8167 SW CAROLE COURT ADDRESS:
41
i\records\microflm\targets\huilding.doc
"'FlFICATE OF
CITY OF TIGARD OCCUPASIL,Y
COMMUNITY DEVELr,PMENT DEPARTMENT PER1117 *. . . . . . . a 14ST9,*:.' 0236
13125 Biva. Tigard,f-lisgon 97223*6190 (503)630-4171
PATE IS'.A.W.D1 04/06/93
ITC AIDDPES *' 001E%7 j C11,00 P A R(,.'L-t 3 11,Ci8C--kt8100
--OBDIVISION. . . . PAIZE ZCNINGs R-4. 5
TT4
CI.At)3 OF WOrkir. ;NEW
TYPE OF USL. . . jSF
OCCUPANCY GRP. tR3
OCCAN-1ANCY LOAD 322A 4
..NAN1 NAME.
�'marks - PATH I
jf)mr,,g ppZf-,.,
wl.IPTLAND OV
Phone 0i a('.--Iivl 144
Contv,actor:
(A-0-ICK OLSON CONSTRUCT ION, INC.
5803 N. [If-.".PAUW
F'.IORTLAND OR 97203
Phone *k
Reg 41. . 1 1"5757
06cuparway of 11--ii Abovv vofererced building ii; Veweby given, eAnd vov,tiftes
the comps iami, 1,4i-th the 1,3atm Of Oregon Specialty Codes for thV group#
ay)(A fisf 1.1mcs'er whi0i thp refs-cericed persit v;,sks isbued.
F IRE: it I iF' (I ILIA T
co-F A(AOL.
II(Y"T )h CAIINJ'4"l I
INSPgCTION NOTICB gi y��_
City of Tigard Building Departoefl
13125 811 Ball Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone.1t 639-4175 Business Phone: 639-4171.
_.iepecti.on'----- -- -- ------
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line ?INAL:
Poet/Beam struct. San. Sewer Framing
Post/Beam Mech. Rain Drain Insulation -•Plumb.
Plbg. Inderil.00r Water Line Gyp. Bd. -Hoc
Date Requested: .3— 2 ^ -^—Time= —_AM /PN
Addrese: /�___��-� Sf� permit �: L -pTTTL���j`{►
Builder: --_ —
TRE FOLLOWING CORRSCIIONS ARE REQUIRED:
- - s - _c)-fid A-I—
Inspector:
APPROVFC DISAPPROVED APPROVED St1BJECT To ABOVE
----Call For Reinsp.
INSPECTION NOTICE
City of Tiqard Building Department
13125 SM Ball Blvd. Tigard, C--moo 97223
inspection Line (ROC.-O-Pho ): 639-417�5f� Business Phones 639-4171
Inspection:_
Footing Plbq./ n relab Mech. Rough-in Appr/Sdwlk
Found. Plbq` Top Out Gas Line FINAL:
Poet./Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Dd. -!tech.
Date Requested► yam_ —�/J /� Time: _ _AA PN
Address: �jL07_��/i �(`_ ( Permit 1: —LJZy
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Insper_tor:.—{
—_APPROVED DISAPPROVED V APPROVED SUBJECT TO ABOVE
-- Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department '' --
13125 SM Ball Blvd. Tigard, Oregon 97223 1/
Inspection Line (Rec-O-Phone): 639-4175 Business Mine: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in App•,'Sdwlk
Found. Plby. Tap Out Gas Line FINAL:
Post/Beam Struct. San. Sewer. Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. __yy""���� �-Nech.
Date Requesteds ��
_ U _ ___Tisgk"' , —AM i_PM
Address: LL Permit. #s G ' , ,J
Builders [�J/ .„/24621'�" _-
THE FOLLOWING CORRECTIONS ARE RRQUIREDi
Inspector: c E7 j &—CAW _2
date:
_Z APPROVRD __ DISAPPROVED APPROVED SUBJRCT TO ABOVE
Call For Reinap.
