9155 SW NORTH DAKOTA STREET FILE NO. �y 9 STR. OPN. PERMIT
NORTH DAKOTA STREET SW - 9155
i
CIT XTWAM
EXPENDIT'C E REIMBURSEMENT REQUF,ST
1
This form is a muiti-use form. Where appropriate receipts must be attached.
Documentation is important for all purposes. Staple iccumentation to form.
VENDOR NO: DATE:___
PAYAB).E T0: Requested by:
r GCCG¢RCC
---------- ^S SSCIICIIC .....GC4IICCCL�.----S1 L'GC6CG 06
MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc. ) :
Date Description Account No. Amount
_ ; , , c . ] �_.lY-:+_+nc cv •\�n- 1'1 - Z Z CSC, 6CXR, 00
c-
=r�rr_----------¢nez¢Exa IIas=aQs.- --n. II-ccvn---------
GENERAL MEAL EXPENSE-
-Date Description Amount
Account Number to b, clarged: r Total
C3CCISCOC¢CS¢�lS.:LSCSS[SECC¢E_..--L'ECS::[--...0---CII-.�C�-^���II¢C�[::IIC CC CASE ---
C-LtE 3EE 6S CC¢SSIIII
MILEAGE:
Date Description: (Include en /!.tart readinl,s and to al miles) Amount
I Actount Number: Y _ Total
rria...r¢measnnr_c c...sc¢EE��¢��c._ •-os� mJ� 1CS x$.21
CE=EIIE=---SCS:L'. -¢CU¢CCEG-L-S tGSCSSptS CC
APPROPRIATION BALANCE; AS OF:
- �. Signature_
AP°ROVALS (if $25.00 or under mcy be reimbursed throng' petty cash) :
(u') to s500.00Section Manager
. . Pur<•,h• Agent _
($500.01-$5,000.00)Dept. Head/rur•ch. Agent
—_
APPLICATION - STREET IMPRO' 1ENT/EXCAVAIIONtYELLOW),
PY To:
ORDINANCE NO 74-14 WHITE)-FILE
INSP,
(INSTRUCTIONS ON SEPARATE. SHEET) (PINK)-OTHER AGENCY bldg
(BLUE)+-APPLICANT 7
APPROVED X APPLICATION NO.: 74-
NOT APPROVED CI I Y OF1GARD, OREGON FEE AMT.; 5 Z,4��---L
PENDING FEE PMT. [] CITY HALL, RECEIPT O �ZL=45,73 _--_
PENDING SECURITY [1 PUBL IC WORKS DEPA R TMEN T BY DATE_ -7 114-1 c57
PENDING AGENCY ''OK" ❑ Application and Progress Record 1n—
PENDING INFORMATION C_)
FOR STREET IMPROVEMENT/EXCAVATION M 1ASEE""IRE°oN C 1a$
ANNUAL
PENDING VARIANCE [] EXPIRATION DATE: ,rear
PERMIT NO S�J_ DATE ISSUED ] .1141 `Z._ BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _ Sewer Co nection _
_ _Lat-e::al AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS
vw,le- z49
APPLICANT Aconomy Homes 4900 SW Griffith Dr. Beaverton,011 97005 226•-3901
N
-- -----
ADORE95 --�-- CIT v-----
CONTRACTOR—Rill %k 40132 S.F. Skaw M pE Rd. Estacada, OR _�_ 630-5050
CITE—_ -__��---PHONE
PLANS BY _per eitj standards and specifications
-- NAME ADDRFSS ---- CITY
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ __600.00
DOLLAR! __
FOR OFPI 5
(2) EXCAVATION DATA: MN
0.04 X s _ s s 24.00
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT I CUT MATERIAL INSTALLED ITEM DATE REMARKS/'TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
atd��Dakota treet See 9t ached )rawing STREET
INSPEC-
R TION
E -
O
ESTIMATED STREET OPENING DATE: __�_- / E
ESTIMATED STREET CLOSING DATE: T
�._. E
STREET
(3) SECURITY NO. SECURI,TYAMT: S 6�•� CLOSED
SURETY CO : FINAL
cEkrlrl€OCMe t �� BOND INSPEC. .'
(4) PLOT PLAN. INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. 1) Notify City Inspector
Mr, Mike Mills 0639-4111)
1 1 ( ( prior to commencing work
SIVA 911t Ct. SN 9nd Av .
