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13047 SW BROADMOOR PLACE REv1SM DATE QT neanl �� "1110 M N He 3'44' E A"�1 4b ST R[vN10q v» M o 11 0400' �� 640r 0`I4MIT HT vl1 M o o s qo 0 43l I � I � 1 . I � 1 I LOT �♦ 41 LCT 6 I ur LuI � uovo' d x 6'cow U 1 rAT10 Z I u I 1 x ` Ia II'x p'COW h ro rA . x I � O s 1 < 43640Lu r. I � x OLOT b 8 I rRorown>+s�n>t.Taer I1aI1I -- _ �'� m I _MAM RooR M"An N 43100' n I , 43000' BArIM _ MIVA I rORtzl / x LM 4'A!I RAN/DRAM- 1 430DATLIOu!0 CMD I f7Ii0' I , 1ol �1 4'rYC OAMR I1r x R00' Illlat LI0- RIAR 1 43d I ,/ "WART 10=` I , LATERAL C 45AO'06 1 � I � I x I 6ARA" 42 Z I �r\ 4XV r9 \0 (0 I � uIN I E� __j LA Ib I � ' I � D�o�lD AoeRlbAn _r,'ki CONCRlIt DRNEIAT Aye l 004, a oil 4300 LJ so LJ N CAVI .AMI �a a 436 40 c�. �0 0 0 L,z 48 Jon", 43120' Z J d!�i R•x,00' In N L•»so' d a 44 NORtH Dun n MICNAEL �F LCT 1, 'AMESBURY HEIGHTS' DATE LOCATED M THE S.L V4 OF SECTION 4, tOWNSHP t SOUTH, RANM I HEST, OLLAMETTE MERIDIAN, APPLICANt� CITY 0' TIGARD, 11ASNINdTON COUNTY, OREOON DALTON CONSTRUCTION CIV.SITE PLAN W41 S.W. DROADMOOR PLACE S4�ST10ARD,ORL�W= —VOL_44t TAX MAP S 25104DB TAX LOT S 0100 (SO3) 452-0U! SPIFFY I �� ZONMbi RR-01/ NOTICE: IF THE PRINT OR TYPE ON ANYi 1-1j.11 �-� 111r�r� 1 IMAGE IS NOT AS CLEAR AS THIS NOTICE, $ 19 - lQ 11 1 2 �GrZ .� IT IS DUE TO THE QUALITY OF THE — — — — -- - — ---- L _ No.38 ORIGINAL DOCUMENT — E�111111� 1i6Z 8ZH111111l111 LZ '111111,11 5Z Z TZ OZ 5 '1111111 8I � JTi 5I � T ET ZT TI T 6 8 L 8 SIT �' E Z T �1ai�w I'llililIII I �� !I Ilii l_lll �� I)l Illi _Till l<<I �!!!. fl�►IIIlI illi J!!! III! !!!! IIIIIIIII III! IIII Ili! IIlIIIIII !!.� Ilii Ilii IIII IIII IIII Ilii Illi 1 Illi ll�l illi 1111 111111.1 11.1, 11111411 I CA) 0 4 W X O D v 0 M r n m � r 13047 SW BROADMOOR PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP Date Requested �' Z c� AM PM BLP Location__ '? �IYC ` )(`�' Suite q MEC Contact Person <.L rn0 Ph PLM S9 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Fig Drain SGN Crawl Drain Inspection Notes - ---- Slab _ -. SIT Post&Beam �- Ext Sheath/Shear Int Sheath/Shear Framing `I - - --- ------ --- Insulation Drywall Nailing --- -- - -----_ -� --- -- ------ - - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc. - - ----- - ------ - ----- -- _ _ —_-_ Final -- ---____ PASS PART FAIL -- ----- M Pus(& Beam -- -- -- -- - ---- Under Slab 1�� Top Out 1 I Water Service Sanitary Sewer Ra Drains m --. - -AS PART FAIL_ CHANICAL Post & Beam -- -- - --- Rough In Gas Line -- - -- Smoke Dampers Final - -� PASS PART FAIL ELECTRICAL - Service Rough In UG/S!ab - Low Voltage itU / Fire Alarm __ _- - - Final PASS PART FAIL SITE Bar.kCI/Grading - Sanitary Sewer Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RE'_. [ ]Unable to inspect no access ADA ��L / ? Approach/Sidewalk Date Inspector r _ ' - _Ext Other - �- - - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#• PLM1999-00253 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSU' D: 8/9/99 SITE ADDRESS: 13047 SW BROADMOOR PL PARCEL: 2S104DB-00lrj0 SUBDIVISION: AMESBURY HEIGHTS ZONING: R-4.5 BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS. WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Rgsidenlial