12500 SW BROOKSIDE AVENUE-1 FILE NO. )29",?O STR. OPN. PERMIT
BROOKSIDE AVE. - 12500
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September 9, 1931
C.L. WOOi.R O
10215 SW ':alnut
Tigard, OR 97223
re: Street Opening Perait
Ecnd ;.o. 129--50
r=ant lenen:
Encloaed please find you street construction Perrit fo: a street sewer
t ^. :'our '�on1 is liei^; relc =ea a^ t?--e 70,11.2nt
'*hand; you for your cooperation in this rattcr.
Yours truly,
Ro'hert L. The^r�sart
Engineerin; Tech. II .
Enclosure ��
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REQUISITint,
CITY O" 1 IGA R _
WASHINGTON -OUNTY,OREGON DATE
CHECK ONE: C7 I want to buy the following. Please research. Foward to Pur-
chasing Coordinator.
F-:3 I have researched the following (ectached quote information) .
Please issue a PurchdsE Order. Forward to Purchasing Coordinator.
r-1 I have ordered the following. Please issue a confirming Purchase
Order. Forward to Purchasing Coordinator.
CJ I have received the following. Please make payment, Forward
to Accounting. Received: , d
Dcf-A Initials
P.U. #
DATE REQUIFID SHIP TO
OTHER INFORMATION
ACCOUNT # QUANTITY DESCRIPTION (Please explain thoroughly) UNIT PRICE TOTAL PRICE
TOTAL AMn11NT $
RECOMMENDED VEMJORS
DEPARTMENT HEAD APPROVAL _ Distribution:
FINANCE DIRECTOR APPROVALWhite - Pur. Coord. or
(for 600 Accounts over $2500, and all 700 Accounts Accounting
Yellow - Department Copy
Bond No. 97-74 06 86
LICENSE AND PERMIT BOND 11 ►0��I ��
STAIT F ',R)l EIRE AND CASUALTY COMPANY
BLOOMINGTON, ILLINOIS
KNOW ALL MEN BY THESE PRESENTS, That tive,
WOOOARD�C L XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
of 10215 SW WALNUT, TIGARD,OR 97223 as Principal,
and ST,j,TE FARM FIRE AND CA�UALTY COMPANY, a corporation organized under the laws of the State of Illinois, having
its principal office in the city of BloorT ington, Illinois,a-,Surety, are held ana firmly bound unto THE (,'!TY OF T IGARD,
OREGON, PUBLIC WORKS DEPARTMENT
FIVE HUNDRED AND NO/100 ---- --------
in the full and aggregate Burn nf— -- _Dollars (S 500.00
lawful money of the United States, for which payment well and truly to be made, we bind ourselves, aur heirs, executors,
administrators,successors and assigns,jointly and severally,firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH that whereas the said Principal has been granted a__
STREET OPENING PERMIT IN ACCORDANCE WITH TIGARD, OREGON CITY ORDINANCE.
for a term beginning 10-17-80 10-17-81
9 9------ ------ -----and ending-- — —
NOW, THEREFORE, if the above Principal shall indemnify and save harmless the Obligee, against loss by reason of said
Principal's breach of any ordinance, rule or regulation relating to the above described hceq�e or permit, then this obligation shall
be nu'i and void, otherwise to remain in full force and effect
Provided, that if the Surety shall so elect, this bond may be cancelled by giving thirty (30) days nonce in writing to the
said Obligee and this bond shall be deemed cancelled at the expiration of said thirty (30) days; but said Surety so filing said
notice shall not be discharged from any liability already incurred under this bond or which shall accrue hereunder before the
expiration of said thirty (30)day period
This bond may be continued frorn year to year by means of a continuation certificate.
Signed,sealed and dated this29TH day of—___�.._-OCTOBER__.,_ __ _— _ _ - 19 80
Prr,n.,p.d
GTATE FARM FIRE AND CASUALTY COMPANY
•
By
DONNAoKt0rC OWLY
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RESIDENT AGENT
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1 ` ` CITY OF TIG,`RD
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APPLICATION - STREET I.NIPR' EMENT/EXCAVATION COPY TO:
WHITE)-FILr
(
ORDIN-4CE NO. 74-14 BLUE)-INS,'
❑ (Y ELLOW)-OTHER AGENCY
(INSTRUCTIONS ON SEPARATE SHEET] a (PINK) -APPLICANT
APPROVED APPLICATION NO.: - dy-1
NOT Af`PROVED
CI'T'Y OI� TIGARD, OREGON
❑
PENDING FEE. PMT. ❑ CITY HAI,1, RECEIPT NO.:
PENDING SECURITY ❑ PUBLIC VVORKSDEPART,MENI BY _J...L—_– DATE
PENDING AGENCY "OK" Q Applicatil -i and Progress Record MAINTENANCE BOND * —
PENDING INFORMATION Ll FOR STREET IMPROVEMENT/EXCAVATION' AS REQUIRED N
ANNUAL _
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.. nATE ISSUED: BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBE HEREIN, N VUL ACCORDANCE WITH CITY PEQUIREMENTS.
