10580 SW 105TH AVENUE FILE NO.
105TH AVE. - 10580 STR. OPN. PERMIT
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APPLICATION - STREET IMPR '_'MENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 ❑ (WH
BLUE) - FILE
(INSTRUCTIONS CN SEPARATE SHEET) ❑ IYELLOW) -OTHER AGENCY
(PINK) APPLICAN-1
APPROVED APPLICATION NO.: IcIIyy3
NOT APPROVED ❑ CI.1'Y OF TIGARD, OREGON FEE AMT. S
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.:
P�
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY �_ DATE 5F
PENDING AGENCY ''OK" ❑ Application and Progress Record - _
El BOND
PENDING INFORMATION #t_
FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ] EXPIRATION DATE: /
PERMIT NO : r!_.}�.. - / DATE ISSUED: . / `. / 7 5� -' --
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
--- —_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
NA•M - .. ADDAEtg -i CITY, / PHONE -�—
CONTRACTOR_ (,� ���,t
N w �---L ADDRESS IL LtJ C•.•
�•'- /) _ CITY PHONE
PLANS BY %c:�_--1 aL C_ f- ,.✓.l h. G Si"��f,�2y
N ADDRt98 CITY PHONE
� O
ESTIMATED IMPROVEMENT TOTAL_ VALUATION ( COST): f J� 00 _
--- __ DOLLARS
(7) EXCAVATION DATA: FOR OFFICE USE:
_ 0.02 X S
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITEM Ar QUANTITY ITEM DATE REMARKS/TYPE BY
STREET
+� +r
�I 7 p it INTP-
J R
E -
Q
GG p U
ESTIMATED STREET OPENING DATE: A / G' / / E
S
ESTIMATED STREET CLOSING DATE / / !� T� g '-
--- D
(3) SECURITY NO. -2 974 y 7
SECURITY AMT.: f �� ' STCLREET
_�:_
SURETY CO.: .� 675.�s•rn Sc��- F y !' OSE FINAL --
_ -.CERT(FItb CHUCK ❑ CASH O •VPD INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL =�T SPECIAL PROVISIONS J CONDITIONS"
FEATURES, EXCAVATION LOCATION AND EXTENT.
CURS ^ � _-
- VIA -" +► .^ .. � � �./n,5 0Po7- �77 '
(5) NOTE THE CITY OF TIGARD DO98 NOT, I,FRESY, GRANT P[RMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 19 THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT TPE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO rONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MA 'RESULT FROM APPLICANTS ACTIONS.
APPLICANTS 91GNA1URE: � �'1'h'�"`� DAT[ v / y� / •�
APPLICATION — STREET IMPRr1� :MENT/EXCAVATION COPY TO:
ORDIN``f. _, E NO. 74-14 (1 ISLUE) -INIPE
�� �BPUE) -INSP.
(INSTRUCTIONS ON SEPARATE SHEF_T') INSPE 7OPS CopyIYELLUW) -OTHER AGENCY
�'^ (PINK) -APPLICANI-
"F'PROVED Cl APPLICATION NO.:
.OT APPROVED [] GIIY OF TIGARD, OREGON FEE AMT.: $
PENDING r:E PMT. 0 (JTY HALL RECEIPT NO.:
PENDING SEC'JRITY 0 PUBLIC WORKS DEPARTMENT BY DATE / / _
PENDING AGEIICY;'OK" 0 Application and Progress Recor — — — — — — — — — — — — — --
MAINTENANCE BOND ik
PENDING INFORMATION 0 FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED o
ANNUAL
PENDING VARIANCE EXPIRATION DATE
PERMI'( NO.: __ - DATE_ ISSUED —_-- L-- --L .-.- . BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
CONTRACTOR
ADDRESS CITV _._. _.PHONE _-
PLANS BY
NAME .. ADDRESS --.._.. CIT S--- PNONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E
DOLLARS
❑MIN,
(2) EXCAVATI "� DATA. FOR OFFICE USE:_ 0.02 X $ _
STREET _ DESCRIPTION PROGRES_S_& INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET
-- --- IOPENED _
i INSPE - —
R TION
_ Q
ESTIMATED STREET OPENING. DATE:.--.-- S
ESTIMATED STREET CLOSING DATE: T —
(3) SECURITY NO. SECURITY AMT: Z c�REET
SURETY CO. FINAL -
_ CFPTIFII_D CHECK U CASH ❑ ■OND ❑ INSPEC-
(4) PLOT PLAN: INDICATE SITE PEI''rINENT PHYSICAL — �— SPECIAL PROVISIONS /CONDITIO.IS:
FEATURES EXCAVA''IC N LOCATION AND EXTENT.
