10741 SW NORTH DAKOTA STREET ukw�WIMwM'.wW�fi � YYJi'J1Y�WMF':YJI�IiWNWl�ifiYYWW� 'v:�M'�N�+'wNt�.41w w:MM6J.Y4'�b1�M1Y�1rY�Yl' ..
r
10741 SW NORTh DAKCTA STREET
CUrTIFICATE OF
OCCUPANCY
�'�OFTIFARD PERMIT *. . . . . . . i 1viST)J.
C"OF"mrm
COMMUNITY DEVELOPMENTDgkOAFENT OATE ISSUEDc 07/31/'�P
13125 SW Hall 8W. P.O.Box 23397.Tigaml,Omogon 97-, j(bW)&,&4175
I I L (40D(R(19G. I 12T747i-7-; N7M71 I iZa PARCEL: 151.34DR-ND12
SURD I V I S I ON. . . . li MLPI)1 000'—' ON I NG
DOCK. . . . . . . . . . c LOT. . . . . . . . . . . . . 12
CLASS OF W(JRK. eNEW
tYPL OF USE. . . c BF
OCCUPANCY GPP. ,R-3
OCCUPANCY LOAD: 116 4
TENANT NAME— :
Romal-kaz
Owner;
FrRNWOOD DEVELOPMENT, ING.
7600 SW ELMWOOD ST
PORTLAND OR 97823
Phrmp *1 244.-1,'--'33
Lorotroutor-A
FERNWOOD Df--'''ELOPMENT, INC.
7600 SW EL.MWOOD ST
PORTLAND OR 97223
Phone Mc 244-1~33
Popq #. 49P'16
(joctipamc.'y of thp abavr, referenced bUilding IS hereby PiVell), And Certifies
the c-ompliance wii-h the State Of Oreyon Specialty Godes for thc3 gv-,I'Ap,
ocrupancy,, and under which thp refprenced permit 1,pafs irisjuad.
F'IRE DePARTMENT Bu DING PspFL Tf,
PU I L 1)1 N6�F i C I Al-
POST IN CM19PICUOU3 PLACE
,LNSPECTION NO`rICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4115 Business Phone: 639-4171 �
Inspection: ---- — - ..- ------- -- -
i
looting Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Gas Line FINAL:
Post/Beam St_rnct.. San. Sewer Framing -
Bldg.
Post/Beam Mech. Rain Drain Insulation
Plbg. Underfloor Water Line Gyp. Bd. -M
Cate Requested: - 2— Timet __AM �PM
Address:- /0 ,/ Permit it`�'
Builder:_`
THE FOLLOWING CORRECTIONS ARE REQUIRED: e
r �
cod
Ae
Inspectort Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
-----Call For Reinsp.
INSPECTON NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
inspection Line (Rec-o-Phi : 639-4175 Business Phone: 639-4171
Inapectiont
Fcx:tingPlbq. eralab Mech. Rough-in Appr/Sdalk
Found. Plbg. Top out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation G�
Plbg. Underfloor Nater Line Gyp. Rd. -Mech.
Date RecTieated: _Timet �^ AM —1 PM
Addreaa: Permit
Builder: /JIr/A�71L�'I J �4/4-1
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1�le,1� 19P��Lkll[�� AV' kc Lv Q ✓
eC__V]()ezL� Q 44L 4,1 L '1. S41l61b4a , 1)yl ld era
Inspector: L. Date: -7 L3Z:
--APPROVED DIEAP APPROVED SUBJECT TO ABOVE
Call !or Reinan.
INSPECTION NOTICE -
City of Tigard Building Department
13125 SW Ball B rd. Tigard, Oregon 97223
Inspection Line (Rec-O-Pho e)s 6?9,4175 &ininess Phone: 639-4171
Inspect ion s --------- _-----e\-
looting Plbg. derslab Mech. Rough-in App r/S -
Found. Plbg /Top Out Cas Line FINAL:
Post/Beam struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation --Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date nequenteds I- Times AMMJ PH
Addrees s Permit #i
Buildert_ /'--
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Act 1�0,r r Y v
el
� 45fo -tet u t V� .
