13249 SW BOUNEFF STREET e
y
i
V
•I
CRY OF TI A L,!-'RTIFICATE UF
OCCUPANCY
COMMUNITY 05VELOPMENT OPPAR PERMIT 14. . . . . . .
131 Rd$W H&H ENS.Tigard.On
,W "Wool* DATE ISSUED 05/g:.i/93
911L ADDRESS. . . 11 13249 SW BOUNEFF ST PARCEL.; RS104PC-09100
GjUBDIVISION. . . . i MORNING HILL 09 Z ON I NG i
SLOCK. . . . . . . LOT. . . . . . . . . . . . . 1234
OF WORK. 04EW
TYPE OF USE. . . eSF
(IGGLIPANCY GRP. oR3
CILCUPANCY LLAD a 29 4
Yr-,.NAN'r NAME. . . i
F?*marksi PATH I
Owner
JAY MILLER BUILDERS INC
0 BOX 83291
TIGARD OR 47224
Phone On 684-7543
!-'ontractorr
JAY MILLER
1-10 BOX 2.3P91
TIGARD OR 97281
Phnne #s 684-7543,
P43g) *. . 1 30109
Occupancy of the at-love i,"forenced building is hereby given, and certifies,
the compliance with the S*Atp Of Oregon Specialty Lodes for the group,
,-yrrltpant:y. and use undo- whi ,:h the referenced permit was issued.
FI iFF—D-EPARTMENT I T r, ICTOR
L INGiF Fl ;IAL
POST IN CONSPICUOUS PLACE
i
INSPs�rION_pS?'wICIF
clsv or Tigard Building Departwoot
13115 " mall Blvd. Tigard, Oregon 97213
Ineraction Line (Aossc-O-Phonal 639-417. BusinwM• Phonal 639-4171
Inepaations
Footing Plbg. Underslab Mooch. Rough-in AppR//dwlk
Pound. Plbg. Tor Out Gas Line I=MALs
Post/seam struct. Ban. Bewer Framing -Alda.
Post/sea= Iwoh. Rain Drain Insulation �flu�b. j
Plbg. Underfloor Mater Lim Gyp. ad.
t"
Date Mr•4ueetede�._ y —Time /N
Addreme Z Nr71t #o "M'5—
Builders
TIIR TOI.IQNICN7 fv)nnRl Tif1r1A Ann RRQ111RRns
r
f
Inapwcf or, I)af wt
APPPOVRn D1nAPPPnv1[h APPPnvRf) PIIn.iR1`T 20 ASM
Call ►ur 1!wlnnir
Citi of Tigard Building nospartmant:
13125 e11 Mall Blvd. Tigacl, Oregon 91223
Inspection Line (Rwc-0-P1Wna(, 639-4175 Business Phanat 639-4171
Inspection#__
Zga-
rootingUnderelab Hoch. Rough-in `- 16r/k
Found. Top Out Gas Line tIIKAL_i�
Peet/seas struct. San. Gower Framinq -Bldg,
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbp. Underfloor Mater Line Gyp. ad, -Hoch.
Date .,oquestode
Addroses J �1�3 �-Q Lc _
hrolt �
Builders
TMR FOLLOWING ODRRRC10"M ARE RRQUIRRD,
Inspector)
Dates t
APPROVED DIRAPPPOVRD APPWWFD Smite? To AR0VR
__ Call For Relnsp.
;r
IN/PI<GTIOH NOTIQ, ���..
City of Tigard eoildlog D"wrtaent
13325 NII Ball Blvd. Tigard, Oregon 97223
Inspectlnn Lines (Rae-O-Phono)i 639-4175 Business Phones 639-4271
1nspec:tlon1
rooting 01bg. Underslab Hoch. Rough-In Appr/Sdwlk
round. Plh;. Top Out gas Line FINALe
Post/Seam stru^`r.. Ban. Bower rraming -Bldg.
Post/Beam Meeh. Rain Drain Insulation -Plumb,
Plbg. Underfloor Water Line
gyp. M. -Koch._ \��O
Date RaQuestods .. `7 'S �._T 1.me /SAN
Addressc_ l r rsrmlt /c L ~Q Z
11-1-2
Buildery
TNR YOUA30ING MCNISC9I009 AM RBQOIRSDI
Inspector Datel 7
APPROVED n1nAPPRcnnlD APFFAAM To ADM
call For Rainsp.