backfiow prevention device Owner: - FEES�- -- Type By Date Amount Receipt JAMAL EI_OGBI - 13047 SW BROAUMUGR PL PRMT BON 8/9/99 $25.00 99-317521 I TIGARD, OR 97223 5PC BON 8/9/99 $1.75 99-317521 Total $26.75 Phone 1: 503-521-0229 Contractor: JOHN DARBY LANDSCAPE INC 13152 SW CLEARVIEW TIGARD, OR 97223 REQUIRED INSPECTIONS Phone 1: 519-7168 RP/Backflow Preventer Reg#: LIC 7110 Fioal Inspection ORIGINAL This permit is issued sub;ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires you +._ follow rules ad pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 000 1-0010 ter&gh OAR 952-000'1-0080. You may obtain copies of these rules or direct questions to OUNC.Iay�alling (503) 246-1987. Issued By: I, 'tG�( � _ Permittee Signature,- Cal{ (503) 639-4175 by 7:00 P.M. for an inspection needed 1�6xt/�uss day CITY OF TIGARD Plumbing Permit Application Plan Che 13125 SW HALL BLVD, Commercial and Residential Recd ByT TIGARD, OR 97223 Date Recd (503) 639-4171 Date to P.E Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# Related SWR#_ Called Name of Development/Project FIXTURES (individual) QTY PRICE All Job I M &C��1_—t ,-v 1 ) }` Sink 11.50 Address Street Address I Suite / Lavatory 11 50 4 r Tub or Tub/Shower Comb 11.50 Bldg# City/State Shower Only 11.50 C I _ Name Water Closet/Urinal (Specify) i — 11.50 Dishwasher 11.50 Owner ailinglAddres r l 5ui e Garbage Disposal 11.50 / / Washing Machine/Laundry Tray (Specify) 11.50 City/Stale Phone _ � Cl ��( rj Floor Drain/Floor Sink 2" 11.50 Ev, Name 7 3' 11.50 C 'e 4" 11.50 Occupant Mailing Address Suite Water Healer O conversion O like kind 11 50 Gas piping requires a separate mechanical permit. _ City/State Zip Phone MFG Home New Water Service 28,00 --_--- MFG Home New San/Storm Sewer 28.00 Name I 11 50 -- Contractor 9. _ Rain Drains Mailing Address Suite 11.50 y�V Drinking Fountain 1 1,50 Friar to permit City/SlatZi P one Other Fixtures(Specify) 15.00 issuance,a Copy _ v of all licenses are egon Const Cont.Board Lic# Exp.Date required If `7�_ _ - expired in COT Plumbing Lic,# Exp.Date database Name Sewer-1st 100' 38 00 Architect __ uit_ Sewer-each additional 100' 32.00 Gr Mailing Address Se Water Service-1st 100' 38.00 — Engineer clly/state Zip Phone Water Service-each additional 200' .32 00 _ _ Storm&Rain Drain-1st 100' 38.00 Describe work to be done Storm&Rain Drain-each additional 1 OF-- 32.00 New O Repair O Replace with like kind Yes O No O Comrnercial Back Flow Prevention Device 3200 Residential O Commercial O — — Residential Backflow Prevention Device' 19.00 Additional description of work: _ Catch Basin 11 50 Insp.of Existing"lurnt Ing 50.00 Are you capping, moving or replacing any fixtures? er'hr Yes O No O Specially Requested Inspections 50.00 If yes, see back of form to indicate work performed by _ _ per/hr fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain,single family dwelling 4500 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps — —11 50 I hereby ac ledge that I have read this applir-ition.that the information QUANTITY TOTAL given is cwf 31naLl am the owner or authorized