12755 SW 67TH AVENUE FILE NO. 524-92
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67th AVENUE - 12755 STR. OPN PERMIT
1
L
,ENGINEERING PERMIT
PERMIT #. . . . . . . : ENG92-0081 DATE ISSUED: 11/12/92 By:
PRIM. PERMIT #. : SDR92-0010 PARCEL: 2S101AD-01101
SITE ADDRESS. . . : 12755 SW 67TH AVE ZONING: C-P
SUBDIVISION. . . . : WEST PORTLAND HEIGHTS :33
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . .
________ __ --------------
------------------- VALUE
PERMIT TYPE. . : SOF _ PUBLIC IMPRV QUANT. (LIN FT)
GRAD/EROS _***_ $
AGREEMENT DATE: / / $
ASS1;RANCE EXPIRATION--- STREET __
SAN SEW $
PERFORMANCE: / / -- $
MAINTENANCE: / / STM SEW
PATHWAYS _ $
ALL OTHER
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Remarks: STREET OPENING, TO INSTALL A SANITARY SEWER SERVICE & TAP THE MAINLINE
AND TO INSTALL A STORM SEWER SERVICE & RAISE AN EXISTING STORM INLET TO GRADE
(INSTALLING A SOLID LID THEREON) .
-------- FEES --------------
Permittee: date recpt
STEVEN JOHNSON type amount by
37121 S.E. GIBSON RD . OPEN $ 12?_ .00 JSH 11/12/92
92-233638
WASHOUGAL WA 98671
Phone #: (206) 835-8646
Engineer:
$ 12.00 TOTAL
Phone #: - REQUIRED INSPECTIONS - ------
Permittee/Agent Signature:
---STORM SEWER--• -----STREET-•----
M.H. & C.B. CRB LINE & GRADE
-- - PIPE LN & GRD SUBGRADE
BCKFLL & CMFCT BASE ROCK
AIR & TV TEST LEVEL COURSE
WEARING COURSE
City of Tigard, Oregon -
13125 Hall Blvd. --SAN . SEWER--- TRAFF & PED CONT
131 BS.S.W.. Hal M.H. & C.O. MONOMENTATION
P .OTigard, Oregon 9'I?.23 PIPE LN & GRD STREETLIGHTING
Phone #: 639-411 BCKFLL & CMPCT WALK/APRON/RAMP
AIR & TV TEST
FOR INSPECTION, CONTACT: __REPR' S/AUJ,S-- CONTOURS
Letha Thomas #639-4171 (office) DRAINAGE
#780-2647 (mo0i.le)
----PATHWAYS----- ERCgION CNTL.
APPLICATION - STREET IMPROV'--MErMEXCAVATION ` COPY TO:
D (WHITE)-FILE
OR DI N Af%, E NO 74-14 ® (YELLOW)-INSP.
(INSTRUCTIONS ONSEPARATE SHEET) ® (PINK),OTHER AGENCY bldg.
Q[J (BLUE)-APPLICANT
APPROVED X APPLICATION NO.: s69
NOT APPROVED ] CITY OF TIGARD, OREGON F5 E AMT . S_. 12.00 _
PENDING FEE. PMT. [� CI IlI HALL. RECEIPT 4: .__`L?-Z3363 91'
PCNDING SECURIYY ❑ PUBLIC WORKS DEPARTMENT BY DATE—
PENDING AGENCY ''OK'' ❑ ppli(ation and Progress Record — —
MAINTENANCE BOND
PENDING INFORMATION D FOR STREET !MPROVEMENT/EXCAVATION AS REgUIREo
ANNUAL
PENDING VARIANCE I ^_ EXPIRATI))N TE: /
�,.
PERMIT NO. - -_ -RZ• -- - DATE: ISSUED. 'L��- BY:
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL Storm Sew r 'Tap/R.alise existing- storm
inlet& Sanitary Sesser Tap_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT - Steven B. Johnson 37.121 SE Gibson Rd. Washougal, WA 9867.1 #205-835-8646
NAME -. -_ _--.._ _- ADORlSS—�_.— -.__.___. _ CITY _.... PHONE
CONTRACTOR - Same
_..
NAME _ -._ ---.
