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CITY OF TIGARD tJccl.jr-Aw"r
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223+8199 (603)639.4171
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15 7 J-
.6 SW .JORT)fa1V !J`r 'ON T tVG
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I'► ` [VI;1.'r.1:J1V» » » LkE;'DE"ORD GLEN e
Or..CUPANCY GRP-
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t LpmAr1.5A Peith .1 r'dhl4sf'?.: -0190
ovinor e
t iw Fit:C1�l f I!! 1E''..ti INC.
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} EAE;OVE. RT ON CIR ':i;t+`6i 75
Phone #I 5L,14-1999
BEACON HuPff".11
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PO 1rLIX 13E.,01
E3EAVU' TON 171?
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1'hraTiR�
',%:`.14- 1990
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the c;:amp!, i.sA1iC'e H1i.t:hi th7n� .;t rat ie C:11= tJrF*ycin 1-7�+c:1:�] t , 1::uei�+ for P'h r,]r^t
1 crr;r°c.iEa�>nryh r,Altci I.ihe under whic=h the 'c feta_-its eci permit %.qAs i.s��it.trcla
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INSPECTIO�i NOTICE•
City of Tigard Building Department /
13125 8R Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Phones 639-4175 Business Phoned` 39-4171 �
Inspectlons__
Footing Plbg. Underslab Hoch. Rough-in Appr/Sd:Ylk
Found. Plbg. Top Out Can Line FINAL:
Post/Beam Struct. San. Sewer i'raming -Bldg. 4
Post/Beam Hoch. Rain Drain Insulation -plumb. 1
Plbg. Underfloor wrter Line Gyp. Bd. Awh.
DAtu Hequ.,teds „ �/-7 Times All PM
Address: Permit #:
Rullders _
THE FOLL4DWING CORRECTIONS ARE REQUIRED:
fil
Inspecto
APPROVED 7ISAPPROVED APPROVED SURJ'tCT TO ABOVE
call For Reinsp.
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City of Tigard Building Departeent
13125 RW Ball Blvd. Tiger.%, Oregon 97223
Inspection L'ne (Rec-O-Phons)i 63°-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underslat Hoch. Rough-in Appr/Sdwlk
f
pound. Plbg. Top Out Gas Line FINALS
Post/SePA Struct. San. Server Framing -Bldg.
post/Ream
?moi
Post/Beam Nech. Rain Drain Insulationumn• )
Plbg. underfloor P7ator Line Gyp. Nd.
Date Requesteds -� ---T ime. AM PH
SSSS � r l L.1 Permit t' L
Builder:
TER FOLLOWING COL ECTIONS ARE REQUIRED'
E17XC
� I{
Inspector' . __ Dates
APPROVED DISAPPROV'PH/ 11PPROVED SUBJECT 1V ABOVE
_Call For Reinsp.
i
mYiINSPECTION NOTICE
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,t Cty of Tigard Bildg Department
, ,Fr i
13125 SW Bail Blvd. Tigard, Oregon 97223
Vk r inspection Line (Rec-o-Phone)s 639-4175 Business IN e: 4171
Inspections 1 (� Q �A(.✓^"..,._...=
Footing Plbg. Underslab Much. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line "INAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet./Beam Mech. Rain Drain Insulation .-Plumb.
Plbg. s:nderfioor Water Line Gyp. Bd. -Mech.
Date Rew7stede`� z-I ( � G l'�- Timet AM
Addreees Permit #o,72
Builders ' l 1VYV�P� i
THE FOLLOWING CORREC"ONS ARE REQUIREDs Y
'ry
j
Inspector: — ---- ----Date: ' �-�
_—APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Reinap.
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INSPECTION N,ITICE
City of Tigard 3uildi-isg De^rP"tll
13125 SM Hall. Blvd. Tigard, Oregon 9722
4:
( , Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
p Inspection: _—�-
root ia Plbg. Underelab MFch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out jag Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
4
Poet/Beam Mach. Rain Drain Insulavlon -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mec` '
AM PM
DateR queatedP.ddrs n" t
�j) Permit
Builder:
a
L
THE FOLLOWINU CORRECTIONS ARE REQUIRED:
— s
14
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,
4
IVV
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InepeCtO!
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
It1.
