9835 SW INEZ STREET-1 i
i
is
WASHINGTON COUNTY DEPARTMENT OF HEALa3 AND HUMAN SERVICES CR � 77
155 N. First Avenue
Hillsboro, Oregon 97123 Ag �" ��
Telephone: 648--8722 .
SUBJECT
LOCATION
HEALTH DEPARTMENT MEMORANDUM
The subject noted above has been reviewed and the following decision is recorded:
No Yes
( ) ( .aj. . . . . .Health Department requirements have been met in full .
No 4e s
) . . . . . .Additional requirements as follows must :-*e met before Health Department
approval can be given .
Comments !` �. /� t . / % kt
/ r / f•..,.�+ l .IS L f �� a �I . ! � mow.�.I a� .�. �-. ' I�'
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1-7
Date ,+ -
9835 SW Inez Street Public Health Sanitarian
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4/86-rev . WCDPH SE-4 1 of 2
If this notice aI}Gears ^tearer than the
document, the (I0i1111ent is of alargin.fl gmrdity. MAY 1. 9 1997
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!oration, depttrr $ arrangemWd Of Ail parts - •• +, n.r.
of the ,Rdlv�dual septic tank systOm pncludin �' :' i,+� "r}'r. ` �� r ` r� ,.w }�'^.''.�/• �,
distribution bnz & subsurface eines) will
conform to detalls shown on this Piot plan I
Any deviation from plan as here shoran must L._. D E ?"1
be approved by the County Health Uepartmeht
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en the part of the bulider or mvne� tar �l ,- f
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comply with these requirements voids Airy Y �' 'v
! obligation for Health Oepartmorit approval d!
the flnldmd systo
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9835 SW Inez Street
2 of 2
If this, notice avhears dearer than the
document, the (10C1lment is of inarginal giiality. MAY 1 9 1997
LMA INCA IN CHINA
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OCCUPANCYCITY ®F PERMIT #. . . . . . ,. MST90--0.► :8J-
COMMUNITY DEVELOPMENT DEPARTMENT DA I'E ISSUED; 08/18/94
13125 SW Hall Blvd.Tlpmrd,Orogon 97223.9169 (503)634-4171
PARCEL: ��51 1 1 L1A._@`1 tt16
r ADDRFS ,. . . : td9H 7 SW INEZ ST
SUBDIVISION. . . . o I N(3f:E WIND HI 'C(:T a [CIN I NC c R-:3. 5 �
. II13
(",LASS OF WORK. II NEW
r'YPE:. OF 1.JF'. . . II Sr
f]CGUPANCY OFF•'. 1 R3
A
r i Nr1NT NAME. . . 1
j1 H til ril Y'N q
owncrr C
DON 1A.LL1CKSON BUILDER INC
3018 li ST.
t
rORE.ST G110VF OR 97t 16
Phone #' 33-7 -0568
C;or c react nr II
DON HELLICKSON BUILDER INC
P
3018 H ST.
FORL.ST GROVE 0I4 971 If,
Phone #. 357-0568
2396P
Occupancy of the above referenc�eci buIldiny is hereby giVe", and certifies
ttte compl lanc:eb with the State Of Ur-eyctrn Spipc ialty Code-i for the group,
ocr.�t.tpancy, and u%e under which the r pferersc.ed pe-l`~mit WAS
rte....._..,✓
9 J.
N �t�r.:r�J
NlJ D I No 7 I C I AI_
POST IN I:; NSP I CUOU', PLACEY
.. . ^e'•".wn.wr.ea+rue!n,ww.tir'!!e�q�i!w' w'rl. � '4�� � �f
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CITY OF TIGARD
OREGON
December 4, 1991 \,
or
Don Hellickson Builders, :Inc .
3018 "B" Street
Forest Grove, OR 97116
Re: 9833 SW Inez Street Permit #MST 90-0202 f
Dear Sirs:
The last inspection conducted at the above project was not I j
7 approved. The next- required inspection will be a final {
reinspection.
f
Please advise the Building Division of the status of this project t
as soon as possible so the file may be kept current.
Please note that any permit—without activity for over 180 days
becomes void. If you need additional time to complete the project,
please contact- this department so that an extension can be
discussed.
