10900 SW CANTERBURY LANE F'IL,E NO. 165-8144"64SV OPN. PERMIT
CANTERBURY - 10900 -
;r
i
UNITED STATES NATIONAL RANK 1230 NO.
r)I Oregon
" iigyr;l OftkJOn
C'TYCW TIGARD 6/28/84 739 L— _$600. 00
PAY --- --
rO THE ORDFR nF
CITY OF TIGARD
sxnnco PROPERTIES NOT NEGOT[ABLE.
400 SW 6TH
Authnrized Slynphu�
PORTLAND OR 97232
Avihnntett ignnlwr
CITY OF TIGARD, TIGARD. OREGON SIMMCO PROPERTIES t:/Zu'84 2739 NO. U 0 f_ ( J 9
TNVOTCE NO REFU;IO DUE 6/29/84 600 00
1
iw-l-.r_- ---.--.-.---..-. ......
.�.-. .-.... .-- .
MILEAGE:
Date Description: (Include end/start r,2adinAs and total miles) Amount
Account Number: _ Total _ miles . 20
==cexzaaaasax===�==aeaaveva=�as_r.v.c�=v.-a.=a=_=-r_ c-c a.c_�v=eaxs=sa000aaoo=acx
APPROJIRIATION BALANCE:
AS OF: - - Signature t --
APPROVALS ( it $25.00 or under may a reimhutsrd tllttru�:It petty cash) :
("P to S500.00)Section Manager - - I'llt, It. Agent.
( $')UU.Ul-$5,000.UU)Dept . head/Pu�th. Agvn t
.1 1 1 v r
EXPENDITURE REIMBURSEMENT REQUEST
This form is a multi-use form. Where appropriate receipts must be attached.
Documentation is important for all purposes. Staple documentation to form.
VENDOR NO: DATE: lune 25, 1984
PAYABLE TO: Simmco Properties Requested by: Bob Thompson
_ 400 SW 6th
Portland, OR
=s=====-...------•__�___._..--
MISCELLANEOUS (parking, bocks, subscriptions, dues, memberships, etc. ) :
Date Description Account No. Amount
5/13/84 Cash Bond Refunds on:
Street Improvement Permits
SW Canterburz R#18221 15-00000-339-OOB 200.00
_ SW 109th & Murdock R#18173 _ 05-00000-245-OCV 1 400.00
GENERAL MEAL EXPENSE:
Date Description _ Amount
Account Number to be charged: Total
==.-=s=ar_aazae=arrs�wwwwess=wswwwwac=asaw�a:z=s==x===asa<rsaca====rase=act==saw:cnws
MILEAGE:
Date Description: (Include endt'start readings and total miles) Amount
Account Number: i Total_ miles x �2O =
----n-vc=a=rcavnaa-s._aa==assn s,waaa=caaaaaa====aaaaa aa=sssasc-aaaa=cwewwwwww ww
APPROPRIATION BALANCE; AS OF: Signature
APPROVALS (it 125.00 or under may be reimbursed thruul;h petty cash) :
(up to $500.CU)Section ManagerALZ=��= Purch. Agent
(:500.01-$5,000, 00)Depr. Head/Purch. Agent
C,cJ� �� � y..r. �,,. d �%� �...0 �-�--n-•� ,cam..
tz 0 ,
2zl
as �
C
/1 C4�TIftoon�
12755 S'N ASH. PO BOX 23397 TIGARb,OREGON 97223 °H 639-4171
June 4, 1984 C17YOF TIIFAP®
WASHINGTON COUNTY,OREGON
American E.arthstations, Inc. I
Suite 1000, Orbanco Bldg.
1001 S.W. 5th
Portland, Oregon 97204
Attention: Mr. Norman G. Hotz
Reference: Street Opening Permit No. 183-84
[Mar Norman:
All work has been satisfactorily completed with the exception of
the utility cut on Murdock Street, between the curb and sidewalk.
The backfill material. was not properly placed or compacted, which
resulted in trench settling and a cavity forming under the sidewalk.
