9125 9145 SW NORTH DAKOTA STREET FILE NO. A( 5-8.3
:d)RTH DAKOTA — 9125 & 45 STR. OPN. PERMIT
801099
BOND 140.
LICENSE OR PERMIT BOND
KNOW ALL MEN BY THSE PRESENTS, That we Thomas R Rasch dha: Tam's Excavating
PO Box 276 Gladstone, Or 97027
as Principal, and t h e Contractors Bonding and Insurance Company
with its principal office in Seattle, Washington r as Surety* are held and
firmly bound unto the City of Tigard
hereinafter called Abligee, in the penal sum
of***One Thousand and 00/100******
• ($1,000.00 ) Dollars,
for the payment of which well and truly to be made we do hereby bind our-
:Ielves, our he executors, administrators, successors and assigns, jointly
and severally, firmly by these pre.,.,,ts.
SIGNED AND SEALED WE 28th DAY OF July19 83
WiIRREAS, the said Obliqee has granted or is about to
grant to the said
Principal a License or Permit to engage in the business of
Street Opening
NOW TIIEREFORE, if the said Principal shall indemnify the Obligee against
ally loss directly arising by reason of the failure to comply with the laws
and ordinances governing the business of Street Opening
_ in said City of Tigard
then this obligation shall be void, otherwise to be An(] remain in full force
and effect.
IINGARDLESS t)f the length of time this bond shall continue to he in effect,
the aggregate liability of the Surety hereunder shall ire n() event exceed
ere amount of the bond.
PPUVIDED,IIOWEVLR, that the Surety shall have the right to terminate its
11,luility hereunder by serving written notice upon the Obliqee ten( 1U)
drys in advance of its intention to do so.
11:I4M OF BOND; July 28 19 83 to July 28 84
Tan's Excavating r `,19
N(_I PAL Contractors Bonding and Insurance Qompwy
SURETY
signature 1-Y -
DonAld S tk I PRESIDENT
APPLICATION - STREET IMPF 'IEMENVEXCAVATION COPY TO:
L) (WHIT'EI - FILE
ORDI:. .ol(-E NO 74-14 p (SLUE) -INSP.
(INSTRUCTIONS CIN SEPARATE SHEET) ❑ (YELLOW( -OTHER AGENCY
❑ (PINK) - APPLICANT
APPROVED _ APPLICPTION NO.: If-3
NOT
/ -3NOT APPROVED El CITY OF TIGARD, ORLGONFEE AMT.: f 0•_o-w.__
PENDING FEE. PMT. [� CITY BALL RECEIPT NO.: /413 -S-
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY -_-. DATE g /
PENDING AGENCY ''OK" Application and Progress Record r
MAINTENANCE BOND M
PENDING INFORMATION ._) FOR STREET IMPROVEMENT/EXCAVATION A5 REQUIRED sr.�•-
ANNUAL I:
PENDING VARIANCE C EXPIRATION DATE: /
PERMIT NO.: 1(�� DATE ISSUED: / / / ._E-Z-L , BY: _�__T`'_
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
_- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ �C`4vn 5 XCd✓'IA �Irct _ I�0 CX}x �CD CT�Q�C_46 DG� - - �1q-CUSUO_
NA ADDRESS CITY PHONE
CONTRACTOR S 0411-t
NAME AOOR[f CITY -- PHONE
PLANS BY_ - 2ylO
NA AE ADDRESS_�_ CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S I060 ,a�L'
DOLLARS
FOR OFFICE USE: _ ---- r:OMIN.
(2) EXCAVATION DATA: Wu�_ o. ;x f Qlr�' `4 m f G,
STREET DESCRIPTION PROGRESS & INSPECTION STATUS�
NAME SURFACE CUTCUT CUT MATFRIAL INSTALLED tT' M DATE REMARKS/TYPE BY
TYP LENGTH WIDTH DEPTH ITEM d QUANTITY
77A, STREET -�
N 1
INSP C-
R TION
E
W
U
ESTIMATED STREET OPENING r)ATE:— / / E
— - S
ESTIMATED STREET CLOSING DATE: / / T
E
(3) SECURITY NQ. .90164 SECURITY AMT.: s lUc:'D. .-v CLOSET /✓1 t: (/ ,
SURETY CO.:LrI4-vt /. -q-_ FINAL
CERTIFIED CHRCW ❑ CAfH ❑ V •UMO INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS J CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT.
red
I I 1 I
CURB -
•CUlks - - - - •- - -• - -
it
I 1 I 1
(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 !TATE OF OnEI ON
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTIOFI SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND To SAVE HARM(ESS THE CI I AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE DATE ! J l d
_ITY OF TIGARD—12420 S.W.MAIN--TIG. J,OREGON 97223
PECEIPT
DATE:_ _C ---_-- --�- AMOUNT $
NAME: Of
.� . ,CASH:
ADDRESS:_ ,�C."` . -�. + CHECK:
�� 1'.t✓—ill -- _ __..
MC)
N OF
FOR. --� _ ACCT. H PERMITS SURCHARGE AMOUNT
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 26-366
PARK DEV.CHARGE 01, 30•-367
PARK DEV CHARGE #2 30-368
ZONING ADJUSTMENTS 05.362
TOTALS $ S-
RECEIVED BY
PERMIT NUMBERS ASSIGNED:
Number Amount Number Amount Number Amount
-- - -- — RECEIPT • i �1 0 -
Data&Staff Service Company
RIKKA GRONNEI
Bond Underwriter
901 S E-Ooh St Suite 207 ■ P O 8a■ 12057 a NI'lland,Oregon 0721 2
-wi
iS07) 272-401D0 .vnr i i!1 (0 0)452-8505