14685 SW 83RD AVENUE-1 FILE NO.-
493-92
� e
83rd AVENUE - 14685 STR OPN PERMIT 71
.rax63..w.R�.
.DEFINE:entrct=case->eng definition incorrect
ENGINEERING PERMIT
PERMIT #. . . . . . . : ENG92-0033 DATE ISSUED: 05/26/92 By: _
PRIM. PEPJ1IT # . : ENG92-0033
SITE ADDRESS. . . : 14685 SW 83RD AVE PARCEL: 2S112BC-03200
SUBDIVISION. . . . : HAMBACH PARK ZONING: R-4 .5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :16
PERMIT TYPE. . : SOP IMPROVEMENTS QUANT RATE VALUE
AGREEMENT DATE: / / GRAD/EROS
ASSURANCE EXPIRATION--- STREET
PERFORMANCE: / / SAN SEW
MAINTENANCE: / / STM SEW
LTILITIES
ALL OTHER
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
Remarks: STREET OPENING, TO INSTALL A CONCRETE SIDEWALK AND DRIVEWAY APPROACH.
Permittee: ---------------- FEES ------------ --
OREN WILSON type amount by date recpt
10525 S.W. 69TH AVENUE OPEN $ 24 .00 JSH 05/26/92 227719
TIGARD OR 97223
Phone #: (503)246-762.4 1
Engineer:
ENGINEER NOT ON FILE
$ 24 .00 TOTAL
Phone #:
------- REQUIRED INSPECTIONS ------
Permittee/Agent Signature: ---STORM SEWER-- -----STREET-----
_ M.H . & C.B. CRB LINE & GRADE
PIPE LN & GRD SUBGRADE
BCKFLL & CMPCT BASE ROCK
AIR & TV TEST LEVEL COURSE
City of Tigard, Oregon WEARING COURSE
13125 S .W. Hall Blvd. ---SAN. SEWER--- TRAFF & PED CONT
P .O. Box 23397 M.H. & C.O. MONUMENTATION
Tigard, Oregon 97223 PIPE LN & GRD STREETLIGHTING
Phone #: 639-4171 BCKFLL & CMPCT WALK/APRON/RAMP
AIR & TV TEST
FOR INSPEC'."ION, CONTF,CT: ----GRADING-----
Carl Vieweg #639-4171 (office) --REPR' S/ADJ,S-- CONTOURS
#780-2647 (mobile) DRAINAGE
--- -PATHWA',G---- EROSION CNTL.
APPLICATION - STREET IMPRO'n-MENT/EXCAVATION
OR DIN AN.-.,E NO, 74-14 COPY TO:(WHITE)-FILE
i
(INSTRJCTIONS ON SEPARATE SHEET) (YELLOW)-INSP.
(PINK)-OTHER AGENCYBLDG.
(BLUE)-APPLICANT
APPROVED x T
NO'r AFPROVED IJ CI Y OF TIGARD, OREGON APPLICATION No.: SJ8
PENDING FEE, PMT, 11 CITY
AMT.: : 24.00
CITY BALL RECF,IP
FENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT By __ ___
PENDING AGENCY "OK'• ❑ DATE-
-Application
ATE,Application and Progress Record - - - - - - - - - - - - -
PENDING INFORMATION U FOR STREET IMPROVEMENT/EXCAVATION CE
MAINTENANCE BOND
AS HFuu >r� _
PENDING VARIANCE ❑ ANNUAL
a -- EXPIRAIN DAT- u
PERMIT NO.: `�-9Z —
_ DA1 E ISSUED: -
( 1) APPLICATION IS HEREBY MADE. TO EXCAVATE FOR AND INSTALL SID
CONC _ EWALK &_ IVEWAY
APRON — - AS DESCRIBED HEREIN, IN FULL. ACCORDANCE WITH CITY REQUIREMENTS, r
APPLICANT Mr. -Oren Wilson 10525 SW 69th Aveneu
NAME - — ------- _ - Tigard, OR 97222 #_246-7624
CONTRACTOR - Unknown - ADDREss -
CITU
N A MY----
A —
DORES
PLANS BY =_per City S��dards — -- ---~CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( CCI E CITY MON
_,._—.._�_. DOLLARS —�.—
(2) EXCAVATION DATA: -- ` --'— -FOR OFF(
�— 0 04 X i �� 00 cMIN.
