16652 SW JORDAN WAY � y y. / .. � �r I, �� 117M+�*NMV fMM'MINI�•�'7MIWM Mh'�'1"�i"'f'E1t M�iM
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AUG- 9-94 TUE 12:51 MARINER HOMES, INC, FAX NO, 5241998 , 01
131.25 sw Mal Blvd. TigaL.4, oregm 9
YnYpn 'tion Lpw (1kee4O-Pkcne)t 639-4175 burineaa ones 639-4171
Inrpectiors
;.' Routing Plbg- Onderelab Meeh. Rough-in App.!sdvlk '
Round. rlbq. Top Out Cta Line PIKAL:
Poet/6eae 6truct. Ban. Fewer framing -Bldg.
Port/!"an Koch. Rain Drain Inaulatlon -Plumgb.
Plbg. onderiloot Nater Line Gyp. Be. -Kbch.
Date Requsrtad: / _Tine: 1lll PM
Z �z.
Builders 1rY��t`dZ r�j-✓ - J
!t3 MLf,MKQ CORRRCTION3 "X RBQnIRED: i
p@ctor: C
`�,,:_7lPPRUvgA DISAPPRO APPROM S
� OR.J7lt'P TA A.;pVE
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11 Por Relnrp.
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CE RT IFIL;ATE OF
CITY OF TIGA"mr% F'E:C;MIT OCCUPANCY
MST93 .(d182
' COMMUNITY DEVELOPMENT DIP;ARTIVI EFT DATE ISSUEDs 07/26/93 �
t ti 13125 SW Hell Blvd.Tlgard,Orogon 87223.8190 (503)030.4171
PARCEL.s 2S116AI)--HED31
SITE ADDRESS. . . s 16652 SW JORDkNI WY �
:EAJB!DIVISION. . . . s BEDFORD GLEN ZONINGi �I
L1L,.C1CK`..N* ..._.. . ._..9...__•__.__.._L.OT....... .,.+,.+ ..... .. . W.._.s 31
CLASS OF WORK. s NEW �
TYPE OF USE. . . s SF 1
OCCUPANCY CRF'. s R3
OC CUPONC:Y LOAD s 117 4
I C.NON'l Nf sMF. . . s
Remarks : PATH T �
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Clwner s
BEACON HOMES
PO 80X 13611
B1--U4Ve^T01`! OR 9707`5
Phnne 4; 524-19- 91)
BEACON IACIMES
1)500 SW 1 c .`5TF1
B AVERTON OR 97005
Phone #4 524-•1999
Req M. . s 70782
OccupArscy of the above r•e?f•rrren ed building is hereby give��, and ct+.rtifies
the c,.omp). tanc p with thk State Uf' Ov'09011 'Spoc:ialty Codes for tha r)roup,
occupiancy, and Esse ut%de"r^ which the refer-en end petrmtt was issued.
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POST IN (:,(7NSP),CU(:IUS P'1-AC
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jam$,'r191NOTICE 1
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City of Tigard I;.,ilding Departaent
I:M a sw Ball Blvd. Tigard, Oregon 97223_/Ai_ �/'.'� b
Inspection Line iRoc-O-Phones 639-417: Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Hoch. Rough-in Appr/Sd.-Ih +
Found. klbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewe. Framing -Bldg. Mr
r
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. Mech.
Date Requesteds ]L 3 Time:Od
AM PM
Address: /!i �iy� �_ �.-�!1 Lw�_! yLJ��•li�L ormit 1: f a
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Builder:_ �!�' r;,(�-'� -- — ;y,�,' I ■
TEM FOLLOW:NO CORREcTions ARE REQG:RSD:
W.
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1nsprcto s21 --4Le —_ Dats:�
PROVED DISAPPRO APPROVED SUBJECT TO ABOVE
all For Rei.nap.
