9125 9145 SW NORTH DAKOTA STREET-1 FILE NO. !(,f-iC3 STR. OPN. PERMIT
DAKOTA STREET-9125-9145
APPLICATION -- STREET IMPRC 'MENT/EXCAVA'T'ION COPY TO:
ORDINANCE Nom. 74-14 ❑ IWHITE) - FILE
❑ (BLUE) -INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ❑^ (FELLOW) -OTHER AGENCY
LJ (PINK) - APPLICANT
APPROVED �] APPLICATION NO.:
NOT APPROVED ❑ CI FY OF rlGARD, OREGON FEE AMT.: E
PENDING FEE. PMT. ❑ CITY HALL IECCIPT NO.:
PENDING SECURITY ❑ PUBLICWORKS UEPARTMENT BY .__— OgTE____ _�
PENDING AGENCY ''OK" ❑ AP11licmion and Progress Record _ r _ — — — — - — — — — —
MAINTENANCE BOND
PENDING INFORMATION El FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL, L
PENDING VARIANCE ❑ _ —` EXPIRATION r)ATE:
PERMIT NO.: - -- .----- - - DATE ISSUED: - �� , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
� �=RSL` AS DESCRIBrD HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
--- —----
NAME _—
' AOORFSS —� CITY PHONE�
CONTRACTOR--
7 V
ONTRACTORTY ------
PLANS BY
ADO!aE55 CITY -- -- - 1YHONE --"—
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
----- - 6OLL^4
(2) EXCAVATION DATA: FO OFFICE U9E: OMIN.
0.( xS_ = s_
STREET _ DESCRIPTION __PROGRESS 8c INSPECTION STATUS
NAME SURFACE CUT CUT CUT'—�jvIA7ERINL INSTALLED ITEM DATE REMARKS l'YPE BY
— TYPE LENGTH WIDTH DEPTH ITEM S QUANTITY /
-- STREET -
-- OPENEp_.
INSPEC- -
R TION
E —
Q
U _
ESTIMATED STREET OPENING DATE:._._ --, S �—
ESTIMATED STREET CLOSING DATE: / � — E
D
(3) SECURITY NO. SECURITYAMT.: SCREED �—
SURETY CO.: FINAL --
_ CERTIFIED CHECK O CASH O EONp[ _INSPEC•
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION ANU EXTENY.
N
I 1 * \ I 1
I I I I
1 I I I
(` ) NOTE THE CITY OF "IGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAV JUR'SDICTION IS THAT Or WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION FPECIFICATIONS 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 — DATE
801099
BOND 110.
LICENSC OR PERMIT BOND
'!NOW ALL MEN BY TIII:SE PRESENTS, That weThomas R Rasch dba: Tam's Excavating
PO Dox 276 Gladstone, Or 97027
as Principal, and the Contractors Bonding and Insurance ccupa ny
with its Principal office in Seattle, Washington
' as Surety, are field and
firmly bound unto the City of Tigard
hereinafter called Obligee, in the penal sum
of***One Thousand and 00/100****,*
for the payment of which well and truly to be made we do hereby bind our-
selves, our he executors, administrators, successors and assl(lns, jointly
and severally, firmly by these presents.
3IGNE0 AND SEALED Till: 28th DAY OF July 8 s
, 19
W1113RLAS, the said oblir,ee has granted or is about to grant to the said•
Principal a License ur Permit P-) engage in the b,uslnesu of
Street opening —_-------—
NOW THEREFORL, if the said Principal shall indemnify the Obliqee against
any loss directly arising by reason of the failure to comply with the laws
and ordinances governing the business of Street Opening
in sold City of Tigard
then this obligation shall be void, otherwise to be and remaln in full force
and effect.
liECARDLESS of the length of time this bond shall continue to be in affect,
llrrr aggregate liability of the Surety hereunder shall in no went exceed
the amount of the bond.
"'OVIULD,110WEVE14, !hat the Surety shall have the right to terminate its
liclUility hereunder by serving written notice upon the Obligee ten( IU)
JOYS in advance of its intention to do so.
'1'1:1(M OF BOND; July 28 19 83 / to July 28
84
'tam's ,^_v�avating _ _ __—,l y _
pbritractors Bonding and Insurance cb"ny
1 ItINCIPAL
By
s�—lure
j.9 rkln -PRNSIDLN'I �''