STREET DESCRIPTION = f 24'00 --•
NAME SURFACE CUT CUT CUT PROGRESS & INSPECTION STATUS
TYPE LEIVGTH WIDTH DEPTH MATERIAL1INSTALLED ITEM DATE REMARK
-- - - _ Q QUANTITY .a/TYPE BY
STREET
=83r(i AV - SP_e a a ed —" ? N
INSIDE
R TION
E
ESTIMATED STREET OPENING DATEQ
E
ESTIMgTt.D STREET CLOSING DATES
T _
(3) SECURITY NO. -�' - -= D
SECURITY AMT.: $ 600.00 STREET
SURETY CO.: CLOSED \\
f FlEcl 'x _ FINAL I (
INDICATE IQl
CA9M :, �oIVD INSPEC. I/ZO9Z. raved L,T.
IQ) PLOT PLh")^ .;ITE PERTINENT' PHYSICAL
FEATURES, EXCA-,ATION LOCATION AND EXTENT. SPECIAL PROVISIONS/CONDITIONS:
1. All work shall conform to Cit
li jIlk I ) _ Standards and Specifications.
I I I I 2. Notify Mr. Carl Vieweg, City
Cull
,'i t� I____npsector, (#639-4171) 24 hrs.
� -
�
— 3rd AVE. 3. ORS 757.541- .571 (Utili� Cc.
-<uIts -
-- prenotification pt—C.) applies
I I SITE:
I I 14685 S.W. 83rd Ave.(5) NOTE NOTE THE CITY OF TIGARD DOES NOT
RIGHT OF WAY CT WORK WHERE
, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT � a
JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
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 DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTI011
APPLICANTS SIGNATURE 6Q
DATE :t6 cJrL -
1 ,,y,av,
130 to Y 16OI �o wi/ I 9i-210
ba00 P_�S.CI 91_ 7592 ./QAC. --M >n
A
' 9 opt`to o K 1400
A2 2 39.51 R-30. 9 6800
/ P• 81.09 i O J '? n A .45 A
/'� m 7700 �� )
W I � N 10 /1 N n 125.47'
/ 1600 120.01 6900 }�
n
------_ / /. 55 Ac m 7600 M 2
/n r 99,44 (..+ O =� 1 4 1
/ p R-25'7000 >st to
/ U LLQ
/ (C.s. 24,(58, S.W. a s 83rd 3 `
i7abe.e9P1. ^' g
/ '���4o.eo Rea, N� 7100 U-1
4e / v 7500 7400 6 1s.> 2 Pal
4 (n.,1
/ 40 /\ C r') f ^ N A
/ %- 1-1 !_, o o" _7300 ° 90' :tl
' U 8
/
(272.59) s7.e7 I 6 o �'< 7200 �
\\ j 1 39'sel.W 5 f ,
GO
-V5INMA /n
��
3 F��,Q K / 2100 2200 a sl 9se n.42 4Qb4 m
/ 2300 s e9�56 e 3300 3400 '
F_ET � °
/
/ o '� 6 0 1�7I%
J\/j rte) /,(., 11 guy
5 $ 18 3500 "
/ / _J
e'1 ^ _1 N
16
/ 2000\ (_) 2400 Z�IIZBC m" 19
/ = M
o �' p 103
/I s eT O ^ it 8 _ 9392 I i
n
AAP / r Q' 3100 Yr W ;
A[) / a
I 10709 � , tiryk ��921 1i QhV p 3600 F
"32 500 v w 15 a•`"'� Z �R.+J }
/ 1900 80 N 20
P .G mi 9 izeI 11743 4
/ P 3 ''- ns Q 3700 a bl)O'
1oe.61 _ ob v2600 300� aooo
- -— / 1800 t- n 21 S 0 8100
o° 14 R o IU u, m Ile 13 °s n 4
2 ns 128 3800 V)
— —
6!0
0 2700 2800 2900 22 99.51
1' O
r 0. n
114 e4 8200
V) II 12 ---
w1 s �K, /� r I ''1900 r
.,
--81 71 'f' 23
2 S.W. M U R D C�C;K ---- -- 115`:.
STREET
f "-<N4
5545 ---B0 80 4000
- -- - --- _ _ INITIAL F1
�460U 4500 p — _7q u% 24 �51.1
4400 14300 4200 p,' 01
1'l, r' w L.. 112 25 '
30 :q29 28 9001
?e' Irvlrinl I t 27 26 9 .,4100 '
o
31, 4 , 94 AC
r
1 `li N 89° 5e 30" W b(j U) 25
4v01 0 5 l) I R f 0 1
6100 6200 3 70 .�
6300 6400 ;' D1 56 71 I
\ 6;UO 6wo 6700 110 RI
1 ,
N / \\ 4800 ,
_ r 15 �� r-1 ��j (� 1 8
r 14 16 17 IU903 } -- - -
18 19 20 4900
801
=6000 J�./ � `� �6. b0 �() 90 4075 .b 2 ' l(1f.�•�i.
