Case File ADDRESS:
i:\records\microflm\tergets\building.doc
CERTIFICATE
OF
�a TIGARD
OCCUPANCY
PERMIT i . . . o MS
721
COMMUNITY 09KPM*NT DRPAR*iAE 7' DE: It;s�.OEDt aeixr/ )3
19129 6W Mall OIv@,71@44,Ot"m 07243*3190 (9119)630-4171
PARCEL.: 1 G 134CB-•1 7'300
SITE ADDRE,"'. . . : 122,:,121 SW ANTON DR
SURDIVISION. . .. . : ANTON I'APF< 42 ZONING:
13k_C)CK. . . . . . • . • • LE;TA v • n a . . . . . . . . 11D6
------------------------------- --
CLAMS OF WORK. MEW
TYPE OF LOBE. . . :SF
OIXUPANCY ORP. r 1t3
OCCUPIANC Y LOAD t 2 '7 4
TENANT NAME:. . . a
denorkss PATH I
Owner n
U C ANDERSON INC i
4575 SW TUCKER OVE"
BEAVER OR "37005
Phone #: 627- 9999
Contractors
D ANDERSON, INC
4575 SW TUCKER AVE
BEAVFRTON OR 97005
Phone 0% 627-5499
Reg 0. . : 4634/4
Occupancy of the above referenc=ed building is hereby given, and certifies
the colMplianr_e with the 'Stats Of Orequr SpPr_ialty Codes far the group,
occupancy, and use a.lnder which the referenced per-ait was 11.slaed.
�k
F I RE DE:PhR'rl4f;N"Ti
IN
PErCTOR
illiLDI - 1 ICTAL
POST IN CONSPICUOUS PLACE
f
i
1K5pzQxOff Narlcq
city or Tigard Ruildiog Departannt
13125 M Ball Blvd. Tigard, Oregon 117223
Inspection Line (Roc--O-Phone): 639-41;5 Ruafneas Phone: 639-4171
Inspections
Footing Plbg. Dnderslab Mach. Rough-in Appr/Bdwlk
Found. Plbg. Top out Gas Line FINAL$
Poet/Beam St_ruct. Ball. Newer Framing -11dg,
Poet/Ream Mach. Rain Drain Insulation -FleAb.
Plbg. underfloor later Line Gyp. Rd. _Nech.
Date Requested: > TierI __LM
Addrasa: � Q /A/l1 ! Permit
Builder:
17M FOLL Mme (ORRBCTIONS ARR REQtlTRET.
4/
Inepectorr____-.,_L _ Drte:
` __APPROVED DIRAPPROVED -- — APPROVED &,IRJECT To AROVE
_—Call For Reinap.
INSPE4TIP1NOTiCE
C:Lt7 or Tigard euildii.:q Department
13125 H�yz�""qy
led. Tigard, Oregon 9723
Inspection Line (Rwc )s 639-4175 Business Phcnas 639-4171
Inspection:
Footing Plbg. V derelab Mach. Rough--i•i (,hppr/.Sdwlk
Found. P1 , Top Out Gan Line FINAL:- - -�
Post/Seam Struct. San. Seller Framing _11149.
Post/Seem Mach. Rain Drain Insulation -Plumb.
Plbg. UnderfloorM7/7/
r Line Gyp. Rd. -Meeh.
Onto Requested: '1 13 Tinea: AM PM
Permit f:Builder:
TBE `OLL.OVING coPAnc-r IONS ARE REQUIRFD:
�APPROVRD DISti^ioVlD APPROVRO SOWRCT TO ASOVR
Call For Rsinep.
INSPS&; :O_K NOTICE
City of Tigard Building Deper"e not
13125 Bw Ball Blvd. Tigard, Oregon 97223
Inspection Lino (Rec-O-Phone): 639-4175 Business Phones 639-4171
Inspections .__
rooting Plbg. Underalab Hoch. Rough-in AEpr/Sdwlk
Pound. Plbg. Top Out Gas Line FINALt
Post/Ream Struct. ;an. Sewer treating of
Post/Beam Hoch. Rain Drain insulation _Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. Meeh }
y -
Late R�pm
usled t yt --Times toe s ,_ AM� -pN
Addrmsst 1�� /,cam�;r)r� Permit
BuLldors—
TM FOWAPI M ODRRECTICNa ARE REQUIREDt
1 M 1_411/ Flo --- LL/ —
7 / r Gw� -
�p
r'
Inspectors a�✓` Dates 1 `i
APPROVED DISAPPROVND APPROVED SUBJECT TO ABpyE
Call For Reinap.