INSPECi'ION ICE
city or Tigard Building Dopsrtnemt
13125 BW Ball Blvd. Ti d, Or ~
9, egos 97223 I
Inspection Line (Re(-O-Phone): 639-4175 Business Ph �63-4171
Inspection:_—,— '
'Tooting Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out ` ' Gas Line FINAL:
Post/Bfsam etruct. San. Sewer Framing -Bldg.
Post/Beam Nerh. Paln Drain Insulation -Ply.
Plbg. Urgerfloor. Mater Lino Gyp. Bd.
-Hoch.
Date Rantuestede�__-��.-� - Time: AN P.Y
z 1
Address s � Permit
■
Builders
TIM FOLIAMING CORRECTIONS ARE REQUIRhD:
_ -_- : p+ ,
Fy�{
ti -;•t
In" tor:_—�� _R----
)"`" Date:�
,,,— APPROVED DIAAPPROVBD APPPOVED SUR. EcT TO �►B011i"
_--Call
For Reinsp.
JUN-04-193 FR I 13:5" I D:C I TY OF K I V3 C I T'r FA'< NO:5113 639-3771 #GOO P06
KING CI'T'Y
msr9� - moi X2_ � •
15300 S.W. 116th Avenue,Ung City,Oregon 97,224 Phone:6;!9.408? + '
COMMUNITY DEVELOPMENT
APPLICATION FOR SUILDTNG PERMIT
(Instructions an reverse)
DATE r
1. NPME OF APPLICANT: �,5p11���t,L c i Ptaone No_ Jr� t 1—/�9� _ ■
ADDRESS., :40 jexx /ti• ^ L��e;Lyttitrr�,_,
A MMSS OF PRCiPOSPD _ w f 31 ` L 5-min
2. TYPE OF CHN.GEE, IMPROVEMENT OR UC:rSTRUCTION FOR WEICH PERMIT IS REQUESTED. �
DESCRIBE BRIEFLY - ATTACH IWO COPIES OF FLANS OR DRAWINGS OF
PROPOSED PROJECT
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3. NAME AND ADDPESS OF C CNTRAC'POR_ _ —
PHONE No. .5,1 4-17474'1 LIC ISE NC -7 -7 '4 Z
4. NEIGHBORS WHO MAY BE AFFECTED BY Td?S PROJECT WILL BE NOTIFIED BY THE CITY.
5. APPLI= OR HFR/HIS RE>rRESETJTATIVE MUST BE PRESENT AT THE PLANNING CCHMISS10N
M1r.ETING NEXT HELD
REFRESENTATIVES NAME PF%M NO.
(The Flag cit, plannia o 'ssian wi consider oal, those applic:tius ro6ei►ed at least five (5) days
prior to a see '
SIAVATURE
" *#**icic##�►+k�lt�f�F�ltyk'ktMilt�it7Ank9t�t:IPt4tM#4_ 7ttk�k�1"lnlryci:***r.*t###t####�t�k#*#7k�k�f�k�1(orf#�k#'k*7t**tkit�k'�t*1t�F'yt#ic
APPLICATION RECEIVeED -.-
APPLICABLE ME RECEIVED $_ ���' C1 U _ '1'OML
PLANNING CX3 iiSSION 1)QC'ISICr1: AppravecL Denied
00NOITIONS �`-J r l jj -t_ t�<� ( n.� �' - -J
C approv._d LJ
ap lical.ions are ►.slid for sit eoattis only
SigrlatureNate 66-
1042: Dreg gosebuilders Law reqs res that all persons oho contract for vork as their residence be
registered vith the Builders Boats which seaas the contractor is bonded and insared on the iob site.
for your protection, be certaia your contractor is registered by calling City Hall Ph: 639-4082.
