11250 SW 78TH AVENUE FILE NO. 3
78th AVENUE - 11250 STR. OPN. PERMIT r
C1TY OF TIGIAM
EXPINDIIIM RBQU(=-
11iii. form is a multi-use form. Appropriate receipts mist be attached. Documentation
LS important For all Staple documentation to form.
VU=R NO.: _ _ DATE: AU c1R o
PAYABLE TO: Rn�nc-k 5c, ,a el ar. RDQUESTED BY: C !L-X& I)0,j es
O n CL
-- Qn r ��•an DTP__Acrt 912 I I * Approved request due Wednesday
10:00 AM to A/P for checks by
Friday.
MISCELLANBOUS EXPENDITURES:
Date Description, Invoice No., etc. Account No. Amount
Or
S L, tu-
LiTt7rAL $
Mileage $0.255
APPROPRIATION BALANCE: AS OF: SIGNAIIM:
(Up to $25.00) Section Manager Punch. Agent
($25.01-2,500.00) Division Manager
($2,500.01-7,500.00) Dept. Head �/z
_`-
($7,500.01-15,000.00) Ci Adminis
City trator
015,000.01- ?) Local Contract Review Board
�/1501F
APPLICATION -- STREET IMPRO ' -MENT/EXCAVATION " " COPY TO:
ORDINAL'—E NO. 74-14 [2 (WHITE)•FILE
® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)-OTHER AGENCYbldg.
(BLUE)-APPLICANT
APPROVED X APPLICATION NO.
: M 4-78 _..
NOT APPROVED (- CITY OF TI�GARD, OREGON FEL: AMT.: f 6.00
PENDING FEE. PMT. ❑ CITY HALL RECEIPT . — 1 -z 11555*
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY ---� DATE
PENDING AGENCY ''OK" ❑ Application and Progress Record MAINTENANCE BOND �r
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REuujf4ED L,
ANNUAL
PE14DING VARIANCE ❑ LKPIRA ION DAY19:
PERMIT NO.: � �3-91 DATE ISSUED -._.L.1 !1_ 1— BY:
11 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ CRU79D RWK-,S WT-DER AND
AN AREA DRAIN_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS
APPLICANT Patrick Scheeland 3741 S.W._hQmQ a_____ Portland, CR q'l�l9 245-4915
NAME ADDRESS CIT: PHONE
CONTRACTOR (
Same) _
NAME -AbDRESS _—
PLANS BY per Cit St?.ndardsL—Specifications
NI,ME ADDRESS CITY PHONE
ESTIMATED IMPROVEML.-4T TOTAL VALUATION ( COST): $ 150.00
---DOLLARS
) EXCAVATION DATA:
FOR OFF I(
(2196".'00
USE
_ 0.,04 x S _196".'0
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM 6 QUANTITY_
STREET
OPENED
78th Averue INSP -
R TION
E
Q
U
ESTIMATED STREET OPENING DATE: / / E
S
ESTIMATED STREET CLOSING DATE: �.� / / E
STREET
(3) SECURITY NO. ____ SECURITY AMT: $ -150.99..___ CLOSED
SURETY CO.: FINAL — )
CERTIFIED CHECK CASH 0 BOND INSPEC, /�) 111 A
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. 1. Notify City Inspector Carl
Vieweg (#639-4171) 24 hours
'Arc-02.I q before starting work.
f I I Allwork shall conform to City
� V 1 1 L- _ Standards & Specifications.
3. Excavator shall comply with
78th AVENUE -
-- --- - ORS757.541-.571 (re: utility
prelocation, etc. )
4. Traffic and erosion control shall
1 ( I I I - be provided for by the contractor
( I 1
(S) NOTE TNF. CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS Th AT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES 1'0 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 AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RE ' LT FROM APPLICANTS ACTIONS.
ii
APPLICANTS SIGNATURE -.�. T''•._�, DATE C Cr
APPLICATION - STREET IMPRO' -MENT/EXCAVATION COPY TO:
LX (WHITE)-FILE
OR DI NA1v:E NO. 74-14 ® (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) (B (PINK)•OTHER AGENCYbl(�].
(I (BLUE)-APPLICANT
APPROVED It APPLICATION NO.: _4___7_5___
NOT APPROVED ❑ CI1 ' UI' T►GAR1), OREGON FEC AMT.: S 6.00 _
PENDING FEE. PMT. ❑ 0111 111AI-,L. RECEIPJT'NQI: _ 9 —z1g5"ZZ --
PENDING SECURITY ❑ PUBLIC WORKSDEPARTMENT BY_ .�_ DATE "1 / 19 /91
PENDING AGENCY ''OK" ❑ Application and Progress Record Y
MAINTENANCE BOND
FOR STREET IMPROVEMENT/EXCikVATION rc
PENDING INFORMATION ❑ As RoulRED
ANNUAL
PENDING VARIANCE '� EXPIRA ION DATE: -__—
PERMIT NO : 3 ."q� _ _ DATE ISSUED: �.Ll�_L_ L�- _ BY:
( 1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ ._._(='RUSljED Y ROCK $[_, DEP. AM)
AN ZMM DRAIN AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT Patrick Scheeland _ _ _ .3441 S.W. Pw 14 Pcrtland, _QR 9?119T_— 24_ 4915___ -
NAME -- ADDRESS CITY PHONE
CONTRACTOR (Same)
NAME ADDRESS CITY 1'HOhC
PLANS BY - pel:_City 5ta1ri rdg & SpecjfiEat_iniyA _
NAME ADDRESS CITY PHON--
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 150.00
DOLLARS
FOR OFFICE Use!
