9295 SW ELECTRIC STREET-4 FILE NO. STR. OPN. PERMIT
ELECTRIC ST. - 9295
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APPLICATION - STREET IMPF, EMENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 ❑ (WHITEI"FILE
❑ FLUE)•INSP.
(INSTRUCTIONS CN SEPARATE SHEET) ❑ (YELLOW)-OTHER ^GEN,
❑ (PINK)-APPLICANT
APPROVED APPLICATION NO.:
I
NOT APPROVED (, CITY OF TIGARD, OREGON FEE AMT_: f
PENDING FEE. P IT. CITY HALL RECEn� e U
PENDING SECURITY p PUBLIC WORKS DEPA R TMEN T BY _ DATE
PENDING AGENCY "OK" C] Application and Progress Record - - -
MAINTENANCE BOND �'& v I -2-
PENDING INFORMATION p FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
❑
PENDINv VARIANCE ANNUAL pEXPIRATION DATE: J
PERMIT NO.: _ ;.j - - - DATE ISSUED: _ ( % BY: �-
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
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AS DESCRIBED HEREIN, IN FULL ACCORDANCE I�Y REQUIREMENTS.
APPLICANT MIE .}+�
IcIX�C '. JAry('�tJ l 1 ( R�-1� �-
PHONE
CONTRACTOR—lil —l
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(� ,('� NA- E - 1CITY
PLANS BY_ C-% �-_/. LONE
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NAME KDDNCITY
ESS
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
"z—=- -.-- DOLLARS
(2) EXCAVATION DATA: - FOR-OFFICIC u.. """0 NIN.
0.ozx —
tt `' = s �• 017
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE
CUT CUT CUT LENGTH WIDTH DEPTH MATERIAL
QUANTITY /TYPE BY
ITEM DATE REMARKS
k.1, rTl IG I:FP STREET
PEND
INSP
R TION
E O
Q
U
ESTIMATED STREET OPENING DATE: _ $ Ft V r '
ESTIMATED STREET CLOSING DATE: T
(3) SECURITY NO.-� .� _-- �� =% - STREET —
� SECUR�-TY AMT,: S �G, CLOSE
SURETY CO FINAL
CERTIFIED CHECK ❑ CASH 0 SONb� INSPE'C. �--
--
(4) PLOT PLAN INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS:
FEATURES, EXCAVATION LOCATION AND EXTENT.
Gust i3 __
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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 THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTFIUCTION :9'ECIFICATIONB PERTINENT TO CL,iDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINS. ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
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Af'PLICARITS SIGNATURE: �.a-� t a�T,,a� - DATE l t rJ!
OREGON A(JTOMOBI!E INSUR.,IPICE COMPANY
HOME OFFICE - PORTLAND,OREGON 97207
Bond No. So 32.142
F remiLIM: 520.00
BOND
KNOW ALL MEN BY THESE PRESENTS:
That we, RALPH JAMES PETERS of Tigard, Oregon 97223
as Principal, and the OREGON AUTOMOBILE INSURANCE COMPANY, a corporation
organized under the laws of the State of Oregon and authorized to transact
the business of Surety in the State of Oregon, as Surety, are held and
firmly bound unto _ CITY OF TIGARD - PUBLIC WORKS in the just
and full sum of THREE HUNDRFD FIFTY AND NO/100-------------_, for which
sum, well and truly to be paid, we bind ourselves, our heirs, executors,
administrators, successors and assigns jointly and severally, firmly by
these presents.
Sealed with our seals, and dated this 21St day of March 19 78
THE CONDITION OF THIS OBLIGATION IS SUCH, THAT, WHEREAS RALPH JAMES PETERS
has made application for a permit to make a cut on the
szr=ec =t - 9295 S.W. Electric,. Tigard, Oregon —
NOW, TH,MFORE, If the said Principal shall abide by the terms of said
permit, then this obligation to be void: otherwise, to remain in full force
and effect.
IT IS AGREED THAT the Surety's liability under this bond shall remain in
force for a period of one (1) year following the completion of work for
which the permit has been obtaineJ.
i RALPH JAMES PETERS
Principal
OREGON AUTOMOBILE INSURANCE COMPANY
BY
Joan ar - "
ee, •_r
Attarne}•-in-fa�k