8205 SW HUNZIKER ROAD FILE NO. 2"1(p- 1'7
HUNZIKER ST. - 8205 STR. OPN PERMIT
QTY OF TIGAI.'D
EXPEND"iURE RFJQuF";1
Zhis form is a ntdti-rise form. Appr_upriate rc�apts tmst be attached. Documentation
is important for all. purposes. Staple documentation to form.
VENDOR NO.: _ ++ _ _ DATE:
PAYABLE ID: -Tr v_ I mV-e Zn RHQUEST D BY: /
Z3o3b
Approved request due Wednesday
10:00 AM to A/P for checks by
Friday.
MI:I7LNNBDM EXPF1Mr1 RFS:
Date r r 1=i.ption, Invoice No., etc. Account No. l�iruttt
(� XIACC cX 721VS I V- Z 2000 $ zoo.
Q :
Z .10 1IIz f 9 t4 7 --- -------
IWAE.
Mileage $0-255
APPROPRIATION BALANC'F,: AS OF: SI(3JA11m:
(Up to $25.00) Section Manager _ — Purch. Agent
($25.01-2,500.00) Division Kviager
($2,500-0I-7,500.00) Dept. Head
($7,500-01-15,000.00) city Admi.nistr-tor
($15,000-01- ?) Local Contract Review Board
ke/1501F
J/
CITY OF TIGARD No- 28090
13125 S.W. HALL BLVD
P.O. BOX 23397 pale.
^ TIGARD,OR 97223
Name
Address k
Lot
'Block/Map Subdivision/Address
Permit N's Bldg. Plumb Cash
SewerOther Other Rec. B
-)'
r ��
Acct. No. Description An1��unt
10.432 Building Permit Fees _
10-431.600 Plumbing Permit Fees _
10-431.601 Mechanical Permit Fees
10.230.501 State Bldg. Tax
10.433 Plans Check Fee
30.443 Sewer Connection
3(1.444 Sewer Inspection
51.448 Street Syst. Dev. Char e
52.449.610 Parks I Syst. Dev, Charge
52.449.620 Parks 11 Syst, Dev. Charge _
1
31.450 Storm Drainage Syst. Dev. Charge
10-430 Business Tax _
10 434 Alarm Permil
10.227 Bail
10.455• Fines • Tralflc/MisdlParking
10 23�- CPTA TralficlMisdlVic. Asst.
10.456 Indigent Defense
30.122.461 Sewer Service/USA
30.122.402 Sewer Service/City 309 ^_ _
30-123 Sewer SeyicelCity Maint.
30.125 Unmatched
31.124 Storm Drainage _
40.475 Bancroft Prin. Pymt.
40-471 Bancroft Int. Pymt.
00
600 pi�_UA.AM7
A-Z,00 ... p�• rCNtaiNi.ty __.��
ACCOUNTING COPY
5 w
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CITYOF TI17ARD
EXPENDITURE REIMBURSEMENT REQUEST
This form is a multi-use form. Where appropriate receipts must be attached.
Documentation is important for all purposes. Staple documentation to form.
VENDOR N0: qq
PAYABLE T0: .r� ,tr• 1,ctn - �`Ccrp1 c.J_t, Requested by:
-- Pc % a 4 F)% `1y-za —
enc�c smmlccev am��e�e 1c�cx�•ta CCC os
Cl�t=i-r��accccacccc cc ac^ccs cc ncco=eaeclucc amml r!
MISCELLANEOUS (parkins;, books, subscriptions, dues,, memberships, etc. ) :
Date Description Account No. -�-A-m-o-uitt--
ccs=cccscccmmmc=vccccccc-cccvcccccccccs_cccccrccccvccccaccc-cc.ccr_cccc!lmmcmmlmm.
GENERAL MEAL EXPENSE:
-Date Description P Amount
Total
mmccm � •1�,1 ' -sccacmmrsr mcacrmmmrnlmrrrrrrrmmrm!
i to
M I LEA(
Date f J ,_cj/ 9dinPs and total miles) Amount -_
�'l Y77 1 I vJ a r jCi -- — —~`—_
i
Accour M1 miles x$`2
mmmmme e!lrrrmmmmrrmrrrwrmmmmmrmmmrmmmrrmmmr.
APPROPRIATION BALARLt: F: Sirnncurc•
APPROVALS (if $25.00 or under may he t tnthutsed thlotigh pr( ( y r.tsltl :
I. .. �cnn itnit•...� u....,.
1116rrh. Ao,.Ist
4
RELEASE AND WAIVER
We hereby agree that all damages which may be incurred due to incomplete
construction done on our property At 8205 S.W. Hunziker Street shall be our
sole responsibility and that our signature(s) release the City of Tigard and
its employees .from all responsibility.
It is also our understanding that any damages which show up within one (1)
year of this date, which were caused by sewer construction done on the above
listed property, will be repaired at our expense.
Signed10 _ Ot..
