6910 SW PINE STREET FILE N0. �n"j(p
PINE STP.ERT - 6910 STR. OPN. PERMIT
C1- j4J
ee-f',
C11 OF T117ARD
EXPENDITURE REIMBURSEMENT REQUEST 0
I
This form is a multi-use form. Where appropriate receipts must be attached.
Documentation is important for all purposes. Staple documentation to form.
VEZ;DGR NO: DATE: — -
PAYAB�E T0: _C�r� P, f? �aJ `.- l�wel� Requested by:
t.91 5, � �
Fit
r ) 9-1 ZZ.�
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MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc. ) :
Date De-st-c-rtiption Account No. Amount
f o -z L oc) 00„vc�
0010514 7 `6 k11 eA
ccras-...r.......,.r r a a r a..rsm as aa--=sc=atccr-c==ccca�v=.._nix a.ac.uaar_cr_ac.r.Gac=-r_._rscc ea
GENERAL MEAL EXPI3NSE:
Date Description Amount-
Account Number to be charged: _ Total
n ..WORM=.....x—.a.... scar_=---ccc=caca=-c.eee vett=acs Ursa-ct=e_c—.nra=cc!a
MILEAGE:
Date Description: (Include end/start readings and total miles) Amount
I AcCotint Number: Total_ _ miles x$.'1 =
a=Ma=,nr==M=Ms=aavr.anaaacara-ac�i=cc-=aaavac=an=cc=asaccacana..aaa�cr_c.�-=-aasscv
APPROPRIATION BALANCE: -AS OF: Signat'.cc
APPROVALS (it $25.00 or under m.ry b-! reimbursed throug,t petty cash) :
(up to $500.00)Section Manager Pt, tn. Agent
($500.01-$5,000,.00)Dept. Head/Porch. Agent
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APPLICATION - STREET IMPF EMENT/EX.^,AVATION CQPY TO:
ORDINAIICE NO. 74 14 (WHITE)-FuU
(YELLOW) -INSP.
(INSTRUCTIONS JN SEPARATE SHEET) ❑ (PINK)-OTHER AGENCY
(BLUE)-APPLICANT
APPROVED yl APPLICATION NO.
(,1 I Y OF TIGARD OREGON
NOT APPROVED FEC AMT.: S
PENDING FEE. PMT. ❑ CITY HALL, RECD IP
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY
PENDING AGENCY "OK" ❑ .Application and Progress Record _ -- _
MAINTENANCE BOND*
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL U
PENDING VARIANCE U EXPIRATI N D TE:
PERh11T NO.: _.. 33�o''t�� CATE ISSUED. LZ ��_-'�L_ , BY
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND I" . -ALL ___'tempora Catch_ esin. Area
Drain or French Drain _ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS
APPLICANT ____farlqcl rAME X914 i-amine i _____ Tigard p_R 97223 246-0515
AME ADDRESS CITU -PHONE
CON TR AC TOR _ _
NAME _. _ ADDRE �J -- CITi1 FNONE
PLANS BY Per City Standards/Specifications
NAME ADDRESSC TV
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E _
DOLLARS
FOR OFFICE USE::. po lN.
(2) EXCAVATION DATA: o.oa x s
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTI',LLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM AI QUANTITY
Pine Street (shoulder of road) or.-:. catch basin STREET
INS I-_
R TION
F.
ESTIMATED STREET OPENING DATE:. /3U / �K,'� E
ESTIMATED STREET CLOSING DATE: __ / / T –
— E
D
TREET
(3) SECURITY NO. SECURI TY AMT. E ._ Ln�, CLOSED
SURETY CO._— FINAL q �, h
cf wnrlEo c +Ecn rgSN _ 80146 .. INSPEC. 5 c� fCVCc
(4) OL-OT PLAN: INDICATE SITE PERTINENT PHYSICAL/ -* SPECIAL PROVISIONS/CONDITIONS:
FEATURES: EXCAVATION LOCATION AND EXTENT. * This is a temporary installation
and may be removed at any time as
deemed necessary by the City.