_Call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Depar went
yv�t 13325 Sq Ball Blvd. Tigard, Oregon 972236?.
Inspection Line (Rec-O-Phone): 639-4175 Business Phone Q-4171
Inspection:
Footing Plbq. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plog. Top Out Gas Line FINAL:
Pr.st/Beam Struct. Sar.. Sewer Framing -Bldg.
Poet/Beam Mach. Rein Train Insulation -Plumb.
Pltg. Underfloor Hater Line � Gyp. Bd.J Mech.
Date Requed d: /-� L
�— w
��� Times _�AM PM
Addzeae: . t} -- '� �. � Time
It �
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Bu Llder: �J _---
■
THE vOLLOWING CORRECTIONS-ARE REQUIRED: I
tnnpectorS
Date,!--
APPROVED
ate:APPROVED DISAPPROVED APPROVED
SUBJECT TO ABOVE
I
_Call For Rainsp.
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P INSPECTION NOTICE 1
City of Tigard Building Department
y 13125 sM Hall. Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 6'19-4175 Bueinese Phone: 639-4171
M ' Inspection: _-__-
Footing Plbg. Underelab Mech. Rouqh-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Crain Insulation` -Plumb. }
Plbg. Underfloor Water Line Garp. Bd. -M h.
7 r"J
Date Requee p (� �`� V- /C� _— Time: AM _PM
Address:_ /�(` C L3 �- �% --(�if /�� /�� n?fes
Permit
TH t FOLLOWING CORREC','Tr ;S ARE REQUIRED:
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Inspector: Gy
Data:_
APPROVED DISAPPROVED - APPROVED SUBJECT TO ABOVE
Call For Reinep.
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INSPECTION NOTICE /
city of Tigard Building Departe:ent
s 6 13125 BW Ball Blvd. Tigard, Oregon 9722
Iropection Line (Rec-O-Phone): 639-4175 Buoineou Phon 639-4171
Inspect ion: �— ----------
4
Footing Plbg. Underelab / rh. Roujh-in Appr/Sdwlk
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Wound. Plbg. Top Out G+.r Line FINAL:
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Poet/Beam Struct. San. Sewer ing ) -Bldg.
1-1,!Boam Hoch. Rain Drain Insulation
Plbg. Underfloor Nater Line Gyp. Bd. -Hech. '
Date Re este Tima: — AH PM
Address. .Permit #: j �•�—
Buildnr:— ■
THE FOLLOWING CORRECTIONS AftZ F.EQUIRED:
�.�-... 1.
P:
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Inspector: __YYi4 __---- Date: Z
APPROVED DISAPILOVED APPROVED SUBJECT TO ABOVE
Call For Reinop.
"
Nl SPECTION NOTICE
City of Tigard Building Departoent t kt�ir1S��it'
,� 13125 SR 8x11 Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineae Phone: 639-4171
Inspection:
r,
+ v `• , ', Footing Plbg. Underelab �jchLRough-in Pppr/SdwlkRil
FINALSPound. Plbg. Top Out ine x 1�t} r
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Pont/Beam Struct. Sar. Sewer raminy -Bldg. F ptP1";
Poet Beam Mech. Rain Drain n:iu ation -Plumb. cr'iT
/ a A7�.,.,• q
-Mach. '
Plbg. Underfloor Water Line Gyp. Bd. } „a
�.L L./ Permit f:
PM a
Date Re wets : ` Timer 1
Address: �
Builder: -
THF, -LI.OWING CORRECTIONS ARE REQUIREJ:
i
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ry-+1p�t�r�r�li u P r
Inspectors _ Date: CJ
APPROVED ISAPPROVED APPROVED SUBJECT TO ABOVE
Vt d( t + r f
4Pt�' Call For Reinep. R,�
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INSPECTION NOTICE
City of Tigard Building Department '
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Yhone): 639-4175 Business Phone: 639-4771
c
Inspection:__ _ —
�'
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwl.k
Found. ` 1. Top Out Gas Line FINAL:
Poet/Beam "tract. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech. e'er
r1
Date T. quested: f �� -�1/ _ Time: _ — _AM —�_PM .
