13815 SW 115TH AVENUE FILE NO. �
--T1.5TH AVE. - 13815 STR. OPN. PERM
�F
October 21, 1975
Decal Construction Company
0317 SW Flower
Portland, Oregon 97201
Ge nt:1eme n s
mor your records, enclosed plea,.: find permit 0 15-75
vary truly,
J. ;. Hagman
Superint�indent Rngineer Division
JH s In
Mncl.osure
City of Tigard
INSPECTION REQUEST
p
or
J
INSPECTION TIME: _`' I PERMIT NO. :---
DATE:
O. : _DATE: L / 2S DATE ISSUED '.— /
OWNERS NAME eaLA.JIn
ADDRESS '------,. SLA_. I I '
CONTRACTOR
TEST : Air p, Water Q , 'usual A?, Laboratory p
RESULT: Approved ),�, Cieapproved O , Pending
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INSPECTOR r. DATE
rNOTE Attach fupple,nentel "Jot data bereta]
APPLICATION — STREET IMPRr 7MENT/EXCAVATION copy ro.
ORDINP- ,gCE NO. 74-14 IwF11 TE) - FILF
(BLUE) -INSP.
IINSTRUCTIONS ON SEPARATE S+HEET) �] IVELLOWI OTHER AGENCY
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APPROVED x APPLICATION NO.:
NOT APPROVED p CITY OF TIGARD, OREGON FEE AMT.: q ��
PENDING FEE. PMT. p CITY HALL RECEIPT Mf:).: -- I �O I41
X71
�� `'{n' `---- PUBLIC WORKS DEPARTMENT BY
PENDING AGENCY ''OK" p Application and Prugress Record — — — — — — — —
PENDING INFORMATION EJ FOR STREET IMPROVEMENT/EXCAVATION til AllkUREQU EDO *—`g 45L'
PE14DING VARIANCE ❑ ANNue L d- I'
_-_ EXPIRATION DATE- $���v_�--22—
PERMIT NO.: _ -- /5--75 DATE ISSUFO: BY: --,
_ -
�.zs��
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL c- f-) S
��—L� AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _/A J. 1`k 3 ^C:4
1. PMON¢
CONTRACTOR D`C� Co�_S�T4w _ �, 1,1 S ou f� a�.r.<1� �). .-- �YG l$?aN
NAME ADDRESS CITY •HONE
NAME ADDRE58 CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
_ —_-- - -- - - OOLLARI
(2) EXCAVATION DATA: 'OR OFFICE SE: �o--- UMIN;LL—
STREET _ _ DESCRIPTION _FROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL It9STALLrn
_TYPEI LENGTH WIDTH DEPTH ITEM & G'UANTI,r.^
ITEM DATE REMARKS/TYPE BY"`—I 4c? -- _- STIiCET
h/ ctu L �r�? INRIPEC• --
R TION
Q
ESTIMATED STREET OPENING DATE:-_ / I4 / 7S_ ES
ESTIMATED STREET CLOSING DATE: T - --- --
F_
STR
-
(3) SECURITY NO. C IjYA ^E --- tl
OEET
r� OSEST
SURETY CO.: Kh NAL_ _ CERTIFIEDCNECK ❑ CASH ❑ EpN SPEC.(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL CIALPROVIS NS/CONDITIONS
FEATURES; EXCAVATION LOCATION AND !XTlNT. � IC- = �I//I�` d— HLYL-'�i�—__--
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1 I 10
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(5) NOTE THE CITY OF TIGARD DOES NOT HEREBY, GRANT PERMISSION TO APPLICA14TS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OIr WASHINGTON COUNTY OR TNR: STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONnUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
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APPLICANTS SIGNA TORE �• /r / � •
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: /.*00Pn7 PERMIT NO. :
DATE: DATE !SSUED :..
OWNERS NAME :
ADDRESS: 11-3S'/S
CONTRACTOR : -�� Cr /
TEST : Air '"„ Wcte-JV, Visna: �1. Laboratory C
RESULT: Approved
Disa;)provej � ', ending L
SKETC'�:
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3), bo-)e,
;•'INSPECTOR DATE
COTE: A4tach fupplemintal�t4st data hereto l'
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AS -- BUILT
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�4S __ 131'ILT
CITY OF TIGARD
Dab /p7AmountL
6/ dollars
Cash
Name e ' M.O.
Ad.4ress
_..�.....
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Bldg. - ❑ St.Opng. ❑ Bus.Lie. ❑
P 16g. ❑ Pubctns. ❑ Bike Lie. ❑
Flctl. E] Copies -
❑ Sew.Serv. ❑
Sewer
❑ Filing - ❑ Fine&F. ❑ I
Assml.