(2) EXCAVATION DATA: 0.04 x S_150.170 _= S
STREET __DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DA'Z'E REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET ~�
P g,N r
6D
78th Averue INSP C-
R TION
E --
Q
IJ
ESTIMATED STREET OPENING GATE:__-_._---_....__L_ _
ES
ESTIMATED STREET CLOSING DATE: .__ E
D
STREET
(3) SECURITY NO. _ _ _. SECURITY AMT.: $ 150,00 CLOSED
SURETY CO.: _ FINAL ^_
CER i1 r1E.o CHECK �.lCASH 0 AONO 1 INSPEC. 1`3 1 :�
(4) PLOT PLAN: INDICA I'E SITE PERTINENT PHYSICAL �- SPECIAL PROVISIONS/CONDI IONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. I. Notify City Inspector Carl
Vieweg (#639-4171) 24 hours
before starting work.
I rW 1, 1 2. Allwork shall conform to City
Standards & Specifications.
CURB ' \� — — — .. _ .. — — •� — —
78th AVENUE3. Excavator shall comply with
OL ORS757.541-.571 (re:autility
prelocz-.tion, etc. )
4. rraf f i,; arid erosion control shall
rz
I be provided for by the contractor
(51 NOTE TME 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 T14E REQUIRED SECURITIES, 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 MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE �. 'r ` !� DATE
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8 NOTES
PLAN I. CONCRETE SHALL ATTAIN A MINIMUM
COMPRESSIVE STRENGTH OF 3000 P.S.I.
1N 28 DAYS.
2. FOR FRAME DETAIL, SEE DWG. NO. D-107.
3. FOR GATE DETAIL , SEE DWG. NO. D-108.
171/21
30
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DITC H
27" 24"X.Ma II\ `_ 277__ 1� 24"
MAX. MAX. MAX
w
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2-0"
— .2'-331'9
3'-0" — 3'- 3%,
SECTION A—A ELEVATION 8-8
WASH114GTON COUNTY
--. DEPARTMENT OF LAND USE AREA DRAIN , TYPE II
AND TRANSPORTATION
SATE CIVIL ENGINEER MAWR APWA NO. WASK COUNTY NO,
1 - AEA b 85 4 ( MOD. ) D-- 105
FOR CURB PLACEMENT 'IEE OWE
NO. CS-304 AND NO. `D-104 ,i�=*—2'-3 3/8"
MIN. MIN.
EXISTING PIPE
A Q
USE OVERSIZE
FRAME AND GRATE
EXIST. GRATE
LOCATION
INSTALL
3/8"x 4"
DOWELLS
AT 6"O.C.
REMOVE
6 B CORNER
0
oc
EXISTING �
FRAME AND GRATE A
SEE DETAILS D-107 9 ECT I O N A - A
0-108 EXISTING DITCV' iNLET RAISED TO MAKE
PLAN VIEW OVERSIZE CATCH BA IN
_DITCH
BOTTOM
FlI
I I
_ 1
F R 0 N T
! EXISTING ELEVATION 8 - 8 EXISTING ELEVATION A - A
CONCRETE TO BE 3000 PS.I.- 28 DAYS-6 SACK MIX
WASHINGTON COUNTY
'�DF-PARTMENT OF LAND USE RAISED AREA DRAIN
AND TRANSPORTATION
DATE CIVIL ENGINEER DRAWN APWA NO. WASK COUNTY Na
NONE D - 106
J�--- 2 - 3"
A I
A
m ti
a a _2 1/2"X 1/4" S0. EDGE FLAT DAR
% TYP. GRATE BAR (9 EA.)
3/16" TY P.
S0. EDGE FLAT BAR
C.m C.
PLAN
l i t 1/2" 1 1 1 1/2"
FFT 11 IL F
SECTION A - A
WASHINGTON COUNTY GRATE
�UEPARTM N
E T OF 1-AND USE
SAND TRANSPORTATION AREA DRAIN , TYPE H
DATE CIVIL ESIGINEER DRAWN APWA NO. WASK COUNTY NO.
aEAe06 5 - 8 D - 108
-�n
— --- 2'-4 3/4" �}
Y --- 2'-3 3/8" I�
A A
__jL.�
2 1/2" X 1/2" N
SQ. EDGE FLAT BAR
co
N
3 X 2 1/2" X 1/4"L
_ TYP. _ —
3/IS
M
PLAN
--TYP.
1/2"X 3" BOLT
SECTION A -•A
,WASHINGTON COUNTY FRAME
DEPARTMENT OF LAND USE
AND TRANSPORTATION AREA DRAIN , TYPE 11
DATE CIVIL E1491HEER DRAWN APWA NO. WASH. COW TY Na
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