9115 SW NORTH DAKOTA STREET FILE NO. 473-92
NORTH DAKOTA ST. , 9115 STR OPt-4 PERMIT '`
.DEFINE:entrct=case->eng definition incorrect
ENGINEERING PERMIT
PERMIT #. . . . . . . : ENG92-0010 DATE ISSUED: 03/10/92 By: _
PRIM. PERMIT # . : ENG92-0010
SITE ADDRESS. . . : 097.15 SW NORTH DAKOTA ST PARCEL: 1S135DB-07800
SUBDIVISION. . . . : ASHBROOK FARM ZONING: R-4 .5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :25
----------------------------------------------------------•----------------------
PERMIT TYPE. . : SOP IMPROVEMENTS QUANT RATE VALUE
AGREEMENT DATE: / / GRAD/EROS
ASSURANCE EXPIRATION--- STREET
PERFORMANCE: / / SAN SEW
MAINTENANCE: / / STM SEW
UTILITIES
ALL OTHER
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
Remarks: STREET OPENING, TO INSTALL SANITARY SEWER, WATER & GAS SERVICE LATERALS
TO SERVE A RESIDENTIAL LOT.
Permittee: -----•----------- FEES --------------
TROY BRYAN type amount by date recpt
5150 S .W. GRIFFITH #100 OPEN $ 60.00 JSH 03/10/92 224322
BEAVERTON OR 97005
Phone # :
Engineer:
ENGINEER NOT ON FILE
$ 60.00 TOTAL
Phone #:
- ------ REQUIRED INSPECTIONS -------
Permittee/Agent Signature: ---STORM SEWER-- -----STREET-----
_ M.H. & C.B. CRB LINE & GRADE
PIPE LN & GRD SUBGRADE
BCKFLL & CMPCT BASE ROCK
AIR & TV TEST LEVEL COURSE
City of Tigard, Oregon WEARING COURSE
13125 S.W. Hall Blvd. ---SAN. SEWER--- TRAFF & PED CONT
P.O. Box 23397 M.H. & C.O. MONUMENTATION
Tigard, Oregon 97223 PIPE LN & GRD STREETLIGHTING
Phone #: 639-4171 BCKFLL & CMPCT WALK/APRON/RAMP
AIR & TV TEST
FOR INSPECTION, CON'T'ACT: -----GRADING-----
Carl Vieweg #639-4171 (office) --REPR' S/ADJ,S-- CONTOURS
#780-2647 (mobile) DRAINAGE
----PATHWAYS---- EROSION CNTL.
APPLICATION - STREET IMPR %IENT/EXCAVATION +�'' COPY TO:
ORDINA ,ENO 74.14 �, Xj ( WFILE
�i] (YYELLELL OW)•INSP.
(INSTRUCTIONS ON SEPwRATE SHEETfj (PINK)-OTHER AGENCY bldg.
(BLUE)•APPLICANT
APPROVED 91 i -LICATION NO.: 5149
NOT APPROVED U CITY OF"i'IGARD, OREGON FEE AMT. f 60.00 _ y
PCNDING FEE, PMT'. ❑ C1rV KALI. RECEIP _ 27-43zz
PENDING SECURITY ❑ PUBLICWOR KSDEPARTMEAr flyV_- DATE 3_ LLo La z-.
PENDING AGENCY "OK" ❑ Application and Progress Record ^.IAI•,l'SPJANCE BOND
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVA.T ION AS R: jUIAFI]
ANNUAL.
PENDING VARIANCE ❑ LXPtRAl O 01-TE.. 7.eq
PERMIT NO.: _ �'1 =�.z- DATE ISSUED: ___3_���' r�, BY
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL ANITARY SEWER,_WAT __-& GAS
SERVICES AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _.TP.OY R. F,RYAN 5150 SW GRIPFITH #100_ 13EAVcE_-XTQN_L��7SX�`.z__—b41_-5582
-- - N IMF. — �ADDR[SS CITY PHONE
CONTRACTOR SILL ERNST EXCAVATION & BACKHOE 1709 SE 74TH, PTLD.,OR 97215 774-5622
NAM11IF ADEP ESS PHONE�
PLANS BY PER 'CITY STANDARDS/SPECIFICATIONS
NAME ADr1RF.5S CIT PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 15QQ._Q(._ _
DOLLARS _
(2) EXCAVATION DATA T3---- f PCR" 'IfW'60' z J60.00 MIN
0,04 X f _
STREET _DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYPE LENGTH WIUTH DEPTH ITEM d QUANTITY _
STREET
N D
NORTH DAKOT A.C. se atta ed INSP C-
R TION
E `
O
U
E
EST!MATED STREET OPENING DATE:
ESTIMATED STREET CLOSING DATE: / E
D
1 I
STREET
(3) SECURITY NO. SECURITY AMT,: E 1500.00 _-- CLOSED
SURETY CO.: ----_.-- _ FINAL
_ _ _ CHF'_�t X CASH o 1loND ! INSPEC. "01.0 Z. (-p�Jt
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. -Notify City Inspector Carl Vieweg
(SITZ_ : 9115 SW North Dakota St. ) (639-4171) 24 hrs before starting
w I wor work area ^ 1 I
1 \• � I i I
* 1k.