INSPECTION NOTICE �1')
City of Tigard Building Department
13125 SII Ball Blvd. Tigard, Oregon 87223
Inspection Line (Rec-o-Phones 639-4175 Businans Phones 639-4171
I napect 1-on t-- --� —__--- ^— �-
rooting Plbg. Underelab Hoch. Ro+igh-in (\ Arer/edwlk
Pound. Plbg. Top out Can Line FINAI.t
Poot/Beam Btruct. San. Sewer rrasuing -Bldq.
Poet/Beam Hoch. Raln Drain insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Nisch.
Date Requenteds � � -__Times [7� 'AN PH
Addresss _ Pernit. /
1 ,
Builders_-- ��/' J --_------
TBR FOLLOWING OORRECTIONS ARE RSWIREDt
fill I CIL LQ i.A?
?� '&k- 6291)Z k D
A f- TE9. POZ/4//.l 6, _--
Inspectors e M f Date r_ / Z
_"r"1`__
APPROVED DISAPPROVED / APPR(r."M S!IRJRC'f To ARoVE
-Call for Reinap.
IHBPBCTIOH NOTj�
City of Tigard Building Department
13125 BN Rall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)i 639-4175 Business Fhonot 639-4171
Inspections
Footing Plbq. Underalab Mach. Rough-in Appr/edwlk
Found. Plbq. Top out sae Lina FINAL.
Poet. Rn,im Htrurt., Ben. Hewer Framing -Bldg. �
Post/Deem Mnch. Bain Drain Insulation -Plumb.
PIlxa. Underfloor Na or Line oyp. Bd. ,� -Mach.
Date Requested) Timet
Addraaat 7;"114 9 1 / �f" 51 Permit 0,711-cej '3 2—
Builders v / /( C`J)�1% �� 6,,SAS – V����
TNR FOLLONINO CORRRCTIONB ANN prguipRot
Inspector(---sem`*` Datet__ _'.3��/
APPRo1►fD ,-- DIHAPPROVRD vAPPR(riF,U Rl)RJR(,T Tt) AR(ri/R
Cell For Hnlnnp.
I11RP�Q�SIM NOTICE
City or Tigard Building Department
13175 611 Ball Blvd. Tigard, Oregon 97273
Inspection Lina (Roe-O-Phone: 639-4175 Business Phones 639-4171
Inspections__-___ -- — --- — ---- —
Pootlny Plbq. Underslab Nech. Rough-in Appr/Sdwlk
Found. P1bg. Top out as 8r PINALs
Post/Beam Struct. San. Sewer yraming -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Oyp. Bd. -mwh.
Date RoWesteds 3-,z ^�3 Timet AM PM
Address s_�3.Z Permit
Builders
TME FOLLOWING QORRECTiow; Asir nv.Q111Rltnt
Inspectors_ _ Date s _
APPROVED DICAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
S�Pa4.�EQtl_rm'x&�
City of Tigard Building Department.
13125 SH Ball Blvd. Tigard, Oregon 97277 '
Inspection Lina (Roc-O-Phona)z 639-4175 Huninsae Phonal 619-4171
Inspection:. — --- — ----r �— --- -- — 1
Foot
xinq P1tx1. Undaralab (Noah. Wiugh-- 1►ppr/5dw1k
Found. P1Mj. Top Out Oa. :eine FINALI
Poet/Ream Struct. Ran. Rawer JC Framing -01c1q.
Pont/Ream Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Lino Gyp. Bd. -Koch.
Date Request.dt (.f _ _ TLreI —�1K ♦' PM
Addr...t 1� u YAPermit to
Builders —91
THE roMMINO CORRECTIONS ARM RMUIREDc
0,900 c A s`�+_d6a, ['tJ.�T�cf�v 4/v t T a
�/s i4ns,i 2 N'� Sm2 y t�to�_ Bc�7D�_
i
i
In.pectort _- Data — -73Z
i
APPROVED DIAAPPRovRD APPROVED SUBJECT TO ADM
Call For Rainsp.
INS PC�MM._49Uce
City of Tigard Building Department --�
13125 BW Ball Blvd. Tigard, Oregon 9722
Inspection Line (Rwc-o-Phone)t 639-4175 Business Ph at 639-4171
Inspections —.�-�._---.--
Footing PIN. U •lab Mach. Rough-in Appr/edwlk
Found. . TopOut Gas Lina FINALa
--�� r j.
Post/ROAM 9Lruct. Han. Sewer Framing �ld /
Post/Ream Mach. Rain Drain Insulation
1
Plbg. Underfloot: Nater Line Gyp. Bd. -Nach.