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APPLICANT L LrJ�lr�N I.v F'� �'^ `y 4� C-1'�+ �r
NAME ADOCITY—T PHONE
CONTRACTOR- ,�-1 *z2f-gnO►e .1 j6 ;fN AMR �' Sad (&4 �-' � . >?
PLANS BY
NA E ADDRESS CITE- PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
n
•`�� _-
DOLLARS
FOR OFFICE USE: _ ❑MIN.
(2) EXCAVATION DATA: 0.02 X s-_—__-__._= s._ ��
�SIREET _DESCRIPTION PROGRESS_& INSPECTION STATUS
NAME SURFACE CIJ'T CUT CUT MATERIAL GINSTALLED ITEM DATE REMARKS/TYPE :dY
TYPE LENGTH WIDTH DEPTH ITEM NIti QUANTITY
STREET _.._ _
Li1sL- –�('1 / L 1 ! 7 J OPENED -- --
INSP '
R TION
Q
CSTIMATED STREET OPENING DATE: ET --
ESTIMATED STREET CLOSING DATE: E
(3) SILCURITY NO. 0-�T 1- SECURITY AMT.: S . ��' ci OSEo
SURETY CO - ?1 `Af-c K FINAL-1
_ INSPEC. y -� �
CERTI O H l K 1' CASH ❑ NOND
(4) PLOT PLAN'. INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
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(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 THL STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, 1'0 COMPLY WITH AL1. PERTINENT LAWS ANn
CONSTRUG:TION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPL'3YEE:S AGAINST ANY INJUR\ OR DAMAGE WHICH MAY RESULT FRCM APPLICANTS ACTIONS.
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APPLICANTS SIGNATURE, f �)�Ude r. DATE�e -!-1-- —
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APPLICATION FOR LICENSE, PERMIT, OR MISCELLANEOUS BOND
S'IA] 1', 1' '� �t11 1' IItlr .0 1) CAST -11 "I ` a ►111' 1 1
BLOOiVM'NGTON, ILLINOIS
7Y Sofe l+ioprlelm
��-'�P,ulncrship
1. Name of Applicant
Address _- 3, V- V")>aIr14LC, I M_SJc4�l
2 Amount of Br,nt! S � c�r.� —�
_ -•-- Effective Date,
1 To Whorn Pa/atbir:
4. Description nM Bnnl
5. If this a License. Bond, Date Lirense Expires.—
If a Special Bond Form Is Required,Attach Bond Form
6. Does the applicant have State Farm Auto Insurance?—
7. Fire Company Policy Number(s) -Y-,z S
9. Billing: Annual Prepaid --- --- _—
Send hills to: XNnncrpal Other—__._—__
Premium$ Amount Agent's Code Stamp
Paid S _ _
IF BOND IS OVER $10,000 OR IS A FINANCIAL GUARANTEE _
THE FOLLOWING SECTION MUST BE COMPLETED
(Financial GuaranteesAre Livestock Dealers Bonds, Tax Bonds, Etc.)
9. fylw of business _ _--
\ How long in business?
10 Has the bppllrant illifflherl to any ntfu Nurety rompany for this brnui?
If sn,hive full particulars__ _
11. If the applicant has furnisher) a similar hoed heir.titfnre,why is new hoed desired?
12. Has the applicant ever liven bankrupt or insolvent? My CotnnifSSlon EX ii eS
13. Has the applicant ever compromised with his creditors? � d T
14, References (Bankers anti Merchants prof-rred): \
NAME �
POST OFFICE ADDRESS OCCUPATION
3 - ---
The apr)lir.ant and mdenrnitorlsl, if an +e icy pay $ _ _ ----
y' ami the Company's usual premhtm for this
Iwnd• ut thereof,
and the same amount aluntally Ibereafter, i;t advance, so long as the hoed, or any new hoed, or any
rr,newal theravf, nr suhslitute Ihaeuf, shall continue in tot , and until ihae Shall have hien furnlshr'd to the. Surety
cunrlletent, written, lerpol evldencr of its dischdfile and release flora any and all liability upon said hull
rnI.4uIt,
COMPLETE gEVEiiSE SIDE
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Minn W WIN V 0 AIR,,ONK"A Ot". 1 PH A"4111