12560 SW HALL BLVD-1 BILE NO. 11
HALL BLVD. - 12560 STR. OPN. PERMIT
APPLICATION — STREET IMPR( -MENT/EXCAVATION COPY TO:
❑ 1WHITE)-FILE
ORDINA .4CE NO 74-14 ❑ (BLUE)-INSV
❑ IVELLOW)-OTHER AGENCY
(INSTRUCTIONS UN SEPARATE SHEL i) ❑ (PINK)-APPLICANT
APPROVED APPLICATION NO.: _ 42 --
NOT APPROVED CITY OF TIGARD,OREGON FEF: AMT.: $ ' '
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.:_45' Z7 L^
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT eY DATE__L - 1-3 177
- - - A - - - - - - - - - - -
PENDING AGENCY ' OK" ❑ Application and Progress Record MAINTENANCE BOND 4►�
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS RE.4IUIRF_D l(
ANNUAL U
PENDING VARIANCE ❑ EXPIRATION DATE:
_ _ r
PERMIT NO.: 'do L 77 DATE ISSUED: 1.__L __� LL , BY: ----
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _. -?_Yr -
AS DESCRIBED HEREIN, IN FULL ACCORDANCE� cF=
WITH CITY RE01J1RMNTS
APPLICANT �,2u>7 L�`Jyyt,i }'/ �.� /V/i /..J��.�v daw, 22.: ' 1,
INA ADOT� CIT HONE
CONTRACTOR _��-7 1 r�`''��-"� —�--
��-� NAM ADDRESS CI�Y PHONE
PLANS BY —L/ ts-Li ���y�� ,•, !'L,.�n.t �1 i1 /�w "0,
NAME AbDI�[Stf T CI_ H NE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S _S[
DOLLARS
---- --
FOR OFFIC[U [: ti d3, ❑MIN,
(2) EXCAVATION DATA: - j _ 0.02 x 9 c —= $
STR- r-T ___ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CLOT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM SO QUANTITY
91TREEI
' 1•Q .i,l f,• I��.A� �C d oPE
IHS
R TION -
-- — E
O
U
" / E
ESTIMATED STREET OPENING DA-i E: / �� 2! --- T
ESTIMATED STREET CLOSING DATE: / �� 7 ED
—� STREET
(3) SECURITY NO. . SECURITY TT.: S _�_ _ --_-- CLOSE
SURETY CO.: __�L� l Wi2�!_ FINAL
_ _ C[K If1EDCH[ K ❑ CASH O SOMD�- IN9PEC.
(4) PLOT PLAN' INDICATE SITE PERTINENT PHYSICAL—�—' SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
I I I 1 -
I I 1 1
uPll - �
I )
Ll�f
(5) NOTE. THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUN'!Y OR THE STATE CP OREGON.
THE APPLICANT AGREES TO DEPOSIT 'rHE REQUIRES Sti.URITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH NAY RESULT PROb1 APPLICANTS ACTIONS.
J
APPLICANTS SIGNATURE �����'�" �! "' - DATE =- ��—
CITY OF TIGARD (
-Dale Amount $
dollars
Name/12(-�t- Cash
M.O.
Address heck
Bldg, St.Opng, Bus.Lic.
P 16g. El Pubons, Bike Lic.
dol. Copies
Sew.Sei
-
Sewer E] Filing Fine&F.
Assmi. F] 011ier E] Zoning
For:
Permit
CITY OF TIGARD
By:
15716
� � . - - and Deposit C0* Mpany
SOME 0:7FICE OF IN f A R Y LAONTID BAMMORE, 310. 21.103
;11111/4)r 'iPer,-2ift
KN(YX ALL MEN BY THESE PRrSENTS:
That we, ...P.1 wnbi.ng,&q......
.............................................................................................
as Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAN-1), ince porated under the laws of the
State of :Maryland, with principal office in Baltimore, Mar'.1and, as Surety, are held and firmly bound unto
........ ...................0.ty...Pf ...............................................................................-.1 as Obligee,
in penal sum ofjwq..jundred Fi f ty... . -------- Dollars,
lawful money of the United"States,'*for**which payment, well and tr,,l I y.to be made,.we bind.ourselves,.. . . .o.ur heirs,
executors, administrators, successors and assigns, jointly and severally, firmly, by these presents.
WHERI -�'J the above bounden Principal has obtained or is about to obtain from the said Obligee a
license or permit ...pgr # 6 1
. ...... .7 .-1.................................-..:........ ............
......................................I..................................................; and the term of said license or permit is as indicated
opposite the block checked below:
A Beginning the............ r d....................day of......j9!-0PqC-Y........... ..........19.17., and
ending the.................3r dJanuar .................19..7.
.............day of........................ ...y
❑ Continuous, beginning the.,................... ..................day of................................................19.........
WHEREAS, the Principal is required by law to fi!e.with -Sily..Pf... ..................
........................----.....................----......................... ....................................................................................................I..........
a bond for the above indicated term and conditioned as hereinafter set forth.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That if the above
bounden Principal as such licensee or permittee shall indemnify said Obligee against all loss, costs, expenses
or damage to it caused by said Principal's non-compliance %vitb or breach of any laws, statutes, ordinances,
rules or regulations pertaining to such license or permit issued to the Principal, which said breach or non-
compliacce shall occur during the term of this bond, then this obligation shall be void, otherwise to remain in
full force and effect.
PROVIDED, that if this bond is for a fixed term, it rnay be continued by Certificate executed by the
Surety hereon; and
PROVIDED FURTHER, that regardless of the number of years this bond shall continue or be continued
in force and of the number of premiums that shall be payable or paid the Surety shall not be liable hereunder
for a larger amount, in the aggregate, than the amount of this bond, and
PROVIDED FURTHER, that if this is a continuous bond and the Surety shall so elect, this bond may
be cancelled by the Surety as to subsequent liability by giving thirty (30)days notice in writing to said Obligee.
Signed, sealed and dated the.... ......3.Q.th............ ......... ...... . day of.........pecember ........ ......... 19.76
........... ........... . .....
...Vean....W.a.r.r.en....Plumbjpg...�o.
.........................
Principal
By,
*............................
FIDELITY AND DEPOSIT' C N PANY OF MARYLAND
By...V. .�- ' . . ��.. ............... ......
Richard W. Recob Attorney-in-Fad
3 15 191943