Loading...
12127 SW LINCOLN AVENUE NILE No. -3 -58 STR. OPN. PERMIT LINCOLN .STREET - 12127 I 3eatember 15, 19:-'i e 2-SN_ 1-e_ 1✓�5. _C: Z�r_ City o+ T i a. d 13125 S.W. Nall Blvd. • r�`S� Tigard. OrcAA OI 4722; k 'Xa✓.1ce , Attn: Mr. john Hagman Re. 12127 S.W. Lincoln ano 12145 S.W. Lincoln We have completed the r -oatching of the street cut made a year ago, and hops it meets with Your sate . action. We wuuld like to have our t'i, ,0U releasen upon your acceptance of the patch . Thank ,gnu for corsioerii my reo(,est , Sincerely, FERNWOOD OE',ELOPMENT, By William A. Godwin cf wq%dq / r CQmmunll�Da►elapmant T-9 /� RECEIVED JUN 19 1989 6ITT C-"�- �1fsfl�17 IA CDt,k1)jfTfU AKE LAO?It 51T4�T- ffiT 12/45 12I Z 7 S.W L I r► ( N-N sr. I N `h � Amu E�OPE )T' mE-ETS art Y6aL � 'rl'S*oFv)ctt 64 ,4 3C16`�' I S 9t I AJ6- '1�k 5 �4-�' Ccs Fb4 5 f wEe fl I 'FHt�4 r'1 f�(3C 7n `7014 V!t � c to L /n /h?e_ D BEV, 5x�.t►�ra� t�tiP�e� Tx APPLICATION — STREET IMPRO' IIENT/EXCAVATION COPY TO: ORDINA��-E NO. 74-14 (WHITE)-FILE (YEL.LOW)-INSP. INSTRUCTIONS ON SEPARATE SHEET) [I (PINK)-OTHER AGENCY (BLUE)-APPLICANT APPPLICANT APPROVED APPLICATION NO.: 3 _ NOT APPROVED r CITY OF TIGARD, OREGON FEL AMT. S IZ PENDING FEE. PMT. i CITY HALL RECEIP� PENDI' SECURITY [ PUBLIC WORKS DEPARTMENT Hv _ DATE—1 X31 /_ Cr PEND . ; , ENCY • OK^ El %ppGc.+tion and Progress Record — — MAIN rNANCE BONp_{1 PEND—(s 'N ORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION As REQUIRCC �rJ — ANNUAL PENDING VARIANCE ❑ EXPIRATI N ATE: PERMIT NO '�.5�"-�c� DATE ISSUED: __LD L- L & BY: .— (1) tY: _(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _ ;�t_R AS DESCRIBED HEpflN4yjjFUll ACCOR(DANCEYV,ITH CITY REQUIRE:MF,f p APPLICANT tri /a �� D�I /� - - ��y,<—�4►4r'IcL 1 "71 NAME ADDRESS - -- - CITY ----------- _-PF/ONE-- CONTRACTOR _ NAME ADD wass ._- --- C'T _P.NON-E PLANS B YEF_ C1477' SJ?�iS/G� .S NAME ADDRESS C9n CIV- PHOfi E� ESTIMATED IMPROVFMENT TOTAL VALUATION ( COST) $ _ ©p• DOLLAR—! (2) EXCAVATION DATA: row oFricr USE: 00w MIN 0.04 X S -?9192, STREET DESCRIPTION PROGRESS & INSPECTION STATUS — NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM a QUANTITY _ STREET --• _ OPENED N - INSPEC _ R TION E Q ESTIMATED STREET OPENING DATE: E S f 3TIMATED STREET CLOSING DATE: �0 /�— / c � E — _—-- - D STREET (3) SECURITY NO. —. SECURITY AMT: : —3O�• CLOSED SURETY CO.: _ FINALF z �q#� �r e CHE.:K CASH Ll110140 INSPEC. (4) PLOT PLAN: INDICATE SITE PERTIN►NT PHYSICAL SPECIAL PROVISIONS /CON 91TIO�: v FEATURES: EXCAVATION LOCATION nND EXTENT. ��/ MIS OL �Sit� //IICC - CuRe ` (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPt ICANTC TO CONDUCT WORK WHERE 1 RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF ONEGON. THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIi-!CATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANN' INJURY OR DAMAGE WHICH MAY RESULT F77M APPLICANTS ACTIONS. APPLICANTS SIGNATURES DATE i CITYOF TI4 ID No. 32784 13125 S.W. HALL BLVD. P.O. BOX 23397 Date TIGARD, OR 97223 Name Addrpss Lot Block/Map Subdivision/Address Permit M's Bldg. Plumb Cash Check Sewer - — - — "ec Other Other Fiec By Acct. No. Description Amount 10432 Building Permit Fees 10431.600 PlumbingPermit Fees_ 10.431.601 Mechanical Permit Fees 10.230.501 State 81d . Tax — 10.433 Plans Check Fee 30-443 Sewer Connection _ — 30-444 Sewer Inspection 51.448 Street Syst, Dev. Charge 52-449.610 Parks I Syst. Dev. Charge �— 52-4rk 49-620 Pas II Syst. Dev. Charge 31.450 Storm Drainage Syst. Dev. Charge 10-430 Business Tax 10.434 Alarm Permit -- 10.227 Bail -- — 10-455• Fines• Traffic/Misd/Parking P30-122. 