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9875 SW GARRETT STREET FILE NO. -� GARRETT ST. - 9875 STR. OPN. PERMIT CITY OF TIGARD EXPENDrTURE 11D2= 9bis form is a multi-ucx-, form. AV-,ropriate receipts wilt be attached. Documentation L.; important for all purposes. Staple documentation to form. VENDOR NO.: II 11DATE: PAYABLE TO: k SXwk PT3QUESTED BY: :1-7 JJO Approved request due Wednesday 10:00 AM to A/P for checks by Friday. MISCMT-A1, E".XPaMI11JRES: Date Description, Invoice No., ecc. Acomit No. Amount IS 1 REE Q Ost> Z.z 00(D $ 0 Mileage $0.255 APPROPRIMON BALANCE: AS OF: SI(.NAIXW,: (Up to $25.00) Section Manager Purch. Agent ($2.5.01-2,500.00) Division Manager ($2,500.01-7,500.00) Dept. Head ($7,500.01-15,000.00) City Administrat--r ($15,000-01-- ?) Lccal Contract Review Lk.)ard V 1501 APPLICATION -- STREET IMPR .a' _-MENT/EXCAVATION ` yyyC���OPY TO; ORDINLE NO. 74-14 (WHITE)-FILE (YELLOW)-INSP, ` (INSTRUCTIONS ON SEPAkATE SHEET) 3f(PINK)-OTHER AGENCY-61- . (BLUE)-APPLICANT JJJJJJ APPROVED x APPLICATION NO.: . 4g 1 NOT APPROVED ❑ CITY Oi: TIGARD, OREGON FILL AMT.. S PENDING FEE. PMT. ❑ CITY HALL RECEIPT 9l-Zliblt 'll-Z170(.Q PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY . DATE..--I ATE GI PENDING AGENCY "OK" ❑ Application and Progress Record - PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION MAINTENANCE ReoNlPED ANNUAL L' PENDING VARIANCE ❑ EXPIRATION DATE: PERMIT NO. ''f 9 DATE ISSUED, __�I�_1 �j,/ By; --�---�'-' (I/ APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTAL)_ _LTI�R'{_ �,irlA TAF AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. c�WtiE72 _IME ►1DLl.A�D ___.__- ci 67:a /�pk=pT N A iN E A U D R E S! �'sL_�LYJ.'!tiL.r'T'_'"a--__.�.aZ-.-.- J_ Ai"P�IrAN'r CITY PHONE CONTRACT R 11x1 ,12 r�, `S i>I.►l_ . RTpS NAM I AObRE!! CIVY PHONE PLANS 13Y__. CIT`{ STh__ 1.1b[�i�bS SPS -t�iCAny NA E ADUREffi2 CIT ��PHON �- [It ESTIMATED IfIPROVEMENT TOTAL VALUATION ( Cr?5f): s _. DOLLAR! (2) EXCAVATION DATA: -FOR oPilcc usE I,v --�-Ilk� 0.04 x s I s 4�. --_- STREET DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY ITEM DATE RFIAARKS/TYPE BY STREET '- P N c _ INSP C- — R TION E '— Q U _ ESTIMATED STREET OPENING DATE: �_ �_ � E 7 ESTIMATED STREET CLOSING DATE. / / E - -- D (3) SECURITY NO. __..—_ SECURITY AMT.: s—]I_I�O.� � CLOSET CLOSED SURETY CO.: FINAL HFCK CASH O__ •OND INSPEC. c1 II „ ►c-+,rte �',u,' � (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDI)IONS: FEATURES; EXCAVATION LOCATION AND EXTENT. 1 I s•r�: 9c'.