12215 SW 128TH AVENUE FItZ NO. _
M tv AVE. -- 12215 STR. OPN. PERMIT
TYOf INIGA RD
EXFdNDITURE REIMBURSEMENT REQUEST
This form is a multi-use form. Where appropriate receipts must to attached.
Docuncnta_ton is important for all purposes. Staple -;ocumentation to form.
VENDOR NO: , DATE:_ 4 .-
PAYAl1LF T0: air !fin , e- Requested by: 1,j -
-��.
04 u7, MtLQ"'lA v —
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MISCELLANEOUS (parking books, subscriptions, dues, memberships, etc. ) :
Date Description _ Account No. Amount
1C-ZZO 404 `*o
..........ss.......w....ww....w.........r-.cw....... ............... ............
CENER,a.L MEAL EXPENSE:
Date Description
--- Amount
Account Number to be charged: Tot&
............w..........................................
.........ww..........................w..
MLI.EAG;;
Dace Deocription: (Include end/start readings a:id total miles) Amount
Account Number: Total X20
miles x w
•••.swrs.sww.wswr.wws......... - —.. .-•
w s..+wwAs OF w.■wwwww�+w..w.w.wwwwwwwwwww..wws.w.
IAPPROPRIATION BALANCE: Signature
APPROVALS ( if X25.00 or under may be re1mbursed through petty cash) :
(up to "00.00)Section Manager Purch. Agent
( 1500.01-15,000.00)Dept . Nead/Porch. Agent
INSPECT'"N NOTICE
City of Tigard Building Department
P C Box 23397
Tigard, Oregon 97223
Phone:639-4175
Type of Inspection
Dre Requested / — �71rvw A.M. P.M.
Address � 7T _��"k"07 — Permit # __
Owner y//'CeVy�� Lot #_
Builder
The following Building Code deficiencies are required to be corrected:
.1-
Presented to _ pproved
Inspector _ __— ❑ Disapproved
Date4
CALL FOR REINSPECTION
o vee 0 NO
G��efi
B°s reg°n
dVARD No. 10141
a '^W' ASH
i.8OX 23397 ,
TIGARD,OR 97223 Date
Name � �� �— _ _ � � .;C •-1�
Address ------
Lot Block/01Subdivision/Address
Permit M's Bldg. Plumb
Cash Check
Sewer Othe--�--- --- Othh�" u
er Rec. By,
Acct. No.
DWS "�
cr Iption — —
10-432 Buildin Permit FeesAmoun'
10-431.600 PlumbinPermit Fees - --
10.431.601 Mechanical perrnit Fee— 5— —
10.230.501 StateBld . Ta—x—^ —
10.433 --------- - ,
Plans Check Fee —
30.443 �--— — -
Sewer Connection
30-444 Sewer Inspection
51-448 Street Syst. Dev,Char e
52.449.610 Parks I Syst. Dev. Charge
52.449.620 Parks II Syst. Dev. Charge
31.450 Story m Drainage Syst, Dev. Charge - ?
10.430 Business Tax — —'-
10.434 Alarm Permit
10.22;
10-455. Fln—es • ralf /Mlyd/Parking
10.230- CPTA Traffic/Misd/vic. Asst. —
10.456 Indig ne et p Tense
30.122.401 Sewer Service/USA ---
30.122.402 Sewer Service/CIt� 30% _
30.123_ Sewer Sevice/Cityeu�j int. -
30.125 Unmatched
31-124 Storm Drainage
40.475 Bancroft Prin. Pymt —
40.471 ancro t Int. Pymt
_
_ 1
TOTAL
A' CUST •
bMEq
PLEASE TAKE THIS TO THE CASHIER FOR A RECEIPT
r
NAME- �Y 0 Q v `ti 0. DATE: -J441,
TOS
�► 972 z_3
ACCT. N DESCRIPTION AMOUNT
c1t?
10-220 Refundable Performance Bond Deposit
10-435 Sign Permits HOP _ TU $
10-436 Public Sewer Plan Check/Inspection Fee
10-436 Public Storm Plan-Check/Inspection Fee
10-436 Street Dedication/Public Improvement Fee
10-436 Street Opening Permit
10--437 Subdivision Applications:
S MLP _--
10--440 Zoning Applications:
ZC CPA ZOA PD SDR Misc
SCE CU SLP _ V
21-442 Street 1-ight Fee___—.— s --- -----
10-451 Document Sales:
Engrg. Planning__ Bldg. s —_
10-451 Street and Traffic
TOTAL
(1045P)
FLEMMERS CONCRETE 1
Rte 1, Box 900
Beaverton,oregon 97007
628-126!
PROPOSAL
Roger & Diane ,oath jari. 14 19 86
Dear Sir:
The undeisigned proposes to furnish all materials and perform all labor necessary to complete the following:
1,28th in 4011MQkd—,,-.UbmZjViSjon
of property line .
wi—de
61, deep for approach thickness.
All of the aboye w rk to
CpSletrjoa, substantial and workmanlike maturer for the sum of-A404 QQ
9�ur_ hundlre� ane r ars
--- —($-1LTL-—00 ---) D-UW--
Pad nents to be made each------ as the work proMaws to the value OE___
Per cent W all Work completed The entire amount of contract to be paid within-----!Q- ---- Any# after completion
Any attention or deviation from the above specifications involving extra coat of material or labor will only he executed
up,on written orders for same, and will become an extra charge over the sum mentioned in this contract. All agreements
must be ;ni,de in writing-
The Contractor agrees to carry Workmen's Com;)ensation and Public Liability Insurance, also to pay all Sales Taxos,
Old Age Benefit and Unemployment Compensation Taxes up,.,n the material and labor furnished under this contract, at:
rrquired by the United States GoveLrnrnent and the State in which this work is performed.
Respectfully submitted.'
By
ACCEPTANCE
You are hereby authorized to furnish all materials and labor required to complete the work nwrilioned in the elvive
proposal, for which the undersigned agrees to PAY the amount mentintied in said proposal, and according b-) the t*rmr. Owreof.
hate
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