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10715 SW HIGHLAND DRIVE FILE No. 523-92 HIGHLAND DRIVE - 10715 STR OPN PERMIT ew:v,LbuwVlb+aiiC 1i 7y4d1VN� . ..r a .. .,ns„inlp'EII . 1 1 ENGINEERING PERMIT PERMIT #. . . . . . . : ENG92-0080 DATE ISSUED: 11/10/92 By: PRIM. PERMIT #. : ENG92-0080 SITE ADDRESS. . . : 10715 SW HIGHLAND DR PARCEL: 2S110DO-12000 SUBDIVISION. . . . : SUMMERFIELD 110.13 ZONING: R-7 BLOCK. . . . . . . . . . . LOT . . . . . . . . . . . . . :689 PERMIT TYPE. . : SOP PUBLIC TMPRV QUANT. (LIN FT) VALUE AGREEMENT DATE: / / GRAD/EROS -*** $ ASSURANCE EXPIRATION--- STREET " $ PERFORMANCE: / SAN SEW " $ MAINTENANCE: / / STM SEW _ " $ PATHWAYS _ " $ ALL OTHER -***- $ TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ Remarks: STREET OPENING; TO REMOVE, AND REPLACE, A DEFECTIVE ( 41x 12 .5' ) CONCRETE SIDEWALK SEGMENT. i Permittee: ----------------- FEES --------------- DON CRANFORD type amount by date recpt PO BOX 1167 OPEN $ 5.00 JSH 3.1/10/92 92-233568 MCMINVILLE OR 97128 Phone #: (503) 835-7373 Engineer: $ 5.00 TOTAL Phone #: ------- REQUIRED INSPECTIONS ------- Permittee/Agent Signature: ----STORM SEWER-- -----STREET----- _ M.H. & C.B. CRB LINE & GRADE PIPE LN & GRD SUBGRADE BCKFL.L & CMPCT BASE ROCK AIR & TV TEST LEVEL COURSE City of Tigard, Oregon WEARING COURSE 13125 S.W. Hall Blvd. ---SAN. SEWER-- TRAFF & PED CONT P.O. Box 23397 M.H. & C.O. MONUMENTATION Tigard, Oregon 97223 PIPE LN & GRD STREETLIGHTING Phone #: 639-4171 BCKFLL & CMPCT WALK/APRON/RAMP AIR & TV TEST FOR INSPECTION, CONTACT: ----GRADING----- Letha Thomas #639-4171 (office) --REPR' S/ADJ,S-- CONTOURS #780-2647 (mobile) DRAINAGE ----PATHWAYS---- EROS-ION CNTL. n!eklaVsu�dla'.dMYl,t kn !fibs'�/'xdfr�i'M�,'G$9A:'iN�ri'giYYl/,IAWYEIN'�.4.PK�k�.Yb/dlr�7u{'�iSuF"'�.MJ�'eu�A. gip... APPLICATION - .STREET IMPRO'" MENT/EXCAVATION COPY TO: OR ISI N A. ..E NO. 74-14 (WHITE)-FILE � (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) X (PINK)-OTHER AGENCYbldg• $j (BLUE)-APPLICANT APPROVED ® APPLICATION NO.: Y NOT APPROVED [J CI I Y O I IGARU, OREGON FEE AMT. S- _ 5.00 PENDING FEE. PMT. ❑ CITY Y HALL RECEIPT N PENDING SECURITY ❑ PUBLIC WORKSOEPA4TMENT I�r__Yg- DA�E 11_1 PENDING AGENCY "OK" ❑ APPGCatlon and Progress Record MAINTENANCE ®OND PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED U ANNUAL 2 PENDING VARIANCE CI EXPIRA7 ON DATW_J-- PERMIT NO : 5_Z 5``1 Z --- DATE ISSUED 1 �_�h L � :_---- BY ( 1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR ANOX ._Remove- and ReDl���__4'-_g_12�5' Concrete Sidewalk Section AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT __Mr. Don Cr ord PO Sox 1167 McMinville, OR 97128 # 835-7373 NAME -- AUDRESB—._-__. CITV�.. PHONE CONTRACTOR .-. (Same) 'PVA ME __ CIYV --- --4- PRONE .