9660 SW JOHNSON STREET-1 FILE N'`. 150-d2
JOHNSON STREET - 9660 STR. OPN. PERMIT
CITYOF TIGARD
WASHINGTON COUNTY,OREGON
January 18, 1984
. Western Plumbing
. 9665 S.W. Commercial
. Tigard, OR 9722.3
RE: Strect Opening Permit
Dear Sirs:
We are returning the bond that you posted when you worked in public right-
of-way in the CIty of Tigard.
Thank you for your cooperation.
Sincerely,
R. L. Thompson
Engineering Services Crew Chief
enclosure
RLT/dc
-- 12755 S.W ASH PO. BOX 23397 FIUAND,OREGON 97223 PH'639-4171 -- -�
APPLICATION — STREET IMPRf 'MENr/EXCAVATION C:JPY TO:
ORDIN, .CE NO. 74-14 E] (WHITE)•FILE
❑ IBLu[1•INSP.
❑ ( [LLOWI-OTH[R AGENCY
(INSTRUCTIONS 7N SEPARATE.SHEET) P
APPROVED (_� Ar,PLICATION NO.: . �
NOT APPROVED J CITY OF TIGARD, OREGON FEE AAT.: f_ J
PENDING FEE. PMT. I_� CII Y IIALL RECEIPT NO.:�/ ` let
PENDING SECURITY O PUBLIC WORKS DEPARTMENT BY - -- _ DATE � ,
�—
PENDING AGENCY "OK" ) Application and Progress Record MAINTENANCE BOND #► —
PENDING INFORMATION I I FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED 17
ANNUAL ❑
PENDING VARIANCE U EXPIRATION DATE:
PERMIT NO.: Y I' '�`_ DATE ISSUED: _ _ _ 1�rl_S-L- , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND IN'�7,'eLL
__ AS DESCRIBED HEREIN, IN FUI_t_ ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT l!'�/.c:�T.C` / &01_)1le2qir GS_ _GG ci►��I►f4h'C:A� ell
s �
NAME ADDRESSCIT PHONE
CONTRACTOR-!-
NAME ADDRESS
---- ----CITE-- -- O [
PLANS BY.
NAME ADORESS� - --� CITY PHO14F
gn 44
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): !S'� @.�� —_
DOLLARS
(2) EXCAVATION DATA: - vl-t — Z----. 0.0 X FOR FFICEUS . OMI.S.
f f
STREET r _ DESCRIPTION I PROGRESS & INSPECTION STATUS
NAME SURFACE CU! CUT CUT MATERIAL INSTALLED , ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
f0/7N S /1► L I / Zfo C STIEET
OPENgy
1 N TIO N
..._ E
Q
ESTIMATED STREET OPENING DATE: -1 2 S
T
EFTIMATED STREET CLOSING DATE: ED Af (j_ 0'
(3) SECURITY NO. T ECUR YT.: $-AM — STREET '� u
SURETY CO.: C _ _ Y - r!NAL / lh
CERTIFIEOCH[CK ElCASH OBoNl' (,/''� INg''�V• _
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL 9Pkf7.IAL PROVISIONS/ CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
r
1 I 1
1 �-fz
-,qw- I 1 1 1 1----
CURB ---
I r
( I 1 1 I
( 1 ( 1
r
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF ORE&.44.
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 SAVE HARMLESS THE c.rY AND
EMPLOYEES AGAINST ANY INJURY OR DAM4GE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
7
APPLICANTS SIGNATURE: MATE �l
CITY OF TIGARD—12420 S.W.MAIN—TIGARD,OREGON 97223
RECEIPT
DATE: AMOUNT
12 1
-- =7=---DO[I.ARS
CASH:ASH:
ADDRESS:
MO.:
0 OF
FOR: ACCT. # PERMITS SURCHARGE. AMOUNT
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-33!
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPE(7-TION 40-365
SYSTEM DEV.CHARGE 25-3t6
PARK DIV.CHARGE #1 30 67
PARK DIV. CHAPGE #2 30-368
ZONING ADJUSTMENTS 05-362
TOTALS)
RECEIVED
PERMIT NUMBERS ASSIGNED-
Number Amount Number Amoi1M Number Amount
4,
ia 11",
RECEIPT "115 0 0