10020 SW JOHNSON STREET-1 FILE NO. 409-91_
i
JOHNSON STREET - 10020 STR OPN DERMIT
I
CrIT OFTIGARD
F-XPEND=E RH�UFSr
9bis. form is a multi-use form. Appropriate receipts rust be attached. Documentation
important for all purposes. Staple docum(-,ntation to form.
VINDOR NO. DATE: z-4-
PAYABLE TO: Rw=rm BY:
Y.2 v% 9-7 7- Approved request due Wedry--:;diy
10:00 AM to A/P for checks by
Friday.
MISCE11ANMUS F�JWDMMJ--S:
Date Description, Invoice No., etc. Account No. Amount
IC)- Z-Z-000
7 Z,-S.
jer- I-N 7 3-9 +J& 9
WrAL
,,I teage $0.255
APPROPRIATION BALANCE: AS OF: SJC.NAIIW:
(141 to $25.00) Sect ion Marvig(ir Larch. Agent
($25.01-2,500.CO) Division Manager
($2,500.01-7,500.00) Head
($7,500-01-15,000-00) city Administrator
($15,000.01- ?) Lf-,-al Contract Review no,-jrxj
1501F
i
.DEFINE:entrct=case->eng definition incorrect
ENGINEERING PERMIT'
PERMIT #. . . . . . . : ENG91--0010 DATE ISSUED: 04/08/91 By:
PRIM. PERMIT #. : ENG91-0010
"ITE ADDRESS. :10020 SW JOHNSON ST PARCEL: 281-2RB-01200
SUBDIVISION. . . ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
PGGERRRMMggITEETYPE. . : SO/P IGMRPARDOVEEMENTS QUANT ----RATE - - VALUE
ASSURANCE EXfIiATTON�-- STRE�TROS
PERFORMANCE:: / / SAN SEW
MAINTENANCE: / / STM SEW
UTILITIES
ALL OTHER
TOTAL $
Remarks : STREET OPENING, TO INSTALL, A CONC DRIVEWAY APPROACH (SERVING FOUR
PARCELS IN JOINT USE) .
Permittee: ----------------- FEES ----------------
DAVID L. LEARY CONSTR. CO. type amount by date recpt
10020 S .W. JOHNSON ST. OPEN S 29.00 JSH 04/08/91 211738
TIGARD OR 97223
Phone #: (503) 639-6255
Engineer:
ENGINZER NOT ON FILE
S 29.00 TOTAL
Phone #:
------- REQUIRED INSPECTIONS -- ----
Permittee/Agent Signature: ---STORM SEWER-- -----STREFT------
M.H. & C.B. CRB LINE & GRADE
PIPE LN & GRD SUBGRADE
BCKFLL & CMPCT' BASE ROCK
AIR & TV TEST LEVEL COURSE
City of Oregon WEARING COURSE
131.25 S.H . 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 3CKFLL & CMPCT WALK/APRON/RAMP
AIR & TV TEST
FOR INSPECTION, CONTACT: --- -GRADING---- ---
Carl Vieweg #639-4171 (offiro) ---REPR' S/ADJ, S-- CONTOURS
#780-2647 (mobila) DRAINAGE
----PATHWAYS----- EROSION CNTL.
APPLICATION - STREET IMPRO (' ENT/EXCAVATION COPY TO:
41' !Z (WHITE)-FILE
OR[ IVA ENO 74 1 4 19 (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)-OTHER AGENCY—b],(3g
(BLUE)-APPLICANT
APPROVED X APPLICATION NO :�J* ---
NOT APPROVED CI'T'Y OF TIGARD, OREGON FEE AMT. $ -_22.00 —_
PENDING FEE. PMT. _] CIrY HALL RECEIPT NQ i9! _•Z0738 1
�
PICNDINGSECURITY C PUBLIC WORKS DEPARTMENT 13Y _ _ DATE_ L�L6_L
PENDING AGENCY 'OK'' ❑ Application and Progress Record —
MAINTENANCE BONG k_
PENDING INFORMATION C] FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRFD X ^'
A 1:NUAL ...