__ . PLANS BY - Per City Standards/Specifications _ NAME "--ADDRESS — --�--� CITY --------- ESTIMATED IMPROVEMENT TOTAL.. VALUATION ( COST): S XXISM-125•00 DOLLARS (2) EXCAVATION DATA: FOR OFFIC E MIN`. _ ().()4xS _ - S_5f01Z__ _ STREET _DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT r CUT MATERIAL INSTALLED ITEM DATE.. REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY — STREET D - --,- ` Highland D_ ive _ see tach R TION E Q - -� ESTIMATED S` BEET OPENING. DATE: �� / ET ESTIMATED STREET CLOSING DATE: ,_�_... E (3) SECURITY NO. `__ -.___- SECURITY AMT: X_ `? __. ��OSEe SURETY CO.: _ FINAL o►1} L'�'C HECK ✓ CA$4 ❑ SOND INSPEC. ' /I (4) PLOT PLAN. INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS / CONDITIONS F"FA.TUFES. EXCAVATION LL.rATION ANU EXTENT. 1. Notify- Inspector Letha Thomas ,'< �.A- , meq __T ____ v( -d 24 hrs. before starting SI'Z'E: 10715 S.W. 1 , _�t13[ldards & soecj f;cat j onx_ 13 g 1-_ Highland Drive ' , 3. ORS 7.57.541 i .571 (Utility Co. --V,Vf 1\ ____.�. _ ____ —_. ( --xx- pr`e=no 1 ica ion, e c. a`pp'e._ 4.- -�- a rian controlmust �,rryidg�fG _ S.W. Highland Drive � contractor _ -- - - - --- - 5. Erosion control must be provided for by contractor. N (S) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION 77 APPLICANTS TO CONDUCT WORK WHERE_ RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE ESTATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT rHE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT L-AWS AND CONSTRUCTION SPECIrICATIONS PERTINENY 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 � DATE (�U ^ 1 IF ,i127U 112 e c�C`�<// 1 I / I^.G I 11466 /• �' m C, a) d m O[' 07 C, cr 11250 1129s r0 p L - c v v v o v o o �p I a ,n G, o c c, c) G, c, Z C m 11265 / -UINQ�IWG*.�njl�U o. J�mu,�tr0(r"v,N :PQ1�Wo O 1126601124 s cn v O0 N `" _ N m A tT w -o O C 1 2 3 V 1 cn LW C T— N p O J ?_TTI D_'? 111,15 �� a�- 110 7 �_ -n D 11225 �!'115G little (n , - — 11210— �Illtlb p����OC11 ;1( c 110 5 �C m Z +- 11235 ///��� '�`/j o 11220 �lllle5 I tIUU3 I( 6;, 110 3 c` _c�LO 0 � I `11176 11116 �� i0o� IIG63 110 1 w�n�mU) C) 11061 O w I1G47 ' III70 I x/"11065 1t(.4�, a' N 10990 nc' IIG75 / IIC)4 Ilea, Acs I 11000 11 / 025 G . 11076 2-�1 II 109%( / �_ 11045 .- J N 10960_ - 11055 p t) C) I r� I O y 4 5 .( -.) LIM -4 1094to 09/0 1095: /3.. / (D (� t I^` 10666 �s�� ' (^v cn 10950 0265 C ! / h d` n ,, / �toee���,,O `" 10555 / /��* �s�� / o cn ,L�rr\ L e♦5 Cl76 Sj '? r ., SyyQ ~ c.loss 1c,e2s ." d� �� /J,i ` p` 4 �� �( to loels� �I �10 6 a 0 1^90 /S S C1- /J.- U 7 W --- I G 61 /e ,'> �� I r I !1 �" i 09 w w 1 / \10520 J /� 111 / � C _4 -- c v �? R 1pj2V f �56r y 112(1 jp7'1F O/ 106 p 11D trc h o �n I tn66 I05B5 0 \°�6� � 10615 10575 10 70 cn, I a < ' I I!,62 / � _ -y �c�6 \�6 y- 1055 Iy %e. / r 60 / I I_v 15 r , 11,55 777 `_~ 05�� / _ _1 / m IOE J� / ___ ��0h`��� IC`5B �! 