7750 SW PFAFFLE STREET FILE NO.
"PMFLE ST. -- 7750 STR. OPN. PERMIT'
APPLICATION — STREET IMPRC nMENT/EXCAVATION ccgPY TO:
rot
tWHI7E) FILE
ORDIN,, . . _*E NO, 74-14 (BLUE) )NSP.
(INSTRUCTIONS GN SEPARATE SHEET) YELLOWI OTHER AGENCY
PINK) APPLICANT
APPROVED APPLICATION NO.: 1S-3
NOT APPROVEDCITY OF TIGARD, OREGON '
FEE AMT.: f
PENDING FEE, PMT. ❑ CITY HALL RECEIP !f/3S
PENDING SECURITY ❑ PUBL IC WOR KS DEPA R TMEN T BY_- �== SATE /0 1.5/01
PENDING AGENCY "OK" ❑ AI)Piic_IIII,-1 ;Ind Progress Record
MAINTENANCE BOftDI
PENDING INFORMATION ❑ FOR STREET IMPROVEMENiitXCAVATION As REQUIRED 7r� - --
ANNUAL C7
PENDING VARIANCF ❑ EXPIRATION DATE: 60 H IZ,44M 2r--___
PERMIT NO. !�S__ DATE ISSUED: _1Q I_71_cE_3/ . BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
-- - - __ AS DE5CR'BED HEREIN, IN FULL_ ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT ��c� 1, .,lS
�–FIAM ADDRESS-• CITY PHONE
CONTRACTOR ��/�1t -e-,
NAME ADDRESS CITU PHO141L
PLANS BY _ f-11 If U-7—t t. 1— _
NAME ADOR[7;i---"�� CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): : _t ����� ,f)c7 _�-
------ DOLLARS
(2) EXCAVATION DATA: FOR OFFICE use: - nMiN.
STREET _ DESCRIP'I ION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT -CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE B)'
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET i Vl�k7,2(� C 1 ( INS — -- _—
i � `F C I R TION
Q
' E U _
ESTIMATED STREET OPENING DATE:— �G / '1 / L^ E
S
ESTIMATED STREET CLOSING DATE: _ _/_ti / / _ T —
(3) SECURITY NO.47-6130'"/A - ' STREET —
` ECUR TY A T.: �-�� ct.osED
SURETY CO �. FINAL
F_I D CHECK U _ CASK G GONL' (� INSPEC.
(4) PLOT PLAN INDICATE S'TE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATIOII LOCATION AND EXTENT. ---�--
1 �, i 1 � 1 -•- I -
---
1( 1 t
1 1
CURB - '
•Culla � - �I�L, - .. _. _ . --7- �J•
I I P 'S4 --
1
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERM ISION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 15 THAT OF WASHINGTON COUNT) OR THF STATE O!' OREGON,
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED ISECt,R11'IES, TO COMPLY WITH ALL PEaI'INF_'NT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINEN r TO CONDUCT OF THE WOR!(, AND TO SAVE HARMLEE4, THE r:ITY AND
EMPLOYEES AGAINST ANY INJL`lY OR DAMAGE RHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE. .yG�'L''� C_.i/ —_ - ✓.
V DATE __L ' i
t �
CITY OF TIGARp,_ r I
12420 S.W.
W.MAIN--TIGARp
DATE: '_ s-_ RECEIPT ,OREGON 97223 I f
9y
AMOUNT:$�_ �
f NA E: ---- f9C�LLARS „
ADDRESS: �.
-y • _7 =-. CASH:
-
FOR: �- --���?i
ACCT. I *C.F M.O.:
• SEWER BILLINGS —"-"- PERMIT; ;URCNAROE
40-364 __" AM-- MOUNT
BUSINESS LICENSE
PLUMBING PERMIT 05-331
05-332
MECHANICAL PERMIT -- $
05-332 ---------'--------_.�.__
BUILDING PERMIT
SEWER CONNECTION 05-333
40-363
SEWER INSPECTION
40-365
SYSTEM DEV, CHARGE
25-366
PARK DEV. CHARGE 01 ,30-367
5
PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS
05-362
TOTALS -----
RECEIVED BY rf•..
PERMIT NU RS ASSIGNED:
—NumbK Amount
Number --Amount
----__ �_ - -- Nun►_bw Amount "E�
RECEIPT r n
� i, ill lei
STA-1-Is h:l!Dl! Lfl �� n ®1��G`���I�1"�(
(A Stock Company)
G3-0130-1058113-
BOND NLfABER.. ... .... .e].......... ....................
i';ej
STATUTORY PERFORMANCE BOND
iii.•I KNOW ALL MEN BY THESE PR':Si.NTS:
`,
That we, ... ..D[)N..&...LOTIS..CCNST.RUCT.I.O.NJ....INC.�................................................................................................................
;<r LA FAYETTE, OREGON
........•.............................................................................................................................................................................................................•.. asprincipal
and UNITED STATES FIDELITY AND GUARANTY COtAPANY, a corporation organized and existin under and h virtue of the laws of the State
�..:� g E Y
of Maryland, and duly authorized to transact a surety business in the State of Oregon,as surety,are jointly and severally field and bound unto
Eu' C.ITY...OF....T.hGA..WQ...................................
TWO EIUNDRED AND NO 100---
;- as Obligee, in the penal sum of .......-.-.-..........................:............................�............................................................................................................... •
�2UU.00 1 DOLLARS
for the payment of which we jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns,firmly by these
presents.