jNSi'$CTIUN NOT CR � /
City of Tigard Building Department
13125 M Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-A-Phones 639-4175 Businaee Phones 639-4171
Inspections
Tooting Plbg. Underalab Meech. Rough-in AErpr/Sdwlk
Mound. Plbg. Top Out Cas Line FINALS
Oost/Beam 8truct. San. Sewer Framing -Bldg.
Pnst/Exam Asch. Rain Drain Insulation
Plbq. Undorfloor �i Nater Line Gyp, ed, -Koch.
Data Rrquesteds �J - �� Time: AM PN
n
Addr,esss � til /)r / Permit
Builders uL,,/jf,.t
TBL FOLLORINO OORRNCTI% 2 RRQUIRM
4
Inspectors —� -.___-- Dates Y
APfROIIiC D18APPROVltD �ROVRD SUBJECT TO ABOVR
--Ca)] For Rainsp.
ISPECTION NOTIcE
Clt7 of Tigard Building uepartsent
13125 Sp Hall Blvd. Tigard, Oregon 9722'
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 6Q 171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found- P]bg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rein Drain Insulatinn -Plumb.
Plbg. Underfloor Wate Line !� _Meoh.
Dat_ee RHquAet.ede _� J Timet AH PM
Permit #ITS O
Builder:
THE FOLLOWIIMC. CORRECTIONS ARE REQUIRED:
v�
..nspector: _� OVDate:_
APPROVED -_ DISAPPROVED —
SUBJECT To ANOVF
—-----Call Fir Reinsp.
jffgf CE ION NOTICE
City of Tigard Building Dopartsent
13125 Sof Ball Blvd. Tigard, Oregon 9722.3
Inspectiun Line (Rec-O--Phone): 639-4175 Business Phone: 639-4171
Inspection:__ _
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk l�
_s"
Pound. Plbg. Top Out Gas Line FINALi
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain InnulalAon _Ply.
Plbg. Underfloor we r L no Gyp. Bd. _�h.
Date Requested:
2 5LA
Address: �
Permit #1��'-D DI Z
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIREDt
61<
6t
Inspectors
Dates-4-"�O--090,�__
APPROVED DISAPPROVED APPROVED SUB.IECT To ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec•-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Mach. Rough-in Appr/S"lk
Found. P1bg. Top Out Cas Line FINALS
Poet/Beam Struct. San. Sewed Framing -Bldg.
Poet/Beam Mech. Rain DrainCfnsulat -Plwib•
Plbg. Underfloor Water Line Gyp. Ed. -M*ch.
Doti- o..questod: _rM
Address: ';Z-';L22eD / (2/Y/Z _ Perifixt !(
Builders /l_ W e� _ _I 9 9
TNM FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:-
l
_APPROVED DISAPPROVED __ APPROVED SUBJECT To ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of % -gard Building Department
13125 SW Bal, Blvd. Tigard, Oyvgon 97723
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 39-4171
Inspection:
Footing Plbg. UnderO.ab �I(ach_ Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL.:
Poet/Beam Struct. San. Snwer taming -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. ech.
Date Requested: Time: 11N PM
Address: 1,;71 �y7cJ Permit fs!
Builder-
THE
uilder:THE FOLLOWING CORRECTIONS ARE REQUIRED:
— —� '-- ----- S
Inspectors
vT APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE.
City of Tigard Buildiny Department
13125 SW Hall Blvd. Tigard, Or Wn 97223
Inspection Line (Rec-O-.Phone): 639-4175 Business Phone: 63 71
Inspect ion:_._.^��
Footing Plbg. Underslab 42ch. Rough Appr/Sdwlk
Pound. Plbg. Top Out `�/ FINAL-
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. --Mach.