Inspectors__ . Date:
_APPROVED DISAPP VED " APPROVED SUBJECT TO ABOVP,
all For Reinsp.
Ztis-PEM ON_NCTICE f
city of T19ard Rodding DePartmOnt
13125 SW Ball Blvd. Tigard, oregun 97221
Inspection Line (Roc--O-Phone): 639-4175 Business Phone: 6.39-4171
Inspectlon:_,�---- — ------ — -- - - - --_ __
Footing Plby. Urderslab Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top Out One Line FINALz
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requeeted:_�'�2y'f)D��— — Time: AM �PN
Addresses /tJ-7 /� ��� Permit ie
Builders_ ��1Z/i/Z�7Zx�� -
THE FOLLOWING COMMONS MR RRQUIRED:
i
e ti
InepectCre � ,� Date--
—_
�►pPIUVRD DISAPPROVED APPROVED SUBJECT T(I ABOVE
call For Peinep.
e� ra
Jl
xNS mmol NOTICE
City of. Tigard Bulldlnq DOP@rts'e97227
13125 SM Ball Blvd. Tigard, orego
Inepec
tion Line (Rec-O-P Phone: 639-4171
*)r 639-4175 �,ueines°
Inspection:_-_ -— .-�
rooting plbg. ''.derslab mech. Rough-in
pppc/Sdwlk
Pound. Plbq• Top Out
Gas Line FINAL:
Framing -Bldg.
Poet/Beam Strutt. an. sewer
poet/nOam Hoch. Rain Drain
Insulation -Plumb.
Flbq. underfloor Nater Lino Gyp. Bd.
-Meth.
Time: � AM —PH
Dat@ Requested: �---- -
Z�
pddr@ss:
(� Permit f ._
Bu i l.dec: -'7 ,_..
TAE FOLLOWING CORRECTIONS ARE REQUIRED,
Dater�_�
Inspector:-1 �-�-
APPROVED DIF goVED APP'AMD SUBJECT TO ABOVE
k11 For Aeinsp.
�L,��CTION IiOTICE
City of Tigard Building Department
13125 SM Hall Blvd. Tigard, Shegon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171.
Inspect ion: __ — ---
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwl.k
Found. Plbg. Top 0,,t Gas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mer_h. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line tlyp. Bd. --Hoch.
'tate Requested: ` Times ///^ AM PM
AAdreess_ D —T Permit #:L 1
Buil.der:
_�� —�_-- —
TIiF. FOLLOWlNG 00RRECTI01.4 ARE REWIRED:
7 L
Inspector:___ ' �-,/ _---- Date:
//-
APPROVED DISAPPROVED APPROVED SUB.IRCT TO ABOVE
Call For Reinnp.
ME MIR
�sccioN NOTICE.
City of Tigard a l.ldiog Department
13125 SM Hall Blvd- Tigard, OrS910
n 97223
inspection Line (ReC-o-/P`hoonn�e))l 639-4175 Susineen Phone: 639-4171
Inepections,_�=
Mesh. Rough-in Appr/Sdvllk
Tooting Plbg. Underslab
Gas Line FINAL'
Found. Plbg. Top Out �1\
/
Poet/Beam Struct, San. Sealer amin
Poet/Beam Hach. Rain Drain
Insulation -Plumb.
Gyp. Bd. -Mach.
plbq. Underfloor water Lina -
r / }— _-'f ime s ___./� PM
Date Requset�dt �f�-
_ Permit
Address'
Builders
THE FOLLOWING CORRRCPIONS ARE RICQUIREDI -
001.
r
APPROVED DIsAP/P�ROVED APPROVED SUBJECT TO ABOVE
y Call For Reinep.
zN$p�_�'TION NcYI)<CE
City of Tigard Building Department
133.25 SW Ball Blvd. Tigard, Oregoc, 97223
Inopection Line (Rec-O-Phone): 639-4175 Businoos Phone: 639-4171
Footing Plbg. Undernlab Hech. Rough-in Appr/Sdwlk
Pound. Plbg. Top out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Pram 9 1 -Bldg.
Post/Ream Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh.