Date Roque stedt -�'/ � --_TimesAM _ PN
Addrowas f ;7 V !7_ :�>-& '3 X1
is ou
Buildert� 14
' !� �. ------
THE FOLLOWING (VRRNC`-IONS ARE REQUIREDt
Inspector ---- --- ----_ DatesS�T�/��
APPROVED n19APPRnVRn APPROVED BUB.tNCT TO ABOVE
call For Reinnp.
i
jNIFAMION STIC
City or Tigard Building Departaeot
13125 BN Ball Blvd. Tigard, o_-wgon 97223
Inapeation Line (pec-O-Phone)e 679-4175 Business Phones 6.19-4171
1napactlona
Footing PIN]. Undwralah MecF.. Rough-in Appr/Bdwlk
►Mmnd. PIbg, Top Out Gas Line PIRALi
(Beam at Y. Ban. Newer Praming -Bldg.
•t/Ream MM—.h. Rain Drain Insulation -Plumb.
lbg. underrloo Nater Line Oyp. ad. -Mech.
Date Regueateds�2 /V _ TLaIsi AM
Addresse Permit
Tin POLL0VING OORRRCTIONB AMR RRQUIRRDi
I nspeotor i –-- D1te I
APPROVlD DIRAPPROVOO APPROVBD BUWBCT 7'I1 AwVB
Call For Relnap.
A
G 3N6P6GTION Nip, �/��.
itr or Tigard building Department /
V J 13125 SW Ball Rl.rd. Tigard, Or qon .17223
tnepaction Line (Rec-,i-Phono t 639-4175 Business Phonet 639-4171
Inspections
looting Plbg. Undorelab Mach. Rough-Ln Appr/Sdwlk
o,,^.d. P1bq. Top Out Gas Line rINAT.i
:.,dL ' ,fvnm Struct. Ban. Bower Framing -Bldg.
Post/Beam Mach. Ra1n Draln� insulation -Plumb.
lbq. Un� .rrloor liter Llne� Oyp. Bd. -Mach.
Date Requantedt r v ` Tunes __)�Al( PM
Addreaat_/3 Z 4 Z Permit til-3
i
Buildari___ 22Q/�
TNS FOLLOWING CORRECTIONS ARE REQUIREDe
Inspector,- �! `�_— --—---- Date t: .
X=_
APPROVED DISAPPROVED APPROVED BUEJECT TO AB()VIS
,_Call For Reinsp.
IMMOIN MAMM
City of Tigard Building Departwe t
13123 Bp Nall Blvd. Tigard, Oregon 97223
lnnpe(Alon Line ,Roc-O-Phone)i 639-4175 Buolnoss Phones 639-4171
l nspact.i on t--_. -- ------
1.
Tooting �) Pibg. Underalab Much. Rough-in Appr/Sdwlk
round. Plbg. Top Out Gen Lino FtNALt
Pout/Ream struct. Nen. Rower naming -Bldg.
Post./Beam Mach. Rale Drain Insulallon -Plumb.
Plbg. Underrloor Nater Line Gyp. Rd. -Hoch.
Onto Raquootede_,.'_,I Times _ AM
Aedreaacy 2
�� ;,�1F--- � Permit ft��
Bulidert
TNR rOLLONIN9 CORRECTIONS ARE RXQUIRBDt
rAti
__APPROVED DIRAPPROVRD /✓ AP!'RCYVRn RURJECT TO ABOVE
_Call Por Ralnap.
