11610 SW 135TH AVENUE FILE NO.
135th AVEIJUE - 11610 STR. OPN. PERMIT
QTY or ':'IcARD
mmamrzvR,_, R irsr
`'lair form is a multi-use form. Appropriate receipts roust be attached. Docmentatior.
LTortant for all purp:-;es. Staple doomentati.on to form.
VFNDOR No.. _ 1 DATE:
PAYABLE TO: S� � u
F2WJL'STLD FiY:
-- min eaov� `il Z z3 * Approved request due Wednesday
10:00 AM to A/P for checks by
Friday.
MIS`r-rIAn zus r.P0mrIuzm- : i -
Date Description, invoice No., etc. Account No. Amowt
3oU_ao
--
I-
----- -- �-_- ZC7rAL
-=i
1•ti.l(-sge $0.255
APPROPRTATION BALANCE: AS O,': SIGNA=-:
(Up to $25.00) Section Manager Parch. Agent T
($7.5.01-2,500.00) Division Manager($2,600-01-7,500-00) Dept. 'lead
($7,500.01-15,000.00) k:ity Adminjstratnr
($15,000.01- ?) Local Contract Revic , ik�.itd -
/1501F
� res 9-23 ..
CAY I q,
� IWC
CUIx �- I at, I -l(O
Mt"Cl-vJ4 f Lzj ctx-L-,,� A'a
mod
INSPE(,'TION NOTICE
City of Tigard Bu"ding Department
13125 SA Ball Blvd. lard, Oregon 97223
Inspection Tine (Rec-O-Phone): 6�y 4175 Business Phone: 639-4171
Inspect Ion:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Post./Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain IrsuIati(in -Plumb.
Plbg. Underfloor Hater Line Gyp. Bd. -Mech.
Date Requestedt ^'fit ,I I A-MM PH
t I
Address: h.C�._�� ��J, � .3;.3,57t�o Permii 443
�i -C
BuI ldere �Ct`ll['n
THE FOLLOWING OORARCTIONS ARE nNQUIRtDt
a pJn l.O.11�_�
Via
kok [Lt ck� Alk
't 2 q 'I C C c4 ;4 Irf
fly
� J o✓1S
Impactor:
Dates `! J
--APPROVND I O _ APiROVEn suR.IXCL' To ABOIR
��1a11 For Ralrjp.
APPLICATION STREET IMPRO1."E
AENT/EXCAVATION „ COPY TO:
ORDINA NO. 74-14 4� ( -FILE
IIC�1 (YYELLOELLO W)-)NSP.
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCY
(� (BLUE)-APPLICANT
APPROVED APPLICATION NO.: 48
15 _^
NOT APPROVED CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE. PMT. U CITY HALL RECEIPT NO.: �� z1f,953
PENDING SECURITY C PUBLIC WORKS DEPARTMENT BY — DATE 9
_ -
PENDING AGENCY ''OK" Q .Application and Progress Record
MAINTENANCE BOND M
PENDING INFORMATION C FOR STREET IMPROVEMENT/EXCAVATION AS RFouIRED i—
ANNUAL C
PENDING VARIANCE C EXPIRATION DATE:
PFRMIT NO.: _-1 .-y1 DATE ISSUED _ BY
-- -- —
01 APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITTY REQUIREMENTS.
APPLICANT
1�
N ME ADDRESS i TV HONt
CONTRACTOR � Sw +~ _ =L1�1
` NA E D RES S c 1 IT y HONE
PLANS BY C `T xcc
AME ADDRE CITY ^� HO
NIt
ESTIMATED IMPRDVEMENT TOTAL VALUATION ( COST): S
,)OLLARS
(2) EX AVF'I ION DATA: Fon OF"G s +✓- =__ MIN
_ 0,04 x I
';TREET DESCRIPTION PROGRESS tic INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED I-EM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET
i►• ENFD
INSPEC-
R TION
log EQ may - (-----
CS'FIMATEO STREET OPENING DATE:__ �_ E S
ESTIMATED STREET CLOSING DATE; _ _- - - LD I - vm
—
/yl STREET
(3) SECURITY NO. SECURITY—AMT S1S�S/ CLOSED \
SURETY CO.. FINAL 10 �3 A.
/\
CHECK�Ii_ _ —CASH D POND INSPEC. VG
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICALSPECIAL PR VISIONS/CON ITIONS:
FEATURES. FXCAVATIUN LOCATION AND EXTENT. Y I EIV( c
1 I 1 I 1tari-
S 13 S - �1 LDiL r44C.�
I 1 I I 1
I
(5) NOTE THL CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPL.CANIS TO CONDUCT WORK WHERE
RIGHT OF WAY JURISDIC:T OF WASHINGTON COUNTY OR THE STATE OF OREGON.