�'7$'-S,w� 1 7Tr' C�IY S7A�t.'D/�+L' � �/F - I sae J✓ - - - - - - - � �� _ _ S7-4171) View" 24�te ca ts xx! r'T- cr � _ I Bl o�� s ertiy ctr��x . _- - ---- ( Q. ' J�7.Sal:S-7/ 1 _ -1 . -R4•'- i � I -----_--._--------- I �� , v-_ 1 .dY �'r�c I/X'iyc�t (S) NOTE THE C.TY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO AFPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAY JURISDICTI,73N 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 .)ARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJp OR AMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. P4"_It&MTS OL k) .._— SIGNATURE DATE__q / I 1 BUILDING SEWER PIPE, SIZE: AS SPECIFIED I PLANT FABRICATEU TEE FITTING ON SEWERS IS" AND SMALLER, BACKFILL 2X4 1 FIELD 'rAP ON EYISTING SEWERS AGAINST PWG TO AND NEW SEWERS LARGER THAN PREVENT PLUG THAN 18BLOWOFF B SECUR' 2X4 IN PLACE W:fH I TRENCH BACKFILL. SEWER MAIN OR LATERAL Ir L_ N 1 I .EXTEND AT LEAST r-GROLIND 12"ABGVE SURFACE SURFACE MINIMUM SLOPE FOR S" PIPE= 0.010, f UR 4"PIPE= 0.020. ---_NICE CONNECTION MARKER : 1 WRAP 12-16 GAUGE GREEN LOCATOR WIRE AROUND 2X4 LI IG e„Oti i�••• ;�.o w•.a i '%4"-0 PIPE ZONE MATERIAL R•.dAS SPE4IFIED �,. -�,• SUPPORT TEE WITH � hc BEDDING GRAVEL, MINIMUM 2'0" WIDE Sl DE BUILDING SEWED tj 4 of Unified Sewerage Agency of Washington County 24( MIN. 3" A G IN 2 LIFTS — - STREET AREAS I OUT OF STREET AREAS 6AW cur -- -� Ex1STING SECTION RESURFACING i c / / CLASS A BACKFI L L 10. V w D 1 2.. 0., -} CLASS B 3/4"!-0 GRANULAR / U BACKFILL \ 0 \� N,% f, n ° \ 1D ►J � o o a Q W o � Q �-� D W �t - :. •• •o b m . e •• o PIPE BASE BACKFILL IN ,TREE ANEAS 1. IFS/W 13 AGAINST CURL, FILL TO BACK OF 9/W 2.IF 3/W Is NOT AGAINST CURB, FILL ROCK 2'BAC..K FROM CURB CITYOF TIIFARD PIPE B EVDI N G AND BAC_;_<FILL nETAILS OKE , ON DE-516N 6Y L1F'P".10VE, F DRAWN Esy G A _ P_6 t) t E ��TE CJR1�L.11NG No NT5 9 214 MILLER & SONS ONTRACTORS, INC. ROUTE 5 BOX 62 625-6562 24 2211230 SHERWOOD, OREGON 97140 ©RANCH GM —9-5 --199L PAY TO THE CITY OF TIGARD ORDER OF -- - - -- - ---- - --- - - - - - ------ -- .. -- $ 1 ,100.00 ELEVEN HUNDRED AND N0/100 •DOLLARS U.S. BANK MILLER B SONS CONTRACTORS. INC. TIGARD BRANCH P.O.BOK Q3.70B TIAARO,OR 172!# UNITFO STATES NATIONAL BANK OF ONeGON de on str. o enin -Holland _- FOR-_--_p_- - _--____ p _ � — lie 00 L' 2 1411' 1: 12 3000 2 201: 0 36 00 i 2 34811• I CI.fY OF TIGARD - RECEIPT OF PAYMENT RFCEIPT NO. :91-217092 I CHECK AMOUNT : 1 i0k}„ 00 I AME : MILLER & SONS CONTRACTORS CASH AMOUNT 0. 00 ADDRESS : RT O BOX 62 PAYMENT DATE 09/05/91 SHE RWOOD, OR 97140- SUBDIVISION I !URPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT FIAID USTOMER DEPO 1100. 00 I C STREET OPENING PERMIT #444-91 ' 5 �4►y e �v�. 'OTAL AMOUNT PAID - - - -> 1 100. 00c,1 p GSS CITY OF T I GARD -- RECEIPT OF PAYM'.:NT RECE I RT NO. :91-2146 CHECK AMOUNT 1566. : NAME SP I CKELM 1(ER, JEAN I E CASH AMOUNT 0. 