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10620 SW COOK LANE-3 FILE NO. I2d0'&O STR. OPN. PERMIT COOK LANE - 10620 I I IA■MaAAN.fi State Farm Insurance Companies Northwest Office October 12, 1981 460025th Avenue,N.E. Salem,Oregon 97313 City of Tigard Excavation Licensing Division Tigard, OR 97223 Gert t 1 eme n: Re: Bond Number: 97 73 8371 On the 3rd day of September, 1980 the State Farm Fire and Casualty Company as Surety, executed a Street Improvement Bond in the Penalty of. Three Hundred Sixty Dollars ($360) on behalf of Charl.%s Atherton of 10620 Southwest Cook Lane, Tigard, OR 97223 as Principal , in favor of City of Tigard as Obligee. The bond, by its terms, provides that the Surety may terminate its liability by giving notice of its ell—Lion to do so to the Obligee. In accordance with the terms of the bond, we hereby elect tv terminate our liability and shall, as of the 1.4th day of November, 1981 consider ourselves released from all liability by reason of any default committed thereafter by the Principal. Very truly yours, Jim Reiser Bond Representa,:ive Fire and Casualty Company EP/rh Ml%822 cc: Hudson 1467-97 Charles Atherton HOME OFFICES BLOOMINGTON, ILLINOIS 61701 APPLICATION - STREET IMPROVEMENVEXCAVATION COPY TO: Ll tEl ORDINANCE NO. 74.14 (WHU - FILE ❑ (BLUTE)E)-INSP. ❑ (YELLOW) OTHER AGENCY (INSTRUCTION SEPARATE SHEET) ❑ (PINK) - APPLICANT APPROVED �f APPLICATION NO. NOT APPROVED ❑ CITY OFTIGARD, OREGON FEE AMT.: S 41 PENDING FEE. PMT. ❑ CITY HALL RECCIPT PENDING S—JRITY ❑ PUBLIC WORKS DEPARTMENT RY _ _ DATE � '^' PENDING AGENCY ''OK" ❑ Application and Progms Record - - - - - - - - - - - - - - PENDING INFORMATION 1-3 FOR STREET IMPROVEMENT/EXCAVATION MAI As REQUIRED ANNUAL ANNUAL O PEND,NG VARIANCE L] EXPIRATION DATE: PERMIT NO.: .I4 �' _ C DATE ISSUED: _� _1.F. '_.._._. . BY: (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. / APPLICANT L 1 d������—e e.i_ /OG 2e .f NAME ADDRESSCITY- CITY - - PHONE CONTRACTOR - ----_- -- -------- -.- _ NAI�i [ � ADORERS C1Tv PHONE PLANS BY ANDRESS CITY PHONE dN _ ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ �- _ FOR OFFICE U E: CIMIN (2.) EXCAVATION DATA' 0.02 x f STREET _ DESCRIPZ .ON PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY (_ _TYPE LENGTH WIDTH DEPTH ITEM 4./QUANTITY 1 ri, V�, �I /ZVL/�[�►1}lL�i 0' STREET IN R TION E —T Q EST IMATED STREET OPENING DTk. L— // E _ S ESTIMATED STREET CLOSING DATE: L• _ g 43&'-- Sl BEET (3) SECURITY NO. SECURITY AMT.: $ —� CLOSED SURETY CO.: ir ��-t-e_ :G rM _ FINAL _ CERTIFIED CHECKCAIN O SONO INSPEC. �� -- _� (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS j CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. CURB _ , `• - - - - - - - . - I I I (5) NO—E: 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 APPLICANT AGREES TO DEPOSIT THE REQUIRED lSFCURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS TIDE CITY AND EMPLOYEES AGAINST ANY INJURY OR ')AMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS I, LICANI'SSIGNATURE �`� {�(��1 !s V �' � DATE APPLICATION STREET IMPR' IEMENT/EXCAVATION COPY TO: ORDIN,..4CC NO. 74-14 U (WHITE).FILE ❑ (BLUE) --NSP. ❑ IVELLOW)-OTHER AGENCY (INSTRUCT IONS ON SEPARATE SHEET) ❑ IPINK) -APPLICANT APPROVED © APPLICA'nOO NO.: NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE: AMT.: R — PENDING FEE. PMT. ❑ CITY IIAIJ, RECEIPT NO.: _ PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY DATEI _ _ _ _ _1_—_ PENDING AGENCY "OK" ❑ Application and Progress Record PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATIriN MAINTENANCEAS REQUIRED L � ANNUAL ❑ PENDING VARIANCE ❑ EXPIRATION DATE: / PERMIT NO.: DATE ISSUED: l—�� , BY: (1) APPLI,ATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL .— AS NSTALL .AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT NAME -- --�_-�---ADDRESS --- - -----i CITU PHONE CONTR ZTOR - _ 'NAMl--- -- ADDRESS -�._----- CI-Tom---- -- PHONE PLANS BY---_.----- P.AME AMORE ---- CITU — -----FHONE---- ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S DOLLARS FOR OFFICE USE: ❑MIN. (2) EXCAVATION DATA: 0.02X $—.— STREET .ozX $____.—STREET DESCRIPTION PROGRESS & INSPECTION STATI.S NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TV PE LENGTH WIDTH DEPTH ITEM & QUANTITY STREET INSP R TION E U ESTIMATED STREET OPENING DATE: ES ESTIMATED STREET CLOSING DATE: T —--- -=-- _—=-- ED 1 ry G (3) SECURITY NO. _— SECURITY AMT.: S STREET SURETY CO.: INALID"I CERTIFIED CHECK 11CASH O BOND p (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. I 1 I 1 1 I I 1 1 (5) NOTE. t',IE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE IIIGHT-JF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICAN'r 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 TM A'-.I E a►- � o� r IL r� I _7' C It 40 o ft T _ h7 _ G:Z Er.,.VA,/ tit 3--ir- 1 O � ���- cF'K o e I cn .) cIS o -I• i J � c �IS � VE SJ ~— �3 J�� - r� 7 G �' 6` I ^► 1 N i Of I II � o �� `� � 7 � \� '. � � d 'd J 7, I O �• i �.r - • 1 �.I t. _ • L 4_ I \�/�'`�j V w ���T � _�...J .� - -- UWOFT! ARD r r � ) 6"' se .——_.____)J170 6.W.MaM I'��G�151►/ 716AK.tMFOrx�c»^r nH !»�ir —__—__