NCTE: A permit roost also be obtained frau the City of Tigard Department of
Ccmrunity Development Yes_..,,,__ _ No
CITY OF TIGARD INSPECTION 13�''ORT
The above listed project has been inspected and Approve:i Denied
Date _ CrnrkL-Its
Signature _
Wiydi .i "."Ptah, {jAab2 n.afrurn MZ I T) C-DPY tD K.ing CiU)
CO 1.91
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INSPECTION NOTICY
City of Tigard Buildioy Departamt
13125 SW B&).1 Blvd. Tigard, Oregon 97223
Inspection Line (Pec-O-Phons)s 639-4175 Business Phones 639--4171 I
Inspections
FootA ny Plby. Underslab Hoch. Rough-in Appr/Sdwlk
-..
found. P1bq. Top Out Gas Line lINALs r-
Post/Beam Struct. San. Sewer Framing -Eldq.
Post/Beam Mach. Rain. Drain Insulation -Plumb.
Pl.bq. Underfloor Nater Lina yp. 8d.
Date Aoquseteds_//
_Tim�
Addrs..s�//12 Permit f
Builders__
TM 1OU4VING CORRECTIONS ARE REQUIREDs
ee
Date s
APPROVED - DISAPPROVED APPROVED SUBJECT TO ABOVE
` Call For Relnsp.
{�7�WWJItlNgaMeMF'wte�u'RV+mMNnwrr*rrsXu..ri41t:MLnNARiWiCY... ..,r... ..,.. .. w.a w.l
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INSPECTION NOTICE
d ) city of Tigard Building Departsr'nt
13125 SN Ball Blvd. Tigard, Oregon 97223
t � Yi' 4 Inspection Line (Rec-O-Phone): 639-4175 Bunineen Phone: 633-417' 1
Inspection:__ _ -^—._-_--_-- -
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Flbg. Top Out Gas Line FINAL:
Poet/D,-am Struct. San. Sewer Framing -Bldg. '
Post/Bean: Mech. Rain Drain C� Ineulat)-on NI -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requesteds Pq
AW
Addreee:., rmit
Builder:
- W �
THE FOLLOWING CORRECTIONS ARF REQUIRED:
J
P"
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Inspector: - -- - - - �.-_ Date:
;APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
—Call. For Reinsp.
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: 4'1N4�-V�.'..Fnnn^i:'.'�Rb:•!?✓'.n'.Y'm'M'JiN1A11�'!?.'N1LSlh'iUPIS/WI.nSIYYAfT'16". rYsq �'�4�!91*'. � 1
jffux Thy qOTICp ``{C
City of Tigard RuU ding Depe ctaent t6 -4171 13125 BW Rall Blvd. figard, Orlmgon, 97223Inspection Line (Roc-O-Phone): 639--4175 uvsiness Fhone:
I nspoct ion:__ I
Footing Plbg. Underslab !Groh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out gas Linn FINALe I
Punt/Beam Struct.. San. Sewer l llYillg -Bldg.
Post/Beam Mech. Ra1n Drala insulation -Plumb.
Plbg. Underfloor Mater Line gyp,. Ed. -Mach.
Date Reques/t_od--t_ Timet AM PM
( jew Permit 1t
Builder: \aci I�11 etc&y^,,
THE FOLLUW*NO cORRECTIONs ARE REQvTRED*
�a STUB Q IV —
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Inspector
PPRD�G DIBAPPROVRD APPROVED SUBJECT TO ABOVE
Call Por Reinep.
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NOMINEE
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INSPRCTIOff (?TICK '
City of Tigard Building Depart�H.
13125 SW Ba-1.1 Blvd. Tigard, OrOgoa 9722 ,
Inspection Line (Rec-o-Phone)s 639-4175 Busineas Phon 63�,9.4171
Inspection:-
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg Top out Gas Line FINA ,t
Post/Beam Struct. Ban. rraming -Bldg.
Post/Beam Mach. Rain Drain Insulation -PI-Amb. •
Plbg. Underfloor Mater Line Gyp. Bd. -Mach.
