9885 9895 SW GARRETT STREET A.
FILE NO. I&Z-93 STR. OPN. PERMIT
GALRETT ST. - 9885 & 9895
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WESTERN rS ETY COMPANY
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CHICAGO C1W(. fl`-� � `Afr c�LLAS
PALO ALTO,l'�74LA.4a�,.PA.-
LICENSE AND PERMIT BOND
(For County, City, Town or Vniage Only)
KNOW ALL MEN BY T14ESE PRESENTS: FORM No, L& P 440436
That we, Linden t.. Ealls dbe L E Concrete and Framing
of the City ofOregon Cid State of Oregon as Principal,
and the i''' STERN SURETY COMPANY, a corporation duly licensed to do business In the
State of Or000n as Surety, are held and firmly bound unto the
City of Tigard _ Stste of Oregon Obligee, in the penal
(Valid only when a County, City,Town or Vlllaite is named ae Ohlfgee)
sum of - - One Thousand and no/100 - - - - - - - - - ($,1,000.00 ) DOLLARS,
(NOT VALID IF FILLED IN FOR MORE THAN $10,000.00)
lawful money of the United States,to be paid to the said Obligee, for which payment well an(] truly
to be made, we bind ourselves and our legal representatives, Jointly and severally by theme presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the said Principal
has been licensed a sewer contractor - ^
--_-------- - --- _ by the said Obligee.
NOW THEREFORE,if the said Prineil al shall fnithfully perform the duties and in all things corn-
Hv with the laws and ordinances, including all Amendments thereto,appertaining to the license or per-
iuit applied for,then this obligation to be void,otherwise to remain in full force and effect for a period
commencing on the _-_day of 19__, and ending on the
--_ day of_ 19— unless renewed by continuation certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, by cer•
tified mail,to the clerk of the Political Subdivision with whom this bond Is filed and to the Principal,
addressed to them at the Political Subdivision named herein, and at the expiration of thirty-five (36)
days from the mailing of said notice, this bond shall ipso facto terminate and the Surety mhall there-
upon be relieved from any liability for any acts or omissions of the Principal subsequent to Fiat(] date.
Dated this_ _ 22nd - day of November __ _4 , 19 es_.
Linden L. Eells dbe L E Concrete & Framing
�' J, ✓, `� /�----- Principal
-Principal
('ounte l�/gad WESTERN SURETY COMPANY
Jff By
Resident Agent M. Kroon. Asst. Sec.
ACKNOWLEDGMENT OF SURETY
(Corporate Officer)
STATE OF SOUTH DAKOTA �
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(',ninty of Minnehaha 1
r On this -?2nd_ day of— November __ 19 63 before me,
the undersigned officer, personally appeared M. Kroon, Astil Sec.
who acknowlc.iged himself to be the aforesaid officer of the WESTERN SURETY COMPANY, a
corporation, and that he as such officer, being authorized Fit) to do, executed the foregoing Instrument
for the purpose therein contained, by signing the name of the corporation by himself am such officer.
IN WITNESS WHEF HOF, I have hereunto set my hand and official seal.
My 0ommission Expires
— — ► ►(PI erltL—
My Commusion 6 splras i 31.6>j Notary P lie South Dakota
1J.
APPLICATION - STREET IMPR �MENVEXCAVATION COPY TO:
ORDIN-4CE NO. 74-14 (WHITE)- I ILE
�;BLU E) -Irlgp,
(INSTRUCTr'
'IONS ON SEPARATE SHEET) u 'VELLOIA1-OTHER AGENCY
(PINKI - APPLICANT
APPROV EL: APPLICATION NO.: /11-7
NOT APPROVED CITY OF TIGARD, OREGON FEE AMT.: III_ 4C,icF —
PENDING FEE. PMT. [] CITY HALL RECEIPT NO.: IS'S Y?
PENDING SECURITY ❑ PUBLICWORKS DEPARTMENT By LJA DATE
PENDING AGENCY "OK" ❑ Application.ind Progress Recor(' _ `
PENDING INrORMr„ r.o -,ION 0 FOR STREET IMPROVEMENT/EXCAVATION MAINTENAN D
AS ar
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PENDING VARIANCE CI EXPIR'.A'IONDATE:
PERMIT NO.. �`' 3r�-� DATE ISSUED: -, �' '
a ---_ _ LL2_L'-~-._—. BY: ---- -
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL Xlye
-- - -----_ . AS DESCRIBED HEREIN, IN FULL.ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANTG1t' /CES' .C�IIS 11 rs __Lr1_� I v �- - M ��'
NAME
ADDRESS - '---
ONTRACTOR ���` C� err .� Jt'091414ji /'Qj C1AC/cam Cr - �O/V
NA v AO[TR! s C y — PHONE
PLANS BY -–Z—/A&1V” - I4.E'E- CSt�Ar A / ONE S i 1 , )I '_
NAME Abs iT�E;1P --_
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S SOD.O>O ♦ , � +�p �►tro.c Tc�t`yC°
DOLLARS
(2) `EXCAVATION DATA: FOR OPPICE UIEI
STREET DESCRIPTION _ PROGRESS & INSPECTION STAT LIS
NAME SURFACE CUT C j"T CUT LENGTH WIDTH DEPTH MATERIAL TEM & QUANTITY /TYPE BY
ITEM DATE REMARKS
� L yI• I ' x'aG STREET
i OPEN
.S i - 't "t w- , r. _� v ry IINISPOD
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ESTIMATED STREET OPENING DATE: / /IBf�// Y s
ESTIMATED STREET CLOSING DATE:_—,/ //P+21/ R3 T --- --
(3) SECURITY NO. `�SECURITY AMT.: S 'CCL' `�' STREET
Ic.
SURETY CO.: =� �a � �•� -_ FINAL _
CERTIFIED CHECK CAE ■OND q INSPEC.
- -=-- - _F
(4) PLOT PLAN: INDICATE 91TE PERTINENT PHYSICAL SPECIAL PROVISIONS/cowwrIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
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s.�cr Garre'ft srreer - - _ : r
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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.
THF APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIEP, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTMUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLES'3 THE CITY AND
EMPLOYEES AGAINST ANY INJURY LOR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS51GNATURE: / '
DATE �r� /
CITY OF TIGARD—12420 S.W.MAIN - TIGARD,OREGON 97223
RECEIPT
NAM!
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AL P
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r OF
FOR: ACCT r PERMITS SURCHARGE AMOUNT
SEWER BILLINGS
BUSINESS LICENSE (_)5 331
PLUMBING PERMIT 05
MECHANICAL PERMIT 05-332
BUIIDIr�7, PERMIT ()5 333
SEWER CONNECTION 4r_,-36.3
r,r_WER INSPECTION 40).365
SYSTEM DEV CHARGE
PARK DEV CHARGE +tri 30-361?
PARK DEV.CHARGE #2 Y) 36,9
ZONING AD.'USTMENTS r75 3C-2
PERMIT NUMBERS ASSIGNED
Number Amount Number Amount Number
Amount
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RECEIPT . 15 8 3 9
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