Signed /
lft
Date -�5 — Irvington-Moore, Inc.
cn/2695D
January 13, 1988
Irvington-Moore, Inc. '
f Y OFTIGA RD
Attn: Mr. Gary Barrett v
PO Box OREGON /
Portlandd,, OR OR 97223
RE: Street Opening Permit #276-87 �
Dear Mr. Barrett:
In response to your letter dated January 7th, 1988, we have conducted an
inspection of the work performed by Specialty Remodeling, Inc. , and find the
following needs to be corrected prior to our release of the 000 assurance:
1. ) The connectien to the manhole reeds to be grouted; and
2. The rock backfill within the easement area I.e. within
seven-and-a-half-feet of the main-.line and the manhole, both sides) needs
to be brought to grade; and
3. The aforesaid area neeti,: to be paved.
I
It is our unders ndinti that you are delaying completion of work on item
number two and thr P above since it is your intent to refinish the entire
parking lot. Subseq ently, I would propose that we proceed as outlined bel ,w
to facilitate release f most of your assurance deposit:
1. Correct item numbell\ one above; having our inr,pector, Mr. Mike Mills,
confirm satisfactory +completion.
2. Execute the enclosed "release and waiver." form, to relieve the City of any
possible liability which could arise from lack of immediate completion of
Items number two and three\Vove.
3. Upon my receipt of the, release and waiver document and upon Mr. Mills
confirmation that the/grouting work is complete, I will release six
hundred dollars. Then, when the final surfacing work Is finished over the
easement area, I will release the balance ci the assurance monies.
If the aforesaid im satisfactory to you, please let me know as noon as
possible and initiate action to proceed as outlined.
Very trulyyo
John S. Hagman
Fngineering Technician
en/2695D
Encl. I
cc: File
Specialty Remodeling Inc..
11825 SW Greenburg Road
rigard, OR 9722
13125 SW Hall Blvd.,F O.Box 23397,Tigard,Oregon 97223 (503)639-4171 —
—
RELEASE AND VIAIVER
We hereby agree that all damages which may be incurred due to incomplete
constr.uction done on our property at 8205 S.W. Hunziker Street shall be our
sole responsibility and that our signature(s) release the City of Tigard and
its employees from all responsibility. .
It is also our understanding, that any damages which show up within one (1)
year of this date, which were caused by sewer construction done on the above
listed property, will be repaired at our expense.
Signed
Signed
Date Irvington-Moore, Inc.
cn/2695D
post It'rouUup request pad 7884
ROUTING - REQUEST
Please
r READ ---
t
El HANDLE
LJ APPROVE ---- ��•e•,�ni ►,��•� _ _
and
Lj FORWARD --
RETURN
IL KFEP OR DISCARD �liti�A ,?wW► _�S�
lj REVIEW WITH ME
Date 1' _-!� Rom
�rm
n�
Irvin tON-nn M
too BOSS SWIMS
FOHEST PRODUCTS DIVISION
O/US NRIIIRAI Rr50UPCr51NC
P.O.B(,x 23038/Portland,Oregon 97223
Phone(503)620-0800/Fax(503)620-6600
January 7, 1988
Mr. John Hagman
Engineering Technician III
Community Development Dept.
City of Tigard
P.O. Box 23397
Tigard, Oregon 97223
Mr. Hagman:
Irvington-Moore recently obtained a street opening
permit from the City of Tigard. In doing so Irvington-Moore
posted an $800.00 bond to the city. The work is now
completed.
I understand that eighty percent of the bond money
is refundable upon job completion and the balance refundable
at a later date.
I am requesting the eighty percent refund at this time.
Please find the enclosed copy of permit #312 .
Thank you,
i
Cary Barrett
Purchasing Manager
APPLICATION — STREET IMPRC MENT/EXCAVATION wy TO:
WHITE)•FILE
ORDINAo%CE NO. 74-14 '(YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHE E I) %ZIPINK)-OTHER AGENCY—"
BLUE)-APPLICANT JJ
APPROVED 10, APPLICATION NO.:
NOT APPROVED 0 CITY OF TIGARD, OREGON FEE AMT. S ,p3��
PENDING FEE. PMT. ❑ (, ' s Y HALL RECEIP Z8Og0
PENDING SECURITY ❑ PUBLIC WORKSOEPARTMcNT eY _ DATE I Z- /3/ /e
PENDING AGENCY "OK" ❑ Application and Progress Record
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION MAIASEEQU NCE REDO 60 20
ANNUAL C
PENDING VARIANCE EXPIRATION DATE: 7
PERMIT NO.: __-„ DATE ISSUED: _1Z Lj11 47 BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL __k_Vf_ _.1! K?_,_ - „T't!J(1 ,^
5 _�lAhll�� AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT .12VlUCCTO k VRE__ �ZOS U�)f�L�i�� `j'( • 14`l� ®R, _�pZ0--owo
NAM[ AODT1 t�� CIT ''�"1"-� PHONE
CONTRACTOR �Pf+1� . �Aa I�' ZS Sl,� CSR lI u-41 'A_ _ N
NAME
p CITT- PHONE
PLANS BY _ __ *S �� H c�t •S
NAME 09�C-.�-
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S DO .