10011
i
13S.W< LA MANCHA C1'n r, 5000 No v
A
U SU s0 4678 ,?O 10
5900 ?VSs x1'' a 5600 5500 5400 530d'� 5!00
50
01 58 57nn o --
�, � 4
12 ° II�� r`10 9 H 7 $ 6 p R - -
00 INOIAL p, co 11609
,,, L 4,: Irl e�3� f- r so' a 5200 80r)
R/W
5 MIN.—
CURB JGINT SEE NCTE 5
�— 2
ROAD �—
o .
2" OF 3/4%0
COMPACTED SUBGRADE
SIDEWALK ADJACENT TO CURB
R/W
I
MIN.
J I i r
2 % I I
COAD
II SEE NOTE 5 I
_ f
2" OF 3/4"-0
COMPACTED SUBGRADE
SIDEWALK AWAY FROM CURB
NOTES :
I. CONCRETE SHALL BE 3000 PSI. AT 29 DAYS , 6 SACK MIX , SLUMP RANGE
OF 1 1'2 TO 3
2. PANELS TO BE 5 FEET LONG
3, EXPANSION JOINTS TO BE PLACED AT SIDES OF DRIVEWAY APPROACHES ,
UTILITY VAULTS ,WHEELCHAIR RAMPS , B aT SPACING NOT TO EXCEED 45 FT.
4. FOR SIDEWALKS ADJACENT TO THE CURB 8 POURED AT THE SAME TIME AS THE
CURB, THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN I/2"RADIUS,
5 SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE
CURB IS USED OR IF SIDEWALK IS NTENDED AS PORTION OF DRIVEWAY .
OTHERWISE SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 4 INCHES .
6. DRAIN BLOCKOUTS IN CURBS SHALL. BE EXTENDED TO BACK OF SIDEWALK WITH 3"DIA. PLASTIC
PIPE AT 2 % SLOPE CONTRACTION JOINT TO BE PLACED OVER PIPE.
WASHINGTON COUNTY
,sDEPARTMENT OF LAND USE CONCRETE SIDEWALKw AND TRANSPORTATION
DATE CIVIL ENGINEER DRAWN APWA NO. WASK COUNTY N0.
A�Lb-1�2 NONE CS - 305
r
Fig OF CUR!!
DIRAINACE DLOCKOUT
WIDTH OF STREET 3" I.D. PLASTIC PIPE
WITH COUPLING
I" R 6" / 1/2" R
ROAD •
I .
MAX. `O
e
A
BASE COURSE •
o a o
9
I. FOR DESIGN SPEEDS GREATER THAN 40 MPH THE EMERGENCY MOUNTABLE
CURB CS-300 SHALL BE USED.
2. CONCRETE TO HAVE A BREAKING STRENGTH OF 3000 PS.1. AFTER 28 DAYS
EXPANSION JOINTS .
A. TO BE PROVIDED
1) AT EACH POINT OF TANGENCY OF THE CURB .
2) AT EACH COLD JOINT .
3) AT EACH SIDE OF INLET STRUCTURES.
4) AT 'EACH END OF DRIVEWAYS .
3) AT LOCATIONS NECESSARY TO LIMIT SPACING TO 43 FEET
B. MATERIAL TO 6E FRE - MOLDED, ASPHALT IMPREGNATED, NON—EXTRUDING,
WITH A THICKNESS OF 1/2 INCH.
3. CONTRACTION JOINTS .
A. SPACING TO BE NOT MORE THAN 15 FEET
S. THE DEPTI' OF THE JOINT SHALL BE AT LEAST II/2 INCHES
4. BASE ROCK -2"-0 OR 3/4"-0 , 95 % C,)MPACT IL 4. BASE ROCK SHALL BC TO
SUBGRAOE OF STREET STRUCTURE OR 4" IN DEPTH , WHICHEVER IS GREATER
5 DRAINAGE SLOCKOUT - 3" OIA. PLASTIC PIPE .
A. I.D. PLASTIC PIPE WITH COUPLING.
8. DRAINAGE ACCESS THROUGH EXISTING CURBS SHALL BE CORE DRILLED ')H CURB
SAW CUT VERTICALLY 18" EACH SIDE OF DRAIN 9 REPOURED TO FULL DEP)H OF CURB.