� -' ADDRESS
PLANS BY see attached -
NPMF ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTA' �%LUATION ( COST): $
DOLLARS
(2) EXCA\ ATION DATA.: FOR OFFICE USE CMIN.
_ 0.04 x s—M0.001
STREET DESCRIPTION PROGRESS & INSPECTIONSTA
NAME SURFACE CUT CUT CUT MATERIAL IFISTALLED `ITEM DATE REMARKS/TYPE BY
- TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET
67th Aven�.a (vacated R/W) - INSRr-
_._ 4 _ R T'ON
---
_ U _
ESTIMATED 3TRr-ET OPENING DATE. / / E
ESTIMA4'EU STREET CLOSING DATE: I / T
E
STREET
( 3) SECURITY NO. SECURITY AMT.-: $ 3W•00
C_ _ CLOSED
SURE 'Y CO.: FINAL ZZCAfo soE
^4ECK _
(4) PLOT PLAN: INDICATE SITE PER-1-INENT PHYSICAL SPECIAL PROVISIONS / CON'.3ITIONS
FEATURES: EXCAVATION LOCATION AND EXTENT. 1. Notify Inspector Letha Thomas
SITE: W work area (@ re�3r of site) --�-4 r�s• Before starting
( I -- W i0fI I work_
I ! 12755 S.W. 68th Parkwa� ' �'i 1 I 2-All work shall conform to City _
t I standards & specifications.
ORS 757.541 - 571 t>lity Co. Pre-
S.W. control must be provided
S.W. 68th Parkway _
for by contractor.
SDR 92-0010 applies.
! saa I (
(5) NOTE THE CITY OF TIGARD DOCS NOT, HEREBY, GRANT PIERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON CCUNYY OR THE STATE OF OREGON.
THE A'PLICANT AGREES TO DEPOSIT THE REQUIRED SIECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUOTION saLcirICATIONS PERTINENT TO "ONOUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHI.^.H MAY RESULT FROM APPLICANTF ACTIONS
APPLICANTS SIGNATURE +�+ �� 1An `�^ DATE
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ORG. NO. 400 6~
2'- 3 3A
ExiSTING PAPE
A u
�,NIAAIJFAPTiJItE�� ���` •:�
EXISTING GRATE INSTALL
LOCATION y8rs Ar
OOWELLS
AT 6"O.C.
B B kEMCIvE
CORNER
r -TM
IB SUMP
Low
Q EXI''TING fRAME Cbl!
ONAMBOW DETAILS
EXISTING DWG. 040. 430*m"MD ----
PLAN VIEW �EU IQN A A
DITCH INIZI RMED,..Q MAKE
OVER I-2E CATCH RA5IN
DITCH BOTTOM
1 1
1 1
1 1 _
I
1 GONCRE"(t TO Bf
3()OO P S.1. t R DAYS
I 6 SACK Mix
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1
EXISIMG ELEVATION E - 8 EXISTING ELEVATION A- A
RAISED Uf AREA DRAIN
DRA W tN`l NO. 410 U.►fffwd t�w+.o Aponc y
2'-4
} --Ze-3 314-
A
1 A �- - wt-t_b
A
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srsv,�✓c�sS sr�t
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30. EDGE FLAT BAR �
a
3X2V2" X 1.4%
T'f R
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' PLAN
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TY t
11,/- 1/2"X 30 DOLT
I
SECTION A'-A
------- FRAME AREA i _------- .-_� unif led
DRAIN, TYTYPE 11 - �� sewerag4
agency
OFIAWINt3 NO. 430 --- ------ -- --------- -..
