12098 SW MAIN STREET FILE NO. (6-1'18
MAIN ST. - 12098 STR. OPN. PERMIT
I
APPLICATION -- STREET 'MPR( "MENT/EXCAVATION COPY TO:
OF DIN/,,.CE NO 74-14 IBLUES) IN�PE
(INSTRUC"ION; ON SEPARATE SHEET) ❑ (YELLOW) gGENC\'
�/� �IPINKI APPLICANT
APPROVED .T9_ APPLICATION NO.: _ Cl _
NOT APPROVED !El _ CITY OF TIGARD, OREGON FEE AMT.: S
PENDING FEE. PMT. CITY HALL RECEIPT NO.:
PENDING SECURITY O PUBLIC WORKS DEPARTMENT BY 45 (A. DATE I �i/ W13
PENDING AGENCY "OK" ❑ Application and Progress Record
PENDING INFORMATION O
FOP STREET IMPROVEMENT/EXCAVATION MAIN SER AQU RED D
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: �_ 7=_7 � GATE ISSUED �_- -'1 BY:
(1) APPLICATION IS HEREBY MADE TO 'XCAVATE F'OR AND INSTALL �.:1�tt �► _ u'�h'._.
y-�_ _SAS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH Ci REQUIREMENTS.
APPLICANT -�'C "13 L���` 1��1_ ��ffW�N C IC _1D P0#e7-1 4,p
NAME - -----' -_ ADj� s �� CITV PHONE
CONTRACTOR _-
NAME ^ ADDRESS / — CITY �— PHONE
PLANS BY /-F'� L� S,I-� C /, M.�
—._.--- ---- NAME I ^DDREt CITv_ O-lgv—
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
Do�LARs
(2) EXCAVATION DATA: 0.0 oFFlcc��usgg�� .�iM7N
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
SURFACE CUT CUT CUT MATERIALINSTALLED t
NAME ITEM DATE ' EMARKSj-i TPEa
_ TYPE LENGTH WIDTH DEPTH ITEM At QUANTITY
�- /I ^
STREET
AD
. l:
INSP .C- ---
--� R TION
E -- — -
O
--- U —�
ESTIMATED STREET OPENING DATE: e 1,7 E
S
ESTIMATED STREET CLOSING DATE: ' / Z - T
E
- — D
33�4�! STREET
(3) SECURITY NO.��. S CUR TY ANT.` ' CLOSE
SURETY CO.: f-/�N-►a+ti .K =/+��+ IF a,,� � FINAL -
---
CERTIFIEDCHECK ❑ CASH ❑ ON INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CON DIT'IONS:
FEATURES: EXCAVATION LOCATION AND EXTENT.
.� I or
—
� I 1 1
--
/ --- —---- _-I - T-- --
Iv-
IP
I
(5( NOTE THE CITY OF TIGARD DOES NOT, HEREBY. GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT 17F-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 AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE .]ITY AND
EMPLOYEES AGAINST ANY AURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
c� ^� V
AFPL.ICANT5 SIGNATURE` DATE I
'T_,F.NZRAL FORM Bond No.. 6336441
® t� r�)L,1►,(,1 }�r�C FIREMAN?FUND INSu RANCE COMPANY
11 l `C Ir AN J THE AMERICAN•INbURANCE COMP-
AsSOC1ATED INDEMNITY CORPORArio!.
AN/1E IC N AMERICAN AUTOMOBILE INSUR!:.CE COMPANY
1 N S,U R A N C E C 0 SI I'A% I t.S HOME OFFICE SAN FRANCISCO,CALIFORNIA
KNOW ALL MEN BY THESE PRESENTS
That we, _WE_ST_WO_OD CONSTRUCTION CO.