�WASHIP► 3TON COUNTY CURB NON - MOUNTABLE
w'�DEPART��IENT OF LAND USE FOR USE ON MEDIANS
AND TRANSPORTATION
DATE CIVIL ENGINEER DRAWN APWA NO. WASK COUNTY NO.
r 1.17 685 - 301
18 ( MOD.) CS
92 -
'2A?0" MAX, 12' - 0" MIN. �
DRIVEWAY I �— R/W LINE
A
cn CONTRACTION JOINT b
W OPTIONAL
SIDEWALK
LD:ATION
R O
LSIDEWAL K — EXPANSION JOINT EXPANSION JOINT
CURB JOINT
1s
3' - 0" 6� -0" MIN. -0 MAX. _6 - O" MIN. - OtMAX. 3 '0
FACE OF CURB
SIDEWALK ADJACENT TO CURB SIDEWALK AWAY FROM CURB
PLAN
1-1/2" EXPOSURE
USE EXISTING EXPANSION
JOINT OR SAWCUT AND
T.
ELEVATION B'-F; SEECDWG. NO. CSOLDIN306.
STREET
6/
COMPACTED SUBGRADF_ 2" OF 3/4" MINUS
SECTION A-A
NOTES
I. CONCRETE SHALL HAVE A MINIMUM BREAKING STRENGTH OF 3000 P.S.I.
AFTER 28 DAYS , 6 SACK MIX.
2. CURB JOINT SHALL BE A TROWELED JOINT WITH A MINIMUM !12 ' RADIUS
ALONG BACK OF CURB.
3. MATERIAL OR JOINTS EQUALI,AEXTENDING FROMMOLDED SUGGRADE TOLT FINISHED IMPREGNATED
4. SEE DWG. NQ CS-300 AND NO. CS-305.
WASHINGTON
S-305.
WASHINGTON COUNTY
fir.~- DEPARTMENT OF LAND USE RESIDENTIAL DRIVEWAY'W AND TRANSPORTATION
PATE CIVIL E IkEER Amb•5 NONE O DSA/ rOj M�TYj.� N0.
r
•• y't
C7
x C Cl X
„ D x x
x F, Im m
or
C)
C:
� m I E
� � I
0 �n I
c
X
10 U
a
o M I
rTl
c D i - ru
O C I
IW
_ � I
X ZCU
z
o ? I cn m
p
m Z 3�
I m
m
naDi to
0i � m ' � 'Uz
< > m
m r m I -Vc
m m;u
� m z I � :a oa
N . I
LP D
rn o 0D I I
> (n z
G)'
z
X -1
M
C l
C__ cn -c _ _ I I� z 0 R W i
D
� o 1
C, mem I I
s
0
m 0 w 0
'00 I I
.. m
Do (nm
� rnz
N r m
w
w V5
114W crui
T L z Q
I I v Z 0 z n r _ -
I } ' Q r
I f m
I zmca � Q a U
cr W 0
i I � 3 "
O \U
cr
nn;a I I o
--- � �. - -
_- O
cr
�hw o
L — � — _ -- - - 0 �1
C—M 78 v w
U
Q W
w f
I ui w `
cfj
I I oQ n
IN cl�
m cr I w Z C)
cr w w
—7- K
z a I T I w >-
w m cr
W W cr
3� Z a
t-
n.Q I o
w V) I tr
MZ I I �n 0-
.0.o
z_
It
m
t4lo,� ( o U
ww
(rL4-
(�
I cn a
--- \ W FO—
w0
m
O rj
I � �
V) U
_. li
�j I c.) O
V.
I aj O
:J
wa i
3 Q LL-
(r rr �I \
rr > tr
V
CITY OF TIGARD
EXP11-MI7UIZ.D RllZ�UEST
^hi= form is a milti-use form. Appropriate re�ccipts must be attached. Docunrnntation
!: important for all purposes. Staple doc Lrneit.ation. to fonn.
