Permit CITY OF TIGARD
� �,�,�;� DEVELOPMENT SERVICES SEWER CONNECTION PERMIT
�:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # 4 .1
• SWR98 -0080
DATE ISSUED: 11/09/98
PARCEL: 16126DC -06600
SITE ADDRESS...:O9277 SW LOCUST ST
SUBDIVISION •MLP96 -0014 PP1997 -124 ZONING: R -12
BLOCK LOT •002 JURISDICTION: TIG
TENANT NAME -LUNDMARK HOMES, LLC
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE •SPA NO. OF BUILDINGS: 1
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: Sewer connection for a new duplex.
Owner: FEES
BERT LUNDMARK type amount by date recpt
3381 COEUR D' ALENE DRIVE PRMT $ 4600.00 DST 11/09/98 98- 310651
WEST LINN OR 97068 INSP $ 35.00 DST 11/09/98 98- 310651
•
Phone #:
Contractor:
LUNDMARK HOMES LLC
ALBERT C LUNDMARK
3381 COEUR D'ALENE DR
WEST LINN OR 97068
Phone #: 655 -8004 $ 4635.00 TOTAL
Reg #..: 122499
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days fray
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 install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952- 0011010 through OAR 952 You way obtain copies of
these rules or direct questio•s to OUNC by callin. :a. )246-1987.
!
Issued by• Permittee Signature: _ 411411.
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
'CITY OF TIGARD Commercial Building Permit Application Recd By
13125 SW. 3ALL BLVD. New Construction and Additions Date Recd
ITIGARD, OR 97223 Date to P.E.
Date to DST
(503) 6394171 Permit #
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
•
Name of Development/Project
Job Existing Building ❑ New Building ❑
Address Street Address I Suite
9 87 c I .0 0. — r Building
Bldg # City/State Zip Data
Existing Use of Building or Property:
Name
Property LT 05 H,? 42-1 _-
Owner Mailing Address ' Suite Proposed Use of Building or Property:
53-(s/ er)t64 /2- /OE -7 )2.
City/State Zip Phone No. Of Stories:
o- )C��
Occupant Name Sq. Ft. Of Project:
Name Occupancy Class(es)
Contractor )-\ y412_
Prior to permit Mailing Address Suite Type(s) of Construction
issuance, a copy
of all licenses
• are required if City/State Zip Phone Will this project have a Fire Suppression System?
expired in C.O.T. Yes ❑ No ❑
database Americans with Disabilities Act (ADA)
Oregon Const. Cont. Board Lic.# Exp. Date
Valuation X 25% = $ Participation
Complete Accessibility Form
Name Project $
Architect Valuation
Mailing Address Suite
Plans Required: See Matrix for number of sets to submit
City/State Zip Phone on back
Engineer Name I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and
Mailing Address Suite that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date
City/State Zip Phone
Contact Person Name Phone
Indicate type of work: New 0 Addition 0 Demolition 0
Accessory Structure 0 Foundation Only 0 Alteration 0
Repair o Other 0 FOR OFFICE USE ONLY
Description of work: Map/TL# Land Use:
Notes:
Parks: Estimated # of Employees
TIF:
If the above figure is not supplied at the time of application, the city will
calculate the fee based upon the number of parking spaces.
Note: Site Work Permit Application must precede or accompany Building
Permit Application
I: \COMNEW.DOC (DST) 5/98
•
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
application For an e(ecthcal submfttal, the apphcation must contarn the
signature of the superytsn eJecfrtcar before plan rnviw will be cotiduted
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aggitongtggpiigowtogiggtopoiggipurptooCmgogilf0(ppoloptotER60•1110:111
11111111:10111::51:1111:11,114001401::::::
KEY:
Subrrntted
......................................................................................................................
.....................................................................................................................
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical —
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
.................
NOTES:
......................................
lAdsts1maxtrix1 .doc 07/06/98