9670 SW FREWING STREET FILE NO. ivz-79
FREWING ST. - 9670 SPR. OPN. PE MIJ
APPLICATION - STREET IMPR 7MENT/EXCAVATION COPY TO:
U (
ORDINhIvCE NO. 74-14
n (EINLULUEJ - FILE
E) (NSP.
(INSTRUCTIONS ON SEPARATE SHEET) -) (YELLOW( OTHER AGENCY
i (PINK) - APPLICANT
APPROVED N' APPLICATION NO.:
NOT APPROVED (TI Y Ot FIGARD,GREGON FEE AMT.: S Z11. -._---
PENDING FEE. PMT. 0 CITY HAIJ, RECEIP NO.: 39.39
PENDING SECURITY 0 PUBLIC WORKS DEPARTMENT BY DATE
PENDING AGENCY "OK" L] Application and Progress Recor'1 �
MAINTENANCE BON[r
PENDING INFORMATION ❑ FOR STREET IMPROVEMENTIEXCAVATION AS REQUIRED
ANNUAL r
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: ~- . DATE ISSUED: _% �!=�L_�..1BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS PIESCRIBED HEREIN, IN7,71'r-',
ACCORDANCE WITH CITY EQUIREMENTS.
7 -,
APPLICANT y_/G 1'LE= t. L '<�� 1 1 _- , /'` C(L�%ff, ,-I
/ME ADDRESS CI PHONE
CONTRACTOR ) - y)
-NAME ADDRES�� AHONE �—
PLANS BY
- - - -------nAME ��---- ADDRESS
STI MATED IMPROVEMENT TOTAL VALUATION ( COST): $
DOLLARS
(2) EXCAVATION DATA:
FOR OFFICE USE: UMIN.
_ STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYPE LENGTH WIDTH L`F,PTH ITEM 3 .QUANTITY
STREET - ---- -__
QUM
INSPE
/t TICSN
E
Q
ESTIMATED STREET OPENING DATE: S
ESTIMATED STREET CLOSING DATE: ��- ,' g
D
y�x_ STREET(3) SECURITY 'VO. SECURITYAMT: S ,�-Qtj CLOSE _
SURETY CO.: lu! i.n 5',o,,-,v !-6 _ _ FINAL
CERTIFIED CHECK fl CASH U DONL) 0 INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT. 4,
A /I1 L _....�
I i 1 1
b
-CURS .
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I5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK W°IERF
RI GH't 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 PERTINENT LAWS AN
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORtt, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROI61 APPLICANTS ACTIONS
7
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APPLICANTS SIGNATURE L,
% "'yam �{ DATE
CITY OF TIGARD-12420 S.W.MAIN-•TIGARD,OREGON<,,7223 - ----
RECEIPT
DATE: L�� 7 - - —AMOUN 1: S.. -(�L0
LLARS
NANtE- { (CASH
ADDRESS: y S.S 'A. •� CHECK:---
A)
HECK:--A)_3�_ .LL_ti� •b �' M.O.:
FOR: ACCT./ FlRMits SURCNARA! AMOUNT
SEWER BILLINGS 40-364 $ _
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
I
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 50-367
PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362 II
TOTALS S _----- ----,--
10,
RECEIVED BY:
PERMrT NUMBERS ASSION10!
Nnmt,�r Amours) Number Arnounl Number Amount
$ .l
RECEIPT * 3 9 3 -
9
E WESTERN'l ETY COMPANY
, o�rt�avtiPil.
ry ZC,
dt'rIIC,AI- � SI:.rU7C i,A l�:fy�� ,�Atr+Y:AS
;. ALO A4 * SALA:9` 'i15:PA.
r LICENSF AND PERM171' BOND
(For County. City. Town v- Village Only)
KNOW ALL MEN BY THESE PRESENTS: BOND No,L&P 290974
MARVIN H. HUTCHISON DBA M. HUTCHI90N ELATE ISES�� _—,
�—
of the_ __CITY_o[.__. RRC_. State of—_.411iSi011 _,as Principal,
and the WESTERN SURETY COMPANY, a corporation duly licensed to do business In the
State of-_—_ OREGON____._��_ as Surety, are held and firray bound unto the
State of____oREGOu-_—___,Obligee,in the penal
(Valid only when a County.City,Town or Village is named as Obligaa)
sum of___--ELM HUNDRED--=-uo/100 -50D..00_----)DOLLARS,
(NOT VALID IF FILLED IN FOR MORE THAN$10.000,00)
lawful money of the United States, to be paid to the said Obligee, for which payment well and truly
i
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
TO SEWER CONNECTIONS FOR CITY OF TIGARD
has been licensed__ ___ MAKE
the said Obligee.
NOW THEREFORE, if the said Principal shall faithfully perform the duties and In all things romply
with the laws and ordinances, including all Amendments thereto, appertaining to the license or permit
applied for, then this obligation to be void, otherwise to remain in full force and effect for a period
commencing on the 2th -_ day of SEPTEMBEB___ _, I9]_9_,., and ending on the
___I th _ -day of_..__SEPT .MR .R __-�• I9&1—. unless renewed by continuation certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, by cer-
tified mail, to the clerk of the Political Subdivision with whom this bond is filed and to the Principal,
addressed to them at the Political Subdivision named herein, and at the expiration of thirty-five (35)
days froth the mailing of said notice, this bond shall ipso facto tErminate and the Surety shall there-
upon be relieved from any liability for any acts or omissions of the Principal subsequent to said date.
Dated this of_ SEPIEMIIE)i_..__. 19_I9 -
s� .��tG*'s-�✓rGlr_G_-aE�.�_="""—ter_.
Principal
Principal
Countersfgned I �� WESTERN SURETY CQMPANY
tlyBy
/ / Resident,Agent /7/� --
ACIKNOWLF.DGMENT OF SURETY
(C.rr•htlrntr ORlcer) �`
STATE Of' SOUTH DAKOTA
County of Minnebeha
On this _ _. 12t b_—_._._day of SEPTEMBER _ -�.__--, , 19.14.,before me,
j,llt:p9. A. t. SNC y.
the undersigned officer, perronally appeared_-_,.__ � _
who acknowledged himself to be the aforesaid officer of the WESTERN SURETY COMPANY, a
corporation, and that he as such officer, being authorized so to do, executed the forei oing Instrument
for the purpcsm therein contained,by slgnln� the name of the corporation by himself ej such officer.
C IN '*lTNtSS WHEREOF, I have hereunto set my hand and official seal.
My Corratiss;on Expires
A. CQ.00ics, Notrav Pubi
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Notnrc l'uhllc-South Dakota -
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