9300 SW DURHAM ROAD FILE NO. 9j 7 STR. OPN. PERMIT
DUPMAM RD. - 9300
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EXPENDITURE REIMBURSEMENT REQUEST ,
This form is a multi—use form. Where appropriate receLpts must be attached .
Documentation is important for all purposes. Staple documentation to form.
VENDOR NO: DATE: January 31 , 1985
PAYABLE 10: Mrs. Ed Ferrel Requested by : koh Thumps ll
114UU SW North Dakota Street
Tigard, OR 9.727.3
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MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc . ) :
Date Description Account No. _ Amount
l 30 85 Refund of Security Depujit_ fur1 - tlS_?l1_`Z30
Street Opening Permit 8 28/84 (R#201 W)
(Please make the check payAble to -Kr Fe rel
Ed Ferrel is deceased) .
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GENERAL MEAL EXPENSE:
Date Description Amount
Account Number to be charged: Y Total
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•MILEAGE:
Date Description: (Include end/start readings and total miles) Amount
Account Number: a�Total -- ~+l les--x
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APPROPRIATION BALANCE: :•1' i. AS OF: ){v_t+;Wl titlit.n.lturt,
N11PROVALS ( i I SV)-00 ))t' 11nd4') "I"v l �' 11 Iiiihui ;rJ 11 nl,l In t l y .101 )
(kill (u $ /1/11. 00)Set ( Lott Manakel � �r i' i li . ll rii
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INSPECTION NOTICE
City of Tigard Building Dapartment
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639-4171
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Type of Inspection n,
Date Requested. Time A.M.2
Acldress j 04, Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
$00Approved
Prp.sentpdto,.
I Inspector F1 Disapproved
Date
CALL FOR REINSPECTION
Dyes ONO
_.iCATION - STREET IMPRr 'EMENT/EXCAVATION COPY TO:
fWHITF) FILE
ORDIN. .CE NO. 74.14 BLUE) -INSP.
YELLOW) -OTHLR AGENCY
(INSTRUCTIONS UN SEPARATE SHEET) ,PINK) APPLICANT
APPROVED �Iz APPLICATIONNO. .__ �^C --
NO1' APPROVFD ///(']-- C TTY OI'' 7Ii.:AI::.�, OREGON FEE AMT.: S_,
I -
�_.- --
PENDING FEE PMT. ❑ CITY HA1.1. RtaG-'rT NO : o�0/ 0
PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY �w — DATE__O Pf / Y
PENDING AGENCY ''OK'' ❑ Application and ProRTcss Record _
MAINTENANCE BON,p *
PENDING INFORMATION [j FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED J.1 -�
AN IUAL 11
PENDING VARIANCE ❑ EXPIRATION D TE: N_ f--4'r
PERMIT NO.: DATE ISSUED: BY: ---_—_—
( 1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT S e�'h ��- h1 0r]`�L., /tib'�;� �Z/�c`� A .,
NAMS AODRE9S CITY ` - PHONE
CONTRACTOR_ ��`��' > __ _ —�
A O?iEE1 CITY PHONE
PLANS BY 1b/\ GL c-i e—�tV_v
.--NAFTiE ADDRESS
ESTIMATED IMPROVEMENT TOTAL- VALUATION ( COST): S
- =----_-._«._—. DOLLARS
(2) EXCAVATION DATA: FOR OFFICE SE: 4- � MON.
0.4x9 5D _A = $ I� �_
STREET DESCRIPTION PROGRESS & INSPF.CfION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED —
��\�._ TYPE LENGTH WIDTH DEPTH ITEM 4 QUANTITY ITEM DATE REMARKS/TYPE BY
STREET —__--
INSP
_. R TION
U
ESTIMATED STREET OPENING DATE:_ Z S _ E
ESTIMATED STREET CLOSING DATE: J T --
E
D
(3) SECURITY NO. STREET _
SE URITYAMT.: S ��� CLOSE
SURETY CO. - - V�Y to AA fo#-A to FINAL
bI► CHECK CASH O BOND ❑ INRPEC.
(n) PLnT PLAN: INDICATE SITE PERTINFNT PHYSICAL c SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
1 i 1 I •_�.� � A a' _
I 1 I I 7.Vi 16k-.1, lZ.y •
I
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(5) NOTE THE CITY OF TIGARD DOES NOT, HEREDY, 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 'nCURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO COP.DUCT OF THE WORK, AND TO SAVE HARMLESS 'TI'E ''ITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPL ICAPIT3 ACTIONS.
V'APPLICANTSSIGNATl1Rr_ DATE__ 1