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12090 SW MAIN STREET-1 FILE NO. MAIN STREET - 12090 STR. OPN. PERMIT CIT 3F ivARD I EXPENDITURE REIMBURSEMENT REQUEST This form is a multi-use form. Where appropriate receipts must be attached. Documentation is important for all purposes. Staple dacumentation to form. VENDOR NO: DATE• l —ZS S PAYABj.E T0: esA Requested by: _ -- d wrrarrwrwrrrrrrrwrrwwrwrwrwrwwrrwrrwrwwrwwwwwvwwwwww w.wwrrrrwrrwrrnrrwwwwrwrwrr MISCELLANEOUS (parking, books, subscriptions, dues, memberships, etc_.): Date Description Account No. Amount ` Zu8�o3r RE V�J o 4a5sclr 5t 10 -ZZG?Q #351- • • • wwt rrrrrrrrrrrw---waft.=rwrwwrwwwarwwwsar�:swrswwmrwswwawwwwvrwrrwrrrswrwnrrrrwrrw GENERAL MEAL EXPENSE: •Date Descri tion -Amount Account Number to be charged: Total rwr- crwrrrwsrrwrrrwwrrwvwwwsrwvwrav vieuavwcvaas=awwwwwrwrwrrrwrrrrrwrrwrrrrrrwww MILEAGE: Date Description: (Include erd/start readin �i and total miles) Amnunt i Account Number: _ Total miles$I w wwwrwwwarwwwwwwrwrrrwrras areas....... vwwvrwrwrwramwwwrwrwrrrwrrrwrrrwrwrrnwrrrww APPROPRIATION BALANCE: _ _AS OF: Signature APPROVALS (if $25.00 or under may be reimbursed through petty cash) : (up to $500.00)Section Manager Purch. Agent _ ($500.01•45,000.00)Dept. Head/Purch. Agent: : 1 L A nFITANT MIIP"4AGE FOR DATE— _ TIME ,.L P.M. i M. /,.� AaEA CODE NUMf3En !'.XTENMON A/� 1{L s,i 1"p— MED ,.— �►_ SN 1'�Cr�FF TELEPHONED t PLEASE CALL ll( 1 CAME TO SEE YOU WILL CALL AIMIN WANTS M SEE YOU _ RUSH RETURNED YOUR CALL SPECIAL ATTENTION MESSAGE Ae!° Tlel 51GNE: _1_ I L ITHO IN IJ - I-- ^ "1�— TOTAL. OFFICE PRODUCTS '44' 1300-.s and printers, Inc. �'` r� 22.8-239E APPLICATION - STREET IMiPRO HENT/EXCAVATION ��CCOPYTO: ORDINA, E NO 74-14 (WHITE)-FILE (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) (PINK)-FJTHER AGENCY ""(BLUE) APPLIICANT APPROVED APPLICATION NO.: 3c36 NOT APPROVED ❑ CI I N' OF TIGAR REGON l+.e FEC AMT. f ry�� �-tLJ PENDING FEE PMT. ❑ CITY HALL RECEIPT ;-_�_ LQIo©gy PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY,__'� !}'_ DATE // //$ / -9 PENDING AGENCY "OK" ❑ Application and Progrea! Record MAINTENANCE BONP,* PENDING INFORMATION [I FOR STREET IMPROVEMENT/EXCAVATION AS F+e-UuivEU ANNUAL PENDIn;C 2ARIANCE ❑ EXPIRATI N GATE: `� PERMIT NO _g d �_L_—.�----- _ DATE ISSUED: ��G-'� BY (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ �� k.MI1_- `W-__ AS DE13CRIBED HEREIN. IN FULL ACCORDANCE WITH CITY REOU}REMENTS. APPLICANT _ UL'slP�v1 �-Oyrs}1Kc.�+cw� tiyl=vtt (o�Q1 (JE r;At',-n _�ls�nCl_W� S 4,`l 31 L NAME ADDRESS CI�'�� —�� - PHONE CONTRACTOr� a v+� _ /� ' NI1A AQDp CiT�— PMONE� PLANS B Y �.4 NAME ALADRESS CITY ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): DOLLARS (2) EXCAVATION DATA: roR oFFtcE Usr ��- - `� MIN. 00.04 x s._ 4,5t s 34• -- STREET DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL IWSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM 9e QUANTITY STREET VA Is 1N �,r, INQP _ R rI�N - ) E c� u ESTIMATED STREET OPENING DATE: �� / 14- 1 --�� S ESTIMATED STREET CLOSING DATE. (3) SECURITY NO, _ SECURITY AMT.: S44V STREET 1_ CLOSED SURF FY CO.: _ FINAL `-^.71FIED CHECK '� CASM •OND C INSPEC. (4) PI-OT PLAN INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT. L ,�. 