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WITH FLOOR F'OKA-MHOL-E I SET SUMP 1- I/L" I]tSCIdARGE
WITH /SOV E I►RLY S T P_ E Q G T Vk CONCRETE
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o4D. No.SAI.-36L 382
IV O NE
CNAINt AND tMtAN DATt LAWNNIS CNKD A►/D AMD w' N C C
1 OF 2
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GTEP 900.1cio-903 NW
NEW 3/4 "L D iV LL//T f`S EP l//LE Lt//,,PE woman vuwpm" a."a„Ifo.,,,t„ff%
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NOTE: IF THIS MICROFILMED �j-�� �-�•- 2 3 4 _ 5 9
DRAWING 1S LESS CLEAR THAN
THIS NOTICE; IT IS DUE TO
TW QUALITY OF THE ORIGINAL
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MARCH 30 1992
FILE 'Q0. l i 4-B2-
F N ST. - 12460 STR. OPN. PERMIT
APPLICATION -- STREET IMPRC 'MENT/EXCAVATION COPY TE
(WHI7E) FILE
ORDINr,..�'E NO. 74-14 ❑ (6LUE) INSP.
n (YELLOW) -OTHE.i7 AGENCY
(INSTRUCTIONS ON SEPARATE SHEET) 1.1 (PINK) APPLICANT
APPROVED ❑ APPLICATION NO.:/��
NOT APPROVED ❑ CI*I ti O I IGARD, OREGON FEE AMT. S
PENDING FEE. PMT. ❑ CITY Y HALL, RECEIPT NO.:
PENDING SECURITY ❑ PUBLIC WORKS DEPA R TMEN T BY __ DATE-
-
ATE=_L_--�---
PENDING AGENCY 'OK" ❑ Application and Progtrss Record MAINTENANCE BOND --
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRIEU _1
ANNUAL u
PENDING VARIANCE ❑ EXPIRATiONDATE: --
PERMIT NO.' —SLS _ _ , DATE ISSUED: BY: r_ _'
O I APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL 1 1/L" " PPC, Grain Line
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _GENERAL TELEPHONE CO. OL 11HE' N !I' °460 W Main St i�
1' ava _ 620-0373-
NAME ADORff 1 7V --- PHONE
CONTRACTOR — ____
NA [ff CITY PHONE
PLANS BY _ GENERAL TELTPHONE CO. OF THE A.W, 12460 S. h'. Main St. Tigard 620-0373
NAME ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S _ --- ---
DOLLARS _ . .
- ��- FOR OFFICE USE: ��// 'MIN.
(2) EXCAVATION DATA: 0.02 X s_ f ----..--
---
STREET DESCRIPTION PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE COY
'TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET
P
RPEC-
TION
--- E _
Q
v ESTIMATED STREET OPENING DATE:--_ --�— -- E$
ESTIMATED STREET CLOSING DATE: __—_ / ED
�� STREET
(3) SECURITY NO. -- SECURITY AMT.: E� __ Ct
SURETY CO.: _ FINAL.
TI FI[O CHECK U CASH D •OND L INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT. ..Tt.rl_Of GGA 7,E.
I5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHSRE:
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPC"3IT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY ANUI
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE "� ,-- ,— DATE _-
t
GEnu-RAL TELEPHom COn1PAnY OF THE nORTHMEST, onC.
1;460�,W MAIN. P O BOX 13416,TIGARD,UREr;ON 9722:!
March 18, 19J2
City of Tigard
P.O. Box 23397
Tigard, Or 97223
PE: 546-3869.582
Enclosed for your information and approval are two copies of the
above-honed job. The purpose of this job is to reduce mater level
in manhole by placing a 1,12 H.P. pump. This will relieve the load
on the Central Office punrp-
If you have any questions regarding the ,job, please contact Tim
Lewis at 620-0373.
Very truly yours,
Donna Donaldson
A&ninistrative Ascistart
dd
enclosures: 2