10470 SW HIGHLAND DRIVE _BILE NO. '�y430 STR. OPN. PERMIT
HIGHLAND DRIVE - 10470 !�
l �
CITY OF TIGARD—1;1420 S.W.MAIN—TIGARD,OREGON 97223
RECEIPT yam.
DATE �..�fi' .�1� AMOUNT:S fE 7 14-
t-ARS
NAME: L
ADDRESS:— G � S i.`' c..tv �(„ J�" _
CHECK:
7 2
FOR: 1 ? M.O.:
I OF ----
_ ACCT. • FIRMITS SURCKA_RGE AMOUNT
SEWER BILLINGS 40-364 `
BUSINESS LICENSE 05-331 _
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 0-5-332
pUILDING PERF IIT 05-333
SEWER CONNECTION 40-363 ---
SEWER INSPECTION 40-365
SYSTEM DEV. CHARGE 25-366 —
PARK DEV. CHARGE #1 3O.3oi
PARR DEV.CHARGE 02 30-368
ZON NG ADJUSTMENTS 05-362
7 ,Gy
TOTALS R S — j � .
RECEIVED BY:
PERMIT NUMBERS ASSIGNED: "
Number Amount Number
— Amount -Number Amount +i
FRiCEIPT
5289
APPLICATION - STREET IMPR( -MENT/EXCAVATION COPY TO:
IFO�l
-FILE
ORDIN,...CE NO, 74-14 IuLUEI-INSP.
YELLOW)-OTHER /.GENCY
(INSTRUCTIONS ON SEPARATE SHEET) „PINK)-APPLICANT
APPROVED 1150 APPLICATION NO.:
NCT APPROVEII ❑ CITY OF IJGARD. OREGON FEE AMT.: S
PENDING FEE. PMT. CITY MALI(. RECRI"T NO.:
r-LADING SECURITY r PUQLICWORKS DEPARTMENT BY fes- JATE
PENDING AGENCY ''OK" [3 \pph,,mmi and 1'rogTcss Rcuord — — — — — — — — _ '—
MAINTENANCE
— I_
PUN DING INFORMATION ❑
FOR STREET IMPROVEMENT/EXCAVAT!ON MAIN SEEQNREDo
ANNUAL CI
PENDING VARIANCE ❑ l0ki•IRATION DATE:
PERMIT NO.: -;C D TF ISSUED: -- '� L 1 --` _ . C Y,
-
(1) APPLICATION IS HEREDY MADE TO EXCAVATE FOR AND INSTALL A i_'1 '_ kY _
•;I-.IAI. r_X, _____.______ AS DESCRIBED HEREIN, IN FULL ACCORDANC.F WITH CITY REQLII-?EMFNTS.
APPLICANT 1� 1 J! ��1[Ll I In4'10 <- 1-1 �T5._G�►R.L� �__
AME AEMNESS rITY PHONE
CONTRACTOR NS �nN l le �✓L< . �L I
-- -- [se CIS --- /--� �d1c
PLANS BY 14 _ 4LtlG: CITY �KOi�HFL2-
1
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST: _
DOLLARS
/OR -)FP'ICE USE. vu MIN. ._
(2) EXCAVATION DATA: —__ o.oz X :. 7 =$— 1:4
STREET _ DESCRIPTION __ _ _ PROGRESS & INSPECTION STATUS
NAME SURFACEI CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE_ LENGTH WIDTH DEPTH IITE�M����& QUANTITY _
' 8. 3�6 Iy `�f ZtiJL�[� 3 ER NE J
IN TION
au
EST IV,ATED STPEET OPINING DATE: L, S L�iS
ESTIMATED STREET CLOSING DATE: J I M�V� �� L _ E
f�- _ D
O. . z4 —_ SECURITY AMT: S—71� CLOSET w_
SURETY CO.: _ FINNAL
CERTIFIED CHIECK __ CAr1lDON D-.I INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICI SPEC,'AL PROVISIONS/CONDITIONS:
FEATURES, EXCAVATION LOC%TION AND EX � +"
(/c)4 .K�61e — —
TY ,.w Tr i s
I I I I 1
a IF- .
