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12296 SW MAIN STREET FILE NO. 32*76 V 3'1-76 MAIN ST. - 12296 STR. CPN. PERMIT l Avoid Verbal Messages A-1 ©© CITY OF TIGARD 1 ' To: �^^F��,, 11 _ From : Subject: �F1No�b� G�.'�Q_�;1� Date 4�.�r StrGe.� OP�Hir NG.rw� 1� Sec�ri � � r 3i5 J v4.r �-�,�Vt r N �C� ✓\D t.t.� r e. C �V1 APPLICATION — STREET IMP) /EMENT/EXCAVATION COPY TO: [j (WHITE) - FILE ORDINANCE NO. 74-14 ❑ (BLUE) -INSP. [_] (FELLOW) OtHEI7 AI.ENC-Y (INSTRUCTIONS ON SEPARATE SHEET) ❑ (PINK) APPI_I(-AN r hPPROVED ❑ APPLICATION NO.: NOT APPROVED ❑ ('',I'I'Y OF TIGARD, OREGON FEE AMT.: : par 41 if PENDING FEE. PMT. ❑ CITY HALL REC PT NO.: ' 4 i 1G PENDING SECURITY 11 PUBL IC WORKS DEPA R TMEN T BY DATE_-/ 7T - I ../- - - .- - - PENDING AGENCY ''OK'' ❑ Application and Prc,ress Record ��� MAINTENANCE MOND IM(__S=_�Li_ PENDING INFORMATION (..l FOR STREET IMPROVEMENT/EXCAVATION AS R'_QUIRED bR,, ANNUAL PENDING VARIANCE I_I EXPIRATION DATE: r .� 7 - L- - -- - PERMIT NO. 3y-.�_G' DATE ISSUED: Y: L1.__� -_ B - ( 1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL ,�K AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT ( r �._�c11 , �) j 11.-.-1"-' t �^ �� �i�Y_f ��1� DI�!'/.A o�t�)f Alf AM[ ADDRESS CITY PHONE CONTRACTORS PE_ NAME � .�.� —� ADD--- R[�� - CITY- PHONE PLANS BY_ k�Cf4 + kk' tL'Ll e�_ rC 7050 �'t HU CC'��Q NAME— ADDRESS CITY H► ONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): : . — 0OLLARS FOR OFFICE USE /11 1]MIN. (2) EXCAVATION DATA: STREET _ DESCRIPTION PROGRESS 8c INSPECTICN _STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REM ARKS/l%'PE BY TYPE LENGTH WIDTH DEPTH ITEM AI QUANTITY Co Ai C 1 1 STREET ---.. --- — INSPE --.�— -- E TION - -- Q ESTIMATED STREET OPENING DATE ESTIMATED STREET CLOSING DATE: �~r Z i f� 7 A! E --_, - --. yc� SrREET -- (3) SECURITY NO. — SECURITY AMT.: S_ r7 , __ CLOSED — — SURETY CO. 1 _ — FINAL C[RTI VIED CM[CK CASH U MOND n INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS FEATURES; EXCAVATION LOCATION AND EXTENT. I 1 1 I IRP -CURS -• - - - - - -- - - - 1 1 (5) 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 c n INS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK. AND TO SAVE HARM!FSS 111E c ITY AND EMPLOYEES AGAINSTrY INJURY OR DAMAd[ WHICH MA,,* RESULT FROM APPLICANTS ACTIONS l 1 � r- APPLICANTS _IGNATURF.. DATE I --.- APPLICATION - STREET IMPROV 'ENT/EXCAVATION COPY TO: Ej (WHITE)- FILE ORDINAN_.. NO. 74-14 ❑ JOLUP-) -IHsP. (INSTRUCTIONS ON SEPARATE SHEET) ❑ (YELLOW) OTHER AGENCY [I {PINK) APPLICANT APPROVED ❑ APPLICATION NO NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.. f PENDING FEE. PMT. ❑ CITY KALI. RECEIPT NO.: .—.