16664 SW JORDAN WAY .1*�+Y.rrW+N�•,rt,..wagf IINMI�Y•Fi�l"I4 +!•rM 7: 'y �/�j,� .
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CITY MJF TIGARD' CERTIFICATE OF
COIIIiMUNIT'r DMLOPMeNT WARTMENT OCCUPANCY
t�tREi�Y'h�N Illrrtlpr/,OM/ee hElt>1N1�0 (fW).w1M11�� PG IM IT #. . . . . . . s MST92-030 + 1
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1%1 DPTE ISSUE::Dt 06/22/93
PARCEEL t r?ii 1 1 F AI1 -Eai�llc8
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ADDRESS. t lE+664 EiW JORDAN WY � I
SUBD I V I S I ON. . . . z BEDFORD ®LEN 1 Z!7N I N(y; p
si-OC1�.�_.__._...__..__:_._. __..._�LClT. . . . . . . . . .._ t28
. • • • • • • M
CLASF OF WORK. t NE•rW
1'YPE OF USE. . . z F3F
0t,GUPPNCY GRP. t R3
OCCUPANCY LOAD z 117 4 I
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TENANT NAME. . . z
«ema�rk!�t PATH I
BEACON HOMES
PO Box 1368
BE nVEr'RTON OR 91070.5
Phi-ne #t 524•-1999
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L ont rac.t or t _._..._. ._____ .___.w.._,_...__._.._. .__._..._..._.__
1EzAC:ON HOMES
9300 5W 125TH t
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BE:AVER'TON OR 9700n
Phone #t 524-4999
Fjeg #. . t 7078 '
(7 c,jpancy of the 40-,ova referenced building is hereby gi,,en, and certifivx
ti,e r.ompliance, with the State Of CWPgon !"specialty Codea tot- the group,
occ-apancy, and use under �-ihic:.�h 1 ie r�efe+renced permit was 1 ����.+wd.
FIRE= I7EF�ART MEEIVT U I LD`1• CE i i,16PE.CaTUR
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FF I C I AL.
POST IN CONSPICUOUS PLACE
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INSPECTION NOTICE 1
Citi of Tigard Building Department
13125 811 Ball Blvd. Tigard, Oregon 9,12
Inspection Line (Rae-O-Phone)s 639-4175 Business phones 639-4171
Inspections '
Tooting Plbg. Underelab Mach. Rough.-in Appr/Sdwlk
Found. Plbg. Top Out Oss Line dLNALs
Post/Beam Struct. San. Sewer rramins• -Bldg. / "w
Post/Beam Mach. Rain Drain Insulation
Plbg. Underfloor Nater Limetel,
Gyp. Bd.
Data Requested: 1 _ Times AMS' ,, f
Address: //,7 i Permit ts'•=-f-'�, '/_ _ B
Builders
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THE FOLLOWING CORRECTIONS ARE REQUIRED: i
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ni Inspectors /17
Dates
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APPROVED
DIBAPPR.OVED APPROVED SUBJECT TO ABOVE
_Call For Reinap. aJJ' t
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INSPECTION NO
City of Tigard Building Department.
13125 SA W.1, Blvd. Tigard, Ozow n 97.!23""-""".';
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Inspection Line (Rec-o-Phone;S 639-4175 Businssa Phone:l -4171
Inspections
Footing Plbg. Underalat Mach. Rough.-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINALS
(, Pest/Beam Struct. San. Sewer Fram.-%g -Bldg.
Post/Beam Mach. Rein Drain Insulation -Plumb.
Plbg. Un,lerfloor Water Line , gyp. !d. -Hoch.
Date Requesteds. Tian:
l ,_,,X_AM 'PH
Address: `' =it #S /1/)11
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Builder: l i 0
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THE FOLLOWING CORRECTIONS ARE REQUIRED j
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�: 2,�/r,C c�' C��•zf T
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Inspector:_
} ,APPROVED DISAPPROVED APPROVED SIIBJRCT TO ABOVE
_—Call For Re-nap.
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1:11PECTION NOTICE
Citv of ligand Building Department
13125 SW Hall Blvd. Tigard, Oregon 9727.3
Inspection Line (Rec-O-Phone)s 639-4175 Bue near Phone: 639-4171
Inspection:—
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Fcoting Plbg. Underslab Mech. Appr/Sdwlk
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Found. Plbq. Top Out Gas Line 1 FINAL:
Post/Beam Struct. Sun. Sewer Framing -Bl.dg.
Poet/Beam Mech. Rain Drain Insulation -FI.,Imb.
