11330 SW 90TH AVENUE ADDRESS:
L"
n
J
i]
it
J
i:\r(Icordslmicrofim\targets\l)uilding.doc
n
L
CITY OF TIGARD
COMMUt:ITY DEVELOPMENT DEPARTMENT �
13125 SW N["2':'."acrd,Oregon 97223.8199 (501)839.4171
i
I
i
I
a
a:
F--
N
H
r
r
I
f
('11Y OF TIBARD RECEIPT OF r'AYMF-"NT REUEIPT NO. 93.— '4 30 19
CHECK AMOUNT 56. 23
NAME x KFP CORPORATION CASH AMOUNT 0. 00
ADDRESS 15424 ';E-. RHONE. cT PAYMFNT DnTF a 08/06/93
PORTLAND, OR SURD IVIGION
97236--
PURPOSF OF P0YlMFNT AMOUNT Prim PURPOSE OF PAYMENT AMOUNT PATD
r0i CHECK Ff- 8---1 1 R 56. P3
CD
LLI
11330 5W 90TH
-0'(4,41- AMOUNT PAID 56. 23
CITY OF TICORE) RECEIPT OF PAYME-141' RECEIF-,T NO. :93-c431j'S
CHECIA AMOUNT 160. 38
1AAME LACP',AFF, PETER CASIA AMOUNT 0. 00
P D D R E CS S PnYMEN-r DATE. 08/11/93
SUBDIVISION
',A
.)URPOSE OF PAYMENT AMOUNT PnID PURPOSE OWP ID OF PAYMENT
UNT
-P-,F—R M— 80. 30 PLUMBING PERM 45. 00
ECHANICAL Pr- 2r.-;. L710 ST. BUILD PER 7. 5:3
r-',L,-('N C14ECK FE 2. :3`a
rr
11.33N (:jW 90TI-4
TOTAL AMOUNT PAID 160. 3A
INSPECTION NOTICE ( �f
City of Tigard (Building Departmsnt
13125 SN K&11 Pled. Tigard, Oregon 97223
Inspection Line (Rec-a--P�honn)`: 639•-4175 Business Phone: 639-4171
Irspectiont s !✓� -d �___ ��`_
Footing Plbg. Underc:lub Mach. Rough-in Appr/Sdwik
Pound. Plbg. Top Leat Can Line
Post/Beam Struct. San. Sewer Fruning
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Dyp. ad. -Neap.
41
Dat4 Requested: / �' 4/1Times AN PM
Addresa: i C� Permit izy7 7
Bu i lder:
THE FOLLOWING CORRECTIONS AAE REQUIRED:
04
4
�0 a— t e vim__ f f2 ✓v-,,o
ca
f-A U
LLJ
InspActor:, ��1— Date:
V APPROVND OTM PROVED APPROVED SUBJECT TO ADOVR
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building DepartmOnt
13125 BW Ball Blvd. Tigard, Omega 97223
Inepeetion Line (Rec-o--Phone): 639-4175 Business Phones 639-4171
Inspections_
Footing Plbg. Underslab Mach. Rough-tn Appr/Sdwlk
Found. Plk.g. '_'op Out ciao Line FIl1ALs `
Pont/Beam 3t:ruct. San. Sower Framing -D1dg.
Post/Ream Mach. Rain Drain Insulation 1.
Plbg. Underfloor Waterf Line r,yp. Bd. �liAoh.
Date Requested: �' ! --T Lme s _AM PN
Address Ifr 1 �✓l--� ll1 t Permit #s
Builder: 1 J I\..1/\,Q ..C -T l l l_IAti►�/I(nom 1i r' `,-�_ J -.
1HE FOLLOWING CORRECTIONS ARE RBt;UIRSDs
I ,
0.
r-.
Ln
F--
rr
W
ll!
.J
InspactoGf' _ Dates r
RPPROVRD DISAPPROVED APPR(riJED AUBJE!'J' TO ABOVE
Call For Reinep.
I
INSPECTION NOTICE
City of Tigard Building Departakent
13125 fila Nall Blvd_ Tigard, Oregon 97223
Inspection Tine (Rer-0-Phorv3)s 639-4175 Business Phone: 639-4171
Inspection:_
vooting Plbg. Underslab Meeh. Rough-in Appr/Sdwlk
Foc:nd. Plbq. '__�, out Gas Line P7NALs
Poe,:/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
41bg. Underfloor Water. Laine Gyp. ad, -Meeh.
