13505 SW 110TH AVENUE-1 FILE NO. ;
110TH AVE. - 13505 STR. OPN. PERMIT
a
APPLICATION — STREET IMPR(' 'MENIVEXCAVATION COPY TO:
�oLnl 4, IWH•rE)-FILE
0RDt... vCE N0. 74 14 OLLIE) -INSP.
(INSTRUCTIONS ON SEPARATE SHEET; �IYELLOW) OTHER AGENCY
(PINK) APP
77LICANT
APPROVED APPLICATION NO.: - 7-S _
NOT APPRO"ED r ❑ CITY OF TIGARD, OREGON FEE AMT.: S �=v ._
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.:_ r 2-70 "'
PENDING SECURITY ❑ PUBLICWOR K.SDEPARTMENI BY .��� _�_ DATE g l Z l �'
PENDING AGENCY ''OK" ❑ Application and PloKress Record
MAINTENANCE BON0
PENDING INFORMATION LlFOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL. ❑
PENDING 'v ARIANCE ❑ EXPIRATION D TE: —�.�
PERMIT NO I 1 DATE ISSUED: -- L�_�� 77
BY:
(1 ) APPLICATION IS K—REBY MADE TO EXCAVATE FOR AND INSTALL "'Ir r"'Ore^+ —°.4 IAJ'
a S- 5%v In+�' AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT WSE. ___ .__�_d
rd�^ AME ADDRESS CITY PHONE
CONTRACTOR r u r� ��W c e�� 84,2,,!" w 11,01'.41r, X'4 tO� -ojIT
jS
AME �DRESS v ell Y PHONE
PLANS BY ___- *"•. I ' r il.S IG N _
NAME -- t -� A DRESS Or CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 00 _,
DOLLARS
(2) EXCAVATIONFOR OFFICE USE: =�! �❑MIN.
---�- DATA: 0.02 x s /-QC- --- = s__F2.—
STREET I _ _DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUTMATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY ��
Cts /� STREET
L P N D
INSPEC- - ---�-
R TION
E
O
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ESTIMATED STREET OPENING DATE: _._ g
ESTIMATED STREET CLOSING DATE: 2 g T
D
STRGFT
( 3) SECURITY NO _ sURITIY A : :_ CLCISF n
SURETY CO.: U c jx C FINAL
CERTIFIEO CHECK ❑ CASH ❑ INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHt?ICAL _ SPECIAL PROVISIONS /CONGITIONS:-
FEATUF'F-S; EXCAVATI N LOCATION AND EXT►NT. c
1 ( 1
v
1 1 i 1
(5) NOTE: THE CITY OF TIGARD DOES NOT, HERESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON C13UNTf' OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REOUIRED SECURITIVS, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OI' THE MORK. AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RE=ULT FROM APPLICANTS ACTIONS.
APPI IC AN1551GNATU R[ ��� DATE �' I�—
APPLICATION - STREET IMPR• -MENT/LXCAVATION COPY TO:
ORDINrtIvCE NO. 74-14 U (WHITE)
❑ IbLUEI -;NSP.
(INSTRUCTIONS ON SEPARATE SHEET) I] (MELLOW' -OTHER AGENCY
Ll IPINK) -APPLICANT
APPROVE[ F7 APPLICATION NO.:
NOT APPROVED [] CITY OF TIGARD, OREGON FEE AMT.: E
PENDING FEE. PMT. ❑ CITY HALT. RECEIPT NO.:
PENDING bECURITY ❑ PUBLIC WORKS DEPARTMENT BY DATE:-_-_ .1_ L`
PF NDING AGENCY ''OK" ❑ ,kpplication and Progress Record ,. - - - - - - - - - - -
MAINTENANCE BOND
PENDING INFORMATION ❑ FOR S'T'REET IMPROVEMENT/EXCAVATION AS REQUIPED --
ANNUAL_
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.. DATE ISSUED: ----- �_ _-/ , BY:
(1 ) APPLICATION IS HEREBY MADE TO EXCAVATE FOF AND INSTALL
AS DESCRIPE HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
NAME AOORESS CITY PHONE
CONTRACTOR
ADDRESS _.._ PHONE.__
PLANS BY
----- - --
NAME ADDRESS CIT - - ' RHONE �—
ESTINATED IMPROVEMENT TOTAL VALUATION ( COST): S
DOLLARS
(2) EXCAVATION DATA: FOR OFFICE USE: nMIN.
