14412 SW 130TH AVENUE k
FILE No. 504-92
130th nNE. — 14412
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ENGINEERING PERMIT
PH:RMIT #. . . . . . . : ENG92-049
DATE ISSUED: 07/20/92 By:
PRIM. PERMIT #. : ENG92-0049 PAP-CFL: 2S109AD-WDF6
f_-ITE ADDRESS . . . : 14412 SW 130TH AVE ZONI4G:
SUBDIVISION. . . . : WOODFORD ESTATES 6
BLOCK. . . . . . . LOT. . . . . . . . _ --------
' ----'UA.4T-------
------------------ ----------------- RATE VrALUE
PERMI'. TYPE. . : SOP GR;IMf RJVEMENTS Q
AGREEMENTSTREET LATE: / % /EROS
ASSURANCE EXPIRATION--- TF.EET
PERr ORMANCE: / / :'AN SEW
'4AINTEPIANCE: STM SFN
/ /
LUTILI'. 17:S
ALL OTHEF.
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
Remarks: STREET O''F.NING, TO INSTALL A SANITARY SEWER (BLDG) SERVICE LATERAL &
TO TAP THE MAINLINE.
-------- FEES ----- ----- --
Permittee: type amount by date recpt
J-D BUILDERS, INC. OPEN $ 31.80 CRD 07/20/92 229701
5308 S .E. KNAPP ST.
PORTLAND OR 97206
Phone #: (503) 771-6429
Engineer:
$ 31 .80 TOTAL
P"wile. #: REQUI.-IIF.D ?NSPECTIONS -------
---STORM SEWER-- -----STREET-----
Permittee/,kgent Si3nature: M.H . & C.B. CRB LINE & GRADE
-- P1PE LN & GRD 3UBGRADE
BCK-FLL 4 CMPCT BASE ROCK
AIR & TV TEST 7EVEL COURSE
WEARING COURSE
City of Tigard, Oregon ---Sp,N. SEWER--- TRAFF & PED CONT
13125 S.W. Hall Blvd. M.H . & C.O. MOouMcNTATION
P .O. Box 23397 PIPE LN e GRP, STREETLIGHTING
Tigard, Gregon 97223 BCKFLL & CMPCT WALK/APRON/RAMP
Phone #: 639-4171 AIR & TV 'TEST
----GRADI"iG--•---
FOR INSPECTION, CONri,CT: ---FEPR' S/ADJ,S-- CONTOURS
Carl Vieweg #639-41 . 1 (office) DRAINAGE
#`180-2647 (mobile) EROSION ChTL.
----PATH��AYS----
APPLICATION -- STREET IMP110 •'=MENT/EXCAVATION COPY
WHT g •) . TILE
ORDINf...,E NO, 74-14 • 9 (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) Ia (PINK)-OTHER AGENCYa417
® (BLUE) APPLICANT
#\PPROVED x APPLICATION NO.:
NCT A-'PROVED 11 CITY OF TIGARD, OREGON FEL AMT.: $ �����j-�
PENDIIlG FEF_. PMT. 13 CITY HALL RECEIPT NO.: ?1- bel�.1�
PENDiNG SECURITY 0 PUBLIC WORKS DEPAPTMENT J!'tV 110/
_ _ F_..-....--- DATE 7 `?.
PENDING AGENCY ''OK 1-3 Application and Progress Record INAINTENANCE BOND +11 _-
PENDING INFORMATION ❑ FOR STREET IMPROVIEMENT/EXCAVATION ASREQUI14Fu R
A NN U 1.t
PENDING VALIANCE -_ - EXPIRATION DATE. _1---_
- —
PERMIT NO. ,, #' DATE ISSUED: _=� BY.
(1 APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTAL[-'".' AIS) LI�T�TtI�_ AL
gP MA11Jt_►►JEAS DE SCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPI-ICANT It-NC5`3o�c s L kn4n►� Ct 7`7-7-6 L1�_
NAM ADORRSS �I y-- CITY PHONE
CONTRACTOR `Llnckn
NA gR�Xi �f — TE ARE
PHONE
PL ANS BY_ �� ,M�CCS �4 :bo -� --kQnc,�o �Or ��-PRONE .
CITY
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S _ -1 S-.c>
_DOLLARS
(2) EXCAVATION DATA. �. FOR OFFICE USE: ' MIN.
