Permit OF TIGARD CITY SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
� PERMIT # • SWR96 -0546
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/96
PARCEL: 2S110AA -00300
SITE ADDRESS...: 14145 SW 105TH AVE
SUBDIVISION • ZONING: R -12
BLOCK LOT •
TENANT NAME -TIGARD MEDICAL REHAB
USA NO • FIXTURE UNITS...: 26
CLASS OF WORK...:ADD DWELLING UNITS..: 2
TYPE OF USE •COM NO. OF BUILDINGS: 0
INSTALL TYPE •LTP IMPERV SURFACE: 0 sf
Remarks: Installing 2 sinks, 1 lay, 1 shower, 1 toilet, 1 washing machine, and a
map sink
Owner: FEES
TIGARD MEDICAL & REHAB type amount by date recpt
SUNRISE HEALTHCARE PRMT $ 4400.00 JSD 11/27/96 96- 287031
14145 SW 105TH AVE
TIGARD OR 97224
Phone #:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 4400.00 TOTAL
Reg #..:
REQUIRED INSPECTIONS
This Applicant agrees to couply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The perait expires l8 days frea
the date issued. The total mount paid will be forfeited if the
perait expires. The Agency does net guarantee the-.accuracy of the
side sewer laterals. If the sewer is not located at.the nealwrenent
given, the installer shall prospect 3 feet in all directions. fres
the distance given. If , net so located,rthe installer.shal:l , purchase
a "Tap and Sewer' Perait and the X , •• will ins 11 a. lateral.
0 Permittee 9 '' 1 / Aei
Issued By:
�jI' jI ,
Call for inspection — 639 -4175
c14014 11 -75 -1,
Commercial Building Permit Application
City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223
(503) 639 -4171
Jobsite Address: 1 l 4 OFFICE USE ONLY
Tenant: I aa(� � katIN � r Su e # Planck/Rec. #
'J
Valuation: Permit #
Map & TL #
Owner:
Approvals Required
Address:
Planning
Engineering
Telephone:
Other
Contractor:
Address:
Type of constr:
Telephone: Occupancy Class:
Contractor's License # Sprinkler? Yes No
(attach copy of current Oregon license)
Sq. Ft. Of Project:
Contact name & telephone:
Story (1st, 2nd, etc.):
Architect & Engineer:
Proposed Use:
Address:
Previous use:
Note: Plumbing & mechanical plans must
Telephone: be submitted at time of building permit
application.
JOB DESCRIPTION:
(Applicant Signature & Telephone Number)
Received by: i I Date Received: / l Z / `" /&
PERMIT# Account Description Amount Amt Pd. Balance Due
Building Permit (BUILD)
Plumbing Permit (PLUMB)
Mechanical Permit (MECH)
State Tax (TAX)
Bldg.
Plumb.
Mech.
Plan Check (PLANCK)
Bldg.
Plumb.
Mech. ' ! �t
— Q�j U 4
Lap Sewer Connection (SWUSA) �1o0
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
Office TIF (TIF -O)
Water Quality (WQUAL)
Water Quanity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: 1 -1L-100 41-00
CITY OF TIGARD BUILDING INSPECTION N E
Inspection Line: 639 -4175 Business Phone: 63 1 1
1
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
an. Sewe Gas Line i Appr /Sdwlk Reins.
/ r
Other: / / � 4 , it -4-4 al L L
Date: [ )- -2 4' A.M. P.M. Entry:
Address: )/ 14 S < 6 ,s ---- Q r / k�
Tenant: --- ri Q/ I') r��•�D, Ste: MST:
a — )--. O -- Ca 3 -- BUP:
Con /Own: ?7 � MEC:
q6 LtY PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
A C /A7ef 2 R,,,:1IA -4 /.>,ela /A.iS 0 /c
CG 7r O ? CLt `L c i �� "aw
1" ° .7,A-d,47 / '5 ''ec 9I'L 4
G /
"e6 A Trot', da/ -v /- -s 7
(
I P Inspector: �� Date:
_APPROVED DISAPPROVED/CALL FOR REINSP. CF CO