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11330 SW TIGARD STREET ADDRESS: is\records\microflm\tai gets\building.doc I un IRIA --T--.+.ti..�.,R�,..yr...Ynrt...sn.........._+r+...�n.�.n.�.......�1....+.,�._.,..,,.,-r-«r-. - APPLY AT►'JN STREET IMPROVEMENT/EXCAVATION COPY TO: ORDINANCE NO. 74-14 r , © (WHITE)-FILE r (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) I,// (PINK)-OTHER AGENCY bldg (BLUE)-APPLICANT APPRr`'rED 6iJ \ APPLICATION NO,: � NOT APPROVED O CITY (* TIGARD, OREGON FEL AMT. S 1.1.2-80 PENDING FEE, PMT. El :.1rY HALL. RECEIPT NO.: `13-2­37K-73 PENDING SECURITY G PUBLIC WO R KS DEPA R TMEN T BY ., DATE S I 17 PENDING AGENCY ''OK" ❑ Application and Progress Record — — — PENDING INFORMATION ❑ FOR STREET IMPROVEMENTIEY.CAVATIC MAINTENANCE BOND N. _ AS RF_t;LUINEU ANNUAL. U PENDING VARIANCE ❑ EXPIRATION DATE: 1 PERMIT NO. _ 1M_S3b`°P DATE ISSUED _-- /I— /__'1�_ BY (1) APPLIICCA1ION IS HEREBY MADL TO EXCAVATE_ FOR AND INSTALL _'IDN=Kf M SIDEWALK,'ANU DRIVEHAYAPR ` __. ._ --------------.--- __�_-____ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CIT`( REQUIREMENTS i 775-2285 APPLICANT _. Childs NA 8036 SE C_la�!St._ PuCtl�►r►d, Cit 9721 A 229-9544 di — Aho-TI[fS ---- -- CITY PHONE CONTRACTOR eagle FLANS BY r City d�„ r r +' & ;�r �j � tiy►�+ _ _._ --- — - A A�IDR[ff CITY MON ESTIMATED IMPROVEMENT TOTAL VALUAT0N ( COST): $ 320.00 ----- DOLS-ARS (2) EXCAVATION DATA: "OR OFFICE 1MIN. 0.04 x s � STREET __DESCRIPTION PROGRESS & INSPECTION! STATUS _ NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY STREET � — "— OPENED Tigard Ste at (. tit a taI_:he } I rPC - ON E — Q ESTIMATED STREET OPENING DATE_ E ESTIMATED STREET CLOSING DATE: ____j j E —" - - - D �lU.(;� L-LOSET (3) SECURITY NO. SECURITY AMT: $ cLas _ Eu SURETY CO.: _ — FINAL - -- "&.0 HECK CASH ❑ SONG INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS: FEATURES: EXCAVATION LOCATION AND EXTENT. ) Right-of-wayd ic:ation or ea$� I!Iu11L'c L'U 'c is ' 30 f rOtll coater l •i nt. t. Notify Inpr,ector Letha Thctms I I I II"71-7` ra. before s r ny work- CURB - - - '-� - � 1� 3. All work :;hall conform Lo City Standards & spectic catcat>�n�. S. W. TIC" _ STREET -} 4, ORS 757.541 - .571 (Utility Co. pre-! area - _N_ -__jar by coi)tractur. I I I I I IErosion c011t1:01 Imat be provided I SITE;: 11330 SW Tigard St.1 ,� ) c My colmraccor. IM9316 Rt. WINH notU :_. -- _ .a=..-...:, -__- - =�-�.-._.. tf�'�h�ta�fic, -at-a►�y xla�. (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. - HE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CCNSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJU?vY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. 1 APPLICANTS SIGNATURE ! t A r L-- GATE —; 1 /