HSPECTION N01'ICE
City of Tigard Building Department
13125 FW Ball Blvd. Tigard, Oregon 97?23 V
Inspection Line (Ree-O-Phons): 639-4175 Eusiness Phone: 630-4171
Inspection:
Footing Plbg. Underslab .Mach. Rough-in Apr/Sdwlk
Found. Plbg. Top (jut Gas Line FINALe
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date RequesteJ:_1__1 r.::-Qm `3 --Time: __ AM
Addresses � 7 ��dGij00fPermit ts �i[/_ y�(�
Builders___ —_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: 7�#{ �/f�fyj Dates�f e-
-,APPROVED
—_APPROVED DISAPPROVED —� APPROVED SUBJECT TO ABOVE
JL.ZC all For Reinsp.
INSPECT?ON NOT].CE_
city or Tigard Buildicq Department /
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Businese Phone: f-4171
Inspection:
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plhg. Top out Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
���Dare Requested:---�— Ti,,197 � PM
�' n
Address: /"/��r �' - Permit r=_ ' 2
Builders-
THE
uilder:THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspecto — - Dater__/
APPROVED DISAPP VRD APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICV. i��n
City of. Tigard Building Department
13125 ON Hall Blvd. Tigard, Oregon Z2W
Inspection Line (R//c..-O-Phone): 539-4175 Buninean PhonF-: 639-4171
Inspections
Footing ,plbg. Underslab Mech. Rough- 1►ppr/Sdwlls
Found. Plbg. Top Out Gas Line FINAL:
Poet/3eam Struck. San. Sewer. Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Neter Line Gyp. Bd. -Mach.
Date Requostods� Z ----Times AM_
-D 3�
Addrase: L��/Z� [(�. `- Permit is�z Z
i
Hu 1 ld.ar s
TF;E FOLLOWING CORRECTIONS ARE REQUIRED:
—�����/' i"� .rte �cr' � • .�' D�C�G'
CIA-
Inspector — D
atet
JJ _APPROVED - DISAPPROVED APPROVED SUBJFCT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
17125 OW Ball Blvd. Tigard, OrpTun 91223
Inspection Line (Pec-o-Phone): 639-4115 Business Phones: 639-4171
Inspection:_ \
Footing Plbg. Underelab h. Rough-in Appr/Sdwlk
Found. PJbq. Top Out _ rise LineFINAL:
Poet/Beam Strutt. Sen. Sawer Framinet -Bleq.
Post/Beam !tech. Rain Drain Ireu:ation -Plumb.
Plbg. Underfloor stater Line Gyp Bd. -Hoch.
Date Request:edt_I L - - 2- Times AM_ PM
iMST
Address:_1��� 0.uU� � 1�V I permit A: -1 2-0L36
� f
Builder: \C C r T - S- /Q
�-
THE FOLLOWING COhRECTIONS ARE REQUIRED:
LZ
Inepectors
^APPROVFD - DISAPPROVED APPROVE)' SUBJECT TO ABOVE
0.911 For Reinsp.
INSPECTION NOTICg
City of Tigard Building Department
13125 BW Ball Blvd. Tigard, Oregon 97223 4-1
Inspection Line (Rec hone): 639-4175 Buninesn Phone: 639-4171
Inspection:_.Y / --
Footing . Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gan Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain ( Insulation -Plumb.
Plbg. Undwrfloor Water Line G,T. Bd. J -Koch.
//-/, --`> -7-4vzr?1j
Date Requested:_ Time: _AN __PH
/` Perot 1:
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:
PROVED ___ DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTIOI NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
lnspectiQn Line (Rscc��,�-O-Phons): 639-4175 Business Phone: 539-4171
Inspection:
Ecx:tinq Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINIAL:
Poet./Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line q Gyp. Bd. -Meeh.