agent of the owner,and Isometric or riser diagram Is required d Ouanhty Total is >9 _Lot pfa bmitted are'n co2�pliance with Oregon State Laws _ 'SUBTOTAL $1S►tuRent -- to r%f ------ 7% SURCHARGE Comet arson Name -------� one "'PLAN REVIEW 25% OF SUBTOTAL 11 13ATFFHOUSF 178.00 Required only if fixlule qty total is>9 _ 2 BATH HOUSE$250.00 TOTAL 3 BATH HOUSE$285.00 (This fee Includes all plumbing/lxtures In the dwelling and the first 100 feet of sanitary sewer Storm Sewer and water service) ' m permit fee is S50, 7%surcharge,except Residential[3ackflow Prevention Device. evice.winch Is$25+7%su charge —All New Commercial Buildings require plans with isometric or riser diagrarn and plan review I�,wOormslplumapp doc N19r99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed Haw Moved Replaced Removed/Ca _ _ pPed Sink Lavatory Tub or Tub/Shower Combination Shower Only _ Water Closet _ Dishwasher Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" Wafter Heater — Laundry Room Tray Urinal _ Other Fixtures (Specify) — COMMENTS REGARDING ABOVE: I ldstslfwmslpk,mnDP dux',111,J9 CITY OF TIGARD _ CERTIFICATE OF OCCUPANCY PERMIT#: MST98-00354 DEVELOPMENT SERVICES DATE ISSUED: 9/8/98 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104DB-00700 ZONING: R-4.5 JURISDICTION: TIG SITE ADDRESS: 13047 SW BROADMOOR PL SUBDIVISION: AMESBURY HEIGHTS BLOCK: LOT:007 CLASS OF WORK: NEW TYPE OF USE: SF TYPE OF CONSTR: 5N OCCUPANCY GRP: R3 TENANT NAME: REMARKS: New SFD PA FH I and a RETAINING WALL Final Inspection Approved 7/2/99 by Ken Schriendl, Building Inspector Owner: NOURI-JAMAL ELOGBI PO BOX 230371 TIGARD, OR 97281 Phone: Contractor: DALTON CONSTRUCTION INC 8465 SW HEMLOCK ST SUITE A TIGARD, OR 97223 Phone: 452-0969 Reg #: w. This Certificate grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use upderwhic .the referenced permit was issued. BUILDING INSPECTOR BUILDINd OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION MST - • S 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 _ 1 C BLIP Date Requested j�quested -Z� / 1 AM PM BLD _ Loc}tion ✓ ��wI �/ ,fid!� ' ,1 /)Of Suite MEC Contact Person Ph -SdJ-� '_ CD PLM _ _— Contractor Ph SWR BUILD! Tenant/OwnerELC _— Retaining Wall — ELR _ Footing ACCP •S. r FPS -- Foundation f i 0 1 N � I , �` �f J Fig Drain I 5GN Crawl Drain Inspection Notes: -- Slab _ SIT Post&Beam --- Ext Sheath/Shear Int Sheath/Shear - Framing -- Insulation w - -- Drywall Nailing Firewall Fire Sprinkler ..._.-------------- Fire Alarm Suap'd Ceiling - -- — ---- - - Roof Misc: __.... _. *AS PART FAIL. -----_-- PLUMBING Post & Beam - I Inder Siah 1 op Out - - - - Water Service `unitary Sewer Rain Drains I incl ------- -- - PASS PART FAIL _ MECHANICAL Post& Beam -- Rough In Gas Line - - - -- ------ -- Smoke Dampers Final -- — PASS PART FAIL. ELECTRICAL Service Rough in UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill/C,rading -- -- Sanitary Sewer Storm Drain [ j Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ ] p —_ [ ]Unable to inspect-no access ADA Approach/Sidewalk Other Gate ,7 — S'J' Inspector Ext Final PASS PART FAIL 00 NOT REMOVE this Inspection record from the job site. CITY QF TIGARD MASTER PERMIT DEVELOPMENT SERVICES FI RMIT 4. .. . . . . . . MST98--0354 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 09/08/98 FARCE l..