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12500 SW BROOKSIDE AVENUE ADDRES0: i:Wecord s\rnicroflm\targets\bu ild i ng.doc APPLICATION - STREET IMPROJEM6VEXCAVATION \ COPY TO: ' �� f �1-T.L Gl) (WHITE_)-FI,E ORDINANCE_ NO. 74-14 (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET` ® (MINI(DE))-OTHER AGF_NCYbI(�. -- '' � (TIL -APPLICANT i APPROVED u APPLI(:Al ION 'JO.: _6.00 _.�_. NOT APPROVED ❑ CI IY OF TIGARD, OREGON F•eF AMT.: !,_� �� �_.a—Q_ _--- PENDING FEE, PMT. D CITY HALT. RECEYPT NO.: _]���T�--- PENDING SECUR1TV O PUBLICWORKS DEPARTMENT BY —:5. --- DATE .L1L1_1.j.- Pc. DING. AGENCY "OK" ❑ Application and Progress Record MAINTENAN,-E BOND PENDING 'NFORMAT ON ❑ FOR STREt T IMPROVEMENT/EXCAVATWO" As RQk IREO AN , A r. A- Q PENDING VARIANCE r1 FAPIRATIOV HATE: PERMIT NO.: S5-T=V ----__- DATE ISSUED: BY: 1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL AS DESCRIBED HEREIN, IN FULL. ACCORDANCE WITH CITE REQ II9 A Y. APPLICANT lurles L. Woodard 10215 SW Walnut St. —_ Tigard, OP. 97223------ 6:39-1483 (wk NAN'�E JAODWESS� CITY PHONE CONTRACTOR_ .W4 ren Brown & Amoc. 11640 3.W. Myalonv Ln. Tulalat;.n, CR 9706?_ _ 692-5948 Rti NAME --"ADDty .. —.-- kHONE PLANS BY-. -" per City Standards & Spectficatiom - — --_ __-- NAM)[ ADDRESS �Ifv, J r-MO�If EST,..iATED IMPROVEMENT TOTAL VALUATION ( COST): _ _ 300_00 DOLLnRe FOR OFFIC E: -- 'MIN (?) EXCAVATION DATA. _ _ 0.04 X s STREET -- DESCRIPTION PROGR-SS INSPECTION Sl ATIJS NAME SURFACE CUT CUT CLT MATERIAL INSTALLICD ITEDATE REMARKS/TYPE BY TYPF LENGTH WIDTH DEPTH ITEM A QUAFITITY -- -- 8TIFEET OPENED 84Q; 1St E-30W INS pt T I O - �. E _-- Q -._ U - ESTIMATEDSTREETOPENINGDATE: ___ S,r ESTIMATED STREET CLOSING DATE.:_ I E STREET (3) SECURITY NO. _-- SECURITY AMT.: E_-. - CLOSED SURETY CO.: _ __ FINAL. C[RTIFIRO CHrCH li CASH U •ON r7 r_ _IN- EC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL — SPECIAL PROVISIONS/CONDI rIO,IS: FEATURES; EXCAVATION LOCATION AND EXTENT. 0 Sae attached apec's/details. ( I 1 — I ( 1 1 0 A ' san.ltary seweC COMOCtiOn permit" must be obtained from uhe - ' the City Building Division before (see attached) connecting any structures to the C-112-95 ewer eyatem. • Notify City Inspector Letha Ttmms tAve. I I (639'•4171) 24 tics. before starting any work. (5) NOTE THE_ CIT, HERIESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAV JURISDICTION IS THAT OF WASHINGTON COUNTY DR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT- LAWS AND CONSTRUCTION SPECIFICATIONS Pr . .,:!FNT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINSTANY INJUR JR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS, APPLICANTS SIGNATURE DATE 10395 11410 ckf FK o ♦tee, W� O 34S p y `s Y� u' Ln ✓ O a' \2��g /2310 �/S tk `O 9y 31s ~ p I /2'100 O - 0�0 h v P �o ti of 12430 /Up / a(b `� O��O O �' '�✓ �`�� r •/ ♦ ��h �° 125'85 c�, /2q sp nf- N 1250i 190 N /n � ooKs, X2500 61. � h I 1' - P ylip eo li / s 0 , e% � b 00''T 0 j ti°16 s "� Oo�� o�°� �� , . ,, ?fit 0 I YD ��0 I '� ?68�• /r, 0 /2 I 0a /� "'o d -- DIST. 23J19 3 ♦ ��♦s 96 0 2S I 2E) C I ti e�• i s fr'/ oy i �r N J w ,•'��'10 I �f e J / 17 •+k �^•b +,'��'�� I ra e�� 110 o, log 0 9 i �Oj, I 8 ^' / 4 -INITIAL POINT CANCELLED TAX LOTS ' & til N 100,101,116,1000, 2101, •y * 90 �d 2900,3000,2700,3100,1900, j 6 ^�� / a6 3703,904, 104 �� J,% •°19 �� `�' 3 •a vJ �' �.,` , ! V,-116201 r+{, 2./3Ac. �• y fJ �'�� �� 'III +A� / ✓ �^ `/A✓// o b�°�`O�J �I2 44'°rro� 1 � ✓� 'fid �;� 10113 •��'1 2� ✓'/.,r` „t„�C 04 KSA-t- f 114 rr�' o .:r �j LV fJ n 13 o° ! ? ,1�� °" 400 4BAc. 4w 14 200 Q�a I e 500 �a��,�► ��,� 30d�� .4/Ac. +0 ' .tip • II `tie .89 Ac. Mti� 1400 y►' .3O Ac. •+s . 