Date Requestodt��,�/� Times AN _pq
Addreses .= �
_ q -P-.>ms,t #t N67
Builder:
TH>! 1►OLLOWING COr./RECTION3 ARTS REQUIRED: 2 ell
(25
?) L] tc1�1 GT �.1!•t v
AC-11-
. Lc .c.•GsAes
,L
sr
4
l,spectort— _� � ---------___— nates !J "
APPROVRD r DISAPPROVNn APPROLED SUBJECT TO ABOVE
Call For Relnep.
!NSPECTION NOTIC.F,_
City or Tigard Building Departaent J
13125 BW Ball Blvd. Tigard, Oragon 9'7223
Inspection Line (Rea-O-Phone)t 639-4175 Business Monti: 634-4171
Inspection:^,
Footing Plbg. Unders!ab Mach. Rough-in Appr/Sdwlk
round. Plbg. Top Out Can Line FINAL:
Pon"-/Bewro St:uct. San. sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lite gyp. Bd. -Koch.
Date Requested: Time: AM PM
Address: Pornit #1 &
(
Builder: A �-C,, 1-7� 1
TM FOLLOWING CORRECTIONs ARE REQUIREDI
✓ Qtiv.zew_M= L.
_ r
f_.
n
F-
N
_.I
G.
C7
W
�L-- 9-
Ino
p*ctor�: / bate,
V APPROVED Dis"PROV3D APPROVED quaiNcI' TO ABOVE
�� Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Departassnt
133.25 SN Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-•4175 Business Phone: 639-4171
Inspection:
Tooting Plbg. Un.le�(slab Hoch. Rough-in Appr/Sdwlk
round. Plbg. Top Out Gas Line TINAL:
Post/Beam Struct. San. Sewer Prart7ngg -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbq. Undorfloor Nater Line Gyp. Rd. -Koch.
nates Requester: Ti:oes
/�• 7 / AM PM
Addrese r 113-3b �-� 4 Permit
Builder: kr—'4
TRZ FOLLOWING CORRECTIONS ARE REQUIRED:
�i
Un
L3
LL!
J
Inspector: _.`-,� - natal
APPROVND DtUPPAOVED APPROVED SUSJECT TO AROVR
Call For Reinsp.
d
INSPECTION NOTICE
City of Tigard Building Department
13125 811 Bell Blvd. Tigand, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phor.e: 639-4171
Inspections; ,?t_,
Footing Plbq. Underslab Much. Rough-in 7ip•,ir/Sdwlk
Pound. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. Sun. Sewer Framing -Bldg.
Post/Beam Mech. Rain Orain Insulatton -Plumb.
Plbg. Underfloor Nater Line E Gyp. ed. ech.
I L
Data Requesteu: L� 3 ^�`7 Times AM PM
Addrass: .�� —` �.• Permit L
Builders
THE FOLLOWING CORRECTIONS ARE RZQUIREDs
Inspectors _ Date:
APPROVIO DISAPPROVED APPROVED SUBJECT TO ABOVE
J Call For Reinsp.
w,
LSPeCTIoN NOTICR
City of Tigard Building Department
13125 BA Hall Blvd_ Tigard, Oregon 97223
Inspection Line 4Rec-o-phoneys 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found plbq. Top out Gas Line FINAL:
Post/Beam Struct. Ban. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain T-isulation -Plumb.
Plbg. Underfloor Water Li�ne� Gyp. Bd. [-Hach.
f
Date Requested: , - 1-1
( 3 1
Times ` AH pM
Address: 1� '2JV ^ PermiitQ 1 e M/5N_ 13 oYY2_
Builder:. `1 /!����
J
TNR FOLLOWING CORRECTIONS ARS UVIRE01
-----------
N
1—
an
l_1
Inspector:___ Date.
_APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Relnep.
INSPECTION N(YfICR
City or Tigard Building Department
13125 SW Ball Blvd. Tl�jard, Oregon 972?3
Inspection Line (Rec-O-Phons)t 639-4175 Uasiness Phone: 639-4171
Inspection: �^"W�V✓ `i C ) ��
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Post/Beam Struct, San. Sewer /Framing -Bldg.
