11750 SW 121ST AVENUE _-FILE NO. =1�
121ST AVENUE-11750 S7R. OPN. PERMIT
I
Y
".ay 23, 1980
I.itld-ra,^,cnz trop
5000 N,F. xMlin?swarth
Portland* OP
�'^rut�.encn:
thn City of % and I't'.1 v.« C "�._ nryYwrr �� w:. In
cl nt�bIiC r1'C1"-:-��-+t?,^r
'.hank you icr your co•-n-crnticr
Your truly,
nobert L• 71iTsor
Pubiic i,Trrlts Inspector
SLTtpjr
venal•
APPLICATION — STREET IMPRC PMENT/EXCAVATION COPY TO:
ORDINA,.CE NO. 74-14 ❑ ( -FILE
❑ (BBLULUE)E) -INSP.
(INSTRUCTIONS ON SEP AR' 'E SHEET) ❑ IYELLOW).OTHER AGENCY
❑ )PINK) -APPLICANT
APPROVED ! APP'_ICATION NO.�_, � F
NOT APPROVED Ll C.I I Y OF TIGARD, OREGON FEE AMT.: ;_L��
PENDING FEE. PMT. ❑ CITY HALL RECEIPT _ IR26
PENDING SECVRITY10
❑ PUBLICWORKS DEPARTMENT BY _ DATE
"ENDING AGENCY "OK" C] Application and Progress Record — /--x
MAINTENANCE BOND #1.-6_3-�K
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION ATE:
PERN.'_ NO.: _ � � J DATE ISSUED: _!v _� EKY: --
(1) APPLICATION IS HERESY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT �!N� - �v_S�/�� �'1 0� _ L2�L11,� Sfd�d� j�jLl7 - _4- Q; 3
NAM ADDRESS CITY PHONE
CONTRACTOR- __ S Aq-,I
NAME _--- - /.DORE45-------�---------- _
--- C --- - -P HONE -----
PLANS BY—_p_
NAML --`---- --ADDIVESs -. —. —._-y. CITU PHON! —
FSTiMATED IMPROVEMENT TOTAL VALUAT'ON ( COST): $
---- - - DOLLARS
(2) EXCAVATION DATA: FOR OFFICE USE.
_ 0.02 X f_
STREET DESCRIPTION PROGRESS tic INSPECTION STATUS
NAME SURFACE CU"' CUT CUT MATERIAL INSTALLED v
TYPE LENGTA WIDTH DEPTH ITEM A QIJ NTOT ITFM DATE REMARKS/TYPE F3Y
L NGS L CF, sPRNED
R TION
� E
a
ESTIMATED STREET OPENING DATE: �_ E —
9
ESTIMATED STREET CLOSING DATE: LL��_L� E —
(3) SE:CURI'rY NO.� 1 -7� '�) STREET ---
SECUR fY AMT.: � CLOSE�� �
SURETY CO. �ZLQ-_1ZL, / rINAL - -
__� CERTIFIED CHECK_tI CASH ❑ nom___ _ INSPEC.
(4) PLOT PLAN: INDICATE SITF.PERrINI:NT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
444A -
Li
Ilkf._---
I I
(5) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONUUCT WORK WHERE-
RIGHT-OF•WAY JURISDICTION IS THAT OF WASHIN:TON COUNTY OR 'HE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIVEO SECURITIES, r0 COMPLY WITH ALL PERTINENT 1.AWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONUUCT OF THE WORK, AND TO SAVE FIARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT aRCM APPLICANI'S ACTIONS.
,
APPLICANTS SIGNATURE: DATL �G __L�-� �_
APPLICATION - STREET IMPRO' LENT/EXCAV/,.TION COPY TO:
�) (WHITE)- FILE
ORDINANCE NO. 74-14 ❑ (BLUE( -INSP.
