12175 SW 127TH AVENUE FILE NO. 3f?-
127TH
-127TH AVE. SW - 12175 STR. OPN. PERMIT
i
I
CITY OF 71GARD
EXPEND=E RBC�U=
191iis form is a mlti-useform. Appropriate receipts zust be attached. Documentation
is inpDrtant for all purposes. Staple documentation to form.
VENDOR NO.: DATE: l a Z4 -10
PAL%= TO: 14-a V,� V)11-Z M &N6k!5c-vA RBQ.UESrED BY: jx
8£3` LQ icVr-c-
cl-17 Approved request. due Wednesday
10:00 AM to A/P for checks by
Friday.
MISCELIANDDUS DW114DrIURES:
Date Description, Invoice" No., etc. AocoLmt No. Anxxmt
C& 400 c,n
4- 3 9-9 Q
TOrAL 400 `1-0
Milo-age $0.255
APPROPRIATION BALANCE: AS OF: STGNATURE:
(Up to $25.00) Section Manager Purch. Agent
($25.01-2,500.00) Division Marv-,,jt,!r
($2,500.01-7,500.00) Dept. Head
($7,500.01--15,000.00) City Administrator
($15,000.01- ?) Local Contract Review Board
ke/15011-
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APPLICATION - STREET IMPRO' MENVEXCAVATION , COPY TO:
(N (WHITE)-FILE
OR DI NA..0 E NO. 74-14 ® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)- PPLI AGENCY�1Clg
(� (BLUE)-AAPPLICANT
APPROVED 51 APPLICATION NO.: 434
NOT APPROVED ❑ CITY OF TIGARD, ORI•.GON FEC AMT. S $16.00
PENDING FEE. PMT. ❑ CITY BALL RECEIPT �DA
50zq'
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY __ y Z2 9d
PENDING AGENCY ''OK" ❑ Application and Progress Record - ,-
MAINTENANCE BOND
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE.
PERMIT NO.: 389-90 -_- DATE ISSUED: ._—_` .1� � By A �
1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL- Cjtx � n_c�ad CQ_ reQ_-___
Drivew y_A ron - - AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT __ Hao Pham 1, Tigard, OR 97224-- #_x_84-5223
— --
NAME ADDRESS � CITY PHONE
CONTRACTOR- (applicant)
NAME --- ADDRESS --------- _-- — _ CITY -_�-.��------ PHONE
r-LANS BY Per City Standard (Detail Attached)
NAME ADDRESS CITY PH7NE
'ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 400.00
DOLLARS _
(2) EXCAVATION DATA. FOR x III 44Ce0 —16 00 rMIN -
ooa Xs_ = 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
-- -- 1 PEN D 10-b'-10 ,.I V" L �
127th Ave. Attach ) INSP c-
e,
R TION s 6_ Cl,drl
E
U _
E I
ESTIMATED STREET OPENING DATE: / S i, L
T -- -
ESTIMATED STREET CLOSING: DATE: _.- E
D
STREET
(3) SECURITY NO. -- SECURITYAMT.: $ 400.00 _. CLOSED _
SURETY CO. FINAL p
XIU'g07 M CHECKCASH 0 BOND INSPEC. i0
(4) PLOT PLAN. INDICATE SITE F -RTINENT PHYSICAL _ SPECIAL PROVISIONS /CONDITIONS:
FEATURES. EXCAVATION LOCATION AND EXTENT. 1. Notify Mr tel ViIM (C.L ,,y__
Inspector) #639-4171 Prior
I I 7 -07- I to initiating any work.
I I I ( 1
All work shall conform to
City standards & specifications.
1 ,_,* - 3. Excavator shall cc-mly with
oRS 757.541 to 757.571.
,►. - - - - -- - _ _ •- - 4. Tra-ffic & Pedestrian cor.`rols
shLdl be provided for by the
applicant/contractor.
5. Form(s) inspection is required
prior to pouring concrete.
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-VF-WAV JURISDICTION IS THAT OF WASHINGTON COUNTY O ` THE STATE OF OREGON
THF APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTI-ENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK. AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
<'
APPLICANTS SIGNATURE �< _ DATE / / Ir
s�
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection - `�. �.W Z4—
Date Requested 1G -'/40— 'Y9 .0 Time A.M. _P.M.
Address 1.2/ 2S_ Z
.2 Permit #
Owner _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
- �7 V
Presented to _ V
R1 .gd
� \f") , i
Inspector __a _ ck, 'J
t ^ 1 r] Diapprowd
Date. _.11.' _`1 qD
CALL F R REINSPECTION
�YElZ ❑ NO
APPLICATION - STREET IMPR( MENT/EXCAVATION COPY TO.
