The URL can be used to link to this page

13110 SW FALCON RISE DRIVE-1 F:[LE N0, liL,t.,d/.� STR. OPN. PEPIKIT FALCON RISE AR. - 13110 -- 4 APPLICATION - STREET IMPRr 'c-MENT/EXCAVATION copy ro: ORDIN.../C.E NO. 74-14 p (WHITE) INSP[ (INSTRUc BIONS ON SEPARATE SHEET) ❑ Ir[LLOW)-OTHER AGRNCV (PINK)-APPLICANT APPROVED ( APPLICATION NO.: 4 NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: $ ' PENDING FEE. PMT. El CITY HALL RECEIPT NO.: f T Z-3 PENDING SECURITY ❑ PUBLICWORKS DEPA8TMENT BY-__ DATE- ZL'��- � PENDING AGENCY "OK" ❑ Application and Progreac Record MAINTENANCE BOND M PENDING INFORMATION ❑ FOR STREPT IMPROVEMENT/EXCAVATION ASREQUIRED D ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE:_ �_— PERMIT NO.: [ _3 K > DATE ISSUED: l��l Y_� BY: (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL -- ---- AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT ss 57j f(�J�,�4'au�/sE ),< TiGV _ � SZ - 3 NA M[ 'DON CIT- PHONE CONTRACTOR. Cyn1 S rQvc ne.1 gy-zd �w�`0? ,�/p (e�2�S4 L —�DDP CITY PHONE PLANS BY�(1T •�Psiic.t�c� DZ7 [f C' C 1-fii PROF d-- ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S DO _"___•----mss �-.— -� -- - DO LLARf (2) EXCAVATION DATA: !� POR OPFICS USK: `--""-- ❑M111, -.- 0.04 X$.L��,i -- —_ STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED Y TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY ITEM DATE REMARKS/TYPE BY � t'�=:Sl IN Ti U ESTIMATED STREET OPENING DATE: 7 / ESTIMATED STREET CLOSING DATE: 7Z/3/f 3 / _/ E -- - -- �_- --- - _ D (3) SECURITY NO.'` c -_3 ZSE UF�ITY AMT.: s �� ' � STREET SIJRETY CO.: it , /(-f " i�`� . FINAL r CERTIFIEDC`4rCK D CASW o fUN7'^ INSPEC. l (4) PLOT PLAN: INDICATE SITE AERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. R.1 I 1 cults �w Fi►�� -(ug. I to 1 LOT I I - 1 I I I 5i NOTE: THE CITY OF TIGARD DOES No,.*. ►IEkKOw, 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 REOUI4IED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CO OF THE WORK, AND TO SAVE HARMLESS THE CIT/ AND EMPLOYEES AGAINST ANY INJURY OR Dj I JAAGE WHICH MAY RESJJLT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE: �Lt� DATE / / 1r3 CITY OF TIGARD-12420 S.W.MAIN-TIGARD,OREGON 97223 RECEIPT Od DATE:- '7-/.2-�3 -AMOUNT: S -- ----------- - o _-- ------- __ - ' fjOLLARS NAME: CASH -- ADDRESS: ------ �� --.------- M.O.: --- - 0 OF FOR: ACCT. 0 PERMITS SURCHARGE AMOUNT SEWER BILLINGS 40-364 BUSINESS LICENSE 05-331 PLUMBING PERMIT 05-332 MECHANICAL PERMIT 05-332 BUILDING PERMIT 05-333 SEWER CONNECTION 40-363 SFWER INSPECTION 40-365 SYSTEM DEV.CF,ARGE 25-366 PARK DEV. CHARGE #"1 30-367 PARK DEV.CHARGE #2 30-368 ZONING ADJUSTMENTS 05-362 --- TOTALS RECEIVED BY:J - PERMIT NUMBERS ASSIGNED: Number Amount Number Amount Number Amount -- S - ----- $- _-- ---- $ RECEIPT 'p 1412 3 "_MFRICAN STATES INSURANCR COMPANY INDIANAPOLIS,, INDIANA EX 490-352 LICENSE OR PERMIT BOND KNOW ALL MEN BY THESE PRESENTS, That we Wedgwood Homes Inc. as Principal, and the AMERICAN STATES INSURANCE COMPANY, with its principal office at Indianapolis, Indiana, as Stirety, are held firmly bound unto City of Tigard, Oregon _M9fn 1 ny_H 1,_J j_s .Subd i y Is Ion hereinafter called Obligee, in the penal sum of _.TWQ Hundred and No/100ths - - _ _ _ _ - ' 200.GQ----- _)Dollars,for the payment of which well and truly to be made we do hereby bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Signed and sealed this _ 12th day of --_.,I_u1y _ 19 83 WHEREAS, the said Obligee has granted or is about to grant to the said Principal a License or Permit to engage in the business of ._Sfreet Cutr NOW THEREFORE, if the said Principal shall indemnify the Obligee against any loss directly arising by reason of the failure to comply with the lawn,ordinances,resolutions,rules,and regulations governing said business,then this obligation shall be void,utherwise to be and remain in full force and effect. PROVIDED,HOWEVER,that the Surety Phall have the right to terminate its liability hereunder by er:ving written notice upon the Obligee thirty (30) days in advance of its intention to do eo. Term of 13ond: _ J u1 12—_ 19 83,to July 12 1884 I WS t? Wedgwood Homes Inc. ^r��' Principal ' F JRICAN STATES INSURANCE COMPANY By Cheryl E: WRight Attorney-in-Fact 9.1608(1.79) GENERAL f'OWEP Or ATTORNEY