1(.5 7` ._ z ae /IU536 �(y\ G7 // �0 b� ,hCE,0 j ;Q Lp T m1(o 10490 AF 1( `, 55 10 '510 m ' -T � I �'_ u) I Lr N Z ` ( — / 104a� �L� 0% rr \m, CAa,. _ / O� 104 I I // /T/ 10 n1 -w�- RETAKE OF PREVIOUS DOCUMENT .., I -: I ' i O 06POI i )I \V0\ W �, I/ ww�: �, Q 01501/ 01'GI�' (I\\ l7 C. r / (7 Sir+o012901/\ _— J yL S01 ji 99J1 A y t� I/ ;+iJl tLl 51 n 11 / 09'J' Z901 I •911' yrl\ ,f 901 r\ C,\ / 91901'cn OL 01 y� 9 p by0' ,t. \ C,d 59401 d Iy ,'Ot a g9vl i q� ,I I O J i yq\ o / (n o T - ! ;.901 T- 8901cr 901 Z O l _ 1 � \ / ;ZLQ1 �i� n n do LLJ \ c:_ 0" 1p d' lp J \y0h6v 7 6 r�'C/ u; 0 r4' B�, .h ozsoI ) -41601 Y --M OA / PCO r9 r�/ ( stool N °col o-aol -� '^ In I�h^ OD 4s4o1 ",'�, e��` 9Lto1 Sl9ol l:2J"I Cr 24401 04401 rF 096011 ? 4i ^ ' 1`� �i aaao peso! a?" m ti '=* rn rn rc S�0 � M _ � r ^ :seSeFol -- , MJ I p ry p N N ! / to I �(�/� I { o I V 9ES"I 49601 C7�� M £011 a►on 4[011 00011 I U N b'JII I/ 9L011 _ t 61 Q0- ;loll 0r-�-1 £t•011 ;LIP 9110 l__._1 r +--- / oesol S 9 p I N 09111 Co W) 19011 0011 �I < fill J ' I .011 19011 5001 41111 oil 9 )1' £ooll I 2411► oaallil.J W 7901) L 9n ; 1001 L 011 ' :"Q 24111 2iL11 --01211 Q lL —rD m p31.. > 2 11� Hall � I Itz /�• 20,111/� Q rj co O V m N _„ 10 ,M�/� I `/ I OE711 / O 0 W) [� +f In O to 0 (`s ♦L 110 019 0 N'n- n In ut m a? o 'n N rD U) rt Ict 4 4 L 11 0 I - - - r, �+•cov.'�C�M [tcv94211 (n 00 0 0 0 0 0 0. �u � a o / / SBLII o9L11 ' J J U m M MD 0) D m 0] C13 Ira 1 � I )aLll 1 � n<7.1i0 I RETAKE OF PREVIOUS DOCUMENT / 1 / 0 112 t o 7 F I t L l6 m lD 4' tr C. r S r- r- m F- 07 0 II295 r o r 0 r r r r 00 �./ 1 � c c` , c, o cn 0 C) c' n c�C1 cA I `/�,1126e 3 U 0) N �' n um- UON-cnN,5;o -4 IDFn -7-1D0 g 0 `/ / /1 1 2 4 S to L" O N �� N W CAo W ti C / 11230 I /V' /� 1 G — o i / )1 11 n E 1jA A�C` C r— N 11017 0 A7 O V j I 11225 _11115bIIILe (n m m— y- }--!1110 11235 f�I111e fin/ 1001 :.VF7 11(1 5 O vt! Rl z 11220 < 111.5 I v 11003 Ir CC, 110!3 1175 In16 1005 IRA, 11051 A _ I 111• IIOU11061 o`Tw� 11190 11047 10380 II11n I ✓ 1i0Gg II,45 m Ilu7s 110x3 Ilr,a, 11015 00 1os�1• fZ jn�o26 d1 / /� A 11000 IOfl _v 11036 U� I IIGB ' L� � O11045 � N _.— `-11055 — E � & f j 10985 11,935 N N N O mA O 1 / 10930 luso 5 -4 lr W iy lT c". O p / tll .v r, / 1094 /s �T VI (p , 1. -4 - , ins �r m W �/ / OW a locee orae i, ss� 10950/ eIOB50� / 1 W / \ ...