10145 10175 SW KATHERINE STREET FILE NO. j
KATHERINE ST. - 10145 & 10175
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APPLICATION - STREET IMPR -.MENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 '] IWHITF)- FILF
(GLUE) -11.-
(INSTRUCTIONS OM1I SEPARATE SHEET) U (FELLOW) -OTHER AGENCY
IPINK) -APPLICANT
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APPROVED APPLICATION NO.: (�,e�9^�-0
NOT APi'F'OVED CIT Y 01. ' IGARD, OREGON FEE AMT.: S `3e VV _
PENDING FEE. PMT, fX CITY HALL R[CgIP�190,:
FENDING SECURITY -Crl' PUBLICWORKS DEPARTMENT
AGENCY "OK" ❑ .Application and Progress Record — — — — — — — —
PENDING — n �g
MAINTENANCE BONpwlt Ji _ � �
PENDING INFORMATION O FOR STREET IMPROVEMENT/Ei(CAVATION AS r.ecuCE.tjS ]IL
)1
PENDING VARIANCE ❑ ANNUAL. L)EXPIRATION DATE:
PERMIT NO.:
DATE ISSUED: J_
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
---- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT Ye'&t"j 14 A SII,
ObORElS me
WTVT-- PHONE
CONTRACTOR - St1, _
.PHONE
PLANS BY —.•S.' �► �__
NAME - ----'ADDREE!t CITY --
ESTIMATED IMPROVEMENT -TOTAL VALUATION ( COST):
DOLLARS
(2) EXCAVATION DATA: Fon oFFicE us 'MIN. -
- 0.02XS--
STREET DESCRIPTION PR_OGRESS & INSPECTION STATUS
NAME SURFACE 1CUT CUT EUI' MATERIAL INSTALLED
TY E LENGTH WIDTH _DEPTHITcM QUANTITY ITEM DATE REMARKS/TYPE BY
1+ c
fr INE- c T-71 .4_ �. RPFrjREED 5 AA b' G' �-
iNSP
R TION
E
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EST(MATED STREET OPENING DATE E -
ESTIMATED STREET CLOSING DATE: -S_ 1�� T _
E
(3) SECURI"'Y NC7,�r83 /L? SECURITY AMT: $ -- STREET ---
CLOSED
SURETY CO.: dam' —�
'� w�'t1(�g�< < " _ FINAL
__ - t[RTIFIEDCHECK �l CASH ❑ DON O (j� INSPEC. 1
(4) PLOT PLAN: INDICATE SITE PEnTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS:
FEATURES: EXCAVATION LOCA'r10N AND EXTENT.
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(5) NOTE THE CITY OF -IGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RICHT-'-)F-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
.HE APPLI,ANI 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: 'L U`/1
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DA'FL
APPLICATION STREET IMPP 7--MENVEXCAVATION COPY TO:
Ll (WH I't F) - FILE
ORDINANCE NO. 74-14 (81-1-01-.) INSP.
(YELLOW) GTHER AGENCY
(INSTRUCTIONS ON SEPARATE SHEET) (PINK) APPLICAN-1
ArpRovED APPLICATION NO.:
NOT APPROVED CITY OFTIGARD, ORF,GON F'!EE AMT.:
PENDING FEE. PMT, CITY11ALL RECEIPT NO.:
PENDING SECURITY PUBLIC WORKS DEPARrMENT BY - ---- DATE--
- - - - - - - - - - - - - - - -
PENDING AGENCY ''OK'' I Application and Progress, Record `MAINTENANCE BOND
PENDING INFORMATION f 1 FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED 1.1
ANNUAL
PENDING VARIANCE EXPIRATION DATE: L
PERMIT NO. DATE ISSUED: BY:
(1 ) APPLICATION IS HEREBY MADE To EXCAVATE FOR AND INSTAL'
AS DESCRIBED HEREIN, IN FULL A(.( 'RDANCE WITH CITY REQUIREMENTS.
