15670 SW 98TH AVENUE FILE NO. j
98TH AVE. - 15670 STR. OPP4. PERMIT
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Avoid Verbal 1,4essacjes ;
CITY OF TIGARD
To :
•-�/' From :
subjec-. tWy'. 3 `r!.� � Date:
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OREGON CITY PLUMBING & HEATING -0.
,,�� ` 611 7th St. +
loC%�' �'�" � Oregon City, Oregon 97045
l,- 656-8558
656-4671
Date F — -/ ?U
Subject
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CttY OF SIGARD
Signed - ---
Signed
�~ SENA) INTACT WITH PINK =PV
City of Tigard
or
6N REOUEST
ION TIME PERMiT
DATF :
DATE tSSUE.L:
OWNERS NAME :
ADDRESS : —ZS'�
CONTRA CTn R
TEST' Air r,, Wcte:-P(I ViGUGUK, Lcborofory ;,]
RESULT* App;ovsjd1(. Disapproved 0 t rvmu:
SKETCH:
INSAECTOR DATE
OTE Attach supplemental feel date osrol-
APPLICATION - STREET IMPRI" -MENT/EXCAVATION COPY TO:
URDINh,4CE NO. 74'I4 ❑ 1WHITEI- FILE
❑ (BLUEI INSP.
(INSTRUCTICNS ON SEPARATE SHEET) ❑ IVELLOWI O-.HER AGENCY
r-�
LJ (PINK) -AI PLICANT
APPROVED APPLICATION N4,:
NOT APPROVED -! CITY OI TIGARD. OREGON
FEE AMT.: S
PENDING FEE, PIV T CITY HALL REC�IPT NO.: Q___ �/
PENDING SECURITY PUBL IC WORKS DEPA R TMEN T BY t_I'q'� --_- DATE_ j4�J v
PENDING AGENCY "OK" ❑ Application and Progress Record - - - - - - - - -
MAINTENANCE BONDxit__
PENDING INFORMATION ❑ FOR STREET IMPROVEMENTiEXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE. /
PERMIT NODATE DATt= ICSUEC�• __� _L�`-y_l_L� BY:-�2• ',;.�'.C� +.
!IJ APPLICATION iS HEREBY MADE TO EXI,:AVATE FOR AND INcTALL. ���li y a�-
\�- —\r---.— _- IIAS DESCHi 3ED HEREIN, IW FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT(t( � \MYI I --- l�"\ _ 65 6" U-� r
NAME DDREAS
Coll VHO/N!/,Y/x�i
CONTRACTOR--C.1'-�" t•} (�1r l �• b�V V\�� ~Tl Qv — � tjL-
AUDRESS 11 f L PHONE
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PLANT By �`S�1t"\ t+�►Ot�\ ��q �1 ` .�< w� l �' la
yi
NAMJ ADOR ESS CITY PHONE
t
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
DOLLARS
(2) EXCAVAI ION DATA: v -Foil OFFICE USE: MIN--
' 0.02XS � --= 5
STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MA-1'ERIAL. INSTALLED
TYPE LENGTH WIDTH DEPTH IT.M tl qU/NTITY ITEM DATE REMARKS/TYPE BY
GcC' 0 '�i.l ',I' Milk <�II' E A Irl STREET
-.�_ Il
-- 1NSi'
R TION
E -- -
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ESTI MA (ED STRELT OPENING DATE: -7 FJ' _ S
ESTIMATED STREET CLOSING DATE S _(-�� Y E ----- --
-- D
(3) SECURITY NO. *� OL t,p _FFREE
--"�-
p____ SECURITY T.: _ - CLOSED
SURETY C0.:I.�gt,mLQ 'w +� Kt� = C a FINAL
E IFIED HECK CAS ❑ _ L'OND IN$PEC.
(41 PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL- - SPECIAL PROVISIONS !CONDITION`
FEATURES: EXCAVATION LOCATION AND EXTENT.
I ( I 1
I I 1 1
CURB - '
1
(5) NOTE THE CITY OF TIGARD DOES NOT HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF WAY ;URISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE RECIUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPEC IFICATIOMa PERTINENT O CONDUCT OF THE WORK, AND TO SAVE "fkAf4LESS THE CITY AND
EMPLOYEES AGAINST
ANY INJURY DAMAGC MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATUR 4 4"' j / 4l I�
DATE r._ / V V—��
APPLVATION — STREET IMnRr c.AENT/EXCAVATION COPY TO:
GR DI N.- .CF NO. 74-14 El (WHITE)• FILE
❑ (BLUEI-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ❑ IYELLOW:.OTHER AGENCY
❑ IP'-;;;!-APPLICANT
ROVED ❑ APPLICATION NO.:_
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE.PMT. ❑ CIT1" HALL. RECEIPT NO.:
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY- DATE--
PENDING
ATE .—PENDING AGENCY "OK" ❑ Application and Progress Record — — — — — — — — — ` — — — —
PENDING INFORMATION O FOR STRFET IMPROVEMENT/EXCAVATION
MAINTENANCE DOND +�
ANNUAL U
Ll
PENDING VARIANCE C7 EXPIRATION DATE: /
PERMIT NO.: Z ___, DATE ISEUED: ` 1 � BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
------- -----.-.-� �.__._ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY R:OUIREMENTS.
