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CITY OF TIGARD
COMMUNITY r)EVELOPMFNT L.EPARTMENT
13126 SW Hall Blvd.Tigard,Orayon 972230199 (603)039.4171
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CITY
`113123 Sw I1,a BW PLNCK/RECT N -��� 3--2 3`J93 OF 1►jam IGNIZI) PERMIT a
COMMUNITY I)EVFLOI'M ENTI)EPARTM NT �'c+��6«'9nu
(503)6344171 DATE ISSUED
JOB ADDRLSS: �2�'�5 5(A) Cl�h�� 1�,X MAP/LOT o? S jC>Z�C -(JQ SOU
SUB: )t111(,�- - - Lor - 5 - -- LANAI USE:
- -
vnI IJA1 ION:OWNER SPECIAL SPECIAL NOTES
NAME: IK P REISSUE OF:
ADDRESS: _ S s'� G��w1 � __------__-- LAST REISSUE: --
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_ jtrA ►'A FLOOD PLAIN/
PHONE: ("-mA -�� SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: M- W fit_ -�W 5T . PLANNING: -
ADDRESS: I �U'� S,LA) LSA ` _ ENGINEERING:
'I lmd , �I-LL3 _ _ FIRE DEPT:
PHONE: � _ OTHER:
C0141 R. BOARD P: _ Y16 DATE: Z
ITEMS_REQUIRED
SUBCONTRACTORS: PLUMB: __ LIST/SUBCONTRACTORS:
MECH: _ BUS TAX: _------____ ---_-:_--
ARCH ENGINEER CALCULATIONS:
NAME: _ _ _- TRUSS DI IAILS:
ADDRESS: --_-- OTHER:
PHONE: — - - -- -
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE
Received By: ___ _ _ __ Date Received:
,�Z
PERMIT # ACC # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
h13�yj- (1 �2 10-432 00 Building Permit Fees Y0 S-1)_
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building -�
Plumbing
Mechanical
10- 433 00 Plans Check Fee
\Building -S2.3S
Duinbing
Mec?kanical
I0-230 06 Fire _ .
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fe
25 -448-04 Industrial TIF Fees\, _
25-448--06 Institutional TIF Fees -
25-448-03 Office T;F Fees
25-448-01 Residential Traffic Fces
2.5-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Stovin Drainage Syst Oev Chrq
(SSDC) - --- ------
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL (, � 52-33
nm/3587P.WPI
INSPFCTION NOTICE.
city of Tiy,rd Building Department
13125 Ssl Ball B_vd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones 639-4175 Business Phone: 639-4171
Inspections_ ----- --
Footing Plbg• UnderalaV Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line f_Xfi_#Lk
Poet/Berm 3truct. S'.n. 3e Framing -Bldg.
Post/Beam Mech. / ain Dra-ai� Insulation -Plumb.
Mg. Underfloor Water Line Gyp. Bd. -Koch. �
Date Requested: C l �J �s �/'
• PM
AddresesZ,-;L�Q US /P-S 52
Builders (V :1 - )
TRE FOUDWINO CORRECTIONS ARE REQUIRED:
�'u..--.� G., l�Pte✓ .�� vw'�-
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Inspectors - " Dates
/1►pPIIOVED DISAFPRO'rND APPROVED SUBJECT TO ABOVE
,_Call For Reinssp
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