11643 SW PACIFIC HIGHWAY-1 FILE NO. 2'775.-6-7
PACIFIC HIGHWAY-11643 STR. OPN. PERMIT
CIT - OF T16-ARD
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:
PAYABLE T0: ��e Requested by:
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MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc.) :
Date Description Account No. Amount
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GENERAL MEAL EXPENSE:
Date Description Amount
Azcouut Number to be charged: Total _
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MILEAGE:
Date Description: (Include end/start readings and total miles-) Amount
Account Number: - �� Total_
............ ac r_ GaGcccaaar =Gr-Gcc^accuGa-caeaaGe�@Gca c.Gac- eaIIc-v
APPROPRIATION BALANCE: AS OF: _ _ Signature
APPROVALS (if $25.00 or under may be reimbursed through petty cash) :
(up to $500.00)Section Manager Purch. A,gcnt _
($500.01-$5,000.00)Dept. Head/Purch. Agent
RECEIVED
FEB 2 J 1989
cu+wr*hr
M I L-N� F2EAL
P'"C3 P"F=—RT- I k:::_. '.:: ,
P. 0. Box 2740
Pow-t 1 and, OR 97208
(503) 222-9836
February 21,
Mr. John Hagman
Public Works Department
City of Tigard
13125 S. W. Hall Blvd.
Tigard, OR 97223
Re: Security Pond - Permit #273-87
Dear Mr. Hagman:
Per our conversation a few weeks ago, enclosed is an "as built" drawing
showing where thr_ connection into the main sanitary sewer was made. Per
your requirement, it shows how this connection relates to the manhole or,
the main line on Pacific Highway.
This drawing is being provided in order for you to refund the $4(:.)(-). CIO
security bong paid on November L20, 1987.
If you require additionalinformation, please contact me.
Sincerely,
Dorothy D. K t
DDK/as
Eric: "as built " drawing prepared by Babbitt Plumbing, Inc.
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— 13'lL�- /a" S or►h Only. /� "ei
Dec Irt '87,
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BABBITT PI.UJIBING, INC.
7611 SW ALDEN 5T.
PORTLAND, OR 97223
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APPLICATION -- STREET IMPRI %MENT/EXCAVATION J'(WH
Y TO:
OR D:f�.,.+CE NO. 74-1 4 ITE)•FILE
(YELLOW)-IN5P,
(INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCY�(�{.
(BLUE)-APPLICANT pyr,
APPROVED APPLICATION NO.: 3017
NOT APPROVED CITY Y Off' TIGARD, OkFGON FEE AMT.: S /G 0–f
PENDING FEE. PMT. CITY HALL RECEI ZL9�3�
PENDING SECURITY PUBLIC WORKS DEPARTMENT DATE�11L,13Q/cJ
PENDING AGENCY 'UK" ❑ Application and Progress Record
MAINTENANCE BOND N_ Z0Z_-
PENDING INFORMATION Ll FOR STREET IMPROVEMENT/EXCAVATION ASREQUIRED `J'n
ANNUAL
PENDING fARIANCE 1-1 EXPIRATI N D T .. C
PERMIT NO 2-73-��] DATE ISSUED BY.
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WIT TY REQUIREMENTS.
APPLICANT _ ! z� d�•~ t, pr�i�..� `163E,
� � ,11 AME ADDRESS `1 CI V PHONE
CON-TRACTOR�1r �.ti SAAC, "1 a l� X11,) A 1 \` i{ 9'1sc>I
1� - -.� Z4�-!57.7"1
AM
ADDRESS CITY 9�ZZ3 PHONE
PLANS BY_.- S
A [ ADD1iF58 A CITY _. O t
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S ` �QD ,•
DOLLARS
(2) EXCAVATION DATA: FOR OFFICE U
0.04 X s -- C'E
STREET DESCRIPTION PROGRESS tic INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM d QUANTITY
STREET
_ P N D
1 INSP G- w
R TION
E --
O
U
ESTIMATED STREET OPENING DATE:_ L_7U _— g
ESTIMATED STREET CLOSING DATE: T
— E
D
STREET
(3) SECURITY NO. --- _ SECURITY AMT.: E �QQ. CLOSE
SURETY CO.. — _ _ _ FINAL +
_ CERTIFIED CHECK •OND C INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPCECIA'LROVIS19NS /CO DITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
) I [ a i I s A - L It
r1lAC_� dL.�
1 ) I I
(5) NOTE THE 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 AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THIL WORK. AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE - DATE
MILNE
®Y_ _DATE
GNKO. •Y_ _DATE
— t comeTEyrnpN SHCET NO. Or 1 _
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b� LLJQ_ ._ --4 CL N
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LONG RADIUS
LONG RADIUS
BENDS NOT – BENDS AS SERVICE
GREATER THAN 45° CONNECTION
* REQUIRED l PIPE
20°MIN.
