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9180 SW BURNHAM STREET-1 FILE No. _ olo-'Zq BURNHAM, ST. - 9180 STR. OPN. PERM CU 'QF TICrARD EXPENDITURE RE'(iuURSF.MENT REQUEST , This form is a multi-use form. Where appropriate receipts must be attached. Documentation ie important for all purposes. Staple documentation to form. VENDOR NO: DATE: ZcN £�G� PAYABLE TO: �,� c� r�t v�� Requested by: _ e.rw... .......w..i...............w..r.......................................... MISCELLANEOUS (parking, books, subscriptions, dues, memberships. etc.) : Date I Description Account No. _ Amount PV\„��,Pew �� y% 10 ZZ �u 1 .....................lrr/....r..//////... ...r....c................. ........r/! GENERAL, MEAL EXPENSE: Date Description 0 AmounL .gyp Account Number to be charged: Total wrrrrw/wwwr/rr wwrw/rwrr/r//rwrwwwrrwwwrwwwrwrrwrwrrrww/wwrwwr.wwwwwwrwrwwrwwrwr MILEAGE: Date Description: (Include end/start readings and total miles) Amount Iccount Number: Total miles x .20 ! rrrrrrw/rwwwrwwrwrwrrrrrrrrrrw, r■wrrrrwwrwwr■warrwrr/rrwrwrwwwwwrwwwwwwrra�r.! APPROPRIATION BALANCE7 --_AS OF: � Signature___. APPROVALS (if $25.00 or under may be reimbursed through petty cash) : (up to $50U.00)$ection Manager Putch. Agent {000.01-85,000.00)Dept . xsad/Pureh. Agent Y REQUISITION CITYCSF TIGAW WASHINGTON COUNTY,OREGON DATE CHECK ONE: E:0 I want to buy the following. Please research. Foward to Pur- chasing Coordinator. 1-J I have researched the following (attached quote information) . Please issue a Purchase Order. ForTard to Purchasing Coordinator. E::3 I have ordered the following. Please issue a confirming Purchase Order. Forward to Purchasing Coordinator. M I have received the following. Please make payment, Forward to Accounting. Received: , Date Initials P.O. DATE REQUIRED SHIP TO OTHER INFORMATION CCOUNT # QUANTITY DESCRIPTION (Please explain thoroighly) UNIT PRICE TOTAL PRICE qU TOTAL AMOUNT r _ � $ RECOMMENDED VENDORS DEPARTMENT HEAD APPROVAL Distribution: FINANCE DIRECTOR APPROVAL White - Pur. Coord. or (for. 600 Accounts over $2500, and all 700 Accounts) Accounting Yellow _ Department Copy I ----- PROPOSAL AND CONTRACT —.� Page No,—/--of, ex.�_Pages � Proposal Number R. N. ANDERSON 2691 Ek Road West Linn, Oregon 97068 .-- (503) 638-8705. Proposal Submitted To Job Name or Number a Street treet— City, Stats and Zip Code City, State and Zip Codil , Phone Numbers Date— P O. IF 7 -jf 0 We hereby submit specihcavons and estimates for: — ,1�..1� T 11 © R �t=[ �_t�et�--_ AQ��_—=------ — ---_ --- -- ------------ �Alot WE PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum 11-1, _7_7_eAACAr_--A1V�A1,0 4__,7___--_ ---- ----,_- _____ dollars($_-. oo Payment to be made. as follows. All material Is guaranteed to be as specified. All work to be completed in a workmanlike / manner according to standard practices.Any alteration or deviation from above$Pacifica Authorived / tions involving extra costs will be executed only upon written orders,and will become an Signature �— � �--- ---- extra charge over and above the estimate.All agreements contingent upon stokes.accidents r or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note'. This propo,al may he �,,,..