C -
Plbg Underfloor ......Line Gyp. ed. -Nech.
Datn Re uesteds ._
9 .� / Timet A•i Pr.
441
Address:_-�_L1y Permit 1t
Builders—_ /�GE .r_✓l» �_Sl _L._ j n4+{+Ir ,
f ;M�f IC4�'4pt�^l n S
fTHE FOL'10WMG CORRECTIONS ARE REQUIRED:
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Inspector —�
APPROVED `- DISAPPFOVED APPROVED SUBJECT TO ABOVE
-_—Call For Reinsp.
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INSPECTION NOTICE �� �'
City of Tigard Building Dep—tient doll,
137125 89 Btll Blvd. Tigard, Oregm 97223
Inspection Line (Rec-o-Phone): 639-4175 Bueiness Phone: 639-4171
ry Inspection: _`�
Roo:-ing Plbg. Underelab �V ggh+�in Appr/Sdwlk
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Found. Plbg. Top Out lai�L'iltf-- FIN'+LP
Post/Beam ;trust. Can. Serer
Post/Beam Hoch. Rain Drain Insulation -Plus b. n d� qtr rv�
til' 2 slit. •
Plbq. Underfloor Nater Line UYP• Bd. -Hoch. t �
Dates Requesteds. Time: AM PM
Address: ' ermit f t 6k"9i t,��;N ,w ■
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Builder:
TlIZ FOLLOWING CORRECTIONS ARE MUIRED:
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T rel n�i?/F`t'��" ) 1,7
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Inspectors_ Date:
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APPROV1tD __ DISAPPROVED VxPPROVRD SUBJECT TO ABOVE
y Ca7.1 For Reinep.
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INSPECTION NOTICE
i
Cit} of Tigard Building Departxent
13125 an Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Basinees Phone: 639-4171
1
Inspections ——
Footing Plbg. Underalab Mach. Rough-in Appr/Fdw)k
Found. Plbg i Topsu Gag Line FiNhL:
Post/Beam Struct. San. Sewer Priming -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
P.bg. Underfloor Wate�r7 Line] �} Gyp. Bd. -Mach..
Date Requeeteds / ! 7 Times ��AM/ —PH
Address:/[c4' S� 1,4/0/?APOOX/ i"-//Permit i:_ �'V / •
Builder.• __—
TBE FOLLOWING CORRECT77NS ARE REQUIRED:
Inspector: tr Date:_ 7— /
PPRO'rED DISAPPR:!VhD -- APPROVED SUBJECT TO ABOVE
Call por Reinap.
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City of Tigard Building Department
13125 811 Ball. Blrrl. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspect.ionf
Tooting P1bg. Underalab Mech. Rough-in Appr/Sdwlk w
Found. Qlbq. Top Out Gas Li.vi FINAL: I
Post/Beam Struct. San. Sewer rraming -Bldg.
Post/Buam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Koch.
Data Requested, J , / __Time: _ ,J AM PM
Address f �2�-- .� r�dl/-�i i /Dfsrmf.t
Builder: -
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TtM FOLLOWING CORRECTIONS ARE REQUIRED-
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Isespectort
IIPPROV/D DISAPPROVED APPRJVED SUBJECT TO ABOVE
Cal). For Reinep.
INSPECTION NOTICE t
City of Tigard Building Departs-nt �l!
13125 611 Ball Blvd. Tigard, Oregon 97223 ! i
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Inspection Line (Rec-O-Phone): 639-4175 Business Phone 4171
1
+{� Inspection:—_--_----� -- ---`---- 1
i Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk 1
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4I
Found. Plbc
,. Top Out Gas Line FINAL:
K*19o-st/Beam Structi San. Sewer Framing -Bldg.
`'— `c--
�et!eeam Mech. J Rain Drain I -Plumb.
-Underfloor— WR.ter Line Gyp.. Bd. -Mach.
D '.eque d:_— `' _ —Timet _ AM --PM ,
Adress: („(Q � Permit 1:� —C)
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Builder: •-- -- a
THE Fri LL WANG CORRECT';ONS ARE RECT]IRLD-
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Inspector- /' Date: }d
\ APPROVED __- DISAPPROVED APPROVED SUBJECT TO ABOV15 q txy i
Call For Reinep. 1fi�;.,')
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XNSPE4'TION NOTICE �j �.�� I
City of Tigard Buildl.ng Departaent U
13125 SM Ball Blvd. Tigard, Oregon 97223 1
Ineoection Line (Rec-i-Phone): 639-4175 Business Phone: 639-4171
1.