DOLLARS
--- �_ _ FOROFFIC[ U fA0 bit"MIN=--
(2) EXCAVATION DATA:
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT ICUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET `
i� INSPEC-
R TION
E
Q uf
ESTIMATED STREET OPENING DATE:_ / Z /, / E
'S
ESTIMATED STREET CLOSING DATE: — /Z / 3/ / 7 T
E
D
f STREET
(3) SECURITY CO. SECURITY AMT.: S _.. _�_ CLOSED
SURETY . -_ `� �� FINAL
.Kyr ASH ❑ _
BOND INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CO DIT ONS
FEATURES; EXCAVATION LOCATION ND EXTENT.
1 I �N0Ntf c /M ,xt� c -/
I 1
,URB ' `� — — — _ / - 47,
of -r(o
go
(S) NOTE THE CITY OF TIGARD DOES NOT, HcREBY, GRANT PERMISSION TO APPLICANT'S TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAI' 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 ANr)
EMPLOYCL3 AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANT, ACTIONS
APPLICANTS SIGNATURE J�CI�,/ _ DATE_ �� / 0 —
v
�l
CITY OFMARD No. 28090
13125 S.W. HALL_ BLVD. �1
P.O. BOX 2397 pate_l
TIGARD,OR 97223
jL
Name
Address
Lot Block/Map Subdivision/Address –
Permit k's Bldg. Plumb Cash
Sewer Other Other Re c. B e
Acct. No. Description Amount
10.432 Building Permit Fees
10.431.600 Plumbing Permit Fees _
10-431.601 Mechanical Permit Fees _
10.230.501 State Bldg. Tax
10.433 Plans Check Fee _
30.443 Sewer Connection
30.444 Sewer Inspection
51.448 Street Syst. Dev. Charge
52.449.610 Parks I Syst, Dev. Charge
52-449-620 Parks II Syst. Dev. Charge
— 1
31.450 Storm Drainage Syst. Dev. Charge
10.4?0 B .iness Tax J
10.434 Alarm !-ermlt
10.227 Bail
10.455- Fines • TrafficlMisdlParking
10.230- CPTA Traffic/MisdlVic. Asst.
10.456 Indigent Defense
30.122.401 Sewer Service/USA
30.122.402 Sewer Service/City 30%
30.123 Sewer SevicelCity Maint.
--
30.1:5 Unmatched
31.124 Storm Drainage
40-4f-5-- Bancroll Prin, Pymt.
4 4 1 Bancroft Int. Pymt,
10,
00
TOTAL
ACCOUN11NG COPY
j
I
MoeH su1rM 11 forint,In( �
CITY OF TWA RD No. 28090
13125 S.W. HALL BLVD. �/ �n
P.O. BOX 23397 Date_
TIGARD,OR 9722)
Name
Address
L.2 ' e:
Lot Block/Map Subdivision/Address
Permit M's Bldg. Plumb Cash Cc�g r
_ �f
Sewer Other Other Rec. Bfc,pp ,
Acct. No. Description Amount
10.432 Building Permit Fees
10.431-600 Plumbing Permit Fees
10-431.601 Mechanical Permit Fees _
10.230.501 State Bldg. Tax _
10.433 Plans Check Fee _
30.443 Sewer Connection
30.444 Sewer Inspection
51.448 Street Syst. Dev. Charge
52.449-610 Parks I Syst. Dev. Charge
52.449.620 Parks II Syst. Dev Charge
31.450 Storm Drainage Syst. Dev. Charge
10.430 Business Tax
10.434 Alarm Permit
10.227 Bail
10.455- Fines - TrafficlMisd/Parking
10.2:+0 CPTA TrafficlMisd/Vic. Asst.
10--456 Indigent Defense
30.122.401 Sewer Service/USA
30.122.402 Sewer Service/City 30%
30.123 Sewer Sevice/City Malnt.
0.125 Unmatched
31.124 Storm Drainage
40-47 Bancroft Prin. Pymt.
40.471 Bancroft Int. Pymt.
-"� TOTAL
( ACCOUNTING COPY
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/PLEASE TAKE THIS TO THE CASHIER FOR A RECEIPT
N AML: ... /- 'i✓1 ft>7 f - �'7c/G'r�
DATE:
ACCT. y DESCRIPTION ✓✓ AMOUNT
10-220Up ! Refundable Performance Bond Deposit
10-43500 Sign Permits HOF'— TU
10_43600 Public Sewer Plan Check/Inspection Fee _ $
10-43'600 Public Storm Plan Check/Inspection Fee
10-43600 Street Dedication/Public Improvement Fee $_
-,--f6--43600 > Street Opening_Permit�J_
10-43601 Street and Traffic Marking
21-44200 Street Light Fee
10-43700 Subdivision Applications:
_. S MLP
10--43900 Zoning Applications:
ZC CPA ZOA PD Misc
SCE CU SLP V $
10--44000 Othgr Planning Bees:
SDR
Non refundable portion of Appeal Fees $
10-22000 Refundable portion of Appeal Fees $
10-45100 Document Sales:
Engrg. _Planning _ Bldg. $
10-43000 Business Tax_
TOTAL. $ "3z
1045P/0023P