.ORS 757.541-571 (utilities pre-_
notification, etc) applies.
CURB - '- - - _ - - - - - - - - - � _ _ _ - -- - -
.Traffic control must be provided
?--SW- DAK ------ _ for; closure of the roadway is not
allowed.
.TIL work shall con orm to City-
1
I I 1 I .A HAM sur ace
pa c1 is required
aIf a enci of each days wor -
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 15 THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS APO
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJORRY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATUR�i-. 1►.— DATE
,.......-.n•. ^.-n.,,r„�-.�,,.,"^"e"^^��.R.n-..,, ._�ni, „ryx..twr••r a+rTM-w•r+.+»�^-.*..-r+t-+*.---.�r-•7^.-.w-•ry...--....--..�.i'_-..�..w.,�,y..,�..,r....-.....
APP_L CATIQN - STREET IMPROC 1ENT/EXCAVATION r COPY TO:
ORDINANCE NO. 74-14 ( T) (WHITE)-FILE
(YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCY bldg.
(BLUE)-APPLICANT
APPROVED ® APPLICATION NO.: 1-1;1� _
NOT APPROVE.0 ❑ CI I Y OI' IIGARU, OREGON FEC AMT. S 60.100
PENDING FEE PMT. ❑ CI Y IIALL RECEIPT NO.: 77-4 3 Z Z
PENDING SECURITY ❑ PUBLIC'WORKS DEPARTMENT By — -_-_ DATE__._-___L—�..�
PENDING AGENCY ''OK" ❑ Aphlicalicln and Progress Record ^. — — — _ -- — — — — — — — — — —
MAINTENANC': BOND s.
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUII,XD
ANNUAL
PENDING VARIANCE ❑ EXPIRAT O 1)DAT^: . f /
PERMIT NO. 4-7 L-�_Z. DATE ISSUED: --- 1_��1 �1 - 9Y: "'"
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ SANITARY SEWER, WA _& GAS
SERVICE: _ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _TROY R. BRYAN 5150 SW_ GRI FITIi if1U0 BEAVERTON, OR 971005
NAME ADDRESS CITY PHONE
CONTRACTOR BILL ERNST EXCAVATION & BACKHOE 1709 SE 74TH, PTLD.,OR 97215 774-562
NAME ADDR.SS -- CITY ----� PHONE
PLANS BY _PERCCITF STANDARDS/SPECI!"ICATiONS
-
NAMR ADDRESS CITY _PHONE
ESTIMATED IMPROVEMENT TOTAL VALUAI ION ( COST): $ 1500.00
DOLLARS
E MIN.
'
(2) EXCAVATION DATA: 0.04 X s FOR OFFIfi (�•UQ = S 60.00 _
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
^_ TYPE LENGTH WIDTH DEPTH I'rEM & QUANTITY
STREET
OPENED
AoRTH D ►.;:. se a a a ,, - INSP - --`
R TION
O
U -----
ESTIMATED STREET OPENING DATE: E-_.__ / L_— S
ESTIMATED STREET CLOSING DATE. _ /_ � E
D
lcJ� STREET
(3) SECURITY NO. SECURITY AMT.: S CLOSED
SURETY CO : FINAL- -
_ CHE_CN w CASH O _IOMD INSPEC.) l�
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. I.NOtify City Inspector Carl Vieweg
(SITE: 9115 01 Nocth Dakc"tA S . ) (639-4171) 24 hrs before starting
1 I work area I + work.
+ , 2.ORS 757.541-571 (utilities pre-
- notification, etc) applies.
3.Traffic control must be provided
SW NORTH DAKOTA STRECr _ or; a osure of t e roadway is not
allowed.
-elle - � - - - - -- -• - •• - -
_�``) ,' 1' r _ worK shali con orm to cl.ty
at the ant, Of ch nay'q .
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 CITY AN"t
EIAPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
—
APPLICANTS SIGNATURE w -- DATE �
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IN 2 LIFTS
STREET AREAS (1UT G'F STREET AREAS
slaw_CUr--
EXISTING
SECTION RESURFACING
2'of 3/s3:'-o..-------
CLASS CLASS A
/ • _ ' BACKFILL
s -
2" n" _�--- f o• h
J
CLASS B
3/4"-0 GRANULAR
BACKFILL C - O
41,
cn
O
-o . O • C e
U 4 . .
• I v a o
i —� '^• ' - - o ----
PIPE BASF
BACKFILL IN STREE]�AREAS_
L IFS/W 13 AGAINST CURB, FILL ROC,% TO
BACK OF S/W
2.IIx 3/W 13 NOT AGAINST CURB, FILL ROCK
2°BACK FROM CURB
PIPE BEDDING AND
CITYOF TI6i4RD BAC-;(FILL DETAILS
OREGON OE516N f5Y APFFWWFIJ F3Y DRALJN 1W
GA 2 E5
`JC-ALE. DATE DPAL,JING 1`10.
NT.S 6/50/66 E. "2-
i . COMPLETE RUBBER SLEEVE (ASTM C-4431
' INCLUDES A MOLDED SEGMENT THAT HOLDS
IT IN PLACE.