0.04 X s — = i .�0
STREET DESCRIPTION PROGRESS & INSPECTION STATUS _
NAME SUOFACE CUT (
:UT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYi F. LENGTH Wi DTH DEPTH ITEM !4 QUANTITY _
�E
STREET Tf I�c >!1 L11 xk PND
INSPEC- OP
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ESTIMATED STREET CPENING DATE, __--__J _ / - S 1 _
ESTIMATED STREET C LOSING DATE: E
STREET
(3) SECURITY NO. .^ SECURITY AMT.: S I Tb,C)0.._ CLOSED
SURETY CO.: — _ _ FINAL -•'�ZI q ►eAJ U,
CERTIFIED CH[CK tl CASH-w,-- [OND INSPEC,
(4) PLOT PLAN: INDICATE SITZ' PERTINENT PHYSICAL -' SPECIAL FR'JVISIONS/CONDITIONS:
FEATURES; F74CA'd AT1ON LOCATION AND EXTENT. -A \ y
Ca_ 1,,3ti - RI-1 1
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(S) NOTE THE CITY OF 1iuNRD DOES NOT, HEREBY, GRANT PERMISSION i0 APPLICANTS TO CONDUCT-1vORK WHERE
RIGHT OF-WAY JURISDICTIUN IS THAT OF WASHINGTON COUNTY OR 14E STATE OF OREGON,
THE APPLICANT AGREES TO V_POSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINEN r TO CONnUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATUr4E ' DATE
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CITY OF TIGARD
STREET OPENING PERMIT
APPL.IATION
DATE
• APPLIANT'S NAME
1 ADDRESS _
Vvr-f zip g72 C, 6, -
PHONE
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• CONTRACTOR'S NAME C _ �-\ ,�� 5 C t'\
ADDRESS C) 6`RJ F ~u�T SG ►'e l
C')Ce C.A 4Cac_ ZIP
PHONE _ (c�3 c1 (n Cj (-j a
• PLANS 9Y
ADDRESS
ZIP 9 )db6l
PHONE
• DESCRIPTION OF WO^,K PROPOSED TO BE DONE:
• ESTIMATED VALUE OF WORK (within public right-of-way) $_J ILL Cill
• WORK LOCATION/SITE ADDRESS: _
• IS THIS WORK RELATED TO A LAND-USE ACTION? IF SO SPECIFY (MLP, SDR, ETC.)V,Vro_)_
T`1C)
IS THIS RELATED TO A BUILDING PERMIT? IF SO, SPECIFY (BLDG. PERM!T) NO.
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CITY OF TIGARD
Ei{PENDI=- RDS(=
"'his form is a multi-use form. Appropriate receipts imii-t: be att-died. Documentation
iiiWrtant for all purpose!.. Staple doczme--ntJation to form.
VENDOR NO. : _ D?I-TE: -7
PAYABLE TO, —E Z 1 �n e s r _ RB:(=D D BY: ---
_ --s'1000 5, �
Approved request'2e Wednesday
10:00 AM to A/P for checks by
Friday.
��1ISCELLAI3DxTS EXPEt1DZ'1LIRE.;: — ----- _-- —
Date Description, Invoice No., etc. I'Dcount No. Amount
d
Z.000 5 05
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Mi,lenge $0.7.55
APPROPRIAVION BAILANCE: — --— AS OF: —_ SI I7URE:
(Up to $25.001 Section Manager — Purch. Agent
($25.01-2,500.00) Division Manager
($2,500.01-7,500.00) Dept. Heid
($7,500.01-15,000.00) City Admi.nistratoc _
($15,000.01- ?) Local Contract Review Board
,1501F
.s-aY(�'n 1 M'^r..r, `I vr/,..1 rly.•.r;x
�w�.rti a�'t rvn'w.r:mr^•�^�7'"+-`^�'""•`�
COPY TO:
IMPRC' -MENVEXCAVATION �] (WIiITE)-FILE
AP• LICATI.ON — STREET ® (VEL' 7W) -INSP.
OR DIIVA�.,CE NO. ']a"'14 ® (PINK) OTHER AGENCY
(BL'i-')•f.-i LICANT
• (INSTRUCTIONS ON SEPARATE SHEET)
IAPPLICATION NO.:
APPROVED IX CITY OF TIG,ARD, OREGON ( FEE AMT.: S 2
NOT APPROVED ElCITYI IAT.I, rECE1PT NO.: CIA
PENDING FEE. PMT. ❑ by -I,�- . _ DATE--7—
PENDING
ATE -PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT _ _ _ _ - - -
%pplic.1tion and Progress Record MAINTENANCE BOND s--
PENDING AGENCY "OK" [IAS REQUIRED r
FOR STREET IMPROVEMENT/EXCAVATION ANNUAL.
