9125-9145 Dakota Street #165-83 DAKOTA STREET - 9125-9145 1 OF 1
FILE NO. na5- STR. OPN. PERMIT
DAKOTA STREET-9125-9145
i
1
APPLICATION STREET IMPRC -MENT/EXCAVATION COPY TO:
ORDINANCE NO 74-14 p (WHITE) PILE
❑ IBLUsi -1N...
(INSTRUCTIONS ON SEPARATE SHEET) ❑ (YELLOW) OTHER AGENCY
0 ('INK)-APPLICANT
APPROVED n
APPLICATION NO
NOT APPROVED ❑ CITY OF TIGARD, OREGON
FEE AMT : . _
PENDING FEE PMT. ❑ CITY HALL RECEIPT NO. _
PENDING SECURITY 0 PUBLIC WORKS DEPARTMENT BY _ . DATE____
FENDING AGENCY "OK" ❑ Application and Progress Record L���
PENDING IN7ORMATION O FOR STREET IMPROVEMENT/EXCAVATION w1AINtsE[cN aEEsONO N�- —
PENDING VARIANCE 0 ANNUAL b❑
EXPIRATION DATE: I
•
SIIIMMINIIIIIMIIIMMIL
PERMIT NO.: _-_, DATE ISSUED: . ______/ I , , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
l_Parla"``� AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
WAME -- -----
-__ADDT[1S _- - _. -
CITY -"-PHO [-
CONTRACTOR
N.4"Wi - -ADOREss ---- --- fry----
_FN3Tv�--PLANS BY _
—FMO--N'F —.
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ _
[loci.ARS
(2) EXCAVATION DATA.
FoilOFFICE USE MIN
-----� O.OXi�_ sS
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE E CUT CUT CUT LENGTH WIDTH DEPTH MIA EM TERIAL INSTALLED
QUANTITY /TYPE BY
Si ITEM DATE REMARKS
• t
STREET 4
_tkOPEp _
I _may !NSP
R TION
E
1 _ I O
ESTIMATED STREET OPENING DATE: / ~i U
1 _ E
ESTIMATED STREET CLOSING DATE / / S
T
E
(3) SECURITY NO., . — SECURITY AMT.: : CTREET
CLOSED
SURETY CO.:
TONAL FINAL
..- CERTIFIED CHECK '7 CASH a wear• INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL
FEATURES: EXCAVATION LOCATION AND EXTENT. SPECIAL PROVISIONS/CONDITIONS
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(5) NOTE THE cry or TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT 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 AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO RAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT PROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE
DATE _/ /
801099
BOND No.
LICENSE OR PERMIT BOND
n:404 ALL MEN BY THESE PRESENTS, That we
Thomas R Rasch lbs: It is Excay.rr „i
PO Box 276 Gladstone, Or 97027
a': Principal, and th.OD^tractors Bonding and Insurance company
with its principal office in Seattle, Washington N Surety, are held and
firmly bound unto the City of Tigard
, hereinafter called Obligee, in the penal sum
of***One Thousand and 00/100
($1,000.00 ) boilers,
for the payment of which well and truly to be made we do hereby bind our-
selves, our heirs, executors, administrators, successors and assigns, jointly
and severally, firmly by these presents.
SIGNED AND SEALED Till: 28th DAY OF July
19
•
WIIRRCAS, the said Obligee has granted or is about to grant to the said
Principal a License or Permit to engage in the business of
Street Opening —` -- —
+rrw TIIERI:roRE, if the said Principal shall indemnify the Obligee against
any loss directly arising by reason of the failure to comply with the laws
and ordinances governing the business of Street Opening
in said pity of Tigrud
then this obligation shall be void, otherwise to be and remain in fulforce
anti effect.
In:r;ARDLES5 of the length of time this bond shall continue to be In effect,
the aggregate liability of the Nurr.ty hereunder uhall in no evt•rtt exceed
the amount of the bond.
PooyIUIiD,H WI.Vi:R, that the Surety shall have the right to tormrnate its
liauility hereunder by serving written notice upon the Obligee tenni)
Jayu in advance of its intention to do so.
'MOM OF 11011Dt July 28 83 July 28 8+
19to ,19
sFSccavat int' Unntractors r -- _
I'E c N C 1 t A L rand int' and Insurance Company
3URP.TY
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