1 1 _ 4, t _40 1 1 URS iL� ij 1 1 1 (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-CIF-WAY JURISDICTIMI IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PER'.IHENT )_AWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTION;. �7 i �J APPLICANTS SIGNATORE DATE f R/W 5MIN. ICURB JOINT- SEE NOTE 5 20/6 ROAD e �2" OF 3/4"-U COMPACTED SUBORADE SIDEWALK ADJACENT TO CURB R/W 5 • MIN s I I ROAD --- �— 2 % 9 SEE NOTE 5 2" OF 3/4"-0 =� COMPACTED SUBGRADE SiDEVVALK AWAY FROM CURB NOTES I CONCRETE SHALL BE 3000 PSI AT 28 DAYS , 6 SACK MIX , SLUMP RANGE OF I V2" TO 3 2. PANELS TO BE 5 FEET LONG 3. EXPANSION JOINTS TO BE PLACED AT SIDES OF DRIVEWAY APPROACHES , UTILITY VAULTS ,WHEELCHAIR RAMPS , a AT SPACING NOT TO EXCEED 45 FT, 4 FOR SIDEWALKS ADJACENT TO THE CURB 9 POURED AT THE SAME TIME AS THE CURB, THE JOINT BETWEEN THEM SHALL BE A TROWELED JOINT WITH A MIN 1/2"RADIUS. 5. SIDEWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNTABLE CURB IS USED OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY . OTHERWISE SIDEWALK SHALL. HAVE A MINIMUM THICKNESS OF 4 INCHES . 6. DRAIN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3"DIA. PLASTIC PIPE AT 2 % SLOPE CONTRACTION JOINT TO BE PLACED OVER PIPE. IVWASHINGTON COUNTY DEPARTMENT OF LAND USE CONCRETE SIDEWALK AND TRANSPORTATION DA tE CIVIL ENGINEER DRAWN APWA NO, WASK COUN'PY N0. 117Aq_ _e5 NONE CS - 305 WESTERN CONSTRUCTION SERVICES, INC.CALIC, ' -lir,99 PUR %SE ACCOUNT ^C99 18 91 6502 NE . JOHNS RD 699-5317 WA LIC. ,ESTECS162R8 VANCOUVER, WASHINGTON 98661 AY TO THE t� ORDER OF fit/ --- ----- -- DOLLARS V " NOT GOOD FOR MORE THAN $500.00 ANED NOT VALID WITHOUT P.O.# r.aFau.F.•Fnr.,y.am e.. was w F v"e r"e srx«,r ae vww...we�e •_ 1: 3233710631: 4 L 0116 ' L891 WESTERN CONSTRUCTION SERVI^,ES, INC. PURCHASE ACCOUNT CA LIC. #513599 1892 6502 NE ST JOHNS RD 699-5317 WA LIC. ,MESTECS162R8 VANCOUVER. WASHINGTON 98661 1W 5- /-:5-- 19 ylE-;� RT AY THE DER OF BOC_ARS NOT GOOD FOR MORE THAN $500.00 VANFED NOT VALID WITHOUT P.O# ,aZ 3 rY[aywerfa[W Ywep e..t 1 kMIF M F ehM rM ar blur w �e!�L/1 - vrneni.r.w.Vein] • -- 1: 32337 &0631: 4 1 OL167 ? • L892 001 ------------ _-_r_-___S1 I so'-1:3cl IN13WAticl An _4srj.:j,4n.a �.� rtz�..,;•, � ,1 I.q r1:ala! lvj T9986 UM ``�3nnfJCNNr1 � F..I ::F14-1 (P` SNHor is 3N Z097 MCJII.E�1'iJl.�t.!OC iol- ,?3M CCN ;:.?'t Cir• � ;�;)'=, ;� ^3!JNhI dD ,ti.l1C CITY OF- I I C4*,,r-.,fp CA" F;.'rC N134 00 1.06171)8t, N(I M F IE5T17'PN COPISTPUC11014 CHECl- AMCILRAT 8919.60 ('Oi`:;;H .'-filOLJN'r t . 00 AD T",P,F 1:"3 1 e1502 NE ST JOHNS RID F--ovmi,wr DATE- ,)ANCOUVER, WA NO 'ADDR: 120-�o SW MAIN 51 PURPUSK VIP' rAy'P11=t-4'T AMOUNT F,"(.)IE) PURPOSE OF Pi'tYrIPIT AMOUNT Pi:, ('USTDIEP Tl')f--'F-;'CISITS 8c--)5 00 FUIA. IC IMPPMEM REPAIR