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12090 SW MAIN STREET FILE NO. `4C)2 -6tt MAIN ST. - 12090 STR. OPN. PERMIT Cr 1'Y OF T.LGM4) DDE NDr1URE: R17Q= This form is a multi-use-form. Appropriate receipts must be attached. Doc mentation -)is important for all purposes. Staple documentation to form. VENDOR NO.: _ DATE: r P.AWMZ TD: Wt y�Q,rt^ +� Je4 v�Cr� -AC-, ED BY: ("-;.Q LI.),E, ---- -- LQa Cie,6, Approved request due Wednesday 10:00 AM to A/P for checks by Friday. MSCELUXBOUS FXPENDIZURFS: -- Date Description, Invoice No., etc. Acx=nt No. Amount. IA IUM, Mileage $0.255 APPRCPRLIITION BALANCE: ! ---_ -- AS OF- — SIGNMIM: ((4) to $25.00) Section Manages' purch. Agent ($25.01-2,500.00) Division Manage-r ($2, 00.01-7,500.00) D(-,L)t. I{ead ($7,500.01-15,000.00) City Ac3mini-strat:,or. ($15,000.01- ?) Local Contract Inview Lk),tird -)ke/1501_F t~o�j V-) 2z-9 +L s �tNy� O v APPLICAIi'ION - STREET IMPRC MENT/EXCAVATION COPY TO: ORDINANCE NO 74-14 (WRITE)-FILE I (YELLOW)-INSP. (UV'=TRUCTIONS ON SEPARATE SHEET) ❑ (PINK)-OTHER AGENCY (BLUE)-APPLICANT APPROVED in ' APPLICATION N'),: 44-1 -•_ NOT APPROVED n CI I ti UI 11GARM OREGON FEC AMT, S 226.00 PENDING FEE. PMT. ❑ CI)Y f11ALL RECEIPT NO. -0a 9 71 PENDING SECURITY ❑ PUBLICWORKS DEPARTMENT 13Y _-__ ___-___ DATE - 12-5-1 `11 PENDING AGENCY ''OK'' F3 Application and I'roRrrss Record - - - - - - - - ,_ _ - - - - - - MAINTENANCE DOND >< PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS RE4UIRED x ANNUAL. PENDING '1AR1ANCE ❑ EXPI RATION DATE; one year PERMIT NO ( DATE ISSIJED •� (1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL concCete sidewalk repairs AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT WestEorn Constr. Service Inc. 6502 N) St. Johns Vanc. WA. 98661__ 206 699-5317., NE AMADDRESS- CIT also 222_-92966 NE * CONTRACTOR SAME --- - ---- ------ - - _�.-- -- r. NAME ADDRESS CITY - -_.PRONE PLANS BY Per City_atandarda__($..ee__J ttsdches�.�/hl__ i311) w'AML ADDRESS CITY --�_. ---- HONE _ ESTIMATED IMPROVEMENT TOTAL_ VALUATION ( COST: E _ 650.00 DOLLARS (2) EXCAVATION DATA. fbR OFFfCE USE MIN. 0.04 x s STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS_ NAME SURFACE CUT CUT CUTMATERIAL INSTALLED ITEM DATE REMARKS/TYPE By TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY STREET MAIN ST CONC. 6'x8' S Px3l CONC. S/W INSP c- - R TION — Q ESTIMATED STREET OPENING DATE:- / / E S EST MATED STREET CLOSING DATE: / / T E D (31 SECURITY NO, SECURITY AMT.: E_ 650 00 STREET -- •��. CLOSED SURETY CO.: _. _- , FINAL XxAxjwkdtcHELK R w CASH_❑ _SONO INSPEC. (4) PLOT PLAN INDICATE. SITE PERTINENT PHYSICAL -_- `-T SPECIAL PROVISIONS / CONyT DITIONS. FEATURES. EXCAVATION LOCATION AND EXTENT. 