Inspection:___ —
Footl.:g Plbg. Underalab Mech. Rough-in Appr/Sdwlk
t
round. �/ P1'jg. Top Out Gas Line FIN?L: I
Pon ry �sewecFraming -Bldg.
am Aain Drain Insulation -Plumb.
--'
r �-9-at,er LinoGYP. Bd. � ',eMech.
edt T =C ��.--Ali PN
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Addreea:
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Builder:_ �-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspectors �.--- —_... Date:. -G
PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp. d y
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INSPECTION NOTICE
City Tigard Building Departuent
13125 !q Ball Blvd. Tigard, 011e, R 97223
�,Al Inspection Line (Rea-0-Phone): 639-4175 Br.siness Phone: 639-4171 y
Inspections � - ------
�ootissq Plbg. Underslab Hoch. Rough-in ApprtS .rlk
Found. Plbg. lop Out Gass Line FINA1•:
Post/.team Struct. San. Smver Framing -Bldg.
Poet/Beam Hoch. Ra1_n Drain Insulation -Plumb.
Plby. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: _71Ti'Oes (�1 AM _PH
Address: Permit !sjs��I
Builder: •
THS FOLLOWING CORPECTIONS ARE REQUIRED:
1
Inspectot Dates
~ AP' OVER DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinat,. '
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:url"•d SANITARY• D a
155 N. First Ave.,Suite270270 Hillsboro,Or.,97124 SURFACE WATER
503 848.882
CONNECTION I'1:101IT �
ISS11F' DATE r)3'. 393 EXPIffflrjl C)�T,'01G 14: 091�1`'�''3 PE:fyf4l'T 10":i�'()p
SS 2 R 71 F'RO J"C;•T 1.939 I
S , RUCTURE AU'1F`E�.� 1z.91,r
rF:li(:TUf<(" S1'F'EE I' SW '50RDAN WAY
LOI 20 Ii L. 1CK
1YF'I" GONNE.CTION-• NEW OF BEDFORD 01—EN PH6SE '2
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TYPE INST'AL.LATI.ON— ( 19) BLD 5W ./E:RO C ON/SL:IC
TYPE 0C+ LIAN a ( 1. ) 3INrLE FAMILY PARCEL 2SI 13 AD 26200
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OTR OEC 4716 MH 10:1091 �
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OWNER Ti r_ ttCOPI TTCINF'S INC
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ADDRESS 1905 NUI 169TN''MiTtiCE TRF"A1'MEN•T PLANT T+lil::lli;t1
BEAVERTON pk`t '97006
PHONE 5"-i-1999 J0RI9I1
FIXTUF�E EQUIVALENT ItWl:l_I..INn RFSa1I1EN'TIA1.
UNITS SiE'RVI�:17 UNITr 0 .() U N I TS 1 SERVICE tINTJ
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CONNECTTON FEES (SUrTA',47 14OTFR DEVELOPMENT FE'E'S
j SE".WFR CUNNE:CT ION 2100 ,00 W6I'll R ('.)LIAL 'I T'Y 11`40 00
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F131", CREDIT' i.F30, 00
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WATER OLIANT C'T'Y 100 .00
LEGS' CREDIT 0. 00::'•
EROSION CnNTROL
INE:PEC'TION 40.00
FLAN CHT::CK 26 .00
SiU0Ti1 fill.. 2100 .00 iiJP101 fal... 166 . 00
TO'I nl 2266 0
APrI.. NAME RAY 11Fi0(:;K i'11+1tlf.:: ....__ ...._... _......_ ...._-._
IA1'J(Jt1 REP
REMARK!) PRO.) 1939 LOT 211
X24 HoF� ,FROSIO .01'TF<0l ] N";F>E("'I '.r.CINS RFOUIRE'T
SIGNAIAIRL IS',?MED BY CUNNIN113HOM
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Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. When calling
for an inspc:tion, please ref:r to the Permit Number. The Permit expires one hundred eighty (180) jays from the date of
issuance. The total amount paid (permit fee, connection charge, line tap fee end/or other charge) will be forfeited if the
permit expires.
The Agency does not guarantee the accuracy of the location of side sewer lr.terals. If the sewer is not locited at the
measurement given, the inste ler shell prospect three feet in all directru;: from the distancegiven. If not so located, the
installer shall purchase a *Tap and Side Sewer" Permit at the current charge and the Agency will install a lateral.