ORDINANCE NO. 74-14 ( .) -FILE
($� (YYELLELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) BI (PINK)-OTHER AGENCY-bldg
A (BLUE)-APPLICANT
APPROVED X APPLICATION NO.: —.434....___
NOT APPROVED CITY OF TIGARD, OREGON FEE AMT.. S $16.00
PENDING FEE, PMT. CITY HALL RECEIPO.: 90_zoSoz4 _
PENDING SECURITY PUBLIC WORKS DEPARTMENT BY ___. DATE 51 1 /'JO
PENDING AGENCY "OK'' Application and Progress Record _
MAINTENANCE BOND +r_
PENDING INFORMATION FOR STREET IMPROVEMENT/EXCAVATION AS REOUIREu
ANNUAL p
PENDING VARIANCE _ EXPIRATION DATE:
PERMIT NO 3$9_4Q , DATE ISSUED _ 11 c f�C-' _ By __ —
( I ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _City 3tit]11-51_-.0 rete
___Drivew__ay_Apron AS DF-SCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
-S vv ( ;,
APPLICANT ___ Hao Pham __ -Ave. , Tigard, OR 97224 # 684-5223
NAME _.- ._ -__- _.�____ _
ADDRESS CITY PHONE
CONTRACTOR - Applicant)
NAME ADDRESS _.- _
CITYNONE
PLANS BY Per City Standard (Detail Attached)
NAME ADDRESS -_. _____-_--.. CTV-
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ _ 400.00 _ _
DOLLARS
(2) EXCAVATION DATA: FOR OFFIC4„IJ¢EA_ MIN
115 004 X S ___ _— S --QQ__J—
"TF?EET DESCRIPTION PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH I WIDTH DEPTH ITEM Q QUANTITY
STREET
OPLNED
127th Ave. (See Attach6d) INSPE -
R TION SCS_
Y- U C_I+
ESTIMATED STREET OPENING DATE: / / E
ESTIMATED STREET CLOSING DATE: / / T -
_—�� E
(3) SECURITY NO. _ +- SECURITY AMT.: S_ 4QQ,.00 _ STREET
cLosEo
SURETY CO.: FINAL
XKKlOX1S7p CHECK )C _ CASH D - ao_N_n = INSPEc. 10- 1'1 yC� �, ,Iryr.�
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL---
SPECIAL PROVISIONS/CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT.
1. Notify Mr= Carl Viewed ( i v _
Inspector) #639-4171 Prior
( I to initiating any work.
2. All work shall conform to
CURB , ' `� _ _ _ . _ ,. _ _ .. ._ _ _ �� _ _ _ _ City standards & specifications.
Excavator -shall cgmp = with
_ORS 757.541 to 757.571.
n
'(�"• � ) r — — — -,-Traffic & Pedestrian a_n contrnl s_
shall be provided for by the
), applicant contractor.
N 3 5. Form(s) inspection is required
prior to pouring concrete.
(S) 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 r:ITr AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM AIPPLICANTS ACTIONS
i
..
APPLICANTS SIGNATURE ._ DATE ,T„_�,- ,L �V
1
HAO DINH PHAM 0649
LAI TNI NGUYEN
8895 SWAVON CT. 684-5223
TIGARD,D, OREGON 97224 Q 19 24-7141
PAY3230
TC THE
,,
ORDER OF
O
S
a Wftnmette Savkxjs Tw•M� _ nas
P o Elm ssss
FORand loan Association Ponl.no,OR Mme
I: 3230714L5t; OLS 7L24055��
649 I'
J
'ITY OF TIGARD -- RECEIPT OF PAYMENT RECEIPT NO. :r?c)-2CI5f--)24
CHECk,: AMOUNT 416.00
)ME : HAO DINH F'HAM CASH AMOUNT
)DRESS : LAI THI NGUYEN PAYMENT DATE (:)9/2C)/9CI
4095 SW AVON CT, SUBDIVISION
TIGARD„ OR 977224-- 1.2175 SW 127TH AVE.
JRPOSE OF PAYMENT AMOUNT PAID PURF'02E OF PAYMENT AMOUNT PAID
JSLIC IMPR O',,' ?y 9 —9i:1 16.tic:i CUSTOMER DEF`0 4(--)C;.c:►cj
rFFET OF'`IvING PI;F"NI T 7,09 -9,-.)
]?AL AMOUNT F'All) 416.:1(:,
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In
_ * MAX 12, 0" M N.
I -- – DRIVEWAY— -� R/W LINE
�— - -�--- - ------a
of
Lu -COP11 RACTION JOINT OPTIONAL
j SIDEWALK
LOCATION
B
SIDEWALK EXPANSION JOII;T
FXP,4NSION JOINT
CURB JOINT
i I
L:3� 0" 6' -0_MIN. MAX. 6' - 0" MIN.
FACE GF CURB '//
SIDEWALK ADJACENT TO CURB 'tIDEWALK AWAY FROM CURB
PLAN
r-1 /2" EXPOSURE
C PLACE COLD
JOI USE EXISTING EXPANSION
ELEVATION Q_® JOINT OR AND
OINT,
_ SEE DWG. N0, CS-306.
STREET
L
COMPACTED SUBGRADE' - 2" OF 1/4" MINUS
SECTION A-A
NOT E 3
I. CONCRETE SHALL HAVE A MINIMUM FjRFAK; 4G STRENGTH OF 3000 PS.I.
AFTER 28 DAYS , 6 SACK MIX.
2. CURB JOINT SHALL BE A TROWELED JOIN WITH A MINIMUM 1/2" RA)IUS
ALONG BACK OF CURB.
3. EXPANSION JOINTS SHALL BE 1/2" PREMOLnIFD ASPHALT IMPREGNATED
MATERIAL OR EQUAL , EXTENDING FROM SUE1f. MADE TO FINISHED GRADE .
4, SEE DWG. NO. CS- 300 AND NO. CS-305.
WASHINGTON COUNTY
vl'DEPARTMENT 01 LAND U;.,E RESP DENTIAL DRIVEWAY
AND TRANSPORTATION
DATE CIVIL EF491HEER DRAWN ti PWA NO. WA—S COUNTY Na
_AEA 61 6r, NONE DW-- 200
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