14127 SW HAZELTREE TERRACE FILE NO.
HAZELTREE TERRACE SW-14.127 ST. OPN PRMT
CITY OF' TIGARD
F"{PFNDI7lURE REQUEST
'This form is a tmilti-use form. Appropriate receipts must be attached. Documentation
is important for all puxT-xx-,4---. Stzple docimlentation tc; form.
VfMAR NO. : -- — __-- =TT-.: -) -_ q _ `W� -
PAYABLE ZO: E t h 1�� � -` h` u � RDQUIS'I'FD BY: --
JW
Approved mquest du Wednesday
10:00 AM to A/P for checks by
Friday.
MI:��,T1ATD'JLT,S F�CPEPIDI'IUI2F;�:
(date (�De�cription, Invoice No., etc. Account No. Am=t
ZZc)cy $ -3Do r'e,
— -----� '
Mileage $0.255
APPWFRIATTON IWANCE: -- AS OF': -__-- - SICNAIURE:
(Up to $25.00) Section Manager _ �___.-_----_-_-_-- Purrh. Agent
($25.G1-2,500.00) Division Manager
($2,500.01-7,500.00) Dept. Head
($7,500.01-15,000.00) City Administrator
($15,000-01- ?) Lowl Contract Review BoatT.i
ke/1501F
INSPECTION NOTICE
City of Tigt wilding Department
P.C. Box 23397
Tigard. Oregon 97223
Phone: 639-4175
I
Type of Inspection A
Date Requested --- �� f �C/ Time A.M. P.M.
Address f , Y i�1 �_ �_\„�� permit # f `
Owner _ _ Lot #_
Builder
The following Building Code deficiencies are required to be corrected:
I
Presented t•.) _ [[;'(Approved
Inspector _ f, U Disapproved
Date � � �-�C7
CALL FOR REINSPECTION
C7 res ILNO
INSPECTION NO'T'ICE
City of Tip , D
Den �Iment
P.O. Box 2339;
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested ^ �. �� V
Ti rde— A M._�.P.M.
Address t L4 1
— Permit # r
Owner
Builder l9V
IJ ( 1rf L �—— Lot #.
. 1 y �..
The following Buildin Code deficiencies are required to be corre ed: ----
Presented to _
Approved
Inspector _�V
—--- Disapproved
Date-
CALL FOR REIMSPECTIO.N
I�$ YES L NO
APPLICATION - STREET IN ')VEMENT/EXCAVATION COPY TO:
�
y�
�
ORLJ,NANCE NO 74-14 (WHITE)-FILE
(YELLOW)-114SP.
E:
(INSTRUCTIONS ON SEPARATE SHE 'f) (PINK)-OTHER AGENCY-LIA,
'^'
( (BLUE)-APPLICANT
�
3.7 A-
APPROVED APCL.ICATION NO, Id I ml
NUT APPROVED ❑ CITY OF TIGARD, OREGON FEL AMT.. S _i�Z
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT NO.: 60/OLS
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT eY2z_ DATE-1 –it / v�
PENDING AGENCY "OK" ❑ Application and Progress Record
MAINTENANCE BOND
PENDING INFORMATION ❑
FOR STREET IMPROVEMENT/EXCAV.tiTIv?I As "FUL)IRED
ANNUAL
PENr)ING VARIANCE ❑ EXPIRATI N DATE, G G-A -
PERMIT
PERMIT NO.: 3.53-' L_--- LATE ISSUED: BY: –
(1) APPLICATION IS HERFSY MADE TO EXCAVATE FOR AND INSTAL(-
GGA—L"CzzT. AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS
APPLICANT . Ke nil NAC_I -�x �3 'P.a 440 clTv 71 L461,
� z- '
ME ADDaE55
CONTRACTOR
NAP4V u OR 4 --
CITY_—___ FRO_ONE
PLANS BY_ sti —�--
NAME DDNE _
ADDIIESS
- e,7� CITU PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST: $
DO(.LARS
(2) EXC,.\/ATION DATA: FON OFFICE USE, MIN.� or
q 04 X S LCX 1 = S �Z,
sT�EET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED REMARKS/TYPE-TYPE LEITEM DATE RE
NGTH WIDTH DEPTH ITEM IN QUANTITY / YPE BY
STREET -
P NEP
IN TP E-
2< RION
E
U
U _
ESTIMATED STREET OPENING DATE:-- / / E
S
ESTIMATED STREET CLOSING DATE: — / / T
E ---� -'
(3) SECURITY NO. STREET - —
— SECURITY AML: $ 3r'O _—_ CLOSED
SURETY ca: FINAL
/j
IERTIFIf_1)(.HECK ------- . CASH OOND ! INSPEC. Is^
- --. _.eL. r.
(4) PLOT PLAN' INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISI. NS /CONDITION
FEATURES: EXCAVAT-UN LOCATION AND EXTENT. / I
I I 1 kir
04
-
/
N.
�} NOTE THE CITY OF TIGARD DOES NOT, HER'---f, GRAi:T -r"MISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAV 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 SPECIFICA TIONS_,'ERTINENT TO CONDUCT OF THE WORK, AND TO SA,/F_ HARMLESS THE CITY AND
EMPLOYEES-*IOA.LNST ANY IN Y O\ DAMAGE WH�QMf'fMAY/'RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE DATC'.