Bate Requested:-� G 7�1Z' Tim6� _PN
Addreen: 2w � l _ Permit M ,�1
Builder:-
THE FOLLOWING CORM-TIONS ARE REQUIRED:
i
IT
.coir c�:-,�-t.a✓-
Inspectors Date:-
-APPROVED DISAPPROVED APPROVED SUBJECT TO ARMS
. Call Por Reinap.
A
i
NI SPEC ION NOTICE L Y
City of Tigard Nnildiag Depasrtrant.
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (ROC-O),kone)s 639-4175 Business Phonar 639-4171
Inspections__
Footlnq
r1bg,
Underslab Nech. Rough-in Appr/Sdwlk
Gas Line } FINALS
Found. . Top Out ( ,_, -
Pont/Beam Struct. San. Sewer
Framing -Bldg.
Poet/Beam MOCK. Rain Drain
Insulation -Plumb.
Plbg. Underfloor LWater Line Gyp. Bd.
-Neth.
C'> __Timet AM
Date Requentedt� Z
- 1 Permit 1�
Address,
Bullders
THE FOLLOWING CORRECTIONS Ah F. REQUIRED!
�� Date s �'— 1- r'— L•
Inspectors
APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
A
I_.N5PSCT 9N- NOTICE
City of Tigard Building Depart went
13125 SW gall Blvd. Tigard, Oregon 97223
Inspection Lino (ROC-O-Phone)e 639-4175 Business Phone: 639-4171
Inspect loll:
Footing Plbg. Undermlab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out can Line FINAL:
Post/Berm Sj:ruct• San. Sewer Framing -Bldg.
g
Posc/Beam Moch• Rain Drain Insulation -Plumb.
Y�umb.
Plbq. Underfloor Nater Line
/ Gyp. Bd. -Meeh.
Data Requested: `� / "" _YTime: �_AM
J � PN
Address;
Permit 1:_
Builder'
TNM FOLLOWIUO OORRECTIONS ARE kEQUIRFD: 1
J
Inspectors 1111�- _ Datel
;!L _APPROVtD DISAPPROVED _ APPFAYM 5UWRC, TO ADM
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Be Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Bueinens Phone: 639-4171
I napect ion x _._ _—_.�__ —
Footing Plbq. Underslah Mech. Rough-in Appr./Sdwl.k
Found. Plbg. Top out Gas Line FINAL:
poyET-Beam Struct. San. Sewer Framing -Bldg.
�--�—=
Post/Beam Mach. Rain Drain Ineulatlon -Plumb.
Plbq. Ilndorfloor Nates Line Gyp. Rd.
Date Requested:,._.'3 __Timet
Address: G' 7L�/ Permit It'
Buiidert
THE rot4ANIRG CORRECTIONS ARE RRQUIRED:
Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
I,
woo
IpISPEC"ION NOTICi~
City of Tigard Building Depart-lent
13.125 SW :fall Blvd. Tigard, Gregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business phone: 639•-4171
Inopectioat -_.�._ -- - -—•
Tooting pl,q. Underslab Mech. Rough-in Appr/Sdwlk
PeLend, "ex-rV-' Plbg. Top Out Gfe Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Koch.
Date Requested:
-�i
Addreent � /J �Pstmit #s
Builders_2jr/
THE FOLLOWING CORRECTIONS ARE RS-9UIREDs
Date:___ /
APPROVED DISAPPROVED APPROVED SUR.IEOT TO ABOVE
Call For Reinsp.
6
s
i
s
S
ON
city of Tigard build tog Department
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 635-4171
inepections _--_-------------
Tooting Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Round. Plbg. Top out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lina Gyp. Bd. -Hoch.
Date Raquesteds ----
Times AM-fr�YM
Address:- Permit
/i: T
Builder: /,�i/1L..�--�'7 {�,
i
THE FOLLOWING cop-mcTIONs ARE RBQUIRRDs
r
I
AsInspertors Dates_ �� l_-
APPROVED DISAPPROVED APPROVED SUBJECT TO ABDVE
Call For Rainsp.