El 06.9r - Zoning ❑
`1
For.
Permit P —
OTY 16F TIGARD
By:
G _ yPMIfCNlN�A1Ni1NOOfifllONfN�
10016
., ')ATE
NOtifnal I3')nJin4 nstd AcciJelnt Innsttrance Company
c/o In.,.co Insurant:a Servkes,Inc.
?09 Chet Avenue West,Suite 315,Seattle,W:mhington 91119
R11) VR
To he attached to and form a ,cart at' Bowl hla. �?n���n .issued b i
NATIONAL I ONNI1lI; G AND M."C"IDENT M^'AUI.ANCC COMPANY, dated the 16thday
on
• ;: W; e of Ore,,o:i
and to favor of
In considertion of the premium c bir cd, it is unil,,Mood and agreed that:
Calvin ", 1at,,r ba r,�rCnl ron trilr:t;irin`erne, 11bi l i.nj Compnny,
Provided, howcvcr, that 0m, IiaG,,ility of 1` iMONAL ROP1,4D. MC. AND ACCIDENT
INSURANCE (;{.?s1tPMJY. terrier fl,W ctt:nl7d by tleis rimer shall oot
be cumulative.
Nothing herein contained ,shall l+t* held 16 V-11 1-YAv:9, 7ltexr or oxtenal tiny of the tertn%
Conditions, agrcrr?:e*nt�s car trarrvttt�iCS tat' 1110 :7�nn•,Tnlenti weed bmI0, other than as stated
abov^.
Signed thia—..=t,0Ul7y
Acropt^d:
M1)11�,t, A145 AC,
+( 11)FNT
tnl Co•a wtt � hitt
ren~i ai 1r,1' f I Yt ADIl1 C0 ;'`a2"JY
By 9
' r'1tti►rrll:.y-p,, 'Gt'3 �,;�J'� 1►,1Pt�wz,n
r
b-7
Nn 47111 WA
24L-:5S
r• .,,.� *' BOk 1UMGER X89'+so_
(Show fol r name and assuwcs business nary a, if any)
BOND FOR SMIAGE DISPOSAL SERVICE BtIINESS
MOW ALL JIM BY THESE PRESENTS: That we,^ TMeCni Congtruceio•r E Piambinq
as Principal(s),
and NAtonnl Pnnit�y1lc�i,'�nt Cemmr�pg
a corporation organized Aird existing under the lams of the State of New York
And drrl,y arrtho:17ed to transact a surety business in
State of Oregon, as Surety. aro held and firmly hoand unto the State of a
Oregon in the sum of TWO WONFA'0, FIVE 111JIMMEO DOLLARS ($2,500.00) lawful
money of the United States, for the payment of 01-h arell and truly to be
made, we hind Ourselves, nIlr 1'eirs, enocr:rtorS, administrators, successors
and assigns, Jointly and severally, firmly by these presents.
THE COMITIONS OF T11M OMTM TTOfl ARE SUCH TH,gT: Whereas the abbve
named principal(s), pursuant to Oregon Revised Statutes (hereinafter referred
to as "QRS") Chapter 454 grid pursucnt to rales of the Environmental Quality
Commission of the State of Oregon pertaining to standards for subsurface
sewage And nonwater-rarried waste disposal, Oregon Administrative Ru1'!s
Chanter M, dilrisinn 7, is (114e) Applying to the Department of Environmental
Quality for a 14conso to engage in the business of Sewage Disposal Service
As defined in ORS Chapter 454.
N014 THEREFORE, if th•: said principal(s) above named shall faithfully
comply with all Applicable statutes and miles of the State of Oregon, then
this obligation shall be null and void, otherwise to remain in full farce
and affect.
As provided by ORS 454.70s, Any prrsnn in.irrred by eailurri of the principai(s)
to comply with the above conditions in performing work shall have a right of
Action on this bund in his m.n name in tho maxirmim aggregate limit of $2,500.00,
provider] that written claim of such right of action shall he made to the
principal or the surety company wi0in two years after services have been
performed.
This bond is effective beginn'ng 23 , lh 75,
IN WITNESS WHEREOF, the above ,lamed parties have rxecutgd this
instrument the ,2rrh day of 19
Corporate
19.3,x.
M1
Corporate Seal beeal Pnn!jtrunt+nn r w, «�g, ,,nv _
of Principal
(if corporation)
National Bondima 6 A �
Surety
a �"'
Corporate Seal Dy ' �. 1•ry; a
of Suretyt
u+rn'y- ri r-Hatt
Uocty Arun Markham
Countersigned:
��Pid•err�gent for• Ureyuir�'
Address
Data: .,
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