600 Js�• V / ' 1300 rye '°o° $111,1-19113 gyp% '3 + .30Ae.� /0�,�0- J i' •°lot '• a 70112 .75 Ac. ray .,° 700 01.1 ; Boo .6 'O0 y�'� ./7AC. Y 0o y� 1100 '1 ��W..* 0 e° '' ./9Ac. �a `sl*w SEE MAP �P J 2S i 28D C) J� 1102 ./7Ac. cy cr ¢, 902 s 4 /.27Ac. s �� ►�' .24 Ac. p � �= 2 8 A �r11 7 O S F c1 ,1►� I 7 00 N f'n L 61 !11 �r u 1 Q ?- cn+ cocn �, x rn x ao =w m OD 3 + 59 -5 + 25 N CNS e x 6"WY� % Ox 62 + 29 „ Cp tl) x x cr Q diX 6WYE 0 + 98,"4 3 � �. W. G fid A N T AVE. . ! - -- —--W-H-O + 00 (SEE SHEET G. 1 MH 17 + 061 ) // I . COMPLETE RUBBER SLEEVE (ASTM C-443) INCLUDES A MOLDED SEGMENT THAT HOLDS IT IN PLACE. 2. STAINLESS STEEL BAND (9/ I6" SERIES 3001 �^ SECURES UPPER HALF OF RUBBER SLEEVE TC HE PVC HUB. 3. PVC HUB (ASTM 3034 SDR 35) DRIVE INTO CENTER OF RUBBER SLEEVE AFTER SLEEVE IS PLACED IN HOLE. i 3 � I 2 HT1 ll CONCRETE PIPE _DLIII. Z1- NOTE: -NOTE: ALL INSERTA--TEE HOLES SHALL BE MACHINE DRILLED. urdfled INSERTA -- TEE s r DRAWING N0. 360 I I --~-�� PVC SADDLE (TEE) STRAP RETAINER RIDGES 1 RUBBER GASKET Z SEWER PIPE Nt '��-STA'NA'S S STEEL STRAP x PVC SADDI.E SHALL BE ASTM 3034 SDR 35 • PVC COMPOUNDS SHALL BE ASTM DIT84 WITH CELL CLASS OF 12454-•B/C OR 12364-C ■. ALL ELASTLMERIC SEALS (RUBBER GASKETS) SHALL BE ASTM F477 ■ STAINLESS STEEL BANDS SHALL BE 300 SERIES, FULL 9/16" WIDTH SAM, 5/16' SHOULDERED HEX HEAD, SLOTTED SCREW AND IS CADIUM PLATED, CARBON STEEL. INSERTION HOLE SHALL BE CORE DRILLED. PVC GASKETED unified SADDLE UfA6y pRAWING W. 350 NO%in I BUILDING SEWER PIP£, SIZE AS SPECIFIED PLANT FABRICATED TEE FITTING ON SEWERS 18" AND SMALLER. BACKFILL 2X4 FIELD TAP ON EXISTING SEWERS AGAINST PLUG TD AND NEW SEWERS LARGER THAN I PREVENT PLUG --- DIAN 18". 1 BLOWOFF B SECURE 2X4 IN PLACE WITH SEWER MAIN PLAN BACKFILL. I ,OR U►LATERALPLAN I I EXTEND AT LEAST GROUND 12"ABOVE SURFACE SURFACE MINIMUM SLOPE FOR 6" PIPE 2 0.010, FOR 4"PINE = 0.020. ICE CONNECTION MARKER: MAGNETIC TAPE �^ GREEN w/3LACK LETTER^ (WASTEWATER) GREEN w/SLAC( LETTERS (STORM ORAIN) PLUG 0 3/4"-0 PIPE ZONE MATERIAL. SUPPORT TEE WITH AS SPECIFIED BEMNG GRA','-L, ~Mum 2'b" w1DE Sl DE BUILDING SEWER Uf M Wu8, ,Cot,Itr Uwg, No. 300 MIN. 3" A C IN 2 - STREET AREAS ' OUT OF STREET AREAS '*AI.J CLr - EXISTING _ SEC]70N RESURFACINGCLASS A ' v• � BACKFILL E. O"— - CLASS B o r/ 3/4"-0 nRANULAR U , BACKFILL 0 ` or t< v � . lL 'a d o o c W O � 'Q • o �• u � ' • O • � ¢l l'1 •s C q e o Q W -a. a•• Cl_ .a • O (L p\A 'O •Q O D o >' .a U ' oW �P `• a ca 1 �—moo' - �e o • � P11tiE BASS BACKFILL IN 3TREET ARCA3 1.I r3/W 13 AGAINST CURB, FILL ROC.% TO BACK OF 3/W 2-(f 3/W 13 NOT AlUINST CURB FILL ROCK 2•BACK FROM CURB � CITY4FT11F.�RD PIPE BEDDING AND BAC_;(_ E1LL DETAILS OREGON DESIGN (3Y ArrWWE0 9-y DRPA AWN Y K GA r 15 SC1�LE DATE U)PAWING Na NTS 6/'50/, S_Z STANDARD CAST IRON-- FRAME Q COVER WA' i ERTICNT PIPE PLUG FINISH ORAOE ��: ;;:` • :::14'MIN. °0 ' 6M 0 ,0° \-STANDARD MANHOLE MIDI. C, a GRADE RING • NOTE' o ° 0 u: 00 CLEA/V�Gi'II' /NSTALLAT/OWS ARE a 0°'0 PROVIDE 5/4"-0 FOR A LIMITED TO EASEMENT AREAS � 0 0 oQ0 MINIMUM of G' AWAOID OR MAY BE ALLOWED ON A f e`'a °o OQ CLEANOUT TEMPORARY BASIS /N R/GqT-OF-•WAYS. A. \ a 60p 0�0 O \ a 7 O.Oo s 00on . Odd• Ao.O \ <- o0 aO p o ell-INa o e n 0AaQi� QO�0o 00 00 ....:• /1O CQNCRETE ENCASED WYE;: __-- - 3/4"-0 STANDARD CLEAN OUT Uf No. 15G rt 3/4' SV OJ;E Dt� A A 6 �1011011 8 O ' � 0 a UOs dov n0 on / a v 6p 5ECTION 8-8 SECTION A—A V4` AL -EN HEAD BOLTS - - I" u NG RECESSED 6" DETAIL CLEANOLF1 RING a COVER Unified Sever©rape Agency Chapter 8 -- STANDARD SPECIFICATIONS FOR. `bUILDING AND SIDE SEWERS 8.01 General Provisions The specifications contained herein, together with the State of Oregon Uniform Plumbing Code and all other applicable requirements of `ederal, state and local law, shall govern the installation, of all building and side sewer:,. 