14020 SW 72ND AVENUE-2 FILE No. �
72nd AVENUE - 14020 STR. OPN. PERMIT � w--•�
CM OF TIGAM)
E-)MII4D=RE IU)QLJZ-T
form is a multi-use form. Appropriate reO(-.iptS Du-Ist be attact.od. Documentation
is iffportant for all purposes. Staple documic-ntation to fol.-m.
VaMOR NO.: DAM-: I i - z-Z--c)
PAYABLE To: L e vi v-i�, e-�A �n n Tv%C, RFXX�� BY:
C)(0
c -7 2Z3 Approved request dile Wednesday
10-00 AM to A/P for checks by
Friday.
F MUSC
TMIANBOUS MIND11=:
Date Description, Irwuice No., etc. Account No. Amount
ZZ000
Ruoo'6
,1 0� V-
t No.
7 0;� c_e
s LI,
TU LAL
Mileage $0.255
APIWPR.TM0tj PAIMCE: M OF: SIMAIIAZE:
(UP to $25.00) Section M-v-Jager Purch. Agent
($25-01-2,500.00) Divi--ion Mana,-Tar
($2,500.01-7,500.0o) Dept. Ijead
($7,500.01-15,000-00)
($15,000.01- ?) Local Contract Review BoarTj
2/1501F
APPLICATION - STREET IMPRC -MENT/EXCAVATION .4p' COPY TO:
® (WHITE)-FILE
ORDIN/',I.CE NO 74-14 ® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPC RATE SHEET) ® (PINK)-OTHER AGENCY bldg.
7� (BLUE)-APPLICANT
APPROVEC x APPLICATION NO.:— 500
NOT APPROVED CITY OF TIGARD,OREGON FEE AMT.. S 6.00
PENDING FEE. PMT. ❑ CITY HALL RECEIPT N .:-_9I`Z Iq 552 _
PENDING SE _URITY p PUBUCWORKS DEPARTMENT BY __ DATE_
PENDING AGENCY "OK" ❑ Application and Progress Record — — — — — — — —
MAINTENANCE BOND �t
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED -
ANNUAL p
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: 5S—y� DATF ISSUED: t _L171_"2t BY.
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL __W_1t Q
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ L.S. Henriksen_Coru it., Inc. PO Box 230639 _ Tigard, OR 9722.E __#_ 9-.
639-393
NAME � ADDRESS � � - CITY PHONE
CONTRACTOR (S�) ___ ___ __ ___
NAM'[ ADDRESS CITY - PHONE PLANS BY __ Per City Standards __ _ _ _
NAME ADDRESS - — CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ _ 150.00
DOLLARS
FOR OFPIC[ UfE:_._ _ MIN. .__
(2) E. '�AVATION DATA: 0.04 X S 150.00 6"00
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET
• _� OPENED
j
API5LICATION - S'rREET IMPRENT/EXCAVATION Ir'l COPY TO:
ORDINA NO. 74-14 (` ® (WHITE)-FILE
® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)-OTHER AGENCY bldg
TX(BLUE)-APPLICANT
APPROVED ml �y
APPLICATION NO. 50�/
NOT APPROVED ❑ CITY' OF TIGARD, OREGON FEC AMT.: $ 6.00 _
PENDING FEE. PMT. ❑ C:ITY I{.'OI,I. RECEIP�.� iq�S'0�PENDING SECURITY ❑ PU3LICWORKSDEPARTMENT BY_- —LLl_-_ _-_ -
PENDING AGENCY • OK" ❑ Application and Progress Record —
MAINTENANCE BOND
PENDING INFORMATION ❑ FOR STREET IMPRO'JEMENT/EXCAVATION AS REQUIRED --
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE,
PERMIT NO.: ._ �i-� - - DATE ISSUED: _- L1 1 2i__ BY: -__-__--
PE
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_
- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT -_ L.S. Hentiksen Const. , Inc. PO Box 230639(Same)
-_ Tictard, UR 97223 1>k 69- 939
NAME ADDRESS CITY PHONE
CONTRACTOR (S )
--NAME - ADDRESS TY CI ----- 0H6NE
PLANS BY Per City Standards
NAME CITY rMONIE
----
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST: E 150.0() _ ___-
_,__ DOLLARS
(2) EXCAVAI ION DATA: FOROFFICE USE: MIN.