�_____ PENDING SECURITY ❑ PURL ICWORKS DEPARTMENT BY PENDING AGENCY "OK" ❑ Application and Progress Rccord — — — — — — — — — — — — — — — MAINTENANCE BOND PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION As RF QUIRED ANNUAL. PENDING VARIANCE I ) EXPIRATION DALE: PERMIT NO.: DATE ISSUED: [_ BY: (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INS TALL -- _ AS DESCRIBED HEREIN, IN FULL A(-CORDANCE WITH CITY REQUIREMENTS. APPLICANT -- ---------._-------_.--- --- NAMF -- ----���- ADDRESS CI CONTRACTOR -- -- -- - NAME ADDRESS CITY -'� PHONIt— PLANS BY NAME---- ADDRESS - CITU s-----p p E- ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ DOLLARS FOR OFFICE USEw ❑ININ. 2) EXCAVATION DATA: 0.02Xs— STREET DESCRIPTION PROGRESS & INSPECTION STATUS -NAVE SURFACE Cul. CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE By TYPE_ LENGTH WIDTH DEPTH ITEM 6 QUANTITY STREET -- - OPENSPED jam" INE - R TION -- Q C/ ESTIMATED STREET OPENING DATE: 1_ / E ESTIMATED STREET CLOSING DATE: / / T — - E - -- - - D (3) SECURITY NO. -STREET __- SECURITY AMT: $ - CLOSE _ SURETY CO.: _ FINAL CERTIFIEDCHECK Cl CASH O •OND_F INSPEC. < t� (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS J CONDITIONS FEATURES: EXCAVATION LOCATION AND EXTENT. I 1 1 I CURB - I I I r (5) NOTr THE CITY OF TIGARD DOES NOT, HEREBY, GRAIJT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT OF-WAY JURISDICTION 15 THAT OF WASHINGTOM COUNTY OR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SIT-CURITIES, TO COMPLY 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 MA V RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE _ DATE / / I t CITY OF TIGARD ; DaIs Amount � _dd an J , Cash Name M.O. Bldg. �png) Bus.Lie. ❑ lbg ❑ puhclns. � Bike Lic. P169. - 169. ❑ Copies - ❑ Sew.Sery ❑--�� Sewer Filing ❑ Fine&F. LJ ❑ Assml. ❑ Olher ❑ Zoning for: ,,v Permit ,. � �I OF I A By: -----' /)•I � [• MINTING�[11t10N[AY BUJ,,S•y—` . 1545 APPLICATION — STREET IMPF 'EMENT/EXCAVATION COPY TO �:EILUE WHITE) FILE ORDIN',kiACE NO 34-14 �- INSP INSTRUCTIONS ON SEPARATE SHEIPE 14OTHER AVh.NC ( SHEET) �IPINN1 APPLICANT Ai`1T APPROVED >P- APPLICATION NO.: _—/3* NOT APPROVED ❑ CII Y 0 I'll G A R 1), OREGON FEE AMT.: f - &:vey -- PENDING FEE. PMT. ❑ CL I Y HALL. RECEIPT NO.: -_ IG 10 50 - / PENDING SECURITY F] PUBS!IC:WORKS DEPARTMENT BY _"I— DATE�Z� - - - - - - - - - - - - - - - - PENDING AGENCY "OK" ❑ Application and Progress Record MAINTENANCE BO D _JI A--- 15 @LdII FOR STREET IMPROVEMENT/EXCAVATION PENDING INFORMATION ❑ AS REQUIRED ANNUAL I PENDING VARIANCE I EXPIRATION DATE: .._, dh�� PERMIT NO _ -7 Lr' DATE ISSUED: _. � �,1�__. BY: (1) APP"L�JCATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL Sjr.