12560 SW PATHFINDER COURT FILE td0. —R 7 STR. OPN. PERMI,Z„
PATHFINDER NAY -- 12560
CITY OF TIGARD
F.XPR41)TT(TRE RTVJE5V
This form is a multi-use form. Appropriate receipts must be attached. Documentation
is important for all parpose-, Staple documentation to form.
VRMOR NO.: DATE: 5 31 ` `�C
PAYABLE TO: I�r, M i�G �a L., ----------- RD7JESZ'ED BY: WV
---- t,� v
Approved requ due Wednesday
10:00 AM to A/P for checks by
R iday.
MZSCEL ANDOUS EXPFNDTIURIS:
Date Description, Invoice No., etc. iccount No. Amount
_--
Mileage $0.255
APPROPR=ON BAIANCE: -- _ AS OF:
(Up vo $25.00) Section n%-oger ._ _ ._ Kirch. Agent
($25.01-2,500.00) Division Mam-iger($2,500.01-7,500.00) Dept. Head
($7,300.01--15,000.00) City Administrator
($15,000.01- ?) Local Contract Review i3aarci
V;.
DeCal Construction and Plumbing Co.
10206 N. Midway, Portland, Oregon 97203
Westside Eastside North
246-3895 255-2965 285-2146
May 30, 1990
To Whom It May Concern :
We have no claim on the $400.00 deposit Mike Regan put down
for work done at 12560 SW Pathfinder May 7, 1987 . Receipt
#22217.
Sincerely, .,,C.
, ' 60—f
Kim Baty
Office Manager
��,/ c /c�eG-1
APPLICATION STREET IMPF 'CEMENT/EXCAVATION COPY TO:
ORDII, .ACE NO, 74-14 f (WHITE)-FILE
(YELLOW)-INSP.
(I NSI RUCTICNSONSEPARATESHE EY) ❑ (PINK)-OTHER AGENCY
54 (BLUE)-APPLICANT
APPROVED ❑ APPLICATION NO.: ._293
NOT APPROVED ❑ CIIY GE TIGARD,OKI".(.ON FEE AMT, S — 16
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO. 04
`O. -72
/ 7
PENDING SECURITY (> PUBLIC WORKS DEPA R TMEN T BY .%E DATE "r_L_�_1�
PENDING AGENCY "OK" ❑ Application and Progress Record - -
MAINTENANCE BOND __
ENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE CI - EXPIR!t ON DATE j _`
PERMIT NO.: _ 251--87 DATE ISSUED: --5 _7- / .87 BY
( 1 ) APPLICATION 'S HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FALL ACCORDANCE WITH CITY REQUIREMEN
APP ICANT in,.M.i c.e_ Re�aan 1.2560 SW Pathfinder Ct .
NAti+E"�"'--"—" woowcas
CO
TRACTOO�sDeCal Plumbing 0317 SW Flowe`rT�ortland Fb389:
CITY
PLANS §Y
NAME-- ---ADDRESS C11
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S _ 400.00
DOLLARS
- FOR OF/ICE USE:
(Y) EXCAVATION DATA: 0.04 x s 400_
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
Watkins AC 20' 2 �— STREET
�— P N U S
INSP C.
R TICK S {!l L e� / % .t 1
E
Q
U
ESTIMATED STREET OPENING DATE . 5 / 7 / 87 EI tel,f7k,,
ESTIMATED STREET CLOSING DATE. _ � ....-11 / 87 T
- F
_ D
(3) SECURITY NO. SECURITY AMT. $ STREETCLOSE
SURETY CIO.: ------- check FINAL
CE-RTIFIEU CHECK n r_ASH U BOND C INSPEC.
(4) PLOT PLA14 INDICATE SITE PERTINENT PHYSICAL' SPECIAL PROVISIONS/C64-61TIC Sr \I
FEATURES: EXCAVATION LOCATION AND EXTENT.
ZSLD SCJ u,,y�+ —_gtreet traffic control is
1 I J 1 1 contractor' s respons ' ilit�'
I I 1 I
L 1 h
T
1 I I ICA
.,l
(5) NOTE THE CIT'! OP t IGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT"OF"WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF rREGON.
THC: 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 ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE C' `�f
DATE )I
/
i
CITY®F TIOARD No. 222.17
13125 S.W. HALL BLVD.
P.O. BOX 23397
TIGARD,OR 97223
Name
Address --
Lot Block/Map Subdivision/Address
i
Permit #Is Bldg Plumb Cash
'•i Check
Sewer Other Other -
Rec, ey i
Acct. No,
10-432
Description Amount
Building Permit Fees
10-431.600 Plumbin Permit Fees ---
10.431.601 Mechanical Permit Fees----
10.230.501 State Blda. Tax
10-433 Plans Check Fee -- —
30.443 Sewer Connection _ --
30-444 £ewer Inspection -- -
51.44$ Street Syst. D- ev. Charge -----
52.449.610 Parks I Syst. Dev. Charge
52.449-620 Parks II Syst. Dev. Charge -
31.450 Storm Drainage Syst. Dev. Charge
10.430 Business Tax
..... __... . __..,.. 10.434 Alarm Permit
10.227 Ball _
10.455• Fines • Traffic/Misdlparking
10-230-
FIA Traffic/MIsdlVic. Asst.
10.456 Indigent Defense -- -
30.122-401 S saver ServlcelUSA - — —
30-122.402 S,awer ServlcelCity 30%
30.1<3 Sewer SevicelCily Maint. —
30-125 Unmatched ---
31.124 Storm Drainage
40.47P,— ancrofi�rin. Pymt.
40-471 Bancroft Int. Fymt.
tTOTAL
C1.1
CUSTOMER
PLEASE TAKE THIS TO 7-HE CASHIER FOR A RECEIPT
NAME: DATF:
_ ACCT,—N DESCRIPTION
AMOUNT
—...-.-
10-22000 Refundable Performance Bond Depu4it
10-43500 Sign Permits HOP TU
10-43600 Public Sewer Plan Check/Inspection Fee— $........
10-43600 Public Storm Plan Check/Inspection Fee
!0-.43600 Street Dedication/Public jMrovoment. �ree
10-43600 Stree.t. Opening Permit
10-43601 Street and Traffic Marking_—
21-44200 Street Light Fee
10-43700 Subdivision Applications:
S MI-P
10-43000 Zoning Applications:
ZC CPA ZOA PD Misc
SCE Cu SLP
10-44000 Other Planning Foes:
SDR
Non refundable portion of Appeal Fees
10-22000 Refundable portion of Appeal Fees
10-45100 D,ment Sales:
--- - Planning Bldg,
10-43000 Business
TOTAL $
1045P/0023P
Pont It"routing request pad 708A
ROUTING REQUEST 7171,r 7
Please
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