Ar"Pi_ICATION - STREET IM )VEMENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 (WHITE)-FILE
(YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCY_�JA
IQ.(BLUE)-APPLICANT316
FPPROVED '
APPLICATION NO.:
NOT APPROVED r(J CI I ti OF I IGARD, OREGON - -s,;t —
FEE AMT.: :._��Z• _
PENDING FEE. PMT. ❑ CITY FIALL RECEIPT NO.: _-. "'s010Lej'L3
PENDING SECURITY 01PUBLICWORKS DEPART-ME.NT BY -__ _
DATE____L__ L__ /
PENDING AGENCY ''OK'' C] Application and Progress Record
MAINTENANCE BON
PONDING INFOF MATION ElFOR STREET IMPROVEMENT/EXCAVATION AS REuuEB -�
ANNUAL. UPENDING VARIANCE U _ EXP117AT1 N DATE:
PERMIT NO s w`Sr'.� DATE ISSUED: i' , j_/ /_ ,. BY:
( 1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ E.S}S1 pp,
CONTRACTOR ADD. 'CITY -Ili
�ON�E
c-
NA E DDR S --_—_.____ _CITY
PLANS BY 1 ra L � , L_. -- - ------ --
NAME ADDRE ��Q CITU PHON
'G.w.
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
DOLLARS
(2) EXCAVATION DATA: ErOFFICEn oaFiusE: C MIN
--- __ 0.04 X f
STREET _DESCRIPTION PROGRESS_& INSPECTION STATUS
-
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
TYPE LENGTII WIDTH DEPTH ITEM & QUANTITY ITEM DATE RF_MAHKS/TYPE BY
STREEY i --- -
��//
OPENED _
IlriZ� ;1 f - INSPEC-
ar E TION
�r Q
ESTIMATED STREET OPENING DATE:. / / E
ESTIMATED STREET CLOSING DATE / / T j' 1
Z STREET
(3) SECURITY NO. _ -_ _ SECURITY AMT: S �'CO CLOSED _
SURETY CO FINAL //
CERTIFIED n CNECK CASH BOND C INSPEC. 6
(4) PLOT PLAN INDICATE SITE PERTINENT PHYSICAL. SPECIAL PROVISIONS J CONDITIONS:
FEP'rURES; EXCAVATION LOCATION AND EXTENT. I
44"_ , _ _ 1 I *637_4171 Cl krA-
CURP
UIP
77-
(5)
NOTE THE CITY OF TIGARD DUES NOT. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON rOUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COPA PLY WITH ALL PERTINENT 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.L'
----���� PROPOSED EDGE
2"C LASS " C"A.___I OF SHOULDER
a" 2"-0 PROPOSED EDGE
j I \ SLOPE VARIES OF PAVEMENT
a w
w
Z U.
y�
O O <9 O J Z
N
a aU.
,�� •� 3
W TYPICAL SECTION
UA
z
< _ A.C. DRIVEWAY
wl z
PROPOSED EDGE
2" 3 4 - 0
I I I oc N OF SHOULDER
4 2
_O
PROPOSED EDGE
SLOPE VARIES OF PAV!"MENT
I II r
w I
I; z o
TYPICALSECTION
x < �� vi =
w J I GRAVEL DRIVEWAY
Imo _ I
PLAN
p� PP)POSED EDGE
TYPICAL PL N OF SHOULDER
A.C. OR GRAVEL DRIVEWAY -" PROPOSED EDGE
OF PAVEMENT
SLOPE VARIES 4'
i
UNLESS OTHERWISE NOTED �A GR*10%
SEE O W 0. NO. DW-202
----
TYPICAL SECTION
ALTERNATE
WASHINGTON COUNTY DRIVEWAY DE
AND TRANSPORTATION USE IVON ,- CURRIE�DETAILS FOR
D AREA„ ----�
r [FATE CIVIL ENGINEER ;`LR,IWN APWA NO. WASK COUNTY No. I
NONE TDW- 205
J
i �vvivt I nus .,....
z) ELEV. SAME AS CROWN ELEV.F, E 1 SHOULDER CROWN 1
I
OF ROAD
3 MIN. SLOPE 20 I
I I ROAD SURFACE
77
I I
i I
C� 130TTOM OF DITCH EL-EV. I
MAY BE ADJUSTED B" INSPECTOR
NOTES:
I.SEE DWG. NO. 205 FOR ALC ERNATIVE
2.IF AC DRIVEWAY 13 TO BE CLWSTRUCTED, USE 2" OF CLASS"C"MIX
ON APPROVED BASE
PROFILE
CUNCRETE HEADWALL REQUIRED _
WHEN USING CORRUGATED METAL
PIPE SH.+LL EXTEND A MIN. ON PLASTIC PIP[
I' PAST TOE OF FI L L
} RFAC OF RIVE WAY ?•�
.y -0 ROCK k
IIi
i
i
41�I11-10t!ul� _III A ;IN=1115 ,.
CONCRETE PIPE i OTHER THAN CONCRETE
APu1 . -�
PE SIZE TD BE DETERMINED PIPE, AS APPROVED i
BY INSPECTOR AT THE .TOB
SITE ( 10" MIN.)
PIPE TO BE LAYED AT EXISTING GRADE OF DITCH .- NO SLUMPS
CROSS - SECTION
,,WASHINGTON COUNTY
-DEPARTMENT OF LAND USE DRIVEWAY FOR STREETS
AND TRANSPORTATION WITHOUT CURBS
����D,�ATT�E CIVIL ENGINEER DFtAWN APWA NO.
1 -7zA.b_ �"'+� WASK COI KTY NO.
stGy b D5 NONE DW - 202
UO
NAMEt BERNARD WS1*01.1 (:CjlriiRiv. i .UO
ADPPFSSt RT 3 E.QX 440
HILLSPOP0. (W t f'Y I Irl r!k
PUPPOSE OF PAYMENT R-1 Atlirilit.17 PAID
CUSTnMER DEPOSITS L
712.00
2358 8093
ROUTE 3,BOX 440
T.W HILLSBORO,OREGON 971.24
71 PA q----
OLL-i
ror
rift
S � 0009 70 7110