14130 SW 105TH AVENUE DILE NO. 138 8�
1051H AVE. - 14130 STR. OPN. PERMIT
APPLICATION - STREET IMPRf ?MENT/EXCAVA-TION COPY TO:
E)
ORDINn,iCE NO. 74-14 (BLU
[-]t ) -FILE
IJ (BLUE) -INSD,
(INS7MUCTIONC ON SEPARATE SHEET) ❑ (YELLOW) -OTHER AGENCY
U IPINK) -APPLICANT
APPROVED 11 APPLICATION NO.:
NOT APPROVED [J CITY OF T'IGARU, OREGON FEE AMT,' ;
PENDING FEE, PMT. ❑ CITY BALI., RECEIPT,�O.:
PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY - k _ DAl'ET__^ ul
PENDING AGENCY ''OK" [] Application and Progress Record
MAINTENANCE BONDS 51.=>)'(r
PENDING INFORMATION L1 FOR STREET IMPROVEMENT/EXCAVATION As REQUIRED J�J
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE. On 4e _
PERMIT NO.: DATE ISSUED: f3Y: --- '"�°'
11) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALLciv
��-�f�� -- /_"001_= AS DESCRIBED HEREIN, IN FULL AC,-.ORI.Afgt:E ',y.TH CITY REQUIREMENTS.
APPLICANT _ cI..�J wl N:! ;s .I:.1 �— �, "60 y. 549 _tA, •_ Lh3•BslL
NAM ADDRESS CITi PHONE
CONTRACTOR S��S,_
NAME ADDREff I ( CITY PHONE
FLANS BY
_)NAME ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E 7_9 50 c _
DOLLARS
(2( EXCAVATION DATA:
FOR OFFICE USE Crt C„ iN IIM,N.
0.02 X s—4 'r-D%
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WID i'H DEPTH ITEM B, QUANTITY
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ESTIMATED STREET OPENING DATE: E g
ESTIMATED STREET CLOSING DATE:_ 1 S _ E
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(3) SECURITY NO. L ' SECURITYA T.: t� � � CLOSE -
SURETY CO.: vC.tci"'. . _7'.1 Aq
p, FINAL '
CERTIFIEDCHECK ❑ ❑ SONO INSPEC. -_
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS.
FEATURES; EXCAVATION LOCATIf N AND EXTENT.
1 1 1 1
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7E. 441
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(5) NOTE: THE CITY OF TIGARD 0099 NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK W14ERE
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 Tlir C'IT'Y AND
EMPLOYEES AGAINST ANY INJUitY OR DAMAGE WHICH MAY RESULT FRO14 APPLICANTS ACTIONS
APPLICANTS SIGNATURE PATE
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APPLICATION - S" REET IMPR(" -MENT/EXCAVATION COPY TO:
ORDINt-...CE NO. 74-14 ❑ (BL UE) -" FILE
[] (BLUE) �INSP.
(INSTRUCT'C NS ON SEPARATE SHEET) [j (YELLOW) -OTHER AGENCY
rj' (PINK) APPLICANT
APPROVED ❑ APPLICATION NO.:
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: S ...�_
PENDING FEE. PMT. p CITY HALL RECEIPT NO.: –
PENDING SECURITY p PUBL IC WORKS DEPA R TMEN T BY — DATE _L—�—
PENDING AGENCY ''OK'' ❑ Application and Progress Record — — —
MAINTENANCE BOND *_
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED —"
ANNUAL
PENDING VARIANCE ❑ v —_` EXPIRATION DATE.
PERMIT NO —_-- DATE ISSUED: --- -L___..�--.--___ . BY: ----- ----- -- - -- __-
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOP: AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
NAME - - -- -------- ADDRESS CITY PHONE
CONTRACTOR
NAME -__------ _--- ADDRESS CITY _ -- PHONE
-�--
PLANS BY - _
NAME ADDRESS -�� CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST!.
DOLLARS
FOR OFFIC7E USE: L.IMIN.
(2) EXCAVATION DATA: 0.02 X s = t
STREET _ DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUTCUT CUT MATERIAL INSTALLED ITEM DATE REMR,RKS/TYPE HY
TYPE LENGTH WIDTH DEPTH ITEM 4 QUANTITY
STREET yy
OPENED -
INSPE -
R TION
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ESTIMATED STREET OPENING DATE. E
S
ESTIMATED STREET CLOSING, DATE: / T -- —
E
(1) SECURITY NO,
SECURITY AMT.: s -- _ CLOSET —
SURETY CO.: FINAL
----- CERTIFIEDCHECK n CASH D BOND u IN SPEC. /}
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
I I I I
I I
i
I
I I I 1
(5) NOTE. THE CITY OF TIGARD DOES NOT, HEREBY, (,RANT PERMISSION TO APkICANTS TO CONDUCT WORK WHERE
RIGHT-OF"WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT 11GREES TO DEPOSIT THE REQUIRED SECURITIES TO COMPLY WITH ALL PER,INENT LAWS HND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THF WORK, AND TO SAVE HARMLE.3S THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANrS ACTIONS.
APoLICANTS SIGNATURE
--- DATE-- /
CITY OF TIGARD—12420 S.W.MAIN--TIGARD,OREGCN 97223
RECEIPT
DATE: 3 `� ' ( �___ AMOUNT.
DOLLARS
NA CASH: �
�- r
ADDRESS: y�0' _,li `'r CHECK: _�__ "' I'''
M.O.: -- _ ,.�_
4 OF
FOR: ACCT. I PERMITS SUPCHARGE „ AMOUNT
SEWER BILLINGS 40-364
BUSINESS LICENSE 05.331
PLUMBING PERMIT 05-332.
MECHANICAL PERMIT 05-332
BUILDING PERMIT (.)5-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV. CHARGE #T 30-367
PARK DEV. CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
TOTALS
RECEIVED BY'
PERMIT NUM11SRS A6J
_Number Amourd _ Numb« Amount_ t4umbor Amount *t
RECEIPT +
8094
WILSEY& HAM _ Earl P.Wilsey(1892-1957)
521 S.W. Eleventh Avenue/Portland,Oregon 97205
(503)227-0455
March 20, 1981
Doug Edwards
Edwards Industries
P.O. Box 549
Beaverton, Oregon 97005
Re: Storm line Connection
S.W. 105th Ave, Tigard
4-1100-5602
Dear Doug:
We have completed the engineer's estimate of cost for a storm drain in S.W.
105th Ave. in Tigard, Oregon as you requested. The work required is generally
indicated on the attached sketch and more particularly involves:
1 . 75 linear feet of 8 inch concrete storm drain in S.W. 105th Ave.
col—ie-sac.
a. Pavement cut & trench
excavation 75' @ $12 900
b. 8" cone. pipe & bedding
75' @ $ � a � �,> 600
C. Trench ackfill & pvmt.
replace 75' @ $16 = 1200
2. Connection to existing catch basin _ 250
Total Estimate = $2950
Yours eery truly,
LSEY R HA.
rlffM
J rry Palmer, P.E.
V ce esident
JMP:cah
dc%ehquncnr sen iceti • civil:nginecring• urban and regional piann;ng•environmental and regulatory affaim• surveying and mapping
Office,located in: Portland,Oregon • Foster City,California Fresno,California • 'iacoma,Washington • Seattle,Washington
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