11865 SW BURLCREST STREET r
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OPN. PERMIT
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APPLICATION - STREET IMPRO' VIENT EXCAVATION COPY TO:
R (WHITE) - FILE
ORDINANCE NO. 74-14 (BLUE) INSP,
(INSTFiJCTIONS ON SEPA ROTE SHEET) L1 IYELLOW) -OTHER AGENCY
F}.IPINK) - APPLICANT
APPROVED C7 APPLICATION NI+.: --,
NJT APPROVED ❑ CITY OF TIGARD, OREGON F'EE AMT.: S `' '
FENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: n O ;PENDING SECURITY p PUBLICWOR KSDEPARTME_NT BY ..__— —_ DATE
PENDING AGENCY 'OK" ❑ Application and Progress Record _
MAINTENANCE BOND..#
PENDING INFORMATION ❑ FOR STREET I11flPROVEMENT/EXCAVATION AS REu(n1eLD �''SS
ANNI AL
PENDING VARIANCE ❑ EXPIRATION DATE: _
PERMIT NO.: ---- DATE ISSUED: L --- BY:_ •-4�,�' e:` .-moo ,/r , ��
- _
(1) APPLICATION IS IiEREBY MADE TO EXCAVATE FOR AND INSTALL_
2 �" __. ------ AS DESCRIBED HEREIN, 10 FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
NAME ` ADDRESS -- --- CITY -- —PHONE
CONTRACTOR_ _ r
NAME ADDRESS - t1TY PHONE
PLANS BY 7„' ','.
NAME ADDRESS CITY PHONE
L_1TIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ -__-_ _'S[�✓� ” _
DOLLARS
..UMIN.
(2) EXCAVATION DATA: FOR OFFICE U1 E:0.02,X s
STREET _ _ DESCRIPTION PROGRESS & INSPECTION STATUS -
NAME SURF'4CE CUT CUT CUT MATERIAL INSTALLED
TfPE LENGTH. ITEM DATE REMARKS/TYPE BY
_ WIDTH DEPTH ITEM & QUANT17Y /
STREET
--- —� — N E .. --
INSPETD
R TION
Q
ESTIMATED STREET OP'_NIN G DATE:— / /_ _ _ — E S
ESTIMATED STREET(.:LOSING L ATE: __ / / r TE
--
�
(J) SECURITY NO. _ _. SECURITY AMT.: $ ,STREET
_ CLOSED
SURETY CO.: _ _ FINAL — --
CERTIFIED CHECK U -A CASH ❑ _BOND CI INSPEC.
(4) PLOT F AN: I .nICATE SITE PERTINENT PHYSICAL — SPECIAL PROVIS;ONS /CONDITIONS:
FEATURES; LXCAVATION LOCATION AND EXTENT.
1 I 1 1
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 WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPt7SIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO S.-AVC HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANta ACTIONS.
APPLICANTS SIGNATURE: DATE _._ /
uNz+r�r� �czIPIc I3NTSu1R,A rrt. X ccs �Ar�rx
HOME OFFICE TACOMA. WASHINGTON
LICENSE OR PERMIT BOND BOND NO. U49 .34 94 2
KNOW ALL MEN BY THESE PRESENTS:
That we, KENNEDY PLUMBING, INC.
as Principal, and UNITFD PACIFIC INSURANCE COMPANY, a corporation organized under the laws of the Statr'
of Washington having it; principal office in the city o! Tacoma,Washington, and authorized to transact the busi-
ness of Surety in the State of as Surety, are held and Firmly bound unto
CITY OF TiGARD
--- - --- - - - - - --- as Obligee,in pend sum of
FIVE HUNDRED DOLLARS AND NO/100------------------------------- 500.0��
- -- �a --..... Dollars,
lawful money of the United States, for which payment, well and truly to be made, we bind ourselves, our he;-s,
executors, administrator;, successors and assigns,jointly and severally, firmly, by these presents.
WHEREAS, the said Principal has applied to said Obligee for a license or permi
i STREET OPENING PERMIT
s�ar76e nntura o7Tlcenee or perm7E) -
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That if the said Principal she,' in-
demnify said Obligee against all loss to it caused by said Principal's breach of any ordinance, rule or regulation
relating thereto, It en the above obligation shall be voi�, eOierwise to be and remain in 'ull force and effect.
PROVIDED, THE LIABILITY OF THE SURETY upon this bond shall be and remain in full force and effect for
thefull period of the certificate, license, or permit issued to the Principal above named but not beyond XXXXXXXXXXX
XXKXXX XXXXXXXXXXXXXXXXXXXXXXXX*#)XXq ten days afrer receipt bythe Obligee of a written notice signed
by such Suretv,or its authorized agent, stating that the liability of such Surety is thereby terminated and anceled.
Provided f-irther, that nothing herein shall affect any rights or liabilities %thick shall have accrued under this bond
prior to the date of such termination.
This bond may be P.•-nded fer n further term by the issuance of a Continuation Certificate signed by the Surety.