Sincerely,
R.L . Thompson
Building inspector.
Notice.A
13125 SW Hol!BW.,F.O.Box 23397,11gard,Oregon 97223 1503)639-4171 — - -
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INSPECT;ON NOTICE /
` City of Tigard Bui`.din9 Depr rteient
13125 SN Hall Blvd. Tigard, Oreg3n 97223
Inspection Line (Rec-O-Phon s 6319-4175 Suef.neee Phone: 639-4171 \�
Inspection:___ ---- -
Plbg. U arelab Hoch. Rough-in �Y Appr/Sdwlk
Footing
�
Pound. Pl.bq. Top Out
Gas Lino FINAL:
Poet./Beam SY.ruct. San. sewer
Framing -Bldg.
Post/Beam Mech. Rain Drain
Insulation -Plumb.
-Mech.
Unuerfloor Water L" 'e Gyp' 0-''
—� Ti
'� j I met AN PM
Dato Requentedi
Permit r s ! � �-
Address:----
Tp FOLL0wINO CORRECTIUNS ARE REQUIRED: '
ap, --
1 ( 1
✓IU, 06,
`� �,`{1,.�.C•� -G''XIS��►i:, FC,Uc'�1��tt-..! C1���' v - c
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1 rl, y
1 IRej7eCQOri Y U r
(i peAPPROVED SUBJECT TO NBOVE
4 �i 41 A tl APPROVED _ DISAPPROVED
`Call For Reinep.
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1jtJ lxp�'�(NiFYl4 5�. t 1
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INS2ECTION NOTICE
City of Tigard Building Department
13125 SN Hall Blvd_ Tigard, On3gon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones Go9-4171
" Inepea t 1 on: -
-- -
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
C Y
Found. Plbg. Top Out Gass Line 'INAL:
r Pont/Beam Struct. B�ewe= J Framing -Bldg.
� r
Poet/Beam Mech. Rain Drain Insulation
Ali
Plbg. Underfloor Water Line Gyp. Bd. -Meth.
Da!e Requested- .� _ �� Times AM PM
{�j� �1
f .3 Pfrmit i t %L/-6'Re..-_..
V '� F
A.7d�eas:v� -� ._ � k7
DuJ.1etlY:----�'��
THF POLI,OWINr: CORRECTIONt; ATA R3QUIRED:
A V i �f,r
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Inspecto Dates__ ,
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_APPROVED DISAPPRVV?n APPROVED SUBJECT TO ABOVE
ry � ,
Call For Reinet.
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�..✓�.ew1..'M111:v�C..e1.+S`?1UC r, .ry KJt71'+.,. .N ...n.. - '
1 MACTION NOTICE
1
Cit-, of Tigard Building Depertssent
].3125 311 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Phono): 639-4175 Business Phone: 39-4171
Inspections
rooting Plbg. Underelab Mach. Rouqh-in Appr/3dw1k
i 11
Found. Plbg. Top Out Gas Lino FINAL:) I „
Post/Beam Strutt. San. Sewer Framing -Bldg.
?' Post/Beam Meth. Rain Drain Insulation
Plbg. Underfloor iiater�i.ine Gyp. Bd. -Hoch.
Time- PM
Date Requested: �� — � �
s ,
•
�� C i r i r•�i tF �F, .
Address: --� r)l� Ing r— <"3� Permit #I
Builders — �
TBi FOLIAWING CORRECTIONS ARE REQUIRED:
- Td 1 1 1• 1
f.:. 1 t xe+ 16 4n
r i :J;:
Inspectors Dates
ROVED DISAPPROVRD APPROVED SUBJECT TO ABOVE
rCall For Reinap.
9
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INSPECTION NOTICE �y
City of Tigard Building Departreent
rte•
13125 Sm Ball Blvd. Tigard, Oregon 9722.3 _�n
Inspection Line (Rec-O-Phone): 639-4175 Business Phone I-639-417/,1 __-
Inspection:,_ _ --- ----
Footing Plbg. Underslab Meech. Rough-in Appr/Sdwlk
E
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb. ra J 1e�ygyj,
wri
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
'v tiro -
Date Requested: �,� / - __Time+
Address: 61V��� L Permit 1:��1-
Builder:
THE FOLIAIWING CORRRCTIONS ARE REQUIRED: yA�a Fli<cxyjr;fni� �41,yy.ppi�;
MUST
29
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Inepectnic _. . � _ Pate:
APPROVED DTSAPPROVED 10\ APPROVED SUBJECT TO ABOVE
_1kCall For Reinsp.