Pont./Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water
Line Gyp. Bd. -Hoch.
Date Requested$ l) /1. � Timet �
AN PM
Addreeet X13-0g _Permit It�
Builder: r, F J,c 17L9
THE FOLLOWING CORRECT;ONS ARE REQUIRED:
i
inepector$ Data: J
`__4 APPROVED DTSAPPRAVED APPROVED SUB.TE(Ir TO ABOVE
—--Call For Reinsp.
city of Tigard Building 3epartmmt
13125 SW Ball Blvd. Ti3ard, Ot'egor 97223
Inspection Line (Rea-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Onderslab Meeh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Past/tleam ^tract. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: - p- 2-CO 3 Times �1►M PH
Nddrees: C- L�
Builders �ZcT7i�-
TBE FOLLOWING CORRECTIONS AI.E REQUIREDs
t
I --
Inspectors s Dates O
APPROVED` DISAPPROVED APPROVEt'. SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard BuildL&j Department
1312.5 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. Cr.n. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Mate Line Gyp. Bd. -Mech.
Date Requested: Time: . ]AM Ph
Addreees '
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
4
F--
N
mss.
F—
J
.—v
C
lil
J
L.f I
Inspector a .-�f/� 7^i4!"7 rt f-��, --- -- nate�
�"PROVIM DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Reinsp.
E�.
CITYjj (�T(�! A1312SSWH311MA PLNCK/REC #O1' Il 1 V ARD Ti cam,9rt� PERMIT 0 r1I.S� � 3 lJ y V z-
COMMUNITY DEVELOPMENT DEPARTMENT
(503)63"171
DATE ISSUED
JOB ADDRESS: J' j Li ,_ TAX MAP/LOT f51 33-P�-0, uUo —
SUB: LOT: LAND USE:
VALUATION: A/O aoa D
OWNER / SPECIAL NOTES
NAME: _ 5l a V p� lel l �l �. _ REISSUE OF: —
ADDRESS: /l C S• Ccs! �D t PAST REISSUE:
j:ii Q y-0, FLOOD PLAIN/
PHONE: u SENSITIVE LAND:
CONTRACTOOT APPROVALS REQUIRED
NAME: _ K F A C C r �- _ PLANNING:
,ADDRESS: /S ;z y S E, � �' aN� � ENGINEERING: —
P rpE CT^�, 9 27 3 C FIRE DEPT:
PHONE: ` OTHER: _--_
CONTR. BOA;t0 #: 54/ ,7 .� _ EXP�¢ATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: � _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCN/ENOTNE 4 CALCULATIONS: _
NAME: ___ TRUSS DETAILS:
ADDRESS: _ OTHER: _
a
PHONE: —
r
~ /
PROPOSED BLDG. USE: � _�f .�� ---- --
w COMMENTS: �— -- --
AP LICANI S GNATURE
Received fly: __ �` '` �_ Da Le Race i ved:
PERMIT # ACCT # DESCRIPTION AMOUNT / AMOUNT PD. BAL. DUE
,'iL�qj-ewL 10-432 00 Building Permit Fees *-,q.5-D I)y
10-431 00 Plumbing Permit Fees
r
10-431 01 Mechanical Permit Fees 12.7 "'' �> �1,'
10-230 01 State Building Tax (5%)
Building 4-, 3
Plumbing -?• � _ 1
Mechanical 2i
10-433 00 Plans Check Fee s'8 S8 p, Z •-3,�
Building 5-2.33
Plumbing
Mechanical
10-230 06 Fire
30 202 00 Sewer Connection
30-444 00 Sewer Inspection _
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees _
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448- 01 Residential Traffic Fees
2.5-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrq
(SSDC) _
2.4-445-01 Water 'Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
1i TOTAL I�i• �-XO ,Z 0.3
nm,/35871I.W{1{
¢ 11 1
IAA14
S.e9'S8'W. %7.3.0 '
h
lit
!� � + � Exist.cAairtlink�'1►ncC� N � �� I
c
I °o
a
fxiat rave/drive wa
I
c�4 1770
)moo
Exi.r�!ctiain7in/c{e17ce- - '-- —
#cr
WAY 9PUl h'WLi
i
I lns r'�T
Sup0 ���
r W .