(5I NOTE THE CITY OF rIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS YC, CONDUCT WORK WHERE
RIGHT-OF-WAY JURISCICTION IS THAT OF WASHINGTON COUNTY OR THE !STATE OF OREGON,
THE APPLICANT AGREES 1'0 DEPOSIT THE PEQUIREi1 SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY IN IURY OR DAMAGE WHICH MAY RESULT PROM APPLICANTS ACTIONS.
i s\
;\ _ / 14
APPLICANTS SIGNATURE: L �y
DATE
,n
y..
PROPOSAL and ::ONTRACT
Lei to____. ru ix_y 19-$L_
Dear Sir:
--�—_propose to furnish all materials and perform all l_bor necessary to complete the following:
—---�;-Pump &-Zeftl l Septic-tang—- - ------$-250.0.0--
underG
-.... ;-C--4--&-repleet- l %te aepty---- ------ v 25Q —
2QQ_04-�QIl_- --
wit!, rozk�-lam circ-swear`------ - -
---�;---Ere�1C--foto-irlE-.-__-----_ ------- - _ -------- 25Q_nQ ---- -
- -----------.—�—__- ------ TQTAL .. - $2-3-1.00
---
All of the above work to be completed in a substantial and workmanlike manner according to stand-
ard practices for the sum of -g,ro� ,111d__tih ci r .�Dollars ($ _2,3aa-0..il_____—)
Payments to be made ___._ e }e{_f .. _aeee{�tase kwt�u-Ci-t3r--Ir�.{ioctcar —
--_—_-as the work progresses
to the value of per cent (_ o) of all work completed. The entire
amount of contract to be paid within_- --- days after completion.
Any alteration or deviation from the above specifications involving extra cost of material or labor
will only be executed upon written orders for same, and will become an extra charge over the sum men-
tioned in this contract. All agreements must be made in writing.
Respectfully submitted,
NOTE: OWNER TO FURNISH L: SEMFNTS
AM RESTORE LI1W143 IN ----_----
PIPFLUTE ARU Paul 0. Miller
ACCEPTANCE miller & Sen3 Contractors, Inc.
You are hereby authorized to furnish all materials and labor required to complete the work men-
tioned in the above proposal, for which --___ agree to pay the amount mentioned in
said proposal, and according to the terms thereof.
ACCEPT ED — - ------- -------- -
Date. - ----.— -_— , 19—
1n Pad,-- Ts.. U11UTY Ore faun No.53.007 So �1 6--d— ouof4-ee _ Fm N. % 2V
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VENDOR
ADDRESS
CITY, STA'L'E, ZIP ��TMQ� �'V�RD
DATE P.O. #
-- —— WASHINGTON COUNTY,ORE C O
CHECK ONE: a I have received the following. Please make REQUISITION
payment. (Forward to Accounting.
ceived:
Date Initials
I have ordered the following. Please issue OTHER INFORMATION: —
a confirming purchase order. (Forward to
C� Administrative Secretary.)
I have researched the following. Please
issue a Purchase Order. (Forward to
Administrative Secretary.)
0 I want to buy the following. Please research.
Return price information to this office.
(Forward to Administrative Secretary.) --- -- "�—
ACCOUNT # QUANT'IT'Y DESCRItPION (Please explain thoroughly) UNIT PRTCE TOTAL PRICE
TOTAL AMOUN'1' DUE $
DEPARTMENT HEAD APPROVAL:
FINANCE DIRECTOR APPROVAL: _
( for 600 Accounts over $2,500, and all 700 accounts) —
DISTRIBUTION: White - Pur. Coord. or Accounting
Yellow- Department Copy
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