11205 SW SUMMERFIELD DRIVE E1LE NO.
-7MMEREIELD DR. - 11205 STR. OPN. PERMIT
I
APPLICATION - STREET IMPRr K:MENT/EXCOVATION PY 1'O:
ORCIN-4CE NO. 74 14 (BLUE) - FILE
(BLUE) -INSP. C ,1 IMS
(YELLOW(-OTHER-AGENCY
(INSTR CTIONS ON SEPARATE SHEET) (PINK( - APPLICANT
APPROVED �XI APPLICATION NO.: /13 '
NOT APPROVEDCI I Y 01 TIGARU, OREGON �--
❑ FEE AMT.: f 10
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT r �77 2 _
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PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BYE DATE q l 141 gl'
PENDING AGENCY "OK" ❑ Application and Progress Record ' n�
MAINTENANCE BOND M S-'z l�lAa�
PENDING INFORMAT"ON ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED �
ANNUAL of 9•.24-Q/
PENDING VARIANCE ❑ EXPIRATI N 9ATE. E tel�6*--)
PERMIT NO. _ ( Z�` �_ DATE ISSUED: `�Z`} Rr" BY: _--_
( 1; APPLICATION iS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH C/I�TY REQUIREMENTS.
APPLICANT RIs>!Il&r':.fc �iAl�i�I**S _Tit4.tiA� }/'/�____ it 9__�i X---_` P!1'
A -ET- ADDRESS � ` CITY PHONE
CONTRACTOR __—Iy� C�ii, �
LM � ;e
_-_ ME ADDR[S CITY PHONIC
PLANS BY 1� _=-��_ �
NAME ADDRESS Al za
` ITV - - PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S X00
�-_ - - - ---- DOLLAns
POR OFFIC[USE! A-I' OMIN.
(2) EXCAVATION DA-f A,: y
-- — 0.02 X f ._. �- °--- - f
STREET DESCRIPTION_ PROGRESS 8c INSPECTION_ STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED `ITEM DATE REMARKS
TYPE ,rvpE H
LENGTHWIDTH DEPTH ITEM AI QUANTITY
/ STREET _.._
_ SP
INP N D
- -.. - --- -
_
R TION
E
ESTIMATED STREET OPENING ;SATE:_ 2f► / & E
3
ESTIMATED STREET CLOSING DATE: M1 / E
(3) SECURITY NO. 912 — -- SEGURITYAMT: : C.`"G CLOSED
c
F M. "„
SURETY CO.: _� _ .�,�IL.� *H FINAL --�
CERTIFIED CHECK U CASH O BOND I INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS !r0Nul I Ic+Ns
FEATURES; EXCAVATION LOCATION AND EXTENT.
1 I I
I 0
uRig AQ,
(5) NOTE TPE 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 OREGON.
THE APPLICANT AGREES 70 DEPOSIT THE REQUIRED SECURITIES, TO COMPEY WITH ALL PERTINENT LAWS 01ND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE: � __� 0ATE
1
CITY OF',IGARD—12420 S.W.MAIN---TIGARI),OREGON 97223
RECEIPT
DATE:�y==L — <2 —_ AMOUNT: 5
i s
--- rb'LARS �.
NAME: `
CASH:
ADDRESS:
- `CHECK) _
POR_ AC:1. 0 PERMITS SURCNAROE_ AMOUNT
SEWER BILLINGS 40-364 _ S _
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332 _ S
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333 _
SEWER CONNECTION 40-363
SIEWER INSPECTION 40-365 _
:YSTEM DEV.CHARGE 25-366 _
",ARK DEV.CHARGE #1 30-:.h7 `
PARK DEV.CHARGE#2 30-368
hii:ING ADJUSTMENTS 05-362
TOTALS SL1Z, 64)
RECEIVED BY: _ r
PERMIT HUMMERS A
Number_ Amount _Number Amount Number Amount e
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r!Rfcf'PT
6751
rr�r,�-,VED
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tk SEP 23
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Roderick Enterprise, Inc.
1820 W.VLRMONI ST.;P.U.BOX 19410;FORT LANG.9R 97219
15031 2456444
September 19, 1980
Bob Thorpson
City of Tigard
P.O. Box 23397
Tigard, Oregon 97233
D-2ar Bob:
Enclosed please find a bond in the amount of $500.00 for completion
of the work at Summerfield Clubhouse Estates. We would like to obtain
elease of our funds at U.S. National Ban'. of Oregon, 4th & Harrison.
Would you please call me or Yola White at 245-6444 when the release
has been sent so that we may follow up with the bank.
Very truly yours,
Ct
Nancy S. Tlartson
\ Tax Manager
N��%�
♦.� ' \� C ,e. LAI) S OC c-L YrIC '�1 unt �� `Fp
i
046 SUMMERFIELD CLUBHOUSE ESTATES DATr• 09/04/80
PAYEE: CITY I)F T I(ARD 329411,
REFERENCE ollecollhTION ACCOUNT AMOUNT ACCOUNT AMOUNT
ASH-090490 ')FPo')'IT ESTIIAATED COST OF 3ei71, 1U. ')Li
STREET I MR l i EMENTS
I
THR ATTACHERETAIN THIS STATE
D CHECK IS IN PAY 1ENT OF ITEMS DESCRIBED ABOVE. TOTAL CHECK AMOUNT QQ
DETACH AND MENT. •
i.
Roderick Enterprises, Inc.
1810 S.W.VERMONT ST./P.O.BOX 19410/PORTLAND OR 97219
Ail 15031 1451444
September 3, 1980
Mr. Ed Walden
City of Tigard
Public Works Department
P.O. BOx 23397
Tigard, Oregon 97223
Dear Mr. Walden,
Enclosed please find a completed application for Street
Improvement/Excavation for. Summerfield Clubhouse Estates
along with a check in the amount of $10.00. Our insurance
brokers , Fred S. ,Tames & Company, will be forwarding a
surety bond in the amount of ;500.00.
Please send a release to U.S . National Bank of Oregon,
4th & Harrison Branch, in order for Roderick Enterprises,
Inc. to receive its funds out of escrow.
Please call me if there are questions or if you require
additional information.
Very truly yours,
J �
Nancy S. Hartson
NSHjm