Permit u :- -, CITY OF TIGARD SEWER CONNECTION PERMIT
IN ,:a COMMUNITY DEVELOPMENT Permit ti: SWR201000013
T 6 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/11 /2010
Parcel: 2S112BD09100
Jurisdiction: Tigard
Site address: 14738 SW 78TH AVE
Subdivision: BRITTANY MEADOWS Lot: 27
Project: Brittany Meadows
Project Description: Connect new SFR to sewer.
FEES
Owner:
ECF DEVELOPMENT COMPANY INC Description Date Amount
1310 SW 17TH AVE Sewer Connection Fee 02/11/2010 $3,600.00
PORTLAND, OR 97201 Sewer Inspection - Residential 02/11/2010 $35.00
PHONE:
Contractor:
PACIFIC LIFESTYLE HOMES
11815 NE 99TH ST #1200
BRUSH PRAIRIE, WA 98604
PHONE: 360 - 213 -0864
FAX: 360- 574 -6401
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,635.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to ODU(�NC by calling 503.246.6699 or 1.800.332.2344. /m
Issued By: _ j r,n J Q j Permittee Signature: �i1 -
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City Tigard TI and Received
Date Permit No.: - ..- • • 1111 v:
° 13125 SW Hall Blvd., Tigard, OR 97223 JAN 2010 Plan Revie � ._, p
Phone: 503.639.4171 Fax: 503.598.1 960 U Date /Bv: Other Permit: 1 1. to ..
. •
TIGARD
Inspection Line: 503.639.4175 Date Ready, 0 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: 3 4 . l 0 � Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
® New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $4.24000400- - �I- 7
® 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building El Multi-family Number of bedrooms: -1
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 14738 SW 78 Ave, New dwelling area: 2569 C I square feet
City /State /ZIP: Tigard, OR 97224 Garage /carport area: y (p 3 square feet
Suite/bidg. /apt. no.: Project name: Brittany Covered porch area: , 1 `l square feet I L. 70
Cross street/directions to job site: ,�L ,4, 77 Deck area: � square feet
Other structure area: � square feet Z3
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Brittany Lot no.: 27 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: R2155946 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SFR Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name. . y f $ - `4 / 514›.7 ✓ Type of construction:
Address: 1 t ut a >vc nosh S.tr,.,.t, Ste 1 S- � Occupancy groups:
City /State /ZI • ' 1_476t �
6- 7 / iX- �..?1 Existing:
Phone: (3644243886. AV/ 5 Fax: ( 3607554 Sv3 dzy - 5 4/2 New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Pacific Lifestyle Homes, Inc. All contractors and subcontractors are required to be
Contact name: Elizabeth Kyser licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11815 NE 99th Street, Ste 1200 jurisdiction in which work is being performed. If the
City/State /ZIP: Vancouver, WA 98684 applicant is exempt from licensing, the following reasons
apply:
Phone: (360) 213 -0867 Fax: : (360) 574 -6401 d00 i _ �J ' 1 at a A-`�
E -mail: ElizabethK @pacificlifestylehomes.com t .— ( ' , ( .0
CONTRACTOR
Business name: Pacific Lifestyle Homes, Inc. BUILDING PERMIT FEES*
Address: 11815 NE 99th Street, Ste 1200 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP: Vancouver, WA 98684
Phone: (360) 213 -0867 Fax: (360) 574 -6401 FLS plan review fee (if applicable):
CCB lie.: 173524 Total fees due upon application:
Amount received:
Authorized signature: `f This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: A Date: 0s—A * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP -RES PermitApp.doc 10/01/09 440 -46I3T(1 I /02/COM/WEB)