APPLICANT
DAME
CONTRACTOR__.._ _
�E-� - ADDRESS)l� -"
CI. Y
PLANS BY
NAM ---
C
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
__------- ----_-_--- DOLLARS
(2) EXCAVATION DATA: FOR OFF'--- E USE
0.02X6
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITZM III QUANTITY ITEM DATE REMARKS/TYPE BY
Df
Z z-73 f� A-e , -
R TION
E
ESTIMATED STREET OPENING DATE:_ -_(-- / Q E �r ~'
-- S
ESTIMATED STREET CLOSING DATE: _ _-[ T
— ED
(3) SECURITY NO. I .� -__ SECURITY AMT: _ STREET -
CLOSE
SURETY CO.: _ _ FINAL --
CERTIFIED CHECK ❑ CASH ❑ BOND U 1NlPEC.
(4) PLOT PIAN IVDICATE SITE PERTINENT PHYSICAL SPEC AL PROVISIONS/CONDITIONS:
FEATURES, EXCAVATION LOCATION AND EXTENT.
CURB -
I I ( 1
C 41
I 1 i I
9 NOTE THE CITY OF TIGARD DOES NOT, Hr.REBY, GRANT PERMISSION TO APPLICANTS ?O CONDUCT WORK WHERE
RIGHT-OF-WAY JUPISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES TO DEPOSIT THE FiLQUIRED 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 ACTIONS.
APPLICANTS SIGNATURE.
DATE =.,.... /
OREGON CITY PLUMBING & HEATING
PHONE: 656-8558
61 1 SEVENTH STREET, OREGON CITY, OREGON 97045
SHIP TO k � � DATE i9U/
AT
HOW SHIP.
WHEN ~\! Q SALESMAN
QUAN ARTICLE PRICE AMOUNT
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2_5 - t
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N. .voce
SIGN
CUSTOMER'S SIGNAIIIRE.
,. SAFECO INSURANCE COMPANY OF AMERICA
GENERAL INSURANCE COMPANY OF AMERICA
FIRST NATICNAL INSURANCE COMPANY
OF AMERICA
HOME OFFICE:SAFECO PLAZA
SEATTLE,WASHINGTON 8818E
Bond No. 2879021
KNOW,IU,MEN BY rtIESEPRESE'NTS,That wc.OREGON CITY pLUKRINC• AND HEATING CO.
a,, Pim,h.d. and the SAFECO INSURANCE COMPANY OF AMERICA.a curpojalion organfted under the laws—.rthe
Stilt:A%kj Ilnngton,and'alllllUriied ill transact the business of%urety III the State ,I OREGON
as Surety.are held and firmly bound unto
-the CITY_OF TICARD, OREnON- _in the just and full sum
or _*THP Er-.T$Q11$AND AND NO/100ths-----------------—-----Dollars($3,000.00*
for which sum,well and truly to he paid,we bind ourselves.our heirs,executors,administrators,successors and assigns,
jointly and severally,firmly by these presents.
Sealed with our seals,and dated this 17th day or_ AUGUST —'108
TNI:CONOITIO,VOF'THISOBI.ICAT'IONISSUV,Thai,l✓IIEREAS,the above bounden PRINCIPAL has
been issued, on AUC►TST 17, 1978, a permit to install aRlr2ximete1yJ18Q feet r—
newer line.
NOW,THEREFORE,11 file said _PRINCIPAL herein shall comply with 4L1I the terms. corrA.JJions,
AgreementsLatipulations and provisions contained in_»sial permit, and any_o_ther___ _
applicable regulations, larr or rltdnr,_
then this ohligalion to he void:otherwise,to remain in full`orce and effect —_-
ORF1 NXITT PL S AND HEATING CO.
-_.—.C-.. (Seel)
Principal
-- --(:Seal)
Principal
Principal
SAr1C(T INS(:RA%, Cl: COMPANY OF AMERICA
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_oT CITY OF TIGPARD
17 77'1
tTr.l 22. Nima W Allumny
r,-17-11 A�rr,:TCY Ruby It. Cox
.9 SMECO INSURANCE COMP 1MY OF AAAMCA
POLICY r,c"
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