8.01 .1 Permits, Fees, Other Requirements The provisions of Ordinances 21 and 2.4 requiring permits, fees, and other requirements shall be complied with prior to the start of work on any portion of the sewer system. 8.01.2 Licensing of Sewer Contractor No person other than the Owner of the property on which the sewer is being installel or a state or DEQ licensed sewer contractor may excavate or dig up such property and install building sewers within the boundaries of the Agency. 8.01.3 Sewer Contract with Property Owner Contracts between property owners and sewer contractors shall provide that the sewer contractor will comply with any and all regulations of the Agency and other governmental agencies having jurisdiction over the construction. 8.01 .4_Service to Side Family Each single family residence shall be served by a side sewer discharging directly into a public sanitary sewer line. The minimum size of a s; de sewer shall be 4--inch for PVC and 6-inch for concrete. 8.02 Buildi�Sewers 8.02.1 Materials A. Pipes for building sewers shall be one of the following types or approved equal: 1) A.D.S. (Acrylonitrile Butadiene Styrene) , conforming to ASTM D7.751 . 2) P.V.C. (Polyvinyl Chloride) , conforming to ASTM D3034 . 3) Concrete conforming to ASTM C-14, Class 2. 4) Ductile iron or cast iron conforming to Class 50. } 8.02_2 Joints The ends of pipes, collars, gaskets, and retaining clamps shall / Chapter 8 - Building and Side Sewers -- Page 1 f be kept clean and free of foreign material when pipe is laid. All joints shall be made wate-tight and gastight. 8. 02. 3 Cleanouts All changes in direction shall be made with long radius bends, 450 , 22-1/20 , tee or wye branches with straight-throuyii opening plugged for a cleanout. Cleanouts shall be installed in the building sewer between the building outlet and the side sewer when the distance is greater than 100 feet. All bends within the sewer shall not exceed 135° without an additional cleanout Cleanouts shall be plugged to prevent entrance of dirt , roots, or ground water. Plugs shall be sealed with rubber gaskets and secured against back pressure. 8.02. 4 Size The minimum size of any building sewer shall be determined on the basis of the total number of fixture units drained by such sewer in accordance with Table 4-3 of. the Oregon State Plumbing Code. 8.02.5 Installation A. Connection. Where two buildings are adjacent to one another on the same lot , each building shall have a separate connection pi.pe to the receiving line. The pipes from each building shall be in separated ditches to point of connection on the receiving line. A duplex may be served by one side sewer providing that a deed restriction is placed on the property requiring the owners thereo': to be jointly responsible for maintenance of the building sewers and side sewer . A copy of the deed restriction shall be submitted at the time of sewer permit application. No roof, surface, foundation, footing, or other ground water drain shall be connected to the sanitary system. B. Connection to Cesspools and Septic_ Tanks 1.) Direct connection from all plumbing fixtures in the building to the sanitary sewer systam is required. 2) No connection shall be allowed from a cesspool, septic tank, or kitchen grease trap to the building sewer . 