Date Requeisted:- (/ �`n� /W _Time: ___>Ar / PM
Address: `,
_- t� r -0-A � � Permit f:_ �`��y��l�'
Bullc.ar:
THE FOLLOWING CORRECTIO118 ARE REQUIRED:
r
or-
Inspectors ool�— Dater
APPRO•!ED DISAPPROVED APPROVED SUIMECT T:T ABOVE
J Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 fill Ball Blvd. Tigs...d, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: ` 1 ZQ(Z��ti�-_w
Footing P.lbg. Underslab Mech. Rough-in Appr/Sdwlk
F,)und. Plbg. Top Out Gaa Line FINAL:
oat/Beam Struct San. Sewer Framing -Bldg.
l(Rojp/Beam Hoch. Rain Drain Insulation -Plumb.
/?15g. Underfloor Hater Line Gyp. Bd. - *ch.
Date Reguee{ted:_ I ` " ')_ 12, Times AN
Address: t ` (f—1 ( IGLy( I l Pe,mit is MSTI2 "x-11-Afp
Builders (.'4�.(� V� c.'f. Z,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: 1�l Uates
APPROVED DISAPPROVED �T APPROVFD SUBJECT TO ABOVE
__Call For. Reinap.
INSPECTION NOTICE
City of Tigard Buildljmq Department
13125 BM Hall Blvd. Tigard, oregon 9771u
Inspection Line (Rec-O-Phone): 639-4175 Buvinees Phonex 39-4171
Inspection:
looting Plbg. Undernlab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Hech.
Date Requested:—Lv , 3 �l�// Tim4k _L- AH / PH/
Address-
Pe
rst
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: _ - --- -- - Date:
— DISAPPROVED APPROVED SUBJECT TO ABOVE
PROVISO --
Call For Reinnp.
MENEWIM
CITYOFTIFARD
C�i1f PLUMBING PERMIT
COMMUNM DEVELOPMEVff DEPARTMENT me C PERMIT M. . . . . . . z MST92-0236
ar 29
19126 BW HA BNd P.O.B307.Tipnd,Oregon 077+9(5W)639-4176
- -_---� --- — DATE I SSUM 10/14/92
SITE ADDRESS. . . x'08167 SW CAROLE CT PARCEL# 23112BC;•-oAto0
SUBDIVISION. . . . r RAZE MEADOWS ZONING# R--4. 5
BLOCK. . . . . . . . . . # L.OT. . . . . . . . . . . . 44
I f.;LAfiB-OFrWf]Rli. . #NEW-_..__..-pfaRBAGEWDI9fyOSAL9. . r1___�___._-__._..____-,.._._________._M_....
TYPE OF USE. . . . o SF WASHING MAC14. . . . . . . i 1 HHCI(,F LJW PREVNTRS. . e 0
OCCUPANCY GRP. . 03 FLOOR DRAINS. . . . . . . #0 TRAPS. . . . . . . . . . . . . . 80
STORIES. . . . . . . . e 2 WATER HE4TE RS. . . . . . # i C:ATC 14 BASING. . . . . . . t O
FIXTURES-------------- LAUNDRY TRAYS. . . . . . al SF RA'rN DRAINS. . . . . : 1
SINKS. . . . . . . . . . o l GREASE TRAPS. . . . . . . 10
LAVATORIES. . . . . s3 OTHER FIXTURES. . . . . sO
TUB/SHOWERS. . . . a SEWER LINE (ft) . . . . r0
WATER CLOSETS. . s3 WATER LINE (ft) . . . , al�►;�
17 ifaN1�A£iHriRf3. . . .rt i 4RAIN $)RAIN (fti+:-r."r.1ve a
Remarksa PATH T
OWNER# --______.______...____.___.-----___.. ------------------FEF-S--------------
JAMES RAZE TIF 1 1460+ 00 JH 10/14/92
16725 SW PACIFIC DR BPRT .386. 00 JH 10/14/92 -
BPLC f P52. 20 JLH 10/t2/92 P32595
PORTLAND OR 97230 85PC f 19. 40 JH 10/14/9,2 -
i hone Ne 220-11.44 SSDL $ 2891. X10 JH 10/14/92 -
PARK t 500. 00 JH 10/14/92
i ,I Amb Ing f.:untract dr#-___.____. ...-..___:.__ MPRY f 43. 50 JH l0/14/92 _
1 MPLC; f 10. 8e JH 10/1 4/9r -
Namer 1 M5PC s 2. 18 JH 1+)/14192 -
Oddressa PPRT $ 140. 00 JH 10/14/92 -
i;itya _ State# PSP(.., $ 7. 00 JH 10/14/92