Date Requested: , —LIZ
—4�_3 Time: -- _AM PM
Addreriee -_� y �QL ` Permit zw
Builders
THR /)OLLOWING CORRECTI�OONN_S ARE REQUIRED:
.00
Inspector: natal
APPROVED �DI8APPROVED APPROVED SUBJECT TO hBOVta
Call For Reinep.
t
INSPECTION NOTICE_
City of Tigard Building Department
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4,171
Inspection:
Footing Plbg. Underslab ech. Rough-in Appr/Sdwlk
Found. Plbg. Top out Gas L no FINAL:
Post/beam Strutt. Sart. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Inealation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requeeled: Times AM PH
Addraee:_ JC/ 1 �jL1 Permit f:9&
Builder: G/
THE FOLLOWING CCO"RRECTIONS ARE REQUIRED:
Inspector:— _ l-- - — -- Dates
- APPROVED -- - DI3APPFP.-)VRD APPROVED SUBJECT TO AROVA
- Cell Tor Reinap.
M.tp of Tigrard Buf;ling Department
13125 M, spall Blvd. Tigard, Oregon 97223
Irwpe-t an Line (Rec-O-Phone s 639-4175 Businea.4 Phone: 639-41'1
Itspictions—
ftu`iog Pltq. UndocAab M�x,1. Rough-in Appr/Sdwlk
FoB1t' plbg. Top Ort Gas Line FINALS
Poet/',, I St.uct. ^.-n. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfl.,ior WaterLine
Gyp. ed. -Mach.
er
Date Requeel.ed: ^ [ q'.,-S _Timet AM PM
Adn_dees , �J 0 sof n� % Permit
Buildors
THE FOLLOWIN^ CORRECTIONS ARE REQUIRED:
f �- -Inspectors Date:_/ _
APPROVED DISs1PPROVED APPROVED StIB.7ECT Cfi :'s%OVE
TCall
For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
lbq. Qndetllooc Nater Line Gyp. Bd. -Mech.
Date Requesteds C Z t/ 3 Times q AM PM
Address:_/ Z_ Z_ j CJ / Jam.✓/ Permit Os
!.Iulidpr:
THE FOI.i.OWING MRRECTION; ARE REQUIRED:
Inspector: --C�— -- - - Dates_2-
APPROVED DIBAPPROVED APPROVAD SUBJECT TO ABOVE
C.211 ?or Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 ON Ball Blvd. Tigard, Oregon 9727.3
Inspection Line (Rec-O-Phons): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underslab Mach. Rough- in Appr./Sdwlk
Found. Plbg. Top Out Gas Tine FINAL:
Post/Beam attuct. San. Sewer Framing -Bldg.
Post/Beam Mac h. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Lino Gyp. Bd. -Mach.
Date Requested:_ __-Time: _x_--AM -PM
Addrens: % L Z s�� ����.`i-r. --- Permit 4:
Builders
THE FOLLOWING CORRECTIONS ARE REQCTRED:
inspector• `7v_ ---- _ Dates Z _2 it
___ APPROVED DTSAPPROVED _ ROVED SUBJECT 'O ABOVE
Call For Reinsp.
imp grrjON NOTICE
City of Tigard Building Departsaent
13125 99 Ball Blvd. Tigard, Oregon 97223
inepection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out vias Line FINALs
Poet/Beam Struct. San. Sewe19 Framing -Bldg.
Post/Beam Mach. liain Drain Insulation -plumb.
Plbg. Underfloor `N ter Line—., Gyp. Bd. -Hoch.�Q �
Date Requeatedt_.���� Timet AM _ PM
Addreea: /�'��� iU_ Permit #s Biel
THE FOLLOWING CORRECTIONS ARE RRQUIRED:
Inspe^_tort / Datet�
�A�PROVED —_ DISAPPROVED _-_ APPROVE6 SUB.IECT TO ABOVE
____call For Reinap.
INSPECTION NOTICE
city or Tigard Building nepartAent
131.25 BW Ball Blvd. Tigard, Oregon 97223
Inspection Li.,* (Rec-O-Phones 639-4175 Buoineee Phone: 639-4171
Inspection:
ooting Plbq.. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top &-t Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Meth. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Reyueated:— ;12 _Z/ A _Time. -�y _