INSTRUCTIONS ON SEPARATE [_� (FELLOW) N AGENCY
( SHEET) I-� (PINK( -APPLLICCAANT
ePPROVED J APPLICA;'ION NO.:
JT APPROVED 1 CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE. PMT. !_ CI'T'Y HALL RECEIPT NO.:
PENDING SECURITY [i PURL IC WORKS OEPARTMEItIT BY __- DATE—__-__-1—L_
— — — — — — — — — — — — — — — —
PENDING AGENCY ''OK'' [] Application aild Progress Record MAINTENANCE BOND
PENDING INFORMATION f l FOR STREET IMPROVERIENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE EXPIRATIOND#'TE:
PERMIT NO.: -_-_ - DATE ISSUED:
(i) APPLICATION IS HEREBY MADE TO E).'_AVATE FOR AND INSTALL
AS DESCRIUED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT -___.-_-.
- -- _
- ------- ---NAME _ - - A DORE35 -----_ CITY PHONE
CONTRACTOR __ _ __-_
-- NAME �- --__-- -- ADDRESS - -- - - - CITY PHONE
PLANS BY
_--- ---
NAME AV"RESS __– ---- - – CITY —_. - PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E
DOLLAR'
(2) EXCAVATION DATA: FOR c, isa: —" MIN.
STREET DESCRIPTION __ PROGKESS & INSPECT ION STATUS_
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM— DATE REMARK°/TYPE�bY
_TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET —
PENED
-- -- --
INSPEC-
TION
E
U '?`7 SAW WIY / / �.
ESTIMATED STREET OPENING DATE: / J S
ESTIMATED STREET CLOSING DATE: I E
STREET
(3) SECURITY NO. SECURITY AMT.: S _ i LOSE
SURETY CO.: _ FINAL
CERTIFIED CHECK U CASH U ■OND L INSPEC,
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL, PROVISIONS /CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
1 I I I
I 1 i 1
-444
-cults - �- - - - � - - - - - - - - - - ---• -
I 1 ► I I 1 ___--
I I i
(� ) NOTE THE CITY OI TIGARD DOES NOT. HEREBY. GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RICHT OF-'.VAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICAWI AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
INSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
L.MPLOYEES AGAINST ANY INJURY OR DAMAGE_ WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE DATE I .(
CITY OF TIGARD—12420 S.W.MAIN—TIGARD,OREGJN 97223
RECEIPT
GATE:! AMOUNT $
-- -- - —------- DOLLARS ;
NAME:`
— i ( � (( LADDRESS: (HECK _ +
C. MO.: -
OF
FOR: ACCT. . PERMITS SURCHARGE AMOUNT
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
ZONING ADJUSTMENTS 05-362
TOTALS
RECEIVED BY: .
PERMrf NUMII;ERS ASSIGNED: ` W
Nutnbw Amount _NumbN Amount Number Amount
S _..
RECEIPT N
1706
;� l^�
I J —
Bond No. 503-0696
Bond to Guarantee Installations
on Public Right-of-Way
KNOW ALL MEN BY THESE PRESENTS, that we, LIND--FAGENSTROM
CQBP,Qi�1,�I9N� �0„N,_.E. Killingsv:orth, Portlan- ,-Uregbn 9-/7=
as Pri.:c�pal, and Si HARTFORL) ACCIDENT AND INDEMNI'PY�ANY
a corporation organizes-under t epi-Ta`ws of t.a State o
r , and authorized to transact the business off`-.
surety n the State of Oregon as surety, are hereby held and
firmly bound unto the City of Tigard, a municipality of the
State of Oregon, in .thhae_ sum of Three Thousand Six Hundred
which sum;7 wend ff'o tr:o be --------- Dollars , .
heirs, executors, administrators—d'wsucces;.ursse jointly
our
severally, firmly by these presents. � jointly and
THE CONDITION OF THIS BOND IS SUCH THAT, WHEREAS, the
City of Tigard has issued a permit for construction in a public
right-of-way; to wit: S,W._121st Avenue, Tigard, Oregon
NOW THEREFORE, if the said principal, herein, shall restore
said public right-of-way to a condition required by the City of
Tigard as specified in the permit under which the work is being
performed, thorn this obligation is to be void; otherwise, it
shall remain in full force and effect.
