13615 SW 72ND AVENUE FILE NO.
72ND AVE. - 13615 STR. OPN. PERMIT
CII'Y OF TIGARD
1DCPENDM 1RE PJI�X T
Ibis form is a multi-use form. Appropriate recxaipts must be attached. Document:.:itiocc
is important for all purposes. Stat ale docimwnt:ation to form.
VENDOR NO.: DATE:
1 1t
PAYABLE TO: _ do ).1 vv� ► 1� Zugµ, `��c v e� _.----- REU TED BY:
`L Av r
Approved request due Wednesday
10:00 AM to A/P for checks by
Friday.
MISCELIME)OUS EXPENDITURES: _
Date Description, Invoice No., etc. Account No. Amount
.--[- $
01 - IU Z'Z0O0 `l0 •c�
9�, —
Mileage $0.255 --- --_- _
APPRDPRIATION RAIMICC: AS OF: - SI�1AT(h2E:
(Up to $25.00) Section K--anager -- -- - F.urh. Agent
($25.01-2,500.00) Division Manager _
($2,500.01-7,500.00) Dept. head
($7,500.01-15,000.00) City Administrator
($15,000.01- ?) ]ncal Contract 1-review t3o jrd
ke/1501F
I
INSPIC OTICE
City of Tigard 1- -ding Depak•taent
13125 BW gall Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O--Phono)1 639-4175 Business Phone: 639-4171
Inspection: ez!�lz.1G`-
looting Plbg. Underslab Mach. Rough-in ( AppC/&talk
Pound. Plbg. Top Out Gas Line ` FINAL*
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
Date Requested: �l r � 7 (� _Timor A-5HAH _PK
7 �� /
Address: / t #1Mj -
wCat
Bu i 1 do:r:-
THE FOLLOW*NG CORRECTIONS ARE REQUIRED: S�
I
CR v S I S1 O
] (A l l l r Ir d1
t C\ •� 0!OA N �G.--CIO�
i
Inepactor:` Datef-
APPROV211 DISAPPROVE APPROVED SUB.iRCT TO ABOVE
—_Call For Reinap.
APPLICATION — STREET IMPRO' 'MENT/EXCAVATION COPY TO:
ORDINAI,ENO, 74-14 Ll (WHITE)-FILE
❑ (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ❑ (PINK)-O-i HER AGENCY
❑ (SLUE)-APPLICANT
APPROVED /�
APPLICATION NO.: _Z�—__-
NOT APPROVED CI 11"
OF TIGARD, OREGON
FEE AMT.: f �
PENDING FEE. PMT. CITY HALL
RECEIPT NO.: —.l•{�_=Z�t '1!j� Z
PENDING SECURITY [,' PUBLIC WORKS DEPARTMENT By
DATE l I /? I /`LL,_
PENDING AGENCY "JK^ ❑ Application and Progress Record ` � — � — � — � —
PENDING INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION MAIASEREo"REU
PENDING VARIANCE
ANNUAL r
EXPIRATION DATE:
PERMIT � `1� `I�'- DATL ISSUED: _�1
NO BY
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_
----.--____ _ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT __ E1C�_ME__j
_ � AO /R _ —� —
. T ��
CONTRACTOR � CITNJPM ?E—Z?
��• 1S
NAME
_ PHONE----
PLANS BY 1'c_r ' A — — —
.0
N AE --- —'—'--- ADDRESS � -- CIT Y
----fie M O_NE-
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
_-" -- - - - DOLLARS -
(2) EXCAVATION DATA: FOR OFFICE USE [ MSN==
0.04 X Y
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
l TYPE LENGTH WIDTH DEPTH ITEM_ AI QUANTITY ITEM DATE PEMARK�/TYPE BY
` ` ns STREET--
R
TREET
R ION
E
U
ESTIMATED STREET OPENING DATE: �_ 1_Z/ / ��(i E — - -
3
ESTIMATED STREET CLOSING DATE _.[�_ 1 Zi / rj(I T
- g
- - -- D
(3) SECURITY NO. . 195SECURITY AMT.: : .`�CL J STREET
SURETY CO.: CLOSED
FINAL
�iAMT/fp CHSCIt r � CASH—a ' •t:'Nb�� INSFEC. I( � e �7►r)
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL —�
FEATURES, EXCAVATION LOCATION AND EXTENT. SPECIAL PROVISIONS i CONDITIONS
1
I I I
.J 1
ern —
(51 NOTE THE CITY OF -TIGARD DOES NOT, HEREBY, GMANT PERMI68ION TO APPLICANT a TQ CONDUCT WORK WHERE
RIGHT OF WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOT IT THE REQUIRED SECURITIES, TO r'OMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECO-ICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLF-3S THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE [ Z ��U L // �% j� r,. / t
1---_.. DATE
��s'�'�++•-'mry�- `•�c!"�rn+r u r ,^�rrrs'r�S"-4,,rnr+ry
I
APPL-ICATION - STREET IMPR1d' -MENT/EXCAVATION COPY TO:
ORDINAI.--'E NO. 74-14 ❑ (WHITE)-F,LE
❑ (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) Ll (PINK)-OTHER AGENCY
❑ (BLUE)-APPLICANT
APPROVED APPLICATION NO.: 441 _
NOT APPROVED CITY OE TIGARD, OREGON FEE AMT.: S 3.100
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: 90—ZO TD3 Z
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT
By DATE /7 + /Sc,
PENDING AGENCY ''OK'' ❑ Application and Progress Record
MAINTENANCE BOND ie
i PENDING INFOPMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQU.RE,3
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE: _ 31
PERMIT NO.: �3YL __ 90 DATE ISSUED: �� �211 _.r�_'_ , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT � �,/L lil.��X41 Af�_ ��CC,^�.L, s� S kl 7l �,y'j9✓11 120
AME CIT PHON ��S
CONTRACTOR 1V P L SON _ "flGj�Ji,� L —_ --/CITY _.