I
I
CITY OF TIC ARD — RECEIPT OF PAYMENT RECE:I PT NO. o 9 —2?R 533 �
CHECK AMOUNT 8729. "58 j
ratahlf a FERNWOOD DEVE:LOPMEN1 CASH AMCIUNT 0. 00 �
OUDRESS a PAYME:Nf DATA: t 01 /28/W �
SiUAD I.V I S I ON �
L-1-J12POSE OF PAYMENT AMOUN1 PA T PURPOSE OF PAYMENT AMOUNT PAID
I
B111;:..DINr PERM :382.04A PLUMBING PERM 117. 50
MELHANIC4L PE (l. 00 ST. BUILD PER 26. 76
i PLAN C'HE'CK F-IF 7. 30 RESIDENTIAL * RAFF I C FEES 1280" 'Be
MASS TPANSIT TIF FEES too. 00 PAWS snc 500. V
: TORM GRA I V4 SDC 280. 00
i
i
I
h 10141 SW NORTIA DAKOTA i
1 1
IMP[, AMOUNT PAID F729. 158 �
i
j
MASTER PERMIT
CIIYOFTIFARD CnYOFTM T #. . . . . . . : MST91-0L-.'5j2
COMMUNITY DEVELOPMENT DEPARTMENT osteon 27
13125 SW HWl Blvd. P.O.Box 23397,TkpW,Oregon 9723 1600)8D94175 r)ATE ISESUED: 01/i-046/92
SITE (-ADDRESS. . . 10741 SW NORTH DAKOTP ST PARCEL: 1S134DA--1\JD,-..
5UBDIVISION. . . . ML.P91-0005 ZONING:
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . ....
S'-1ILDING
REISSUE:MST90-0335 DWELLING UNITS: I BASEMENT. . . . . . . . :0 s
CILASS OF WORK. :NEW BEDRMS:3 SATHS:2 GARAGE. . . . . . . . . . :445 Sf
TYPE OF USE. . . :GF FLOOR REQUIRED SETBACKS------
TYPE OF CONST. %5N FIRST. . . . -. 1630 Sf LEFT. . : 10 ft RIGHT. zll ft
OCCUPANCY GRP. :R3 SECOND. . . :0 s FRONT. .-37 Ft REAR. 35 ft
STORIES. . . . . . . . I TH I RD. . . . :0 5f RFOUI RED---
HEIGHT. . . . . . . . : 18 ft TOTAL----.- 1630 ';f SMOKE DETECTORS. :Y
FLOUR LOAD. . . . :40 osf VALUE. . . . . $ 92990 PARKING' SPACES. . -0
Remarks :
PLUMBING -------------------------------------
5 1 NKG. . . . . . . . . . .- 1
FLOOR DRAINS. . . . .0 BACKFLOWBACKFLOWPREVNTPc3. . :0
L(AVATORIEG. . . . . :2 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . -2 LAUNDRY TRAYS. . . :0 CATCH SAqINS. . . . . . . :0
WATER CLOSETS. . :2 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWAI;HERS. . . .. - 1 WATER LINE ( ft ) . : 100 OTHER F I X I'URES. . . . . :17.1
UARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . -O
WASHING MACH. . . : i bF PAIN DRAINS. . I
MECHANICAL FEES
FUEL. TYPES------ UNIT HTRS. . :0 type .=k m t:)i.,t n t b,,/ date V-ecpt
/UAS/ VENTS . . . . . :0 TIF $ 1380. 00 JLH 01/24/92
MAX INPUT:QA BTU VENT FANS— :3 RPPT $ 382. 00 JLH 0 1/2`4/9 iR
FURN < 100K . . : I HOODS. . . . . . : 1 SPLC $ 248. 30 JLH 01/24/92
FUPN . . :0 WOODSTOVFS. :0 D5f:'C t I'). 10 )LH 01/i24/92
FLOOR FURN. . . -0 CLO DRYER3. : 1 S S D C $ 280. 00 JLH 01 /24/92
BOIL/CMP ( 311P:0 OTHrR UNITS:0 PARK $ ' 00. 00 J1_ 1A 01/24/92'
GAS OUTLE=TS: 1 MPR',' $ 36. 00 JLH 01/24/92
Owr)Pr-: MPLC $ 9. 0111 JI-Ji 01 /24/92:
V'ERNWOOD DEVELOPMENT, INC. MEPC $ 1. 80 JLH 01/24/92
760(' SW ELMWOOD ST PPR I $ 117. 50 JLH 01 /24/92
P5PC $ 5. 88 JLH 01/24/92
1 'CJPI LOND OR 97223
Phone #: 244-1233
PERNWOOD DEVELOPMENT, INC.