� 10890 10895 � `Tj* S � ,I 'n (di � Ln in ��loess os76 iJ S �� �J �l ° p� ioess 10825 ��, ^.r .,ry -7 U` �0% ILn cn cr los-o Ioe3S� Y �6+J 11 vp1091h- D v * O �* 1091 ` c'2 �n <n to / 10 8 2 0 � r` 9� 7 ?GO 0 9 i i �OA6s �✓ V �_"• ! i b CIE, cb CA CP n Qi 4� ;* I fr1 cc v)S— c / \_'I? 10725 /� I \56ir 12 10 7 1c Or, = IC, C0/ I /I 0 ro 1 T 106; [168 r -- p 10 O / CUA6 OCp* I, Z r� I 1, 6 A IOcc h \fJb.. � G 10585 , �� is t06A 10 70 Ln'1057 / � a � � 106'S5 1062 - r / 1055 0 /110530 cam, Ill 10510 - IC._ 7_ - /10510 / 48` 10490 4 10b� cr \CaF,`- 1 W '//~- "s? IOQ i / IU5 �` I . / // � lrI_- armor-•- � (0/•/,// 1.TM.R1W WX J TM tWNaY OREM ` 4 *GALE 1" • OW' SEE MAP !S MA ` 4AMU t60HIGHLA / se be.su Aa9 �� MI r,�s ,,.soe ,or so ate e low 3500 a 5400 5 6d't 1p ft'J0 5700 166 Q6 154 t it4 S 157 , low ' 3 7103 5 324 ~ MTW t11 ODM 4 Neoo 'N 1 L LOW BROOK FARM ,� ,boo M9 uz 0900 •e 400 2 �,A� 5000( dmo 320 5 I � a tea ST DEO 9Se/340 O'C SUMMERFIELa �. ■ •r• so'[ 050•r li 9004 •r• r n't rN ,.� 7800 - 4 a, Poo N1ATC Ells."►wit ►�I�I� R/W CURB JOINT I SEE NOTE 5 I ROAD ..._ 2 2" OF 3/4---0 COMPACTED SUBGRADE SIDEWALK ADJACENT TO CURB R/W 5' MIN. 6� I ROAD III TSE'E NOTE 5 I I 2 OF 3/4'=0 I COMPACTED SUBGRAOE SIDEWALK AWAY FROM CURB NOTES I• CONCRETE SHALL BE 3000 PSI, AT 28 DAYS , 6 SACK MIX , SLUMP RANGE OF I I/7" TO 3" 2. PANELS TO BE S FEET LONG 3. EXPANSION JOINTS TO BE PLACED AT SES OF UTILITY VAULTS .WHEELCHAIR RAMPS, a AT SPACING NIOT VEWAY EXCEEDAPPROACHES DA45 FT.' 4. FOH SIDEWALKS ADJACENT r0 THE CURB a POURED AT THE SAME TIME AS THE CURB, THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN, 1/2"RADIUS. 5' SIDEWALK SHALL HAVE A MINIMUM 6 INCHES CURB IS USED OR IF SIDEWALK 5 INTENDED SASOFPORTION OF IDRIVEWAY MOUNTABLE OTHERWISE SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 4 INCHES 6. DRAIN BLOCKOUTS IN CURBS SHALL. BE EXTENDED TO BACK OF SIDEWALK WITH 3"DIA. PIPE AT 2 % SLCPE CONTRACTION JOINT TO BE PLACED OVER PIPE PLASTIC ^WASHINGTON COUNITY WDEPARTMENT OF LAND USE AND TRANSPQRTATION CONCRETE SIDEWALK DATE" CIVIL ENGINEER / /? _ J, DR/IWN APWA NO. WASH, COGNTy Na NONE CS - 305 F#%.0 OF CURB DRAINAGE BLOCKOUT WIDTH OF STREET �_ 3" I.D. PLASTIC PIPE ' WITH COUPLING I" R 6" / 1/2" R ROAD .o • MAX. 1O • • BASE COURSE • u °o 9"- I. FOR DESIGN SPEEDS GREATER THAN 40 MPH THE EMERGENCY MOUNTABLE CURB CS-300 SHALL BE USED. 2. CONCRETE TO HAVE A BREAKING STRENGTH OF 3000 P&L AFTER 26 DAYS. EXPANSION JOINTS . A. TO BE PROVIDED U AT EACH POINT OF TANGENCY OF THE CURB . 2) AT EACH COLD JOINT . 3) AT EACH SIDE OF INLET STRUCTURES. 4) AT EACH END OF DRIVEWAYS . D) AT LOCATIONS NECESSARY TO LIMIT SPACING TO 45 FEET . B. MATERIAL TO 9E PRE - MOLDED, ASPHALT IMPREGNATED, NON-EXTRUDING, WITH A THICKNESS OF 1/2 INCH. 3 CONTRACTION JOINTS . A. SPACING TO BE NOT MORE THAN 15 FEET B. THE DEPTH OF THE JOINT SHALL BE AT LEAST IV," INCHES . 