(hereinafter called Principal), as P:Incipai, and FIRENIANrS FfT13D-INSZjEtAI �_� ]�(� a corporation organized and doing
business under and by virtue of the laws of the State of(Za-3Uf-Qrn- ,S and duly licensed for the purpose of making, guaranteeing or be-
coming sole surety upon bolds or undertakings required or authorized by the laws of the State of _ Ot'B9Or -
(hereinafter called Surety) as Surety, are held and firmly bound
unto CITY_OF T IGARD
hereinaftet called Obligee) in the just and full
EIGHT H1NDRED AND NO100THS---------------------
sum of Dollars ($ 800.00.,_ )
lawful money of the United States of America, for the payment of which, well and truly to be made, we hereby bind ourselves and our and
each of our successors and assigns, jointly and severally, firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT, WHEREAS,
the above bounden Westwood Construction Co. has requested or obtained a permit from the
City of. Tigard in connection with Ordinances 74-14 and 76-•11 for a sewer cut at
Main on Scoffins Street, Tigard, Oregon
NOW THEREFORE, if the said Westwood Construction Co. shall comply and faithfully perform
the work in connection with said permit, then this obligation to be void; otherwise
to remain in full force and until one year after tho date of the issuance of the permit.
IN WITNESS WHEREOF, said Principal and said Surety have caused these Presents to be duly signed and scaled this _.. 8th
day of - ----- --- June
WESTW00 ONSTRUCT #ON
By
FIREMAN'S FUND INSURANCE C:ONPrMY
Surety
By: -
..-.7 James F. Dare.
ar p_ Drney-m Fa_I
rn. ,
=ORDU40 esov2s m BY n„
AND WHMI AtODeDLD MAIL TO
Nam. F —1
Address
'try L
Stat.
�p
GENEVAL POWER OF ATTORNEY
FIREMAN'S FUND INSURANCE COMPANY
1tNQW AL. MEN BY THESE PRESENTS- That FIREMAN'S FUND INSURANCE COMPANY, a Corporation duty organtssd and existing
under the'.iws of the Slate of California,and having its principal allies in the City and County of San Francisco,In said State,has made,
ronshluted and appointed,and does by these presents maks,constitute and appoint r
-----JAMES F. 13ARBY-----
PORTLAND, OREGON
its true and lawful Altor •/(e' -Foci, with lull power and authority hereby conferred in Its name, place ant+ stead, to execute, seal.
acknowledge and deliver ar and all bonds, undertakings, recognizances or other written obliga—
tions in the nature thereof
and to bind the Corporation thereby as fully and to the same extent as II such bonds were signed by the President, ceded with the
corporate sed of the Corporation and duly attesled by its Secretary, hereby ratifying and confirming all that the said A1lorney(s)-in-
Fact may do in the premises.
This power a( attorney is ranted pursuant to Article Illi, Section 30 and 31 of Bylaws of FIREMAN'S FUND INSURANCE COMPANY
adopted on the 191h day of November, 1965,and now in lull forts and effect.
Article VIIL Ippuielm el and .100—ifs of Nendr til 1++uha AyereNrly/, and .Illerxr e•i.d'.N -1 furnfs le anent 1..0.1 Preeeee ad Neke
AeeesreasY.
Section 30 .1 r muf.rrd. The Chairman of the Board of Directors, the President. any Vt�nPresident or env orlrtr
,er person nuthoed by the Board
1 Dueclors.the��iaumon of the Board of Dueciars,the Prwtdsnt ar any V,-President may,film time to lime appatnt Resident Assistant S...tio,tes and
Rtletneys.m.Pact to represent and act lar and on behalf of uta Corporation end Aaenls to accept Boal process and make appearances for and an behall of
M.Corporation
Semon 31 .tnrh.ofit.Th. Aull—ily of such R.sident Assistant $#"starts Attorneys in Foci, end Agents shall be as prescribed In the ms,Io,s or
.",I.%cines their appointment,nisi any suss:appointment and all authonty arantad thereby may be revoked at any time by the Board of Duction or
bi cmY person empoweted to mak-such aowmtm.ni
This power of nllarney is signed and sealed under and by the authority of the Iallnwin Resolution adopted by the Board of Directors
of FIREMAN'S FUND i1::11RANCE COMPANY at a meeting duly called and held on the 151h day of fuly. 1966, and that said Resolution
has not been amended or•epealed
*RESOLVED, thnt the signalyre of any Vice-President, Assistant Secretary, and Resident Assistant Secretary of this Corporation, and
the seal of this Corporation nay be affixed at printed on any power of altarey, on any revocation of any potter of attorney, or on
any certilicote relating thereto, by facsimile. and any power of attorney.any tevocatian of any power of attorney,or certificate bearing
such facsimile signature or .ncsimile seal shall ba valid and binding upon the Corporation"
IN WITNESS WHEREOF. FIR".MAN'S r' 'In tNSURANCF .Z4PkNY has caused these presents to be signed by Its Vice-President,
and its corporate seal to be hereunto alu..e nls_lr,t day of. August 1B 75
n
rIA'1'S FUND INS RANE COMPANY
e d By IAMra H.Wa S.Vlee Residers
STATE OF CALIFORNIA,
u.