't
��:'_.-'� S ' ... `" -� � 1�, �• i I •MIS „i� s�. 3
IN
ff , 14
44
tie- h
ftt
VII C�vi �
r•
:�crIlA9lle4e►r .R.w�al�.>t.?�pll>lydc yx
PROD�ICT.LISTIN'G 1 Y 'FIREPLACE
• ` . �"e , , ! 4�+ I.,SURROVNO�kACINrrF ✓
FIREPLACE/CHIMNEY:
• Underwriters' Laboratories Report No. MH6018 ;
• Council of American Building Officials
(CABO)Report No. NER-181 �.,,�r • t
• Various City and State Listings Are Available �. I' OPENINQ,�,
Upon Request {
211A'MIN.CLEARANCE I 40•
TO COMBUSTIBLE
INSULATION BOARD(MBS EH2416): PERPENDICULARS-
Wimi, .
• Underwriters' Laboratories Report No. MH6018,
Volume 2 12'MIN.CLEARANCE TO
- Thermal Conductivity('K')is 0.458/iN. USING No co USTiSLLEEWALLWALL SHIELD.(t) t• a-.1'., .
- Total R-value is 2.18/IN. COMBUSTIBLE MATERIAL PERMITTED WRHIIISHADED AREA.
(t)NONCOMBUSTIBLE WALL SHIELD REOWRES 1'KOM EH2414 INSULATION
MATERIAL BETWEEN DECORATIVE NON4:06119USTIBLE RKID COVERING AND
COMBUSTIBLE WALL MINIMUM HEIGHT AND WIDTH 15 40'x 40'.
MINIMUM FRAMING DIMENSIONS (it)DIMENSIONMEGHEE GF ANGLE WILL VATiY DEPEN61NG ON THICKNESS
OF NONCOMBUSTIBLE SURROUND FACING.
2 x 4's
IICHIMNEY SECTION CHART
2 x 4 HEADER
IaNrmadi4b S.e11o1n Intermediate Sections Height
75%• 0 0 1 C 209%•' 0 0 7. J
76%' 2 1 0 0 214' 0 1 7 2
371/4" 4114• 0 0 0 1 221%• 0 0 1 4
f sr 0 1 1 0 M. 0 1 z
417/," MIN. 23"MI I. se- + 0 0 1 277%' 0 0 o s
e4• 0 1 0 1 2011' 0 1 , 4
INSID, n• 0 0 2 0 244' 0 0 7 7
T I _� A%' 1 1 0 1 250• 0 1 0 5
9r 0 0 1 i 25e' 0 0 2 4
66K• 0 1 2 0 259% 0 1 7 7
—2 x 4's—_j417/e"--1 94• 0 0 0 2 M. 0 0 1 S
99%' 0 1 1 , 272%' 0 1 2 4
FRONT VIEW TOP VIEW 104%• 0 0 6 0 ) 280' ti 9 0 o e
110%• 0 1 0 2 284%• 0 t + S
MINIMUM CROSS-CORNER ,,an a a 1 a 2 1 029e%•2911%, a a 7 '
7 , o o e
DIMENSIONS 13r a a 2 ao2 f*.' 0 2 5
740%' 0•` 0 0- 7, �6,4N 0- 0 1 6
S. 0 ',i 1 7 1, ' 2-'� .80'1 �0 1 2 6
511 1 o ,' ,ON, ;9,< r a2llty o. o o T
�fi — 15 o , "°; �'' 671•• to , 1 e
ler o o ' !.. .! an•' - o 0 7 s
T/tl Is?"' 0 •", 6. �T.-:; ( 34r 0 1 0 7
ITS 0 0 1' 9 240• 0 0 2 6
1711%• 01 !`. ! •SST. 1" 0 1 7 5
+er ° 4 fl61••!Q,', 0 0 1 7
191%• 0 1 - 1 7 7e5N4•. 0, 1 2 0
►/+� 197%' 0 0 3 ! �• 3rr 0 0 0 6
3/72V/4�'
207%' a 1 0 4
s,u• OFFSET ELBOW` ' OFFSET
CHARTNv t ,
ct RISE \ l
V)
MINIMUM WALL CLEARANCE
J
SPECIFICATIONS
n-a
Co FIREPLACE WITH NON-COMBUSTIBLE
LD SURROUNO FACING. r IN r r {„ ae.l xu. r Iw r r iw'„4f ah.r xl.. 1
LL)
J 4'BRICK r•— 1 O 0 0 0 0 T 111 0 1 7 [ 1 MK' II7N•