__PM
Address:-/�C Permit f
THE FOLLOWING CORRRCIIONS ARE RFQUIREDs
APPROV'9V DISAPPROVED k-11 APPROVED SUBJECT TO AROVF
____Call For Reinnp.
C 7Y UFA RD PLUMBING PERMIT
momm
COMMUNITY DEVELOPMENT DEPARTMENT 07 PERMIT >I1. . . . . . . : MST93-0012
MOM
is
13126 SW Hrdi 6W. P.O.Bou 23,997,Tigam,Oregon grm(SM)6304176 DATE ISSUEDa 01/28/93
SITE ADDRESS. . . 1 12230 SW ANTON DR PARLELi 1S134CB-.-AP106
SUBDIVISION. . . . I ANTUN PARK #2 ZONINGs
BLOOK. . . . . . . . . . I LOT. . . . . . . . . . . . . 1106
--------------------------------------------------------------------------------
CLASS OF WORK. . sNEW GARBAGE DISPOSALS- 11
"TYPE OF USE. . . . #SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . 10
OCCUPANCY GRP. . sR3 FLOOR DRAINS. . . . . . . 10 TRAPS. . . . . . . . . . . . . . :0
STORIES. . . . . . . . s2 WATER HEATERS. . . . . . 21 CATCH BASINS. . . . . . . 20
FIXTURES------------- LAUNDRY TRAYS. . . . . . :0 SF RAIN DRAINS. . . . . Al
SINKS. . . . . . . . . . i I GREASE TRAPS. . . . . . . 10
LAVATORIES. . . . . e4 OTHER FIXTURES. . . . . :0
TUB/SHOWERS. . . . : SEWER LINE (ft) . . . . 10
WATER CLOSETS. . 33 WATER LINE (ft) . . . . 3100
DISHWASHERS" - 11 RAIN DRAIN (ft) . . . . a0
Remarksi PATH I
OWNERS ------------------------------ ------------------FEES-----------------
D E ANDERSON INC TIP $ 1460. 00 JH 01/28/93 -
4575 EW TUCKER AVE BPRT $ 397. 00 JH 01/28/93 -
);PLC $ 258. 05 JLH 12/28/92 92-235030
BEAVER OR 97005 B5PC $ 19. 85 JH 01/28/93 -
Phone #t 627-9999 SSDC $ 280. 10 JH 01/28/93 -
PARK f 5O0. " JH 01/28/93 -
Plumbing CcPtr tors----------:------ MPRT 43. 50 JH 01/28/93 -
MPLC >< 10. 88 JH 01/28/93 -
Name :, -f=z1:v4 M5PC S 2. 18 .11-1 01/28/93 -
Addresss CZ PPRT 140. 00 JH 01/28/93 -
City: States— P5PC f 7. 00 JH 01/28/93 -
Zip Phone#t
Reg #s
REQUIRED INSPECTIONS --------
This permit is issued subject to the reg-
ulations contained in the Tigard Municipal Foot/found Insp Rein drain Insp
Code, State of Ore. Specialty Codes and all Post/Beam Struct Water Line Insp
other applicable laws. All work will be done Post/Beam Meehan Appr/Sdwlk Insp
in accordance with approved plans. This Pim/undslab Insp Mechanical Final
permit will expire if work is not started PLM/Underfloor Plumb Final
within 180 days of issuance, or if work is Mechanical Insp Building Final
suspended for more than 180 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain
Fireplace !nsp
Gas Line Insp
A Insulation Insp
x &YU&Agg:�-- Gyp Board Insp
AutK6-rized Plumbing Contractor Signature
Call for inspection 639-4175
Contractor Notesa
C17YOFTIFARD
CffY ?ItnrltlD
COMMUNfTY DEVELOPMENT DEPARTMENT osnaon MASTER PERMIT
--- IM258WHOUB►wd.P.0.Buw23W,T1gW,0mW snrZs(SM)63W4176 -- j PERMIT 0. . . . . . . s MST93-0012
639-4171 DATE ISSUED: 01/28/93
SITE ADDRESS. . . : 122:30 SW ANTON DR PARCELS 1S134CB-AP106
SUBDIVISION. . . . s ANTON PARK #2 ZONINGS
BLOCK. . . . . . . . . . s LOT. . . . . . . . . . . . . a106
---------------------------------- BUILDING - _------------------.------------_.---
REISSUEs DWELLING UNITS: 1 BASEMENT. . . . . . . . s0 sf