J�72
Address: lJ �/ permit /:
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Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectorx1 >L//
�/—APPROVED DISAPTROVED APPROVED SUBJECT TO ABOVE
} Call For Reinap. ?"fi
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IN PECTION HCYfI-CE
City of Tigard Building
Department
1312` SW Ball Blvd. Tigard, Oregon 97223 1
Inepecti.on Line (Rec-O-Phone): 639-4175 Business
Phon4 _ 1
Inepeccion:__—.— --- — —
��
Footing Plbg. Underelab /�u'�� R'augh-in PPr/Sdwlk
Found. Plbg. Top Out Gas Line
FINAL:
0
__ .
r:ming -Bldg. .
F It/Ream Struct. San. Sewer
Ines '.ation -Plumb.
,t/Beam Mech. Rain Drain p
Plbg. Underfloor Water Line Gyp. Bd.
-Mech.
�� 7 -`! Z Times AM ----PM
Date Requests s —
Address: II /
Lk) grmit 1:
t�.
Builder:
THE FOLLOWING CORRECTIom ARE REQUIRED:
/moi 12*2
P
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--
-O-
R � �
Inepecs ter: _ -- DatesJL
.
_LAPPROVvD llISAPPAOVED PPROVED SUBJECT TO ABOVE
C. 11 For Reinep.
INSPECTION NOTICF_
City of Tigard Building DepartmOr. r7
13125 sm Hall Blvd. Tigard, Oregon 9722)
Inspection Line (Rec-O-Prone): 639-43.75 euaimeee Pho1rC 639-4 1
Inspection*_---- ----_ `—� '
i
i1 is
Footing Plbg. Underelab Mech. Rough-in P,ppr/Sdwlk
r
r
Fo:rod. Plbg. Top Out Gan Line FINAL:
P e£IBeam St.,jt. ` San. Sewer Framing -Bldg.
—� Rain Drain Insulation -plumb. i
Plbq. Underfloor Water Line Gyp. Bd. -Hech. a,
/D _ -4_� _
Date Requested: Time
Addraee:_'G ��` dey.�., / Aj Permit
Builder:
THE FOLLOWING CORRECTIONS ART REQUIRED:
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yy
Ineperto — — — �— Dater
r APPROVED DISAPPROVED APPPOVED SUBJECT TO ABOVE
—— i
_Call For Reir ep.
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INSPECTION NOTICE
City of Tigard Building Department
13125 Sit 6a11 Blvd. Tigard, :)regun 47223
E
Inspection Line (Rec-O-Phone): 639-4175 &osineas Phone: 639-4171
Inspection:
Footing Plbq. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lin, FI'..^L:
Post/Beam Struct. San. Sewer. Framing -Bldg. )
Poet/Beam Mech. Rain Draln Insulation -Plumb.
Ffbq. UnderfloorWater Line G
yp. Bd. -Hach. •
Date Reque ed: l' _Times AM PM
Addreses ,
Permit #t
Builder: �
ik
THE FOLLOWING OORPECTIONS NAE REQUIRED: -
f�f
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Lsapector: //_
APPROVED DISAPPROVE:' APPROVED SUBJECT TO ABOVE �' a'•
T CPi.l For Reins.p. ht['�I=
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INSPECTION NOTICE
rr� City of Tigard Building Departrnt
13125 W Ball Blvd. Tigard, Oregon 97223 a
Inspection Lira (Ree-O-Phone)t 639-4175 Business Phoney 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/S:wlk
Found. Plbg. Top Out Gan Line FINAL:
Port/Beam Struct. -ban. Aiwa!^. Fr.ming -Bldg.
Post/Beam Mech. Rain rairy- Insulation --plumb.-
Plbg. Underfloor �Ma•��r Lina. Gyp. Bd. -Meeh. :`ru
Date Requs ads O' - Titsas /� AAM PM
', r7ST j%Z- O/ 7/
-A. �^ i.'. /a n/ Permit M:
Address: _
�y •
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
I
Inspector:, --_ ,-- Date
I APPROVED 01SKPPROVED APPROVED StMiECT TO ABOVE
Call rui kelnal,.
ti
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INSPECTTON NOTICE
City of Tigard Building Department
13126 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)e 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbq.
Underslab Mech. Rough-ir. Appr,'Sdwlk
1r�nA_ Plbg. Top Out Gas Line FIY%L:
f
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -plumb.
Plbq. Undarlloor Water Lin Gyp. Bd. -Hoch.