Date Requested: S � TLms: - AM pM
Addressr � r
Permit #:
Builders -
TRIS FOLLOWING ±MP"CTL1OMAR1T�RJCUUIRZDi
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Inspector:
Dater - e7� i
\ APPROVRD DISAPPROVRD ^— APPROVRD BUBJSC!' To APDVR
—__Call For Reinap.
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! INSPECTION NOTICE
City of Tigard Building Department
De
FF"
13125 SN Bell Blvd. Tigard, Oregon 9722
Inspection Line
, 'ec-O-Phoneys 634-4175 Business Ph �j. r;', •-
639-4171
IP"ction•_
— f
Footing Plbg. Underslab Mech. Rough-in A r
PP /04wlk
Found. Plbg. Top out Gas Line FINAL:
ost/Bea, Struct. / San. Sewer Framing -814
oet/Been Mech:',' Rain Drain Inqulation
� c- -Plumb.
Plbg. Underfloair Wrter Line Gyp. Bd. -Mech.
Date Requested:_1 — Time:
AM _ PM
Address:_ _ y -�
Permit 1:
Builder:
THIT FOLLOWING CORRECTIONS ARE ,.I RED;
Grp
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Inspector:
i
APPP.OVEU _—_ DISAPPROVED APPRORFj) SUBJECT TO ABOVE
Ca 11 For Reins
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INfPECTION NOTICE
^.ity of Tigard Building Departnmt
13125 SW tall Blvd_ Tigard, Oregon 97223
Inspection Linec—o hnnes. 19x4 5 Buaness Pnone: 531-4171
Inspection:_ j i.
i
Footing Plbg. Underelab H,r: h. Rouqh-in Appr/Sd.wlk
Found. P bq. Top Out ar, Line FINAL:
Poct/Berm Struct. San. Sewer Framing -Blcg. ■
Poet/Roam Hoch. Rain Drain Insulation ?lamb.
�Pl . UnCerfloo; Water no Gyp. Bd. -Hoch.
Date Roquostads__ 1 Times AN ph
Address: ^ w** PoI-mit
Builder:
ITHE FOLLOWING CORRECTIONS ARE REQUIRED: —
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CYC ��✓f I'}(.1+�1�fy,��'1 i�'
Inspector: Date
APPROVED DISAPPROVED�— DISAPPROVED APPROVED SUBJECT TO ABOVE
�1W F i
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Call For Reinsp.
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Ry��i;1.Y�ahn 7, ^��.!.•if ''':w1��M7M1'ilkWst�Trm.ww+m.nma;xon.w.+.+,wn:...w.w..... -_.,.. � _y ti 3'{b I�� i ��.
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INSPECTION NOTICE 31
City of Tigard Building Department
13125 SA Hall Blvd, Tigard, Oregon 91223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
> �
Inspections
Footing Plbg. Underslab Mach. Rough-in Aapr/Sdwlk
�+ ,R
p y
Founa. Plbg. Top Out Gas Line FINAL: } W,,
Post/Be..i Struct. an. 3ewac-' Fraving -Bldg. y
Poet/Beam Mech. ain Insulation -Plumb.
Plbg. Underfloor. Gyp. Bd. / -Rech.
Date Requested: -----Ti., G�� '3'9AH
Address: VL.) 4-v/Permit
Guilder: Q 1 / �a
A CA ■
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Y,
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rnspectorsZ �+
� Datai��_� ^r
APPROVED DISAPPROVED APPROVED SUBJECT TO ASM
Call For Roinsp.