-: ;RS 1 04DB-0V.r700 FE ADDRESS. . . : 1;3047 SW BRCIADMOOR P,I. IJBDIV1rTON. . . „ :AME'SBURY HE'T(3HTS ZONING: R_4. ' [LOCK. . . „ . . . . . . L-OT. . . . . . . . . . . . . :007 JURISDICTION: T I L:, Remarks: New SFD PATH I ---------------------------------------------------------------- BUILDING --------------------------------- REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-----------__ CLASS OF WORK,:NEW HEIGHT........: 25 FIRST....: 1470 sf GARAGE,....: 754 sf LEFT..........: 35 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND..,: 1505 sf FRONT.........: 20 PARKING SPACES: TYPE_ OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT......... : 17 OCCUPANCY GRP.:R3 BDRM: 4 BATH: 3 TOTAL-------: 2975 sf VALUE.,is 221015 REAR..........: 15 ------------------------------------------ ------------------- PLUMBING --------------------•------------------------------------------- 51NKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS,: 1 RAIN DRAIN ft: 100 TRAPS........,: 0 I.AVATORIES....: 5 DISHWASHERS...: 1 FLOOR DRAINS.. : 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..; P TUB/SHOWERS...: 4 GARBAGE DISP.,: 1 WATER HEATERS.: I WATER LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: OTHER FIXTURES: a -------------------------------------------------------------- MECHANICAL ---- -------------------------------------------------------- FUEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 5 CLOTHES DRYERS: 1 GAS FURN )-1(101' ., : 1 UNIT HEATERS..: 0 HOODS....,....: 1 OTHER UNITS... : 1 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1 --------------------------------- ---------------------- ELECTRICAL --------------------------------------------- -RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/cEFD(`RS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS — --ADD'L INSPECTIONS- 1000 SF OR LESS: 1 0 - 200 alp..: 0 0 - 200 alp.,: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: P EA ADD'L 500SF,: 6 201 - 400 asp.. : 0 201 - 400 alp.. : 0 lst W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PFR HOUR......: 0 LIMITED FNERGY.: 0 401 - 600 grip..: 0 401 600 asp..: 0 EA ADDL BR CIR: 0 SIGNFN_/PANEL,..: 0 IN PLANT......: 0 MANE HM/SVC/FDR: 0 601 - 1000 alp.: 0 601+81p9-1000 v: 0 MINOR LABEL -10: 0 1000+ alp/volt.: 0 ------------------------------------ PLAN REVIEW SECTION ---- --.__.___.---------------__- -- Reconnect only.: 0 1=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC: ----------------- ELECTRICAL - RESTRICTED ENERGY --------------------------------------------- A. SF RESIDENTIAL--------------------------- B. COMMERCIAL-------------------------------------------------------------------------- - AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO 6 STEREO.- FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM,.: OTH: :: X BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNt: GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MFD1CAI......... : OTHR: HVAC..........,: DATA/TELE COMM.: NURSE CALLS.,,.: TOTAL # SYSTEMS: 0 9wner: ------------------------------------Contractor: ------------------ TOTAL FEES:f 5493.45 DALTON CONSTRUCTION INC DALTON CONSTRUCTION INC This oerait is subject to the regulations contained in the 9465-A SW HEMLOCK ST 8465 SW HEMLOCK ST Tigard Municipal Code, State of Ore. Specialty Codes and all TIGARD OR 97223" SUITE A other applicable laws. All work will be done in accordancF TIGARD OR 97223 with approved plans. This permit will expire if work is 'hone N: .32-0%9 Phone A: 452-0969 not started within 180 days of issuance, or if the work i Reg A..: @00677 suspended for more than 190 days. ATTENTION: Oregon law -------------------------------------------------------------- requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 threngh OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. -------------------------------------------------------- REQUIRED INSPECTIONS -----------------------—------------------------------. Frosion 844-8444 Post/Beam Merhan Electrical Servi Gas Line Insp Electrical Final grading Inspecti Crawl Drain/Back Electrical Rough Insulation Insp Mechanical Final _ Footing Insp PLM/Underflnor Framing Insp Rain drain Insp Plumb Final foundation Insp Mechanical Insp Shear Wall Insp Water Service In Building Final Post/Beat: Struct Plumb TOD kit Voltage Appr/Sdwik Insp T s _red By : _.1 Permittee S i gnat r_rr e _._ + ++ 1--f-+•+ F+++ r r i.f f.�. r 4.,1- 4,++4..r.+.+4.+.i..++4-.+.+.++.}+i.+.. +•-F+-+�1 4+4A-44 + + 4 Fi..� 4. r Call ...3'3--4175 by 7:00 pr. m. for, an inspection needed the next bt.rsiness da,,- I CITY OF TIGARD DEVELOPMENT SERVICES SEWER CONNECTION PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . DATE ISSUED: 09/08/98 PARCEL._: ;='S 1O4DR--OO70'j .;1 FE ADDRESS. . . : 13047 SW DROADMOOR PI.- St..)PDIVIS1,01\1. . . . :AMESBURY HEIGHTS ZONING: R--4,. 5i CkI.,OCK. . . . . . . . . . LOT. . . . . . . . . . . . .. :007 JURISDICTION: TIG TENANT NAME. . . . . :DAL.TON CONSTRUCTTON INC USA NO. . . . . . . . . . . FIXTURE UNITS. . . . 0 CLASS OF WORK. . . :NEW DWEL.I_-I NG UNITS. . : i TYPE OF USE. . . . . :SF NO. OF' BU I L. D I NGS: 1 T NSTALL TYPE. . . . :L.TPSWR I MPERV SURFACE: 0 s f Remarks : New SFD [iwner: ----_____.____________.____._____._____________.______._._._ FEES DALTON CONSTRUCTION INC type amor.int by date r,ecpt 8465—A SW HEMLOCK ST PRMT $ 2300. 00 GEO 09/08/98 98-.3089463 TIGARD OR 97223 TNSP $ 35. 00 GEO 09/08/98 98-308948 Phone #: Contractors -__._.._.----______________.—____._--- OWNER Ph o n r #1 $ 2335. 00 TOTAL.. Reg #. . . -- -- -- REQUIRED I NSPECT I ONS —__._.... This Applicant agrees to comply with all the rules and r•egalations Sewer- Inspection of the Unified Sewage Agency. The permit expires le@ days from _ _w 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 latera:s. 