12750 SW 72ND AVENUE EIDE NO. C 7
7Znd AVE. - 12750 STR. OPN. PERMIT
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;4ay 23, 1930
Inc.
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CITY OF TIGARD--12420 S.W.MAIN—TIGARD,OREGON 97223 ~~
RECEIPT
DATE:-- ���-- — _ AMOUNT $
. —=u.Pc��� �! ---DOLLARS
t P1
NAME / CASH:
ADDRESS:._ _ CHECK;_
r
rt q I O _ M.O.:
' OF
FOR: ACCT. / PERMITS $URCHARON AMOUNT
SEWER BILLINGS 40-364 $ __
Bl1SINFSS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332 _ — . . _ _ ------
BUILDING
_-___BUILDING PERMIT 05.333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV. CHARGE 25-366
PARK DEV. CHARGE #1 30-367
PARK DEV. CHARGE #2 30.368
ZONING ADJUSTMENTS 05-362
3- c*1
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TOTALS
RECEIVED BY �r
PERMIT NUMBER$A ONED: ^-~-
_Number_ —Amount Numbw Amount _Number _Amount
e
RECEIPT #
1955
APPLICATION - STREET IMPR EMENT/EXCAVATION COPY TO:
ORDIN_4CE NO. 74-14 [] (WHUI FILE
❑ (BLUIE)E) -(NSP.
❑ (YELLOW) -OTHER AGENCY
(INSTRUCTIONS ON SEPARATE SKEET) ❑ P 1 INK) APPLICANT
APPROVED i APPLICATION NO.: _�
CITY OF TIGARll OREGON
NOT APPROVED ❑ + FEE AMT.-4
PENDING FEE. P.MT, [] CITY HALL RECEIP NO.: _
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY- � DATE_ 1'3e'IZI
PENDING AGENCY ''OK" ❑ Application and Progress Record —
MAIMTENANCE BOND Ik_
P_NDIIVG INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS NE'7UIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE: __.�..
PERMIT NO ' �p '�1 -- DATE ISSUED' ____�/=3C _ � _,__ • BY:
( 1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
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APPLICANT i'0�4_'72-s �L L6il" (Jt �v ��_nv CJk'--- - _ -�e--6-;',
NAME ADDRESS CITY - - PHONE
CONTRACTOR Led"h5 II _ _
NA ADDRESS A PHONE
PLANS BY ___ ___
NAME ADO RF_SS � CITY PHONE
� UG
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
acYLLARS
(2) EXCAVATION DATA: FOR OFFICE USE: U 1
0.02 X f—M�`'__
STREET DESCRIPTION PROGRESS_& INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_TYPE LENGTH WID'rH DEPTH ITEM 6c QUANTITY
"7— STREF_T
_
OPEN
INSP C.
R TION
E — —
0
— U
ESTIMATED STREET OPENING DATE:_— E_L / g
ESTIMATED STREET CLOSING DATE _ / T
-- ----
-- E
(3) SECURITY NO. -S8326-30 SECURITY AMT.: $_1�'- �2 CLOSET
SURETY CO ' FINAL
_ CERTIFIEDCHECK U CASH U SOND + INSPEC.I _
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL — SPECIAL PROVISIONS ,'CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT.
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(5I 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.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PEMTINENT 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
"A ](1C� A _
APPLICANTS SIGNATURE / DATE/ A t-1 I —S —� l 79
BOND BOND # SB 32632
R"O'.1 ALL MI BY TFTSE PRESENTS:
That we, North Plumbing, Inc. , as Principal,
and *dle _ Oregon Autonrobi.le Insurance CoMyy_ , a corporation
organized under the laws of the State of Oregon and authorized
to transact the business of Surety in the State of Oregon _,
as Surety, are held and firmly bound unto City of Tigard, Oregon
in the just and full sum of ONF THOUSAND TAU HUNDRED AND NO 100 -------
( $1,200.00 ---) , for which'sun, well and truly to be paid, we bind our-
selves, our heirs, executors, administrators, successors and assigns jointly
and severally, firmly by these presents.