4. '1ASE ROCK -2"-O ORI/411,0 , 98% COMPACTION. BASE ROCK SHALL BE TO SUBGRADE OF STREET SIHUCTURE OR 4" IN DEPTH, WHICHEVER IS GREATER . S. DRAINAGE SLOCKOUT - 3" DIA. PLASTIC PIPE . A. I.D. PLASTIC PIPE WITH COUPLING. B. DRAINAGE ACCESS THROUGH EXISTING CURBS SHALL BE CORE DRILLED OR CURB SAW CUT VERTICALLY 18" EACH SIDE OF DRAIN 9 REPOURED TO FULL DEPTH OF CURB. WASHINGTON COUNTY CURB NON - MOUNTABLE ,mm� DEPARTMENT OF LAND USE FOR USE ON MEDIANS' AND TRANSPORTATION DATE CIVIL ENGINEER MWN APWA NO. WASH. COUNTY NO, �Ll°7/S4 �•�... � �. lmt &-" 18 ( MM) CS- 301 92 A QTY OF TIGARD - .YR 2 form is a nulti-use form. Appavpriate receipts milst be attached, Doc�r�tat?on j- Wcrtant for all PUrp-Ses. Staple do=-.entati.on to form. VENDOR NO.. _ DATE: ___ I�IbV • 1 v PAYABLE TO: �r��� �e� ctc�C�r i v\��n� RFJWESM BY: - -,CL x_111 f?r1 a, -71 Z�K * Approved request Wednesday 10:00 AM to A/P for checks by Friday. EXPENDI'Ras: `- -- - Date Description, Invnim two-, etc. Account No. Amount Z-Z3 Sr�S �I-A t TOTAL --- $ 1 Z S Mileage $0.255 —' ■ .APPROPRIA- ON BALANCE: AS OF: _ _ SIGNAIIM: (Up to $25.00) Sectio n Manager _ Punch, Agent i ($2.5.01-2,500.00) Division Manager ($2,500.01-7,500.00) Dept. Head ($7,500.01-15,000.00) City AdrunL,trator ($15,000.01- ?) vocal oontxact Review Board APPLIC I - " STREET IMPROV-MENT/EXCAVATION COPY TO: IN ILE ORDINAL..E NO. 74-14 A (WHITE)- - ® (YELLOW) INSP, (INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)-OTHER AGENCYb1dg. (� (BLUE)-APPLICANT c• APPROVED 17Cj APPLICATION NO.: NOT APPROVED ❑ CI'I'I' O 17GARU, OREGON FEC AMT.: : 5.00 PENDING FEE. PMT. ❑ CI I Y HALL RECEIPT NO,: V. PENDING SECURITY O PUBL IC WORKS DEPA R TMEN T BY �_ DATE— I r PENDING AGENCY "OK" 0 \)ph(alion and Progress Record MAINTFNANCE BOND PENDING INFORMATION ❑ >k FOR STREET IMPROVEMENT/EXCAVATION As RFOUTAED —_– ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE: ____L___ PERMIT NO.: ' < I —_- DATE ISSUED: BY: _ I_._^�._.._._...__ �•� 1 i �._-__�.�_r��— (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR ANDWIPP --jriv.-'v� al1d RepI-act' a 4' x 12.5' Concrete Sidewalk Section AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQIIIREMENTS. i APPLICANT _ Mr. _DrA�1 Cr -ord PO Box 1167 McMi_nville,_O_R 9.7128__ # 8.35-7373 NAME ADDRESS CITY PHONE�� CONTRACTOR--. (Sam) __ NAME ADDRESS CITE— ...-_-�YMONE�� PLANS BY _ Per City Standards;Spec i f i c;.+.-.i.I.,1 13_ _ _ NAME —�ADORE5S -� CITE-- PHONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S }CXRUN 125.00 DOLLARS FOR OFFIC �E: CMIN. (2) EXCAVATION DATA -_- _- o.oa x s. � ''� 6.00 _ _ STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEP','H ITEM AI QUANTITY STREET D II- /2-q Highland D ive (see tach ) INSP - TION )-1 -q.? Ins ., Sw ym Q U _. ESTIMATED STREET OPENING DATE:__ 1 L_-.. �` E S ESTIMATED STREET CLOSING DATE: / g 125.W STREET (3) SECURITY NO. ._.