3) When a private sewage disposal system is abandoned and no longer to be used, all septic tanks, cesspools, and similar private systems shall be pumped and backfilled in accordance with the Department of Environmental Quality regulations. 8.02.6 Excavation All excavations required for the installation of a building sewer shall be open trench work unless otherwise approved by the Agency or City. Chapter 8 -- Building and Side Sewers -- Page 2 8. 02.7 Alignment All pipe shall be laid true to grade with the bells upgrade. Pipe shall be carefully centered prior to jointing. The bottom of the trench shall be smooth and free from rocks which may injure the pipe. The pipe shall be laid on four inches of 3/4-inch minus crushed rock throughout its entire length, and any such piping laid in fill shall be laid on a bed of approved materials and shall be adequately supported to the satisfaction of the Agency or City. 8.02.8 Grade All sewers shall be laid on a grade of not less than 1/4 inch per foot for a four-inch pipe and 3/16-inch per foot for a six-inch pipe. A. Special Release. If the grade of the side sewer or building sewer is to be less than 1/4 inch per foot for a four-inch pipe, or 3/16-inch per foot for a six-inch pipe, the property owner shall sign and acknowledge a grade release in a form approved by the Agency. The effect of such form shall be to release the Agency and/or City from all future claims for damages due to the installation of said sewer. If there is doubt about the grade, a grade release shall be procured before the pipe is laid. If upon inspection the grade is inadequate, the grade release shall be filed in the office of the Agency or City before backfilling takes place. In all special cases, the in3tallation of a back-water valve will be i required. B. Elevation. In any buildings, structures, or premises in which the house waste drain is too lora to permit gravity flow to the sewer, the sewage may with L,-.e approval of the Agency be lifted by artificial means and discharged to the sewer. Wherever a situation exists involving an unusual danger of back.-up, the Agency or City may prescribe the minimum elevation at which the house drain may be discharged to the public sewer. Sewers below such minimum elevation shall be lifted by artificial means, or if approved by the Agency, a back-water sewage valve m-iy be installed. The effective operation of the back--water valve sha'.1 be the responsibility of the owner of the property served. 8.02.9 Backfill If common material is available which is free from rocks one inch in diameter, it may be used to backfill. the remainder of the ditch. If suitable material. is not available, 3/4-inch minus granular material shall be used to backfill the trench to a point six inches above the top of the pipe. The remainder of the ditch may then be backfilled with common material. A modified method of backfilling shall be used where the house service laterals cross lawn, shrub, or planting areas between the curb and the property line. In this area, backfill sh. 11 be modified so that a minimum of 18 inches and a maximum of 36 inches of compacted top soil. hall be provided in the upper portions of the Chapter 8 --- Building and Side Sewers -- Page 3 trench. The lower portions of the trench shall be backfilled as described above. r 8.02.1.0 Cover Cover on private property shall be not less than 12 inches from top of pipe to finished grade. 