+•c Our workers are fully covered by Workmen's Compensation Insurance withdrawn by us if not acr..epted wi'Mn _ ____days. ,Arreptaurr of f roponal —the above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified.Payment will be made as outlined above Date of Acceptance: Signature APPLICATION -- STREET IMPR -MENT/EXCAVATION COPY TO: IWH ORDINANCE NO. 74-14 C, (BLUE))-FILE (INSTRUCTIONS ON SEPARATE SHEET) ❑ (YELLOW)-OTHER AGENCV ❑ (PINK) APPLICANT APPROVED APPLICATION NO.: NOT APPROVED xrj CITY OF TIGARD,OREGON FEE AMT.: : PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.: � PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY _ __ DATE ✓� �/ j� PENDING AGENCY "OK'' 0 Application and Progress Record _ w MAINTENANCE BOND M_ PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION ASREQUIRED ❑ ANNUAL. U PENDING VARIANCE ❑ EXPIRATION DATE: PERMIT NO t C�,_�l DATE ISSUED: L_&L BY �. -_. (1) APPLICA I ION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT Alo nete,A ADDRESS a � / CITY ONE CONTRACTOR a, AD R Cmd � HON[ PLANS BY - lei ircaKf 'e15e.' ?,KtNA E AD 1T O NK ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): ; DOLLARS (2) EXCAVATION DATA: FOR OFFICE s[z --cs= .'4xIN: STREET _ DESCRIPTION PROGRESS tic INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ,TEM DATE REMARKS/TYPE BY 1 TYPE LENGTH WIDTH DEPTH ITEM !!k QUANTITY STREET P N•L. INSP - _ R TION E Gl ESTIMATED STREE i OPENING DATE: / / g ESTIMATED STREET CLnSING RATE: /__ / T E r .3TR a (3) SECURITY NO. _ SECURITY AMT.: s 6 CLOSET SURETY CO.: FINAL CASH 00010 0 INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDI'PI NS: FEATURES; EXCAVATION LOCATION AND EXTENT. 4id-et � 5�,u��_ 7rjf�_A ell rv- (5) NOTE; THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLIC NTS`TO CONDUCT WORK WHFRF RIGHT-OF-WAY JURI3DICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON, THE APPLICANT AGREES TO DEPOSIT THE REOUIRED 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 INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. �� APPLICANTS SIGNATURE �._ DATE CITY OF TIGARD-12420 S.W.MAIN--TIGAG D,OREGON 97223 RECEIPT DATE: f�AMOUf J I S DOLLARS NAME: %}��� C- -�,cvJ 5 _(CASH: ADDRESS: 1 --`'��� _ CHECK:—_. _. 14 M.O.: _ f OP POR: i_ ACCT. • PERMITS SURCHAROEAMOUNT _ SEWER 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 2.5-366 _ PARK DEV.CHARGE #1 30-367 PARK DEV.CHARGE #2 30-368 _ _ -- ZONING ADJUSTMENTS 05-362 — - ,TOTALS RECEIVED BY: z'/� 'c'2' . 1,.,- C PERMIT NUMBERS ASSIONEDe � Number Amount Number Amount Number Amr.t nl t TRCiiPT 0 6" i • , `"'""',y:+tp�"':'. "�'.r„�," ;iw�,,.s?g'y115,' • t t'�, :' t{ nY'^' M"' t, ";,"�+'' «e 'tr`"s'+6'?Y"� u��9'. • ~ 7777 ., .i y..'., u. 64'�4ti .