/C 1 tel_ _Timet AM ._ PH
Date Requested _ l ---
Address:_ ^- c� ��i" �" Permit Y s
F
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Builders
THE FOLLOWING CORRECTIONS ARE REQU.RED:
1r.
•MI.
,
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Inspector: i y` Detaz
APPROVED DISAPPROVED APPROVED SUBJFCT TO ABOVE
Cell For Reinsp.
4
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C17YOFTIFARD OF RD hIAS7ER F'ERIhIT
j COMMUNITY DEVELOPMENT DEPARTMENT MOM PERMIT #. . . . . . . . MST'-)2---O t
13125 8W H@1161od.P.O.8-23397,TIONd,Orpon 77273 lel 830 4175
I I E T 3, JE IS I k 5
J&7 2� PARCEL: cS 1 16AD-BED 12
SITE ADDRESS. . . : 1r.--► SW JORDAN WY ZONING:
SUBDIVISION. . . . 9 BEDFORD GLEN
BL.00K. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1
Y BUILDINGREISSUE:-_.____..__._.__._.___.__•-•-DWELLING UNITS: 1 BASE IAENT,. . . . . . . . :0 s f
CLASS OF WORK. :NEW BEDRIvI3:3 LATHS:2 GARAGE. . . . . . . . . . .411 s f
TYPE OF USE. . . :SF FLGOR ARFFIa --_._..__ ____ R1.:.G?UI RED SETBACKS- -_ _ -
TYEE OF DONST. :5N FIRST. . . . : 1557 sf LEFT'. . :` ft RIGHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . :O sf FRONT. :20 ft REAR. - : 15 ft
�
STORIES. . . . . . . : 1 TFI I RU. . . . :0 s f F2EG?IJ I
_ f
HEIGHT. . . . . . . . : 13 ft TOTAL--- --; 155"7 s SMOKE DETECTORS. : " '
FLOOR LOAD. . . . :40 psf VALUE. . . . . : 79020 PARKING SPACES. . : 1
Remarks: Path 1 Reissi.re of MST92-0190
-------------------------------------
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACI'FLC1W PRE'JIVTRS. . :0 �
LAVAIOR1 ES. . . . . ..2 WATER HEATE.RS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. -0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. - t2 SEWER LINE (ft ) . :0 GRE=ASE TRAPS- . . . . . . . :0
DISHWASHERS. . . . A 1 WATER LINE (ft ) - ; x.00 OTHER FIXTURES. . . . . .0
GARBAGE DISF'. . . : 1 RAIN DRAIN (ft ) . ,0
WASH I NG hIACH. . . : 1 SF RAIN DRAINS- - ' I ___
•------------- MECHANICAL --__-___-- - - -----_--_-_- -- - - FEES ---�_- _--__
UNIT HTR5. . :0 type amol-rnt by date r'ecPt
FUEL TYPES--------_--___ -
/GAS/ / / VENTS . . . . . :0 B5PC $ 18. 65 JH 10/05/92
hIAX INPUT :0 LATU VENT FANS. . :3 1v1PRT `F 36. 00 JH 10/05/92 -
FURN ( 10Q1K . . : I HOODS. . . . . . . 1 M5PC $ 1. 80 JH 10/05/92 -
FURN > =100K . . :0 WOODSTOVES. :0 PPRT $ 117. 50. JH 10/05/92 -
FLOOR T=URN. . . . :0 CI.-(j DRYERS. : 1 P5PC $ 5. 88 JH 10/05/92 -
BO'IL/CMP ( 3F'IF':0 OTHER UNI TS:Q1 hIISG $ 35. 00 JH 10/05/92
!,. GAS OUTLETS:2 BPLL $ 40. 00 BCR 08/25/92 -
BF'RT $ 373. 0171 JH 10/05/92
Owner: -___........____.__.__.__..._..._..__.__..__._____ ,
MFLC 4 9. 00 JH 1'?�/05i9�= -
° BEACON HOI+..-S, INC.
PO BOX 1368
BE:AVERTON OR 972075
Phone #: 52.4- 1999
Lontractor;
BEACON HOMES
PO BOX 1368
BE*IAVERTON OR 97075
Phone #: 524--1999
Reg #. . 7078:::'.