µ�.y:. :,r..i„: m.:•:,..!r.,..4.H14:H4 Mc...::.i..i. ..,....,.. ... .. ,.....,..,>w..:.:1Mwi.i/OUrFi'.',� .,:
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INSPEC.'TION NOT'_CE
City of Tigard Building Dept- .�
13125 SSI Hall :iv i. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 39-4171
Inspection• — f
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk r-
e
Found. Plbg. Top Out Gas Line FINALS
Poet/beam Strucc. San. Sewer FramiDq
-Bldg,
Poet/Beam Heck). Rain Drain Insulation
-Plumb.
Plbg. Underflc r W.ter Line Gyp. ad.
-Hoch.
Mx I t I
I AK PH
Date Requesteds Times f
Address U �Aty � Permit s
Builders
THE FOLLOWING ODRft=CTIONS ARE REQUIRED:
I
ala t� rti•' _—'
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Inwpectolrs �____. Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
,. y Win,
1 Y,' • t " k' •Poc-4..,;rt.a.rfir„e,r,�s - y I�nh:P�ttAi`1):4
INSPECTION NOTICE r�jyy
City of Tigard Building Departoent A ;*1 yrrK
13125 SW Hak. Blvd. Tigard, Oregon 97223 ••
Incpaction Line (Roc-o-Phote): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underelat Mect. Rough-in Appr/Sdwlk -
Found. Plbg. Top Out 1 Gas Line FINAL:
Post!"-am Struct.�—'-S M Sewer / Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Undorfloor Welter Line Gyp. Bd. -Mech.
(late Recruested: � 7` r�U Timet _AM PM
Address: C _ Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIREDs
r
{` Yz
S qr.,fit�.�s� r�•
a Cuts � 4
� jai Yt�1 Ihr
1
4 s,1, 1
land � �I t
Pt
o -
Inspectors ^---_----_-- _ Date:/
�- APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
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�4iC^�r'3 'A9r+"+i7°�/ ��: ;,u{%,.! ^f/"- ...�. {,;..,. - ;, .,,�;- v �,:';'sm:, „r•,e;, ,. ..... ....... 4 . ,>�AJ!z+tWr1°:
t�irr !i 1' lye n r y IF°' t •y.1�Y,y� S�+r n 4 .dj.�r ';�, 4ly l,,,.,,4 .
jj
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99 t
INSPECTION NOTICE,
City of Tigard BuIlding Department
1.3125 SN Hall Blvd. Tigard, Oregon 97223.
Inspection Line (Rec-O-Phone): 639-4775 Business Phones -4171
Inspection:
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. s°lbq. Top Out One Line FINAL:
Poet/Beam Struct. San. Severseaming � -Bldg.
—�
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Ed. --Mach.
Date Requested& L) Time: .X AM PM
Addrean:_ 764
L ATO � Permit
Builder:_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
T"
77
ST "
I
Inspector:_ i Date: v
APPROVED DISAPPROVdD APPROVED SUBJECT To ABOVE
_N
-Call For Reinsp.
5'i
INSPECTION N01'T_CE �' l
City of Tigard Build`+oQ Department
g
13125 SW Hall Blvd. Tigerd, Oregon 9722
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: —
f
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
v �
Ar �'' Found, Plbg. Top Cut Can Line FINAL:
tt 1 P`
1 t fn1t,.