VFNDOT'c NO. : --- DATE: _ I Z - A- -"9 L
PAYABLE TO: --_ reY �-ns RL•I",ZUESI'ID BY: /
105 _ky� _
Approved request du� Wednesday
10:00 AM to A/P for checks by
Friday.
MLSCI ANE DUS E'C ITIDM=: —
Date Description, Invoice No., etc. Account No. Amount
• O :?SSIAh�nC z 000 00.
i
I
Mileage $0.255 —"-�
APPROPRIATION BALANCE: _-- AS OF: -- SIGNA'IURE:
(Up to $25.00) Section Manager . _---- 1 urctl. Agetnt —
($25.01-2,500.00) Division Manager
($2,500.01-7,500.00) Dept. Head —
($7,500.01-•15,000.00) City Administrator
($15,000.01- ?) Local Contract Review Board
_J 1501.F
APPLICATION -- STREET IMPRO` `RENT/EXCAVATION COPY TO:
(WHITE)-FILE
ORDINAh�ENO 74-14 (YELLOW)-INSP.
(PINK)-OTHER AGENCYBLDG-
(INSTRUCTIONS ON SEPARATE SHLET) 2 (BLUE)-APPLIICCjANT
J
APPROVED % APPLICATION NO.: S
NOT ♦ PPROV ED L] CITY Y O 1 IGARlj, OREGON FEE AMT_: f 24'10
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT Nx`o 0j: ` 1-ZZ7711�
PENDING SECURITY 11 PUBLIC WORKS D£PARTMEPIT BY I —` DATE 5— � l-(i/
PENDING AGENCY ''OK" ❑ Application and Progress Record MAINTENANCE BOND M.
PENDING INFORMATION 11 FOR STREET IMPROVEMENT/EXCAVATION AS REQUIHEU
ANNUAL
PENDING VARIANCE _ EXPIRA ION DA'r
PERMIT NO _-4��.-C)l_ DATE ISSUED: __ _._ x_7 1 .2=- BY.
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _CONCRETZ SIDEWALK & IVF.yJAY
APRT AS DESCRIBED HEREIN, IN FULL_ ACCORDANCE WITH CITY REQUIREMENTS,
APPLICANT Mr- 01'en tAlson i 10525 SW 6--stn A_✓�mnI-i _7.lgard, OR 97223 # 246-7624_
NAME ADDRESS CITY PHONE
- mown -
NAME ADDRESS
CONTRACTOR ___.----_ — —.- LITV
PLANS BY per City Standards_- —
NAMff ADDRESS PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION (COSI): ! --
DOLLARS
-� - ----- -- _ - E04
S ['MON.
(2) EXCAVATION DATA: " •-- = f 24.00
STREET :� DESCRIPTION ESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEDATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITINS^', FO Ayes Sw,
INSPEC-
83rd Avl sattacW R E TION
Q
U
I-
ESTIMATED _L�—__
ESTIMATED STREET OPENING DATE:__ S.T. --
ESTIMATED STREET CLOSING DATE: ED y,
STREET
(3) SECURITY NO. SECURrrYAMT: S 600-00 — CLOSED (' Ff
SURETY CO.: _ - irisPEC. I( ic, ;h+L- r S/
CHECK CASH O BOND ".
(4) PLOT PLAN:- INDICATE SITE PERTINENT i7HYSICAL SPECIAL PROVISIONS / CONDITIONS:
FEATURES: EXCAVATION LOCATION AND EXTENT, 1. All work shall conform to City
Standards and Specifications.
1 I I 2. Notify Mr. Carl Vieweg, City
Tnpsector, (#639-4171) 24 hr4.
CURB 3.�� _ _ - - - - - - - - - - -� _ _ _ _ before starting work.
3. ORS 757.541- .581 (Utility Co.
83rd AVE. prenotification etc. ) appli-is.
:JAS ` � � r — — _ � .._ —. — — � — —` • ^ — - .. .___
1 BITE: I I
1 ) 3T-4685 S.W. 83rd Ave. I 1
(S) NOTE THE CITY OF TIGARD DOES NOT HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 15 THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE .%PPLICANT 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 DAMAGE WHICH MA, RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE �' r» DATE / 6
FOR---
A.M.
DATE I P.M.
m
OF_,
PHONE--ZM-.-73-(3-
ExToomm
FU400KL
CAMMMYW WILLCULAM 4L
WAMMMMVCU FAM
I - I C., co
YOUR wwmj� 5 Ic
51 Lktf--
C:�'2
ME
'7C4 x *I\U, NOS
BION L�
Lrr#40W#LLOA.-.
