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10900 SW 121ST AVENUE-2 FILE NO. 121ST AVENUE-10900 STR. OPN. PERMIT Ch o OF T10A1W EXPENDITURE REIMBURSEMENT REQUEST I This form is a multi-use form. Where appropriate receipts must be attached. Documentation is important for .11 purposes. Staple documentation to form. VENDOR NO: DATE: Z_' PAYABLE T0: Requested ►.y: i 0 9 Z � ick Y -7ZZ S � G --CSGGC^:CL•CCC GCGCCGGC::C�-�.:GG:YC C-.G....- �--�GGGC�CCCC-GCC-..C--C-C.�ACG-G-L - MISCELLANEOIS (park::.g, books, subscriptions, dues, memberships, etc. ) : Date Description Account No. Amount ZI REFUfJ1J „ „C �ri 10-ZZC©O SD,�o _ a,bra eaR-o eavexscrnraaarra acaceccGva_.�= _G_____c=-=c,.=r�_ccer_c-GG cr__ssc=cccc ec e.-GCGeeevei GENERAI. MEAL EXPENSE: •Dr to Description Amount Account Number to be charged: _ Total L`s.C__�3Rt G6GQrrQrrrrr: r66SICCCCL[CP6G6C^.T-CCG=CG-�=�C-G^.�:C.�CSC Ga s.-�CT3DCC aCOCC.-..CGfl MILEAGE: Date Description: (Include end/start readings end total. miles) Amount i Account Number: Total--- miles x$.21 •.rrrrrrrrrrrrrra.rru rrav ue.r_ery r.r_avc_.v_vcon:cr_::Qa� va�=av eeaaamrmar_aea-=parr rr_Q i'.PPROPRIATION BALANCE: - = uA OF: _ Signature APPROVALS (if $25.00 or under may be reimbursed through petty cash) : (up to $500.00)Section Manager 4 V Purch. Agent ($500.01-$5,000.00)Dept. head/Purch. Agent �a i � V 77, ���i'Y c= J� �`�•- �'-���'f i�-� �� G� �/ PSC/ '�' , To" CITY OF TIGARD Trir —y Evangelical Church 13125 S .W. Hall. Blvd . 10900 S .W. 121st Avenue Tigard , Oregon 97223 Tigard , Oregon 97223 SUBJECT ------ ----- --— ------ --- --- -- — l Strret use permit # 293-88 MESSAGE Gentlemen: Regarding the street work we DATE4-1-89 performed under permit # 293-88 issued on 8-26-88, we wish to request the release of. our $150.00 deposit, if this is acceptable. i Sincerely, Bruce Pearson SIGNED -- — REPLY nArE i _ SIGNED RECIPIENT: REPLY ON PINK COPY — RETAIN WHITE COPY ANS h��s� MF ►� Ole 'ice Rk-l.t�'h�E". C� APPLICATION — STREET IMPR -MENT/EXCAVATION c PY TO: )ISLORDINANCE NO. 74-14 (WHITEFILE [3 (YELLOWW)-INSP. (INSTRUCTIONS ON SEPARATE SHLET) U ( -OTHER AGENCY r-] (BLUELUE1-APPLICANNTT APPROVED APPLICATION NO.: NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT. S— PENDING FEE. PMT. ❑ CITY HALL REC ?T O.: } PENDINGSECU'VITY ❑ PUBLIC WORKS DEPARTMENT 8Y DATE_ PENDING AGENCY "OK" ❑ Application and Progress Record MAINTENANCE BOND II—_ PENP114G INFORMATION Ll FOR STREET IMPROV EMENT/EXCAVATION ASREQUIRED c L PENDING VARIANCE ❑ (EXPIRATION DATE. PERMIT NO.: Z ^�L.�— DATE ISSUED: ._ BY: (1) AFP O ISEREBY MADE/TO EXCAVATE FOR AND INSTALL -- f-_- 5�� _` CZ1� C'o/-C Cu�AESCRIBED HER IN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT !' yci cd*r��v/Z"� C ,I NAME �, ADDRESS — CITY- PHO14E CONTRACTOR fuC_L�L� - ! PLANS B Y �A� DwE CITY - ---- s�l NA DC'�RESS �1• AMU-N�— ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S DOLLARS sOR OfFICErJ�j�j�;, v✓ ,,Q_d..� MIN. (2) EXCAVATION DATA: 0.04 x s _— STREET _DESCRIPTIONPROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED 1'rEM DATE REMARKS/TYPE B'/ TYPE LENGTH WIDTH DEPTH ITEM____& QUANTI i Y STREETOPE —� ;.4SP FI TION E Q — U ESTIMATED STRECT OPENING DATE: S ESTIMATED STREET CLOSING DATE: ____ -.-- f � � E D STREET (3) SECURITY NO. SECURITY AMT S _ �' �J CLOSED SURETY CO FINALAl a901407. C t H 71 r IL c.t11 i.H CASH 901407. 1NSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS: FEATURES, EXCAVATION LOCATION AND LY.TY I I /,CURB - At 4, 1 (S) NOTE THE CITY OF TIGARL, TOES NOT, HEREBY. GRANT PERMISSION TOA PL4NT G - WHERE � r S TO CONDUCT WORK WHERE RIGHT OF-WAY JURISDICTION I_2 THAT OF WASHINGTON COUNTY CTR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERT( ENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR MAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS 4 ( APPLICANTS SIGNATURE DATE C,I T i' OF I I 6ARD RECLD T OF PwolENT FFINT f EW-iNGELICAL CHRUGH RL:C[-IF,T t'40'. PAYMENT DATE: oa- -88 QH- 9 7 22' BLOCK NO/ADDF-s 109011 SW i'lPIOUNT WA117.1 Cli" h"'YPIE" r AIIOU14T F'olO ''.U. 00 PULIL.lL 111PRUVEMENT F'CRMJ.T_, 00 i-iPIOUP-O' PAIO 1";6.CIU 109W S.W. 121 sr A/enue, Tigard, C n 97223 x T•err .'�r �,��'', - TRINITY EVANGELICAL CHURCH 8-8-88 City of Tigard 13125 S.W. Hall Blvd. Tigard, Oregon 97223 Gentlemen: We submit for your review and permit, two copies each of our plans for the installation of an area drain line along the N.E. portion of our property to S.W. 118th Court. Enclosed is a copy of our site plan, installation plan and curb & sidewalk detail alongwith the property easement as requested. Our estimate covering the work involved on city property is $150.00. If there is any additional information needed please feel free to contact me at 620-6140. Thank you . Sincerely, M Bruce D. Pearson AUTOMATIC:FIRE PROTECTION �.� Co. BRUCE PsA1111(910►4 AZO-A14Q 9384 S.W TI(;ARD TIGARD, ORFGON 9 722? -SW • 118.Id Cr, � NoRTI.� Lor 44 _ .— SCJ•I I`� Q 4 TRIM i 7-V r'VANGEL l CA [ OduRe-IJ 3 z CL 3 v) i QSo.z9 S.J• I-Z s' AvE. S�iJi6 7 i 4,AQ,4, AREGoni l oA 3 A� yz�►� r• d dblerd S� ' ll�r�' Lr• t-- J"465 MW ter 4S - :y I Ler 444 Lor I 5 8 � � _ I LAW I 90,01 1s,16z - -PASS tNSF, sky'xr;�P, p�lwtll Par. co. er�tKsre p q3 A"� PE,�F D«iii PAPE fx sr. 7—wiry CMWEIICAt 8JURtP r/4Aa6 , 0R644W mAd /'so' 7.F �lo�zr�J --CORE DRILL EX/Sr CuQg i + 5Cd cur ¢R6 ova EX�Sf �Rr�Ewr.�/ K�P1pCE S'St Tronl E101" wQrEa ❑ ❑ -- ______� �_ w 1 .n LOT 4s "� LGr QQ, 0 5' u rl L i ry EAS EM fnv r �ILFIJlile ? 2a1z,r3 �fI'/JIL. SCA(( 4` = I'•v" rizi4ITY fv,v,v�ELici�L Cf.rY;�c;' r j,-Ai A , DREG oal 3 aF 3 EASEMENT AGREEMET This Easement Agreement made and entered into this day of 1987 , by and between JIM EHLERT and DEBi:Y EHLERT, husband and wife , hereinafter "Grantors" and TIGARD CHURCH OF THE EVANGELICAL CHURCH OF NORTH AMERICA, hereinafter "Grantee" . W I T N E S S E T H: WHEREAS, the parties are the respective owners of adjoining parcels of real property situated in the City of Tigard, County of Washington and State of Oregor, which parcels are described as follows: Grantors (Jim Ehlert and Debby Ehlert) : See Exhibit "A" attached hereto and by this reference incorporated herein. Grantee (Tigard Church of the Evangelical Church of North America) : See Exhibit "B" 'attached hereto and by this reference incorporated herein. WHEREAS, Grantors are willing to convey an easement for utilities to Grantee; NOW, THEREFORE, in and for the consideration of the promises herein made between the parties, each to the other , and of the covenants and agreements hereinafter set forth, it is agreed as follows: 1-EASEMENT AGREEMENT Conveyance of Easement. Grantors hereby grant and convey to Grantee, its successors and assigns , a perpetual easement over , under and across a 5 foot wide strip extending along both the north and south boundary lines of the real property described in Exhibit "A" . This easement shall run with Grantors ' land and the title thereto, and shall. be binding on Grantors and their heirs, assigns, successors and any person whc shall hereafter acquire title to Grantors ' property. This easement is for the benefit of the real property described in Exhibit "B" , and shall run with and be appurtenant to the real property described in Exhibit "B" . IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first above written. GRANTORS: JIA EHLERT DEBBY EHLERT GRANTEE: TIGARD CHURCH OF THE EVAN EL L CHURCH OF NORTH AMERIC By: STATE OF OREGON ) n , County of Personally appeared the above named Jim Ehlert aA4--Bebby B*4*.