Post/Beam Street- San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb. S
1 Plbg. Ur-derfl.00r Water Line Gyp. Bd. -Meeh.
Date Requenteds �� �� —��� Time: AM �7 L PM
Addreea• Permit f
Builder:
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
t
Cb
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Inepecldrs- _ TA^ Date:__�,f l
i
RO"D DISAPPROVED APPROVED SUBJECT TO ABOVE
11 Fcr Reinsp.
INSPECTION NOTICE
City of Tigard Building Departs J rt
13125 Sw Ball Bled. Tigard, Oregon 9 e
Inspection Line (Rec-U+-Phone): 639-4175 Buetneoe'Pte: 639-4171
Inspection: iT/ r✓.� �L�'n oma" i_�--R-/L:csr" _' 4
Footing Plbg. Underal.ab Mech. Rough-in Appr/Sdwlktt
k
Found. Plbg. Top Out Gad Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
,st/Beam Mach. Rain Drain Insulation --Plumb.
Y ' r
.ibg. Underfloor Water Lina Gyp. Bd. -Hoch.
PM
Time::
Dato RegueeL-ed: /-�� G
E:� �—
Addreen: Permit� h li
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED: s y
, 1.
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Inspectors L� ""' Dote:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
9 Call For Reinsp.
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.rrvv,.i;rr�ph,'fiwr..,,ew�;zrd'gnMkh }a � �
INSPECTION NOTICE
City of Tigard Building DepartmentF7,, 10
P.O. Box 23397 � r ;: � ,•
Tigard, Oregon 97223 r ✓� f�t'1 t `' t
Phone: 639-4175 � 1- " ��° � '
Type of Inspection
i Date Requested — Time _ A.M. l` P.M. ` 4
lldnress Permit11L�.c�'� �w �f �+�i�
Owner Lot # y �{aRfr ,Cy+.
Builder
The following Building Code deficiencies are required to be corrected:
—
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Presented to )-[-Approved
Inspector ____--.— i Disapproved
Date —
CAL FOR R I PEMON
❑ YES ❑ NO
A
CITYOFTlw'ARD
/
GITf OF TIirARD �
COMMUNITY DEVELOPMENT DEPARTMENT ( 01110WDN PL U 11BTNG PE 1;Irl I'T � •
13125 SW Hall Blvd. P.O.Baas 23397,Tigard.Oregon 97223(503)839-4176 ` P.".R N I T 0.. T-'I...1*i`:�U 0181
--- -- » a I 7vT..-W,7g-J
r„3�:�-�, r 1 Dfi i'r.- 1 1:5`�uF D: 1.1altati/'au
SITE ADDRESS. „ ,. 3 9835 SW INEZ ST PARCEL: 25111.DA-02106
SUBDIVISION.-- :: INGEBROINID HEIGHT'*, 7O11TNI'
BLOCK. .. . . .. » . ,, » , . LC)T. . ,, ,, . , .. ,, . ,, , , .. . 13 -
CLASS OF* WORK. . ANEW Cif-'11 DOGE LISPOSfll_S.. . r MOBILE HO(IE: SPACES. 9
T'YP'E; OF USE. . . . :SF' WASH ING MACH, ., . ., .. . » a BACKFLOW 11h'.EVHTR'i., .
OCCUPANCY GRP. . :R3 F-I...OQR DRAINS. . . . „ „ „ : TRAPS. . . . . . . . . . . . . � �
ST'OR1.E:S. . . .. . . . . .2 Wi.:iTE:R 1-1 EEP"I FRS. . „ CATCH B;)SINS. , . , ,- » . ,.
F" 'Tl.1RE::L;- _.-__.._.........._ ._.. i.LAUNDRYTRAY''• . . . . . „ :; SI: RA114 DRAINS. ,. . . . !:
. . . ;
IX
SINKS. . . . . » . . » „ : L.)Fil:h!11L..5. . . . . . . . .. . OR
. „ „ ^ EiASI- 'TRWP'S. » » „ . . .
O'THE:R F IXT•URE6. . . .. .
TUB/SHOWERS. » ., . „ SEWER LINE �f l:) . ,. .• . .
WATER CL_OSETS. . a WATER LINE: (ft) — ,. -
DISHWASHERS
ft) . „ ,. -
DI SHWASHF_RS. . . .. . RAIN DRAIN
Remat•rks: Addirlq clr•ywe:1.1.