Sealed with our seals and dated this 30th day of Januan7 1979
THE; CONDITION OF THIS OBLIGATION IS SUCH, THAT WHEREAS:
North Plumbing, Inc. has made application for a permit
to make a cut: on the street at 7125 SW Haa)ton, Tigard, Oreqon and install. sewer.
NCM, '11EREFORE, If the said Principal shall abide by the terms of said permit,
then this obligation to be void: otherwise, to remain in full force and effect.
IT IS AGREED TEIAT the Surety's liability under this bond shall remain in .force
for a period of. one (1) year following the completion of work for which the
permit has been obtained.
North Plumbing. Inc.
Oregon_Aut�mo1L1le Insurance
Vicki L. Nicholson Attorney-in--fart;
CI NORTH PACIFIC INSURANC OMPANY �
XX OREGON AUTOMOBILE INSURANCE COMPANY
Referrod to as the Company
P.O.BOX 74 • PORTLAND,OREGON 57:207
POWER OF ATTORNEY #412
THIS POWER RES-fRICTED TO BONDS AND UNDERTAKINGS NOT IN EXCESS OF $ 100,000.00
KNOW ALL MEN BY THESE PRESENTS: That the Company,an Cregon corporation having its principal once in the County of Wash.
>- ington,State of Oregon,does hereby nominate,constitute and appoint:
a
U VICKI L. NICHOLSON of Beaverton,Oregon
0 its true and lawful Attorney-in-Fact, to execute seal and deliver for and on its behalf as surety, any and all bonds and undertakings,
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recognizances, contracts of indemnity and other writing
U. s obligatory in the nature thereof,which are or may be allowed,required or per-
mitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents,
shall be binding upon the said Company as fully and amply to all intents and purpose,, as if the same had been duly executed and ac-
cc knowledged by its regularly elected officers at its principal office.
V.
This Power of Attorney is made and executed by authority of a Resolution adopted by the Board of Directors of which the following is
a true and exact copy:
"RESOLVED that the President, Executive Vice-President,Secretary,Treasurer, Vice-President,Assistant Vice Prmident or
Assistant Treasurer shall have power and authority to appoint Attorneys.in-Fact, and to authorize them to execute on the
behalf of the Company and attach the seal of the Company thereto, bonds and undertakings, recognizances,cowracts of
indemnity and other writings obligatory in the nature thereof, and they may at any time revoke the authority of any such
Attorneys-in-Fact."
ALL/q A$ IT1 HEREff CONFERRED SHALL EXPIRE AND TERMINATE WITHOUT NOT ICE AT MIDNIGHT OF
IN WITNESS WHEREOF, The Com any has caused these g encs to be signed and its corporate seal to be affixed by its authorized
officer this 14th _day of f-ebruary
❑ NORTN PACIFIC INSURANCE COMPANY
(Seai► IN OREGON AUTOMOBILE INSURANCE COMPANY
1s Leo A. Cassinelli
STATE OF OREGON 1 Leo A. Cassinel , Asst, Vice President__
COUNTY OF Washington ) ss: li
On this_ 14-tjj day of February _ 191Lbefore me,a Notary Public in and for the State of Ore-
gon,personally name_ I_eo A. C7ssin �— , the individual, to me personally known who
executed the preceding instrument,and being by me duly sworn,said that he is the therein described and authorized officer of the Com-
pany; that the seal affixed to said instrument is thn corporate seal of said Company,and the said corporate seal and his signature were
duly affixed by the authority and order of the Board of Directors of said Corporation.
IN TESTIMONY WHEREOF I have hereunto set my hand and affixed my Official Seal at Portland,Oregon, the day and year first above
written.
My commission expires: �S� Joan Pdrtee
Joan Partee V Notary Public
STATE OF OREGON 1
COUNTY OF WASHINGTON I SS:
1, Neil E. Hokkanen, Jr. Secretary of the Company,do hereby certify that the foregoing
is a true and correct copy of a Power of Attorney,executed by said Company,which is still in force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of the said Corporation,at Portland,Oregon, this_'jjLj-Ffa;
of January 1979
Cl NORTH PACIFIC INSURANCE COMPANY
Ga OREGON AUTOMOBILE SURANCE COMPANY
f , AC.*I
D 3054 12 73 NOf E. okkanen, Jr, 9scretary