12485 SW ASH AVENUE FILE M.
ASH KvENUE - 124135 STR. OPN. PF,RMI't
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gay 23, 19110
'r. Ilakealey
10265 MI Ifi+,I:lend thrive
xiRard, OR I 23
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.. Bond for AAi2 3treet
t:rntleman s
'nclosart please ffnd your bond for camper wntcr line imntallc-� in :' WI
,trent
""hank you for ywir c000perat�.on in this •nat ter.
Yours truly,
Ebert L. Thormpnmm
t-ablic Works Tn4rectnr
R4, rhon,pso(nq jr
RECEIVED
APPLICATION — STREET IMPRr 'rMENT/EXCAVAI IONdk�+ r�70 COPY TO:
1 G (WHITE)- FILE
ORDIN. .CE NO 74.14 0 (BLUE) -INSP.
CITY OF TIC^P!� F-1 (YELL.OW)-OTHER AGENCY
INSTRUCTIONS ON SEPARATE SHEET lA i [] IPINK) -APPLICANT
APPROVED i APPLICATION NO.: 93
NOT APPROVED CITY OF IIGARD. OREGON FEE AMT.: E ,-Z0, 6-0--
PI�NDING F'EE. PMT. ' CITY 'HALT, RECEIPT N IL 05-
—
PENDING SECUIIITY PUBLICWORK;'De,PARTMENT BY DATE=_/yl
PENDING AGENCY "OK" ❑ ApphCation and Pr)Rrcav Record MAINTENANCE BON( IR
PENDING INFORMATION L) FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL Ij
PENDING VARIANCE EXPIRATION DATE:
—N
PERMIT NO. A/ " 1 DATE ISSUED: / ? —1/'.-f -�-- BY: �.• i. i n� Sc�'�
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL -Water erviae/12485--SA,__AS1L
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT Mr. Blakesley 10265 SW Highland Dr. — Tidard
NAM - ADDRESS CITY PHONE
CONTRACTOR - Foul loran Company 5221 SW Corbett _ _Portl-tnd _ _ _ 224-5221 _ --
NAME ADDRE S .;ITY PHONE
PLANS BY
NAME ADDRESS
ESTIMATED IMPROVEMENT TOl-AL VALUATION ( COST): E 1,000.00
DOLLARS
FOR OFFICE USE HOMIN.
(2) EXCAVATION DATA: o.oz X S
STREET DESCRIPTION PROGRESS_& INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STRiAsh _ 'lacktoh 50 ft 2 ft 2 ft Copper water line CPE E7 -- -
INSP C-
_ E TION
Q
ESTIMATED STREET OPENING DATE: _ 12 5 /_�78 _ S
E8TIMATF_D STREET CI OSING DATE:.—.�`/ —/8 ED -- - �— —
STREET
(3) SECURITY NO._ — _ S_ECURITYAMT.: S ...... CLOSED
SURETY CO.: "14 G ' FINAL
CERTIFIED CHICK O CASH U so"D INSPEC.
- —
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS,
FEATURES: EXCAVATION LOCATION AND EXTENT.
1 I C a t c h Basin e•1 1 --- ---------.�_--
I
1 1 Water Dept. Bldg.
( a
ommrcia I -----
I 1 I
I ! I I I
�) NOTE. THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPi IC'4NT 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 APPLICANT'S ACTIONS.
Fullman Company - R. L. Van Horn
APPLICANTS SIGNATURE: DATE �•�
a�o�t I�14�rhs" J y, ^y tv' a :uar r" �" •`yti s .y� h tg of log. ly ^TIMI 4 c�
APPLICATION — STREET iMPRr •FMENVEXCAVAT;ON COPY TO:
ORDIN. .CE NO. 74-14 L] (B -- FILE
E] (BLULUE)E) -INSP.
(INSTRUCTIONS ON SEPAkATE SHEET) ❑ (YELLOW)-OTHER AGENCY
❑ IPINK) -APPLICANT
APPROVED [] APPLICATION NO.: _. APPROVED CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE. PMT. CI1 : HALL RECEIPT NO.:
PENDING SECURITY ❑ PUBLIC WORKSDEPAR7MENT BY _ DATE--L----L_
PENDING AGENCY "OK" 1.7 Application and Progress RcI'oid
MAINTENANCE BOND Jt
PENDING INFORMATION r_I FOR ST4cET IMPROVEMENT/EXCAVATION Ac REQUIRED o
/..U.UAL LI
PENDING VARIANCE U_ ' EXPIRATION DAT::
PERMIT NO : ---_ , DATE ISSUED: _--
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
PHONE
NAM[ ADDRl SS
CONTRACTOR
PHONE
PLANS BY
NAME ------ ADDRESS ---�_- ---�--- - CITY —� PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST). $
DOLLARS
FOR OFFICE USE: UMIN.