8.02.11 Sewer and Water Lines Building sewers or drainage piping of materials which are not approved for use within a building shall not be laid in the same trench with water service pipes unless both of the following requirements are met: A. Separation. The bottom of the water pipe, at all points, shall be at least 12 inches above the top of the sewer line. B. Placement. The water pipe shall be placed on a shelf excavated at one side of the common trench. 8.02. 12 Testing All. builCing sewers shall be tested for leakage 15 minutes prior to the Agency or City inspection and prior to backfilling the trench. Sewers shall be tested by plugging the building sewer at its point of connection with the side sewer and completely filling the building sewer with water from the lowest point to the highest point thereof. The building sewer shall. be watertight and have no visible leakage. A tee shall bi installed at the property line at the expense of the installer. After the test is complete, a plug shall be inserted in the tee. After a satisfactory test has been performed, the trench shall be backfilled. 8.03 Installation of Side Sewers 8.03.1 Material A. Pipes for side sewers shall be one of the following types or approved equal: 1) PVC (Polyvinyl chloride) , conforming to ASTM D3034 . 2) Concrete conforming to ASTM C-14, Class 2. 3) Ductile iron conforming to Class 51. 8.03. 2 Excavation and Backfill All excavation and backfill. shall comply with Section 4. 02. 8.03.3 Alignment and Grade Chapter 8 -- Building and Side Sewers -- Page 4 Side sewers shall be laid in a straight grade and alignment from the main sewer line to the edge of right-of-way or edge of permanent easement. The grade shall be a minimum of 2 percent. The pipe shall be laid on a pipe base of 4-inches of 3/4 inch-minus crushed rock. Al]. plastic pipe shall have 3/4 inch-minus rock placed 6-inches over the top of the pipe. 8.03.4 Markings The side sewers shall be marked with a detectable underground magnetic tap. The magnetic tap shall be placed from the main pipeline to the end of the side lateral. The magnetic tape shall be green in color and have the following marking depending whether it is a sai.itary or storm line: 1) CAUTION STORM DRAIN BURIED BELOW 2) CAUTION SEWER BURIED BELOW A 2 x 4 stake shall be installed at the end of the side sewer extending from the invert of the pipe to the ground surface. A magnetic_ tape shall be placed alongside the 2 x 4 . 8.03_5 Testing Sanitary side sewers shall be air tested in accordance with the requirements in Section 4.10.4. Chapter 8 -- Building and Side Sewers -- Page 5 2) Caskets shall conform to the requirements of ASTM 477 and ASTM 3212. Threaded connections shall conform to the requirements of ASTM D2464 for schedule 80 pipe. - Solvent welded joints shall conform to the applicable requirements of ASTM D2-:66 and ASTM D2467. D. Polyethylene (PE) (Smooth-wall ) 1) Polyethylene pipe shall conform to the manufacturers specifications for durability. It shall be premium high density polyethylene resin qualified as Type III, Category 5, Class C, Grade P34 in ASTM D1248-81 and be listed by the Plastic Pipe Institute as a PE 3408. The minimum wall thickness shall be SDR 13.5. All pipe and fittings will be joined together by the method of thermal butt or socket fusion. E. Fittings g - 1 1) General. Tee fittings shall be provided in the sewer main for side sewers. All fittings shall be of f� sufficient strength to withstand all handling and load stresses ence-entered. All fittings shall be of the same materials as the pipe unless otherwise approved. Material joining the fittings shall be of the same materials