7780 SW PFAFFLE STREET FILE NO. �Q _
'BAFFLE ST. - 7780 STR. OPN. PERMIT-
C17YOF TIIFA PM
WASHINGTON CCUNTY,OREGON
January 18, 1984
I
Oregon Excavating, Inc.
6101 S.W. Johnson Creek Blvd.
Portland, OR 97206
RE: Street Opening Permit
Dear Sirs:
We are returning the bond that you posted when you worked in public right-
of-way in the City of Tiyard.
Thank yUu for your cooperation.
Sincerely,
R. L. Thompson
Engineering Servic::�s Crew Chief
enclosure
RLT/dc
-- - - -- - 12755 S.W. ASH P.O. BOX 23397 TIGARD, OREGON 9722:, PH:639-4171 --
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--- -- 17755 SW ASH PO BOX 18397 TIG.ARD.OREGON 97223 PH-639.4171---�
APPLICATION — STREET IMPI 'EMENT/EXCAVA I ION
COPY TO.
ORDINANCE NO. 74.14WHITEI -FILE
BLUE) -INSP.
(INS'TRU'TIONG ON SEPARA'1 L SHEET) IYELLOW)-OTHER AGENCY
1PINKI -APPLICANT
APPROVED tiY
Y"
NOT APPROVED ❑ CITY OF TICARD, OREGON APPLICATION NO.:
FEE AMT.: S—
PENDING FEE. PMT. ❑ CITY HALL
RECEIPT NO.:__jj;S9S _
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMEN7, 9Y--LLMC p q
PENDING AGENCY "OK" (] — — — DATE __{Z—Application and Progress Record — — — — — — — — -
PENDING INFORMATION F] FOR STREET IMPROVEMENT/EXCAVATION MAIN S FLAQU REO _I ,v �9_9f Z7
PENDING VARIANCE ❑ ANNUAL 0
EXPIRATION DATE:�N�. f-'2
PERMIT NO.: GATE ISSUED: _ .—L`31_ Z 13Y:
(1) APPLI TIO IS HEREBY MADE TJ EXCAVATE FOR AND INSTALL __. G S�{„�t•- �;rl ��_
—L ' AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY RE711REMENTS.
APPLICANT icp cN �xc �v: �twl — _� �c Y ��n Blyal, 7 ^7
AII
ME .J ADDRESS /
CONTRACTOR ,c, y l v` clTv PHONE
""
PLANS BY E�J �%'��� �c'T PHONE ADDRESS
CIT ---_--. --- _
ESTIMATED IMPROVEMENT TOTAL VAL-UATION ( COST): S
DOLLARS
(2) EXCAVATION DATA: —_ -- --_ ' Fo'r:oirRlcE use:�p
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
OF
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY ITEM DATE REMARKS/TYPE BY
STREET
PF E
INS EC.
R TION
E
Q
ESTIMATED STREET OPENING DATE:_- / /� / ' U
ESTIMATED STREET CLOSING DATE: / �� ,p� ^� ET
D
(3) SECURITY NO. - - ,TREET
SECURITY AMT _-
SURETY CO.: ._� � ..__ _ CLOSED r
'rrl_J' _ tt����'' FINAL
CERTIf1ED CHECK LI _CA9H a 0 _N X -INSPEG.
(4) PLOT PLAN' INDICATE SITE PERTINENT PHYSICAL
FEATURES; EXCAVATION LOCATION AND EXTENT, SPECIAL PROVISIONS/CONDITIONS:
I I I
URB - \ ( - _._ --. �
-CUk
SAO.
I IL
ISI NOTE: rHE CITY OF TIGARD DOES NOT, HEREBY, GRANTPERMISSION TO APPLICANTS TO CONDUCT WORK
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON, WHERE
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 CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMA3E WHICH MAY REcULT rROM APPLICANTS ACTIONS.
7
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APPLICANTS SIGNATURE: �[/�
— DATE ��-
-1
CITY OF TIGARD—12320 S.W.MAIN--TIGARD,OREGON 97223
RECEIPT 4Gc:
DATE: AMOUNT: S __._.. _
Old 'DOLLARS
NAME: . _ G. CASH:
ADDRESS:
yl,T��c_.,.rit�_ M.O.: _
,E OF
FOR; ACCT. I PERMITS SURCHARGE AMOUNT —
SEWER BILLINGS 40-364 S
BUSINESS LICENSE 05-331 —_,-
PLUMBING PERMIT 05-332 $—
MECHANICAL PERMIT 05-332 —
BUILDING PERMIT 05-333 —
SEWER CONNECTION 40-363 _v—
SEWER INSPECTION 40-365 ---
SYSTEM DEV.CHARGE 25-366 —
PARK DEV.CHARGE #1 30-367
PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
TOTALS
RECEIVED BY: --
PERMIT NUMSERS ASSIONED: _
Number Amount Numb*r Amount Number Amount
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