As soon as repairs are made in that area, and inspected, we will
promptly refune. your cash deposit.
Sincerely,
�d i s
Engineering Tech./Inspection
/hr
12755 S.W. ASH P.O. BOX 23397 TIGARD,OREGON 97223 PH 639-4171 -•- __._�
AMERN 'AN EART_HSTATI%JNSi INC.
COMMERCIAL SATELLITE COMMUNICA'IONS
HAND DELIVER
June 1, 1984
City of Tigard
Engineerin g Department
12420 S.W. Main
Tigard, 0R.
We are hereby requesting final inspection and refund of our cash
deposit in lieu of bond for street opening permits on S.W. Murdock
and S.W. 109 in Tigard.
Permit #213 Receipt #18173 and 18221 totaling $608.00.
Thank you
Norm n G. Hotz
SUITE 1000, ORBANCO BUILDING, 1001 SW 5TH, PORTLAND, OR 97204
(503) 246-1188
fA
Al
APPLICATION — STREET IMPP EMENT/EXCAVATION COPY TO:
ORDIN—NCE NO 74-14 E] (WHITE)-FILE
❑ (HLUF.) -INSP.
❑ IYELLOW) -OTHER AGFNCV
(INSTRUCTIONS ON SEPARATE SHEET) ❑ (PINK.) APPLICANT
APPROVED APPLICATION NO.: _Z
NOT APPROVED CITY OF TIGARD, OREGON FEE AMT.: i
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NC.:
PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY_L .ra–, nATE_-5-__L_�—L -
PENDING AGENCY "OK" ❑ Application and Progress Record _ — — - If,W. M au
MAINTENANCE BOND M—_
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED 1
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE: . /
PERMIT NO.: I _ ,t _ , DATE ISSUED: 5 .31 �. -- , BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _ —_T—
AS DESCRIBED HEREIN, IN FULL. ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT I_MNA C_ 4&&_ L� (�' _____��_R. en ZZ�
NAME ADDRESS
CPHONE
CONTRACTOR
NAME ADDRESS CITY PHONE
PLANS BY
NAME - ADDRESS ,+ CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $
_ - DOLLARS
FOR OFFICE USE: OMIN.
12► EXCAVATION DATA: os•X t_ -s _
STREET DESCRIPTION __ _PROGRESS & INSPECTION S'TATUS�
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM A: QUANTITY _
-7 r 1 STREET
OPENED --
INSP C-
E TION
_ Q
ESTIMATED STREET OPENING DATE: 'Jr (_ �_ E
9
ESTIMATED STREET CLOSING DATE: _
— �— _ -L_ - -
E
(3) SECURITY NO. SECURITY AMT.: $ ZQ 'STREET
CLOSE
SURETY CO.: _ FINAL6_J� ,
CERTITICD rH[..K Cl c.HSli _ - � INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS
FEATURES, EXCAVATION LOCATION AND EXTENT.
1
-CUR!"• r — �. — _. —
r 1 ( 1
NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORM. WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COLINT'Y OP THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF TN.E WORK, AND 'f0 SAVE HARMLESS THE CITY AND
EMPLOYEER AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
r PI'LICANTS SIGN A A .URE ' f
L
��� DATE
I
CITY OF TIGARD--12420 S.W.MAIN—TIGARD,OREGON 07223 pdU
DATE:
RECEIPT d
S'..��''PSL --- 4
AMOUNT: $,?48_
cv� r
NAME: ---DOL S
ADDRES _.- CASH:
S:
CHECK:
N OP M.O.:
FOR: _ _ ACCT. # PERMIT: SURCHARON
-- AMOUNT
SEWEn BILLINGS 40-364 -
S _
BUSINESS LICENSE 05-331
PLUMBING PERMIT --`
05-332 — S
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333 _
SEWER CONNECTION 40-363 —"
SEWER INSPECTION 40-365
SYSTEM DEV,CHARGE 25-366
PARK DEV.CHARGE #1 30-367
PARK DEV.CHARGE #2 30-368 '
ZONING ADJUSTMENTS 05-362 _
TOTALS
RFCEIVED BY: cril�C.�
PERMIT NUMSER8 ASSIONED: -- —
Numbor Amount _Number Amount
Number Amount
— RECEIPT 0
18221
pq
APPLICATION — STREET IMPP 'EMENT/EXCAVATION COPY TO:
Cl (WHITE)-FILE
ORDIf —NCE NO. 74-14 ❑ IBLUE)-INSP.