-rt, fe, and acknowledged the foregoing instrument to be his voluntary act and deed. 2-EASEMENT AGREEMENT BEFORE ME: �~ , Notary Public for Oregon My Commission expi.zes: STATE OF OREGON ) 1 , ^ ) ss. County c f _ n�-4fl ' �'` ) Personolly appearedUJ�7�uX' /, �� 10,(Ao being duly sworn did say that%-� is the\J � C_. of Tigard Church of the Evangelical Church of North America , and that said instrument was signed and sealed on behalf of said organization by authority of its board of directors; and,,441acknowledged said instrument to be its voluntary act and deed. BEFORE ME: Notary Public for Oregon My Commission expires: q7TH 3-EASEMENT AGREEMENT EXHIBIT "A" Lot 44, Penn Lawn Estates #2, City of Tiqard, County of Wasington and State of Oregon EXHIBIT "B" Beginning at the Southeast corner of the Southwest quarter of the northwest quarter of Section 34 , Township 1 South, Range 1 West, Willamette Meridian, Washington County, Oregon. Running thence East 25 feet to a point on the East line of 121st Avenue as said street has been relocated running thence East along the line dividing the North and South halves of said Section 34 ; 453 .49 feet to a point in the center of S .W. 119 Avenue as shown on the recorded plat of Panarama No. 2, running thence Norch 0 dea_rees 15 ' West on the Northerly extension of said cent line 480. 29 feet to a point running thence West parallel with the South line of the Northwest quarter of said Section 34 ; 453 . 48 feet to a point on the East line of S.W. 121st Avenue, running thence South on said East line 480.29 feet to the true point of beginning; less the portion of said real property described in Exhibit "C" attached hereto and by this reference incorporated herein. EXHIBIT "C" A tract of land situated in the northwest 4 of Section 34 , T-IS, R-1W, W.M. City of Tigard, Washington County, Oregon: Beginning at a point on the east-west 4line throuyh said Section 34 N-89 degrees 54 ' 50"-F 1664. 11 feet from the w corner on the west line of sai3 Section 34 ; thence: N-00 degrees 05 ' 10"-W 80. 00 feet; thence: N-89 degrees 54 ' 50"-E 109. 63 feet; thence: S-00 degrees 21 ' 18"--E 80. 00 feet to the east-west ; line ; thence: 5-89 degrees 54 ' 50"-W 110. 00 feet to the Point of Beginning. Containing 8 , 785 sq. ft. A tract of land situated in the northwest ' of Section 34 , T-lS, R-1W, W.M. City cf Tigard, Washington County, Oregon: Beginning at a point on the east-west ; line through said Section 34 N-89 degrees 54 ' 50"-E 1570. 68 feet from the corner of the west line of said Section 34 thence: N-00 degrees 05 ' 10" 100. 00 feet; thence: N-89 degrees 54 ' 50"-E 202. 96 feet; thence: 5-00 degrees 21 ' 18"-E 20. 00 feet; thence: S-89 degrees 54 ' 50"-W 109 .63 feet; thence: 5-00 degrees 05' 10"-E 80. 00 feet to the above said east-west 4 line; thence: 5-89 degrees 54 ' 50"-W 93 .43 feet to the Point of Beginning. Containing 11, 535 sq. ft. RECEIPT FOR CERTIFIED MAIL-30f, (plus postage) SENT TO '— POSTMARK '1�'l�ity Evangelical Chur116D OR GATE 117 STREET AND NO. P.O., S TE AND ZIP CODE —'�EOR AD(j) REVON t Sbeiei Le whom end date deliveRECEIPT WHh delivery to addreuee 4SERVICET- Shawsto wham,date and where-___. _ _ Wlth delivery to addressee _OEIIVERTO AODRFSSEE ON(Y - �SPECIAL DELIVERY (antra Ess required) PS PermNO INSURANCE COVERAGE (See ether ride) Apr. 1971 3800 NOT FOR INTFRNATIONAL M �OPO 1077 O-4ee-1e3