1. NOtlf Cit • Inspector Carl View (#639-4171) 24 hrs• prior to I I I _ startingwork. ' 1 I ro 1 2,AA11 work shall conform to City Baa - _-_Standards &=pecifications. MAIN ST. n �_09J].tl:actor shall provide fo. .___ --Pedestrian & traffic controls_ 4. Contractor msut comply with w �) URS 1 IL 9 I 1 757.541 to .571 Lutility I WORK AREA I I _,.relocation, etc.) I I I (12090 SW MAIN S.C. ) (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS T'O CONDUCr WORK WHERE RIGHT-OP-WAY JURISDICTION IS 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 PERTINE T TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJ .AY OR D AGE WHICH MAY RESULT FROM APPLICANTS ACTIONS APPLICANTS SIGNATURE DATE R/W 5 MIN 1CURB JOINT SEE NOTE 5 V -- 2 ROAD _ a e ,U 1-,ADI 2, OF 3A r COMPACTED SUBGRAOE SIDEWALK ADJACENT TO CURB R/W 5MIN �6• — I �— 2 ROAD . e --- III — 'SEE NOTE 5 J I 2" OF 3/4"-0 � I COMPACTED SUBGRADE ' SIDEWALK AWAY FROM CURB NOTES I CONCRETE SHALL BE 3000 PSI AT 28 DAYS , 6 SACK MIX , SLUMP RANGE OF I V2 TO 3 2. PANELS TO BE 5 FEET LONG 3 EXPANSION JOINTS TO BE PLACED AT SIDES OF DRIVEWAY APPROACHES , UTILITY VAULTS ,WHEELCHAIR RAMPS , 9 AT SPACING NOT TO EXCEED 405 FT. 4 FOR SIDEWALKS ADJACENT TO THE CURB 8 POURED AT THE SAME TIME AS THE CURB, THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN I/2"RADIUS. 5 SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY . OTHERWISE SIDEWAI..K SHALL HAVE A MINIMUM THICKNESS OF 4 INCHES . `;. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3"DIA. PLASTIC PIPE AT 2 % SLOPE CONTRACTION JOINT TO BE PLACED OVER PINE. WASHINGTON COUNTY ��DEPARTMENT OF LAND USE CONCRETE SIDEWALK AND TRANSPORTATION DATE CIVIL ENGINEER DRAWN APWA NO. WASH, COUNTY NO. E -�jNONE CS - 305 CITY OF TIGARD - RECEIPT OF' r'Av`MENT R2-CEIPT NO. :9:1-209971 DAME WESTERN CONSTRUCTION CHECK AMOUNT 676.00 ADDRESS SERVICES CASH AMOUNT 0.00 6502 NE ST JOHNS PAYMENT DATE 02/25/91 VANCOUVER, WA 9©661 SUBDIVISION : PAYLESS - MAIN ST UF�POSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID :USTUMER DL-`PO 650.00 PUBLIC IMPROV 402-•91 26.00 OTAL 'AMOUNT K,AID - - -> 676.00 WESTERN CONSTRUCTION SERVICES, INC. 2758 PURCHASE ACCOUNT CA LIC 4513599 6502 NE ST JOHNS RD 6&5117 )Nj% SIG. MVVESTECSl62H8 VANCOUVER,WASHINGTON 98MI 2-:L ,v`41-- PAY TO THE -.r- A-- //v�t� e� ii $r �b _ -- ---- - ---l�k+upluG r 1..l1(/ _ --- DOLLARS NO 60 N IOD w�R n N1_ 6VANFED P000002758111 1:3233710631: 4 1 OL167 7N' WESTERN CONSTRUCTION SERVICES, INC. ' CA LIC. #513599 PURCHASE ACCOUNT 2759 4A LIC. MVVE51[C51E^R8 8507 NE ST.JOHNS RD OWS317 VANCOUVER,WASHINGTON 9SE81 1-t 5 1v`_i1_ PAY TO THE ORDER OF I O -��'►`"I - --.J S[17 Loo ----_ _ DOLLARS i qct p1 VALOID WI R O P.TH�1� ."'1__00 6VANFED 11'00n0027591" 1:32337 &0631: 4 1 01167 70