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BUILDING PERMITAPPLICAI'ION TIGARD DATE_-
THE.UNDERSIGNED HEREBY APPI IE`:FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN Th' ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE
LOT,NQ. -
0%' TER JOB ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS _ DESIGNC
STRUCTURE ❑ NEW ❑ REMODEL In ADDITION ❑ REPAIR ❑ RENEWAL FIRE DAMAGE ❑ DEMOLITION
L1-RESIDENCE ❑ COMM ❑ EDUCATIONAL GOWT FJ RELIGIOUS D PATIO l ] :AR PORT ❑ GARAGE ❑ STORAGE D SLAT B �FE14CE
OCCUPANCY .�__' _LAND USE ZONE _. ? •T—BLDG.TYPE _ "FIRE ZONE _FLAN CHECK BY __` '" HEAT
t Lwo ;tory �a�l !lti i.c�r� k '� S1r1 Tlr� 3::;1Iy tlirs t.
SEWER PERMIT# --
OCC.LOAD _ "I.00R LOAD_ HEIGHT NO.STORIES _ AREA Nu.BEDROOMS VALUE
BUILDING DEP!RTMENT SETBACKS FRONT —� REAR.' '.. LEFT SIDE_ RIGHT SIDE
Permit THIP PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
— RE4aJLATIONS AND ALL APPLICABLE CODES AND ORDINANCES., AND IT IS HEREBY AGREED THAT THE
Pip Check _ WJRK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
— — Wild ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal ' pcc?RIC FIVE COVENANTS. Ci1NTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
—^ LICENSE SSPARATE PEI,MITS rSOUIRED FOR SEWER.PLUMBING AND HEATING.
State Tax « '
— •-- SDC--
Total
DG-.Total
PDC# APPLIGANI OR AGENT
Receipt No. ADDRESS PHONE
Approved -- — -
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough-in
4me—
Fixture
e_--" Final
HEATING
Contractor
Permit No.
Gas or Oil
,q Rough-in
Fills:
SEWER
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curl)&Street Final
Approach
BLDG.Dim FINAL TEMPORARY CERTIFICATE OCXLFPANCY
CERTIFICATE OCCUr-AW:Y [Final
Latidscapmc,
zoning Faml
AcrJRESS_ Ut"� J�U �ia.Kl�tlt PERMIT NO. 1
PERMIT CHARGE none
OWNER
CONNECTION FEE 4" • `-
PAID BY Lam
TYPE OF BUILDING �1 �►r *e�t � DATE CONNECTED
SERVICE RATE. 1,114� INSPECTION FEE
CONTRACTOR � PAID BY DATE a'
I'1IZE Of' Cot"VECTION ASSESSMENT PAID
, I r
CITY OF TIGARD
ORDINANCE 11-77-26
WRFET SYSTEM DEVELOPMENT CHARGE
DATE : ESTIMATED SALES PRICE ,.---. ---
APPLICANT NAME f'' ,' �, riµ�, C I � _`iELEPHQNE
JOB ADDRESS ,f �- �/? c= Ot SLOG. PERMI r #1
AMOUNT OF EEE FOR S. D. C .
DESCRIPTION OF IMPROVEMENT rJ
EXEMPTIIJNJ -PER ORDIVANCF r=77-26
FEE HATES:
A. Single 'amity dwellir; unit under $60,090.--------- $300.00
B. Single family dwgl!1ng unit over 360,070.------- �1TI-O _M'
C. Mobile Home Court Spree (Now DevelopmenQ-------- - �1SO.00
D. Multi-F, mily Owe'l; ngs--per unit--------------------- $240.00
E . Commercial , Industr..' al & Institutional (Park. Space) a 50.00 each
F. Single family unit under 540, 000. ----------------•-- 4c'j250. 00
CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE.
DATE : ���� I7� ESTIMATED SALE i PRICE $_[J��-,_;a
APPLICANT NAMF �/ ���) R_ 1,cTELEPHONE #
J0E3 ADDRESS -ICI, ��+ �+- (` BLDG. PERMIT #
AMOUNT OF FEE FOR P. D. C. /Op
DESCR1P110N OF IMPROVEMENT
EXEMPTION; - P1.R URDINANCE #77-71
FEE RATES:
A. Single family dwelling unit under $40,000. -------------$ 75. 00
Q. Single Family dwelling unit over $40,000----------------$100. 00
C. Mobile Home Court Space (New Development)--------------- 50. 00
D. Multi-Family dwellings--per unit-•------- ---- 60. 00
CONSTRUCTION IS LOCATED ON N.W. SIDE OF S.W. PACIFIC
HIGHWAY. N.W . is Park District #I . S.E is Park District #II .