CITY AND COUNTY OF SAN FRANCISCO
On this tet----day of Augukt_. . _ _ __ 19_75-• before me personally came James H. Wells to me known, who,
being by me duly sworn.did depose and say that he is Vice-President of FIREMAN'S rUND INSURANCE COMPANY, the Corporation
of in and which executed the above instrument. that he knows the seal of said Corporation; that the seat affixed to the said
instrument is such corporate seal; that It woo so affixed by order of 1hr Board of Directors of said Corporation and that he signed his
nume thereto by like order.
IN WITNCSS WFIEAECI' 1 iru— h.•rn„tit„ .td my hand aiid alBiied my ofnElcI seal,the day and year herein first above written.
■I/IYYI/1..111 it.Ol'.'"G”le/ell lu101gnelree 111O,r■
9C s N. GRAD.. NEWBE OR'IIA
E •�
NOTARY PUBLIC-CAIIPOR!IIA
cltr a coalrtr a sell taulasto a gay ncwatn�4R V
Mir lapirss Sept 2s,1916
NII\IM'/III/llllllssssera/1M11NNNNef111a1017111r1■ CERTIFICATE
STATE OF CAurarNIA,
u.
CITY AND COUNTY OF BAN FRANCISCO
I the undersigned. Assistant Secretary of FIREMAN'S FUND INSURANCE COMPANY. a CALIFORNIA Corporation, DO HEREBY
CERTIFY that the loregoinyy and attached POWER OF ATTORNEY remains in full force and has not been revoked and furthermore
that Article VIII, Sections 30 and 31 at the By taws of the Corporation, and the Resolution of the Board of Directors, set forth in the
Power of Attorney are now in lore@
Sign W and sealed at the City and County of San Francisco. Dated the 8th__doy of June 1%2
D
,e~���� 0 i '_:—Vt�L,�,
';e� g -_. _._ RED TI.BROWNS,Assistant Secretary
360543 iHpt—FP-1-?J
Corroon&Bleck of Oregon
rip Insurance/Sur 3onds
1800 S.W.Fourm Avenue
Portland,Oregon 07201
508/224-4155
ACCOUNT NU. COMPANY CG.NO. POLICY NUMBER BILLING PERIOD
298 848 5 5 Firemans Fund 826 16336441 6-8-78 To 6-8-79
DESCRIPTION LINE TRANS CHARGE CREDIT
$800. Permit Bond to City of Tigard for sewer cut
at Main on Scoffins St. 33 $20.00
INVOICE DATE
Westwood Construction Co. 6-8-78 mw
TERMS
13001 S. E. Johnson Creek Blvd. Premiums are due and payable by the
Portland, Oregon 97206 effective iota of the policy Unpaid pre-
miums are delinquent 30 days after policy
INVOICE •Elective data and are subject to cancellation
and,'or ser vice charge Convenient payment
Plans are available.Policies not wanted must
be returned Immediately for cancellation.
INVOICE
sfs.sfwer�r /.�—r � NO..
BRUCE WAYENBER6 -
0371 S.W. Palatine Hill Rd. � � Da 19
n*
Portland, Oregon 97219 Name � � �-1L-Z m
Phone 244--9030
Address0 � ti�.4-�►ti� �if t.-L4- ft � 1 �
fore _ Descriptions" Unit Cost — Tolol
C a /1-Y-
v
r
/t v Total 2 r