PLUMBING PERMIT
C'7YOFTI IFARD PERMIT #. . . i M8793-0032
COMMUNrTY DEVELOPMENT DEPARTMENT vseeoN DATE ISSUED3 02/09/93
13125 8W HWI Rtvd. P.O.Sat 23M.Tigod.Orepn Of (M)6*4176
SITE ADDRESS. . . 1 18249 S14 BOUNEFP' St 7`41-4r; 23104AC-RHE34
SUBDIVISION. . . . i MORNING 14ILL 119 ZONINGS
BLOCK— * , . . . . t: LOT. . . . . . . . . . . . . e234
—-----------------------__�-----------------
CLASS OF WORK. . sNEW GARBAGE DISPOSALS. . tL
TYPE OF USE. . . . sSF WASHING MACH. . . . . . . sl BACKFLOW PREVNTRS. . sO
OCCUPANCY GRP. . eR3 FLUOR DRAINS. . . . . . . 10 TRAPSo . . . vo . v . . . . . * 10
STOR I ESv . a . . . v . 12 WATER HEATERS. . . . . . $ I CATCH BASING. . . . . . . sO
FIXTURES--------------- LAUNDRY TRAYS. . . . . . : 1 SF RAIN DRAINS. . . . . 11
SINKS. . . . . . . . . . & I GREASE TRAPS. . . . . . . 10
LAVATORIES. . . . . 14 OTHER FIXTURES. . . . . iW
IUB/SHOWERS. . . . a SEWER LINE (ft) . . . . 80
WATER CLOSETS. . e3 WATER LINE (ft) . . . . 1100
DISHWASHERS. . . . sl RAIN DRAIN (ft) . . . . 10
Ramariisa PnTH I
UWNE14 1 --------------------------------- ------------------FEES-----------------
JOY MILLER BUILDERS INC TIF $ 1460. 00 JH 02/09/93 -
P 0 BOX 23291 BPRT $ 455. 50 JH 02/09/93 -
BPLC $ 296. 08 JLH 01/14/93 93-23,N640
TIGARD OR 97224 B5PC $ 22. 78 JH 02/09/93 -
Phone Os 684-7543 SEDC $ 290. 00 JH 02/09/93 -
PARK $ 500. 00 JH 02/09/93 -
PIUMbing C nt rAct ar 0 MPRT $ 43. 00 JH 02/09/93 -
MPLC $ 11. 25 JH 02/09/93 -
Name 1_,_, ,- M3PC
NamesM5PC $ 2. 1:25 JH 02/09/93 -
Address 2PPRT $ 1753. 00 1.714 0P./09/9"1
C.i t y I t a t P5PLI, $ 15 JH Ot?./09/93
Z I p on a#i
Reg
RF_WUIRED INSPECTIONS -------
This permit IS i%SU&d SLO) JOCt to the reg-
ulations contained in the Tigard Municipal foot/found Insp Rain drain Insp
Code, State of Ove. Specialty Codes and all Plost,'Bomm Struct Water Line Inap
other applicable laws. All work vv.. _ ' be done Post/Beam Machan Appr,/Sdwlk Insp
in accordance with approved plans. This Plm/undelab Insp Mechanical Final
pwroit will expire if work is itot started PLM/Underf I uor Plumb Final
within 180 days of isstiancog tit, if work in Mechanical Insp Building Final
suspended for more than 180 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain
Fireplace Insp
Line Insp
IngUlation Insp
x Gyp Board Insp
06thorized Plumbing Contractor Signature
Call for inspection 639-41.75
ontractor 14oteql-
CITY CSF' TIGA ISD
Twora
nar
CQMMUNITY DEVELOPMENT DEPAUMENT CRY MASTER PERMIT
13125 6W HAN BW. P.O."23W,71pM,Orsom 97 (503)830,4175 PERMIT 0. . . . . . . e MST93-0032
639-4 171 DATE ISGUEDo 02/09/93
SITE ADDRESS. . i 13249 SW IJAOUNEF-F ST PARCELS 26104AC—MH234
SUBDIVISION. . . . : MORNING HILL #9 ZONINGS
BLOCK. . . . . . . . . . a 1-07'. . . . . . . . . . . . . :234
------------------- BUILDING
NEISSUEx DWELLING UNITSil BASEMENT. . . . . . . . 10 sf
CLASS OF' WORKoeNEW BEDRMGe3 BATHS#3 GARAGE. . . . . . do . . 1440 SF
TYPE OF USE. . . tSF FLOOR AREAS---------- REQUIRED SETBACKS—----
TYPE OF CONST. :5N FIRST. . . . s1342 sf LEFT. - olO ft RIGHT. v19 ft
OCCUPANCY GRP. sR3 SECOND. . . o851 5f FRONT. i291 ft REAR. . s36 ft
STORIES. . . . . . . :2 THIRD. . . . 10 sf REQUIRED___________________
iE I GHT. .
