15055 SW 88TH AVENUE FILE NO. � Z
88TH AVE. - 15055 STR. OPN. PERMIT
APPLICATION - STREE i IMPRr -MENT/EXCAVATION COPY TO:
r� (WHITE) -FILE
ORDIN/,..CE NO. 74-14 (BLU E) -INSP.
❑ (YELLOWI -OTHER AGENCY
(IN,- TRUC'TIUNS ON SEPARATE SF±F:ETI ❑ (PINK) - APPLICANT
APPROVED ElAPPLICA'r10N NO.: _1,
NOT APPROVED ❑ CITY OF TIGARD, OREGON
FEE AMT.: f
PENDING FEE. PMT. [] CITY HALL. RECEIPT o.:
PENDING SECURITY E3PURL/C WORKS DEPA R TMEN T BY DATE
PENDING AGENCY "OK" ❑ Application and::ogress Record MAINTENANCE BOND #
PENDING INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED I)
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE: —_
PERM!T NO.: 2-_ _ _-_ , DATE ISSUED: _1_ .__ _... . .9Y: .,(,___r�_ ,Z` L2��
G ==—mss- _.__. _ ..__ iza•.r_--a—•— __ --mss
(1) APPI_-iCATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL —
______
AS D • CRIBED HEREIN, IN FULL ACCOPDANCL WITH CITY REQUIREMENTS.
_ _NAT C_ . -
C
" -APPLICANT L6 1 s-1, . -, i } J ,L �
NAM1. ADDRESS NONE
CONTRACTOR [ `G'A1fLiL
CITY
3
PHONE
PLANS BY�___.__.� _ _�W _ ___ --
NAME ADDRESS .� CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
[COLLARS
(2) EXCAVATION DATA: rOR OFFICE USe --- MIN.
(2)
_ o.o�(x$-fib
STREET DESCIRIPT!ON PROGRESS & INSPECTION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPI H I ITEM & QUANTITY
STR T
PEN D
- R TION
-- — __ E
Q
ESTIMATED STREET OPENING DATE:— c / S
ESTIMATED STREET CLOSING DATE: — iv- Lj _. ED
_ STREET
(3) SECURITY NO S/_t�6(r 77 SECURITY AMT: S S50 C, �_ CLOSE
SURETY CO 6' Ora 7- C H-.t. �=' f _ FINAL
(.ERTIFILOCHECK ❑ CATH ❑ ®ONC INSPEC.
(4) PL OT PLAN: INDICATE SITE Pl.RTINENT PHYSICAL. SPECIAL PROVISIONS/CONDITIONS:
FEATURES: EXCAVATION LOC.ATIO 1 NO EXTENT.
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CURB
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(S) NOTE THE CITY OF TIGARD DOES NOT, HEREHY, GRANT PERMISSION TO APPLICANTS TO COQ 4UCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAI' OF WASHINGTON COUNTY OR THE 'STATE OF OREGON.
THE APPLICANT AGREES To DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL CERI-INFNr LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WOrtK. AND TO SAVE HSRMLE:SS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM ,4PPLICANIS ACTIONS.
nr'PLICANTSSIGNATURE Z DATE_ JJ '
CITY OF TIGARD—12420 S.W.MA.N—TIGARD,OREGON 97223
RECEIPT
DATE ^.t:".'SUNT: $ ✓+u'._� — - -----
' DOLLARS
NAME: t
ADDRESS:- — -7 LleZ4 Zt�t CHECK:___
M.O.:
OF
FOR: ACCT. • PEPMITS SURCHARGE AMOUNT
SEWER B!LLINGL 40-364 _ $
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWFR CONNECTION 40-363
SEV IER INSPECTION 40-365
SYSI EM DEV. CHARGE 25-36.5
P/.RK DEV. CHARGE #1 30-367
PARK DFV.CHARGE #2 30-368
ZONJNG ADJUSTMENTS 05-362
V
TOTALS
RECEIVED Bv: ----- --__--- - _. . - -`
PERMIT aUMS ASSIGNED:
Numlw Amount Number Amount Number Amount
RECEIPT / 10? 3 F;
a: "
OREGON AUTOMOBILE INSURANCE COMPANY
HOME OFFICE . PORTLAND.OREGON 97207
Bond No. SB 38EF7
Premium: $30.00
KNOW ALL MEN BY THESE PRESENTS: That we, GENE CLAYTON
as Principal , and the OREGON AUTOMOBILEi ,UPFNCE 11 17, a ,corpoi-ati on of the State of Oregon , lawfully doing the
business of Surety in the State of Oregon, As Surety, are held and firmly bound
unto CITY OF TIGARD, OREGON, as Obligee, in the sum of ----------------------------
FIVE HUNDRED AND NO/100------------------------------- �$ 500.00---------- )
I ,
for which sum we and tru y to a paid, w- eTin-c
- ourse ves , ou-rte rs , executors ,
administrators , suc .essors and assigns , firmly by these presents.
IP WITNESS WHEREOF, we have hereunto set our hands and seals this 22nd
day of January _ _1982
THE CONDITIONS OF THIS OBLIGATION ARE SUCH , That WHEREAS the above bounden
Principal is desirous of obtaining a permit in accordance with Ordinance No.
of the City of Tigard, Oregon for construction in a public right-of-way, to wit' , —
15055 SI-1 88th, Tigard, Oreqon
for tie pe it od eginning the—��ay o ,,anuary , 1982
NOW, THEREFORE , if the said Principal shall , during the continua^ the
term for Iihich said permit shall be granted , faithfully observe and hoiestly comply
with the provisions of said permit and restore said right-of-way to good or be." er
condition as existed prior to said construction, then "his obligation shall be void
and of no effect, but otherwise to remain in full force and effect.
THE AGGREGATE LIABILITY OF THE SURETY HEREUNDER, shall in no event exceed the
pentaly of the bond as stated above. The surety may cancel this bond by giving 10
days written notice to the Obligee, the Surety, however, will remain liable for any
default occurring during the period up to the expit•ation of said 10 days notice.
GENJP CLAYTON
Principal
OREGON AU, 21NIOBILE INSJRANCE COMPANY
8 :--- c L/
Attorney —
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