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11795 SW GREENBURG ROAD-1 FILE NO. 320-89 SrR. OPN. PERMIT GREI::NBURG ROAD SW - 11795 - CITY If T117AFM I EXPENDITURE REIMBURSEMENT REQUEST I Thii forr., is a multi-use form. Where 4�ppropriate receipts must be attached. Doclimentation it: important for al: purposes. Staple documentation to form. VENDOR NO: DATE: � - Z-7 'y PAYABLE TO: C�� tinier �I Ipvle� _ Requested by: G4 Me, r ► . a17 Z 1 ccr..=G viceaarsaa cr_r_ee eee cc sc r_eaaae cevcc�::=^asaaoccr_ccceemcaeetaQea ea ea r_ceceo cec r_cc MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc.) : Date Description Account No. Amount �03Z5_ - -- - - ¢r_e-acevav-----aaeaaa=aaenvveaw..... veeele. GENERAL MEAL EXPENSE: ,)ate Descri tion _ _ I Amount_ Account Number to be charged: _ Total =cr_a=caGvvseaaaaaaecanccvmvaaaen- MILEAGE: Date Description: (Include end/startt readies and total miles) Amount Account Number: Total miles RGGaOatSCr.VafaQaacc=a.tn>=src_r_aa ca aacacca ac oaa:o=aca.ace.-m ccs r_aa aaao a=v=v--=o:xa r_er r APPROPRIATION BALANCE: AS OF: APPROVALS (if $25.00 or cinder may be reimbursed through petty cash) : (up to $500.00)Section Manager i __ Purch. Agent ($500.01—$5,000.00)Dept. Head/Parch. Agent J f , 14 /d1 SJPG c 7 u.�// f"t 1 � / r APPLICATION - STREET IMPROV 'ENT/EX',,AVATIONC PY TO: (WHITE)-FILE ORDINAt.•. ENO , 414 _ (YELLOW)-INSP. IINSTRUCTIONS C". 7CPAFATESHEET) j (PINK)-OTHER AGENCY ] (BLUE)-APPLICANT APPROVED \X APPLICATION NO. - �54, CITY OF' TIGARD, OREGON st NOT APPROVED J FEC_ AMT.: f ' f-� PENDING FEE. PMT, ❑ CITY HALL Clot-0-4Z60— PENDING lb/0-4ZS0PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY � � DATE-3_ /Z7 / _5 PENDING AGENCY ''OK" ❑ Application and Progress Record PENDING INFORMATION L� FOR STREET IMPROVEMENT/EXCAVATION MAINTENANCE REQUIRED BOND N— ANNUAL PENDING VARIANCE ❑ EXPIRATI ATE: _1 _ PERMIT NO.: . . . _ g DATE ISSUED: L�91�'/__- BY: (1) PPLICATION IS HE�REB __MADE TJ EXCAVATE FOR AND INSTALL.. _ _g�\1 ^ ' AS DESCRIBED HEREIN, III FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT CAW—Eh-1—WL ©MES47M `�Il� l Alm' I(:1�� 1.Jp UkkE)'.L'_t4q *G3(v'O_14� ADDRESS CITE' O�b�tC' PHONE CON i RACTOR__ 2M _• I .7 NAME � ADDRESS �-.—. _-�......__-----'-CkTji'-----_----�(O'NE-'-- PLANS BY � '=.r \"t'� f;.,V_S=Wt _ --�:�ON! NAME AOORESS-----�-- PRONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S DOE1 (2) EXCAVATION DATA: rOR Orr CE USE i M114. 0.04 X $ _Z = s STREET DESCRIPTION PROGIIESS & INSPECTION STATUS NAME SURFACE CUT I CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY ST R --- P N' !J l R ►l, �o IRN TPI$ — — E -— — - C, U _— ESTIMATED STREET OPENING DATE: 3_—LZ 9 / — S ESTIMATED STREET CLOSING DATE: 3 / T --- E (3) SECURITY NO. SECURITY AMT.' Zoo Q" Y sCLLOSE i — _.. OSED _ SURETY CO.: _ FINAL CHU , c ASN _` q BOND r- I5PEC. �U r (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. )� 1 I I � I .. !�� 1rr�loF�•t� C[.'1`a"11aC'� '2! u R B V401t VA -V) Cxl-1 job 1 (5) NOTE TML CITY OF TIGARD DOES NOT. HEREBY, 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 PERTINENT LAWS ANrj CONSTRUCTION SPECIFICATIONS PERTINENT 70 CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. r APPLICANTS SIGNATURC DATE>r C I TY OF 1 I YARD — RFCF I RF OF PAYMENT REC NO: 0010.", 00 NAME: CARPENTER HOMES CHECK: AMOUNT : 4013. 00ADDRESS: 3060 SW HUMS CA5H AMOUNI' . 00 PORTLAND, 7R 97219 PAYMENT DATE : 03— 9-89 BLOCK NO/ADDR: PURPOSE OF PAYMENT AMOUNT F'AID PURPOSE OF F'AYMENT -------•-•------•-------- __ _ ___ — AMOUNT FAIL) 00 CUSTOMER DEPOSITS — —2OD F'IJL+L I C—I11F'ROVEMEhJI` PERMITS — — — 8.Ofd STREET OPENING FERM I f #7210--E49 TOTAL AMOUNT PAID — — — .08. 00 CARPENTER HOMES 1.395 3060 SW HL)ME 245-5306 PORT LAND, OREGON 97219 - C��19(� _ED" PAY TO THE ORDER OF C-14 _o.,LLARS U.91'111.0.n011lgl RL NtlAME BRANCH 4T PORTLANO,ORl7l1! UNITEO NATES NATIONAL BANK Of• RFOO, I - �� 1 P innn a an n q q nn L1. t.0 r,uo lq q