EQUIRED-------------------
iEIGHT. b . . . . . . 329 ft TOTAL-------12193 s SMOKE DETECTORS. iY
FLOOR LOAD. . . . a40 psf VALUE. . . . . so 108798 PARKING SPACES. . ti
Remarks PATH I
----------------------------------- PLUMBING --------------------------------------- -
SINKS. . . . . . . . . . it FLOOR DRAINS. . . . i@ BACKFLOW PREVNTRS. . 10
LAVATORIES. . . . . 14 WATER HEATERS. . . s TRAPS. . . . . . . . . . . . . . 10
7UB/SHOWERS. . . . e3 LAUNDRY 'TRAYS. . . : 1 CATCH BASINS. . . . . . . 40
WATER CLOE3E7'8. . s3 2EWkR LINE (ft ) . s0 GREASE TRAPS. . . . . . . 10
DISHWASHERS. — i I WATER LINE-*. (ft ) . v .100 OTHER FIXTURES. . . . . 10
GARBAGE DISP— ol RAIN DRAIN (ft ) . i@
WASHING MACH. . . : 1 SF RAIN DRAINS— o1
---------------- MECHANICAI- ----------------------------------- FEES
FUEL TYPES-------------- UNIT' HTRS. . sO type amount by date ret-pt
/GAG/ VENTS TIF $ 1460. 00 JH 02/09/93
MAX INPUTiO BTU VENT FANS. . e4 BPRT' $ 455. 50 JH 02/09/93
--
F URN ( 100K . . 10 HOODS. . . . . . it BPLC $ 296. 08 JLH 01/14/93 93-235640
F'URN ) -100K . . it WOODSTOVES. iO B5PC $ 22. 78 JH 02/09/93 -
FLOOR FURN. . . . i@ CLO DRYERS. s I SEDC $ 280. 00 JH 02/09/93 -
BOIL/CMP ( 3HPeO OTHER UNITS: l PARK $ 500. 00 JH 02/09/93 -
GAS OUTLETSil MVIRT $ 45. 00 JH 02/09/93 -
Owners ---------------------------------------MPLC $ 11. 25 JH 02/09/93 -
JAY MILLER BUILDERS INC M5PC $ 2. 25 JH 02/09/93 -
P 0 BOX 23291 PFIRT $ 155. 00 JH 02/09/93 -
P5PC $ 7. 75 JH 02/09/93 -
TIGPRD OR 97224
Ptione #1 684--7543
Contractor: --------------------------------
JAY 0111-LER
PO BOX 23291
TIGARD OR 97281
Phone #o 684-7543
Reg #. . s 30109 _______________________________________
f 3235. 61 TOTAL
This Wait it issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code, Stott of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Strutt Gas Line Insp
plans. This permit will expire if work it not started within IN Post/Beam Mectian Insulation Insp
days of ittuance, or if work is suspended for sort than IN days. PIM/Uncislob Insp Gyp BoArd Insp
f;,Launlert I yor Wn,,drtin M
rJer,mittee C ,AT) CA n%p Water - lie 1114S
• Vllotmb Top Out Appy/5dwIk In, p
Issi.Awd ByeFt�aminq Insp MPCIIaniUal FiTIA1
Cavil for s-p 9 c t 1 639-4175
CITYOFTIFARDIF SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT 1-,E.RMIT #.HERMIT'. . . . . . : SWR93--0030
rarzaare IAMOad.P.O.Box23W,T1VM,OregonOf (SMIGN417 ! T77
SITE ADDRESS. . . I 13249 SW SOUNEFF ST FIARCE:L: cS104AC-IIHP-31.
SUBDIVISI001. . . . I MORNING HILI_ #9 ZONING:
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . :214
__._..____..___......____.------------.._-----_-..._-._---__-----._-------------------.._,.__..___...._ �
TENANT NAME:. . . . . I
USA NO. . . . . . . . . . a FIXTURE XTURE UNITS. . . e
CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1
TYPE OF USE. . . . . ..SF NO. OF BUILDINGS: 1
INSTALL T'YPE. . . . IBUSWR IMF,E;RV SURFACE. . : : s<f
Remarks: FIATH I
Owner: ------------------------------------------------------ FEES
JAY MILLEF. BUILDERS INC: type amount by date recpt I
P 0 BOX 23291 PRMT t 2100. 00 JH 02/x.79/9:3 -
INSR $ .35. 00 JH 02/09/93 '
] (GARD OR 97224
I-Ihone #: 684-7543
Contractor% --.__--------------------------
CONTRACTOR NOT ON FIL.F_.
---.- ------------_--------....r_-..-.r- --._.
1hone # f 2135. 00 TOTAL
---- REUU I RED I NSF,ECT I ONS _--
This Applicant agrees to cocply with all the rules and regulations Sewer Inspection
of the Unified Sewage Poency. The permit expires 188 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 setter laterals. If the setter is nut located ai the measurement
given, the installer shall prnspect 3 feet ir. all directions from
the distance given. If not so located, the installer shah purchase
a "Tap and Side Sewer" Permit and the Agency will instal', a lateral.