SEALED with our seals, and dated this 20th day of
_�ecembs'r 19 78
LIND FAGENSTROM CORPORATION
• Princ pa
HARTFORD ACCIDENT AND INDEMNITY
Surety COMPANY
-44-
By-
e n-fact
Gail A. Custer
i
I
I
I
HARTFORD ACCIDENT AND INDEMNITY COMPANY 000004
.l'ine'd.C...w ,
i
POWER OF ATTORNEY
Know all mon by the-e Presents.That the HARTFORD ACCIDENT AND INDEMNITY COM-
P,aryv .i - ... 1 111 the'aws of the State Of Connect,cut.and having its principal office m the City
of ' - 1 .! .a Connecticut.does hereby make.Canst:mte and appoint
LAGLER, GAIL A. CI•STF.R and CENk >I. nIFTZYA!:
of POFTLIRD. OREGON
I
I
Its true and lawful ACom,2yl5l-in•Fact,with full cower and authc my IJ each Of said ADornfyisl-m•Fact,in their separate
capacity it more than one is named above to sign,execute and acknowledge any and all bons and undertalangs and
Other wnfings cbhgili n the nature tbereol on behalf at the company In,n uusmess Of guarantbemg the fidelity of
prisms holding places rn public or private Inst.guaranteeing the performance of contracts other than Insurance pall•
classguaranteeing the performance Of Insurance contracts where surety bonds are accepted by staiaa and municipal-
,ties.And executing or guaranteeing bonds an undertakings required or permitted in all actions or proceedings or by
law allowed.
And to bind the HARTFORD ACCIDENT AND INDEMNITY COMPANY thereby as fully and:b the same extent as d
such bons And underiak,ngs and Other v nilloi s oohyatory in the nature thereof ware signed byy an Executive Officer of
Ire HARTNORD ACCIDENT AND INDEMNITY COMPANY and waled and attested by one p1Aer of such Officers,and
hereby ratifies and confirms all that Its laid Ahomeylsi-in Fact may do in pursuance hereof,
This power of attorney is granted by and under authority of the folloveng provisions
Of f By-Laws adopted by the Slbcknotden of the HARTFORD ACCIDENT AND INDEMNITY COMPANY at a most.
mg duly called and heed on the IOM day of February. 1940,
ARTICLE IV
SECTION 0 The P• .aloin or any V—PIMS.OMl at'nq..in any Sgrrefnn u 4-11 59Crgary'"ll have sower and aueidnN to wrilv'l
IM 1=109 Wp M 11 evM�bne a4"#Prq tivrd.and ufellool off eine,wnnngm e mreol
s aorgaWy the nat .Md 0,man pallor.
Wae•P•Hdents %.owl av9Ital SWCWAnll and Miad whayr and al My mase lu remove any Yvcn h_,k t V,ca�Prlrudera.ReNasrd Ar-
lan, •"TinON ary M ail mer.hra0f a 'll h-—91 and aulikawy i lrM to nim
I
$EOT111 AdomA, ndOCC 044 nave panni and aumonty Wbiedt to ae term%and M,j l of inn bnw%r bf ahamry sued ba dN m p
esec+t Ratan IW.rp1 of bur CMhpitly and M Orion me Me of me con"l ry melwo any Mkt all barn.am,iMYnaAin a aha athVr r nbrlda
01,1
t t and any such aianarran1 e.nrufed or lily W<h Annuit -n Fact inaii be aT filming uvan On�Mipully as�r 1'QneO
by M E..n,the tur once'41d 1ql and Misled by ode 0!. y or 01 fucn Ricers
12)Excerpt from the Minutes of a meeting of the Board at Directors of the HARTFORD ACCIDENT AND IIIOEM-
NITY COMPANY duly caned and held on the I tin day at June, 1976
RESOLVED Paie»Y rer H seRattles�,ee.P•eS onion .it Thr—A.If canonry A...writ vice P'.."ni 0.0 gosh have ae toted Il ase
nod."llOnnht me one C"'i As MY VIONPreyW.n1 uhde'$00"s s T ed B of Amcu IV cl the ey 1.4—of IN Onmoany
Thr power Of attorney Is signed and sealed by lacsnmue undo,and by the authority of the following Resolution
adapted by the Duectors of the HARTFORD ACCIDENT AND INDEMNITY COMPANY at a meeting duly called and
held on the 6th day of August, 1076.