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4--1
INSPECTION NOTICE
Cite of Tigard Building Depa-'ta:ent ,
13125 SV Ball Blvd. Tigard„ Oregon 97223
+ Inspection Liae (Rec-^-Phone): 639-4175 Business Phone: 639-41.71 t
a
Inspection: — -'
t
Footing Plbg. Underelab Hach. Rough-in Appr/Sdwl.k
Found. Pibg. '...p Out Cas Line FINAL: r
i
Poet/Beam Struct. San. Sewer Framing -Bldg
Post/Ream Hach. Rain Drain Insulation -plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Neuh.
l -R—
PH t. ,
Date Requested: `' --Time: AN
Address: ermi.c is —
Builder: -- --
- � II
THE FOLLOWING CORRECTIONS PRE REQUIRED:
F
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Inspector:
_,=__ A••PP11ROVRD DISAPPROVED APPROVED SUBJECT TO ABOVE.
Call For Reinap. \
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CITY OF TIGARD
COMMUNITY DEVEP.JPMENT DEPARTMENT
13126 SW Hall Blvd.Tigan' O, -on 07223.8109 (603)838-4171
MASTER PERM 11
DATE. ISUULD:
`:,1 ;� i;1�DraF�.;:>::.,. , . /�---- 4a J1ar�i:�t=tial �rt< G�iil'rC;LL..y .._`al , ,•t�.�'
GLEN
2CJNANG: 1
l (...Ula.^ . . . « . . . « . LQ ( . « . . . « . . . . . . .
BUJ: DING _._ ..«._.. ....__ __...__..,.._.._._w.._ .. a
DWLLL 1 NG (_)N 1 T;.3:1 _ L-�A;afc:M<✓NI r 1
CLi4S;5 OF' WURK. :NEW BEDRMb 2 3 HHTsiSw GARAGE. . . . . . . . . . :467 s f
s L, ,y ... .. RE.C:iU 1 k2F•L.1 ;3L:C�rlr-�C:r. - __........ .. +
OFUSSL. . ...:,F I L UI? (IRR-0 .._ ...... »
I'Yk E OF' t✓ClNs;1 i fis,r. « a 1 a',�1 'f r,f Lk�F"T. . : ft F2I GI I F. :� f t
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[IlC:lJI'Fa1dC Y C'RP :k;;3 t` tia)NT , :.i4'1 t t REAR, 1 tvt^
r rH1RD. . . . e0 of REW1F3E:I -
=" T`t, f vTAI - : lrY)4 s f SMUVU. I) TLC. ruff s. a y t
g•
FLOUR LUAD. . , . -40 psf' VALUL. . . . . $ s 95530 F'r1F2FC,(NG SF�WCE'u. . : 1
'61NF<S. « « , . . . . « , s 1. 1:'LU(:JR L R01 NS. . « , :t%1 13ACf•lF'L0W I:'f L 11 i)ii-W5. « :0
t_FiVA1URI L S. . . . . :3 WH ER FTLATE46. . . 11 TRAPS. . . . . . . . . . . . . . :14 3
'TUB/ .;t fU6J[ R'E_). . . . J-1-AUNDRY T RAY.G. . � C:ra7'l«,i BOG IN"s-
4 WW'ER CL01 E.CS. . :E SLWE:R LINE (ft) . :0 GREASE TRAPS. . . . . . .
WcGHWAGHF RG- « . . :t 1 WATER LII�L ('rt ? . « 1►00 Cali"Hi~F3 ( l;X�`Ul�f-:'i« . . . .. ;tl)
GARBAGE DISP. . . : 1 RAIN DRAIN i i t i . :0
WPII.: li1NG WICI1. . . : 1 UF 144Iki 1)FAIN15. . : 1
f�iE C W�iPJ1CfyL F:ECS ..__._�» _....._......__ _._. ..