CLASS OF WORK. sNEW BE:DRhl5:4 BATHS:3 GARAGE. . . . . . . . . . :400 sf
TYPE Or:: USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS----------
TYPE OF CONST. s 5N FIRST. . . . ..849 s f LEFT. . :5 ft RIGHT. s 5 ft
OCCUPANCY GRP. :R3 SECOND. . . :896 sf FRONT. s20 ft REAR. . s20 ft
STORIES. . . . . . . :2 THIRD. . . . .-0 sf REQUIRED--------------------
HLIGHT. . . . . . . . s27 ft TOTAL-------: 1745 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . s40 psf VALUE. . . . . gs 87470 PARKING SPACES. . : 1
Remarks: PATH I
--------------------- PLUMBING ----------------------------------------
SINKS. . . . . . . . . . ol
--_---------------------------- -.SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . s4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY 'TRAYS. . . -ib CATCH BASINS. . . . . . . ..0
WATER CLOSETS. . c3 SEWER LINE (ft ) . sO GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . il WATER LINE (ft) . : 100 OTHER FIXTURES. . . . . :0
UORBAGE DISP. . . : 1 RAIN DRAIN (ft) . :0
WASHING MACH. . . s1 SF RAIN DRAINS. . cl
__--------------- MECHANICAL ------------------ ------------------ FEES ---------------
FUEL UNIT HTRS. . :O type amount by date recpt
/GAS/ / / VENTS . . . . . :0 TIF f 1460. 00 JH 01/28/93 -
MAX INPUT:O BTU VENT FANS. . s4 BPRT $ 397. 00 JH 01/28/93 -
TURN ( 100K . . & I HOODS. . . . . . : 1 BPLC $ 258. 05 JLH 12/28/92 92-235030
FURN )=100K . . :0 WOODSTOVES. sO 135PC Is 19. 85 JH 01/28/93 -
FLOOR TURN. . . , s0 CLO DRYERS. s 1 SSDC f 280. 00 JH 01/28/93 -
BOIL/CMP ( 3HP:0 OTHER UNITS: 1 PARK f 500. 00 JH 01/28/93 -
GAS OUTLETS: i MPRT $ 43. 50 JH 01/28/93 -
Owner s ------------------------------------MPLC $ 10- 88 JH 01/28/93 -
D E ANDERSON INC M5PC f 2. 18 JH 01/28/93 -
4575 SW TUCKER AVE PPRT $ 140. 00 JH 01/28/93 -
P5PC t 7. 00 JH 01/28/93 -
BEAVER OR 97005
Phone #s 627-9999
Contractors -------------------------.------
D ANDERSON, INC
4575 SW TUCKER AVE
BEAVERTON OR 97005
Phones #:
Reg #. . s 46344 ----------------------------------------
$ 3118. 46 TOTAL
This pereit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS ------
Tigard *inicipai Code, State of Ore. Specialty Codes and al! other Foot/found Insp Fireplace Insp
applicablle laws. All work will be done in accordance with approved Port/Beam Strc"^t as Line Insp
plans. This persit will expire if work is not started within 188 Post/Beam Meci Ansul-tion Insp
days of issuance, or if work is suspendK' �,� Plm/undslab Insp Gyp b-a+rd Insp
Under, 10 or Ra n dt^ !n Tns
Permittee Signature : �= �1e - anlca Insp W.a er Lane Ins
." Plumb Top Out Appr/Sdwlk Insp
Issued By : Fram4ng Insp Mechanical Final
Call for inspection - 639-4175
CITYOF Tir',FAIW
CITYOFINP
COMMUNRY DEVELOPMENT DEPARTMENT anoo ~� SEWER CONNLCTION
M26 SW HM sad. P.O.8ar 29307,Tipvld,Or+Px+orm(ca+)&W4175 PERMIT
639-4111 DATE ISSUED: 01/28/9:
I rE ADDRESS. . . : 12230 SW ANTON DR PARCEL: 1.6134CB--PIP106
t-)UBD M S I ON. . . . : ANTON PARK #i- ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . 1106
—___—_—_
TLNANT NAME. . . . . :
USA NUJ. . . . . . . . . . : F I XTURE UNITS. . . .