F'EE.13
DON HE LLICKSON EAUIL.DE:R hIC type <:kIII r,c.lnt loy ',1:c,a ^car..pt,
X301.1. 1 B ST. P'AY11 $ 26. 25 JLH 1.0/04/`0
FOREST GROVE OR 971.1.6 '51:'C T $ 1. 25
1:I17(arle #:; 357-0568
C.;c)r1 t•r ct r..•t a•r:
DON HEI._L.ICKSON BUILDF'R INC
30:1.8 B ST'.
F'C)REST GROVE OR 97116
1::'I•(ane+ !1: 357-05,68 $ 26. 25 TOTAL
- - - REGUIRE'D INSPECTIONS
(his permit is issued subject to the regulations contained in the Tap- ac.(t Insp
Tigard Municipal Code, State of lire. Specialty i.odes and all other FA nAI :Lnripec:ti.ari
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 169 days of issuance, or if work is suspended for more
than 189 days.
........ _...............
.
I:'ermi.ttr�L" liigrla�t(trc?:
Is s(.cecl I:+v:
C;< II tar -Y-I 1:)'e-c tiarl f�;39-••4175
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.ITY OF Tit, &W F;M IPT OF r'AYMENT RECLIPT r10. n 9c, ;k;D4":,.4
CHECP.:: AMOUNT ti 26. �'Zjr
NOME a ALOHA SANITARY SERVICE CASH AM0(,.INT y C►.(:0
ADDRESS t PO BOX 309 PAYMENT DATE. l()/04/90
IJUDIVTSION a
'I BAW','S, OR 971t.)b 9835 SW INET. ST
r-urTOSE OF PAYMENT AMOUNT r'A I I) P(Irl:`'OSE OF, PAY11EIlT' AMOUNT PA 11)
E''L.lIf1 INf��F'FFtP1 �F'l Mrat, U101� 00 ST. BUILD P17R
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1.0.1-AL AMOUNT PAID :r.'t�
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INSPECTION NOTICE y,
City of Tigard Buildi:lg Department"
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspectio
Date Requested 1 _�` _ Time . A.M.--4 P.M.
Address _t GZ_. -'� S ✓�C�I - Permit
L�
Owner_. — —,_ — - Lot #-
:,wilder �_---- — —
•
the following 3uilding Code deficiencies are required to be corrected:
Presented to ________—_—__ Approved
Inspector _ _--_—____—_ -- Disapproved
Date —
CALL FOR REINSPECTION
1-1 YES I_7 NO
�J
1
j
I ___J
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 r
Tigard, Oregon 97223 ^
Phone: 639-4175 I O
Type of Inspection
Date Requested _ �G Time A.iV� P.M.
Address Z!�E Permit #
Owner__ — Lot #
l •
Builder
The following Building Code deficiencies are required to be corrected:
Presented to -F} Approved
Inspector Disapproved
Date - - ---- - Al"
OL FOR REINSPECTION
YES CA NO
I
y
INSPECTION NOTICE '
r
City of Tigard Building Department
P.O. Box 23397 -r
Tigard, Oregon 97223
{ Phone: 639-4175
Type of I nspection ��=�
Date Requested Time A.M. P•M•
J G
Address Permit #2� 2 �� �
Owner
Lot
Builder ---- _
The following Building Code deficiencies are required to be corrected:
4' I
r
Presented to --- -------- - pr ved
Inspector .c� - _- ' -' —-- �_� Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
i
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i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection — -- -- �j
Time A.M.__LZ_P.M.
Date Requested
rh `' Address _ Y , __ Permit #
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Owner _ Lot #---
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+tr,,� Builder ---
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Bars:; The following Building Code deficiencies are required to be corrected:
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Presented to -__--_ _—�1 Approved
In4spector1 Disapproved
�Date "
CALL FOR REINSPECTION
❑ YES ❑ NO
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INSPECTION NOTICE
City of Tigard Building Department 0
P.O. Box 23397Offil
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection = -----/ -- --
Date Requested—..__ ! ,_. � –C Tinier P.M.
Address —_ _ "7r�'��, 1�`1 Pte— -- Permit # � ✓�v��_,2- i •
Owner _ _ Lot #_
Builder _
•
The following Building Code deficiencies are required to be corrected:
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Presented to� __ 4- Approved
Inspector — _ Ll Disapproved
Date
CALL FOR REINSPECTION
U-1 YES ❑ NO
I
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CITY OF TIGA RD
MASTER PERMIT
CITYOFTi6ARD V'E:RMIT• It. . . . . . . r.. 11ST90-f1 6;-.'