! IKr# _..__..-------PhaneNo
l{P Q #1
_._._.__w-.• RFOUIRED JNSPECTIONS
., Ihi* permit is issued subject to 1.6. rrog-
ulV.tions containfd ir( the 'Tig♦.;•d Municipal. Foot/found Ins Rain drain Insp
C:nve, State of Ore. Specialty CudeQ And all Post/Beam r3trur_.i, Water Line Insp
ntrier applicable lawn. All work will bp clone Trost/Beam Mec ►tan Appr,/Sdwlk Insp
in 'a+ccorclanco with approver) plans. This Plm/undslalh Itisp Mechanical Final
perm i t wi 1 l a. p1 re if wor-,k is not atrart Eft PL.M/Underf i oar Plumb Final
within 180qf
of issras►nr R, gy� if work is Mer_hatr3c:a1 Ingp E►uil�ling Final
usrende o.rp}� n 1 "aya. _ Plumb .Top .Out Erosion Control
y Framing Insp Crawl Drain
Fireplace Insp
Gas Ling Insp w �.-
j Insulation Insp
- Gyp Hoard Tn%p - -
Wrlthl ci PlUm Ing Contractor Si ghatUre
Call for, inspection 639--4t75 {
Contractor Notesr
CITY OF TIFA RD My
COMMUNITY DEVELOPMENT DEPARTMENT ANN MASTER PERMIT
13125 SW FW Blvd P.O.Sm 27W,Tlg,r-.'Oregon 97223(E 33)ON4175 PERMIT #. . . . . . . . MST9.2-02,36
639-4171 DATE ISSUED: 10/14/92
SITE ADDRESS. . . : 08167 SW CAROLL CT PARCEL: 2S112LAL-08100
ANN
SUBDIVISION. . . . : RAZE IYEADOWS ZONING- R-4. 5
BLOCK. . . . . . . . . . . LOT'. . . . . . . . . . . . . :4
BUTLDING
REISSUE: DWELLING UNITG: 1 BAGEMENI . . . . . . . . PO Sf
L ISS OF WORK. :NEW BEDRIYIS:3 BATHS:3 GARAGE.. . . . . . . . . . s 500 S f
TVPF OF USE. -SF FLOOR AREAS----------- RE(4UIRED SETBACKS------------
TYPE OF CON9T. :5N FIRST. . . . -938 5f LEFT. . .-5 ft RIGHT. oJ.3 fr
OCCU7"INCY GRVI. -R3 SECOND. . . : 703 Sf FRONT. %28 ft REAR. . % 15 ft
STORIES. . . . . . . s2 TH I RD. . . . :0 S f REQUIRED-----
HEIGHT. . . . . . . . :28 ft TOl*AL-------.- 164l s SMOKE DETECTORE. sY
FLOOR LOAD. . . . :40 psf VALUE. . . . . 84486 PARKINU SPACES. . - 1
Remarks: PATH I
PLUMBING
GINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLnw PREVNTRS. . s0
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS_ : 1 CO'TCH BOSI S. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE ( ft ) . :O GREASE TRAPS. . . . . . . v0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . - 100 OTHER FIXTURES. . . . . :0
GARBAGE DlbP. . . : 1 RAIN DRAIN (ft ) . :O
WASHING MACH. . . -. I SF' RAIN DRAINS. . .- I
MECHANICAL ---------------- FEES
FUEL TYPES------------- UNIT HTRS. . :0 type amoL�nt by date recpt
/(3AS" VENTS . . . . . :0 TIF $ 1460. 00 JH 10/14/92 -
MAX INPUT:O BTU VENT' FANS. . a4 BPRT $ 388. 00 JH 10/14/92 -
FURN < 100K . . : I HOODS. . . . . . s BPLC $ 252. 20 JLH 10/12/92 2.32595
FURN ) =100K . . :0 WOODST'OVES. .-O F35PC $ 19. 40 JH 10/ 14/92 -
FLOOR FURN. . . . -0 CLO DRYERS. : I SSDC $ 280. 00 JH 10/1.4/92
Boll_/CMP < 3HP:0 OTHER UNITS: 1 PARK $ 500. 00 JH 10/14/92
GAS OUTLETS sl MPRT 4 43. 50 JH 10/14/92
Owner. MPLC $ 10. 88 JH 10/14/92
JAMES RAZE M5PC $ 2. 18 JH 10/14/92
16725 SW PACIFIC DR PPRT $ 140. 90 JH 10/14/92
F-15PL $ 7. 00 JH 10/14/92
POR71-AND OR 97230
Phone #: 220-1144
Contractor:
CHUCK OLSON CONSTRUCTION, INC.