F UEl_ YYPE!: U1,4 ! 1-0 F •s. . :+Zt >.,yPe amnlAnt Ley ciat;e
LV,R C 9 =+,:1 . Oki JW 031�-'Q+/93 _
WIA); IfdPUI r V: C i l..i VENI I F PN5� . :. DPI.A tozi. 00 JL.H 03'1G/9:� 1,1 i:-:'37 5 F1 1-3
TURN t 1001', « . : 1 HOUDS. . . . . . . 1 1?51-:'C:: 1' ,.:1. 05 .«rt 03/30/93
t'tJRN ) =100K . . .41 WCJ()I)STC.1VI:.S. :it7 ri1`6C; '1 i r« 00 J'F•f 03,/;,30/9' 3
F"LUUR F='URN. « . . :k1 GLU DRYEJ : . a 1 lyiPRT 40. 50 JIT 02/30/9,:j
01"riLR d N I f';::i 1 NPLC; 10. 1:3 JH 0-3/30/9"s
GAS DIJ!LE:i>::i: 1 12. 03 JFI 03/310/rJw;
"
Owner: -.._ _._ _....... - .. p•'F'Fti 1; 0,0 JIt ►lJ3/:3+Zt1'J:3 -
E:1.�:AC:UN HUIYIE.S F'SF'G' � ��,. F.,:3 JI-1 0s/34'►/'�:?,'
PU BOX
BEAVF F4T'CJN ur+ ; 712175
Ptlorle
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Fwl�t'�ElrTLi14 UV,
71218. 64 Tri fAL_
°I fits perlit is issued sub;ect to the regulations contained to the cif-PUIRED IN PLCT1GNS - -
ltgard Municipal I:ode, State of Ore. Specialty Codes anc ail other Fant fattrtc; Insp I it—ep1Hce I1.1sip
i
} pplicable laws. Ali Mork wiil be done in accordance N:0 approved i-', st/Bea-0 ;jtrt+c t; ua: , L_,+r?e Insp
;t:ans. This pera:t will expire t` wo,•k is not started within 1W postiBeiAoi Me!c_Ftart iu1l 11tsr, t
ays of tstivanre, or if w•;,ie is 5115perr.; Sys. Plan/,.tndslat, IriSp Ceyp 806A, :.! I11s,la 1
'.�
iVLPirle, i` l um, Nair j, ;dirt 1110,;:
lrtsp
�lAWH�IAti,7iES'dPCA'�",�, Y'�M�NNI�wYtR:pM'NW77MM9t'/i YAr✓hv.MrtHMI'<`!MW9Mt4M.v::...,r.. .. ... ...a..wMrNiT,..+. r
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1317SswHaualvd. PLNCK/RECT #
CITY OFTIGARD
PO[lox PERMIT # /Yl Sf l�3-U �fl Z
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Oregon 97M
(503)63"171 DATE ISSUED _
JOB ADDRESS: 129, SW Jordan Way i IA. MAP/LOT S /plc
6+1 ,
SUB: Bedfcrd Glen LOT: 31 LAND USE:
VALUATION: JSS_ U
OWNER SPECIAL NOTES
' NAME: 1_�:acon Homes, Inc.