S-03'. GPO OF V2-.2�- 90
EDGE FLAT STEEL BAR
FRAME OF VZ" 'ki-ARE EDGE
2q ROW TO FD
STEEL aA W
C94CLE v LESS IN OtFTER
DLAWTER THAN WE BELL
OWW-3JON DEPTH CV FRAW
TO BE So,%AC AS Pkt - En I
OONC. APRON= OLD, WE BELL4 ALL JOKTS V GRATE TO
BE WELDED L/4"
laY
o
Cr
in
< *KMOE lq, st W ECP T
WHEN USMI SIMON W
THEN USE 9' SLWP BELOW TLET
END OF S"40N
V2STANDARD CONC.POPE
L-L `BOUT PIPE AT BASE
T (X)NC aASE
?a 1-D.PFFEK_j
os-MN)
NOTES--
0 A MWYACTURM SoLtWE/KCTANCAA-AR (RATE AND FRAME
MAY OF USED FOR LARGER DtAME TER
M GRATES SHALL BE CONSTRMTED MCtV-E SAFETY
3) PFCCAST Cr.W. CATCH BASINS MAY BE USED W14FN
sf'EClFul) OR .UTTIIMI)
RFA- DRAINAGE BWA,(,;I N
OR FIELD INLET Uf
Dwg.-N;0 230 Unified Sewerage Agency'
&j
I
1
_BUDDING SEWER PIPE, SIZE AS SPECIFIED
_ i -
PLANT FABRICATED TEE FITTING
ON SEWERS I8' AND SMALLER. BACKFILL 2X4
FIELD TAP ON EXISTING SEWERS -AGAINST PLUG TO
AND NEW SEWERS LARGER THAN I PREVENT PLUG
BLOWOFF a SECURE
THAN 18" 1 2X4 IN PLACE WITH
— I
TRENCH 8A',;KFIU_-
SEWER MAIN ,
.OR LATER`L PLAN
I
EXTEND AT LEAST
GROUND f 12"ABOVE SURFACE
_ SURFACE /
MINIMUM SLOPE FOR
6" PIPE= 0.010, FOR
4"PIPE = 0.020. ---- CONNECTION
MAPKER :
MAGNETIC TAPE--�
GREtN w/BLACK LEITERS (WASTEWATER)
GREEN./BLACK LETTERS (ST1ORM DRAMd)
3/4'-D PIPE ZONE MATERIAL
As SPECIFIED
. . ._ SUPPORT TEE WITH
BEDDING GRAVEL,
VMIMUM 2*07" WIDE S ! DE
BUILDING SEWER
ufq Agency
of W.shW)glan Coun!y
1)wg No 300 --,--
� I
PVC SADDLE (TEE )
I
I I
STRAP RETAINER RIDGES\ I I
—RUBBER GASKET
SEWER PIPE
STA'` =SS STEEL STRAP
i
■ PVC SADDLE SHALL BE ASIM 3034 SDR 35
• PVC COMP0PNDS SHALL BE ASTM DIT84 WITH CELL CLASS OF 12454-B/C
OR 12364-C
e ALL ELASTO.AERIC SEALS (RUBBER GASKETS) SHALL BE ASTM F477 l
# STAIM_.ES5 STEEL BANDS SHALL BE 300 SERIES, FULL 9/16" WIDTH BAND,
5/16 ' SHOULDERED HEX HEAD, SLOTTED SCREW AND IS CADIUM PLATED,
CARBON STEEL .
INSERTION HOLE SHALL BE CORE DRILLED.
PVC GASKETED unffW
agency
N0. 350 S A D D L E
QOsewe""
OMNIi�/
I . COMPLETE RUBBER SLEEVE (ASTM C-44_1.)
/ INCLUDES A MOLDED SEGMENT THAT HOLDS I
IT IN PLACE.
2. STAINLESS STEEL BAND (9/16" SERIES 300)
SE'�URES UPPER HALF OF RUBBER SLEEVE 7C ;HE
PVC HUB.
i
6. PVC HUB (ASTM 3034 SDR 35)
DRIVE INTO CENTER OF RUBBER
SLEEVE AFTER SLEEVE IS PLACED
IN HOLE.
Y.
3 - /I
-2
..---CONCRETE PIPE
NOTE: ALL INSERTA-TEE HOLES SHALL BE MACHINE DRILLED.
unified
I NSERTA - TEE �
DRAWING NO. 360 --_.-
CLASS D CLASS C
SURFACE RESTORATION MOUND EXCESS NATIVE MATERIAL
AS S?ECIFIED OVER TRENCH TO A1_LJW
FOR SETTLEMENT
71
UNDISTURBED - UNDISTURBED
EAR1H • EARTH
COMPACTEn
ItAw_0 M)Sf*D NATIVE
PWK MATERIAL
r
.t�•:� .� . !! •per',• •„ d•
3/4" -O CRUSHED ROCK PIPE O.D. 1 °• •• �: PIPE 0 D
PWS 6+ v I PLUS 5
3/4.'-0Vt
PIPE :;• S�J ,»;• �; •..�Gff �•,.r.