CLASS OF WORK. . . :NEW DWELLING UN I T S. . : 1 �
_f.YPE OF USE. . . :SF NO. OF BUILD1NGS: 1
INSTALL, TYPE. . . . :BU5WR I MPE.RV SURFACE. . : s s f
Remarks : PATH I
(iwner: ----------------------------------------- _____._____ FEES -----------_—_
D E ANDERSON INC type am 0I-int by date recpt
4575 914 TUCKER AVE PRMT $ 2100. 00 JH 01/28/93 —
INSP $ 35. 00 JH 01/28/93 -
BEAVER OR 97005
Phone #: 627-9999
Contractor:
CONTRACTOR NOT ON FILE
----------------------------------
1111orle it: f 2135. 00 TOTAL
"eq tf. . .
------- REQUIRED INSFIECTION6
'his Applican` agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires IN days from �—
the date lssu►d. 1he total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
Gide 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 Ag�enc 11 all a 1
i ,ermittee Signatures
B y
Call for inspection — 639-4175
I
I
017fOF rl J1 GARD 13125 SW Hall Bt d. PLNCK/RLCT # jZ— 734�_
COMMUNITY DEVELOPMENT DEPARTMENT' Tgord,Oregon9T713 PERMIT # rtj-j1� 0012-
(503)639-4171 DATF ISSUED
JOB ADDRESS: IG.�e2 Zpn_. 4/ 4;(-)P'-0 _._-- TAX MAP/1-01 L��✓Y �__p:��_s><wV----
SUB:�T1�N�/ML_����?�_ LOT: A:2 LAND USL: _
VALUATION: zoIF
Qj0ER SPECIAL NOTES
NAME: � g /��— A/ L)c_ REISSUE OF: ---
ADDRESS: �� —LD f1L �� LAST REISSUE: — _ -
__ FLOOD PLAIN/
PHONE: 6v�7--��9 — — _ SENSITIVL LANG:
CONTRMTOR APPROVALS REQUIRED SU/3 91 oaaA
NAME: PLANNING: _('� �T-----
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: -- _-- — _ ___-- OTHER:
CONTR. BOARD #: ` EXP DATE: 14z!2-5 —
ITEMS
4z! 5 — ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ /,�Fa r LIST/SUBCONTRACTORS: — _ --
MECH: Js� c��cC" BUS TAX:
ARCH ENGINEER CA!.CULATIONS:
NAME: TOUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED Pl DG. USE:
COMMENTS:
i
APPLICANT SIGNATURE
Received By: _ T - - — - Date Received: 2--- 2—
e
P1:RMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Perwit Fees--
_ 10-431 00 Plumbing Permit Fees ���� zez-0 ,
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%'., -a1(-� d3
Bufiding
PI umb i ng
J
Mechanical a ,�
10-333 00 Plans Check Fee ?-
Building
Plumbing
Mechanical
10-230 06 Fire - -
JA1973-001, 30-?-02. 00 Sewer Connection mod
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees — -
25-448-04 Industrial TIF Fees — —
25-448-06 Institutional TIF Fees _
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees S 4 /-?S-
25-448-05
-3s25-448-05 Mass Tr?nsit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst. Dev Chrg
(SSDC) I� / k-
24-445-01 Water Quality (Fee in lieu of)
24--445-02 Water Quantity (Fee in lieu of)
ti \
TOTAL
nm/3587P.WPF
CITY OF 'TIYARD RFGLIPT OF PAYMENI RECEIPT NO. 193--,-,36096
CHECK AMOUNT 5003. 46
NAME 3 D. C. ANDERSON, INC CA0H AMOUN r 0. 00
0DDRF.-,','8S o 4g')75 SW TUCKER AVE. PAYMENI DATE s 0i
SUBDIVI-91ON
BEAVERTON, OR 97005—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF r,Aymr-,N) AMOUNT PAID
BUIL.DINCS PERM 397. 00 PLUMBING PERM 1 40. 00
MECHANICAL PE 43. 50 ST. BUILD PER 29. 03
Fll-AN CHECK FF 18. 93 SEWER USA 2 100. 00
SEWER INSPECT 315. 00 PARKS SDC 500. 00
SJORM DRAIN SDC 0180. oal RES IDENT IAL TRAFT IC; Fr.7r'l.i 1350. 00
MASS TRANSIT TIF FFES Ito. 00
LO 106 ANTON PARK #2
J2r*-'30 SW ANTON DR. (MST 93-0012)
TOTAL AMOUNT PAID 5003. 46