��..
PREFER 30°
TRUNK, MAIN, OR \ WIRE SERVICE TO
LATERAL SEWER "
I_ CONTINUOUS 4R4
TRENCH WALL
OR 2"w 6" TEE FRAME.
MUST EXTEND FROM
QBE L SEWER TO UNDISTURBED
G. L E -
1 Gq� PSS Q\Q EARTH.
6 'JL
•
� � — 4°t 4" BRACE
200 TO 70' COMPACTED GRAVEL
BACKFILL TO UNDISTURBED
~\ ( EARTH, MINIMUM 2'-0" WIDE
MAIN, TRIIHK, OR (A ) K MAIN, TRUNK OR LATERAL
LATERAL SEWER
U3E ONLY WHEN WORKING AREA
PROHIBITS USING (A)
COMPACTED GRAVEL UNDER 12'.
COMPACTED GRAVEL OR CONCRETE
ENCASEMENT BETWEEN 12' AND 16',*
DEPENDING ON SOIL CONDITION
CONCRETE ENCASEMENT OVZR
OVER 12' USE CAST IRON AND
COMPACTED GRAVEL �N LIEU OF
CONCRETE ENCASE MEN r.
*MAY GO TO 24' (IEPTH IF THE (�
TRENCH ABOVE THE PIPE IS
L MITER TO 30" ACCORDING TO
COMPLETE
9A,.1(FILL CALCUL ITIONS. ---CONCRETE
ENCASEMENT
;I.
�4
\ POUR CASE FULL
(CONCRi:AETE,TICAL `.1�°,; ^).� �JWIOTN Of TRENCH
ENCASEMENT) \
TO BE USED ONLY ��t
WITH PRIOR AGENCY
APPROVAL.
h � �
SIDE SEWER
CONNECTIONS IO Uf
UnI(I.e S•wNa" AQ«ncT
� �.� ��1�� lel T�•�1 ti_.
CLASS D CLASS C
QEQVIeE!b IN Au__ cw�,Hlr� Ic�►.sc�cvT��
Qc;r,D tc•wµt"•o�• w�-(s
SURFACE RESTORATION MOUND EXCESS NATIVE MATERIAL 1
AS SPECIFIED&-mccr `OVER TRENCH TO ALLOW !`
sDcwA.L_K. �ETC..� FUR SETTLEMENT
I
UNDISTURBED •. - • •� UNOISTURBED
EARTHCQM►WCTED . •' EARTH
CLEAN
WELL—GRADED ,
3/4"—0 CMJ HW NATIVE
RACK••• MATERIAL
• SELECT MATERIAL
(CLEAN WELL-GRAZE0 3/4"-0
CLEAN WELL—GRADED CRUSHED ROCM. REGL)IREO WITH
3/4"—0 CRuSHm ROCK PIPE 0.0. ' . PVC PIPE)
PLUS i" t _
PIPE BASE
• USE TO PIPE
• SPRINGLINE
PIPE
BASE .• ,� 1
f •
4 WlN. FOR PIPE SMA ER 4"
lL THAN 2
6"MIN. FOR PIPE 24" AND LARGES
PIPE BASE
MAi ERIAL
TRENCH BACKFILL DETAILS
UnIII*d 14ow*fb" A®N+cy
CITYOF T16ARD %o 25984
Nam,
Addr, - - --- _.—�
Lot-- SuLid IvIr,I r,;,�ddress - --
Permit q's 61d9 Plumb- --- Cash
Check
Sewer ---- -- -- -- �
Other Other- Rec. ay
-- Acct. - --
10 4432 Arnounl
guild�n Permit Fee ,
10 431 600 PI{.rmbms Permit Fr-r,,,
10431 601 MAchanical Permit F...... --
10 230 FiG1 State Bldg TaY
r —_-_ Plans Check, F,,o - -
{ Sewer Connerhon ---
"') SPWer In9nr+Clion _
`.1 JJrS Street iy�,t tJrw Ch
r —
�r' X49 6To Park; I
44'-)F,20 Park , II Svs,t Dr
J1-4 �( c,tr?Irn nrar n�if)P r, (rr•; - --
Eii�Sinr�S; Ttr. � ---
1 i�i,�rrn Prmt —
f3ail
CPTA Trallir --
Indilrrrt C)rfrn;rt --
r �
- - E3anr,r()tt Ir
_ T()TAt ON.