6/90 WHITE — USA, BLUE — Accounting, GREEN —Inspection, YELLOW — customer
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CITYOF TIFARD
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COMMUNITY DEVELOPMENT CEPARTMENT 4a7LkMASTER P1vliT
w, Pl.,
13125 BW Hmil Blvd. P.O.Fax 23397,Tlpwd.Orr., 97223(603)639.4176 i c. T #f. . i�I',i T
39_'-417'1 GATE: ISSUED.
u1 rL f4jDrtE_Ci`G: . . : 1666,+ 5W JORDAN W'r PARCEL ' A:`�11C�f1Ti k+r L�:
SUSD I V L 51 UN. . . . : LtE;:171 (Jr2D IiLI N ��j'n5 �',' �/ ZON I NC=
QLOLK. . . . . . . . . . . LOO.. . . . . . . . . . . . . :,-,&
_ ..._. ...._.___._._......._....,_._.._.._.___._.._._.....___........._.. BUILllING _..__... ._._._.._.._W_..�. ____._....._.__..__,..__._._.___ ......._.
r2L•:1 SSUI--:10,21'92-0063 UWE:t_L I N UN 17 5. 1. BfaSr�IhEs IV'1". . . . . . . . 101 ,f
CLASS OF WORK. -NEW 8EDHIr1G j 3 D. 1"F1':3:c: GARAGE. . . . . . . . . . t
TYPE: Of USE. . . :SF FL00P i-_1I::LH:a RE QU i RL'D
i'YPE Or CONST. :50 FIRST. . . . : 1sf LEFT. . :5 'ft RIGHT. :5 ft �
OCCUPANCY GNP. :f`3 SECOND. . . :0+ s t. FRO,\11'. ft RE: ;R. . : 15 ft
S1ORIE:S. . . . . . . a1 THIRD. . . . :0 S REUUIREll__.. ..___...._.__.,...M__....
IiG T GH•1.. . . . . . . „ : 1 7 f C0 AL_ : 1 GE4 s,f SMOKE lilts i GC T'OR5- -Y a
'LOUR LOAD. . . , :40 F.sf' VALUE:. . . . . 5 a 93390 PARR ING SPALE:Ei. . : 1
S1NKS. . . . . . . . . . . I FLOOR DRA i NS. . . . :Q, HAC_;Kr LUW PRE:VNTRS. . .0
LAVATOP x E.S. . . . . :3 WATE=R HLATE:RG. . . z1 I RAPS. . . . . . . . . . . . . . :o
rUB/SHOWERS. . . . .3 LAUNDRY I"RAYS. . . -0 CATCH 1s4:31114S. . . . . . . trig
WATER CLOSETS. . 92 SLWIE R i_1 NL (ft ) . 0 Z73RyASE:: TRAPS. . . . . . . :0
DI.Si, 1ASHERS. . . . : 1 WP_jE ? LIN (ft ) . : 100 OTHER FIX1UNE'_-;. . . . . ..r0 I
GARBAGE 1)1SP. . . : 1 '%'AIN DRAIN (ft ) . O
WASHING MACH,. . . : 1 Sr.` RAIN DRA1Na,
_. ._,_.._.._.. _._.___....._ ME:CHAI,,'I CAE _._._,_..___._... ..._._...._._._" ...._......_.._._.__....,.,_ ...._......-• 6'EEaa ..__._ _.._._._.__._..
r''UE-l_ TYF'L.,., _..__..___ __.--'_-_.. i'llI' f1'1'I�a. . :0 type .amcrt.tnt by r:iate r^er_pt
/GAS/ ! J VENTS . . . . . tO BPRT $ 41S. 00 JH 1c/ 8/'fir::
rt INPUT -.0' t BPLL" `k 40. 00 ,7E_H lc/.10/r3c yi
(.r�X 1NF'U . � E+'TU VF'IVT h-F�lhl:�. , w
BURN ( 100K . . t 1 HOC)DS. . . . . . .. I EA5PC 'r :O. 75 JH 12/Z8/9iR
:`L,1101 ) -114014 . . :0 W(*1C)IaL,3TLJV 3. .0 01113Cl $ .3,5. 00 JH 1a 9��: �
FLOUR is URN. . . . a it CLU DRYERS. e 1 IriPR 1' r 40. 50 JH 1 r /28 9c
i+CJII_/C�P11 ' ( :::;;-IF':0 0 H i E f U114IT'r1: 1 VIPLE. b iVl. l;i -
UASCiUTLLt'JS: i iim,_PC; w'. 03 JH 12/26/98
Owner-: _. .. -{ 'F'IRT h i.'rc:. S�Zi JH1t'f,/9%
BEACON HOMES P5PC 6. 63 JH 12/,28/9&
:
F'O BOX 1368 BNLC 15. 00 .''11 14111121•/92
BEAVERTON OR 97075
Pjk)une i#: 5 .4--199`.)