I � 1
I I 1 I
(S) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT OF-W AY JURISDIC I[ON IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
TF,E APPLICAN- AGREES TO DEPOSIT -HE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT 10 CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEE..,•, AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE GATE / /
CITY O"-i IGARD--i2420 S.W.MAIN TIGARD,OREGON 97223 f
RECEIPT
r•
DATE:, `�=>S-__�� ____AMOUNT:$__ - ----__--
•
DOLLARS
NAME: sLa�'• ,�`�s`t> -P- --�!�-��ASH: _
ADDRESS:___�LS.�_�._QQ[.��L�-—1-� _____— �C:HECK: .i
_- (� M.O.,
FOS CCT. ♦ PERMITS _ SURCHARGE AMOUNT
---- - - - ---- --- ---- p
SEWER BILLINGS A0-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL.PERMIT 05-332 _
BUILDING PE9MIT 05-333 _-
SEWER CONNECTION 40-363 —
SEWER INSPECTION 40-365 -
SYSTEM DEV.CHARGE 25-366 ____.__ _------ -
PARK DEV.CHARGE #1 30-367
PARK DEV,CHARGE #2 30-368
Z ING A JUSTMEW S 05-367_
_-416
TOTALS
RECEIVED Bdim;v
PERMIT NUMBlIONlD:Numbor unt Number Amount Number Amount
f t
32
5 3
1
L; K
VJ E: 'S'T E R N' ��.LIIRETY COMPANY
CHICAGO SI.Clx HAI
PALO AkJC.O - DALA- YNWYD, PA
1-ICENS11 ANN) P1''R1147'1' BOE-)N
(For County, City, Town or Village Only)
KNOW ALI, HIEN 13Y TlIKSE Ph�;SENTS: BOND No.L&P 2,90973
ThLt we, MARVIN H. HUIC141SON- D-BA M. HUTCHISON ENTERPRISES
of tile CITY of NEWBERG State of OREGON as Principal,
And the NVESTERN SURETY COMPANY, a corporation duly licensed to-do business In the
State of OREGON
as Surety, are held and firmly bound unto the
CITY of -TIGARD State of____-OREGON
' - -_ - - I Obligee, In the penal
(Valid only when a County, City, Town or Village Is named as Obligee)
sum of FIVE HUNDRED AND no/100 - - - - - - - - - - - - 500.00
($ - -
______ )DOLLARS,
(NOT VALID If FILLED IN FOR MORE THAN $10,000.00)
lawful money of the United States, to be paid to the said Obligee, for which payment well and truly
to be made, we bind 0I.IrSelVeS and our legal representatives, jointly and severally by these presents.
THE CONDITION OF' T1IF ABOVE OBLIG.ATION IS SUCK, That whereas, tile
said Principal
has been licensed-. To INSTALL STORM DRAINS ANI CONNECT SEWERS FOR CITY OF
TICARD by the said Obligee.
NOW THEREFORE, if the said Principal shall faithfully perform the dLIt1v.% 01)(1 in all things comply
With the laws And ordinances, Including all Amendments thereto, Appertaining t(. till, license or permit
applit-d for. 011.11 this I'l0 tion to be void, otherwise to remain In full force W'd effect for a period
bl1V
c" oluncing on thv___S,-t-- day of. SEPTEMBER in.. 79, and ending on the
clay vf_____suTEMflER, Iq_So klilless rene%%
-ed by enritinuptinn certificate._ .
This bond may be terminated at any time by the Surety upon sending notice in writing, by ce
tifled mail, to the clerk r-
of the Political Subdivision with whom this bond is flied And to the Principal,
addressed to them at the Political Subdivision named herein, slid at the expiration of thli-ty-five (35)
days from the mailing of said notice, this bond shall Ipso facto terminate and the Surety shnil there-
upon be relieved from any liability for any acts or omissions or the Principal subsequent to said date.
Dated thia, 5th day of SEPTEMBER 79.
19.
ir'_Apal
Principal
WESTERN Sly It ETY COA1 PAN Y
Ir <i lrnf V n I
Pick No%V1,ED(;NJ I,,,NT OF SLIHE'ry
S,rATF OF SOLIT11 DAKOTA
(Corporate Officer)
Count)- of Mirinelisha Ass
On thls 5th day of SEPTDIIIER 19 79, before me,
the undersigned officer, personally appe,jrcl
who Acknowledged himself to be the afiltej;aid Officer of the WESTERN SURETY CONITIANY,
II corporation, And that he as such officer, being outhorl?,vd so to do, executed the foregoing Ill.strillnent
for the purposes therein rontninv(l, by sig,11111,
the name of the ccrporatton by hinispir as such officer,
M WITNESS I have hereunto set my hnnd and official seal.
111Y Crilliml4don Expires
Notary Puldif- South 1)a*kotn--
rrm. x;