-- 0.02 X f__ = $
STREET _ DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DA
TYPE LENGTH WIDTH DEPTH ITEM h QUANTITY TE REMARKS/TYPE BY
T
STREET — -`-
OPENED _
—
R TION
E - -
_ Q
U _
ESTIMATED STPEET C ENING DATE:_� / / E
ESTIMATED STREE? ( LO.:'NG DATE: / T ---
(3) SECURITY NO, --.---._ SECURITY AMT.: : STREET
SURETY CO.: _ ___
FINAL
CERTI FLED CIIEtK fl CASH O BONGO INSPE C.�-
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL "'ROVISIONS/CONDITIONS
FEATUREBI EXCAVATION LOCATION AND EXTENT.
I I I I I
(5) NOTE. THE CITY OF TIGARD Dr ES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS HAT OF WASHINGTON COUNTY OR THE STATE Cr OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WI rH ALL PERTINENT' LAWS ANn
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDIJCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AN:)
rWg'LOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE -. DATE_ / /
i
Barely fompn.aTa
Road v..SB 29594
STATE OF OREGON
SURETY BOND I
KNOW ALL MEN BY THESE PRESENTS: 1
ED GAUSE CONSTRUCTION
T1a t ...............................................................................................................................................
as principal,and OREGON. ,AUTOMOBILE .INSURANCE COMPANY...............................
.... ...........I................, ..............,....................................................................._............................... ..__..
A corporation qualified and authorized to do business in the State of Oregon,as surety,are held and
firmly bound unto the State of Oregon for the use and benefit of the State of Oregon and of any
other interested person, in the sum of THREE THOUiAND AND„.QPOO .DOLLARS ------
($ 3,000.00 lawful money of the United States of America to be paid to the Slate of Oregon
for the use and benefit stated above, for which payment wall and truly to be made, we bind our-
selves, our heirs, executors, administrators, successors and assigns, jointly and severall,,•, firmly
by these presents.
WHEREAS, the above-named principal has made application for a Certificate of Reg=tra-
ti�n with the Department of Commerce. guilders Board,of the State of Oregon,or for r^newai of a
Certificate of Registration, for carrying on G..t business of a . Home _ builder,
within the State of Oregon, and is required by Oregon Taws 1971, chapter 740, to furnish a bond
in the penal sum of Three.. Thousand..... dollars, with good and sufficient surety, conditioned
as herein set forth.
NOW,THEREFORE,the conditions of the foregoing obligation are that if said principal with
reg.rd to all work done by the principal as a "Builder","Home Builder"or "Specialty Builder"as
defined by Oregon Laws 1971, chapter 740, shall pay all taxes and conlrlbutio.rs due to the State
of Oregon, pay all persons furnishing labor or material, or renting or supplying equipment to the
builder; and pay all amnunts that may be adjudged against the principal by reason of negligent or
improper work or breach of contract in performing any of said work, then this obligation shall
be void; otherwise to remain in full force and effect.
This bond shall become effective on the 11 th day of ..dVly.... 19 75, and shall
remain in force until cancelRd. This bond may be cancelled by the surety and the surety be relieved
of further liability hereunclof by 1-iving 30 days written notice to the principal and the Builder's
Board of the State of Oregon.
('his bond shall be one continuing obligation. and the liability of the surety for the aggre-
gate of any and all claims which may arise hereunder shall in no extent exceed the amount of the
penalty of this bond.
IN WITNESS WHEREOF, the Principal a-id Surety have hast^ set their hands and seals this
11th day of July 1975
Principal
ED GAUSE CONST:KTION
Name _
By Tide Owner
Ed Gause
Surety
Nang OREGON AUTOMOBILE INSURANCE..COMPANY
Title Attorney.10 Fact
By Title L: Colliver
Street Address 1675 S.W. Marl.owe_Ave.
C.,y Portland Stat-Oregon zip 97225
RIO
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