PENDING INFORMATION ❑ EXPIRATION DATE: --1--"-'--
PENDING VARIANCE L
- 3 -- BY. _:l:r__-. - --
- PERMIT NO. '
-- DATE ISSUED:
(1) APPLICATION IS HERESY MADE TO EXCP VATE FOR AND INSTALi. -_ -- - - -- -
Nil TH CITY REQUIREMENTS.
DESCRIBED HEREIN, IN FULL ACCORDANCE
r ` �. 7'7 7-6 LA a- -
_ -A`\`1�\ � CITY —PHONE
APPLICANTlkM
_-� •' `-� ��� ADDRESS
-� �� pM6NE
CONTRACTOR
NAME _ "—
T, CITY PHONE
V- N Ka
CIRESS a
PLANS BY--_-_--- A\M E AO
MIN.-----T' --
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ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ ---DOLLARS _—�_ ��___ t
iOR OFFICE USE: 13V
(I.on x s = f-
(2) EXCAVATION DATA: PROGRESS & INSPECTION STATUS
- DESCRIPTION •______ AREMARKS/TYPE BY
STREET r.UT CUT MATERIAL INSTAL DATE LED LITEM
NAME SLIRFACE CUT
TYPE LENGTH WIDTH DEPTH ITEQUANTITY STREET .-1 rrxC�
TT L F IP N D
NSP
R TIC-
ON y 21
--.,.
T
ESTIMATED STREET OPENING 1 , E
03"
ESTIMATED
D VJ u.
ESTIMATED 4;TR=ET CLOSING DATE - _` STREET / �L
OU
:.LC SED
(3) SECURITY NO. __ SECURITY AMT.: S ----
FINAL
SURETY CO.'.
-_ -_- socio tNSPEc. 7 It I7 1 u� •tip'
--.CERTIFIED CHEC1t �t CASH t� - �. -__.
SPECIAL P OVISIONS/CONDITIONS.
(4) PLOTPLAN: INDICAYE ,SITE PERTINENT PHYSICAL ^�� U
FEATURES; EXCAVATION LO(-ATION AND EXT[NT. A�1 \ ` tor o—
1 I I S`EE FN AAuc``�-
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(;,RANT P[i1MISSION TO APPLICANTS TO CONDUCT WORK WHERE
---s - —' -
(� ) NOTE THE CITY OF TIGARD DOES NOT, HEREBY
RIGHT OF-WAY JURI-DICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
QUIRt:D SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AN
THE APPLICANT AGREES TO DEPOSIT THE REHARMLESS THE CITY ANI)
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE
Y OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
EMPLOYEES AGAINST ANY INJUR
d' DATE
APPLICANTS SIGNATURE =`
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CITY OF TIGARD
STREET OPENING PERMIT
APPLIATION
DATE _ q o�
• APPLIANT'S NAME (`._S 7 rl 0
ADDRESS ?, kgljo_ 0
o C'? zip q72 o �
PHONE Cl 2 _—
• CONTRACTOR'S NAMECxYV�
ADDRESS Q06—KI [A
ice A',4 0 zip
PHONE
• PLANS BY ---
ADDRESS Q'1s 5 L_ k i�YrQ_ —
,, �Ce . —zip 9 70 __
PHONE
• DESCRiPTION OF WORK PROPOSED TO BE DONE:
• ESTIMATED VALUE OF WORK (within public right-of-way) : $-
fr
• WORK LOCATION/SITE ADDRESS: _ --
• IS -PHIS WORK RELATED TO A LAND-USE ACTION? IF SO SPECIFY (MLP, SDR, ETC.) _
_ T"y0
I
• IS [HIS RELATED TO A BUILDING PERMIT? IF SO, SPECIFY (BLDG. PERMIT) NO. —
_
dVl5i4 Wn>
KL
CITY OF TICARD P%F,",EIP'r OF PAYMENT RECEIPT NO. a 9.= .•:'4"x'701.
CIAECK AMOUNT lb. 00
NAME x 33MFL4.iER, EARL CASH AMOUNT 826 80
ADDREFS 5308 SE KNAPP PAYMENT DATE. 07/20�92
PORTLAND, OR SUED IVIFTON
9'7206—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT ()MOUNI PAID
79!li. 00 PUBLJC IMPROV 3A. 80
4-44440- SW 130TH, STREET OPENING PERMIT
"10—T AL 14MOLJN-T PAiD 826. 80