-_ _- SECURITYAMT.: $ _.. CLOSED SURETY CO.. _ _ FINAL CERTIFIED( "ECK Ll _ CASH ❑ BOND INSPEC. I)-I�- I ll)D CIrPLb-TIC_ (4) PLOT PLAN: INDICATE SITE PERTINEN PHYSICAL S"ECIAL PROVISIONS/CONDITIONS: FEATUT; EXCAVATION LOCATION AND EXTENT. 1. Notify .Inspector LeLha Thomas /,+ ,a� •cA -- hrs. orQ-sra-rYThq I _ _1011citt confural to City 1 I SITE: 1011% S.W. I I I ukardards & ar-)ecifications. _ % ,_.I 4 Highland Drive f 1 3. ORS 7.57.541 1 .571 (Utility Co. pue_ S.W. Hi.ahlarici M. ive urovid,d fo,r by contractor. `- - -� - ----- 5. Erosion control must be provided or by contractor. 1171, 1 I - I I I I N (S) NOTE: THE CITY uF TI(,ARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAY JURISDICTION IS 1HAT OF WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICAI"T AGREES TO DEPOSIT T"HE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECT► ICA TIONS 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. DATE / CITY OF T I CAPD - RECEIPT OF PAYMF-NT FiFf.E I PT NO. :92-233568 CHECK AMOUNT t 130. +r0 NAME: 9 NOR`fHWEgl' CONCRETE CASH AMOUNT 0. 00 ADDRESS a PO BOX 1167 PAYMENT DATE 11/ 10/9P Mc.M T NNV I I.A.-E, ('IR SUBDIVISION PURPf. SF OF PA'Y MENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID C;USTCIMER Df~Pfl 125. 00 f"If.ILAL IMPROV . 'r I 'I Vy STF?CL T OPENING 1=4-RM I`I' '523-•92 I OTAf_ AMOUNT F-1011) — -> 130. 00 +M�. .;nrr.�-rl*Si.r:T`rerT+T•-:.••7'ivTfl.';^+rn+tr*-nR,TC!'r*:f^.'.'TT'.:TCR': +r�;:t`T R7' .. .;csi,.:i: -.^Tr-. rrTlMrrf'T.rr-.^ ^.rm.rn'r+.�w�...,-.a... r•nr..c•.+r•.+V^+i ,.nr,n•....,-rrr-.- 1203 ORTHMST CONCRETE 24-22/1230 GRIND14G RRANC;N 017 SPEQMAnNO IN s1oEwAix RFPNR P.O.SOX 1187 McMINNNIIE OR 17178 Y�»s THE OLLARS Tt7ffOANK 11NITFf7 STATE!'.NATIONAL "ANN OF OPEOON )R t9(1?�L 1.� �Q—_��1 C.[l�•¢J_ _ _ 1/'4�f G.xz.1 — — -- 11'00 l 20 3111 I: L 2 3000 2 201: 0 1 7 00 & 7 t,9 SII' �...«..n........aWw�w+W.w.�+•......�,,,..........r,Hwaw..w.�..�..w.�..eww.,...w..i.w.o.a�...wwr..re.w.�wv+mbw.+inw.�rwwwvnw+•.w�rw,...�.............«•wnW w.•..�n.......ww�xwi..r.w.o.�..�i.r+m.�..,...-�..w.-..w.....+.......�.,...«.�.......w.w�.rwa�wwlwWllDtlY I L��4�S �e� rN�SSic�e. 1 �eti li he 2��• I CITY OF TIGARD STREET OPENING PERMIT APPLICATION DATE • APPLICANTS NAME \)D h (LV ot w�0 V ADDRESS a / / la , v \� C 0` q ZIP ! 7� 1z PHONE 7 • CONTRACTOR'S NAME ADDRESS ZIP PHONE • PLANS BY ADDRESS .— ZIP PHONE • DESCRIPTION OF WORK PROPOSED TO BE DONE: ��"�•,P o �^ 0. l� R ! eye I � G X w f Gy► • ESTIMATED VALUE OF WORK (within public right-of-way) :$, • WORK LOCATION/SITE ADDRESS: i 7 % ,5 S F" v L, a • IS THIS WORK RELATED TO A LAND-USE ACTION? IF SO SPECIFY (MI-P, SDR, ETC.) NO. • IS THIS RELATED TO A BUILDING PERMIT? IF SO, SPECIFY (BLDG. PERMIT) NO. (ow-11) SKETCH: ��S �•dl �5 . �I , 9 ..-