APPLICANT
NAME ADDRESS CITY PHONE
CONTRACTOR
NAME ADDRESS CITY PHONE
PLANS BY
NAME ADDRESS -CITY---PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
DOLLARS
FOR OFFICE USE: I'M I N.
(2) EXCAVATION DATA 0.02 x
STREET DESCR;PTION PROGRESS & INSPECTION STATUS
NAME SURFACF CUT cu- CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTHITEM_ & QUANTITY STREET
OPENED
INSP
R E TION
Q U
ESTIMATED STREET O!-LNING DATE: E S
ESTIMAYED STREET,LOSING DATE: T
E
D
(3) SECURITY NO. SECURITYAMT S STREETD
SURETY CO.:
CCF71IrIEDCHECK CALLA O I11IOND
(4) PLOT PLAN: INDICA rE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS CONDITIONS
FEATURES; EXCAVATION LOCATI-N AND EXTENT.
APT, -
NOTE THE CITY OF TIGARD DOE!c NOT, HIE'4ERY, GR,:NT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS ' AT OF WASHINGTON COUNTY OR THE STATE OF OREGON
THL APPLICANT AGREES 10 DEPOSIT *rHE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTPUCTION SPECIFICATIONS PERTINENT 77 CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY ANn
LMPLOYCES AGAINST ANY iNJIJPY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE DATE
OREt-ON AUTOMOBILE INSURANCE COMPANY
i i_CE1 1 E_-o HOME UFFIC[ • PORI LANG,OREGON 97207
6 i,, S
Bond No. B 32159
CITY OF TIGAi'i? Premium: $20.'00
BOND
KNOW f.LL MEN BY THESE PRESENTS:
That we,DEbJEY R. & MARGARET C. HAMIL OOfN 10175 S.W. Katherine St. , Tigard, Ore.
as Principal, and the OREGON AUTOMOBILE INSUE'ANCE COMPANY, a corporation
organized under the laws of the State of Oregon ana authorized to transact
the business of Surety in the State of. Oregon, as Surety, arc held and
firmly bound unto CITY O"TIGARD _ in the just
fu11 sum of ONE HUNDRED SEVENTY FIVE AND NO/100---DOL'LARS_, for which
well and truly to be paid, we bind ourselves, our heirs, exec,,Lors,
administrators, successors and assigns jointly and severally, firm7.y by
these presents.
Sealed wi.h our seals, and dated this 22nd day of March 19 78
THE CONDITION OF THIS OBLIGATION IS SUCH, TIAT, WHEREAS DEWEY P. F! MARGARET
C. HAMILTON has made application for a permit to make a cut on the
street at _ 19175 S. W. Katherine St. , . i ard, Oregon
NOW, THEREFORE, If the said Principal shall abide by the- terms off: said
permit, then this obligation to be void: otherwise, to remain in full force
and effe-t .
IT IS AGREED THAT the Surety's liability tinder tris bond shall remain in
force for a period of one (1) year following the completion of work for
which the permit has SEen obtained.
DEWEY R. & MARGAPET C. HAMILTON
i':incipal
BY:'
OREGON AUTOMOBILE INSURANCE COMPANY
BY
Joan Partee, Attorney-in-fact
�'t r.
CIAI'i'OI' Z'IGARD-1.2420 SW MAIN-TIGARD-OREGON 97223 I
RECEIPT E'CR!.l
A,NOUN .. $
_ DOLLARS
NAM ( �
---St ' ` .,�r,.,f""� CASH
` 1.
ADDRESS: p : _� CHECK:
M.O. . 1
# OF
Fc .ACCT.# PERMITS SUI:Ct{AR3E _ AMOUNT
SEWER BILLINGS 10-131 S
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332 $
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 10-363
SEWz:R INSPECTION 10-365
SYSTEM DEV. CHARGE 40-366
PARK DEV. CHARGE bl 4`.i••-+67
PARK DEV. CHARGE #2 45-368
ZONING ADJUSTMENTS 05--362 _
TOTALS
RECEIVED BY:
ERMIT JUMBERS AS IGNEU:
Number Amount Number Amoutrt Number Amount
--- - $
1
$ RECEIPT #
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