I I
5I * Applicant to provide traffic
I a
_ - o f y City inspector els
S.W. PINE STREET
instal_lation•�
3
I I Work —
I I Site I I
(6910 SW Pine St) --
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUIT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGF EES 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 AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
-4-7
APPLICANTS SIGNATURE DATE – / <Y I "
CITY CIF' T 1 GARD - F:ECE I PT OF PAYMENT REC NO: 001051
CHECK AMOUNT 10't. nu
NAME. HCJL.L.'I D S CHWE I`C i CASH AMOUNT .Gn
A1)itPES'':i. Li',F:L. F. SCHWETTZ PAYMENT DATE
1910 SW P I ME Sl BLOCK NO/ADDR:
T !f-Ar-"'D. OR .,7 Q7.
F URPOSEr' OF PAYMENT NMOUtJ T PAID PURPOSE OF PAMENT AMOUNT PALO
CUSTOMER IIE-POSITS 100.00 PUBLIC IMFRnVEM (136-89? --- -_ --_--4, 00
6PIO SW PTNE-TIGARD
THF'iNK--YOU
TOTAL_ t-M0UP1T F'(,f f)
ytl aim.. 't: "37 -
HOLLY D. SCHWEIT? 5665
EARL R. SCHWEITZ
6910 SW PINE ST. 24&0545
PORTLAND, OREGON 97223 24-22 036
p� 1230
Pay t0 the —7 ,
i ry!/2p�
--'Mlen
U.S. 6ANK
TtOANG 9gANCM
q.0.Dog=3309 TIOARO,OR 978"
UNITAO&TATA&NATIONAL AANM OP OgA00N
246-0 FA 5
FOR
DATE % TIME
OF—. ) —� �[j - 64 14-
PHONE �
AREA CODE t1UNlslil OXTEP46ON
i TELEPHONED PLEASECALL
CAME TO BEE YOU WILL CALL AGAIN 0 E
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL $P£CIAL ATTENTION
1 1Ln�c�hM,ta lr wI 2S
-A �e- C�•1 Cil oc�sce CnA f-
SIGNED -------- — --
�iN
UTNO IN USA
TOPS It FORM 300213
�luR K� `- ►� t 1,t SS 1
loo
1rzse
i
ONE P BAR RECESSED AREA - SEE ;.
NO. 0-104 FOR DETAILb.
B
T Wo NO 4j SEVEN NO. 3 BARS Al 6" O.C.
BARS
A f A
L
FILLER MA71ERIAL - SEE
NOTE 1, DWG. NO. D-101 .
NOTE REBAR TO BE USFID WITH RECESSED
CURB INLET ONLY. SEF_ DWG. NO. D-104.
FOR FRAME DETAIL SEE DWG. NO. 0-102.
FOR GRATE DETAIL SEE DWG. NO. 0-103
SEE DWG. NO D-101 ��
FOR SECTION B-B
FLAN
CURB
/TOP OF PAVEMENT
4" WEEP HOLF-,
O
10° MIN. 1.0. VARIABLE
/ (SEE
--�----- / \ P R O J E C T
\I
PLANS)
I I i
NOTES:
_ 6` I NO SUMP ALLOWED
2.
- I 2. BAf - OF TO I TO
FACILILITATE FORM REMOVAL
?-4 /2 6 WILL HE ALLOWED.
WEEP
SECT ICN A-A 3 ATP SOU'BGRADE. HOLE
WASHINGTON COUNTY
r� DEPARTMENT OF LAND USECAT H BASIN ALSO SEE
AND TRANSPORTATION DWG NO D-lo
DATE CIVIL E IPlE R DRAWN APWA NO. WASH COUNTY Na
95- D- 100
NOTES
1- 3/4" PREFORMED JOINT FILLER MATERIAL TO BE USED AS SPECIFIED BY
ENGINEER ONLY IN CONC. PAVEMENT OR GUTTER, AND TO EXTEND THROUGH
THICKNESS OF CONCRETE.
