13700 SW 72ND AVENUE FILE NO.
77nd AVE. - 13700 STR. OPN. PERMIT
APPLICATION - STREET IMPR/ "MENT/EXCAVATION COPY TO.
❑ (WH(TEI- FILE
ORDIN,o,..CE NO. 74-14 ❑ (BLUE) -INSP.
❑ (YELLOW)-OTHER AGENC V
(INSTRUCTIONS ON SEPARATE SHEET) ❑ (PINK) -APPLICANT
APPROVED x APPLICATION NO.:__]L'
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: f 62 - � G
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT NO.: 4F9 f
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BYDATE � L" I 7�
PENDING AGENCY "OK" ❑ Application and Progress RecordMAINTENANCE BOND N GA V <
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVAI:ON AS REQUIRED K
ANNUAL H
PENDING VARIANCE ❑ EXPIRATION DATE-
PERMIT NO.: t: 1,rZ -,l ! �a BY: t "^"
._�� DATE ISSUED:
(1) APPLICATION1 HEREBY MACE TO EXCAVATE FOR AND INSTALL -S }�gok-...I �ar____
4lo f 7-0 C_o �4 /&1/ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH
CITY REQUIREMENTS.
APPLICANT 41960-01114 r dM'�44'r �3 iU0 Ste, 7«2 4-4 )99/4 `' fy V
AM .p A DR[ t CIT' - ONE
CONTRACTOR All.QderI �0 SIS S4� 8�1� �.hf., Tl1►t►d GIS ri .�'� 3 �
NAME t ADDRESS CITY PHONE
PLANS BY
NAME ADORf.fS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ �•S/ H _
DOLLARS
V
(2) EXCAVATION DATA: OROFFICE USE
_ 0.02 x f
STREET DESCRIPTION PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLKD ITEM DATE REMARKS/TYPE BY
TYPE LEIv_:'TH WIDTH DEPTH ITEM A QUANTIT!
!" 5-T R g T
I
RIC I
Q
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ESTIMATED STREET OPENING DATE:_ l22��f , l �� 7 G C
ESTIMATED STREET CLOSING DATE: „/J�'1-4L l 7 L E
6TREET
131 -- - �3 SECURITY AMT.: S- l�.- �s'" CLOSE
SURETY CO.: FINAL
CHECK Y CAfH O •OND V INISPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATUII,IrS,' EXCAVATION LOCATION AND EXTENT.
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1 1 C 1 I
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-CUNT�� ��. � � ._ � �. � � _ ._ � � • � � ..
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(5) NOTE THE CITY OF TIGARD DOES NOT, HERESY, 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 SECURI CIES, 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.
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l
)/
APPLICANTS SIGNATURE: DATE /
►)-i1 77
APPLICATION -- STREET IMPR' =MENT/EXCAVATION COPY TO:
(WHITE).FILE
ORDIN_gCE NO. 74-14 L]
(BLUE) -INSP,
❑ (YELLOW) -OTHER AGENCY
(INSTRUCTIONS ON SEPARATE SHEET) ❑ )PINK) -APPLICANT
APPROVED �`] APPLICATION NO.:
NOT APPROVED ❑ CITY OF TIGARD, ORFGON FEE AMT.: S
PENDING FEE. PMT. ❑ CITY HAIL RECEIPT NO.: _
PENDING SECURITY ❑ PUBLICWORKS DEPARTMENT BY - DATE
- - - - - - - - - - - - - - - -
PENDING AGENCY "OK" ❑ Application and Progress Record
MAINTENANCE
SENDING INFORMATION C7
FOR STREET IMPROVEMENT/EXCAVATION ASREQUEDON
IREa*�
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: ,_-__—_-- _ DATE ISSUED: �J__.L— BY: .__�_---_–,-- y__--
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
NAME -- -- ---- ADDRESS CIVY
CONTRACTOR �_ `" !
CITY - - -_PMON6
PLANS BY
NAME -- ADDRE __SS — CITY _PMONF
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
DOLLARS
(2) EXCAVATION DATA: FOR OFFICE USE: EIMIN.
o.o2XIII = s_ _
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ;TEM d QUANTITY
STREET
OPENED _.._
INSP
R TION
E _...
Q
ESTIMATED STREET OPENING DATE:_— / / y g
ESTIMATED STREET CLOSING DATE: / T
E
D
TR
(3) SECURITY NO. _ SECURITYAMT.: S CLOSED 1^
SURETY CO.: _ FINAL _
CERTIFIED CHECK p CASH U •0146 �.� INSPEC.
i
_.-_=.�_.--— _ CERTIFIED __.._ --
(4) PLOT PLAN: INDICATE S11-PEPTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS:
FEATURES: EXCAVATION LOCATION AND EXTENT.
I I I I 1
I I 1 1
1 I 1 I
I _ �
1 I I 1
I I I I I
I
(S) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAI OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLI WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY ANC
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE DATE `�
CITY OFTIGARD
Data /Amount $ V 5-1 e"6�
qI, —dollars
NaCash
Address Chock _
Bldg. M St.Opng. F--] Bus.Lic. Fj
Plbg. n Pubctns Bike Lic. u
Elctl. Copies Sew.Serv.
Sewer n filing Fine&F.
Assmt. other - Zoning E]
For: 2 _
Permit #
CITY OF TIGARD
WN11CN[I/MINfINO•[t•f10Nt N/
► 4000
1
i
CITY TY OF TIGARD
f
Amount
2y I—A
dollars
Name qCesh
t Address _Bldg. f i St.Opng. n Bus.Lic.
Plbg. d Pubclns. - [] Bike Lic. L❑J
(IC11. E] Copies - E] St..Serv. LJ
Sewer ❑ Filing Fine d F.
4ssmf. Other Zoning
For.
c
�f
i
' Permit #
CITY 4F TIGARD
By.
14 8 �9 I AM�[Mt1.��INtM6s�•�•C.•iMY
City of Tigard
INSPECTION REQUEST
C
for
INSPECTI
TIME..
� PERMIT NO. : I
DATE. DATE ISSUED --"
OWNERS NAME : --- I
ADDRESS:CONTRACTOR :
------ - ----- -- —
TEST : Air O, Woterp , Visual v, Laboratory p
RESULT: Approved , Disapproved C , Pending p
wSKETCH. 4 e,4,
AMO
ECTOR DATE
OTE: Attach supplemental test data bereta7 f
I
1
City fi of Tigard
i Y
INSPECTION REOUEST
for
INSPECTION TIME : PERMIT NO.:
DATE: DATE ISSUED:__L__L
OWNERS NAME : �gSS�c�A�� 12 �=0 pl-, ru
I
ADDRESS ' �-� . `� lJ L)
1
CONTRACTOR :— "
TEST: Air ❑, water [] , Vieual , Laboratory ❑
RESULT. Approved ❑ Disapproved Pending r_l
SKETCH: i [ "
it c 'C
I INSPECTOR DATE
ICOTE: Attach supplemental feet dot@ heret]
I