF TIGARD
EXPFNDI'I M RDQUEir
"Ixi:. form is a multi-use form. Appropriate rec%Apt:s must be attached. 1)cxxwu-jit:ilt_ion
inportant for all purposes. ^t aple docmw-nt:at:ion to form.
VRMR NO.: II — DKi'E: 1 - Z4
PAYA= TO: C a►-y� L`I v K N c�4 a a e-lA J-Q RDQUEbTb� BY:
I i a�� ► . 9 �zz _ _ * Approved request due Wednesday
10:00 AM to A/P for checks by
Friday.
7MIStELTAiv�(J;; EXPENDIZVI21 :
Date Description, Invoice No., etc. Arount No. Amount
EF U , 01T �S S%'t P 2 KC e-
----- -- 1.
ZnrAI, I $ r s czo
tiileage $0.255
APPROPRIATION BALANCT: _ _ AS OF: SIGMA=,:
(Up to $25.00) Section W,,nagex _ Purch- Agent
($25.01-2,500.00) Dlvis-Lon Manager
($2,500.01-7,500.00) Dept. Heap
($7,500.01-15,000.00) City Adiril;istrator
($15,000.01- ?) Local Contract Revicw Fkx�rr3
/1501T
APPLICATION - STREET IMPRO''r:MENT/EXCAVATION IF, COPY TO:
ORDIN . :E NJ 74 14 ® (WHITE)-FILE
` (YELLOW)-INSP.
(INSTRUCTIONS ON SEP AFATE SHEET) (PINK)-OTHER AGENCY—bldg..
(SI.UE)-APPLICANT
APPROVED x APPLICATION NO.: ____4 '/] _
NOT APPROVED i I Y OlH 'r[GARD, OREGON FEE AMT.: !i_..6_COQ--
PENDING FEE. PMT. -' CITY HALL RECEIPT NO.: C1 I _z1 5501
PENDING SECURITY L, PUBLIC WORKS DEPARTMENT By DATE —7 / I1 /`l( -
PENDING AGENCY "OK" p .Application and Progress Record —
MAINTENANCE BOND
PENDING INFORMATION p FOR STREET IMPROVEMENT/EXCAVATION os Neuuiiveu -`
N N U A L
PENDING VARIANCE EXPIFIATION DATE:
-- —
PEPMIT NO �'32=q_�----__ . LATE ISSUED 1 L�-�-1--- BY.
1 ) APPLICATION IS HEREBY MADE TO EXCF,VATE FOR AND INSTALL_ _Non-Curbed DrYWix-Aprzn _-
_____ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT --.,..-, -Carol TOkuda 8870 S.H1. ewaod St._ TigardL OR�97�2.23 _#_ 63.p4877___,
NAMfi � _ ADDRESS
CONTRACTOR_AunknOwnet��__
.—_NATN.E ADDRESSC—1 —`_."`---'F j•jON�
PLANS BY_PGr Cit Standards_ & specifications
NAME
ADDRESS CITE/-- -----�MONF.
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S _ 150.00
DOLLARS
LO.O4
IC[ USE: MIN.
(2) EXCAVATION DATA:STREET DESCRIPTION ?ESC 8c INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEDATE REMARKS/tYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTIT
STREET
EdgeworA St. (see a ached A.C. _ R TION
E r—
I j Q
')
ESTIMATED STREET OPENING DATE:_ _1 � _. S
ESTIMATED STREET CLOSING DATE: _ L_— 1 T
E
D
(3) SECURITY NO. _ - SECURITY AMT: 150.00STREET
—_ CLOSED
SURETY CO.: _ FINAL c; //� A
(lxX1AxRCNEC.K X CASH :J 80140 INSPEC. IZ3 ql /T LpVIc/ Il
(4) PLOT PLAN: INDICATE 31TE PERTINENT PHYSICAL —�� L SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. 1. All work shall conform to
_ City Standards/Specificat -ms.
I I I 1 2. Notify City Ins -
ctor Carl
ol
Vieweg (#639-4171) 24 hours
before starting work.
( 000 5T1-FsT 3. ORS 757.541-.51 opplies
(re: utility prelvcation, etc.)
,R1 - _ _ _. ._ _ _ _ _ _ _ _ _ _ _ _ 4. Traffic control shall be
\ 1 �, OQ11 ---- -- - I —. provided for by the
�,,�
o M 7 -t* 7 I contractor.
I N9 :C I 1
wgn
- — -----
( 7) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERF
RIGHT-OF-WAY JURISDICTION 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 THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
Y �J p'
APPLICANTS SIGNATURE __ �% tr��-�� �� DATE ---- / / �0 / 9z
CITY OF TIGARD - RECEIPT OF PAYMENT RECEIPT NO. :91-215501
VAME : TOKUDA, CAROL CHECK AMOUNT 156. 00
ADDRESS : 8670 SW EDGEWOOD ST CASH AMOUh.I" 0. 00
PAYMENT DATE : 07/16/91
T I GARD, OR 97223- SUBDIVISION ,
'URPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOLINI- PA T li
:USTOMER pEF'O _...._.. _.._..._....._....c._.__..._.. ..._.._.._._.� _
150. 00 PURL I C IMPROV Y_
6. 00
;TREET OPENING PERMIT #432-91
OTAL AMOUNT PAiD - - - -) 156. 00
t
CAR X L. TOKUDA 279
KAZUHIDE TOKUDA
6670 SW EDOEWOOD ST 639-4877
TIC3ARD, OREGON 97223 'n I ' tg-ltss73260
19
Pay To Thr. l
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*UNLESS )-niERW19E NOTED GR.10%
,
SEE DWG. NO. OW-202
TYPICAL SECTION
ALTERNATE
[^WASHINGTON COUNTY DRIVEWAY DETAILS FOR
--,.� DEPARTMENT OF LAND USE
AND TRANSPORTATION NON — CURBED AREAS
DATE CIVIL. ENGINEER ORAWN APWA NO. WAST. COUNTY NO.^rt
NONE DW- 205