L 6.:,6. 83 TO"TF;L
This pervit is issued subject to the regulations contained in the --- - -- REQUIRED INSPECTIONS --"_._.-........
Tigard Municipal Code, State of Ore. Specialty Godes and all ctler Foat/found Insp Fireplace Insp
applicable laws. All work will be done in accordance with approred Post/Beam Str-uct Gas Line Insp
plans. This permit will expiry if work is not started wi hin 180 Post/Beam hlechan Insi.rlation Insp
days of issuance, or if work is suspended ` are tha 80 ays. Plm/Unwielab Insp Gyp Board Insp
E=LM/Unr.Jerfloor Rain drain Insp
permittee Si nature : ___ __ Mechanical Insp Water Line Insp
F111-rmb Top 01st Appr/Sdw1k Insp
Issi-ted By : _ ____ __--�___--_ Framing Insp Mechanical Final
Call far inspection 639-•4175
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3c` 894 '1297 CITY OF TIGARI1.
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CIOF TI �.I*.D »izs sw Hai etia. PL yCK/RECT Y Z
.,. ,I, i ro9oxzu9� PERMIT i� „ �%S Ty
f' COMMUNITY DEVELOPMENT DEPARIMRNT TIpt4Ormpa97U3
a"171 DATE ISSUED n`
7
JOB ADDRESS: _71*_ Sw Jordan Way TAX MAP/LOT
SUB: hedfoid GlenLOT: Z— _ LAND USE: _
VALUATION: me
�ldE$ SPECIAL NOTES
4 NAME: :_ Beacon Hanes, Inc. REISSUE OF:
ADDRESS: _ , 0, Box 1368 LAST REISSUE:
Beaverton, Ore. 97075
FLOOD PLAIN/
PHONE: �-1 92 _ Fax 524-1998 SENSITIVE LAND: '
i
CONTRACTOR APPROVALS REDUIRED
NAME: s-ar_or► Hollies, Inc. PLANNING:
ADDRESS: P, a_ Box 1368 ENGINEERING:
Lleaverton, Oregon 97075 FIRE DEPT:
PHONE: 524-1999 OTHER:
CONTR. BOARD N: 70782 EXP DATE: 12-ciz �
ITEMS IEOUIRED
i SUBCQN RACTORS: PLUMB: Value Plumbing LIST/SUBCONTRACTORS:
MECH: wgha 9uali v Heating BUS TAX: _
ARCH/_ENGINEER CALCULATIONS: ,
NAME: nanipl V. smith Design Associates _ TRUSS DETAILS•
i ADDRESS: _p. 0. Box 219284 OTHER:
Portla! d Oregon 97225-9264
1 PHONE: 292-9583
PROPOSED BLDG. USE: I .6t1�2-J-tCk_ C�
COMMENTS:
APP CANT SIGNATURE,/--
Received
IGNAT REReceived 8 - j 7
Y ta.-< Date Received:
Jr,
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees 7 _
I
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) —
2-3
Building
Plumbing _5 d a
Mechanical
10-433 00 Plans Check Fee y0 9
Building
Plumbing
Mechanical _
10-230 06 Fire — —
30-202 00 Sewer Connection
30-444 00 Sek-er Inspection S
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
25-448-05 Mass Transit TJ Fees
52-469 00 Parks System Dev Charge (PDC) _
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) _
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL y T7 Jr 9� 3
nm/3587P.WPF
• a
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i�� .r,:e�tg,:Y nlr,1MY,Ttf" M. 11NYrawWMd�^n^.n �
�111r.......a.h1F li [tRl:M�I�Ib.
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13175 SW►fall BNa. PLNCK/RECT #
Box
ciCITY- Poof TIGAR TigarQOrc9reg-97 1 PERMIT #
COMMIJNIW DEVELOPMENT DEPARTMENT (503)6394-4171171 _
DATE ISSUED
TAX NEAP/LOT
JOB ADDRESS: _
_— -
_ LAND USE:
SUB: LOT:
VALUATION:
c_ aFr.IAL NOTES •
,WL. —
REISSUE OF:
NAME.
