9830 SW MCKENZIE PLACE-1 FILE NO.
McKENZIE 9830 STR. OPN. PERffff
r
•.PPLICATION -- STREET IMPRC MENT/EXCAVATION COPY TO:
ORDINAI.L:E NC. 74-T4 ❑ IWHITEIIFILE
❑ IeLUEI-INSP.
(INSTRUCTIONS ON SEPARATE:SHEET) ❑ (YELLOW C,IHER AGENCY
❑ Ipt:•KI -APPLICANT
APPROVED 0 APPLICATION NO •
NOT APPROVED ❑ CITY OF TIGARD,OREGON FECA m,r. t
PENDING FEE. PMT. ❑ CITY HALL. REC PT NO
PENDING SECURITY ❑ PUBLICWORKS DEPARTMENT BY LIATE q 12-1 _
PENDING AGENCY "OK" ❑ Application and Progress Record
PENDING INFORMATION 01FOR STREET IMPROVEMENT/EXCAVATION MAINSEREQUREDON n*�-
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE:_ _-
PERMIT NO.' /.�-{�Cl0ATE ISSUED: Y p Y: 7/ ��..
(1) APPLICATION IS HEREBY MADr TO 7XCAVATE FOR AND INSTALL --TWO-CaVih-Raging -.
AS DESCRIBED HEREIN, IN FULL ACCCRDANCE WITH CITY REQUIREMENTS.
APPLICANT Charles 11. N__.$re.l __ 9830 W—McKenZie..S.t..______—_.___ - I.i -_._�_.. 639PMO _
639P
MO
Banyard Pavinq__Co^PO Box 230350 Tigard, Or 9?223____i 6 9-0914
NAME ADDRESS CITY ---" HONE - -
PLANS BY Applicant
A+ -_--------__.. AODREI4 PHONt -
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): f
OOLLARS
(2) EXCAVATION DATA: F'OR OFFIC US � TWIN.
_ 0.0z x _ ¢ _�_ 7. So
STREET DESCRIPTION _ _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL. INSTALLED TYPE BY ITEM DATE REMARKS
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY _ REMARKS/
TYPE
As P h a I t Per City Code S PANE o _
INSPEC
E TION
v
�. u _
ESTIMATED STREET OPENING DATE: April /29 E
ESTIMATED STREET CLOSING DATE: May / l 5 /1980 T
E
(3) SECURITY NO. -H-3590--- SECURITY AMT: $875• cT
TREE
-- -.
13
SURETY C0.: ..__Ore�n AutQjj]pbile InsLl^anCeCQ__- FINAL
CERTIFIED CHECK 11 CASH IDNr. x INSPEC.
(4) PLOT PLAN: IN-)ICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES: EXCAVATIO14 LOCATION AND EXTENT. .--+� ��OC �p-14,
1 ( 1 I
VC i(—L. LaJ,'U bat C7 au t Fo L�ti-
See attached Sketch i 6 4e ---- ------
CURB ' �•. _ _ _ _ _ w _ _ _ _ i� ♦ � _.
I I I I I
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHIN .TON 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 ACTIONS.
APPLICANTS SIGNATURE � "' DATE April 29 19811
V"jr'? N�
L�Anfl /K�kFvzrC sr
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('larks H. hnawel. OU 9 3,7 SW *IC*"ttt ST Tra-^u
12720 SW pacific Hwy.
TIBard. Oft y712J
CITY OF TIGARD--12420 S.W.MAIM—TICARD,OREGON 97223
RECEIPT
DATE: AMOUNT: S
NAME: CASH:
ADDRESS: I 2 U tJ (CHECKI____
7 9 M.O.:
OF
FOR. ACCT. III PIRMITS SURCHARGE AMOUNT
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWEP ;NSPFCTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV. CHARGE #1 30-367
PARK DEV CHAFGE #2 30-368
ZONING ADJUSTMENTS 05-362
RECEIVED BY: TOTAI S
PERMIT NUMBERS ASSIGNED!
Numbof Afnount-- _Number Amount Number Amount
J_-
ja
7
V
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i
OREGON/ AUTOMOBILE INSURANCE COMPANY
HOME OFFICE - PORTLAND,OREGON 97207
Bond No. SB 35840
Premium: $30.00
KNCW ALL MEN BY THESE PRESENTS: That we, _ CHARLES H. SAMUEL
PIUP-7-1 c—E ' ' a cT�per�lt-I--ofatherSt ttPaof Or�Oo�e OaREGOlJ1AUTOMOBILE —
y doin
business of Surety in the State of Oregon, as Surety, are held and firmlythe
bound
unto CITY OF TIGARD, OREGON, as Obligee, in the sum of --------
EIGHT HUNDRED SEVENTY-FIVE AND NO/100------------------
.00
or whit sum we and tru y Feto-_ _paid, we bind ourse ves,(ou8r75-Te rs—executors
administrators , successors and a�,igns , firmly by these presents. '
IN WITNESS WHEREOF, we have hereunto set our hands and seals this 23rd
day ofApril , 1980
THE CONDITIONS OF THIS OBL'.GATION 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 far construction in a public right-of--way, to ,1
9830 S.W. McKenzie Street, Tigard, Oregon
nr t e pe it od he' g g t e 3rd —3ay of
NOW, THEREFORE, if the SFJ d Principal shall , during the continuance of the
term for which said pennit shall be granted, faithfully observe and honestly carlply
with the provisions of said permit and restore said right-of-t,ray to tined or beaer
condition as existed, prior to said construction, then this obligating shall by void
and of no effect, but otherwise to remain in full force an' effect.
THE AGGREGATE LIABILITY OF THE SURETY HEREONE,-k shall in no teen' exceed ti
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 f able "or any
jefault occurring during the period up to the expiration of said 10 days netice.
!!t Li t.cu c C 4
ar es H. SamuelPrincipal
OREGON AUTOMOBILE INSURANCE COMPANY
An'�"�Z'e ttorney n7d-ct