11630 SW 98TH AVENUE-1 FILE N0.
98TH AVE. -- 11630 -,-, OPN. PERMIT
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APPLICATION — STREET IMPRf_ -MENT/EXCAVATION COPY TO:
L] (WHITE) FILE
ORDINA–CE NO. 74-14
U IBLUEI -INSP.
(INSTRUCTIONS ON SEPARATE SHEET) [_] IP ELLOW) OTHER AGENCY
IJ (PINK) APPLICANT
APPROVED APPLICATION NO.:
NOT APPROVED ElCITY OF TIGARD,OREGON FEE AMT.: f 1 C�
PENDING FEE. PMT. [] CITY HALL RECEIPT N � 'E�I-L^�
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY I DATE
PENDING AGENCY "OK" ❑ Application and Progress Record
MAINTENANCE BONfe
PENDING INFORMATION f1 FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED -�_�-
ANNUAL ❑ CifPENDING VARIANCE ] EXPIRATION DATE: -
PERMIT NO. 7' DATE ISSUED: BY:
s - -
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT CAL B1k.r kf� -7 S,Lk w
, kx7rrfL_ • _Pcpa=,i A�p -J��v��
7� NAME 1 ADDREN C ,n ►�E
-- CITY PHONE
CONTRACTOR D� � . � � s
_ 4gr
NAMr ADDRESS CITY PHONE
PLANS BY !,-' +-- - ----- - - ----
NAME ADORERS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): !i 5a'0 I —
_ DOLLARS
FOR OFFI � - (�iIMIN
(2) EXCAVATION DATA: 0.02 X!
C U
STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SLIRFACE CUT CUT CUT MATERIAL. INSTALLED ITEM DATE REMARKS/TYPE `t7Y
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
-� 't SRET
f.. PTEE ---
-� E TION -
Q
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ESTIMATED STREET OPENIN3 DATE:___ �-^ I—�' L � ES
ESTIMATED STREET CLOSING LATE: ,.L._ E -
/�� � D -- -
- - ..---
Y�MZ(c� - STREET
(3) SECURITY NO . E ITY AMT:: CLOaCD
SURETY CO.: � N_�I _t t"_-1C _ FINAL
CERTIFIED CHECK CASH ❑ SON INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL T SPECIAL PROVISIONS /CONDITIONS
FEATURC9: EXCAVATION LOCATION AND EXTENT.
--� I�-3 -- -_ ---
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, Gr;AA PERMISSION TO APPLICANTS I CONDUCT WORK W1/ERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINr-TON 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
EMPLOYEE A.:AINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. j
APPLICANTS SIGNATURE: DATE
r �r i / 2
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'IN
1. I C I: N s I: 13 0 N l) uorid No, 044,46-2651911 ,
KNM ALL Niel) BY 'MUSE I'Pl:Sl•NTS, 1 ha t „c_- DeC•al_CQnstx:uction "c Plumbing Co.
as Principal,
and C=riean Fidal.ity Fire Inas. Co. it corporation of the State of NOW York
lawfully doing Ln iness in the State of_-_0.'rgon as Surety, arc held and
firmly bound unto_tb&-City of
in the penal suu of_ Five I'uridred and Pio/100 UOLMRS —�00.00 )�
for which sun, µc11 and truly to. I•c paid, said Principal and Surety bind ':hwmselves
,jointly and neverally, firmly by these prevents.
T11E CU\1;1TICN.C1' 1111IS OBLIGATION IS Sull TIiAT,
MIEM%'S, the above bounden __DeCal Construction.Re Plumbing; 6.
is desirous of obtaining; a liee..nne from, the City of Tigard, Qregon _
to carry on business as eerier contractor in said
City.of Tigard, Oregon
for .the period of twelve
..
months, from the_. 25th - ____Orly of J�arruar 1978.
Jit, Tl1E:NL.mlL ' if the gaid DeCrtt. Corstn,ctl.on'&. Plunl:9Co.
shall, during the term ending on the— 25th ' day 19_72-,
faithfully observe and honestly comply with the provisions of "11 Ordinance, of the
City of Tigard regulating_ W-For cQ1itr"�c+�_
City Ordinance 7 -1 ,776-11 -�-
then this obligation shall become void; otherwise to remain in full fore,! and
cif ,ct.
V
PRCVICI.11, IICMEW11, that this bond may be continued from year to year by
certificate executed by the Surety oirl Principal hereon.
SIGNT:D, SEALED AND IMAM? this,__.__ �5t►, 1_ _.day of January _IS 78 .
Ili tness
principal
urnnyy in-1'��ct
4, 36 IOO. 0
00,
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