Permit CITY OF TIGARD
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DEVELOPMENT SEWER CONNECTION
W �~����,�x nmx�.�" SERVICES PERMIT
������ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PERMIT #.~.....: SWR97-0113
DATE ISSUED: 04/28/97
PARCEL: 2S103BD—HG008
SITE ADDRESS...:1261 SW 116TH AVE
SUBDIVISION -HUNTER'S GLEN ZONING: R-4.5 PD
BLOCK LOT.............:008 JURISDICTION:
_ _
TENANT NAME -LEGEND HOMES
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 1
.
Owner: ---- FEES ' ' '
LEGEND HOMES type amount by date recpt
6900 SW HAJNES ST - PRMT $ 2200.00 B 04/28/97 97-297797
TIGARD OR 97223 INSP $ 35.00 B 04/28/97 97-297797
Phone #:
Contractor: ---
OWNER . •
•
�
, '
Phone #: $ 2235.00 TOTAL
Reg #..:
' REQUIRED INSPECTIONS'
This App icant'agreps to comply with all the rules and . regulations Sewer Inspection . .
of the Unified Sewage Agency. The permit expires days from ____ ____ _
the . date issued. The total amount paid will be forfeited if the ____ ________ ____
permit expires�The Agency does 'not guarantee the accuracy ot the ______ ___. _____ .. side sewer laterals :If the Sewer i*nnt lucatod�at thp�mea�ore�a.^ . ____ . . _ __
given, the installer shall prospect 1foet in all directions from ___ _____ _
tho'distaoce givon.'lf not so located,. the instal r __ __ __
a "Tan and Side Sewer"'Pormit and the ta _ ___ �___ '' ___
if �� __ __ _ _
Permittee Si nature: �v �^��r _ __� _ _________
. 7
� V / � _____
Issued By: OP. ____- ' _____ ___
'� __ _______ ___
Call for inspection.— 63974175
' __ .� ____
Plan Check # _4 ".. a*
.ITY OF TIGARD Residential Building Permit Application Recd By trl< `
3125 SW HALL BLVD. New Construction Additions or Alterations Date Recd
IGARD, OR 97223 Single Family Detached or Attached Date to P.E. t-4 I5
503) 639 -4171 Date to DST - / -
Print or Type Permit # ST - Dt2o su3 7—
Called -2 3 - 97 01 i v
Incomplete or illegible applications will not be accepted
Name of Subdivision Lot # Name
Job LEGEND HOMES
HUNTER'S GLEN 08 Architect Mailing Address
ite Ad
Address S 6900 SW Haines St. •
1261 116th Avenue
Name City /State Zip Phone
LEGEND HOMES Tigard, OR 97223 620 -8080
Owner Mailing Address Name
F ROELICH
6900 S W Haines St.
Engineer Mailing Address 6 9 6 9 S W Hampton Zi Phone g ton S t.
Tigard, OR 9223 620 -8080 P
City /State Zip Phone
Name Tigard, OR 97223 624 -7005
General LEGEND H OMES Describe work neddition 0 alteration 0 repair 0
Contractor Mailing Address to be done:
6900 S W Haines St. Additional Description rof Work:
City /State Zip Phone
Tigard, OR 97223 620 -8080
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of 060563 6/ 19 / 9 7 Project
Current I COT Business Tax or Metro # Ex Date $ s > r
Licenses v 9 - � 3 6 g� Valuation
Name /. _3/ -97 NEW CONSTRUCTION ONLY:
Mechanical SUNGLOW INC . Sq.Ft. House 3 Oc, Sq.Ft. —rage
Sub- Mailing Address /
Contractor : 2428 S E 105th Corner Lot Yes No Flag Lot Yes No
City/State Zip Phone (check one) `�-- -(check one)
I Portland , 0 R 97216 2 5 3 - 7 7 8 9 Restricted pia/40 Audio /Stereo 9 /.0/41 - 0 � Burglar q -
Oregon Const. Coat. Board Lic.# Exp. Date Energy A System Alarm
Attach Copy of 48 131 5 -ate 9 Installation g
Garage Door HVAC
Current COT Business 1- Tax � ory � etro # Exp. Date r Opener Systems
Licenses 6 97 - 70)4/ /-/-1
Name (check all that Other:
Plumbing , WOLCOTT PLUMBING apply)
Su - : '.'•ailing Address Will the electrical subcontractor wire for all Yes No
P O Box 2 0 0 7 restricted energy installations?