COMMUNITY DEVELOPMENT DEPARTMENT oRrEooN I.-RIM. PERMIT H. : MST90 'c<�-- 2 �
i
13126 sw Hwp Blvd. P.o.Bm 23397,npa.•d.��97 ( 1)A TE ISSUED: 08/ 4/".1(,) .
do
SITE: ADDRE: 35. . . 4 INEZ ST PARCEL: i?,ci111E+A l%J21(t)Ei I'
SUBDI:VISIONI. . . « : I:hIGF.BTi('rI�I) HI�]:GIArS ZONING.-. R--:3. 5
BL.00K.. . . . . . . . . . . LOT. „ . . . . . . . . . . .. : :L3
b
REISSUE." DWELLING UNITS: 1 BASEMENT. . .. . .. . . , : 158`J Sf •
CLASS (IF WORI/.. :NE.W BE:DRMS:3 BATH53:3 GARAGE. . . . . . . . . . :525 f`
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS-- -_....__._. ___..
'T'YPE'' OF' CONST. "5k FIRST. . . . : J.589 sf LE:FT'.. . : 10 ft RIGHT. :4O ft �
•
OCCUPANCY GRP. :R3 SECOND-:1054 sf FRONT. .-20 ;'t RkAR. . s 60 f''t
STORIES » . :2 THIRD. . . .. :(%) sf REQUIRE.D•-•..•.__._.._._.__......._�._._.__._.
1••IE:16HT. . . . . . . . :20 ft TUT'AL.w :2C,�i:3 sf SMOKE: DE TE C.'TORS. :Y
I"I...00R L..OAD. . » . :40 psf VALUE. . . . . 1;. r O41.22 I-'ARKI:NG S1'(10E..Si,. . :0 �
Remat•rk.s:
_._._..___..........._.__._..._._.....__._..__..._._.._._._._.__ __ PLUMBING
_w....__......_........_.._.._.._._._..__............__...___._._..__.._.._..__..__..
4i INKS. . » . . .. » . . . . 1. FI..00R DRA114S. . . . :0 BACKFLOW V'R13:VNTFi`,.i.. . :0
I...AVATORIES. . . . . :4 WATER HEATERS. . . : 1. TROPS. . . . . . . . . . .. . . . :0
T'UB/SHOWE=RS. . . . ::3 LAUNDRY TRAYS. . . : I CATCH BASINS„ . . . .. .. .. ;(;
WATER CLOSETS. -.3 SEWER LINE: (ft) . :0 GREASE 'TRAVIS. . . . » :a
DI SHWASHE:RS. . .. » : I WATER LINE (ft) . : 100 OTHER 1=IXTURE,Si„
c4ORBAGE. DISID. . . : '1 RAIN DRAIN{ (ft) . co
WASHING MACH. . . : 1 Si E: RAIN DRAINS). . -0.
_. ..........._.__ ._..... MECHANICAL. _.._. ._............_...... _ _......_.. _..__._.. - ..._.. FEE.S ._.._........._-....................- {
I:.UEL TYVIP3. ......... _. UN IT HTR!3.. .. ;c 0 t pam1oun t by date r(,ce p
/E.LE/ / / VENTS . . . . . -0 F'AYM $ 100. 00 JLH 08/14/90 203687 }
MAX 1:NI1::1tJ T d 0 BTU VENT FANG. . :3 BPRT $ 695. 50
TURN ( LOOK . . ^0 HOODS. . . . . . : :L BFILC $ 452. 07
FURN )=100K ; 1. WOODSTOVES. :0 BSFIC $ 34. 7.7
I::'LOOR FURN. . •. .. :H CLO DRYERS.. : I STDC 9; 600. 00
B()1:L./CMV' < 31f:: r.0 OTHER UNITS-.0 SSDC $ 3713. 00
GAS OUTLETSC0 MARK $ 25 0. c;0
C.)w n e•r: _.........___.w...__._...__..........__..._.__._....._..__.___.._.._. . ._._.__..-• M FI R T $ 3 5. 5 0
DON HE:LLICKSON BUILDUR INC I1PL_C $ 8. 88
3018 B
ST. Ih51'",C $ 1. 78
P P R T 'G :155. 00
FOREST GROVE: OR 9.71.16 1.-.115V'C A} 7.