BE 001 NG _ �•
4MIN. FOR PIPE SMAI-1 f_R THAN 19•
F" MIN F04 PIPE ;2 AND I ARGFR
TRENCH BACKFILL DETAILS
nwq No 240 Unified Sewpts"Agency
CITY OF TIGARD
LTEKDrjtW RBWE5"'
mpriate receipts must'. be attached. D tation
'*fur foam is a multi-use form. S�e`documentar._ion to form.
i oi-tant for all purPOsc-.
DATE: 3----
VErIDOR No. . - - —
RTQUE9rED BY:
PAYABLE 10., _ •� '^ ,�o�t�i�9n_--t----
Approved request e Wecbx! qday
1.0:00 AM too A/P for che6l by
Friday.
It,asCM-ANBOUS U(PEM ]RES: int No. Amount
Date Description, Invoicx Ila., etc. _
--
TOEAL a 30C.
Mileage $0.255
APPROPRIATION BALANCE: Ab OF: SIGNATURE: ____---_---
(UP tc $25.00) Section Manager Purch. Agent _
($35.01-2,500.OU) Division Manacler -___--_____— ——
($2,500.01-7,500.00) Dept. Head ----- --
($7,5oo.01-15,000.00) City Administrator.
($15,000.01- ?) Local Contract Review Board _ - -
�1501F
-------------
...-�-...�...----.......-T-+-�.+.-w�.•.n•4-TT'r\+1�.^I'�'�.._�_'�'_T-IT�-'-f ^++�"'�...v.A7r'--..r-+.--,r---•
TION - STREET 1MPRO\ LENT/EXCAVATION 'W OTO:
(WHITE)-FILE
ORDINANCE NO, 74-14 M (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) X (PINK)-OTHER AGENCY bldg.
(BLUE)•�A.•PPLICAN7
APPROVED ® APPLICATION NO.:
.3 4
NOT APPROVED ❑ CI I Y O I IGARU, OREGON FEE AMT.. L 12.00
92-Z3363$'
PENDING FEE. PMT. ❑
CITY� HALLiZE',CIS'T is �—
PENDING SECURITY D P116LIC WORKS DEPARTMENT BY DATE_- j1 / / _
PENDING AGENCY "OK" ❑ Application and Progress Record — — — — — — — — — — — — —
MAINTENANCE BOND
FOR STREET IMPROVEMENT/EXCAVATION AS RE GUI RED
PENDING iNFOR MATION U ANNUAL
PENDING VARIANCE ❑ EXPIRATI NEIATE:,�__—�
PERMIT N:. •:�'/'T."�� DATE ISSUED: _.'I__.L-L. L7___ , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL Storm _Sewdr Tap/Ra se existirl� storm
I,IiuL;& Sani Laf y Sewer Tap- AS DESCRIBED HEREIN, iN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ Steven B. Johnson 37121 SE Slboun '�ci. Washougal, WA 98671 Y #206-835-3646_
--'� NAME ADDRESS CITY PHONE
CONTRACTOR ----- - Sdme u13 r 't»S S �'C •_ _ �_��_— -
NAME ADDRRSS CITY PHONE
PLANS BY - _se attached
'- NAM[ ADDRESS _ CITY NON
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
DOLLARS
(2) EXCAVATION DATA: 0.04 X S FOR OFFICEJ�b MIN
_ s _ 12.00
STREET v DESCRIPTION - PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MAI ERIAL 'NSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WFDTH DE?TH ITEM & QUANTITY
STREET
ENED I i ;[ O? TAP
PE
)]7th Ave'll a (Vaca el R,4,1R TIIOM _
E I
Q
U - J
E t
ESTIMATED STREET OPENING DATE:--.- / / S
ESTIMATED STREET CLOSING DATE. ED
(3) SECURITY NO. _ SECURITY AMT,: S 3W•00 STREET.,. CLOSED
SURETY Cl: : FINAL
- -- — --- INSPEC. t-
CERTIFIED CHECK 1 CASH 0 BOND / /L ` I.