1. ADDRESS 9075 SW GFi-RETT PAYMENT DATE 06/21 ," SUBDIVISION TIGARD, OR 97223- PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID SEWER USA 1500. '( SEWER INSPECT '` � . �7 CATe� ``i-- 1. 50 C1 a , c TOTAL AMOUNT PAID - - -> 1566. 50 ` lc� � ' so q-, (-U 4(� T Ak- C 11-Y (!I ? I c,ARI) RECE I P'T OF Pp'PMENT RECEIPT NO. I ' 1706 + CHECK AMOUPJ 1 NAME SP'I CKEI_M I ER, JE AN I F /r CASH AMOUNT S 4. 5i.t (tD1iEi'C. : 9-5 5 SW GARRET' - PAYMENT DATE a 09/00--i�' !1 i� ' SuaD I V I 5I ON L�'URPOC;E:. 01= L'AYMI-PdT G•11+lC:}IINY +1A_ /P'URPOE.'r- OF PAYMENT AMOUNT KAID 14. .,0 ... ....._. ..__...__.._._...._ C� fFtL. AMUI.IIJ 111;i - � ;. - , --and- or card j�_ APPLICATION - STREET IMPRC MENT/EXCAVATION COPY TO: ORDINANCE NO 74-14 ❑ (WHITE)•FILE. ❑ (YELLOW)-INSP. (INSTR JCTIONS ON SEPARATE SHEET) ❑ (PINK)-OTHER AGENCY (BLUE)-APPLICANT APPROVED ❑ API':.ICATION NO., _ NOT APPROVED ❑ CIT OF TIGARiD, OREGON FLL AMT.. S _ - PENDING FEE. PMT. Cl CITY HALL. RECEIPT NO. PENDING SECURITY ❑ PUBLICWORKS DEPARTMENT BY _ DATE..- PENDING AGENCY ''OK" ❑ Application and Progress Record — PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION MAI ASE NAEBOND >t_ _ PENDING VARIANCE I ANNUAL.- EXPIRATION DATE. PERMIT NO DATE ISSUED: L._1 — , EKY -41) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTAL(_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY RFQUIR94 TS. APPLICANTS %1!����N C1ADDRESS 4tJ - rr�f --_T' -- NAME - ) CATV PHONE CONTRACTOR _ NAMH ADbRFSf `�`"- ' CITY iH -----._ __-----._.._ -O f i �^ PLANS BY -•—_-- NAMF Aqb Es>I^— CITYpN! ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S — _ (2) EXCAVATION DATA: FOR OFFICE Usti "--` -----.MIN-` 0.04 X s_ _ = : STREET DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED TYPE LENGTH WIDTH DEPTH I ITEM & Q:IANTITY ITEM DATE REMARKS/TYPE BY STREET PENL INSPEC- R E'rION ESTIMATED STREET OPENING DATE: E S ESTIMATED STREET CLOSING DATE: - _--__ _L / T - -- --_— E D (3) SECURITY NO. SECUR;TY AMT.: SSTREET - SURETY CO.: _. _CLOSED —� ---- ---- -- _ __ FINAL -- cF.F1110"I c)CHECK-,.-------- CASH L] •GNb INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL - SPECIAL PROVISIONS i COND17IONS: FEATURES; EXCAVATION LOCATION AND EXTENT. 9F �5 sw Cara►-e" �`.-ZOO I I ----- -------___----- -- I Z O v,x Q SETT (5) NOTE CITY OF TIGARD DOES NOT, HEREBY, QlgANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAY 'JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT.THE REQUIRED SFCURITIKS, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFI.:AT'IONS 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, APPL.ICANT'S SIGNATURC —' DATE _ / �