2. CONST. CATCH BASIN PER DETAIL, BUT WITH DIMENSION
PIPE DIA. SPECIFIED. "W' TO ACCOMMODATELARGEST
3. CONCRETE SHALL ATTAIN A MINIMUM COMPRESSIVE STRENGTH OF 3000 PS.I.
IN 28 DAYS.
4. IF APPROVED BY ENGINEER, WALLS MAY BE POURED AGAINST UNDISTURBED EARTH,
EXCEPT FOR THE TOP 8", WHICH SHALL BE FORMED.
5. BACKFILL SHALL BE COMPACTED TO 95% DENSITY THROUGHOUT.
6. OVERSIZE CATCH BASINS 7 STEPS ARE REQUIRED FOF DEPTH GREATER THAN
4 FEET. INSTALL 2 FT. FROM TOP TO WITHIN I FT. OF BOTTOM.
IIY TYPICAL OR AS
SLOPE OF PAVEMENT / SPECIFIED BY ENGINEER
SEE DRAWING NO. CS-304
x SUBGRADF-`� FOR CURB PLACEMENT SEE DWG
�' ----- 0NO. CS-304 B DWG. NO. D-104,
0 6 MIN.
THIS PIPE DIAMETER DETERMINES
27"MAX.
"W'- SEE TABLE BELOW.
SEE ClAWING NO. 0 00 FOR
PLAN B SECTION A-A
T Y P E * W DIA. PIPE l
I ' STANDARD I'- I % 10'= 12"
8
6"+____w 6• IOVERSIZE 2'-33/8" IS"-27"-
SECTION B S B FOR GRATE TYPE SEE D%'G NO. D-103
REQUIRES TWO GRATES, SEE
DRAWING NO D-102.
*"STANDARD" R, "OVERSIZE" ARE
VASHINGTON CO. DESIGNATIONS.
WASHINGTON COUNTY
DEPARTMENT OF LAND USEpH BAS I N ALSO SLE
AND TRANSPORTATION DWG N0 0-100
--
DATE CIVIL. ENGINEER DRAWN NOWASK=CrYNrjLb Br �JU. )
D -
6
67 -
_ 2 1/2" X 1/2"--- - '
SO. EDGE FLAT 8AR �N
0
0
N
TYP. 3 X 2 1/2" X 3/1Y'L
- - -3 6
PLAN
TYP. �2%2 _
I/-4 v� _
5/8.1 X-3" BOLT
SECTION A-A
TYPE DIA. PIPE W. 1_W
STANDARD 10"-12" i'- 31/4" 7- I 7/8"
1 OVERSIZE I'1"-21"� 2'- 4 3/0" 2'-3 T/
I REQUIRES TWO GRAtES
I STANDARD 8 OVERSIZE ARE WASH. CO DESIGNATIONS
WASHINGTON COUNTY
;-` _WAND
- p- DEPARTMENT OF LAND USE F R A M E
TRANSPORTATION
[SATE IVIL ENGINEER DRAWN APWA Nn. WASH. COIIRfTY NQ
6 85 1--C ( MOD.)
El 102-
- 68
I I/g` T Y P
A—
�I 3/4. C. TO C. TYP.
2 %2 x 3/4'
SO EDGE FLAT BAR TYP
— I 3 12
—I2 a.
4 1/i L
80TH ENDS 3/ • ��'� x sig" SECTION A A
M-L BARS SO EDGE FLAT BAR (18 EA.)
A#'
PLAN
T Y P E W. 1.W.
STANDAPD I' - I %2' I' - 0"
1 OVERSIZE I' - 1 1/2" I' - 0"
REQUIRES 2 GRATES.
+1 "STANDARD" AND *OVERSIZE" ARE WASHINGTON
COUNTY DESIGNATIONS.
WASHINGTON COUNTY �
Iti�,�DEPARTMENT OF LAND USE. C R A T E
AND TRANSPORTATION
DATE CIVIL ENGINEER DRAWN 4PWA 110. WASK COUNTY NO.�
/1/7O �— �h bM- -D ( MOD) D — 103
xi
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