11610 SW 135TH AVENUE-1 UUU'U UUU'U ic 0 i
•.e
11610 SW 135th
. i
1
Y'
e'
t
l
r
j
�w+^t+rv+w+r•�^,+>*+,orem•�wrrm•,: ar11m "^^""."-.^';•"R!i"._ �.,..-_,.._.__
APPLICATION — STREET IMPROVEMENT/EXCAVATION COPY TO:
N (WHITE)-FILE
ORDINANCE NO. 74-14 ® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARAT'.SHEET) ® (PINK)-O NCV
[� (BLUE)-APPLICANT
APPROVED ( i APPLIC'4TICN NO.:
NOT APPROVED ❑ CITY OF TIGARD, OREGON F'.-', AMT. 5 —
PENDING
PENDING FEE. PMT:' [] CITY I{ALI. F2LrF:IPT NO.;
PEND!NGSECURITY ❑ PUBLICWOR KSDF.PARTMENT BY DATE
- - —
PENDING AGENCY ''OK'' ❑ Application and Progress Record _ - - - - _ _ - _
MAINTENANCE BOND s_ _
PENDING INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION As REOUIwEu 1
R N N U A L ---
FINDING VARIANCE ❑ EXPIRATION DATE.
PERMIT NO DATE ISSUED: BY:
( 1 ) APPLICATION IS HEREBY MADE. TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN. IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT !' N AD[iREKSS ^FITY — HOMIL
CONTRACTOR <- e.slI f !( � `:.I,.) rY- _ .' - _.-
�
NA c.-� —��—ADDq'E SS IT HO
PLANS BY A-k--f_
VAMIK ADDRESS co P— PIiONt
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S �•��1 V
DOLLARS
(2) EXCAVATION DATA: FOR OFFIct $EA �— MIN
0 on x s
STREET DESCRIPTION PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET -- --
IN3PEC-
R TION
Q
F_
ESTIMATED STREET OPENING T
ESTIMC TED STREET CLOSING DATE: - — *-- - -- - ED
STRFFT
(3) SECURITY NO SECURITY AMT: SCLOSED
SURETY COFINAL
n CASH_0- - INSPEC.
�MCMtCK - tibNb C
(4) PLOY PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT. `y;� t f l
4 _ Y
.r t
1 1 I 1
uAB - �/ I �• - - _ - - - -
.......-µ..ms
-- --- - (
I I
I I )
1
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICAN'rS TO CONDUCT WORK WHERE
RIGHT OF-WAY JURISDICTION IS 7(H OF WASHINGTON COUNTY OR THE STATE OF OREGON
THE APPLICANT AGREES TO OV (; 1T THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
(:ONSTRUCTION SPECIFICAT4009 F RTINENT" TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY, INPArt`Uk DAMAGE WHICH MAY RESULT FROM APPLICANT!', ACTIONS.
APPLICANTS g16NATURE DATE