1 I I in a roadway.
CURB - `. _ _ _ _ _ _ _ _ _ _ _ ,' _ _ _ _ 2) All work shall conform co
S.W. North Dakota City of 2'iaard, U.S.A., and
t -- -- - _ State Plumbing Code requirements
( — - 3) Contractor Shall provide for
( 1 1 traffic control
per the Manual
' I 1 Woax I I On Uniform Traffic Control Devices.
^
9155, Sw Ase w~0M ss;)
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERF
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 ANr)
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGN ATUR�=�=' � �'� — /
GATE
i rl
/0(i
T LIMITS
SO/
Illlllllllllllmum
502 - 2600
203 204
30,0
400 20/ 200 ------- -----�- -
2603 2601
500 r -
30/ 302 202
=m T QO`D -t °o
rr• a o _ r o D I ' N o ao c�
Lr n. rr oo 0 1 A _
.008 36 -- 8„ .018 370 8' .014
IUUWT
8"STUB DAKOTA 8"STUB
T (\i °D
DI r
N 4300 4200 2300 27.00
V
Z 01'1-177O/ / 73C
l/1
Orl
c�
z
Mon
MIN. 3" AC IN 2 LIFTS
STREET AREASI OUT OF STREET AREAS
5Aw Cur-- ---- --
FXISTS --
ING _ I
SECTION RESURFACING 4
O � -
' CLASS A
BACKFILL
o •'
' a
F-
CLASS B U
3/4!-0 GRANULAR
BACKFILL 0 • ,o• • li
U
n 0
7 J• <• \ \
W - •O 1 •.O n .o W
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CL
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QD '. 0
Q = • •e �• •o ' o
W tl b o p
a, • e '' p
4 1
PII6E BASF_
BACKFILL IN STREET AREAS
I.IFS/1V 13 AGAINST CURB, FILL ROCK TO
BACK OF S%W
2.IF S/W IS NOT AGAINST CURB, FILL ROCK
2'BACK FROM CURB
PIPE BEDDING ANDCITYOI: WARDBACKFILL DETAILS
OREGON OE516N e,Y _ 4PPROVEC) F3Y OW-41..1N IiY
1. GA RES
5CALE DATE C7IZAWING NO.
NTS 5-2
DUILDINO SEWER PIPE, SIZE AS SPECIFIED i
\ PLANT FABRICATED TEE FITTING
ON SEWERS IR" AND SMALLER. BACKFILL 2X4
FIELD TAP ON EXISTING SEWED AGAIN-`T PWG TO
AND NEW SEWERS LARGER THAN 1 PREVENT PLUG
1 BLOWOFF 6 SECURE
THAN 10 2X4 IN PL/.CE WITH
ITRENCH RA�,1(F1LL•
EWER MA1N PLAN
r-7 L A^1
OR LATERAL r� 'V 1
1
j I EXTEND AT LEAST
GR0t1r10 IZ ABOVE SURFACE
r1 SURFACE
MtHIMUM SLOPE FOR
G"PIPE'0.010, FOR
4"PIPE= 0.020. :;r-RwCE CONNECTION
MARKER
WRAP 12-IG GAUGE
GREEN LOCATOR 4�t
--WIRE AROUND 2X4
LUG
- —�-"'— 3/4"-0 PIPE ZONE MATERIAL
r -+ AS SPECI FI E D
•�=�.�, -s'-.r SUPPORT TEE WITH
REDOING GRAVEL.,
V� MN7NUM 2V WIDE S I DE
r
BUILDING SEWER
Uf fied w a Agency1
Uni
i' `I of Washington Coounty
CITY fiF 710(iRD RECFIF' l CIF R E,,C NO: 00104577,
AMOUNT 624.00
NAMF: AC-0NOM'Y H(.lME,., CASH AMCIUNT . 00
A 1)1)PS S S 4900 SW CiPIF-FITH sTE. 249 Pi4frlt-NT DATE: 07-14-.89
sEAvr-*r;.,ror%i, cip w7om, SLOCK' NO/AY)I)f.',.
PURPOSW OF t'A'YMEI',JT ON01 JN I PAID PURP09E OF Pt'�OIF.N'r All(JUNIT PATLI
CUSTOMEP DEr,OSITS COO. 00 PURI-IC 111PROVEM (13181t, T4. 00
I'Olot. (4MLION't PAMD 624. VJO