Permit CITY OFTIGARD
- �� u � , h ,�� w , � DEVELOPMENT SERVICES SEWERPCONNECTION
°� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • SW R97 -0 164
DATE ISSUED: 06/09/97
PARCEL: 2S103BD —HG013
SITE ADDRESS. . . :12703 SW 116TH AVE
SUBDIVISION • HUNTER' S GLEN ZONING: R -4.5 PD
BLOCK LOT •013 JURISDICTION: TIG
TENANT NAME •
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK... :NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: PATH I SF
Owner: FEES
LEGEND HOMES type amount by date recpt
6900 SW HAINES ST PRMT $ 2200.00 DRA 06/09/97 97- 295658
TIGARD OR 97223 INSP $ 35.00 DRA 06/09/97 97- 295658
Phone #:
Contractor:
OWNER
Phone #: $ 2235.00 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspecti
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeited if the _
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a °Tap and Side Sewer' Permit and the Agency will ii tall a lateral.
Permitte- °nature ,i!y��'d
Issued By: k AN
Call for inspection — 639 -4175
Plan Check #5 -C I L
:ITY OF TIGARD Residential Building Permit Application Recd By iU
3125 -SW HALL BLVD. New Construction Additions or Alterations Date Rec'd 5 ` I
IGARD, OR 97223 Single Family Detached or Attached Date to P.E. S IS- /
503) 639 -4171 Date to DST- 0
Print or Type Permit # ' - D(' t.U' q7—
�? Incomplete or illegible applications will not be accepted Called 05 0?9 gi . pl 1+9
/;72 A rim t'q v.. z�, _
Name of Subdivision Lot # Name
Job HUNTER'S GLEN 13 LEGEND HOMES
Address Site Address Architect Mailing Address
,�,� 6900 SW Haines St.
W 116th Avenue
City/State Zip Phone
Name
Name Tigard, OR 97223 620 -8080
LEGEND HOMES
Owner Mailing Address Name
FROELICH
6900 SW Haines St.
City /State
Zip Phone
En Mailing Address
Tigard, OR 223 620 -8080 6969 SW Hampton St.
Name City /State Zip Phone
LEGEND HOMES Tigard, OR 97223 624 -7005
General Describe work new+' addition 0 alteration 0 repair 0
Contractor Mailing Address to be done:
6900 S W Haines St. Additional Description of Work:
City/State Zip ' Phone
Tigard, OR 97223 620 -8080
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of 060563 6/19/97 Project
Current COT Business Tax or Metro # Exp. Date Valuation
Licenses 4371 f:6 -Z6 33 6 /1/97
Name / -3i -97 NEW CONSTRUCTION ONLY:
Mechanical SUNGLOW INC. Sq.Ft. House: Sq.Ft.Garage:
Sub- Mailing Address
Contractor ; 2428 S E 105th Corner Lot Yes No Flag Lot Yes No
City/State Zip Phone (check one) 7 . (check one) A
I Portl a n d , O R 97216 2 5 3 - 7 7 8 9 Restricted , , t'f Audio /Stereo i;f-k Burglar
Oregon Const. C:mt. Board Lic.# Exp. Date Energy f System �' Alarm
Attach Copy of ; 48131 S`-.?d -17
Current COT Business Tax or Metro Exp. Date Installation h' L Garage Door HVAC
Licenses 122.6 - ( of: y 7- V,44)/ I -/ -qd- Opener 1. Systems
Name (check all that Other:
Plumbing i WOLCOTT PLUMBING apply)
Sub- ; Address Will the electrical subcontractor wire for all Yes No
Contractor PO Box 2007 restricted energy installations? X
City /State Zip Phone Has the Subdivision Plat recorded? N/A Yes No
Gresham, OR 97030 667 -9891 iS
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach Copy of 73947 10 / 19 / 9 7 (Calculation Attached)
Current Plumbing Lic. # Exo. Date I hereby acknowledge that I have read this application, that the
Licenses 2 6 - 2 0 8 P B 8/31/97 information given is correct, that I am the owner or authorized agent of
COT Business Tax or Metro # Exp. Date the owner. and that plans submitted are in compliance with Oregon
96-4281 12 / 9 V State laws.
Name Signa re of Own /Agen Date
t� e e
Electrical GARNER ELECTRIC G c� ' � �.
Con Perso Na Na a Phone
S ub- Mailing Address ?'-'6/__ �o1U D j6�'
Contractor 21785 SW TV Highwa FOR ICE USE ONLY:
City/State Zip Phone Plat # MapITL #: •
Aloha, OR 97006 591 -1320 'f
Oregon Const. cont. Board Lic.# Exp. Date f OC' 01 L ,, /� . 6o,f ( 2_`)/ -' I 36 73()
Attach Copy of - 1.44+9-6,- ii 7 �(/ y0 j' 7 Setbacks Zone: Solar:
Current Electrical Lic. # Exp. Date i
Licenses 34-305C 07 — 9'9 01' 30k 6 - '- '- v
COT Business Tax or Metro # Exp. Date Engineering Appro}fal: Planning Approval: TIF:
istslmstapp.doc .2‘kf ?kW 30 K
- 04 -97
Permit # Account Description Amount Amt. Pd, Bal. Due
Msf q /G7MST. Permit (BUILD) S73 V 573,
Plumb. Permit (PLUMB) Z25 V 225
Mech. Permit (MECH) 45 / X15
/ 2S0 V 2
ELC/ELR Permit ( E 50
G.5
State Tax (TAX) 54. 4— ' V 54
Bldg: 28.
V
Plumb: //. 2> V .
Mech: A.- zs
ELC /ELR: , l 0
Plan Check �/ ' /
y J V V US
MST: (BUPPLN) 372. 2 � ) /22.
Plumb: (PLMPLN)
/ (MECPLN) /1. Z ' iii Z'/
CDC Review (IAA}BUS) ? L ''' -
Sw02 q7 6116 4 i Sewer Connection (SWUSA) 226 ✓ Z2au
Sewer Ins ection SWINSP 3S v 3S
P ( )
Parks Dev Charge 79 oo (PKSDC) /650 /os o 99 Residential TIF � � y 9,(1' 9 --- (TIF -R) /576
Mass Transit TIF Q 1 11 (TIF -MT) j 2v t Zd
Water Quality (WQUAL)
Water Quantity (WQUANT) /00 V /00
Erosion Control Permit (ERPRMT) 64 ✓ Gix
Erosion Planck/USA (ERPLAN) .7_0. 80 l
,e
Erosion Planck/COT (EROSN) 20, V 20 fry
Fire Life Safety (FLS)
TOTALS: 675!.� 0 6 = .
is \dsts\mstapp.doc ``.. d
Rev. 7/96 (
5/30/00 Activities for Case #: SWR97 -00164
3:01:22 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received 5/13/97 BON PASS JD 5/27/97
SWRA705 Sewer Inspection 6/16/97 MS PASS J *H 6/18/97
SWRA070 Ready to issue 5/27/97 JSD PASS JD 5/27/97
SWRA080 (F) Issue permit 6/9/97 DRA PASS DRA 6/9/97
SWRA720 Case Finaled 6/16/97 MS PASS J *H 6/18/97
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