C;orrtt-ac:tat-: _____..__.... _._....._...___ _._.._.._.. .._. ...__._....._ ._._.__
T:EA'.','Ohl HOMES.
PO BOX 1368
13EAvl:'.R 1 tJN UP 97075,
r>hune #: 524- 1991)
11.7. '54• 1 ]'TESL
This permit ,.s issued subject to the regulations contained in the --" - REUU1RL'•:E) INSPECTIONS ---
Tigard Municipal Code, State of Ore, Specialty Codes and all other r loot/trr'.ttid Insp Fit-epimce insp
applicable laws. All worth will be none in accordance with approved lost/E:tearn :3tr'urZ, Gas Line Insp
plan,. This permit will expire if work is not started within 188 Past/E•teani Mechan Insulation Insp
days of issuance, or if work is suspended for more *,,an 168 days. Pim/t.tnd s i Gala Insp Gy P Boa t r3 Insp
PL!1/Unrfer•f1urr^ Rain detain Inst
Mechanetwal. Insp Hatet• Line InsF°
61_�1t.,mb Top 01_it Aper,/bdW1k 111so
Tss � <<ri Eby : �' r ami.nit Insp, iLa1, I final
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C11YOF T167ARD
COMMUNITY DEVELOPMENT DEPARTMENT CITYCIFi16ARD MAF,ER PERMITr►rtEooN /1 PERMIT #. . . . , , , ; hIST92-O�sO1 ' •13126 SW Hrll 8W. P.O.Boot 23397,TOW,Orpar 97223(5031639.4176
DATE ISSUED: 1.:/28/ 32
SI FE ADDRESS. . . : .-1.a4iF?''SW JORDAN WY PARCEL: ES116AD-SED29
SUBDIVISION. . . . : BEDFORD GLEN ZS' 1'ON 1 114G:
LOT. . . . . . . . . . . . . 7'
BUILDING
RE ISSUE:MS,TJ2-0063 DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 s f I
CLASS OF' WORK. :NEW BE:DRI.IS:3 BA,'HS t 2 GARAGE. . . . . . . . . . :527 S f
TYPE OF USE. . . :SF FLOOR AREAS------______ REQUIRED SETBACKG-
TYPE OF CONST. :5N FIRST. . . . .. 1824 sf LEFT. . :5 ft RIGHT. :5 ft
OCCUPANCY OF, . :R3 SECOND. . . :0 sf FRONT. :20 ft KFAR. . : 13 f h
STORIES. . . . . . . : 1 THIRD. , . . :0 sf REQUIRED--- --------_______.._-_-
HETuHT. . . . . . . . : 17 ft TOTAL------: 1824 sf SMOKE DETECTORS. 1Y
FLOUR LOAD. . . . :40 p s f VALUE. . . . . $ : 93590 PARKING SPACES. . -. 1 �
j Remarks : PATH I
-.-__--_---- PLUMBING - --- ---________•______.__._______,__.._...._......_
SINKS. . . . . . . . . . . I FLOOR DRAINS. . . . :0 BACKFLOW PHEVNTR8. . :0
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . .0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :E SEWER LINE (ft) . :0 GREASE -TRAPS. . . . . . . ..0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 1 'h0 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . % I RA114 DRAIN (ft) . :O
WASHING MACH. „ : 1 SF RAIN DRAINS— : 1
__.___._._•_.-_---__ MECHANICAL ---______ _ ___ ___ _______.._.__.___..___ FEES
FUEL TYPES------------- UNIT' HTRS. . :0 type amar_rrlt by date recpt
/137AS/ / / VENTS . . . . . : BPRT $ 415. 00 JH 12/28/92 -
MAX INPUT:0 BTU VENT FANS. . :" BPLC $ 40. it ,JLH 12/10/92 92--
FURIA ( 1O0K . . : 1 HOODS. . . . . . : BSPC 4 20. 75 JH 12/28/92 —
FURN ) =100K . . :0 WOODSTOVEa. . 011 S." i. 35. 00 JH 12/28/92 _
FLOOR FURN. . . . :0 CLO DRYL: 1 MPRT $ 40. 50 JH 12/28/92 -
FOIL/CMP ( 3HP:0 OTHER UN 'S: 1 HPLC 4. 10. 13 JH 12/28/9,R
_.______GAS�OU ' 1 MSPC $ 2. 03 JH 12/28/9.2' -
Owner: - --___._._.___ -• -P•PRT $ 132. 50 JH 12/28/92 -
BEACON HOMES P'SPC $ 6. 63 JH 12/PA/92 -
PO BOX 1368 � BPLC $ 1 -
� 5. 00 JH ir*/�8/9c
BE:AVEI—oN OR 97075
Phone #: 524-1999 I�
Contractor:
BEACOIJ HOMES
PO BOX 1368
I
BE=AVERTON OR 97075
Phene #: 524•-1999
