15930 SW STRATFORD LOOP FILE NO. LLT-Y("'
STRATFORD LOOP - 15930 STR. OPN. PERITT'L
APPLICATION - STREET IMPR LMENT/EXCAVATION COPY TO:
(WNITE)- FILE
ORDINh..q,.E NO. 74-14 (.�
[] (BLUE) -INSi.
❑ (YELLOW) OTHEf7 AGENCY
(INSTRUCTIONS ,7N SEPARATE SHEET)
F] (PINH)�A PPLIC/eAtNT
APPROVED G APPLICATION NO.:�.
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: S 17. Z Z _
PENDING FEE. P►ST. ❑ CITY HALL REQ:" NO.: S--2-7-.3PENDING SECURITY ❑ PUBLA WORKS DEPARTMENT sY_ DATE_
. (�C)
PENDING AGENCY "OK" ❑ Application and Progress Record -
MAINTENANCE BOND
GL
PENDING INCORMATION O FOR STREET IMPROVEMENT/EXCAVATION UR
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE: _ -
'ERMIT NO.: _�_L1"-L . -__ . DATE ISSUED: 3.1 I L_ tJ_ , BY:
(1) APPLICAI ION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL . 01 OZ L-Ay
/ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CI fY REQUIREMENTS.
APPLICANT /��-/ _I'�' �C , a wtp / - --In Z-2 &,IRLZ �'�O'Y'JS4/
-�-� NAME N
I /J CITU PHOE
CONTRACTOR 14�►4Legn& h7LLf� C:D/tI /.�7-� +4 `c. BLub G,��� 6 ��
NA E AODR[SS CITY H N6
PLANS BY. 67-Y 097 '7_7 04 Rb 7/-4 - 7'/c�
NAME I ADDRI[$$ CIT ON
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ �-
DOLLARS
(2) EXCAVATION DATA: �— _ — --- —_,.__-
FOR OFe1C[ [:
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT I MATEP'At. INSTALLED ITEM DATE REMARKS/TYPE— BY
LENGTH WIDTH DEPT,, IjcM—_A QUANTITY
STREET
-- -- — — —� — P N D ---
INSPtC-
R TION
E
Q
ESTI MA"ED STREET ONtNING DATE:_ / F.
_ S
ESTIMA rED STREET CLOSING DATE: / / TE
— --- �,. -- — ---- — D
r a—�, � STREET
(3) SECURITY NO. J J'S�'4 LSFCURITY AMT.: $ li,� CLOSED
SURETY CO.: t �`� � '-� / n + N r 0, " FINAL
_-__ CERTI FIEI' :H[CK U CASH O 80NO INSPEr',
(4) PLOT PLAN: INDICATE SITE I ERTINENT PHYSICAL 3- SPECIA PROVISIONS/CONDITIONS:
rRATURES; EXCAVATION LOCATION AND EXTENT. l
1 I 1 1 77ryi-t
) 1 ly 1 I
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY. GRANT PERMISS ON YO APPLICANTS TOCONDUCTWORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE ATATE OF OREGON
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECIORITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CIY'/ AND
EMPLOYEES AGAINST ANY INJURY OR VAMAGE WHICH MAY PESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE �- ' �� /
DATE_ � / � .( XO
CITY OF TIGARD—1242 7 S.W.„.AW—TIGARD,OREGON 97223
RECEIPT
DATE: AMOUNT:
__DOLLARS
NAME:
CAr —
ADDRESS:_ �'� =d SCS f-►r 1-r ,!' 1..,-• 1
! CHECK:.__
.1 q ' 1'
*
OF
FOR: ACCT. 0 PORMITS SURCHARO! 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
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?Iv"SiiRi ASSIGNED!
Number Amount Number_ Amount _Numbor Amount
RlCEIPT5 2`7 i
. l
OREGON ,oe'!UTO/1ri3O iLE INSURANCE COMPAAW
HOME OFFICE . PORTLAND,OREGON 97207
Bond No. _SB 35662
Premium: $30.00
BOND
KNO14 ALL MEN BY THESE PRESENTS:
LEWIS OCHS
That we, DBA: T-V CONCRETE of 13545 SW Hall Blvd. , Tiggr �gg�
as Principal, and the OREGON AUTOMOBILE INSURANCE COAg'ANY, a corporation
organized under the laws of the State of Oregon and at,thorized to transact
the business of Surety in the State of Oregon, as Surety, are held and
firmly bound unto CITY OF TIGARD, OREGON _ _ in the ,just
and full sum of EIGHT HUNDRED SIXTY ONE AND N,)/100- --- for which
sum, well and truly to be paid, we bind ourselves, our heire. executors,
administrators, successors and assigns jointly and severally, firmly by
these presents.
Sealed with our seals, and dated this '?th + day of March 19 80
THE CONDITION OF THIS OBLIGATION IS SUCH, THAT, WHEREAS LEWIS OCHS DBA:
T-V CONCRETE has made application for a pert-Lit to make a cut on the
street a- c -=0�--W. Stratford Loop, Tigard, Oregon
NOW, THEREFORE, If the said Principal shall abide by the terns of said
permit, then this obligation to by void: otherwise, to remain in full force
and effect.
IT IS AGREED THAT the Surety's liability under this bond shrill remain in
force for a period of one (1) year following the completion of work fir
whic.li the permit has been obtained.
LEWIS OCHS DBA: T-V CONCRETE
Princip.?�— - -�-
BY
OREGON AUTOMOBILE INSURANCE COMPANY
(- JOan tartee, Attorney-in-facl-