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 952-0014010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OX by calling (503)246-196'7. Issued t _-- Ger-mittee Si gnat r.rr• a ++++++++f•+++++++++++++++++++++++++++++++++++++++++++++•++++++++++++++++++++++++ r Call 639--4175 by 7:00 p. m. for an inspection needed the next br.rsiness day +++++++++++++++++++++++++++++++++++++++++++.4+++++++++++++++++++++++++•++++++++++ Plan Check# CITY OP TIGARD Residential Building Permit Application Recd By c 1,1125 SW HALL BLVD. New Construction Additions or Alterations Data Recd TIGARD,OR 97223 Single Family Detached or Attached (Duplex) Date to P.E.< V 503-639417' 1 Date to DST F 503-684-7297 / Permit#M i /7 Print or Type r _ Called Incomplete or illegible applications will riot btu alepted Name of Project Name Joh t M. 5. We r c h ne - L1 meSb,lru e-i a L Architect Mailing Address Address Site Address —�- 14351 g:— ,-)UC '1 City/Stale Zip Phone Name _ prt 1 end O i Z A -!p5? o L�a.!JL r1 nnS+C - Name Owner Mailing Address Or PI: ' L , �? SL,�rrv�n n s T Engineer Mailing Address City/State Zip I Phone 3l 5 E /dor r i s o n r 1-41 `L ZL City/State Zip Phone General pt, � lZk14 7 3 - 88 Contractor }�,7 Corl$�S VCT,o n T Describe work New Addition 0 Alteration 0 Repair 0 Mailing Addressto be done: Prior to permit - � _ Additional Description of Work: Issuance,a copy City/State Zip Phone of all licenses •, "I bp"_ � ?��'ri PROJECT n are required If O gon Const.<;ont.Board Exp.Date expired In COT Lie.# �rl rl 9 - 5"1 VALUATION $ • QS QS _database `1 Mechanical Name NEW CONSTRUCTION ONLY: - Sub- 1jpr,}ec NCd fk nn Ccn�rnC�'oY Sq. Ft. House: Sy. Ft. Garage Contractor Mailing Address ? 5 _ ___ 1) 5� Prior to permit Pq 3 I Ih� + r Corner Lot YES NO Flag lot YES NO issuance,a copy City/State Zip Phone (check one) (check one) L�� or all licenses Z- 9 Restricted Audio/Stereo Burglar are required it Oregon Const.Cont.Board Exp.Dace Energy System Alarm expired in COT Llc.# Garage Door HVAC database �31� 2 I 1 -9--t�r.� Installation \`/ Plumbing Name — �_ Opener _ Systems Sub- S-4- R P l u m I r1 gi. (check all i"t Other: Contractor Mailinq Address app) - _ Will the electrical subcontractor wire for all YES NO A restricted enerRyinstallations? Prior to pnrmlt City/State Zip Phone Has the Subdivision Plat recorded? N/A Y' NO issuance,a copy OR - -7-7-74;, of all licenses are Oregon Const.Cont Board Exp.Dale - — required if uc.ari �1 Reissue of MST#: Solar Compliance expired in COT g 0 3-Z9-q-1 (Calculation Attached) database Plumbing Lie.# Exp.Date I hearby acknowledge that I have read this application, that the ,3q - -Z 1 y P B I W_3 V-1 9 information given is correct,that I am the owner or authorized -~ Name agent of Cle owner,and that plans submitted are in compliance _ with Ore on Slate laws. _ Electrical k V f_(-4 r 1 C Sigpature of Owner/Agent � M� �) Date Sub- Mailing Address [1rC> r1--L(}-y Contractor (tea "S\.4 W 10ry Contact oni +ame l Phone# �vL . r �a� l, y57_- City/Stele Zip Phone 9b Prior to permit FOR OFFICE USE ONLY: issuance,a copy 4,-31571 Plat#: tC - - MapfTL#: of all licenses are O on Const. Cont.Board Exp Data ✓/GyL�� - �' c required if Lie N Setbacks: Znge: Solar: expired In COT m i�'`i$ c1 -3- G- Q 9 database Electrical Lic.# Exp Date —` - — Engf eering pp v Planning Approval. TIF — LA Li o I C�-I 9 S t, 1 SFREH DOC (DST) 4191 i . SEE 35MM ROLL# 22 FOR LARGE DOCUMENT I