�Hr� 'P�`'4't•(•'f ..Pi�7Stfi4.t ni> w,`x Rana i L1,o)aul3 22265 S.W. 1081H,SHERWOOD,OREGON 91140 Septembei 1-1 , 1979 I Page Stevens Stevens Marine �w 17050 S.W. Pilkington Rd. I Lake Oswego, Oregon Ea Dear Mr. Stevens: Rural Roads Company, Inc. proposes to provide the following 1� services and materials to your Stevens Marine jobsite on T., Burnham Rd. in 7 .gard, Oregon. 1 ) Complete installation of Half Street Improvements per �.; City of Tigard standards 165' along the front part of t the above mentioned property. ' Total Cost $ 4, 500-00 i 3 Payment Schedules Balance due and payable upon completion of contract. Sincerely, j' Rural Road�3 Company, Inc. " I�j�� �• J��'C1ar►�i� Ii Paul W. Goldsmith - Secretary Accepted: Dates _ "RURAL ROADS BUILDS PERMANENT ROADS" Backed by 17 yaars inter ational experience. [- J I CCPY TO: APF;LICATION - STREET IMP[ EMENT/EXCAVATION 4 -I / i 0 (WHITE).FILE ORDINANCE NO. 74-14 ❑ (GLUE) -INSP. ❑ (YELLOW)-OTHER AGENCY (INSTRUCTIONS ON SEPARATE SHEET) L3 (PINK)-APPLICANT APPROVED ❑ APPLICATION NO.: ,NOT APPROVED ❑ CITY UI"1IGARU, ORLOGON FEC AMT.: S PENDING FEC.PMT. ❑ CITY IIALI, RECEIPT NO.:..—.__- PENDING SECURITY p PUBLIC WORKS DEPARTMENT 1 DY_w Da - - _-L.-_ PENDING AGENCY 'OK" Cl Application and ProgTcss Rccord 1 MAINTGNANCr BOND M PENDING INFORMAIION ❑ FOR STREET IMPROVEMENT/EXCAVATION AU REW-IMC ) 1' ANNUA L J PENDING VARIANCC ❑ EXPIRATION DATE: ._—�L_— –.-- PERMIT NO.: DATE ISSUED: BY ------._ _ _.._--- -------------- (1) APPLICATION IS HEREBY MADE l-O EXCAVATE FOR AND INSTALL.AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT -- , 705a,s H��/,, , I &,"/ /e X, (Z440-10 7P 1/-L! �j / C TY — �'NGN6 CONTRACTOR �2 gialu�✓wf / 1 3d% rMG� -- --�— - COT PLANS BY-2b , ��. � :Kcr L►.Z//S4/ �rh� �wc.� 1Pd I AM[ AD at!se ESTIMATED IMPROVENIENT TOTAL VALUATION ( COST): $ _ DO 0 _qIT LARS _—'—'------'—'----"'- - - �—� FOR OFFICE USE: pMIN. J2) EXCAVATION DATA: 0.02 x t _- _-- -- STREETr DESCRIPTIONT PROGRESS & INSPECTION STATUS - r...—.._.---_. NAME SURFACE CIJ'r CUT CUT MATGRIAL INSTALLED ITEM DATE REMARKS/TYPE DY TYPE LENGTH WIDTH DEPTH fir-l'A Q QUANTITY 6TRFCT TION ESTIMATED STREET OPEN , DA76: ESTIMATED STREET CLO', t DATE: ED —_— _ — STREET (3) SECURITY NO. SECURITY AMT,: $ CLOSED, SURETY CO.: __ -- _ FINAL CERTIi•IKO CHECK 0 CASH ❑ SONO ❑ ' INSPEC. ,— (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL BPECIA7.PROVISIONS/CONDITIONS' FEATURES; EXCAVATION LOCATION AND EXTENT. I ( 1 1 CURB I I 1 I 1 1 1 1 1 r (t) NOTE: TILE CITY OF TIGARD DOFS NOT, HEREDY, GRANT PIERMISMON 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 PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY ANU EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE: ✓ ���5 r►ATR _ 1 � I - . N J O i n c — x -( L.LJ > 0 W U) a = x v cm u, ------ -�— a � rn a3 -C) _ ti xI o t w N st 1, Z Q M D MV-\ NLd W -� o �1 OD a r 1= Q �> > 4t 0. 0 z� u W_ ? 4 O m W W I W cr ck: r M z t„ cr C: U cr <t n z _ <c N to 1p OA W 37 ; CL 3- n- x LLJ Ld > -J.J cl -D,j 0 0 U- CD CJ Cal U) C) w < CL U- < C), U 00 rw cr 0 n. 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