A
1ITY
BUILDING PERMIT APPLICATION coF Ti IGARD DATE_ '1 -30"?0 —. 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WOaK HEREIN INDICATED BUILDER PHONEY'�I ^
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO. y }
OWNER ;i JOB ADDRESS 'HOME ADDRESS 0A
ARCHITECT ) 1{i)S'037
ENGINEER
BUILDER 11Ys ADDRESS -., DESIGNER
STRUCTURE KONEW ❑REMODEL QADDITION ❑F&PAIRL]RENEWAL _ ❑FIRE DAMAGE_ ❑DEMOLITION
u RESIDENCE L-ICOMM ❑EDUCATIONAL ❑GOV'T 1_1RELIGIOUS❑PA110 ❑CAR PORT ❑GARAGE ❑STORAG[[_1SL.AB [:]FENCE
OBOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑ r
COUNCIL APPROVED _ IJSIGNS
3
OCCUPANCY LAND USE ZONE- BLDG.TYPE_ FIRE ZONL PLAN CHECK BV__ LFL! -_ HEAT FJb
cofo.it, eillylla frmily Liwelll.t11,i ti/sti,ached gasaWe 4 Dedruam 3 b8th '
11 T2�5. Rs`1Q. .PI. _ ___ --- :tic lt�e 4411
UCC.�ono.__.__.�1,Q4RLQAtL.--- — - 1€Lca►�T__._ 4---_ NO•g1S2�1 :i _-__E1RE.F� 21.67 NQ 9kQn4.Mz.._�_YAI.Uh�'-" •_1
BUILDINC DEPARTMENT SET BACKS FRONT _ 2 - REAR 1_` LEI_T SIDE RIGHT SIDE
Permit 195,30
7HIS PERMIT IS 'SSt.IED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 911.50 REGULATIONS AILD ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
- WORK WILL HE DONE IN ACCORDANCE WITH THr PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total 292.50 ALL APpI_ICAR!.E CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENAIJTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS,
State Tax 7•t�CI L.16fNGE. SEP.4tt/d�E,PERMITS REQUIRED FOR SEINE PLIJMB%NG AND HEATING.
..r• , LI •
Total _ 3 0 U 10 #2 $100.
By
APPI ICANT QR AGrN1
Approved ,61 I tiecelpt Na, i
J AESS
�,,..�u--, .ya+w,u....r.. .u,.,,W�n.;a.�i.•..�nreM'tr�w....ickasA+t.AM��A'A'kd'•W. '•u..r rw++9uwi�a,.:n..1+nceo4..�,w,;.
+� eoD ew nr .ez es e� a�
DATE (v� INSP. TYPE INSPECTION REMARKS PLUM((b.NG ')ATE
T
t actor ,VL�J 41
U✓IMit No.
Rough-in---- — ---
Fixture ---
0N1 Final_ __ --- —
e ,�� �— —_— HEATING _
Contractor
'c`" _ic79lcCt — Permit No.
Gas or Oil
SEWER
L Final ldeX4 l ) z 7
r` DRIVEWAY
i Final - --
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
_ A broach -------
BLDG DEPT. FINAL — TEMPORARY CERTIFICATE OCCUPANCY ----
CERTIF ICATF OCCUPANCY Final —
La�dscaping
Zoning Final
— I
eer et aver we eae
T;;7/fi�7u �C0
SEINER r[:HMIT NY 15837
Unified Sews-age Agency
of Washingtcn County C TTY OF Tigard DATE 5-30-7B
OWNER: Kor, Rar -1 �4 PFONE : _
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
x>❑x '8L TLDiNG SEWER ❑ BUILDING SEWER Ai\,D SIDE SEWER
TYPE OF OCCUPANCY:
4DYNEW x>0>sIiiG`E FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
ADDRESS OF STRUCTURE :
PERMIT CONDITIONS: THE APPLICANT AGREES TO COM,'LY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGF AGENCY. V:HEN CALt_?NG FOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FDRFEITED SHOULD
EXPIRATION OCCUR.
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE 600. Z) _ 1
SIDE SEWER INSTALLATION !f u js,w
ISSUED BY
OTHER
TPTAL $ 62.5.
L), ..
- (///Y/? �,/-
APPLICANT � ' DATE
NOTIrDE: 1. n,irs of r,!E
A90VE FATE, Sr: !Eiil 3 V ;
Ctlr!JGti R'?lll. BECI', F9II THISSEWER PERMITN`•' 15837 I
Y�,►r � lea .