5805 N. DEVIAUW
PORTLAND OR 97203
Phone #: 285-5632
Rer, #. . : 15757
$ 3103. 16 TOTAL
This permit is issued subject to the regulations contained in the -------- REQUIRED INSPECTIONS
------
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/fwind 'I nsp Fireplace Insp
applicable laws. All work will be done in accordance w1h approved Post/BeAm Struct Gas Line Insp
plans. This permit will expire if work is not started within IN Post/Beam Meehan Insulation Insp
days of issuance, or if !ork is suspe d for more than IW days. Vllm/ands lab Insp Gyp Board Insp
PLM/Und P r f 1 a oi- Rain drain Insp
P V-M f t t V P T1'4 t I k Mechanical [risp Water Line insp
P11-imb Top Otit Appr/Sdwlt( Insp
lssf.tecj fly , F raminrl Insp Mechanical Final
Call for inspection - 639-4175
i �_
C1TY0FT1firA SEWER CONNECTION
' RD COMMUNM DEVELOPMENT DEPARTMENT C071
low PERMIT #. . . . . .PERMIT.
ERM 1 T. ' SWR92-0318
a
131268W Mr18M1. PO.Pm 23W.1i"d,Oregon 07223(6x+)6394176
639-4171 DATE ISSUED: 10/14/92
SITE ADDRESS. . . : 08167 SW CAROLE LJ PARCEL- 2`S11EBC--08100
SUBDIVISION. . . . : RAZE MEADOWS ZONING: R-4. 5
BLOCK. . . . . . . . . . LOT.. . . . . . . . . . . . . 14
1ENANT NAME. . . . .
s —
USA NO. . . . . . . . . . : FIXTURE UN17S. . . I
CLASS OF WORK. . . :NEW DWE=LLING UNITS. . : 1
TYPE nF UGE. . . . . :SF NO, OF BUIi_.DINGS: 1
IN5Tl1LL TYPE. . . . -BUSWR IMPERV SURFACE. . : Isf
Remarks : PATH I
Owner: -------------------------------------- ------------------ FEES
JAMES RAZE, type amol_int by date recpt
16725 SW PACIFIC DR PRMT C-`100. 00 JH 10/14/9E -
I IVSD' b
35. 00 JH 10/14/92 -
PORTLAND OR 9,230
Phone #: 220-1. 144
Cort Tact or: --•---------------------------- -
C'ONTRP;TOR NOT ON FILE
Phone #: : 2135. 00 TOTAL
Reg
-------• REUU I RED INSPECTIONS
--_--
This Applicant agrees to comply with all the rules and reguiations Sewer Inspection
of the Ihlified Sewage Agency. The permit expires IN days from
the date issued. The total amount paid will be ;orfeited if the
N
p,;�it expires. The Agency does not guarantee the accuracy of the
side ssw,'r laterals. If the sewer is not located at the measurement
given, the i:istaller shall prospect ;1 feet in all directions fr-m
the distance given. If not so located; the installer shall purchase
a "Tap and Side Sewer" permit and the �;-encr will install a lateral.