�GC45-b- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT `f - NAME AO [SS CITU PHONE /' CONTRACTOR ---- /�N AI AESt I r JJ PHONE PLANS BY _ A$ pet- :—Li-1 -�Ll.l'-L'� 'SIT rlr►tp►'P" FQ�) NAME ADDRESS i I �"� ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ DOLLARS —^ POR OFFICE USE: �m" ❑MIN. (2) EXCAVATION DATA: 0.02 x f STREET DESCRIPTION_ PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INS'rALLED ITEM DATE REMARKS/TYPE BY _TYPE LENGTH WIDTH DEPTH ITEM AI QUANTITY d' 'STREET PN 7 (.. ED I t 'll II INSP R TION E Q r E ESTIMATED STREET OPENING DATE: �� I zA T — -_ F_STIMATE D Sl'FtEET CLOSING DATE: ___� s.1 � _. ED STREET (3) SECURITY NO. ___ _- SECURITY AMT: 3CLOSED _ SURETY CO.: -.611111,111A rlec,." Ir10 FIN At. / - CERTI IED CHECK CASH ❑ sOND •� INSPEC. G-t7' , ok. r, (4) PLOT PLAN, INDICATE SITE PERTINEN PHYSICAL SPECIAL PROVISIONS /CONDITIONS FEATURES: EXCAVATION LOCATION ND EXTENT. As b r I� It I I I 1 1 I 1 (5) 'v/�NOT'E THE CITY OF 'TIGAR S , 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 REOU:RED SECURITIES, TO COMPLY WITH ALL PERTINENT I.AWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HAR'ALESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE � � � DATE 227 h t+'� �" �,;�', rf��'' "c ���""��� "•�dui : ', -_ APPLIdATION - STREET IMPR- 'EMENT/EXCAVATION COPY TO: URDIN. ACE NO. 74 14 L] (WHITE) - rILE (BLUE) INSP. (INSTRUCTIONS ON SEPARATE SHEET) ❑ (YELLOW) OTHER AGENCY L7 (PINK) - APPLICANT APPROVED APPLICATION NU.: NOT APPROVED ( CI OF TIGARI), ORI:GUN FEE AMT.: S PENDING FEE. PMT. ❑ CITY HALL RECEIPTNO.: _ PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY __ _ DATE—_/ / PENDING AGENCY "OK" ❑ Application and ProRTess Record _ - - - - ` - - - - - - - - - - PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION MAINTENANCE U po1vD -- PENDING VARIANCE (-] ANNUAL EXPIRATION DATE: _.__�__•__ PERMIT NO. DATE ISSUED: BY: - (1) APPLICATION IS HERESY MADE TO EXCAVATE FOR AND INSTALL -_- - -- --�--- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT _NA E -__—__._-_ ADbR SS-._--'.._____ CITU N me CONTRACTOR y ADDRESS _--- ---" CITY --y---PHONE + PLANS BY FSTIMA'i FD IMPROVEMENT TOTAL_ VALUATION ( COST): $ (2) EXCAVATION DATA: - FOR OFFICE USE MIN, ` 0.02 X f STREET DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT LENGTH WIDTH DEPTH MIITEMIA&IQUAN QUANTITY /TYPE BY _ ITEM DATE REMARKS STREET - —- - - P .N INSPE —"—" R TION Q U _ ESTIMATED STREET OPENING DATE. _ / E — ESTIMATED STREET CLOSING DATE: / / T —• — — - E - D (3) SECURITY NO. SECURITY AMT.: :_— STREET CLOSED SURETY CO.: _ _ FINAL -._ CERT)FIFO cF1Ef.{( CASH d fONb INSPEC. �3"7 (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL — FEATURES: EXCAVATION LOCATION AND EXTENT. SPECIAL PROVISIONS /CONDITIONS: I 1 I I (S) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONCII'LT WORK WHERE RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON THE APPLICANT AGREES -10 DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAOIS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE C;1'Y AND EMPLOYEES AGAINST ANY INIUF:Y OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. 41 APPLICANTS SIGNATUREF-7--- wli . +' E DATE / i