THE CONDITION OF THIS BOND IS SUCH That:
.ts •i
rincipal herein
as
and
Into a
in
U, vilth
"l the sNid Obligee,.ahcopytofpwhich contract Isaheretoeann xedlanddmade a part ahereoftand tinder which contract the/principal agrees 9to furnish c• it
P
( ! REET PP—E.NI.N.G...AT..•7.8TH A.. PFAF FLE T
certain materials and to p.rform certain work consisting of: ST
. . . ,, ,,,,,,,,,O,,,,,
........CONNECT..............
SEWER LINES, PERMIT 4149-81
: l
NOW, THEREFORE, if the principal herein shall faithfully and truly observe and comply with the terms of the contract and shall well
end truly perform all matters and things by him undertaken to be performed under said contract upon the terms Imposed therein, then this
obligation is to he void,otherwise to remain in full force and effect.
This bond is given and received under the authority of Chapter 279 Oregon Revi,-d Statutes, the provisions of which aro hereby
incorporated into this bond and made a pat hereof.
IN WITNESS WHEREOF, the said principal and the said surety have caused then; presents in be executed by their respe„tive duly
l
authorized Ir-gal representatives on this . ......... _...... ..5T.1I.....__.......:......day ofO.C.T.O.B.L.R.......................... 19�:....
Witness or Attest: ..D.ON. ....&....LUTIS. . . . ....CO. .........NST....RUClON. . •�....I•NC.••,••••............
..... .. ......... .... ........... ..
Principal
Countersigned: UNITED STATES rIDELIT AND GUARANTY COMPANY
.........A.t..... A00W..5KJ...._ ... .................................. B
(C TITL rrN...Ke 5ADOW5KI''. ......... Attoiney(n-Fact' ':`.
fly . _............................... Surety
Resident Agent
Contract 249 (Oregon) (a 61)
CERTIFIED COPY
GENERAL POWER OF AITOMTE31'
N,0.........§.8.5..6.4
....................
Know all Mon by these Presents
That UNITED STATES FIDELITY AND GUARANTY COMPANY, a corporation organized and existing under the laws of the
State of Maryland, and having its principal office at the City of Baltimore, in the State of Maryland, does hereby e4natitute 'knd appoint
Kathleen M. Sadowski
of the City of Salem , State of Oregon
its true and lawful attorney in and for the State a of O re g o n, Ar i z o n a, Cul i f o r n i a, I d a h n an d
Washington
for the following purposes,to wit:
To sign its name as surety to, and to execute, seal and acknowledge any and all bonds,and to respectively do and perform any and
all acts and things set forth in the resolution of the Board of Directors of the said UNITED STATES FIDELITY AND GUAIIANTY
COMPANY, a certified copy of which is hereto annexed and made a part of this Power of Attorney; and the said UNITED ST!:fFS
FIDELITY AND GUARANTY COMPANY, through us, its Board of Directors, hereby ratifies and confirms all and wbatscbver the ra/d
Kathleen ld. Sadowski
may lawfully do in the premix,by villue of these premnta.
In Witness Wheroof, the wall UNITED STATES FIDELITY AND GUARANTY COMPANY has caused this instrwnent to be
scaled with its corporate seal,duly attested by the signatures of Its Vice-Preaident and Assistant Secretary,this 7th day of
April . A' D• 1978
UNITED STATES FIDELITY AND GUARANTY COMPANY.
(Signed) 8r....., Bertram .W....Sealvr. Jr•... .......
Vtce•Prrafdent.
(fE.Ri,) (SignAd) A. Louisa Rush
.......................................................
Aaaittortt Seenttrry.
STATE: OF MARYLAND,
BALTIMORE CITY.
On this 7th day of April , A. D. 1978, before me personally carne
Bertram W. Sealy , J r. , Vice-President of the UNITED STATES FIDELITY AND GUARANTY
COMPANY and A. Louisa Rush , Assistant Secretary of said Company, with both of
whom I am personally-acquainted, who being by me severally duly sworn, said that they, the said Bert ram W. Se a ly Jr.
and A. Louisa Rush were respecttyely the l ice•Prrafdent and the Assistant Secretary of the said UNI',F,D
STATES FIDELITY AND GUARANTY COMPANY, the ;orporation described in and which executed the foregoing Power of Attorney;
that they each knew the seal of said corporation; that the seal affixed to wild Power of Attorney was such corporate seal, that it was
so fixed by order of the Board of Directors of said corporation, and that they signed their names thereto by like order as Vice-President
and Assistant Secretary, respectively, of the Company.
My aommisslon expires the first day in July, A. D. 19...7 8..
(SEAL) (Signed) Margaret M. Hurst. ..................
Notary pub4e.
STATE OF MARYLAND 1
BALTIMORE CITY, !} Set.
Robert fl. Bouse
i, . Clerk of the Superior Cowl of Baltimore City, which Court is r
Court of Record, and has a seal, do hereby certify that M a r p;a r e t 14. II u r s t . Eacluire, Eeron
whom the annexed affidavits were made, and who has therein subscribed hill name, was at the time of an dning a Notary Public of the
State of Maryland, in and for the City of Baltimore, duly commissioned and sworn and authorized by low to administer oaths and t*%Pa
acknowledgments, or proof of deeds to be recorded therein. I further certify that 1 am acquainted with the handwri.ing of the raid
Notary,and verily believe the signature to be.his genuine signature.
In Testimony Whereof, I hereto set my hand and affix the seal of the Superior Court of Baltimore City, the same bring a Court
of H-rord,this 7th day of April , A D. 19 7 8
(SEAL,) (Signed) ...............Robert II. Hous.e.....................
Cler'!-o/the Superior Court o/Baltimore City.