0.04 x S_--150•QO = S _ 6•pp__
STREET DESCRIPT;ON _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUl CUT MATERIAL INSTALLED
TYPE LL=NGTH WIDTH DEPTH ITEM 6 QUANTITN ITEM DATE REMARKS/TYPE BY
STREET W
PLN D
INSP C-
R TION
F_ _ -
L Q I I - I w-
ESTIMATED STREET OPINING DATE: / / S
ESTIMATED STREET CLOSING DATE: _.. / / E
- - - - -- _,z_- D G -
(3) SECURITY NO. SECURITY AMT.: s 154.00 CLOSED STREET
SURETY CO.: _ _ FINAL A
HC NECK-X - - CASH -I Doty t)_ IN SPEC.
-1'}-� AX V"u o
(4) PLOT PLAN: INDICATE OITE PERTINENT PHYSICALSPECIAL PROVISIONS/CONDIT ONS
FEATURES, EXCAVATION LOCATION ANL? EXTENT.
1. Notify City Trugi'xj tL3r `Cit-jr tj-1
I
Site: 14020 Sw Vf?r starting work and Prior to
9 1
J 1 1 1 covering tap. (Carl Vi.eweg
44V 1 1 I I # 639-4171)
CURB - ' _ _ _ _ _ - _ _ _ •- _ - I - - 2. All work shall conform to City
-(See Attached) Standards & Specifications.
—� 3. ORS 757.541 - .571 applies
FO W.G. Utilities prelocation,
3tC.%
1 I
( I 1 I
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY. GRANT 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 SECURITIES. TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK. AND TO SAVE HARMLESS THE CITY A"D
EMPLOYEES AGAINST ANY INJ 'qY OR DACTE WHItH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE DATE
T
REMITTANCE ;E 24-22 03c
L.S. HENRIKSEN CONSTRUCTION, INC. Z�f f30
P.O. BOX 2306.9 DATE /
TIGARD.OF'EGON 97223 _ _ 3236
502-639-3939
�
PAY-___,-/A/D_ -7 G
_ e ••-r- _�-
To --�_ DOLLARS CHECK
/ AMOUNT
illE ORDER _�
OFVT�
7poll (
U S. BANK-TIGARD BRANCH
P 0 BOX 23308 TIGARD, OR 97223
"a 00323611' 1: k 230002206: 036 010 I 6x.611'
rZ.wrr�.rr.w.r:yK•i. ,;v+il.:W4U1+'Ckf' +.��tr':.y�'ttytr.yf^1'+�� - ... ., _.
.1r.� .� ._.� Jy .-....._..�.MYr..+..r--.�'.�'_^, -��,�L.. -• LL '.�r.�•'�a.w�iL
I
I
I
j CITY OF TIGARD RECEIPT OF P'AYME'NT RFCE I PT NO.
f.;HECI•{ AMOUNT 204. 7b
NAME L . S. Hf--'NR I KSEN f.13AST, INC CASH AMOUNT 0. 00
ADDRESS ° PO 809 230639 PAYMENT UPTE
SUBDIVISION
i1"I C3ARD, OR 972,�3�-
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PA SME NT WMf A IN C I-�Ea i i:,
I UMSINO PERM 37. 50 til".I CHECK FF r
lJ I L D PFfi 1. AQ IMf.:R DEPO 1 1 . 00
PUNL.IC. IMPROV C--
I
I
j
j Pciwr--.p RENTS
14020 SW "7r ND AVE:.
TOTAL AMOUNT PAID - _> 204. 76
I
CITYOF TI ASO
CtrFY0F7TWAR0/
'COMMUNITY nEVELOPMENT DEPARTMENT ORIGON
13126 SW HiW1 Blvd. P.O.Box 23397,TOW,Orogon 27223(SM)639-Al 75
-
.,ITF ADDRESS. . . : 140120 SW 72ND AVE PARCELt RS
.-IIJBI)i I V I Si ION. . . . : 70NING:
BLOCK. . . . . . . . . . : LOT. . . . . . .
LASS OF WORK. . .-AI-T GARBAGE MOSII-1- HOME SPACES.
I YPE OF* USE. WASHIN(7- MACH. . . . . . . DACKFLOW PREVNI
L.
0CUPANCY GRP. FLOOR DRAINE. TRAPS. . . . . . . . . . . . . .
.-
,TORIES. . . . . , . . wri-rER HEATERS. . . . . . CATCH BASINS. . . . . . .
1 IXTUFF-'G-- LAUNDRY TRPY ). . . . . . SF RAIN DRr-TINS. . . .
',INKS. . . . . . . . . . . URINALS. . . . . . . . . . . . 6R("A'.'E Tr44PS.
.-RVATORIFS. . . . . . OTHER FI XTLJI?[-'.S.
I'l-lb/SHOWERS. . . . : SLWFR L TWE' (f t: ) . 11210
'-JATER CI-0'3ETG. . : WATFR LINE ( i ' )
IjISHWASHERS. . . . : RAIN DRPTN ift ) .
