12175 SW SUMMER CREST DRIVE FILE WJ.
SUMMERMOST12175 STR. OPN. PERM
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May 20, 1987 CI 1 i (*TI1FARD
OREGON
25 Vvars of SeMce
1961-19H6
Robert & Catherine Hallberg �_�__
12175 S.W. Summercrest Drive
Tigard, OR 97223
RE: Street. Opening permit No. 166-83
Enclosed, please find a copy of the original performance assurance bond
(#1J011936) for the aforsaid project. All work has been satisfactorily
completed and maintained for the required period of time. Robert and
Catherine Hall.berg's obligation hereinregard is fullfilled.
Sin/cce-re ll y/C,-
Sohn S. Hagm-n
Engineerina Technician
cc: Grange Ins. Assoc.
2717 Th'-rd Avenue
Seattle, WA 98121
13125 SW Nall Blvd.,PO Box 23:197,Tigard,Oregon 97223 (503)639-4171 — ---- - -- -- -- ---
AF`PLIr''JION -- STREET IMPRI SMENVEXCAVATION COPY TO:
ORDIN.,.4CE NO. 74-14 p IBLUE)-INSPE
(INSTRUCTIONS ON SEPARATE SHEET) E] (P INK)O APPLCAER.AGEI CV
APPROVED ❑ APPLICATION NO.: -1�4..
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: !� 2�'•
PENDING FEE. PMT. ❑ CITY HALL. RECEIPT NO.: I�,,# �G PENDINGSECURITYCJ PUBLICWORKS DEPARTMENT BY —.—. DATE _L/•� / �`3
PENDING AGENCY "OK" ❑ Application and Progress Record _
MAIMTENANCH klOND #t -
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REI2UI RED
ANNUAL 0
PENDIN,a VARIANCE ❑ IEXF I RATIOV DA E:
PERMIT NO.: DATE� , DATE ISSUED: �._L�¢.LC�-?_ . EKY: .__
-� --
(1) APPL
'CATION IS HER RY MADE TO EXCAVATE FOR AND INSTAt-L _—_.�J>� ccs j ��2
P,S DESCF2IBEC► HEREIN, IN FULL At:COF2Di+NWITH C Y REQUIREMENTS.
APPLICANT ___1Pety e r 92 __. .Y.-
NA ADDRESS 1 V PHONE
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CONTRACTOR—g 1 %f';. _ _EZ 75G�J:53� •'>�<i.. /r. 2Z4-*j&,v,
A / Au0 f SSPLANS
CITY -TNONE
NAM ADDRESS CIT
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST'): S �1J_
DOLLARS
(2) EXCAVATION DATA: FOR OFFIC.t use: ep UMIN.
STREET DESCRIPTION _ PROGRESS & INSPECTION STATiJS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET —
INSPEL-
��+ Of.� R TION
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U
ESTIMATED STREET OPENING DATC: L / _..-_.._ CS
ESTIOATED STREET CLOSING DATE E
STRE
(3) SECURITY NO. ZJAW]f L_._ SECURITY AMT.. S CLOSED
SURETY CO.: ._(� __1���2I¢�' --_________ _ FINAL Q
�TIFIED CHECK �� CASH rl ._�-_BONI `�� INSPEC. f- l
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL 50ECIAL.PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
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NOTE: THE CITY OF T'IGARD DOES NOT, PEREBY, GRANT PERMISSION TO APPLICkNTS TO CONDUCT WORK WHERE
RIG14T OF-WAY JURISDICTION IS THAT OF' WASHINGTON COUNTY OR THIS STATE OF OREGON.
THS' APPLICANT AGREES TCT DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST INJURY OR AMAGE WHIFH MAY RESULT FROM APPLICANTS ACTIONS.