TOPS 1p FORM
r
CITY OF T I GARD - RECEIPT OF= PAYHENT RECEIPT NO. :92-227719
7719
AME URE N WILSON
CHECK AMOUNT : 6�_4, 00 DDRESS CASH AMOUNT- 4?I, vllzl
10Sc0 SlJ 69TH AVENUE PAYMENT DATE 05/26/92
TIGARD, OR SUBDIVISION
9722-3- .
JRPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
JEILIC IMPROV 493-92 --2-4. 00 CUSTOMER DEPO _ 600- 00
I
ITAL AMOUNT PAID - - -) 624. 00
COCK INCL U1> M�
pA
$ 5487.I I
SALE THpusA�tp�n�e�4�►J��
� �4�l1�_�€�1E�1 •t II'I00 — ala//�r.r �
American Pit ific Bank
P.O Ron]SO
112 Main street
Aumaville•Oregon pg!!
004 040799"'
' 30/7 Z-
J-
I
1
1
CITY OF TIGARD
STREET OPENING PERMIT
APPLICATION
DATE_ j I L J 1-=1
• APPLICANT'S NAME
ADDRESS
i
ZIP `/i ZIP
PHONE -2�L_ %�F>1d
• CONTRACTOR'S NAME
ADDRESS
ZIP
I PHONE
i PIANS BY
ADDRESS �. i�. i
Ste►-Ee z3�� 7_!P
PHONE 1
c}SS5-
• DESCRIPTION OF WORK PROPOSED TO BE DONE:
---------------
I
• ESTIMATED VALUE OF WORK (within public right-of-way) : $ < Y
WORK LOCATION/SITE ADDRESS: Z, ti
• IS THIS WORK RELATED TO A LAND-USE ACTION? IF SC` SPECIFY (MLP, SDR, FTC ) NO.
• IS THIS RELATED TO A BUILDING PERMIT'r IF CO, SPECIFY (BLDG. PERMIT) NO. N.-Zia
dj%W*pp
(OVER)
l
I
O
J r \ N
5
. + 41k
j \ L LJ
IN
I i
IN\
j I ; \ _J
NN
INININ,
\ %N
,
\
j �°d� IN.
sI.
IN
IN. IN.
jIN
Q1 I i \ \
I \ IN.
Lo
40
C
I I i
1 �
I
STREET OPENING PERMIT
PERFORMANCE BOND F")ND NO.
KNOW ALL MEN BY THESE PRESENTS that we,
as Principal, and _
_ as Surety, are jointly and severally held and bound
unto the City of Tigard, Oregon, in the sum of
Dollars ($ ) for the payment of which
we jointly and severally bind ourselves, our heirs, executors,
administrators, successors and assigns firmly by these presents.
THE CONDITION OF THIS BOND IS SUCH:
That whereas the Principal herein has made application to the City
Engineer of the City of Tigard for a permit to
within the City of Tigard right-of-way of
Tigard, Oregon, under the provision of
Ordinance No. 74-14 and 76-11 Code of the City of Tigard, and whereas said
application was approved by the City Engineer of. said City and a permit
.issued, subject to and upon certain conditions, directions, stipulations,
terms, provisions and requirements provided for ?_n said permit, a copy of
which permit is attached hereto and hereby made a part of this bond to the
same extent and effect as if written herein and specific reference now made
to all the terms, provisions, specifications and requirements set out,
declared and provided for in said permit;
NOW THEREFORE, IF THE Principal herein shall faithfully and truly
observe the terms, provisions, conditions, stipulations, directions and
requirements of said permit and shall in all respects, whether the same be
enumerated herein or not, faithfully comply with the same and shall assume
the defense of, indemnify and save harmless the City of Tigard, its officers,
agents and employees from all claims, liabilities, loss, damage or property
directly or indirectly resulting from or arising out of the operations or
conduct of said Principal or any subcontractor in connection with performance
or conduct of the work under said permit, and shall in all respects
faithfully keep and observe all of said terms, provisions, conditions,
stipulations, directions and requirements, then this obligation is vcid,
otherwise it shall remain in full force and effect.
WITNESS ()ur hands and seals this day of 19
Countersigned by: --
_ Agert
Ad('ress — -----
«st Attorney-in-fact
�� u�xiiNtta�stantat