Contra t or Has the Subdivision Plat recorded? N/A Yes No
\ City/State Zip Phone
l Gresham, OR 97030 667 -9891 `K___
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach Copy rrf 9 - 3 1 447 10/19/97 (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 / 93' State laws.
Name Signature of Ownerrr /Agent D to
Electrical GARNER ELECTRIC / `Oy `" `dc F% 9,_ 97
Contact Pe son Name p Ph „g ne
Sub- Mailing Address eetley
Contractor 21785 SW TV Highwa FOR OFFICE USE ONLY:
City/State Zip Phone Plat # Map/TL #: 11,,
Aloha, OR 97006 591 -1320 n
Oregon Const. pont. Board Lic.# Exis. Date � 7 MC' y7 j g ��1 ' 3 ( 6I ' ) - 5, e)
Attach Copy of
7_4
96 f � 7� / - f l . Setbacks Zone: Solar: _ --
Current Electrical Lic. # Exp. Date m !�'`�
Licenses 34 -305C /6 -/ VY -60i 0 6- i-I1 •� 1 p O
COT usin T ax t oor Metro # Exp. D to Engineering Approval: Planning Approval: 1 T ( IF: I , `, ei�
Pp• J ` W6 jl -1( I(fiv� -6 ad td1't” V tLCJvv'1
sts\mstapp.doc � �
+4S °11
Permit # Account Description Amount Amt. Pd. Bal. Due
M5111-0120 MST. Permit (BUILD) ('Y• : (®y, Plumb. Permit (PLUMB) 2_45 - i- s
Mech. Permit (MECH) e 4.5 -z/a , "'
ELC /ELR Permit (ELPRMT) 02751 W a 7S. "
GS � a
State Tax (TAX) S 7 , 57 ,
Bldg: 30/4 4 a
Plumb: 1/ /
Mech: �, "/
ELC /ELR:
s
s- 13
Plan Check c� 5 , W
MST: (BUPPLN) ,n5, Z� - ---
Plumb: (PLMPLN)
Mech: (MECPLN) p. Z'- If - —
Cix Pt-ks z0
— . .� CDC Review (LANDUS) 4-6 C� `j) �c' ?(°
Sw1Z4.1 -OIIJ Sewer Connection (SWUSA) 22rco, 02,,?0
Sewer Inspection (SWINSP) 35. `-' 3 .
Parks Dev Charge (PKSDC) lose, /050, "'
Residential TIF (TIF -R) —/-Z- d ( W'!=�..a -
Mass Transit TIF (TIF -MT)— 41•
Water Quality (WQUAL)
Water Quantity (WQUANT) /00 /00 ,
Erosion Control Permit (ERPRMT) (e/, W Gel
Erosion Planck/USA (ERPLAN) Zo. w c20• �`
Erosion Planck/COT (EROSN) _ 20
Fire Life Safety (FLS)
TOTALS: "
250 . _ ._
Odstsknis
7 9stapp.doc 5 , ;i { V t1 I l 1 - /, r " �'_
Rev.
4/26/00 Act for Case #: SWR97 -00113
2:02:31 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA007 Application received 4/9/97 DRA RECD BON 4/15/97
SWRA705 Sewer Inspection 9/22/00 97 PASS MRS 9/22/97
SWRA070 Ready to issue 4/23/97 B • PASS BON 4/23/97
SWRA080 (F) Issue permit 4/28/97 B PASS BON 4/28/97
SWRA720 Case Finaled 9/22/97 MS PASS MRS 9/22/97
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