(4) PLOT PLAN: INDICATE ;ITE PERTINENT PHYSICAL SPECIAL oROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT, 1. Nutify Inspector Letha 'Mommas
Xxxwui.k area (@ -rear of site) rs• betore a ar rvg
work-
I 2. A11 work shall conform to City
12755 S.W. 68th Parkwa
standards & spec cat onc,.
ORS 75-7.
Co. 15re-
nntificat-inn. af-r_ wml au_
S.W. 68th Parkway A. Erosion control must be provided
Y —_ — _ _ or by contractor.
5. 9NR 92-0010 applies.
(S) NOTE THE CITY OF TIGARD DOES NOT, HEREBY GRANT PERMISSION TO LICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAV JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGOII.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AIJD 10 SAVE HARMLESS THE '.ITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIOAS
DD 7
APPLICANTS SIGNATURE !��'� '" DATE —_L_
xa�Msr .
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S�GV.G11_�J.r_Jo�►NIrax S�ot_ IWezr _�_Stm S2..>
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114
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CITY OF TIGARD RECEIPT OF YMENT ECEIPT NO. :92-233638
HECK AMOUNT 3 1 00
NAME JOHNSON, STEVEN CASH AMOUNT 0. 00
ADDRESS 371*21 SE GIBSON RD PAYMENT DATE
WASHOUGAL, WA SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURP E OF PAYMENT AMUUNT PAID
PU
CUSTOMER DEPO X0 . 04' FP SL C IMPROV 12. 00
U)RP_O
STREET OPENING PERMIT 324-92,
TOTAL AMOUNT PAID - - - -> 312. 00
-T -Ste/, ��/S�eve-1
I
J,
01 e4-0
�,.. r..,µ....Y. •....c... .................•.
CITY OF T I GARD - RECEIPT OF PAYMENT . -I PT NO. -'j2-2336--B
CHECK AMOUNT 312. 00 i
DAME : JOHNSON, STEVEN CASH AMOUNT 0. 00
ADDRESS : 3712-1 SE GIBSON RD PAYMENT DATE 11/12/92
WASHOUGAL, WA SUBDIVISION
'UFtI:'OSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT RAID
:USTOMER DEPO 300. 00 PUBLIC IMPROV _ ^ 12. 00
I
I
I
,I-RFOPENING PERMIT 524-91
I
OTAL AMOUNT PAID - - - -> 312. 00
• •r,.1r• r...1,:r ..r r ............ .ir• r . .... ..r i r.• ✓✓✓K4444 •. ... W
STEVEN B.JOHNE'ON 259
GENERALCONTRACT7R
37121 SE GIBSON RD 206 835 8646
WASHOUGAL,WA 98671 l 1 19 19-709513250
9 Z
E PAY TO THE C j-rY p rl(,.'LIZ Q
1 ORDER OF -- W
DOL IAA;
WASHINGTON MUTUAL
a Federal Sawnge Hank
Camas Weehougel Flnanr;lal 146
33
777'G'91rea1 P O haw 1037
Waeho gnl,WA 95671 Amu.WA 994)7
4: 32S0709S0: L46111300083111Slim 0259
CITY OF TIGARD
STREET OPENING PERMIT
APPLICATION
DATE
APPLICANTS NAME,)
-ADbRESS i Z'7 6'7 /4-11 '� I
'Lot it ZIP
PHONE
• CONTRACTOR'S NAME 'S-C F v C t; •�O' r 't��'�
ADDRESS "1 l Z l `•�_ C�t p typ Al r`.' i:+ �, '
L'4 A ZIP
PHONE L�-:.. ..
• PLANS BY
ACJRESS
ZIP
PHONE
• DESCRIPTION OF WORK PROPOSED TO BE DONE:
X 1' r )Lo "IT \
• ESTIMATED VALUE OF WORK (within public right-of-way) : $ �-
• WORK LOCATION/SITE ADDRESS: `• r /Q '
• IS THIS WORK RELATED TO A LAND-USE ACTION? IF SO SPECIFY (MLP, SDR, ETC.) NO. ,N
IwIb(z ClZ -Uo1L)
• IS THIS RELATED T A BUI DING PERMIT? IF SO, SPECIFY (BLDG. PERMIT) NO.
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