761210 9W ELMWOOD ST
V)ORTLAND OR 97223
Phone #: J44-1233
Rep #. . - 49276
$ `979. 5A TOTAL
This persit is issued sub)ect to the regulations contained in the REQUIRED INSPECTIONS
- - -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/fni.ind Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved F-1c)st/lApam Stt-Lmt Gas Line Insp
plans. This verpit will expire if worP is not started within 180 Post/Beam Mechati 1r)s1_t16,tion Insp
days of issuance, or if work is suspendpd*4or tore than 180 days, Plm/i-tndslab Insp Gyp Board Insp
PLM/Under-fluor- Rain drain Insp
iWmittee Siui)ati.ti AI Mechanical Insp Water- Line Insp
Plumb Top Out Appt,/Sdwlk Insp
lsst.ted By . F-i,amiyiq Inc;p mpeflanif:al Final
C:al1 far ineq.)-ution 639-4175
,aTYOFTIFARD PLUMBING PERMIT--
COMMUNITY DEVELOPMENT DEPARTMENT �WYMCFMW Pr-RM(.1 #. . . . . . . '. Ma T"<)
13126,W HWI Blvd. P.O.BW 23W,TOW,Or@Fn 91 (603)6*4175 D(�TE ISSUED: 01 /27/92
SITE ADDRESS—, : 10741 SW NORTH DAKOTA ST PAPCEL: IS134DA--ND2
SUBDIVISION. . . . c MLP91-0005 ZONING:
SLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . ..2
CLASS OF WORIK. . sNEW GARBAGE D I SPOSALS. . i I
TYPE OF USE. . . . i SF WA'3H ING YIPICH" . . . . . . 11 BACKFLOW PREkjN"r'Rri. . -.0
OCCUPANCY GRP. . :R3 FLOOR DR1ING). . . . . . . :0 TRAPS. . . . . . . . . . . . . . .0
STOPIES. . . . . . . . : 1 WATER HEATERS. . . . . . : 1 CATCH BAS)INS. . . . . . . :0
F Ix LAUNDRY TRAYS. . . . . . :0 9F RAIN DRAINS. . . . . : 1
':SINKS. . . . . . . . . . 11 GREA5L TRAPS. . . . . . . :0
LQVATORIEG. . . . . 12 OTHER FIXTURL' i. . . . . :0
TUK/SHOWER5. . . - I, 1-3EWER I-I NE � ft ) . . -0
WATER CL05ETS. . :2 WATER LINE (ft ) , . - I00
D I ;I-IWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . 30
OWNER:
FERNWOOD DEVELOPMEN'T, INC. TIF 1380. 00 JLI-4 01/24/92
7600 SW ELMWOOD s'r PPRT t .1182. 00 JLH 411 /24/92
13PL-L -'='4(3. :0 JLH 01/24/92
PORTLAND OR 972,"M B5PC 1.*., Ila jj_14 01/24/9P.