(EXAMPLE MATERIAL) 1 0 0 0 0 614' 20• 0 0 1 2 1 61114• 124'
�, 1 0 1 0 0 0 11%' 25%- 0 1 Y 1 , 70%- 128•
2 0 0 0 0 13 1A 6%- 29%• 0 0 0 2 1 7414' 1400
1 1 ° 0 0 16K' 3f%' 0 1 1 2 2 78' 14014•
0 0 1 0 0 YON• 40'A 0 0 7 1 2 61' 146'
000 000 2 1 0 0 0 2+14' 47%' C 1 0 7 .2 64' 1SIW
0 0 0 1 0 2614• 61%11' 0 0 2 2 2 or 156 A:
J6•FIREBOX 0 1 1 0 0 2814' MIA* O 1 ] 1 2 611%1 t60%•
ILL OPENING 1 0 0 1 0 71%'� 60%• 0 0 1 5 2 93' 'd114-
D 1 D 1 0 :14%- 6514' 0 1 2 2 2 9514• 171114•
77•tt I 21%•MIN.CLEARANCE 0 0 2 0 0 77% TON' a D 0 1 4 2 99 A. ;/714•
_TO COMOUSTIBLE 1 1 0 1 1 41%• IT'A 0 1 1 J 2 101%' 18114'
I PERPENDICULAR 0 0 1 1 1 45- 9744- () 0 7 2 2 104%• 168%•
1 WALT_ 0 1 2 0 1 4714• V%-' 0 -�1" 0, 4 - 2 177%• 19Vy-
1 0 0 0 2 1 S1' 114'4 0 0 2 7 2 110W 11W14'
12•MIN.CLEARANCE TO 0 1 1 1 1 531A /6' 0 1`' 6 2 7. 1U'— 203%'
HEN
PERPENDICULAR WALL Wt 0 0. 7 0 �r 11 ICN' 107% 01 ti 4 7: 11711• 209%•
USING WALL— :n-� �WALLSHION•CgMBUSTIBLE.'1 ., � a{ '. 1 4 311 123M LI
2
i r.
_...-. _ . _ . - . . l . . . . . .
• 4
.. . . . . . . . . . . . . .
1
y
. . . _ . . . . . . _ _
ul
VS
-
o
. . . . . .
l -
.. . . . .
i
I 4
P4anddRec. 9
car atfagaud Penza _
13125 SW tbl Blvd.
PO Banc 23347
To--QaMJL OR 917223
Ems' �� -- a„r PiumAtLT
oma" alit p1itICE IVur
�F+. 4 -0 taoD
FucnAies
So s,,, 23 P.—a 3tDo
D a
! or
S� 750 1101;p00 •
n
7.50 ;Ktwooc
.� .q or/oafaowbd&Aaw
Rko�Teal 51 mqp%irmmw p"w&
Mina
7SA34 ioo
Qo�iaD."6rftw-riat wrt
11111odum
MIA Sal
b31tPa600��tb10�6N i110
i 750 dweell. p��� 111
!q =i5ltP&6ao'P"lassSWKBW
� &CSCULLANGOM
d�• p"'�K 15110
9� TS,OlTF'a6oa�pe.2S9 eeriBU1
1si ltlil .lRAO das1+{, pweltaer ZtSO
-- iiuo 1q
309D ur at,00P wi t4-7s/i BTU
1st Toa* t 1) s So NP ao Oak 23S d am st9D
r1[~Seewas ow-MAL am /l-0 ue[a L9D
Shaw i 4isis Ora:a 1st 10? _ Mm 1qpw C
—9axw i tta:e lkae MAL"W TSIU -- M 10.m cm o
Molbi"{be"Sp+ ?S1D0 Kam p«�- <9D
t q O.APoca'coca r
O".ioe er A�b�o�OaMae• 731 IMb;
ar
op 7-% gsa�ee wat
a7neeMK7/l b i red" ieedueled A�YP' ` t�
iGat qP&rM
Sp"or pwter ape;w ci r
b"ftr odaC�o�C 490
F>lesdwi"a1 afar pewaeMoe ras es gree b bar�fee� 7-W —
�ioes 15.00 - m1
Zt� tWane lane<Perodld /
e i' ti
i *Wsmi�F.e szsm SUBTOTAL &&4wwAn Foe UsLoo 5t16iOTA1_
i Sm.S RCHAR.. , stc S tAIiG£
f'fl aM REWWW 2M of Sfl O OTAL
pt_M FtEvWw 2s%of SUUMTAL --
- c TOTAL _
TOTAL
.r t�i!'6Sf/ld
by
APPLICATION -- STREET IMPROVEMENVEXCAVATION C COPY TO:
ORDINANCE NO. 74-14 {'� (WHITEWFILE
(YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENC-y BLDG