PENDING VARIANCE �] i _ EX' VAI'10 DATE:
PERM!T NO DATE ISSUED BY
—l•---
( 1 ) APPLICATION IS HEREBY MADE TO EXCAVATE= FOR AND INSTAL(_ 1DRIVY APMALH
�___ AS DF"SCRIBED HEREIN, IN FULL. ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT David L._L- y Construction Co. 10020 SW Johnson_ St. Tigard, OR 97223_ 639-6255
NAME - ADDRESS CITY PHONE
CONTRAC TORS�MII�E
-._ AME ADDRESS C I T Y_.__�__�.
P L A N cj BY - SEE ATTACHED -
__ NAME—_ ADDRESS .—__--_._.._._—_ __. CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 725.CJ
DOLLARS
- �--_ - -- —=.---•— -- FOR OFFICE USE MIN,
(') E:CCAVATION DATA: o nn x s 725-00 s 2_9.00
STP,EET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTAI-LED — ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DCPTH ITEM A QUANTITY
STREET
Jgbnson St., sera attached - R TION
E —
_ O
U - ---- ---._..
ESTIMATED STREET OPENING DATE: E
T - — ---
CSTIMATED STREET CLOSING DATE:
— D
;
(3) SECURITY NO. SECURITY AMT. T 725.00 STREET
GLpggp
SURETY CO FINAL I
1
401lKEIKCt76CHFc.v X CASH U 80140 INSPEC. 1Ev
(4) PLOT PLAN: INDICATE SITE •ERl INENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS
FEATURE''. EXCAVATION LOCATION AND EXTENT. 1.) Notlfv City pector &,—Carl
2 ) I Vieweg (#539-4171) 24 hrs. prior
1 �o initiating work. ____
1 i ' I 2_) 'traffic control to by provided
/ 1 L_-_ -_ -_- _vR I �
_. __,for, at all tim@S,Igy contractor
JOHNSON ST. 3� All work shall conform to City
r — ----- standards/specifications and to
the attached plan.
xx WORK SITE
4. ) Excavator must comely with
11 _ = _ _ -
1 ! zc' I I ORS 757.541 - .571 (prelocate
1 � I (lutfird'S.W.
Johnson St.) utilities, etc.)
I51 NOTE THE CITY OF TIGARD DOES NOT, HEREBY, ;RANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JUR:SDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO C'IMPLY %ITH ALL PERTINENT LAWS AN13
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT QF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST' ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
i
APPLICANTS SIGNATURE �--�� � DATE
i
.�- +!�..r,.�.�-7r!�w(.'..-"^.'�'�,-.+^^-+.m^^....'^r'*tarn",*'.-�y'RrR`qf••r�ITr+�w.'r°?+_'+'.'�^re•'*..r.—r+------
APPLICATION - STREET IMPRC MENVEXCAVATION COPY TO:
_ ORDINANCE NO. 74-14 3 (WHITE)-FILE
(YELLOW) -INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (PINK)-OTHER AGENCY-bldg
(A (BLUE)-APPLICANT
APPROVED / �,A -
® AP"LIr_ATION NO.:
NOT APPROVED ❑ CITY OE"FIGARD, OREGON FEE AMT.: S_._Z9..00
'ENDING FEE. PMT. ❑ CITY HALL RECEIPT NQ.: �l• - ��7-)C�''
PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY __ DATE
PENDING AGENCY ''OK'' ❑ Ap)Ili(alion and Progress Record _
C) MAINTENANCE BOND
PENDING INFORMATION
FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRE❑ x
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE: On@ygar -�
,I
PERMIT NO '_- ,/ It DATE ISSUED: BY:
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL �Aj"[t�A I
- A`' DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APDL ICANT )avid L. Leary C:o:ist_r_uctiouTZu. .10u_'0 SW Johnson St. 'Tigard, OR 97223 #639-625`_,
NAME ACDRESS CITY T—"- PHONE
CONTRACTOR LSAME) _
NAF L' — ADDRESS --�--f.�T�—___.__._..--_. PHONE
PLANS BY _ SEE ATTACHKD
NAME ADDRE94 CITY PNONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COS , ): $ _ 725.00
--_ -._-.�--=-- - - - - - DOLLARS
(2) EXCAVATION DATA: FOR OPFICF wE. MiN
_ 0.04 X S-125.QL!__
STREET DESCRIPTION PROGRESS & INSPECTION S1 ATUS
NAME SURFACE CUTCUT CUT MATERIAL INSTALLED ITEM DATE I REMARKS/TYPE BY
-- TYFE LENGTH WIDTH DEPTH ITEM Ai QUANTITY
.TREET
PEN LF
_
Johnson Gt. - gEe dtt1.IleC] R TION
PEC-
E —
U
ESTIMATED STREET OPENING DATE. / L S
ESTIMATED STREET CLOSING DATE: / / T -
-_ E
--- �__- D
(3) SECURITY NO. STREET
_ SECURITY AMT.: $ 725.00 . CLOSED
SURETY CO FINAL —
K�.WEDI— Kil .�—CHECK ---_---_CASH ❑ DOND INSPEC. ?-z �5L - ,r4 ✓ ((.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL a_-- SPECIAL PROVISIONS /CONDITIONS:
FEATURES. EXCAVATION LOCATION AND EXTENT. 1.) NOtifY City Inspector Mr. Carl
Viewe9 (#639-4171) 24 hrs. prior
I I _ to initiatir
I I � yg work.
2.) Traffic control to be provided
sae - `. _ _ _ _ _ _ _ _ _ ._ _ _ ,' I� _ _ _ for, at all tinme,bv contractor
JOHNSON ST. 3.1 All work shall conform to City )
----.-- > standards/specifications and to
,�, • r 4 _ _ _ _ _ _ _ _ the attached plan.
WORK SITE ^1 -- 4•) Excavator must comply with w
I
I (10C. 'S.w. I i I � ORS 757.541 - .571 (prelocate
I I �_
Johnson St. ) I utilities, etc. )
NOTE THE CITY OF TIGARD DOES NOT, HERESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT OF WAY JURISDICTION IS THAT Or WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO CAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE _ f DATE
I DAVID L. LEARY CONSTRUCTION CO.
10020 SW JOHNSON ST. I� 1
1613
TIGARD, OREGON 97223 1 �
•1L*1 YMY
TO THEPAY / I
ORDER OF_ �+
75 Y
DOLLARS
U.S. E�ANK
TIOAgO BRANCH
P.O.BOX 233013 TIGARD,OR 97PRS
UNITED STATES NATIONAL RANI(OF OREGON
1180016f_1,3"1 1: 1230002201: 036 0lofl 95Sii•
CITY OF TIGARD — RECEIPT OF POYMENT RECEIPT NO. :91 11738
CHECK AMOUNT 754. 00
NAME. : DAVID L. LEARY CONST. CO. CASH AMOUNT 0. 00
ADDRESS : 10020 SW JOHNSON STREET PAYMENT DATE o 04/06/91
SUBDIVISION
TIGARD, OR 97223—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
CUSTOMER DEPID — 7.=C. 00 PUBLIC IMPROV 409--91 : y• 00
10000 SW JOHNSON STREET
TOTAL AMOUNT PAID — — — —> 754. 00
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT 1\10. :91—.211738
CHECK AMOUNT r 74. 010
NAME y DAV I D L. LFlRY CONST. CO. AMOUNT 0. 00
ADDRESS 10OZIth 1,3W JOHNSON STREET PAYMENT DATE 04/08/91
9UBD I V I Sl(IN
TIGORD, OR 972;.:3--
PURPOSE OF PAYMENTAMOUNT PA 1 D PURPOGE OF' PAYMENT AMOUNT PAID
10000 9W JOHN130H STREET
�TUTAI- IMOUN*r wow 754. 01A
Licensed - Bonded - Insured
DAVID L. LEARY CONSTRUCTION
Residential& Commercial
10020 S.W.Johnson
Tigard, OR 97223 (503)639.6255
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