I•:Intone Ii: ;357•-•0568 V'AYM $ 25:1.6. 2;=, JLH 08/24/':10
1 '
Carit•racto•r.: _......_..._.._.._._..._._. .._._....__......_..._......_._......_.-._......_....
DON HE:LL.ICKSONI BUILDER INC i
3018 B ST.
I
FOREST GROVE: OR 9711.6
I'l-imie I4: 357-05C,8
rs�n a. . : 2:31:,162 ..............
`#I 2616. 25 'TOTAL
ThIS perait is issued subject to the regulations contained in the - - RFOUIRED INSPECTIONS -
Ti.gard Municipal Code, State of Ore. Specialty Codes and all other Foot/fcound lnsp III ecl•iariic,a1 1risp
Applicable laws. All work will be done in accordance with approved idt•r P-roof i.rig Bsm Fllumb Trap Out
plans. This perait will expi?e if work is not started within 180 F'rast,/Team Sitruct Fratmirig Irrsp
days of issuance, or if work is suspended for sle
than 180 days. Vast/Beam I'lectiatri F•i-rep.laee Insp
t:•r,AwI D-rai.n Gas L.irie Irisp
Llllnl� PI.m/ciridslab Tri.>p 1:n�sul.at:1.ar1 11.1 sli
Permittee Signature: �l. � ..........
FILM/Underfloor Gyp Boa-rd Irisp
Issued By: F:tng 1)'ra..i.n 1*3sm' t Rain d-rain 1Visp
1,31!- -02,67
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ib•'�r•, ��4}r1'�a�'�+'P.ri.. . . ... ...w .;; '.r. ^4 ,xw.%: r�r 'S!.4Mn44., -Cp,iYgim, . � ,. •ti;•i
•.•°f/'11f�;,� mac i,+nr auv.rtatbY�M�' �
YpVi'
PLAN � APP7�ICATICiN
13125.Bo Nall 7 �+
C1170F T � F.O.Box on 97 PIAN C�iH]C!C ,#
11/! regard Box
97223 PER= I
COMMUNITY DEV E OPMENT DEPARTMENT ' �'°3)639-417,
-
C DATE I.SSIJII)
q3. -
JOB K)DRESS:-t S �� s r, TAX MAP/IDT
SUB: 10r: — LAPID USE:
i OwrtIIt ,, , SPDCIAL NCIEES
NAME: "� ' �i RL-rJASr REISSUE- -- f •`
- _ FIDOD PIAIN/ •
-- SENSITIVE LAND: 4
PHONE: -- — AP13PDVAIS
cbNTrACIIOR PLANNING: •
J1I-C xSla-Lr-) �u r�� c 0,4GINEIMING:
ADDIUF;S: 'Icj7 Lg I2, T> AFIRE DEPT
BUIID8RS BOARD 1: 6, 4a L}IP DATE: 211y 6 LTSr/SLUmmAerats:
BUS TAX:
ARCA FN R—Mm CAIEWf aONS:
Nom: LJ' jL) 933JSS D-I A %
ADC ESS: OTHER:
PHONE:
_ q
PEFMT , ACCT , DESCR 'IZCN AMJUNr AMOLNr PD. BAL. DUE
00 BL ilding Permit Fees
10-431 00 Plumbing Permit Fees
10-431 Ol Mechanical, Permit Fees ✓ 3 S ' :?S.