To-.E APPLICANT AGR S r' SIT THF. REQUIPED SECURITIER, TO COMPLY WITH •.`,L PERTINENT LAWS AND
CONSTRUCTION SPEC; ICA O RTINENT TO CONDUCT Or THE WORK, AND TO SAVC HARMLESS THE CITY AND
EMPLOYEES AGAINS ANY N UR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
3 1
API'l )CANTS SIGNATURE DATE �
^� ar'-•_..'.,^t�'•P-*T'�"41'.+;��!!rl�'X71'�"PT'"'r.,'T".'�,41"�..•,C„�.roar+'.'�vt`*m.�-•.,+...--.........,.,.-r
APPLICATION — STREET IMPRO`'_MENT/EXCAVATION COPY TO:
ORDINA..,E NO. 74-14 (VEELLO S�•
(INSTRUCTIONS ON SEPARATE SHEET) NCY
L (BLUE).-APPLICANT
APPROVED yt', APPLICATION NO.: 1 50 _
NOT APPROVED CITY OF TIGARD, OREGON FEC AMT.; f, Uy
PENDING FEE. PMT, CI I'll' I-IALL RECEIPT NO.: _-
PENDING SECURITY PUBLICWORKS DEPARTMENT BY . DATE_.
PENDING AGENCY "OK'' -; application and Progress Record
MAINTENANCE BOND X
PENDING INFORMATION FOR STREET IVPROVEMENT/EXCAVATION AS REQUIRED
A,4N UAI_. _.
PENDING VARIANCE i. I EXPIRATION DATE;
PERMIT NO.: -' 1 DATE ISSUED: - - - BY:
1 I APPLICATION IS HEREBY MADE T(� EXCAVATE FOR AND INSTALL
AS
DUCRI13ED HEREIN/, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT /� t � ^� - -
rN M[ ADDR[ffTY -r� PNONEt?
CONTRACTOR c<,q- 0 �--.f (r � 5� � i
1, ) NAME ( /,D R[ IT - ONE
PLANS BY l �-• •� �', ��,x C I ti (, `> 11
AME CITV PHO
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
V
DOLLARS
FpR -MIN,
(2) EXCAVATION DATA: o.ua x x
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MAT!AIAL INSTALLED ITEM DATE REMARKS!TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET --
"'i PENED —
INSPEC
0
-- R TION t
QU
ESTIMATED STREET OPENING LATE / E �
ESTIMATED STREET CLOSING DATE, .�_ E --1'--'r' -
- _ -- - D C Y
3) SECURITY NO. STREET
( __ SECURITY AMT $ 1 �. C _ CLOSED
SURETY CO.: FINAL ,
rHUCK t: c ASN "OND 7 INSPEC. IV
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPEC(I1L vR VISIONS/COL (TIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. l 1
111 L ILC �
7
1 I ,
Ati, I vim+ t Ut f
1
CURB ._/3A ,n lu E�r
t_i.._ ll�lD SSU •-
L�j13 S ,►s::.� iiiat
- AP tl —T - - - - - -- �' - �. r IV
r ��,{ f ,\.l [ .� .en e"T \�} It'.t•C-`1
i
(5) NOTE THE CITY OF TIGARD DOE' NOT, HEREBY. GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTICIT-j9' H OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREkS T16 SIT THE REQUIRED SECURITIES, TO COMhLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICA0 RTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST AN I OR DAMAGE WHICH MAY RESULT FROM APPLICANTS -CTIONS.
APPLICANTS S;G,IATURE DATE - / /
f0
In
U7 9 9 Q+
c .L �J 9 t•)
= a
CL
o+
Z F Zr1 h-
0 --D 7 -4 Z
z O � C7W
E O t4 3 r
I- a r- I•- to E
CL flz � Q
- 'i LJ
J w u 2: E A S
wIaaC -+ .+
I
c , z w
Ln
i�J
Vim+ I Q u O
d s
o , LL 4
L. C E
LIU
-�-� i a t1
.. U
` I w
U C ti
-7 ru I w > CL
d CJ I z �J
r5 Ci I LO -"
z rf1 I 0 W LU 2 9
r)
Z ru A 1 ii t
o rm
e �• � H •b lSl I F- f•7
N F- M Z
O w chv i I M a N C
.e Z °1 I a l 11. 4 �.0 C
c� �a '"
zao 1 I caH m 2 m I
ui
M
J \C 3 rA
1 co 3
3 . O n
v 3 W A h
N I I C L Tr
\T� ., -.
„ I .. ..
C, u �.
sw to
z
LL A
Cl
s z
>3 LO w w w s
00 o i i cn to E O7
LL w L C O -J
FQ x Ln
a Q D C ,.
z a _L U to
5i;� ; Ti��` LraT � GCaU � j5/ 33DC�
INSPEGTION_-NOTICI{ l
City of Tigard P 'ling Departsent
13125 SN Hall Blvd. gard, neg'
ron 97223
Tnepection Line_(Rec-o-Phone): 639-4175 Business Phone: 639-4171
Inspect Lon:
Foot Jng Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found.
Plbg. Top Out: Gas Line FINAL*
Poet/Beam Strutt. San. Sewer Framing -Bldg.
Poet/Ream Mach. Rain Drain
Insulation -Plumb.
Plbg. Underfloor
Water Line Gyp. Bd.
Time: M
Drt.e Requested*
1 O 3 - 7i)
Addrens: 4 co to Permit �s
Bu,lders '1 lIIILtOJI ---
THE FOLLc.WjNG CORRECTIONS ARE REQUIRED:
r �
U3� - y �"1 '
Inspoctors wv�- Dats:_ v �`'- r�
_ APPRONVVD FRGVE�� APPROVED SUBJWT To ham
�` all For Painsp.
FDr
1' hDLOQI'Q � I1S �
u --
� ooK
DerMi� No =1y � - � I