Reg #. . . 70782
$ 717. 54 TOTAL
This perm is issued subject to the regulations contained in the --- - - REQUIRED INSPECTIONS -------
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/f mid Insp F'irep Iar..e Insp
applicable laws. All work will be done in accordance with approved Post/Beam Struct Ge,s Line Insp
plans. This pernit will expire if work is not started within 180 Post/Beam Mechan Insulation Insp
days of issuance, or if work is suspenued for sore th 180 days. Plm/undslab Insp Gyp Board Insp
PLM/Underflcor Rain drain Insp
Permittee ':; ignat�_rr Er : Mechanical 1.nsp Water- Line Insp
Plumb Top Or.rt Appr/Sdw) k Insp
1 s s r_r e ci D Y �_. _ ........._._. Framing Insp Mechanical Final
Call for inspection 639-4175
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1]125 SW Hall DI-1 PLNCK/RECT #
CITY OF TIOA RD ''0°°`2"97 PERMIT # In D /
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Oregon 97M
(S03)639-4171 DATE ISSUED
JOB ADDRESS: 37 1(/�`�`C��� ������ — TAX MAP/LOTS
SUB: LOT: 2C� LAND USE:
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VALUATION:
OWNER SPECIAL NOTES
NAME: aA f l ` �� [;— REISSUE OF: _
ADDRESS: Fb 1r�o)� LAST REISSUE:
1'.4(0 U�llr- Zlgl (7y- C1 IFLOOD PLAIN/
PHONE: 6m OtSENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: _ L� �� — EXP DATE:
i '' I ITEMS REQUIRED
SUBCONTRACTOR")'. PLUMB: y!.V , Y UY� � LIST/SUBCONTRACTORS:
MECH: — ty CL) Itom _ BUS TAX:
RCH ENGINEER CALCULATIONS: _
NAME: rZ,T_ (-ki1i
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AMOUNT AMOUNT PD. BAL. DUE !.
PERMIT # ACCI # DESCRIPTION Jam/
Ms z-u3uL 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees —
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (519 —2 1,�1,� — =
Building o• �� f
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Plumbing (3
Mechanical o? 0 3 .
10-433 00 Plans Check Fee -- —
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Building
Plumbing /�,
Mechanical U
10-230 06 Fire — -- —
30-202. 00 Sewer Connection -- --- — —
30-441 00 Sewer Inspection 3 jam, ---- —3-)
I 25-448-02 Commercial TIF Fees _ —
25-448-04 Industrial TIF Fees _--
2.5-448-06 Institutional TIF Fees — —
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25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees _ — —
52-449 00 Parks System Dev Charge (PDC) --
31-450 00 Storm Drainage Syst Dev CFS;-,
(SSDC) --- -- f'
24-445--01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) — — —�=—
TOTAL
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nm/3587P.WPF
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CITY OF T I GARD — RECEIPT PT OF PAYMENT F?!:r'CE:.T PIT NO.. :9; -,2,&r-,t4l
HAMitiCHECK AMOUNT s 677'. 54 I
a bF ACgN F�fJIHF. ; AMOUNTO
C�ARI-i . to t
�1C�11RE iF3 a PAYMENT DATE
SURDI V IS 101-4
1 '
PURAOSC` OF I�AYMENT P110UNT PA I D PURPOSE OF PAYMENT AMOUNT PAID
=F
IE I LD I Nf3 'CORMPLUMBING
41.Vii. 00 P 1_UMB I NG 'ERM — 132. so
ME:CHAN I CAL. Por. 40. 50 ST. BUILD PFR
1-'I.,AN CHECK F E 41
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..,. 13 FWER INSPECT 35. 00
1_01' 29 BEDFORD GLEN
12937 RW ORDAY WAY
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TOTAL AMOUNT PO I D _ - ) 677. 54
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