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'PLICANT£ -IGNATURE: / vy'
DATE
� 1
CITY OF TIGARD- 12420 S.W.MAIN—TIGARD,OREGON 97223
REC:•.IPT
DATA: -� - /,s7
- 6�3 AMOUNT:$ �
— DOLLAR''
NAME- � -� � CASH: _
ADDRESS: _ �
M.O.: ----
#OF
FOR: — - _ ACCT, 0 PlkMITS SURCHARGE A IAOUNT
SEWER BILLINGS 40-364 S_
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332 g
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
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TOTALS S •"z
RECEIVED BY: A
PERMIT NUMBERS ASSIGNED:
--Number Amount Number Amount Number Amount
-- -- S-_ S
RECEIPT •14 5 6 2
Serving the Grange Since 189
1 GRANGE INSURANCE ASSOCIATION
2717 Third Avenue — Seattle, Washington 981::1 —(206) 622-4911
- , LICENSE AND PERMIT BOND Dee McKern President
James Burgess Vice Presiden
(For County, City, Town or Village Only) Duane H. Mtipman Executive Vice President
Gordon E. Hills Secretary
KNCW ALL MEN BY THESE PRESENTS. BOND NO. 1.1 11936
That we, POnFPT E E CATHEPINF HALLBEPG
of the (nI*ITY of VIASHI"1rTroq State of no�r:r*) as Principal,
and the GRANGE INSURANCE ASSOCIATION a co,-poration duly licensed to do business in the
State of nPErnnl as Surety, are held and firmly bound unto the
of State of n"rr.r,�; Obligee, in the penal
(Valid only when a County, City, Town or Village is named as Obligee)
sum of nr,r n t, r,rrp r Cir- tr 'TV rlvr nr. ASS-------------
- --($ l75_�n-------___.__ ) 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 pa.ym-nt well and
truly to be made, we bind ourselves and our legal representatives, jointly and sz-verally by
these pi•esents.
'CHE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas the said Principal has been
licensed "rr+rrOIAL ppEFn0m01rF Fnp rUpq IN rrr*]T OF HnIler
by the said Obligee.
NOW THEREFORE, if the said Principal shall faithfully perform the duties and in all things
comply with the laws and ordinances, including all Amendments thereto, appertaining to the
license or perm;.t applied for, then this obligation to be void, otherwise to remain in full
force and effe,:t commencing on the 2nTN day of .JULY , 19 F;
This bond may be terminated at any time by the Surety upon sending notice In writing, by
certified mail, to the clerk of the Political Subdivision with whom this bond ;.s filed and
to the Principal, addressed to them at the Political Subdivision named herein, and at the
expiration of thirty-five X35) days from the mailing of said notice, this bond shall ipso
facto terminate and the Surety shall thereupon be relieved from any liability for any acts
or omissions of the Principal subsequent to said (late.
Dated this 2•9T 1 day of 1111 Y _+ 19 07
NAME OF PRINCIPAL �.f'��-C r ,
TITLE
SURETY NAME ^A'N Il`I4;l1PA1`•ICF ASSnCIATTMI SU!!ETY SEAL
ATTORNEY-IN-FACT�� r.�l/�7e000'
RESIDENT
RESIDENT AGENT
AGENCY NAME
DIRECTOR$ ---
J1520 Hosea AMES BURGESS RICHARD L.CALLAHAN FRED CHURCH FRANCIS FLOWERS CLAUDE GRIMES RIt HARD R.LEWIS JOHN A.LCDI
Santa Rosa,Ca,95401 Mt.Vernon,We.982'3venue 1020 Farm to Market d� Vs1it uEerNNv19S66yA e. Rt. 3. Box 94•R 5p.'1 '797 Quive,St. 18Ga;i W.Pine Canvou Rd. 36599 S.F.Hwy. 211
Brookings,Or.0'41. Denver,Co.90I21 Lake Hughes,Cr 93132 Sandv,Or.97011
DEE McKERN DONALD F.MORTON HAROLD H.RIKER EUNICE C.WITH DONALD A.STEFFEN C.A.SVINTH DONALD L.WADE EARL. WILLIAMS
Route i Lamont,We.99017 Bot 302 P.O.Boa 201 22013 Ben Howard Rd. P.O.Boa 472 1714%Naches Rd. Rt. 1,Bot 9
Rice,Wa.99167 Manson,Wa.98631 Bagga,Ca.05917 Monroe,Wa.98272 Gig Harbor,Wa.98335 ,Neches.Ws. )8937 Reardan,Wo.99029
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