(7_) EXCAVATION DATA: a.oz x a
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITfrM DATE RF_MAh'KS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM QUANTI i Y
STREET
P IlkN
JUL
INSEE -
r� _ R TION
E •
Q
ESTIMATED STREET OPENING DATE:— / / --- ET `/ o
ESTIMATED STREET CLOSING DATE:— / — E
STREET
(3) SECURITY NO. -------' SECURITY AMT.: s�— CLOqED I
SURETY CO.: _ _ I-INAL
� [
_ CERTIFIED CM—
CK ❑ CASH O ■OND q IP+:NEC
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
I I 1 1
I
•CUR% — — — — — — — — — — —
1 I 1 I r
t 1 I I
(5) NOTE THE CITY OF TIGARD DOES NOT. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT Wnl K WHERE
RIGHT-OF-WAY JURISDICTION 19 THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
1 THE APPLICANT .AGREES Tu DEPOSIT 'THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATION PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJvHY OR DAMAGE WHICH MAY RESULT FROM APPLYANTS ACTIONS.
APPLICANTS SIGNATURE: DATZ /
f
CITY OF TIGARD—12420 S.W MAIN—TIBARD,0REG0A Y72.23
R.CIRIP'T ,2 6
DATE: I,,;L -3 AMOUN 1:S-
DOLLARS
ADDRESS: 7- CHECK:
-Z, Y7>- M.O.:
IOP
FOR, 11i449--ACCT.# PERMITS SURCHARGE AMOUNT r.
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PI-RMlI 05-332
BUILDING PERMIT - 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV,CHAR(.:jE 01 30-367
PARK DEV. CHARGE *2 30.368
ZONING ADJUSTMENTS 05-362
--3 317--(2/
TOTALS
RECEIVED BY:
PERMIT NUM11123 ASSIGNED:
Number Amount Number Amount I Number Amount
S—
RECEIPT 0 1635
FIREATAN'S FIREMAN'S FUND INSUI( .IPANY
FUND
THE AMERNATIONAL
SUR TY CO OMf�pNY
NAYIONAL SURETY CORPORA ION
ASSOCIATED INDEMNITY CORPORATION
AMERICAN AMERICAN AUTOMOBILE INSURANCt COMPANY
INSURANCE CUM PAN 1 1-1 S NOME OFFICE SAN FRANCISCO.CALIFORNIA
LICENSE BOND
KNOW ALL MEN BY THESE PRE`-'1FN'1','
THAT WT..', .. _. _ _ Ful loran CoTany__A Y
as Principal, and _ __The American Insurance Company__^__-,o, New Jersey Corporation
with principal office at .__,_San Francisco, California
---.._.___--- _ --_—, as Surety, are held and
firmly bound unto_ Cid-of
in the sum of __ One thousand and no/IOQ---__-------- DOLLARS
for the payment of which sum, well and tr,,lly to be made, we bind ourselves, our personal representa-
tives, successors and assigns, jo'ntly and severally, firmly by these prosents.
SIGNED, SEALED AND DATED this I I ttlay of_, Derembr
1978
— ---— —
The Condition of this obligation is such, that Whereas Principal. is desi:e+tlt of obtaining a jt
it f Tigard,and OrEon�
from City _._ 9 9
to 91!=X) k)41tK4MXNxinstaI l water service-&t--1.24& -S,4C--##,—T1gard, Oregon -
Ord. 14_14 in._.. _Figard, Oregon
commencing on the_ __ 11 th day nI December
NOW, THEREFORE, if Principal shall, during the period commencing on the aforesaid date, faith-
fully observe and honestly Comply with such Ordinances, Rules and Regulations, and any Amendments
thereto, as require the execution of this bond, then this obligation shall become void and of no effect,
otherwise to be and remain in full force and virtur,subject, however, to the following condition:
'This bond may be cancelled and the Surety relieved of all further
liability hereunder by the surety's giving thirty (30) days written
notice thereof to the Principal and Obligee.
Fullman Company
by —
�� Principal
The American Insurance Company
COUNTERSIGNED: '---- — au sty —
NIA
Agent
Attoey�tnFVSUnnlltq
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