ADDRESS OF STRUCTURE gRRr �t,l r h�.. �
TAX MAP — TAX 1.OT _ SYSTEM fanno creek
LOT _ 1q BLOCK OF
APPROVED BY r DATE IS'UED BY DATE
D. U . ' S _� 1 REMARKS bldg.#1909
"'' N t'LRMiT APPLICATION `IT TIG,'�RD DATE—C$ _ S -__, t,� Nn �� " 9
- JIL_DI G /^1 �y �{
'tr ONDI REIGNED HERS 9Y APPLIES F OR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE__f j—( !PS
OWNER PHO�E
;,�R A5 5HUWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. --
LOT NO.�_ -I
`woe ADDRESSARCHITECT
--!%)—rR Emss
_ ENGINEER
tFl �S lL/V�IJ_w ADDRESS_ _�_f�{ '- DESIGNER A , QLC�
-1C."URE NEW 0 R MODEL ❑ADDITION ❑REPAIR URENEWAL ❑E IRE DAMAGE CIDEMOL64 ITION
'DI`NCE ❑ MMM ❑EDUCATIONAL 0GOV'T ORELIf,IOUSOPAT10 ❑CARPORT IlJGARAGE ❑STORAGFOSLAB C]FFNCE
]FOND ❑MOVING []CONDITIONAL USE OdESIGNREVIEW QCOUNCILAPPROVED []SIGNS -
F NCY ANE
USEZONE -_'= _6LDG.TYPE .. -FIRE ZONE -.PLAN CHECK BY�._ - HEAT ? _
r
AAA
_ AUILDING DEPARTMENT SET BACKS FRONT bREAR- l �IEFT SI RIGHT SIDE
elmlt,� v ---�—
IHIS PERMIT IS ISSUED SUBJE�( TO THE RFGULATIONS CONTAINED IN THE BUILDING CODE, 20NInu
Plan Check 7 REGULAT'ONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMP'.IANCE WITH
Sub—total � ' ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT GOES NOT WAIVE
RESTRICTIVF COVENANTS, CONTRACTOR AND SUB CONTROCTORS T) HAVE CURRENT CITY BUSINESS
',we Tax LICENSE SEPARATE PE RMITS REOUIPED FOR SEWER, PLUMBING AND HEATING.
Total - Q �f-I- = /
by __ _-E't�-_ __�__ ----_`-_�_.__-• -- ---.� __
APPI it ANI 0. AGENT
App,c,ved 1/f/ , ;',eceipl No
-^�---" PHONE
dOw
J moi`'
to
C? PC,mit SLOP
City of (lat
c lical Vcrllit NW►
Fee----
Nevv 1ns,,,i1!;inoFi ✓`�Re:)!ace Ej Relocation ❑ Addition state--*
TOTAL
Cl:%,FRACTOR
ADr)RESS WORK ADDRESS '/ ?'(f
PHnNE APPLIC.ANT
Huai Inout Rating (BTU Per Noir) Vent Size Flue Size.
al.1% 01L EJ GAS ELECT E) OTHER
ITEM NO. FEE ITEM NO. F
For Issuance of Permit, 3 0 Air Condition Compressor 15 to 30 HP
10
New- UndF. 100,P00 BTU W04.00 Air Handling 10,000 CFM
New- 100,000 BTU &over 5.00 _Air Handling Over 10.000 CFM 5
Floor Fu- 4.00
Furnace Evaporative Cooler 3
Nail - Floor - Suspended 4.00 Range Vent Fan 2.
Install Vents On'- 2.00 Vent System
Repair • H-ea I & L jc_l_,n_g
4.00 Hoo
Commercial 3
Air Condition Compressor Under 3 HP
Commercial Duct System
Air Condition Compressor 3 to 15 HP 7.50
INSPECTOR'S COMMENTS
CITY bUS!NESS LICENSE REQUIRED FOR ALL CONTRACTORS OR 1A)S CCATRACTORS
D
APPROVED BY DATE ISSU'_-: BY
DATE
RECEIPT NO.
BUILDING PERMIT APPLICATION TIGARD DATE
THE UNDERsiG?.ED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BLIILDER PHON: _
ORAS SHOWN AND APPROVED IN THE ACCOMPANYING PIANS AND SPECIFICATIONS. o',".NEP Pi10iiE�z�'�7 9cf�S_�
LO T N O.
0104NERc-]l�f.� .� .4, JOBADDRF.SS S71r3
ARCHITE-T
ENGINEER
BUILDER ,,- ADDRESS DESIGNER
muC.i Unit ❑ NEW ❑ REMODEL _ADDITION _❑_ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE 0 DEMOLITION
RESIDENCE C COMM ❑ EDUCATIONAL ❑ GOWT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT Cl GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
Cri,C.uPANCY :k.r',LANG USEZ?ONE �. _ BLDG.TYPE __.FIRE ZUN�t.AN CHECK BY ! _ HEATS'%'_'
.'�/A✓.a�...L.L.4: �� _�.1 - I� C7�'i`/ /S1 i�Y,-,t .i - `i A.1 - _ I Au
•
SEWER PERMIT N _
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES A AREA -- -/,2 NO. qEB DRDR OMF VAL Ura c-I ` 'v
BUILDING DEPARTMENT SETBACKS FRONT REAR ";' ''LEFT SICE RIGHT SIDE
Permit -3 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATiONS CONTAINED IN THE BUILDING CGDE, ZOil:�IG
r� 3 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HERE-?Y AGREED TEAT THE
Play Check WORK WILL BE DONE IN ACCOP.CANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PSRPAIT DOES NOT WAI%'t
Suh total , RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CU9P.Z iT CITY R'J51NESS
LICENSE SEPARATE PERMITS AEOUTAED FOR SEWER,PLUMBING AND HEATING.
State Tax /
SOC
total k-
110;#
-
110.8 APPLICANT OR AGENT —"By _
R::fl+pt No.
Approved ADDREFIS PHONE
SDC -
DOC -
3EWER CCNNECT� Nzll
:�EWEn INSPECT $
- - i
SEWER Su RCLARGE `�$