10-230 01 State Building Tax (5%)
Building ;'/.' 11
Plumbing 7 7 f
Medi /•713 �� �, �
10-433 00 Plans Che-k Fee
Building
Plumbing _ —
/� 1 Medi _
U 30-202 00 Sewer Oannec't?.on _
30-444 00 Sewer Inspection
/ 51-448 00 Street Spr:. Derr Charge (SDC) aO OLI 0
52449 00 Parks System Dev Charge (PDC) J
31-450 00 Storm Drainage Syst Dev Chrg (SSDC)
10-230 06 Fire
'IUTAL
RDC I
APP'IACARr SIGNATURE
Received By: Date Peceived:
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�ii-t, or TICARD RECEIPT OF PAYMENT RECEIPT NO. s90-20409
CHECK AMOUNT a 2516. "t c
lNAME:. % DON 1-1EL1_I CK 30N BUILDER. 1:11ASH AMOUNT o.f>
i ADDRESS s 3018 S *IREC.7'*I' PAYMENT DATE �'`��
! SUBDIVISION �
!� FORE53T GROVE:. OR '?'71 1 b... f
IPURPOSE OF PAYMENT AMOUNT ri')ID PURPOSE= OF PAYMENT AMOUNT rPAID
—1 a . ,�7C,1 PLI JMB 1140 PERM t55. 00
f E'I_IILfJINC�— E'[=ESM—�MciTc�'t'�..t:�;c:>w1� h�i',.;� I
MECHANICAL C'E. 35.50 ST. BU I L...I:+ FLEE% 44.30
FLAN C:HEzC;k:. FE 360.95 STREET 'GDC 600. OQ
PARKS SDC 25C.).00 S'T OF,*,,M DRAIN ':3L1I 375.00 I
J
141530 SW INE:.' ST f
`'1 f'• %
TOTAL. AMOUNT F'A t T) f
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(JF T1:Gi PEI PECE t P T OF 1=''iAYMETI r REC'E T.F T' NO. s 20:;4)El''
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NAME. a LOO (. iSH AMOLIN'T : C). '
AGG'RE'SS >1 OF B TP C—F...' " F'('I', ME:NT C?FlTri' s !)D, /14!9 :+ 4,
f F f::I1 E'E,T C I",OV E: . CII; 9 771 1 t �^a
PIJF'POSE OF r='AYMENT +AMOUI%IT FAxi? C''L.IF:F''I ' E OF PAYMENT AMOUNT F"'A10 r
L�F"N_.CHECK 2�2.' Ci
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iTOTAL AMOUNT PAID -- i ::�. `�•:,
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GRADINGIEROSION CONTROL, INFORMATION .
GENERAL .ONTRACTOR NAME& DDRESS: CASEFIL4.NO.:
_ J c Yc., �, '�» J j►.,�_ PERMIT NO.:
e rt s sT Gas o v z APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME&ADKESS: —
R04 O OWNER NAME AND ADDRESS:
TELEPHONE NUMBERS: — --
APPLICANT: -5 7- O S Co PROPERTY DESCRIPTION:
OWNER: G9Z - 0 33 I __ STREET ADDRESS AND CROSS STREET/LOCATED
GENERAL CONTRACTOR: -2 F - O (p 1 SQ R. LJ. f ri e.r_ ST.
EXCAVATION CONTRACTOR: ,, ' - 30Y
SITE/JOB:
LEGAL DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.:
CO ACT PERON,TITLE,TELFTHONE: 1/4 SECTION:
A a^�'� SITE SIZE,ACRES: 1
DISTURBED/WORK AREA,ACRES_
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE; ONE)
(NOTE:PERMITS MAY BE REQUIRED) CATCH-BASIN DITCH PIPE CREEK
(CIRCLE ONE) PRIVATE PROPERTY
PUBLIC RIGHT OF WAY
ROSiON/SEDIMENTAT N CONTROL (ESC 1yIEASULtES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS c.
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUC:'ION SEQUENCE OTHER k
OTNER
1
PLAN FOR EROSION CONTROL,PREPARED AND SUBMITTED IN ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK-. f
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PRONE NUMBER, SCHF.DULEJSTAGING FOR INSTALLATION AND REMOVALOF EROSION C'ONTROI,MEASURES,AND ,
APPLICABLE STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT ANT)MAINTAIN ESC MEASURES AS NECESSARY ti
TO CONTAIN SEDIMENT ON'THE CONSTRUCTION SITE.
OWNER SIGNATURE APPLICANT SIGMA
OFFICIAL USE ONLY.
RECEIPT DATT. ACCI:I~1 ED
F1:E NUMBER RECEIVED BY