REISSUE OF: �
ADDRESS: _ 9500 SW 125th Ave. LAST REISSUE:
Beaverton, OR 97005 FLOOD PLAIN/
PHONE: 524-1999 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: Beacon Homes, Inc. PLANNING:
ADDRESS: _ ENGINEERING:
FIRE DEPT:
PHONE: _ OTHER:
CONTR. BOARD #: 70782 EXP DATE: 12/17/93
ITEMS REQUIRED
SUK 0 CTORS: PLUMB: Canby Plumbing LIST/SUBCONTRACTORS:
MECH: Muehe Quality Heating BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: ergo Architect/AIA TRUSS DETAILS•
ADDRESS: 16325 SW Boones Ferry Rd. OTHER:
Lake Gswego, OR 97035
PHONE: 636-0755
PROPOSED BLDG. USE: Residential
COMMENTS:
APPLICANT SIGNATURE
Received By: _ ()ate Received:
L. i
PERMIT # ACCT # DESCRIPTION
AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Pe iviit Fees — z`/.� 1
_ 10-431 00 Plumbing Permit fees I �� �y' -,332
10-431 01 Mechanical Permit. Fees
10-230 07 State Building Tex (5%) _ > sem' g-J
Building u 5
I
Plumbing
Mechanical �' o
■
10-433 00 Plans Check Fee
Building
Plumbing _
Mechanical Z- i '
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection 3 >� - '-
1 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
j 25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Bev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
>r: (SSDC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL IALSs i--
nm/3587P.WPF i
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CITY OF 'TIGARD - RECEIPT OF' PAYMENT RECEIPT too. a93--ic-38432
CHECK AMOUNT a 668. 84
NAME a BEACON HOMES CASH AMOUNT a 0. 00
AUDREFS8 s PAYMENT DATE. a �7.130r'93
6UADIVIS1.ON
PURPOSE OF PAYME 14T AMOUNT PAID PURPOSE OF PAYMENT AMOUN V P(4I D
4e:—.'I. 1410 Pl—UMB I N(3 PERM
50
t ME'CHAN I C'Al_ fief: 'tO. 510..E ST. BUILD PER 29. 71
1 PLAN CHECK FF.' 1.0. 13 SEWER INSPECT .?3. 00
i....OT 31 SE'OL ORD f31_FN
LiR973 SW JOPOAN WY
TOTAL. 0MOUNT PAID — > 668. 84
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155 N. First Ave.,Suits 270,8 21boro,Or.,97124 ����/'��� �����
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T�lrlJl: DA11 033093 EXPIJO11•I11M DATE. 092•'.93 PE:R111 T 1 0.;'
STRUCTURE ADDRESS 16652 F'FiO•JE:("'1' I �
STRUCTURE STREET SW JORDAN WAY
LOT 31 FLOCK "
TYPE GONNECTTQN•.. K!-W OF I+rDrORTI OLEN F'IiA`L -
'! TYPE INSTALLATION- ( 19) BLD SWFUERO CON/SI'IC
TYPE OCCUPANCY-•• ( t ) SING!_.l' f A1'I'TLY PARCr:I.. 2S1 16 0D '2''_''01— �
QTF SEC 4716 MN 1.1,.!
OWNER BEACON ROMPS
ADDRESS PO BOX 136B TREATMENT PL.AN'! J'1111'Ifll
BEAVERT'ON ' OR 97075
PHONE 524--1999 JURISD KING CITY '
FIXTURE EQUIVALENT I1411.I..L..INS RESTrll:"N T101..
UNITS SERVICE UNIT113 0 . 0 UNIT!1 1 SERVIM' ON] I '
CONNECTION FEES SLIRFACF: WATFR DF.' IrLOPMUN'I'
SEb1ER CONivECTILIN 2100 .00 WATER QUALJ:TY 100 .00
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LE4:-S C;REIIIT 1.no . 0{)'
WATER QUANTITY 100 .00
LESS CREDIT
0400.
ERnGT()N CONTROL
T.NSPECTION 40 . 00
PLAN CHECK 26 00
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51.113'1'OTOL 2100 .00 5UDTOTAL. 16u > 00 �
APPL. N0111': P1=ll-�:R KI-I'M I'IIOPII.:: :�...� /... .
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V'—',E. .. I'j'';L '1'1 1 Y 11401-11"S011
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Permit Condtt�ens: h pile nt egr s to c pl with aii rules and regulations of the Unified Sewerage Agency. When call ng
for an Insper.tlon, please refer to the P it Number. The permit expires one hundred eighty (180) days from the dote of
Issuance. 'he total amount paid (permit fee, connection charge, line tap fee and/or other charge) will be forfeited if the
permit expires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at the
measurement given, the installer shell prospect three feet in all directions from the distance given. If not so located, the
Installer !hell purchase a 'rep and Side Sewer' aermlt at the current charge and the Agency will Install a laternl.
6/90 WHITE — USA, SLIM — Accounting,, GREEN —Inspection, YELLOW — Customer
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