PLSOLVEO the.Ol Rabin N H 9erer Assstant V.a,P,e%,denl aro Thnmal F Delaney AAw%Inrn wa.ArarOMt Achn�.,p.My
o"a,.ar ASYlNnI SKre7ry.aAM naw the Dm.0 P..'%ufnarliy es'Cris.V M hd'dl%uah Of Kr Ip Ai0aim by a boor,al woo—V no,oud.ie.q
Mary 01 e.Kubr Md alt"Irl bands and urdoexiol inn dthon vMYIVli Othigalory,n me Niure thereof we M more Ras,dsd VI_e P'"i, i
dMu a%i,MMI 11W416 es old A"d"o»n-Faeti
No. !PWOP a de SMTanAnd new Of such Orhrs's And the ARM of the CIMOMy MAY be.e.rrd to My suns Solve, mM
wer 01 sttoey to MY"""hale
'PM,9 In.#%to A t. ,aAny al Power if slime,M 0,Ml he.hh9 such nar.PmlYf PpnAlvq%Or'Al0 NAI shall be...'d Ana
Officals,!pori ms=Y Id any tube tor..'in raKulOd And"%had b Is-rel.M9rid"I'm Sid iecPm,e NN%han OR vow and binding umM ,
-Mil1Mr on the ral.ith—Ml to Nly bond or ii1d tapng to.hro if 11 A"AtlW
In 1fyllnNe I thenal,the HARTFORD ACCIDENT AND INDEMNITY COMPANY has cAuserl mese presents to be
Signed by its Assistant Vice-president.and its corporate seal to be hereto affixed.duty attested by its Secretary,this 9th
day of August. 1976.
Afteessst/J'/////yam►/i/ HARTFORD ACCIDENT AND INCEMf1ITY COMPANY
Th1mu a Oe•am,Y
STATE OF CONNECTICUT, AAPIra»r vie PgnYek
COUNTY OF HARTFORD. u
On this 9m day of August.A D 1976 before me Cereonally came Thomas F.Delaney to me known,who be ng by
me dwy swam,d'd Itepoll and say that he resides In the County 01 Hartford. State of Cdnno0c,d,that he s me
As'Stan,lice•Pshadenl of the HARTFORD ACCIDENT AND INDEMNITY COMPANY,the corporation described rel and
which executed the above mstrument,that no knows the seal of the said corporation that the seal affixed to the said
instrument is Such corporate seal that II suds to
0Mood by order of the Board at DlreCron of said cogloraeon Sea that
•e signed his nems thereto by Ike oroer
STATE OF CONNECTICUT carie Y—R, V".-v rv!"
AA MY Cnmr•.%wa»Ew-it,Ylarbn 31 bra
COUNT,OF HARTFORD Ct11TINfICATE
1 the undoniORed 449tstanl Bee-etary of the HARTFORD ACCIDENT AND INDEMNITY COMPANY.a Connecti-
cut;.w
Atom DO-EREBY CERTIFY mel the furegri and a6AOhed POWER OF ATTORNEY no cafe In full IO,l
and hes not been•evnxad:A•ld furthermore.that Article tY SaCbans 6 Ard 11,of the B-Laws Of the Company,and the
RMolultOha Of Me Board of Orrecton sot forth in the Powe,of AnterJ ev are naw in e
Signed and sealed at the City of HaMal Dat*d the .7-0XKl day of ,P CA_%_A44,Ig ytf.
t�iv�'
re.w►/.ata . .. i
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.� Ifl.'A i ,.Y•..,,y
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1. +
t' C#e- ra
C�i7y OF T4A,90
73 'b
1,607
a
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1 . Mobilization,( learing , & grubbing,
t offsite disposal of debris
Lump Sum
2. 27" Reinforced conr.rete sewer, pipe , A.S .T.M. C-76 ,
Class III , including excavation, native backfill ,
& granular bedding elf c°
a) 0-8' depth , 1 , 227 Lin.Ft. @ $
b) 8 ' -10' depth, 504 Lin.Ft. @
c) 10 ' -12 ' depth, 689 Lin. Ft. @ $ ;y $-.Z-'5.
d) 12 ' -14 ' depth, 81 Lin. Ft--. @
e) 14 ' -3.6 ' depth, 136 Lin. Ft- .
3. 7.7" Reinforced concrete sewer pipe , A. :