8800 SW CENTER STREET r
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FILE NO.
TR. 0PN- PERMIT
CENTER ST. 8800 S.L
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APPLICATION - STREEI IMPRr �MENT/EXCAVATION COPY TO:
ORDINr,,.CE NO. 74-14 ❑ (WHITE)' FILE
p (BLUE)-INSP.
(INSTRUCTIONS ON SEPAR ATE SHEET) ❑ (YELLOW) -OTHER AGENCY
p (PINK) APPLICANT
APPROVED
APPROVED ❑ APPLICATION NO.: /
NOT APPROVED p CITY OF TIGARD, OREGON FEE AMT.: S 6O Amli- _
PENDING FEE. PMT. p CITY HALL, RECEIPT IVO.:
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT By A_±_ DATE /U Ly-,Zr
PENDING AGENCY ''OK" p Application and Progress Record - - - - - -
MAINTENANCE BOND k.
PENDING INFORMATION L; FOR STREET IMPROVEMENT/EXCAVATION ASREWUIRED a ANNUAL -
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: DATE ISSUED: 1__42 l !�/ 7S!� BY: '
(1) ;.PPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
--- - - ---- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT
ADD clTv
NAM S -
CONTRACTOR NA �Gl//1'.�✓///!c� !'7/7-0 -5W Nr ---
D [ __� ` SQ
PLANS BY E
3tZ ,63
NA1NE Z
ADO CIT --PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S -25�
DOLLARS
(2) EXCAVATION DATA. Y FoR OFFICE Fi-11-'----- an-nNi1N.
0.02 X III
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME. SURFACE CUT CUT CUT MATERIAL INSTALLItD
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY IT
DATE REMARKS/TYPE BY
CII'�IQ 3 STR
IN -
R 1 .
E
_ Q
ESTIMATED STREET OPENING DATE: 7G� 8
ESTIMATED STREET CLOSING DATE: _-_L� T
(3) SECURITY NOy' � SEC.URITYAMT.. S 000 $ c OSET
SURETY CO.: �n �- -J, c'.0 r _ FINAL
CERTIFIEDCHECK U CASH O jOND - INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISION6/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTCNT.
I 1
URB -
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i-,
-CUR% -
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(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 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 CITY AND
EMPLOYEES AGAINST INJURJY pR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
0 T 5 9, 1/If'G
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APPLICANTS SIGNATURE: r DATE yd
/D / 2 / /
CITY OF TIGARD—12420 S.W.MAIN—TIGARD,OREGON 77223
RECEIPT
DATE:-(—'C'1� fgS AMOUNT: $_
V
NAME. L
- CASH:
ADDRESS:
CHECK: -
� t, M.O.: �.
0O _ .
FOR: ACCT. 0 PERMITS SURCHARO► AMOUNT
SEWER BILLING 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332 $
MECHANICAL. PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363 A
SEWS?INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366 !`
PARK DEV.CHARGE #1 30-361
PARK DEV.CHARGE #2 30-368 _
ZONING ADJUSTMENTS 05-362
TOTALS
RECEIVFD BY:
PERMIT NUMBERS ASSIGNED:
Number Amount Num_bor Amount Number Amount
0996
) NORTH PACIFIC i.VSURANL COMPANY
XZ OREGON AUTOMOBILE INSURANCE COMPANY
Referred to as the Company
P.O BOX 74 • PORTLAND,OREGON 97207
POWER OF ATTORNEY #412
THIS POWER RESTRICTED TO BONDS AND UNDERTAKINGS NOT IN EXCESS OF $ 1001000.00 _
KNOW ALL MEIN BY THESE PRESENTSThat the Company, an Oregon corporation having its principal office in the County of Wash
y. ington,State of Oregon, does hereby nominate, constitute and appoint:
a
VICKI L. NICHOLSON of Beaverton,Oregon
o its true and lawful Attorney-in-Fact, to execute seal and deliver for and on its behalf as surety, any and all bonds and undertakings,
— fecognizances, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or per-
`) milted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these. presents,
shall be binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and ac-
Lu knowled ed b Its regularly elected officers at its principal office.
w 9- Y 9 Y P"
U.