2. STAINLESS STEEL BAND (9116" SERIES 300)
SECURES UPPER HALF Or 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.
3 I
2
1
CONCRETE PIPE
NOTE: ALL INSERTA-TEE HOLES SHALL. BE MACHINE DRILLED.
u
^-
nMW
I NSERTA -- TEE �
DRAWING NO. 360 !_ ��
i
PVC SADDLE (TEE)
I I
STRAP RETAINER RIDGES 1 1
I 1 -RUBBER GASKET
SEWER PIPE
ST-A'`A=SS STEEL STRAP
• PVC SADDLE SHALL BE ASTM 3034 SDR 35
• PVC COMPOUNDS SHALL BE ASTM DIT84 WITH CELL CLASS OF 12454-8/C
OR 123614-C
■ ALL ELASTOMERIC SEALS (RUBBER GASKETS) SHALL BE ASTM F477
■ STAINLESS STEEL BANDS SHALL BE 300 SERIES, FULL 9/16' WIDTH BAND,
5/16' SHOULDERED HEX HEAD, SLOTTED SCREW AND IS CADIUM PLATED,
CARBON STEEL.
■ INSERTION HOLE SHALL BE CORE DRILLED.
PVC GAGKETED unwed
SADDLE
ufn
DRAWING NO. 350
Ii
I
I
-BUILDING SEWER PIPE, SIZE AS SPECIFIED 1
PLANT FABRICATED TEE FITTING
ON SEWERS IB" AND SMALLER. \BACKFILL 2X4
FIELD TAP ON EXISTING SEWERS AGAINST PL;IG TO
AND NEW SEWERS LARGER THAN I PREVENT PLUG
THAN 18". I BLOWOFF 8 SECURE
2X4 IN PLACE WITH
-- i TRENCH BACKFILL.
--SEWER MAIN P��N 1
OR LATERAL
1
EXTEND AT LEAST
GROUND 12'A80VE SURFACE
SURFACE - r
MINIMUM SLOPE FOR "
G" PIPE- 0.010, FOR
4"PIPE- 0.020. ----.SERVICE CONNECTION
MARKER:
WRAP 12-16 GAUGE
�\
GREEN LOCATOR
WIRE AROUND 2X4
PLUG
3/4"-0 PIPE 70NE MATERIAL
AS SPECIFIED
— SUF'POk i TEE WITH
BEDDING GRAVEL,
MINIMUM 2'0" WIDE Sl DE
BUILDING SEWER
L)f
Unified Stweraga Agency
of Washington County
e17- '
voikT M�Mkykl.t/W 5 4A�
Aof
gvl
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S
('9D /U/A)
6000- 74
10 Af IN
- OAM I&W
to LO 4-
f
CITY OF TIGARD
EXPZ1,M=X RD)UESr
df*, form is a multi-use form. Appropriate receipts must be attaclic-A. Documentation
jq)ortant. for all purposes. Staple documentation to form.
Ka
VENDOR NO.: A N Z2. IC
PAYABLE M:
RD:J�� BY:
V I,/
ar---a!_4—e-V-- Or -7 b 0 n; Approved request 'du 6 Wab)esday
10:00 AM to A/P for checks by
Friday.
MISCEIZANDOUS EXPM.)IIURES:
Date Description, Invoice No., etc. Account No. Amount
-z
`IVJ P-A1, a 1
cSoo
ao
Mileage $0.255
APPROPRIATION BALANCE: AS OF: SIGNAWRE:
(Up to $25.00) Section Manacter Purch. Agent
($1-5.01-2,500.00) Division K-ulage-r
($2,500.01-7,500.00) Dept. Head
($7,500.01-15,000.00) City Administrator
($15,000.01- ?) Local Contract Review Board
1.501F
BRENDA BRYAN 137
TROY R. BRYAN
PH 641-6589 19 24-201/1230
5150 SW. GRIF:ATH, NO. 100
BEAVERTON, OR 97005
PAY TO THIEJ�
$
ORDER OF.
I DOLLARS
'ley"enk ol'bre"
Tige",Office
t211665 SW Pac Ic Ify..P.O.Son 23486
B!�NK TIgard,OR V221,
SID.
1: 12 300 2 0 111: 9 2806 5 211' 117
(:vry or Tisnpi) pFur, irli ar Pr1ytjF7N1' RECKIPT ND. C)':_- 4
CHECK (1110UN T 155 61A. 0(A
NAME, ! IIRYAN, TROY cAsW AmouN r 0. 00
ADDRESS 2 Sw GRIF11: 11.1-1 PAYMENT OWE 0,3 i J 0
110 too SURD I Y 1 1;T ON
BF.HYL.1041h], LIR 47005
PURPIMSE (31" PAYMFNI PM0014T PATD PURPOSE OF PAYMENT 0MOUNT P0 I D
PUSLIC u1 MF _-_-.-...60.
0. 00 CUSTOMER DE PC]
4 7A- -)i,:' STREFA OPENINO PERMIT
'i 01(41 AMOUNI PAID _ f 1560. 00
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