Dated ,__Decembe-- 7 , 19 83
KENNEDY PLUMBING,
PnIN[IP Al
UNIT iFl INSURANCE COMPANY
ROU 7301 ED > 71 Y.
Shari K. Jones At TOMNKT-IN•10I.Gt
UNITEL ?ACIFIC INSUR.ANC.,, CoMpA1%7Y
HEAD OFFICE,FEDERAL WAY, WASHINGTON
POWER OF ATTORNEY
KNOW ALL MEN BY THE� ti
r PRESENTS. That the UNITED PACIFIC INSURANCE COMPANY,a corporaon duty organ,tad under the laws o1 the
State of Washington,dres hereby make,constitute and appoint
SHARI K. JONES Of PORTLAND, OREGON---------------
its true and lawful Attorney in Fact,to make,execute,awl and deliver for,and on its behalf,and es its act and dead
ANY AND ALL BONDO AND UNDERTAKINGS OF SURETYSHIP-•---
and to bind the UNITED PACIFIC INSURANCE COM°ANY Oiereby as fully enr�,o the same extent as if such bonds and unCertakingsand other writing,
obligatory in rhe nature thereof were signed by an E.tecut ve Officer of the I)NITED PACIFIC INSURANCE COMPANY and sealed and attested by one
other of such officer% and hereby Willits and conforms all that its%air'Attorneylsl in Fact may do in pursuance hareof
This Power of Attorney is granted under and b*, authority of Article VII of the By Laws of UNITED PACIFIC INSURANCE COM"ANY which
became effective September 7, 19719,which provisions are now in full force and effect,reading as follows
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKINGS
1 The Board of Directors,the President,the Chairman of the Board,any Senior Voce President,any Vice President or Assistant Vice President
or at her officer des gnated by the 134,rd of Directors shall have power and authority to(a)appoint Attorneys in Fact and to authorite them to execute
on behalf of the Company, bonds find underfak ngs, reciogn Lances, contracts of indemnity and other writings obligatory in the nature thereof,and IbI
to remove any such Attorney in Fact at any time and revoke the power and authority given to him
2 Aticirnay%m Fact %halt have power and authority,subject to the term,and l,mrtat ions of the power n1 attorney r5-wea to them,to titecute
anddelwet on behalf of the Company,bonds and undertakings,recognitancn,contracts of indemnity and other writ ng%obli
The corporate seal is not ne:essary for the validity of any bonds ano undertaking.,recognotences,contracts of indemnify and other gatory m the the nature
atwe thereof
obligatory
,n the nature thereof
3 Attorneys on Fan shall have power and authority to e:scute affidavits reou red to tie attached to bonds,recogr.tances:contracts of mdem
Orly or other txmditional or obligatory undertakings and they shall also have power and suthori,; to certify the financial statement of the Company and
to copies of the By LawS of the Company or any article or section thereof
This power of attorney is signed and sealed by facsimile under and by authority of the following Resolution adopted by the Board of Directors of
UNITED PACIFIC INSURANCE COMPANY at a meeting held on the 5th day of June,
been amended or repealed 1979,at which a quorum writ present,and said Resolution has not
"Resolved,that the signatures of such directors and officers and the seal of the Company rssny be affixed to any Such power of
attorney or any certificate relating thereto by facsimile,and any such Power of attorney or certificate hearing such facsimile
signatures or facsimile seal shall be valid and bonding upon the Company and any such power so executed and certified by
facsimile signature:and facsimile seat shall be valid and binding upon the Company in the future vnth r"plct to any bond or
undertaking to which if -s attached -
IN WITNESS WHEREOF,the UNITED PACIFIC INSURANCE COMPANY has caused three presents to be signed by Its Vice President,and its corporate
seal to be hereto affixed,this r n 9 day of August 19 2
<uwyt
UNITED PACIFIC NSURANCE tOMPANY
Via President
STATE Ot Washington
COUNTY IF King }u.
On this 2nd day of August 106L1 ,personally appeared Charles B. Schmalz
I
, me known 10 be the Vice President of the UNITED PACIFIC INSURANCE COMPANY, erd :ckntwledged that he a■anter arid attested the fore
gong instrument end affixed the seal of said corporation thereto, and that Article VII,S*Lar, 1, ?, end 3 ed the By Laws of said Company, !std the
Resolution set forth therein,are sl,,, n full force
My Commission Empire% , r.,
May 1 -19 86 i!`'1,',w Notary Pubhi -n and f
- a Stall of Wa_, ington
Residing at Tacoma
I Charles J. Falsk.)w Assistant Secretary of the UNITED PACIFIC INSURANCF COMPnNY, do hereby c•rbly that the
above and effect
inp ,/true and correct ropy of a Power of Attorney executed by said UNITED PACIFIC INSURAN,:E COMPANY,which is Sr." --rail
force and!Ilett
IN WITNESS WHEREOF,:hsve hereunta sat my hand enc;affixed the see%of mrd Company this 7th day of December 1g 83
nor 1431 to 1180 � �.)� Assistant Secretary
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