❑ (VF_LLOWI -OTHER AGENCY
(INSTRUCTIONS ON SEPARATE SHEET) El (PINK)-APPLICANT
APPROVED IV APPLICATION NO.: 'Z 12-
NOT APPROVED ❑ CITY OF TIGARD, OREGON FFE AMT. S /C OO
PENDING FEE. PMT. ❑ I CITY HALI. I kECLIPT NP.:
PENDING SECURITY IL-] PUBLIC WORKS DEPARTMENT Iry -_ DATE IS�N
PENDING AGENCY "OK" Ll Application and Progress Record MAINTENANCE BOND 1N1ft ar
PENDING INFORMATION ❑ FOR STREEI IMPROVEMENT/EXCAVATION AS REQUIRED w
ANNUAL U
PENDING VARIANCE ❑ EXPIRATION DATE.
PERMIT NO.: _���___.� _ _.___.__, DATE ISSUED: ._ 5__� a�_ HY: .��-_-_ .>L—
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND IfJSTAI_L
AS DESCRIBED HEREIN, IN FULL. ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _.,1 +m►Y. GO pr094' tr
f NAME M / ADDRESS CITY PHONE
CONTRACTOR—i I h A M (o -------- - --.—.—.—
NAME ADDRESS ------ —--
CITY PHONE
PLANS AME ADDRESS CITY' PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( CI)ST): $ ._ 0. _—
UOL_LARS
FOR OFFICE USE: ❑MIN.
(2) EXCAVATION DATA: o.4x s._�
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEr` ITEM DATE RLMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM tk QIIANTITY
q STREET
1 R TION
E
_. U _
1
ESTIMATED 3TIREET OPENING DATES
ESTIMATED STREET CLOSING DATE: ED
( yl SECURITY NO. SECURITY AMT.: $ o SYREET
��=_-__._ CL036
SURETY CO.: FFINAL
CERTIFIED CHECK U CASIf IVB INSPEC, 'pis- f K
(4) PLOT PLAN: INDICATE SITE PERTIFIaNT PHYSICAL SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATI, N AND EXTENT.
I 1 1
- ,IPP � � - _ �. �. ,... _. _- �. � ._ ., •. _.._.__-_•___.._
1 Ar-
(5) NOTE. THE CITY OF TIGARD DOES NOT, HERESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PER'rINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCTOF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR 'DAMAGE WHICH MAY RESULT' FROM APPL!%;ANTS ACTIONS.
APPLICANTS SIGNATURE ` �� _ ___ DATE ' / v
CITY OF TIGARD—12420 S.W.MAIN--TIGARD,OREGON 97223
RECEIPT /v
DATE. -- S" /-- —AMOUNT:$
NAME: S rn eK P O QA1 0& CASH;
ADDRESS: 5 t, CHECK:
e — M.O.:
# OF
FOR; --- _ ACCT. 0 PIRMITS •URCHAROI AMOUNT
SEWER BILLINGS 40-364 $
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332 __ S
MECHANICAL PERMIT 05-332 _ --
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363 — —
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366 J
PARK DEV.CHARGE #1 10-367 —
PARK DEV.CHARGE #2 30-368 —
ZONING ADJUSTMENTS 05-362
�?NS- -- -
�- ---- -
TOTALS $ =
RECEIVED BY: �'w"
PERMIT NUMRIRS A8819NIM
Number Amount Number Amount Number Amount
- --- $ - ___ — --- S
--- -- 5---- - $ RECEIPT 18173