r (J�J
ry�*'� (BLUE)-APPLII_CANT
APPROVED ) 1AAP'PLICATION NO.: `- -(,,
NOT APPROVED ❑ CI I'YOF I IGARD, OREGON FEE AMT.: S_ 220.00
PENDING FEE. PMT. [J CI I Y KALI. RECEIPTtNQ.:
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY DATE L
I- — — — — — — — — — — — —
PENDING AGENCY ''OK'' ❑ j)[111c,llion and Propess Record
PENDING INFORMATION ❑ MAINTENANCE BOND #
FOR STREET IMPROVEMENT/EXCAVATION As REQUIRED `T—
ANNUAL
PENDING VARIANCE EXPIRATION DATE: /
PERMIT NO.: -'_t�"`IZ- DA i F. ISSUED: (�_Kt_C�__ BY: _ -- -.-'
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _Sallitar} Sewer (building)
tirade Service SCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY T
o�Glover levins 3�-Ol r1.�1
APPLICANT Sharon G. Smith 11330 S.W. 90th Ave. Tigard, Or 97223 291-4665 (wk. )
NAME ADDRESS CITY . PHONE
CONTRACTOR - Warren Brown & Assoc. 11640 S.W. Myslony Tualatin, OR 97062 69_ 2-5948
_--F9
_
NAME ADDRESS CITY PHONE -'
PLANS BY (see attached)
NAME _._ADDRESS CITY PHONE _
ESTIMATED IMPROVEMENT 'TOTAL VALUATION ( COST): $ 5,5W.00
DOLLARS
FOR OFFICE 5 CMIN.
(2) EXCAVATION DATA. 0.04 XS 00^00 220.00
STREET DESCRIPTION PROGRESS & INSPECTION STA1 US
NAML: SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM PATE REMARKS/TYPE BY
u— TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY _
STREET
MIN
Il)I-IIAve. � attach - tNSPEC-
D
E TION
Q
U _
ESTIMATED STREET OPENING DATE:---L ES
ESTIMATED STREET CLOSING GATE: �. E
DI
5500.00 STREET
(3) SECURITY NO. ---_ SECURITY AMT: $. , _._ LLOSED
SURETY CO.: _ FINAL
CERTIFIED CHECK CASH ❑ 8!ND INSPEC. _
_--ate--
(1) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. L. Notify Inspector Letha Thomas
SITE: 1120 SW 90th Ave. hrs. ore s ar Iny
�w Qu'* u� I work.
1 1 work area t 1 2• All. work shall conform to City
I 1 I 1 .
1 K'e—
' ua9 - '�I �� _ _ _ _ _ _ — ��• _ - , _ notification, �et.c. a lien.
4. Traffic control must be provided
I S.W. 90th YkAx Avenue VL —_—
I = fob by contractor.
4,- 1 ---- --_._. -_-_-.__-__- — 6. The roadway shall not be closed
1 1 I 1 M I t o Enroug1ri ra. c, a any Iltt•.
1 1 1
' att the and of each clay.
H. MLP 91-0001 applies.
(Si NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PEPMISSION 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 PL-RTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARM..ESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE ` �.�-x , GL'7� ( l _ DATE /