Rpmav,ks : ADDING 1, 000 GALLON GAND 011-, GFPARAT'OP
OWT,et'i --- FEES
POWER RENTS type amm.11-it by (1,R-1 e A-
;.402'0 SW 7<'-'ND AVE PR17` I. ::..7. Ji+f 11 / 1"1!41
5p,ur s 1. 88 it-1-1 I I/ii:/91 I
IGARD OR 97223 PLCK $ 38 J I..H .11 ! I I
Luntt-actor
CONTRACTOR NOT ON FII-E
'h(me 48. 76 TOTAL.
RF:'L3UIREU INSPECTIEN.F.
Inis pervit is steed subjeci to the regulations contained in the Itip-oiit Iniap
'.pard Municipal Code, State of Dre. Specialty Codes and all other F- Inal Insroor-tiort
iQplicable laws. All work will be done in accordance with
iproved plans. This pervit will expire j work is not its)-tp!
'.1thin 180 days of issuance, or if voork, is suspended for sort ......
'liar 100 days.
sistied By .,
CA11 fOr lnlkpficrti ,ln 639-4t'75
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1
BUILDING SEWER PIPE, SIZE AS SPECIFIED
rAND
RICATED TEE FITTING
18" AND SMALLER. BACKFILL 2X4
ON EXISTING SEWERS AGAINST PLUG TO
SEWERS LARGER THAN I PREVENT PLUG
I BLOWOFF 6 SECURE
2x4 IN PLACE WITH
i
SEWER MAIN PLAN TRENCH BACKFILL.
II
.OR LATERAL
I
F_XTFND AT LEAST
GROUND 12"ABOVE SURFACE
SURFACE
MINIMUM SLOPE FOR
6" PIPE= 0.010, FOR
4"PIPE_ 0.020. -----,SERVICE CONNECTION
I`UWKER:
WRAP 12-16 GAUGE
GREEN LOCATOR
----_WIRE AROUND 2X4
' �—PLU
zr
—r \ 3/4"-0 PIPE ZONE MATERIAL
AS SPECIFIED
e
SUPPORT TEE WITH
•�4.�r_ BEDDING GRAVEL,
MNIMUM 2W WIDE Sl DE
BUILDING SEWER
V
Unified s.Werag.Air
of Washington County
It
94(
4+�`a
MIN. 3" A G IN 2 LIFTS
s,4w cur
STREET AREAS I OUT OF STREET AREAS
----_----�--� �— —
—Ex ISTiNc
SECTION R SURFACING ,
2'OF 31A:.-tO _
°• � '' CLASS A
• � • / BA:.KFI L L
• v
2"- G" - - - -- -
CLASS B
3/4"•-0 GRANULARQ
BACKFILL u . • • ' /
1 to I W
N
� • ap• ° � � • o . cQ m
�D
W A, •° p• '
Q" T_ 2 u
CL
cp .o o •• •'3 °
o O O o
z a�� f I O° •a.A
C1 -�- .s 7 •A ' p
m . A . •• u
PIPE BAJA
BACKFILL IN STRE AREAS
L IF3,A# 11 AGAINST CURB, FILL ROC t TO
BACK OF S/W
2.OF S/W Is NOT AGAINST CURB, FILL ROCK
2'BACK FROM CURB
PIPE BEDDING AND
ITYOF T1��IRD BACKFILL DETAILS
1 OREGON DF51GN 15Y APF'RLJVEU BY DwAwN by
GA _ R0
-E DATE DRAIJING No
NTS
Effective fl�Ste 3/1!91
ROMAC
INDUSTRIES,
IC INC. DETAIL SPECIFICATIONS FOR
►..1 ROMAC "CB" I'^1 SEWER SADDLES
NOV 1 1 1991 GASKET
Virgin SBR compounded for sewer service. Meets
COMMIl"lly UVEIOI MENT ASTM D-2000 3 BA715. Gaskets are cispecially
formulated with antioxidant/antiozonant agent to
incr�ase shelf life.
STAINLESS STEEL 304 ADJUSTABLE STRAP
Bolts, nuts and washers, 1/2" N.C. rcll thread Teflon
coated. Band 3-1/2"wide for spreading out clamp a '
force on pipe. .i he stainless welds are fully passi-
vated. Excess strap goes between pipe and band.'
— Patent #4494780
SADDLE CASTING
Ductile Iron meeting or exceeding AS'rM 536-80,
Grade 65 45-12, protected with a yellow corrosion-
resistant paint.
" Passivated— Chemically treated after welding to produce a highly corrosion reslsiant coating.
Same saddle conforming to different outside diameters. Saddle conforming to pipe.