230 CPTH Traffic/Misd/Vic. Asst. 456 Indigent Defense 01 Sewer Service/USA122 402 Sewer ServicelClty 30% -- 30.123Sewer Sevice/City Maint. 30.125 Unmatched -j-1-1-24 Storm brainage 40.475 gancro t rin. ymt. 40.471 Bancro t Int. yr�1t. TOTAL FILE COPY ms n C17YOFTIGA- RD N0. ' 13125 S.W. HALL BLVD - 7,94 D' i--1)P.O. BOX 23397 PTIOARD, OR 97223 Date4 N 1 Name ) �} rn Lot Block/Ma —T-------- p SubdlvlSlon/Address Permit N's Bldg_ Plumb Sewer da-s-h Check u I Othor - Other Rec. By _ Acct. No. -' . 10437. scriptio�n _ Buildin Permit Fees Amount--- lJ 10.431_600 V Ix - Plurnbingpefmit Fees _ 10.431-601 Mechanical Permit Fees _`� - -- U 10.230.501_ Stage BTax 10.433 Plans Check Fees-- 30.443 _ _Se Cerw onnecti-on--- ----- , 30-444 Sewer Inspection - __ 51-448 Street Syst. Dev. Charge - ---__ 52-449.610 Parks-'1 S o ' st. Dev. Char 52-449-620 Parks 11-Syst. De-C a 9e 31.450 Storm Draln�rg13----- i0-430 ge SYSt. Dev, Charge Business Tax ------ -_�_ 10.43--q '-----------___ ,1 Q 10.27 _ Alarm Permit s z 2Bail Fines Traffic/Misd/Parking ---_ Z� A 0 230- -•-- U CPTH Traffic/Misd/Vic. Asst. 0.456 Indigent Defense w ro$ $ a 0.122.401 Sewer Service/USA---------------- 0-122.4n 02 Sewer S,;rvice/C!, O Q , 0.123 - Sewer,;evice/CIt Y 30% - r" w� a 125 Unm tca hed- Y Maint. ----_ !".9 fu oa --•- 124 - ] 0' a f Storm bralnage '--------_ --- 4 5 Bancroft rin. . y i -471 Bancroft In p t _ O 3 . U , ---=-..�-_- uj -__- TOTAL LL w I i.� FILE COPY r a CM ) Tlf ARD EXPENDITURE REIMBURSEMENT REQUF.Sr �4 I This form is a multi-use form. Where apprc.priate receipts must be attached. Documentation is important for all purposes. Staple documentation to form. VENDOR NO: DATE: PP.fAB�E TO: el ►�wCx� er.•vC_�c�pvHf�� It jj%c Requerted by: ` --T t 3o Z s.W, L24A S �r�voo �C4, 97I4-0 c c¢a caccsac cr_cac r.rc-ccccccc=cr_r:-r.c-c.^.a=racccrcc-cs=cccvc.cr_ccc cnaa rxcacoca-cccaa MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc. ) : Date Description Account No. Amount rcZ,3-- . vF 7 ��r �,rc den- 5�� L � (�- Z©L� O nom' .C_ 305 C c _ �gz-i� ccrszcaaacccacaccxc�acsaac= �=__. _ccccac=ccc:vcca-ccccnr:r.a-aaccccccccrcccac•cccv_ GENUAL MEAL EXPENSE: Date Description Amount Account Number to be charged: ----To—ta 1 __ - Total caa:aaacaaa ccr.vc vacrccccc a=.ac cc mccaac==� �-= aci:aaacr:ac�a aac crscr.-=ar:ccv.a ccna MILEAGE: Date Description: (Include er,a/starC readings and to,.al miles•) Amount Account Number' Total_ miles x$.21 a : say.saeeavvaese:aaceec�arar=ec-:saa ea e=Baca::==c eaas�ar.ca�aceaceacc as ca•�vr.c� APPROPRIATION BALANCE: __—AS OF: Signature APPROVALS (if $25.00 or under mai, be reimbursed throug`. petty cash) . (up to $500.00)Section Manager _ Pu ch. Agent ($500.01-45,000.00)Dept. Head/Porch. Agent