9995 9997 SW WALNUT STREET FILE NO.
WALNUT ST. - 1995 & 97 STR. OPN. PERMIT
APPLICATION - STREET IMPRr 'MENT/EXCAVATION CQPY TO:
ORDINh,+CE NO 74-14 WHITE) FILE
LUL) -INSP.
(INSTRUCTIONS ON SEPARATE SFIEET) YELLOWI-OTHER AGENCY
(PINK) -APPLICANT
APPROVLr, 1 3+
I APPLICATION NO.:
NOT APPROVED '❑ CITY OF TIGARD, OREGON 9•'"
FEE AMT.: f___ Ir _
PENDING FEE. PMT. ❑ CI N" HALL
RECEI T NO.: _
PENDING SECURITY Q PUBLIC WORKS DEPARTMENT by DATE—(2/ ( [ ay
PENDING AGENCY ''OK" [] Application and Progress Record
MAINTENANCE BOI,D,M_--- o
PENDING INFORMATION O FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED �q
PENDING VARIANCE ❑ ANNUAL_ EXPIRATION DATE, .- Ei,i�
PERMIT NO.: )-3�- t� DATE ISSUED:
3y: 4 . At.-
(1) APPLICATION IS HEREP.1 MADE TO EXCAVATE FOR AND INSTALL --I -
�etier AS DESCRIBED HE ?EIN, IN fULI_ ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _ r�.rY C1101S 18195 uanc
"� ;u 1 u
--fiiAM[ -�+� - c.tl; , lJ Z-•e�Un ''V
A..1DRE -- CIT PHONE—
CONTRACTOR
• PHONE
CONTRACTOR J@VP.1. Co . i0X 279 18dStone-Of �r
_ A [ - ^
CITY PHONE
PLANS 3Y ,
PHONE
ADD CITY
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST):
(2) EXCAVATION LATA: ----~ —� -PoriOFFICEIJILE,
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
SURFACE RFACE CU7 CUT CUT MATERIAL IN3TA, .ED
TYt E LENGTH WIDTH DEPTH ITEM III QUA14TITY ITEM DATE RrMARK3/TYPE BY
-
-
ED
IN$p c-
R TION
E — -
Q
-__ U
ESTIMA I ED STREET OPENING DATE:
ESTIMATED STREET CLOSING KATE: ! / ' E --
=..:� _ _ D
(3) SECURITY NO. - �-� �SECUR TY01T.: S CLOSET
SURETY CO. if E'fjtdt t. .� - �,�
=-� FINAL —
.. CERTIFIED CHECK ;:) _ CA! ❑ •CNf] INSPEC.1
(4) PLOT PLAN: INDICATE SITE dERTINENT PHYSICAL _ —
FEATI'RCS; EXCAVATION LOCATION AND EXTANT. SPECIAL PROVISIONS/CONDITIONS;---
-
C `1
-R �
(5) NOTE: HE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CCNDt1C-1'WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHIN,GTnN COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREE,i TO DEPOSIT THE P--QIJIRED SECURITIES, TO COMPLY WITH A-L PERTINI--NT I.AWS AND
CONSTRUCTION SPECIFICATIONS•PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CIT Y AND
EMPLOYEES AGAINST ANY INJURY OR DhPAAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTSSIGNATUR%, L�;�(!-nt DATE - 1 / t�"'
1
1172 2
CITY OF TIGARD—12420 S.W.MAIN—TIGARD,OREGON
RECEIPT
AMOUNT
DATE. __L_--
0
CASi-,
o
NAME: (�4HECK
ADDRESS'
HECK
0.:
# OFAMOUNT--
CT. # PERMITS fURCHARGE
FOR: AC
SEWER BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV CHARGE 25-366
PARK DEV.CHARGE *1 30-367
PARK DEV.CHARGE *2 30-368
.,.ONING ADJUSTMENTS 05-362
TOTALS
RECEIVED BY:
pERPAIT NUMBERS ASSIGNED: Amount
Number-
Amount Number AMOUR-11
Number
7 ,767
6 2
2
'� --�"�4.i7](ttir•r•,-n \ __.—._�--._.__ »__-______.._—._.� ��`Tom'-�'-- �J'
WESTERN - r., E Y COMPANY
ssu�'» �orhparue�s
u1 OALI:,Mi �A L. s
i' PALO A,L,iU�.! 9ALA..;7.I+ S'IPA:"
LICENSE AND PERMIT BOND BOND No. 2420438
KNOW ALL MEN BY THESE PRESENTS: Premium S330.91 ---...
That we, -Timb8s11LE.Dove lo$mertt--Ce-. Inc,_ — _--
of the.. Cites_--___of__Gladstone , State of Oregon as Principal,
j and the WESTERN SURETY COMPANY, a corporation duly licensed :o do business In the
i
State as Surety, are held and firmly bound unto the
_-_--Qtty _.--_.of___TJ,9&rd ,.—__".,State of__—Qr-vgQn ,Obligee,in the penal
sum of� LL+}1T_ILIJfIDiiB� I9L]44=-------------------�-----($84Q,QQ--- --) DOLLARS,
lawful money of the United States, to be paid to the said Obligee, for whi::h payment well and truly
to be made, we bind ourselves and our legal representatives, Jointly and severally by these presents,
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the said Principal
has been licensed As an Excavator
I
the said Obligee.
i
NOW THEREFORE, if the said Principal shall faithfully perform the duties and in all things
comply with the laws and ordinances, including all Amendments thereto,appertaining to the license or
I' permit applied for, then this obligation to be void, otherwise to remain in full force and effect until
Novemb®; 9th ___� 19 81_, unless renewed by Continuation Certificate.
Thi:, bond may be terminated at any time by the Surety upon sending notice In writing, by cer-
tific,i mail, to the clerk of the Political Subdivision wi'h whom this bond is filed and to the Principal,
addressed to them at the Political Subdivision named terein, and at the expiration of thirty-five (35)
days from the mailing of said notice, this bond shall ipso facto terminate and the Surety s.iall there-
upon be relieved from any liability for any u^.ts or omisrlons cf the Principal subsequent to said date.
Dated this 21t ______day of_— lgwetnber _, 19 8 .
LIABILITY HEREUNDER COMK.ACEU NOVEMBER 19thr91980,
ADDRESS FOR RETYSERVICE /l„ �� PH nf�i Pal
WECOMPA
STERN
EMBARCADERO ROAD _,_. G GC A — •li -!7.
PALO ALTO, CA 94103 Principal
Countersigned WESTERN SURETY COMPANY
I -- _
By'1411,,�u--541tt(wu. �L By- ��^
Resident Agent �,. ,.. .,,n•_.: .. st nl SCC..,Et2ry
ACKNOWLEDGMENT OF SURETY
I (Corporate Officer)
STATE OF CALIFORNIA
A9
County of Santa ('lata 1
On this ...____21st -day of_______ November 19 80,before me,
the undersigned officer, personally appeared t-.It oecretery_ _
who acknc:wledged himself to be the aforesaid Wfir,r of the WESTERN SURETY COMPANY, a
corporation, and that he as such officer, being�athorized so to do, executed the foregoing instrument
for ti.0 purposes t'terein contained, by signing the name of the corporation by himself as such officer.
h!
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
My Commission Expires
< %/ blicLCalifornia
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