I
18.8"O.D.
10.50''
18.8"O.D.
Awftyca
MAILING ADDRESS
P.O. Box 5788 • Portland,Oregon 97228
STREET ADDRFSS
7337 S.W. Kable Lane • Tigard,Oregon 97224
4 4 Office: (503) 6207050 Showroom: (503) 6207060
COMMUNITY DEVELOPMENT ASTM D-2000 3 BA715. Gaske
formulated with antioxidant/antic
increase shelf life.
STAINLESS STEEL 304 ADJUSTABLE STRAP
Bolts, nuts and washers, 112" N.C. roll thread Teflon
coated. Band 3-1/2" wide for spreading out clamp
force on pipe. The stainless welds are fully passi-
ated. Excess strap goes between pipe and band."
f�
Patent # 4494,
SADDLE CASTING
Ductile Iron meeting or exceedin
Grade 65-45-12, protected with
resistant paint.
Passivated — Chemically treated after welding to produce a highly corrosion resistant coa
Same saddle conforming to different outside diameters. Saddip conforming to p
I
U6.275" 10.50"
O.D. U.D.
18.8" O.D.
COMOUAMTED
MAILING ADDRI
P.O. Box 5788 • Portland, (
STREET ADDRE
7337 S.W. Kable Lane • Tigai
4-4 Office: (503) 620-7050 Showr
SA,DC
Ductil(
I Grade
resist,,
* Passivated -- Chemically treated after welding to produce a highl
Same saddle conforming to different outside diameters.
1
6.275" 10.50"
O.D. O.U.
4-4 7
Offic
Agency plan snaps. the Agency does not guarantee and shall not be
liable for the accuracy of the measurements or locations of such
plans. if the sewer lateral is not located at the measurement given,
the installer shall prospect three feet in all directions from the
distance an depth given. If the lateral is still not located,
contact the Agency for further assistance.
2 . 13 . 3 Direct Connection To Main Lines
A. No direct connection into main sanitary or storm sewer
line shall be made except by the Agency, or as provided in this
section. When a connection into a mainline is required, the person
requesting the connection ( line tap) shall purchase a tap and side
sewer permit from the Agency and the Agency shall construct the tap
and side sewer .
B. Line tap( s) may be made as part of a construction
project including public sanitary or storm sewers under Agency
Construction Permit Agreement , where the line taps are shown on the
approved plans. Line taps shall be constructed in conjunction with
the project sewer construction. When the owner/contract-or chooses to
exercise this option, the owner/contractor shall install all line
taps shown on the construction plans or none of the taps .
C. Before a line tap can be installed by a contractor , a
line tap inspection permit shall be purchased. The line tap shall be
installed by using the saddle method unless otherwise approved in
writing by the Agency. The line tap shall also be visually inspected
by and approved by the Agency prior to being backfilled.
Chapter 2 -- USA Administrative Provisions -- Paye 7
jNSTRUCTI0N STANDARDS
R&O 91-47 (6-25-91)
IN THE UNIFIED SEWERAGE AGENCY
1
OF WASHINGTON COUNTY, OREGON L
2 In the Matter of Amending )
3 Resolution and Order Numbers 91--9 )
and 91-10; Adopting New and Revised)
4 Construction Standards and 1
Regulations Pertaining to the
5 Sanitary Sewerage and Storm and ) RESOLUTION AND ORDER
Surface Water. Management Systems, ) C
6 Including Regulations for Erosion ) NO. ��-
Control and Permanent On-site Water)
7 Quantity and Quality Facilities; )
Pursuant to Ordinances 21 and 24 ; )
g and Declaring an Effective Date. )
9 The above entitled matter came on regularly before the Board
10 at its regular meeting of. June 2.5, 1991 having been continued from
11 the meeting of June 18, 1991 ; and
12 It. appearing that this Board did, on May 28 and June 4 , 1991,
13 adopt Ordinance Nos. 21 and 24 , respectively, of the Unified
14 Sewerage Agency pertaining to the use and operation of the
15 Sanitary Sewerage System and the Surface Water Management System;
16 that such or.�.inances provide authority to adopt additional rules
17 by resolution and order pertaining to deign and construction
18 for public sanitary sewerage and storm and surface water
19 management facilities, erosion control, and provision of permanent
i{ 0 water quantity and quality facilities; and
1 It appearing that the sewer construction rules and
2 regulations of the Agency, as contained in Resolution and Order
3 91-10, and rules and regulations relating to erosion control and
4 permanent on-site water quality facilities, as contained in
5 Resolution and Order 91-9, are in need of amendment a that the
6 \\\\\\\\\\
age 1 of 3
t