11030 SW GAARDE STREET-1 FILE NU. 311-
GAARDE STREET - 11030 STR. UPN. PERI=
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CINOF TIFAIM
EXPENDITURE REIMBURSEMENT REQUEST :6
This form is a multi-use form. Where appropriate receipts must be attached.
Documentation is important for all purposes. Staple documentation to form.
! �6
VFNDOR N0;
PAYABLE TO; , F. �- �_,,� V1 _` Requested by:
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MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc.):
Date Description _ Account No. Amount _
ZzoC-) _ 700
_ r
(amu " ,� `('.N� �'1'Fwi1"�11-`'3g• --
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GENERAL MEAL EXPENSE:
-Date Descri tion Amount
Account Number to be charged: Total
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MILEAGE:
Date Description: (Include end/start readings and total miles-) Amount
1 Account Number: Total �A- miles x$.?I
I
--------------------------------------------
APPROPRIATION
------------------------------------cera---cr_APPROPRIATION BALANCE: AS OF: Signature I2 �l
Tf-)
APPROVALS (if $25.00 or under may be reimbursed through petty cash) : ' (AIME
(up to 5500.00)Section Manager Purch. Agent
(5500.01-55,000.00)Dept. Head/Purch. Agent
Jr
400
INSPECTION NOTICE
,ity of Tigarc Idinq Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection �/J�
Date Requested_-4 ,I4' Time A.M.--P.M.
7y s'6'U s
Address � J �� '�" Permit #
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
fZeze
Presented to -__ �— F114proved
Inspector L 110 _ _—_ ❑ Disapproved
�¢Date -----` � ----- --_- —
CALL FOR REINSPECTION
Ci YES 1 NO
1600
STEVEN C. KUHN (X
11030 SW, GAARDE 639-4035 Al 24-201/12,M
TIGARD, OR 97224
PAYTO TMF -17 s
ORDER Of.
�qrj
X
Mif" re Oolloo� 7W _DOLLARS
Tlgard Offts,I 16M 6W Pocine Hwy.
P.9 Box 234M TI rd.OR 07M
I: 1230020111: 09 21,9kiti 2115 1600
C J T' OF I I RVCLIPT f--11::* f::'A',r(lE[+T
CHEC,h
81 EW i i CASH ANCOPAT
I I0":4.+ PAYMENT Di' TE I
-r I BARD. OR 97224 BLOCI!- W-11/01'11)P:
larpFE,l OFIEPTNIC3
FILiRPOSE: or-* PAYMENT (41117tIfTY PoTr) FIJPPOSir. OF PAYMENT All0t.114T
_T'S_
ME,"N'r PI-EPOIT " oc,
PLEASE TAKE THIS
�gT�O�THE CASHIk JR A RECEIPT
NAME: �� V � �-_ �_v c� DATE: Z Z�
ACCT N —,DESCRIPTION —_ --� AMOUNT,__
�_
10-22OOD,— Refundable Performance Bond Derosit
10-43500 _ Public Sewer Plar Crieck/Inspection Fee
10--43600 Public Storm Plan Check/Inspection Fee--
10-43600
ee -10-43600 _ Street Dedication/�jblic Imp^ovement Fee
� 10-43600 Street 0 enin Hermit
10-43500 Street and Traffic Marking � I
21=44200 Street Light Fee _
10-43700+ Sign Permits. _
10-43800 Land Use Application Fees
10-22000 Refundable portion of Appeal Fees
MhMMMM�*MwfMNaAarnslrMsss+:::: 10-45100 Document Sales:
-� Engrg. Planning Bldg. ---
10-45200 Park Feservations
10_43000 Busin?ss Tax
TOTAL
ke/3574P
APPLICATION — STREET IJdIPRI- cMENT/EXCAVATION COPi TO:
OR DI N....0 E NO. 74-14 (WHITE)-FILE
(YELLOW).INS
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER P.AGENCYC ,
(BLUE)-APPLICANT
APPROVED APPLICATION NO.: 347
NOT APPROVED ,J CI'T'Y OF TIGARD, OREGON —
FEE AMT..
PENDING FEE PMT. [] CITY HAM, RECEIP
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENTBY DATE /L_ //Z /F.+b
PENDING AGEN^.Y ''OK'' ❑ Application and Progress Record _ r
B
MAINTENANCE OftD M
PENDING 7NFORIIATION El FOR STREET IMPROVEMENT/EXCAVATION AS REDUIRED
CE B
ANNUAL
PENDING VARIANCE ) EXPIRATION DATE: _` �_—
PERMIT NO 31I— DATE ISSLIED: BY:
_
1 ) APPLICATION IS HEREBY MADE TO EXCAVA TE FOR AND INSTAI_I_
-- 0
40 7—
-�>-� AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT ,[T_ /gar 101A) ��.� _�/ I;— r� /�//
AADDRESS (ITV----'-- '- f (ITV
CONTRACTOR
C(Jw�{
NAME ADOR SS
PLANS BY r _
NAME ..1S�fj/>1 E'j
----__..—_--.._. —_
ADDRESS GItV
v
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S >
------------ — _ OOLLA i
(2) EXCAVATION DATA: FOR OFFICE U E ^
0.04 X i --_ yew 7
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY ITEM DATE REMARKS/TYPE RY
STREET
PIED
R TION —
E —
__ _ Q
r? U
ESTIMATED STREE— OPENING Dc:TE: Z I J
c S1
ESTIMATED STREET CLOSING DATE: _ / / T -
-- E
D
(3) SECURITY NO. - SECURITY AMT.: S _ 700_1 STR
'LOSED
SURETY CO.: _--- FINAL
cl�l_t K CASH_; _ sOND INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL. PROVISIONS/Z
NDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
i I 1
Job
13
S NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RICHT-OF-WAV JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGnN.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS ANL)
ro*4STRI;CTION SPECIFICATIONS PERTINENT TO CONDUCT Or THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLO'vrLS AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTSSIGNATURE — v � "y` ~�'� DATB�L,
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TRANSVERSE EXPANSION JOINTS 3
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I TO BE PROVIDED AT EACH POINT OF a
TANGENCY OF THE CURB Q AT OTHER (�
LOCATIONS AS REQUIRED TO UMI f THE �1
SPACING TO A MAXIMUM OF 20 FT f' U
2 MATERIAL TO BE PRE MOLDED NON
EXTRUDED MATERIAL WITH A MINIMUM
THICKNESS OF 1/2 " `r
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TRANSVERSE CONTRACTION JOINT c []
I SPACING TO BE NOT MORE THAN IO FT rn 1
2 DEPTH OF THE JOINT SHALL BE AT
LEAST ONE FOURTH OF 'rHE CROSS
SECTIONAL ARCA
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CONCRETE BREAKING STRENGTH fill
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I TO BE 3000 P S I AFTER 28 DAYS N h
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