This Power of Attorney is made and executed by authority of a Resohltion adopted by the Board of Directors of which the following is
a true and exact copy.
"RESOLVED that the President, Executive Vice-President, Secretary,Treasurer, Vice-President, Assistant Vico-President or
Assistant Treasurer shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on the
behalf of the Company and attach the seal of the Company thereto, bonds and undertakings, recognizances,contracts of
indemnity and other writings obligatory In the nature thereof, and they may at any time revoke the authority of L ty surh
Attorneys in-Fact."
ALLAl1_T.fIQftIT1Y FlEy8B� CONFERRED SHALL EXPIRE AND TERMINA-rE WITHOUT NOTICE AT MIDNIGHT OF
IN WITNESS WHEREOF, The Com any has caused trese pt�sents to be signed and Its corporate seal to bp affixed by its authorizer)
officer this 14th __day of February 19 //'
Cl NORTH PACIFIC INSURANCE COMPANY
9-9 OREGON AUTOMOBILE INSURANCE COMPANY
(Seal)
s Leo A. Cassinelli
STATE OF OREGON 1 Leo A. Cassinelli , Asst. dice President
COUNTY C`' Washington ) ss.
On this__14th day of_ February 19_7Z__, before me, a Notary Public in and for the state of Ore
gon,personally came (_A_ Cassinel_]j_ , the individual,to me personally known who
executed the preceding instrument,and being by me duly sworn,said that he is the,therein described and authorized officer of the Com-
pany; that the seal affixed to said instrument i, the corporate seal of said Company,and the said corporate seal and his signature were
duly a°fired by the authority and order of the Board of Directors of said Corporation.
IN TESTIMONY WHEREOF I have hereunto set my hand and affixed my Official Seal at Portland,Oregon, the day and year first above
written. Joan Partee
My commission expires:
19-8 Joan Partee Notary Public
STATE OF OREGON 1 SS:
COUNTYOF WASHINGTON 1
_— Neil E. Hokkanen, Jr_ Secretary of tht,( mpany, do hereby certify that the foregoing
is a true and correct copy of a Power of Attorney,executed by said Company,whi-h is still In force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and offixed the seal of the ;aid Corporation,at Portland,Oregon, this 4t11 day
of- -----� Lober , 19 78 .
L__ NORTH PACIFIC INSURANCE COMPANY
G OREGON AUTOMOBILE INSURANCE COMPANY
- likretary
03054 12.73 Ne' E. okkanen, Jr.
BOND
BOND # SB 2F2-6
IWYN ALL b01 BY THESE PRI SF.NTS:
That we, North Plumbing, Inc.
_ as Principal, ,
and the Oregon rutomobile Insurance Company
a corporation
oryanizsd under the latus of t11e State of Oregon , and authorized
to transact the business of Surety in the State of Oregon
as Surety, are held and firmly bound unto City of Tigard
in the just and full sum of THREE THOUSAND AND NO/100 ---------------
( $3,000.00 --) , for which sum, well and truly to be paid, we bind our-
selves, our heirs, executors, administrators, successors and assigns jointly
and severally, .irmly by these presents.
Sealed with our seals and dated this 4th _ day of -October , 19 78 .
• THE CONDITION OF THIS OBLIGATION ISSUC[I,. THAT L�+IIIERfdS:
North Plumbing, Inc. _ has made application for a permit
to make cut in street to install 15" Stone Line & 2 Manholes on the street.
at Center & 88th Streets, Tigar3,gegen.
PIOW, THEREFORE, If the said Principal shall abide by the terms of said permit,
then this obligation tc, be void: otherwise, to remain in full force and effect.
416
IT IS AGREED THAT the Surety's liability under this bond shall remain in force
for a period of one (1) year following the completion of work for which the
-rmit has been obtained.
North Plumbing, Inc.
BY:
Oregon
,Automobile
'�Insurance
nsurance Company
1 � 1l � fi
BY: V�'-'�1�• •�1 ��
Vic IT Nicholson Attorney-ir-fecc ! r
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