0hono #.- 244--1233 S Sj DC 4 280. 00 JL0 01 t'24/9^'
PORK 4i 500.00 JLJ4 01/c4/92
P I u m b i p g. C o n t r-ac t o v, MP R T ll 36. 00 JL.H 01/24/92
MPLC $ 9. 00 JLH 01/1-,4/9P
Name z m5pc * 1. 80 JLH 01/24/-?2
Ad d t- s S P F.,R T 4, 117. 50 J I i i 01/,?4/92
C i t yState : p5pC Olt S8 JLH 01124192
Reg
REPU I RED I NSPECT I ONS
' his per-mit is issupd subject to the t-eg---
l.tiationt, contained in the TigAv-d Municipal F=oot/found Insp Rain di-aiyi Instl
Cocje, ,tate of ni-e. Specialty Codes and all Post /Beam '-'Itt-uct W,-Atei- Line 1;,s p
ottievapplivanle laws. All work will he done Post /beem Meehan Appy/GdAllk I n-p
in Ac:cav-1,4nr:e with appr,oved plans. This Plm/undsl4b Tnsp Mechanical Final
permit will ps(pive if viar1j, is not sLat-tt.,d PL.M/Linder,fluor- Plumb Final
t,jitj-)in 180 days of issuance, or- if I-jor,k is Mechanical In!:p Suildipq Final
'-d L - v-v I
Isp-erb nd for- more they, 180 dFYt-- Fll�imb Top 01-0 r-rosioi r"nt
Ft-Aming lrii!p Past /Beam Mechati
Fit-PlIDIAL.-e Ille:P P I m/Lin d P r f I o o r-
Gas Line lr,;p Cv-awl 1))-ain
In-1.11 At i C)n I nn l) Pli.tmbing Toll 1-?111
Gyp BoRt-d Insp Pluml..i Final
T I a.
T,13 o
Authorized Plumbi Aqnti atar Signature
Call for inspection 639-4175
C ontractor- Not e
SEWER CONNECTION
m 5 f 9 1.
�' � TIFARD PE R 111 T
COMMUNITY DEVELOPMENT DEPARTMENT
CffYOFT*ARD IJERMI,r #. . . . . . . : 5WR91 --0166
onem
13126 SW Hell Shfd. P.O.Box 23397,T19mid,Oregon 91226 0503�89pNAl 76 DATE ISSUED:
SITE ADDRESS. . . 10741 SW NORTH DAKOTA--ST —
SUBDIVISION. . . . . PARCEL: IS134DA—XXXXX
BLOCK. . , . _..... . . LOT. . . . . . . . . . . . . ZONING:
I ENANT NAME
USA NO. . , , , , , ,
CLASS OFIXTURE UNITS. . .
F WORK, :NEW
TYPE OF USE. . . . . :Sr:' DWELL I NG UN I TS.
INSTALL TYPE. . . . :BUSWR NO. OF LSU ILDINGS: 1
IMPERV SURFACE. . :
--- FEES -----------------
FERNWOOD DEVELOPMENT, INC.
8type amol.mt by date
150 SW MAPLELEAF* ST recpt
PRMT $ 1500- 00 BCR 07/30/91 21579QI
PORTLAND OR -97223 TNSP $ 35. 00 SCR 07/30/91 215790
,-fione #: 244--1233
Cont r-,?.rtor: ..................... ..
FERNWOOD DEVELOPMENT, INC.
f3150 SW MPPLELEPiF ST
IDORTLAND OR 972'23
F-110ne #: 244-1233
Reg #- . : 49276 1535- 00 TOTAL
This Applicant agrees to C01PIy wth all the rules and regulations REQUIRED INSPECTIONS
of the Unified Sewage Agency, The permit expires 120 days from Sewer Inspection
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals, IF the sewer is not located at the measurement
given, the installer shall Prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral,
By :
Call for- inspection 639-4175
A�- r .IS .1
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT NO. .91. 15790
CHECK AMOUNT - 1535. 00
NME s FERNWO131) DEVELOPMENT, INC CAq1i AMOUNT - 0. 00
BALI DMESFI : 8150 SW MAVILELFAF STREET PAYMENT VArE 07/29/91
SUB[)I V L 9 1 ON
PORT'LANT.), OP SEEn MLP 91-0005
Q
' 'URPOSE OF PAYMEN't' AMOUNT PAID PURPOSIC Ofi., PPIYMF617 AMOUNTPA I D
15001. oel SEWER INsrsm'
-D0000wo I-ow
o
/9
LOT BEHIND 10735 5. W. NORTH DAKOTA 9T.
tM'AL AMOUNT PAID 1535. 00
FERNWOOD DEV. INC.
7600 S W. ELIVWOOD S1.
PORTLAND, OR 97223
244-1233
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S.W. PACIFIC HWY. SUITE 302
OREGON 97223
3) 639-6116
N 89'50'51" E P'-'"-r vF
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