NAME ADDRESS ---
PLANS BY �t`i •+ PHONE
i - ----- NAMI„ --- AODRESS _ CIT PHONE -'
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ _
DOLLARS
(2) EXCAVATION DATA: —�� FOR OFFICE USE
0.04 X f _ �-� •: �SA�__.
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT 1 CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITEM !4 QUANTITY ITEM DATE REMARKS/TYPE BY
STROCT— i
N t0
INSP C-
R TION
E
Q
U _
ESTIMATED STREET OPENING DATE: -_I/ / ? I l `-� IE 3
ESTIMATED STREET CLOSING DATE: /I / 21 / `3 G E
D
(3) SECURITY NO. 1a14S SECURITY AMT $21. UCS—_ STREET
CLOSED
SURETY CO.: FINAL
"fY CHECN ,X —__CASH ❑ DOND INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL sem_ SPECIAL PROVISIONS /CONDITIONS:
FEATURES: EXCAVATION LOCATION AND EXTENT. 1
I I 1 I
MIXT►
IS) NOTE THE CITY OF TIGARD DOES NOT, HERESY, GRANT PERMISSION TO APPLICANTS TC CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION I� 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 ANn
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WH.CH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE: DATE
' r
1
I •
I-- to
Z E�
0 -1zCT0
Z07to - J
E U LO D s a
W Li 2 r. is
u L0 '> cc,
W S -fI 41 "
lL lJfJILCPI C1
i
z v'
r d
z� � u
LL LL
W [J r
I 0
O
CL J
U
W� _ it
L! fL
V; U A I
cc -, a i
�� W tL �•
Lo F- fT
..»....... �., fA � f"' r.w..a•N►w r,N,,,►p,p. -.*„�b;.-rrrltr,M.wre»
h W t"1
I- LC r
r, rltz
z :3
cc Ca h y
CI III iC z W U
E -•{ Q W r �,
J -47 67 E Q
L4 LL. F.•n I— i ' �- JL 4
•• •. W t z
to LU J
L) W LU
L1l LO F F-
W 0 O LU J I
0 Ll
r' n cr h
�2 tz� ! i F- Cl
Z el IL. Ly fd h
LO Y z �9
U --
° ;� In
�� Ua �
J
a xp
Q uW
JWm
J Ij
O z
C)
Z •_
7 I �
2
O
`J LD
L—
ru
1 1
Z
0
z
w d
W
o ..
Ln
in
Ln
z �
_ - O
H �
c o ru
Q U S rfl
U
J N
a 4 r
¢N
J
wO w LLQ Ln
W 0 w� i) d�ULr
�o N
►- O>^
LD
ul y mzo
N^cr I Q
N vl O i' —
Q
¢O
_Jw as
2_ w
7 J ✓
Z Q S
[L h z
Z i'
f LL °
d Q
0 _. _
�19
rz' , I`
CB �' •
228.42 RIM
225.79 IE �r
(E)
m
4 J T CONC. WALKWA Y ♦228.42 G
'REST TREES - VERIFY A�
CITY OF TI.;ARD6228.72 TC lvi
TE r'LAN FOR SPACING 229.23 G I•
•2)7 ,4 r;
CH
228.11 HIM
225.51 IE(E)
I ti I ST MH
« - ,y • 229.36 RIM
222.96 IE
Lti (� • / ,tib' •227.63 i 228.97
�' �� 0 1`✓ CONSTRUCT WHEELCHAIR
�,���6 �, 56 RAMP SEE DETAIL 1 A 1�a y3+35.�5�
,ti O ,►, ry ry e.ti
`� _ _ •��ye,� �c ; I n = P.,9.54'00„
i GRAVEL (,0 R = 15'
\ 2 TW \
°¢ L = 23.54'
tib �'►� I C = 21 . 19'
228.51 G
-, C8 2 t 3 r ��bw� i
ul;m �J---�_REMOVE EXISTING CURB AND CONCRE
STREET ' `• j 73 �,� APRON AND REPLACE WITH NEW CLRI
LIGHT , I b. AND SIDE%&!,. K•PATCH STREET
ROOF DRAIN ,�O qti SECTI N (4" CLASS 'C' AC
OUTLET INA 5. ty.��S G r '� 3
HOUSE CURB rti 2""3/4"-0" AGGR.
t -f I 13 1 1/20-0* AGGR.)
(WOOD FIRM) hQ i ti I
rytib• I III �' '� 25' �.
1 Sb 15 1 I M tCH E S NG
L C RB SAN MH
' ' I 230.89 RIM
226.37 IE(S)
'b
5' DEUI
•226.50
�M W/M -
I
• \' j 225: 0 V REMOVE EXISTING CURB
T- AND CONCRETE APRON
1r \� \ �O • I �^���' 3 3 AND REPLACE WITH NEW
CURB
it `�� \�� \ \, ``� ry�b 5 - +► td ����o�� V SIDEWALKD
DED
• � j
22G` 0 • 'MATCH 11XIS'1NG
CURH ih �5
• 0cs
ST MH
�+ �� 230.42 RIM
��, )l� ) • b 220.72 IE
� V