9250 SW TIGARD STREET-2 FILE NO.
TIGARD GT. - 9250 STR. OPN. PERMIT
Avoid Verbal Messages A_j
CITY OF TIGARD
Subject: . _ Date:____
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O NORTH PACIFIC INSURANCE COMr'ANY
❑ NORTHWESTERN NATIONAL INSURANCE COMPANY
®tx OREGON AUTOMOBILE INSURANCE COMPANY
P.O. BOX 74, PORTLAND, OREGON 97207
City of Tigard
Department of Public Works
Engineering Department
Tigard, Oregon STATUS INQUIRY — ;, ERMIT
PERMIT NO.
BOND NO. SB 30887
°ermittee: Charles J. McClure
Address: 12425 S.W. Main, Tigard, Oregon
Description of Permit: Public Riqht-,yf-Way construction permit at 9250 S.W. Tigard Street,
Tigard, Oregon, License Bond
Bond(s) $_Rnfl_fl(] Effective Date: _ (lprpmhpr 15. 1976
Without prejudicing your right or affecting our liability under our bond(s) described above,we would appreciate such of the follow-
ing information as is now available.
For the Company,
1. IF OBLIGATION COMPLETED, PLEASE STATE:
Approximate ante of completion. _11 3
2. IF OBLIGATION UNCOMPLETED,PLEASE STATE:
''robable date of completion
3. Does it appear there are any problems which would lead you to believe a claim may be made against the Bonding Company?
1 es O No><
4. Comments(if any):
Date l ( — Cl , 19 )
Signature
Title
0 3065 3.71
r
APPLICATION - STREET' IMPRC HENT/EXCAVATION COPY TO:
OROINAiNCE NO. 74-14 ❑ (WHITE)- FILE
(OLUE) -(NSP.
(YELLOW) -OTHER AGENCY
(INSTRUCTIONS GN SEPARATE SHEET) (PINKS - APPLICANT
APPROVED lilT APPLICATION NO.:
NOT APPROVED /[�] CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE. PMT. ( I V CI I�' HAL(, RECEIPT NO.: �,���13
PENDING SECURITY e� j. `Iv PUBLIC WORKS DEPARTMENT CY — DATE "'a /�7 / 74_
PENDING AGENCY "OK" I 1 Application and Progress Record _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MAINTENANCE BON 00
PENDING INFORMATION U FOR STREET IMPROLEMCNT/EXCAVATION AS IREL`
ANNUAL
PENDING VARIANCE L 1 EXPIRATION DATE:
PERMIT NO.: =7 G'_ DATE ISSUED. _2� ._L�4 1-7 _ BY: /j� �r•
- ----
(1) APPLICATION IS HEREBY MADE- TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT —L� , fi// c' ; 1LR �.�_LA�l
NAE/ ADDRESS
/ ,,J // CITY PHONE
CONTRACTOR _ / C O �_Lv .11. _vZ� ___ �-,Q rQ/� .--�i,3�-,� �
NAM DOBE CI Y PRONE
PLANS BY 6L__ _ f 6 4 R
NA ADDRESS V CITY -- -- - _-- PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ L)O --
DOLLARS
(2) EXCAVATION DATA: a oz priC uaE f /6J MIN.
^— ( —
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
A)c) -- STREET
p0 VV � T� (MSP
AL& R TION
II '
ESTIMATED STREET OPENING DATE_-1 - / / / E- S
ESTIMATED STREET CLOSING DATE2 2
T
--,r STREET
(3) SECURITY NO. 51. 30TS7 ECURIT AMT.: $ 16T CLOSE
—2�
SURETY CO.: _ , FINAL
_ CE _IFIED CME K U CASH EJSOND INSPEC. 10*: � D
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL s SPECIAL PROVISIONS /CONDITIONS:
FE�TURES; EXCAVATION LO ATION AND EXTENT.
X
"-C7 � I --
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(5) NOTE THE CITY OF TIGARD DOES NOT, HCRESY, 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 REPUIRED SECURITIES, TO COMPLY WITH ALL. PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TU SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACl10NS.
APPL,ICANTSRIGNATURE bj L DATE 12— 1 _1 / 1?6
OREGON AUTOMOSUE INSURANCE COMPANY
HOME OFFICE - POHTLAND,OREGON 97207
Bond No. SB 30887
Premium: $20.00
KNOW ALL MEN BY THESE PRESENTS: That we, CHARLES J. MCCLURE, as
Principal , and the OREGON AUTOMOBILE INSURANCE COMPANY, a corporation
ofthe State of Oregon, lawfully doing the business of Surety in the State
of Oregon, as Surety, are held and firmly bound unto CITY OF TIGARD, OREGON,
as Obligee in the sum of EIGHT HUNDRED AND NO/100 DOLLARS ($800.00) , for
which sum well and truly to be paid, we bind ourselves, our heirs, executors,
administrators, successors and assigns, firmly by these presents.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this
15th day of December, 1976.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, That WHEREAS, the above
bounden 'Principal is desirous of obtaining a permit in accordance with
Ordinance 74-14 of the City of Tigard, Oregon for construction in a public
right-of-way; to wit; 9250 S. W. Tigard Street, Tigard, Oregon; for the
period beginning the 15th day of December, 1976.
NOW, THEREFORE, if the said Principal shall , during the continuance
of the term for which said permit shall be granted, faithfully observe
and honestly comply with the provisions of said permit and restore said
right--of-way to good or better condition as existed prior to said
construction, then this obligation shall be void and of no effect, but
otherwise to remain in full force and effect.
THE A'�GREGAlE LIABILITY OF THE SURETY HEREUNDER shall in no Fvent
exceed the penalty of the bond as stated above. The surety may cancel this
bond by giving 10 days written notice to the Obligee, the Surety, however,
will remain liable for any default occurring during the period up to the
expiration of said 10 days notice.
Charles 3 – cClure,�- ri—aI
OREGON AUTOMOBILE INSURANCE COMPANY
�r17 Helen L Co 1 TT—vel°, Tttoriiey`in Fact
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CITYOFTIGAM
Date
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Address_
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For:
T
Permit #
CITY OF TIGAW
By:
15643
CHARLES MCCLUKE
ATTORNEY AT LAW
12425 S.-W- MAIN STREET
TIGARD,OREGON 97223
TELEPliowE(503)639-4108