as the pipe unless otherwise approved. Material joining the fittings to the pipe shall be free from cracks and shall adhere tightly to each joining surface. All fittings shall be capped or plugged, and gasketed with the same gasket material as the pipe joint, fitted with an approved mechanical stopper, or have an- integrally cast knockout plug. The plug shall be able to withstand all test pressures without leaking, and when later remo/ed, shall permit continuation of piping with jointing similar to joints in the installed line. 2) Concrete Pipe. Fittings shall be manufactured integrally and be of a class at least equal to that of the adjacent pipe. 3) Ductile Iron. Fittings shall be mechanical or push-on of the class as specified. Mechanical joint cast iron fittings shall conform to AWWA C110 and shall be of a class at least equal to that of the adjacent pipe. Push-on joint fittings shall be gray iron with body thickness and radii of curvature conforming to ANSI A21.10. 4) PVC Pipe. Fittings shall conform to the applicable portions of the following specifications: ASTM 01785, ASTM D2729, ASTM D2466, ASTM 2467, ASTM D3033, ar;d ASTM D3034. Fitting joints shall be the same as the pipe i ) joints._ __-� Chapter 4 -} Construct- ion Specifications -- Page 14 APPLICATION — STREET IMPROVEMENT/EXCAVATION COPY TO. ORDINANCE NO. 74-14 ® (WHITE)•FILE (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCvl (BLUE)•APPLICANT APPROVED APPLICATION NO.: , NOT APPROVED 0 LI IY OF 7IGARD, OREGON FIEF AMT.: S ,_�,y 3z•0c0�_y�r PENDING FEE.PMT. 0 CITY MALL RECi'!PT /3'.zn ssj PENDING SECURITY ❑ PUBLIC 6VORKS DEPARTMENTAri~'" DATE-_ _�----L_�_3� PENDING AGENCY ­OK­ L] Application and Progress Record - PENDING INFORMATION 0 1 Oil STRELI IMPROVLMIENT/EXCAVATION MAINTENANCE RQD PENDING VARIANCE CJ _- ANNUAL. EXPIRATION DAT : .–_�–�__� PERMIT NO.: _-- �4� DATE ISSUED: -. AA.L�_�� BY: I) APPL1C:ATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _ FIYATE_R _ _ _ _-k-wtgrljn8 Be['v1Cp stCt3ilt-•Gift _ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WI TH CITY REQUIREMENTS. 6391533 APPLICANT !ltiARL>B L WI`lODA!!D SW WAWYr ST TIC,AIRI), OR 97223 --� 639`CITY ­ -1M -1 p 0RF -� NAME A- SS '"-" NE CONTRACTOR—WAR—RM BROM & ASSOC- 11640 3" MESLONY LN. TUALATIN Ott 692-5948 NAME PLANS BY_ ; PER CITY STANDARDS it SPDCIFICATIOWc NAME _-_— A D O R ESI-_�• -.._-.__...-...___"-C 1 7 Y ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ DOLLARS -- --=cam ..-_ _ _ -,__•:.-�-mss.-z�-: -�'— -a:�...��.a- '2) EXCAVATION DAYA FOR UF><'IG,¢¢tt��r�; s nMtN. — _ 0.04 X 0 TUU.QQ _• s _'2.00 _ STREET __ DESCRIPTION PROGRESS & INSPECTION STATUS NAME SUR-ACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE Rt-MARKS TYPE BY TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY MARKS/ TYPE AVEMJE (� att ) R�ESP .a - -- R --' --�-- E U -- ESTIMATED STREET OPENING DATE:----_ / �–� E S ESTIMATED STRI~ETCLOSING DATE: / / T �- — - E STREE )3) SECURITY NO. ------ SECURITY AMT.: $ aw•00 CLOSET SURETY CO.: —'_ FINAL N[cK� CASH d snore 1 INSPEC..I. (4) PLOT PLAN: INDICATE SITE PERTINI<NT PHYSICAL SPECIAL PROVISIONS/CONDITIONS: FEATURES: EXCAVATION LOCATION AND EXTENT. —(.3ee attached) BIFOOKSIDE AVI MJB _-- 1 i I work. area 1 I 1 SITE 12500 S.W. BRf 0[S(pia V—E.I 1 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 ,)REGON. THE APPLICANT AGREES TO 'POSIT THE REQUt11[0 SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO COLI UCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLI,_ANTS ACTIONS, r 1�� APPLICANT'SIGNATURE: J�OM 'yy/� c{ }� - -.....��.. DATE