A --- —
LAST REISSUE:
ADDRESS:
FLOOD PLAIN/
SENSITIVE LAND:
PHONE:
PPP ROVALS REQUIRED
CONTRACTOR
PLANNING:
NAME:
ENGINEERING:
ADDRESS:
FIkE DEPS: —
OTHER:
PHONE:
CONTR. BOARD #: — EXP DATE: -
rr ITEMS REQUIRE
SUBCONTRA PLUMB: _
LIST/SUBCONTRACTORS:
MECH: BUS TAX:
CALCULATIONS:
ARCH ENGINEER
TRUSS DETAILS:
NAME:
OTHER: —
ADDRESS:
PHONE:
PROPOSED BLDG. USE:
COMMENTS: _ --
APPLICANT SIGNATURE
Received By: Date Received:
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CI'T'Y OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO, s92-2.; 2384
Clif-I. ,3
'K AMOUNT s 596. 8
NAME:. : BE=ACTIN HOMES, INC CASH AMOUNT : 0. 00
ADDRESS s 190:= NW 169TH PAYME=NT DATE s 10/05/92'
BEAVE RTON, OR SUBDIVISION A
PUPP13SE; OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AhIOUNT PAIL;
BUILDING PERM �MST9 O--0191 � 373. 00E.PUMt;I NCi F'E RM�w _�__ ,__�... 117. 50
MECHANICAL PE 36. 00 ST. BUILD PER 26. '33
PLAN CHUCK FE 9. 00 SEW'.:R INSPECT 35. 00 1
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TOTAL AMOUNT PAID 596. 83
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441
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SANITARY• D
s®W®r$gaWAFER IT
SURFACE
• ,., �, 0i Suite 270,HlNsbord,Or.,97124 ,
603 648-8621 ,.
CONNECTION F1RMIT
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PERM
Ii' 103270 i
ISSUIMID fi 0 592 EXPIRATION DA'Z'E 4U393 PROJLG'I 1908
ST'RUP'T.Jj1t AI!,URESB 1-258716`721
STRUG'�f AX tiW JOR�JAN WAY L0T 1-1-71D BLOCK
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0.4 0 L L N NU - 1
TYR ;" QN. N C�; fll." 'NFiv 1
TYPE xN$1' IONi114,)' BLD SWR/ER LCu/S1C {'
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�'r t 1 > 3INf3LE FAMILY PAkf;, 231 16 AD 24600
7YR,E OCCUPAN Y QT,F SEC 4716 MH 180:. I
OWNER BEAtb ING ' .,.,t, NT DURHAM
N, 169 H P�.ACE �a� ATM NT ':
tB AVE 1`CI `'; ,. ��4i1R 17006
JUkISU-IIUFhAM
£
� ...,..,......, ., .___. RESIDENTIAL
FIXTURE EQUIVALENT DWELLING
SERVICE: UNITS 0.0 UNITS 1 FSERVICk UNITS
4
,'CSNN ICON, FEES SURE ACE WATER DLVELUPME N'f F LES
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i' WATER QUALITY 1"0 .00
py r; LESS CREDIT 180-00'
WATLR QUANTITY 100 -00
LESS CREDIT < 0.00'.
EROSION CONTROL
INSF'ECTION 40 -00
PLFiN CHECK 26 ,00
SUBTOTAL1i 0.00 bUB[UTAL 166 .00
;'"' TUnnTAL 160 .00
APPL NAME PETER KUYSK PHINL
AFFILLIAT,ION'.VP I
REMARKS PRO'i01908-BEDFURD GLEN-LO.1• # 12
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1k24 HOUR NOTICE FOR LRU'3 N CONTROL INSPELi1UNS REQUIRED I '
• 'i'I�' ,hy .!` 1� LlEL1 FiY 7N(1M!'S_f1t1.1�1
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Pernit" tonditionst" The applicant glees to comply with all rules and regulations of the Unified Sewerage Agency. When calling
for, an'inspection, please refer to the Permit Number. The Permit expires one hundred eighty (180) days from the date of
issuance. '-The total amount paid (permit fee, connection charge, line tap fee and/or other charge) will be forfeited if the
permit expires.
TheAgency does' not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at the
measurement' iven, the installer shell prospect three feet in all directions from the distance given. If not so located, the
insta11,00 aha1. pui.thase a`Tap and Side Sewer" Permit at the current charge and the Agency will install a lateral.
WHITE - USA, BLUE - Accounting, GREEN -Inspection, YCLLOW - customer
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