Americ-a States Insurance %.;ompany INDIANAPOLIS, INDIANA KNOW ALL MEN BY THESE PRESENTS,that American States Insurance Company,a Corporation duly organized and existing under the laws of the State of Indiana,and having its principal office in the City of Indianapolis,Indiana.hath made,constituted and appointed,and dope by these presents make,constitute and appoint-- ------------------------------CHERYL ppoint__------------------------------CHERYL E. WRIGHT------------------------------------ of—_Portland and State of Oregon its true and lawful Attorneys)-in-Fact,with full power and authority hereby conferred in its name,place and stead,to execute,acknowledge and deliver any and all bonds,recognizances,contracts of Indemnity and other conditional or obligatory undertakings, provided, however, that the penal sum of any ori- . uih instrument executed hereunder shall not exceed FIVE HUNDRED THOUSAND AND NO/100 ($500,000.00) DOLLARS---------------------- and to bind the Corporation the,eby as fully and to the same extent as if such bonds were signed by the President,sealed with the common seal of the Corporation and duly attested by Its Secretary,hereby ratifying and confirming all that the said Attorneys)-in-Fact may do in the premises.This Power of Attorney is executed and may be revoked pursuant to and by authority granted by Section 7.07 of the By-Laws of the American States Insurance Company,which reads as follows The Chairman of the Board. the President or any Vice.President shall have power, by and with the concurrence with the acretary or any Asaistnnt Secretary of the Corporation,to appoint Resident Vice.Presidents,Resident Assistant Secretaries and Attorneys-in-Fact as'he business of the Corporation may require or to authorize any one of such persons to execute,on behalf of theCorporation, any bonds,recognizances,stipulations and undertakings,whether by way of surely or otherwise" IN WITNESS WHEREOF,Amsr,:an States Insurance Company has caused these presents to be signed by IN V,ce-President,attested by Its Assistant Secretary and Its corporate seal tc he hereto affixed this 2nd day or December A. D. 19 82 AMERIC ES INSURANCE COMPOY (SEAL) � /0, ATTESToil B ._ Assistem VKePresrAent STATE OF INDIANA Assistant Secretary COUNTY OF MARION} SS On this 2nd day of_ December —.A. D.. 19 82 before me personally clime Alanson T. Abel to me being by me duly sworn,acknowledged the execution of the above instrument and did depose and say;that he is a Vice-President of Ame wn,Wan Stales Insurance Company;that he knows the seal of said Corporation;that the seal affixed to the said Instrument is such corporate seal;that it was so affixed by authority of the Board of Directors of said Corporation; and that he signed his name thereto under like authority. And said _Alanson T. Abel further said that he is acquainted with 'Phomas M. Ober Assistant Secretary o1 h h eculed the above instrument. end knows him to be the 4�M$`t°f if�l�pslON �'xrg��'�s February 14., 1y84 My Commission Expires 4W, tdre STATE OF INDIANA COUNTY OF MARION} SS. 1, Thomas M. Ober the Assistant Secretary of AMERICAN STATES 1NOUHANCE COMPANY,do hereby certifyat the above and foregoing is a true and correct copy of a Power of Attorney,executed by said AMERICAN STA 'ES INSURANCE COMPANY, hich Is still in full force and effect. This Certificate may be signed and sealed by facsimile under and by the authority of Section 8.03 of the By-Laws of AMERICAN STATES INSURANCE COMPANY which reads as follows ''All policies and other instruments of insurance issued by the Corporation shall be signed on behelf c it,r Corporation by the president or a vice-president and the secretary or an assistant secretary, whose signatures, It - Instrument is duly countersigned by an authorized representative of the Corporation,may be facsimiles.Such signatures and facsimiles thereof sttrll be authorized and binding upon the Corporation notwithstanding the fact that any such officer shall have ceased to be such officer at the time such policy or other instrument of insurance shall have been actually issued by the Corporation." In witneas whereof,I have hereunto set my hand and affixed the seal of said Cornarallon,this ( day of A. D., 19_ (SEAL) A Form 9-t/69(a-90) AssislaM Secretary