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14835 SW 72ND AVENUE-1 FILE NC's. 72ND AVE. — 14835 S`t'R. O?N. PERMIT APPLICATION -- STREET IMPR( -MEAT/EXCAVATION COPY TO: (WHITE)- FILE ORDINH,rCE NO. 74-14 Of ;) -INSP. (YELLOW) -OTHER AGENCY (INSTRUCTIONS ON SEPARATE SHEET) (PINK) APPLICANT APPROVED A APPLICATION NO.: ___�Z��m --, NOT APPROVED /❑ CITY�f OF 1'IGARD, OREGON FEE AMT.: E PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: 3 ( CSS PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY _�_.—_— DATE �o / 4' / 79 PENDING AGENCY ''OK" ❑ !,pplicalion and Progress Record MAINTENAN(:E BON 5rL — FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED PENDING INFORMATION ANHUAL ❑ PENDING VARIANCE ❑ F_XPIRA'I-ION DATF: _72 PERMIT NO.: �__ -_ DATE ISSUED : � , BY: (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL -L�tauK�� --- ---. AS DESCRIB D HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. `! —�� t� p Cr2l3 S�y(c• APPLICANT ?O0 �CC/9�/ht IAJ S � Smac: icI , NAME A DRESS CITY PHOr1E CONTRACTOR S/4 h9 - NAME ADD RE SS CI-T� -------- PHCNE� PLANS BY _ ,A-- l I NAME C ADDRESS CITY PHONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S —DOLLARS _ 77OR OFFICE USE: MIN = i (2) EXCAVATION DATA. 0.02 x STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY _ TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY SL(�If�4I� /}S �lA�t �C' a'i r _ C,.sS 11,�'�A, 11r �/� 8TRNETEEgD —_ INSP C- R TION E O ESTIMATED STREET OPENING DATE: S ESTIMATED STREET CLOSING DATE: V— _ D STREET (3) SECURITY NO. _'�'�;� rt CURITY AMT,: E --__ _ CLOSED SURETY CO. `E FINAL r_ERTIrIFDCHECK' _ CASH n wOND~ INSPEC. (4) PLOT PLANINDICATE SITE. PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS FEATURES: EXCAVATION LOCATION AND EXTENT- I I 1 1 I 1 — 1 1 uaA •• •tulle — � �- — — — — —I I— — — — _ � � .___ 0,4l' 1 I -- --- -,,A-I a 4L k,C IL4V73 (5) NOTE THE Cl'Y OF TIGARD DOES NOT, HE1#ESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WA , JURISDICTION IS 'THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICANT AGREES TO DCPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECI!'ICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLEFS THE CITY AND EMPLOYEES AGAINSTINJ\'ItY OR DAMA WHICH MAY RESULT FROM APPLICANTS ACTIONS APPLICAN TS SIGNATURE: '� ` L L' DATE APPLICATION STREET IMPR t-MENT/EXCAVATION COPY TO: ❑ (WHITE,-FILE ORDINr„gCE NO. 74-14 ❑ (BLUE) -INSP. ❑ (YELLON) -OTHER AGENCY (INSTRUCTIONS ON SEPARATE SI- PECT/�, S/',RS COPY OPLj (PINK) �APPLICANT APPROVED 0 v APPLICrATION NO.: _ NOT APPROVED ❑ CITY OE TIGARD, OREGON FEE AMT.: f -- PENDING FEE. PMT. ❑ CITY HALI. RECEIPT NO.: _ PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY _ _ _ DATE--L--J—.-.- PENDING ATE= L-1PENDING AGENCY ''OK" ❑ Application end Progress Record MAINTENANCE BOND PENDING INF( RMATION El STREET IMPROVEMENT/EXCAVATION AS REQUIRLD ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE: PERMIT NO.: - DATE ISSUED: --___/._—�� BY: (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT —IT ApDRE55 CITU PHONE CONTRACTOR ---__- ------------- ---- NAME ADDRESS CITY P'HON PLANS B Y -- ---- - --- ------------ - ---- PHONE -- - NAME ADDRESS CITY ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): __-- - DOLLARS - - -- --- - - - FOR OFFICE USEt iIMIN. (2) EXCAVATION DATA: 0.02 x f STREET DESCRIPTIO! _ PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM 9 QUANTITY STREET OPENED _—" INSPE - / R TION — E , Q _ U ESTIMATED STREET OPENING DATE:__-- _—_ S ESTIMATED STREET CLOSING DATE: -- F STREET (3) SECURITY NO. ----_ -- SECURITY AMT: S_ —�— CLOSED �Ir'1/�'l�cr'. " C _ SURETY CO.: _ FINAL CERTIr'IEDCHE_CK '� _ CASH 0 MOND D INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL — — SPECIAL PRr)VISIONS /CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. J I (5) NOTE: TME 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 rHt 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 ANY INJUR'r OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS, APPLICANTS SIGNATURE DATE / .�. CITY OF TIGARD—12470 S.W.MAIN TIGARD OREGON 97233 ' RECEIPT ' DATE; A�4r)UNT: $ er� NAME: ��OLLA2S CASH: ADDRESS: - -� -- _ - CHEC�� __ FOR, r OF ----- - M.O.: ---- ACCT; r PERMIT! lURCNAROE ' SEWER BILLINGS --AMOI)PIT 40-364 BUSINESS LICENSEi $"— -- _ 0.5-.3.�I PLUMBING PERMIT Or.-.332 MECHANICAL PERMIT OS332 BUILDING PERMIT 05-333 SEWER CONNECTION 40-363 SEWER INSPECTION 40-365 SYSTEM DEV. CHARGE 25-366 PARK DEV. CHARGE #1 30-367 _ PARK DEV.CHARGE *2 30.368 ZONING ADJUSTMENTS 05-362 - tJ TOTALS RECEIVED BY: PERMIT NUM/tRS A "----- �_ Numbs Amount NumbN Amount Numb!'__ Amount k,:CEIPT r 3105 ,. f L.ICENF )R PERMIT BOND THE /ETNA 'UALTY AND SURETY COMPANY Hai, urd, Connecticut 06115 LIFE&C-ASUAL TY NO. 42 S 36518 BCA KNOW ALt_ MEN BY THESE PRFSFNI S: That we, Sproul. Excavating Company, Inc. as Principal, and THE k1 NA CASUALTY AND SURETY COMPANY, a corporation organized under the laws of thin State of Connecticut with its principal office in the City of Hartford, Connecticut, as Surety, are held and firmly bound unto City of Tigard., Cregon as Obligee, he full penal sum of ONE THOUSANA TWO R"MRED AND NO/1,')O­--------- ($ 1 ,200.00 ) Dollars, lawful money of the United States, for the payment of which, well and truly to be made, we bind our- selve our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the above bour en Principal has obtained or is about to obtain from the said Obligee a license or permit for Sewer hookup and the tern of said license or permit is as indicated opposite the block checked below: ❑ Beginning the day of 19 and ending the day of 19 U Continuous, beginning the6th day of June 19 79 WHEREAS, the Principal is required by law to file with City of Tigard, Gregor, a i-nd for the above indicated term and conditioned as hereinafter set forth. NOW, TIfEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the above bowided Principal as such list:n- see or permitee shall indemnify said Obligee against all loss, costs, expenses or damage to it caused by said Prin- cipal's non-compliance with 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-compliance shall occur during the term of this bond, then this obligation shall be ,oid, otherwise to remain in full force arid effect. PROVIDED, that if this bond is for a fixed term, it may be r.mtinued 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 the Surety shall so elect, this bond may be cancelled by the Surety as to subsequent li,.1bility by giving thirty (30) days notice in writing to said Obligee SIGNED, SEALED AND DATED this 6th day of June 1979 THE /ETNA CASUALTY AND SURETY COMPANY By Lois M. Mulkey Attorin,Fect IS-21311 ED 2.73 PRINTED IN U SA.