I e r m i't t e e
Call for inspection - 639-4175
I
q2- -243Z
CITY OF' TIGARD -- RECEIPT OF PAYMENT RECEIPT NO. 02-832676
CHECK AMOUNT a 4988. 16
NAME v RAZES JAMES CASH AMOUNT s 0. 00
ADDRESS s 16725 NE PACIFIC DR PAYMENT DATE s 10/14/92
SUBDIVISION
PORTLAND, OR 97230—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PfID
388. 00 PLUMBING PERt, 140. 00
MECHANICAL PE 43. 50 ST. BUILD PER 28. 58
PLAN CHECK FE 13. via SEWER USA P.100. 00
SEWCR INSPECT 35. 00 PARKS SDC 500. 00
STORM DRAIN SDC 280. 00 RESIDENTIAL TRAFFIC FEES 1350. 00
MASS TRANSIT TIF FEES I 10. elel
LOT 4 RAZE MEADOWS
8167 SW CAROLE CT
TOTAL AMOUNT PAID
r 13125 SW liall Blvd- PLNCK/RECT #
CITY OF TIGARD POBox 2'397 PERMIT # 1975fI Z- Oe23(o
COMMUNITY DEVELOPMENT DEPARTMENT Tiprd.Omgm 9nZ3
(W)6394171 DATE ISSUED
JOB ADDRESS: M-7 Sw CGro�P � TAX MAP/P_OT v�SI /Z SC
SUB: a Z ISI ad LOT: L4 LAND USE:
VALUATION: ��_—`
OWNER SPECIAL NOTES
NAME: m e J 2A 2 e-- REISSUE OF:
ADDRESS: / 7.;2- ,5— �'{E- tf(S — LAST REISSUE• —
)0 4-(&-- U r Cf 7 2 -3 O _ FLOOD PLAIN/
PHONE: �' _ / 1 '4 L4 -��,��4- 3 s v SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: L��^c (t_ b (JC, `1 `� (� PLANNING: --
ADDRESS: S �-s ����a ui✓ ENGINEERING:
FIRE DEPT:
PHONE: _ 2- OTHER:
�. CONTR. BOARD f-, — _ EXP DATE: =S�
ITEMS REQUIRED
S�JBCONTRACTORS: PLM --,,LIST/SUBCONTRACTORS:
MECH: �.�r (Jr�,� BUS TAX:
ARCHANGINECR CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: _ _ OTHER:
PHONE:
PROPOSED BLDG. USE: S'.COMMENTS:
AP LICfAT SIGNATUR ^�
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees ��u ! kv,
_ 10-431 00 Plumbing Permit Fees
— 10-431 01 Mechanical Permit Fees .jam
10-230 01 State Building Tax (5x)
Wilding
Plumbing " u0
Mechanical __2.4_16
10-433 00 Plans Check Fee a 3, vel 2
Building Z51,
Plumbing
Mechanical
10-230 06 Fire _
S ,Rrit •0,31 30-202 00 Sewer ConnectionL)
30-444 00 Sewer Inspection 3
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 /3 SJ� _ 1-35o
25-448-05 Mass Transit TIF Fees 1 / u
52-449 00 Parks System Dev Charge (PDC) –Soo
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL 2
nm/3587P.WPF
cry OF TIGARD -- RECEIVIT OF PAYMENT RECEIPT NO. t92—�32SS5
CHECK AMOUNT0�0
NAME t RO Z JAMES R. CASH AMOUNT
ADDRESS s 1( 7a5p NE PACIFIC DPiVE PAYMENT DATE
PORTLAND, OR SUBDIVISION
c) i c",30—
PURPOSE OF PAYMFNT AMOUNT PAID PURPOSE 0PAYMEpur AMOU07 PAID
PLAN CHECK FE 10--20R P-50. 00
RO/E MEADOWS, LOT 4
TOTAL AMOUNT PAID — 250. oel