i
CIV,TOMCR
PLEASE. TAKE THIS TO THE CASHIER FOR A RECEIPT
NAME: c _ DI,TE
ACCT. b DESCRIPTION- J- _ T AMOUNT
-�� Refundable Performance Bond Deposit--.— $ 400 `
10--22000
-� --- _�.. _._ ____.—
10-43500 Sign Permits HOP TU — $_
10--43600 Public Sewer Plan Check/Inspection Fee_ $_
10-43600 Public Storm Plan Check/Inspection Fee $
10-43600 Street Dedication/Public Improvement Fee
�O-4�600' ,)� Street Opening Permit Z?3-8-7 — $ IL"
10-43601 Street and -traffic Marking
21-44200 Street Light Fee
10-43700 Subdivisicn Applications:
S MLP __..._.__.
10-43800 Zoning Applicata,)ns :
Z_C CPA ZCA PD, Misc
SCE CU SLP V $
30-44000 Other Planning Fees:
SDR
Non refundable portion of Appeal Fees $_ —
10--22000 _ Refundable portion of_Apeal Fees
10-45100 Document Sales:
Engrg. — Planning
10-43000 Business Tax
TOTAL
n
1045P/0023P ! '/
MILNE REAL PROPERTIES, INC. a PORTLAND,OREGON 97208 1090
DATE INVOICE NO. _ DESCRIPTION INVOICE AMOUNT DEDUCTION BALANCE
1300 FEE FOR STREET OPENING PERMIT
$400 X 4% 16 . 00 I
11643 SW PACIFIC HIGHWAY
i
CHECKT
CHECK I
DATE _ 11/30/87 NUMBER MRP 1099TOTALS
PLEASE DETACH THIS PORTION AND RETA.N FOR YOUR RECORDS
rti11LNE REAL PROPERTIES, INC. ^-_ ---- --^� MAiNaFFicE�—`
P O BOX 2740. PORTLAND,OREGON 37208 UNITED STATES NATIONAL BANK 1]�0 010
OF OREGON-Poniend,Oregon
PAY: SIXTEEN DOLLARS AND NO CENTS 1099
i
GATE CHECK NO. AMOONT
11/30/87 1099 S16. 00
f-
PAY CITY OF T I GARD SEWER DEPT. MII N RLLP,ROPEA IFS
TO THE 13125 SW HALL BLVD.ORDER TIGARD, OR 97223
OF Rv - - —
L �
111001,099112 I: 1, 2 3000 2 201: 01,0 0402 2 1 311'
i
SEES 0
i
MILNE REAL PROPERTIES, INC. . r,c AND,OREGON 97208 Y� n
DATE INVOICE NO, DESCRIPTION INVOICE AMOUNT DEDUCTION BALANCE
1300 BOND FOR SEWER HOOKUP — RE STREET 400. 00
OPENING PERMIT
11643 SW PACIFIC HIGHWAY
CHECK DATE =11/30/87::ENCUHME=BERMRp- 1098 TOTALS
4 0 0_. 0__C
PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS. '+
MILNE REAL PROPERTIES, INC. MAIN OFFICE 7,_77
P.O. BOX 2740, PORTLAND,OREGON 97208 UNITED STATES NATIONAL BANK 010
OF ORf0ON•Portland,Oregon 1730
109
PAY: FOUR HUNDRED DOLLARS ANDNO CENTS
DATE CHECK NO AMOUNT
r
11/.20/87 1098 $400 . 00
PAY CITY OF TIGARD SEWER DEPT.
TO THE 13125 SW HALL BLVD. MILNE REAL, ROPERTIES
ORDER TIGARD, OR 97923 ,
Of
RY—
BY Z-A
1190010913119 1: 1230002201: 0 LO 0402 2 L 311'
"Get //If /lnhit. lull V fAl"J"
AMERICAN • 4-S— tat1L1A
KOHLER OF KGHLER
7611 S. W. ALOEN
I•t l k T LAN O,OREGON 97223
244.5279
November 25, 1987
Milne Construction Cu.
P. 0. Box 2740
Portland, Oregon 87208
We are Pleased to submit the following estimate:- I , Babbitt Plumbing, agree, for the
consideration of $400.00, to hook new restroom to city sewer at
11643 S. W. Pacific Hwy. ( Battery Factory) Tigard Oregon.
This includes labor, tap, saddle, 4" sch 40 pipe, rock pack
fill and asphalt patch if incorporated at the same time with new
building drain.
Terms a,:e net on completion.
George N. Babbitt
Babbitt Plumbing , Inc.
Accepted By:
HYDRONIC HEAT