Permit CITY OF T SEWER CONNECTION
r y i � DEVELOPMENT SERVICES PERMIT
''� PERMIT # • SWR96 -0523
.; __.. . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11 / 15 / 96
PARCEL: 2S102CB -06801
SITE ADDRESS...: 10475 SW PARK ST #NEW
SUBDIVISION • ZONING: R -4.5
BLOCK • LOT •
TENANT NAME -HESS
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 0
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: Sanitary sewer connection — reimbursement district #7 fees paid
Owner: FEES
PHILLIP HESS type amount by date recpt
10475 SW PARK PRMT $ 2200.00 JSD 11/15/96 96- 286593
INSP $ 35.00 JSD 11/15/96 96- 286593
TIGARD OR 97223
Phone #:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2235.00 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 180 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 /al pur has:
a °Tap and Side Sewer° Permit and the Agen i► st -' a 1.tera,
ii ‘d fr l , / rigio, / Jr I
Permittee Signa I re V `,
/
Issued By: �� i0.1
Call for inspection — 639 -4175
PIjn Creek x
CITY OF TIGARD Residential Building Permit Application R , B
13125 SW.HALL BLVD. Ne.v Construction Additions or Alterations Date Recd
i IGARD, OR 97223 Single Family Detached /Attached (1 or 2 units) Date to P E
,503) 6394171 Date to DST
Print or Type Permit x C G 3
Calico
Incomplete or illegible applications will not t.: accepted
I Name of Project Name
I
I Job
I Architect Mailing Address
'ddreS , Site Address
LOCI (�1y� ,e,„ ` City/State Zio Phone
V �C. \ 111`''lt(� 14 s Name
Owne Mailing Aadress 1�
Engineer Mailing Address
. I C.tyrState Zip Phone g
TOC Cl 6d g9.aa t.y. v -igg
Name CitylState Zio I Phone
■ General Describe work New 0 Addition 0 Alteration 3 Repair 0
1 Contractor Mailing Address to be done.
Type of Use I (.....� r
City/State Zip Phone 1
Type of Construction
Oregon Const. Cont. Board L:c x Exp Date
. Attach Copy of Occupancy Class I
i Current COT Business Tax or Metro x I Exp. Date
Licenses Will it be sprinklered? YesO NOD
Name If Yes. separate FLS plans and
application to be submitted
Mechanical Number of Stones
Sub- Mailing Address
Contractor Propose
'
c tjel
C:tyiState Zip Phone
Previous Use I
Oregon Const. Cont. Board L:c.# Exp. Date
Attach Copy of Valuation I $
Current COT Business Tax or Metro* 1 Exo. Date
Licenses • NEW CONSTRUCTION ONLY:
' Name Building ID
Plumbing
Sub- Mailing Andress Unit Types . square `.t. 1 # of units
Contractor A.)
City/State Zip Phone B.)
C.) I
Oregon Cans:. Cont. Board L:c # Exp. Date D)
Attach Copy of Will the electrical suoconi• actor wire for all restricted I Yes I No
Current I P!umoing Lic. : I Exo. Date I energy installations?
Licenses Has the Succivision Plat recorded? I N/A I Yes I No
COT Business Tax or Metros Exp. Date
I hereoy acknowledge that I nave read this application. that the
Name information given is correc :mat I am the o ner or authorized agent of
Electrical the owner. and that or sub Aare in ompliance with Oregon
State laws
Sub- Mailing Address i /. /.
Contractor
SW„dtt mipm i wear r S GryiSta:e Z,p Phone / �!,�/
��� im Phone
Oregon Cons :. Cont. Board Lic.; Exp. Date FOR OFFICE U E ONL —
Attach Copy of
Current Exec :ncai Lic.* I Exp. Date Plat Map/TL Zone
Licenses l __
COT Business Tax or Metros Exp Date Engineering Approval Planning TIF
Approval
asts coc
Permit At Account Descriotion Amount Amt. Pd. Bal. Due
MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT)
State Tax (TAX)
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check
MST: (BUPPLN)
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review - planning (CDCPLN)
CDC Review - bldg (CDCBLD)
z
gv' Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS:�� 22`36
c rev. 10/96