I'n r m i t t e e '�i [1 n a t e-W e
Call for inspection - 639-4175
CITY OF TWAND — RECEAPT CW PAYMENT RECEIPT NO. %93—,F-'36472
CHFCR AMOUNT : 5120. 61
NAMr MILLER, .JAY CASH AMO,JUNt v 17.1. 00
ADDRESS PAYMENT D14TE t 02/09/93
SUBDIV191ON
PURPOSE UF PAYMENT AMOUNT PAID PURPOSE UF PAYMENT AMUI.INT PAID
ki1J I L I l i NG EERM 455, :i0 PLUMBING f-" 155. 00
MrCHANTUAL, FSE 45. 00 a7. BUILD PER :32. 78
PLAN CHECV. V kZ 57. 33 Irh`_WE;f? 0iA 210 A.til 0
�4:WF'R INSPECT :35. 00 PARMS SDC 500. 00
STORM DRAIN SDI.; ;R80., 00 RESIDENTIAL TRAFFIC FEES 1.351b. 00
Mf1FIc� 1 HAN1317 TIF F V EIS 1 10. 00
LOT c?34 MORNING HILL 9
1 ,"-'49 :;W RUUNE.FF ST
T11TAL AMOUNT PAID — - -> 8180. 61
f
/�� A13125 SW IIall W. PLNCK/REC1' NCITY OF 1 IGARD P0 Mix v11q7 PERMIT aM5 S -OU���2—_ `-
COMWNITY DENE"LOPMENT DEPARTMENT Mprd.Orcgon47 23 —
(S03)6.1"171 DATE ISSUED
JOB ADDRESS: /3 2y9 5v✓ 800 P-ff ,:t' _ TAX MAP/LOT 04&
SUB: 2Qr1)t*(7Hi'll 9 _ LOT: 2-34 _ LAND USE:
VALUATION: jog Zm �
Q.1 SPEC IAI,.�pTf_
NAME: _jc�{ �1Le P dr'. ynC REISSUE Of:
ADDRESS: _ 0 �30X Z? 29 1 — LAST REISSUE: _ �_•
urd . Ot FLOOD PLAIN/
PHONE: _ �► 754 a _ SENSITIVE LAND:
CONTRACTOR ApAp4_YAL_s_n I8.Eu
NAME: J� (1T�'�I�( PLANNING: UL NOk
ADDRESS: ENGINEERING: .
FIRE DEPT:
PHONE: - — � OTHER: Tlf
CONTR. BOARD #: EXP DATE:
-ITEMS REQUJAER
SUff&ffR 99RS: PLUMB: l!'UVf1C-it S,sJ�l1 Q (. LIST/SUBCONTRACTORS:
MECH: �L�t�� fi'nQ �' BUS TAX: +_
_EGLNH; CALCULATIONS:
NAME: — TRUSS DETAILS:
ADDRESS: _ OTHER: _
PHONL:
PROPOSED BLDG. USE:
COMMENTS: —
APPLICANT SIGNATURE
Received By: _ Oate Received:
1PERM IT N ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees �f3S,sv _ w azo
^_ 10-431 OU Plumbing Permit Fees • _ ^ •G
10-431 01 Mechanical Permit Fees _�/, �✓ ' _ elj,,,,,
10-230 01 State Building Tax (5%) 3 7 e
Building d;LjC 1
Plumbing _'7
Mechanical �,��✓�
10.433 00 Plias, Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire , �N
(?�,1-oo 0 30-202 00 Sewer Connection d9l 0
30-444 00 Sewer Inspection 3,J''
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
r'
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees / D ILAIL-
52-449 00 Parks system Oev Charge (PDC) .-G to
31-450 00 Storm Drainage Syst Oev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
CITY OF 716'AkD RECEIPT 01' PAYMENT RECEIPT NO. a 93--,P35640
CHEM AMOUNT a 250. elo
I ir)W- a 11TI.-I FIR7 JAY GAGH AMOUNT s 0.lao
PAYME NI NITS r 01, 14/93
suar)I V I S 10114
I i IPPOSE OF PAYMENT AMOUNT PAID PURPOSE UF PAYMENr PMOIJNT PAID
i ,l .(4N CllrCK FK- 250. 00
OT 234 MORNING HILL 9
1 ..x"49 SM E11JUNEF-P ST
TMAL AMOUNT PAID IA. ovi