12450 SW NORTH DAKOTA STREET •w1iYWs+rInW�GMWiM�M4M .y..rw�.".ww..+l+fMwaa+J' .w+wu+rM.+ rwrrwWWaP++W..:rw+mwrawwsr�.wrM+:w.w.i..wnYe.+p»vtlw�wrww�wwWKM+Y
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12450 SW NORTH DAKO`T'A STREET __
F-7- CkRT1F'1CATL OF
CfTY
OCCUPANCY
OFTI R- D PERMIT It. . . . . . . a MST90--@P,,-*)8
1 r AWJ PRIM. PERMIT M. r MST9061498
COMMUP MY DEVELOPMENT DEPA' T DATE ISSUEDs 09/10/90
113125 SW Hall S.A. P.O.Box 23397.llqarrl,Orogm 97223(6W)M-41175
911E. AVDRV5'i. . . s I j-5.47W-SV--9T1T7TT_7AVUT_A__T)
SUBDIVISION. . . . t ANION PARK ZONING: R-7
BLOCK. . . . . . . . . . o LOT. . * . . . . .
CLASS OF." WORK. tNEW
TYPE OF USE. . . tS'F
OCCUPANCY GRP. eF3
OCCUPANCY LOADIV20 4
TENANT NAME. . . t
Romarkst
Owner -------------------------------------
AQUA-MARINE CONSTRUCTORS INC
P.O. BOX 69195
PORTLAND OR 97201
Phone O 503-241-8358
Contractors
AQUA-MARINE CONSTRUCTORS INC
' P.O. BOX 69195
VORTLAND OR 97291
Phone Na r;03-241-6358
R#nq 14. . s 41115
(jc,cuparwy of the above refetenced bLkildir)4 Is hereby given, and certiftes
the compliance with the !3)tAte Of Oregon Specialty Codes foo the 4TOLIP,
occupancy, and use itndpr which the refe-(,"riced permit was is%Lo.ed.
FIRE DEPARTMENT BUILDING 11HUR'61- 111-F
BL:f�4 N 113
POST IN CONSPICUOUS PLACE
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
/Phone: 639-4175
Type of Inspection =S�'f.1L�
Date Requested — / Time A.M. P.M.
ZZ
Address
f lc �i� Permit
'y
Owner _ _ Lot #_
BuilderThe following B ding Code deficiencies are required to be corrected:
�G
Presented to __ —. ___ l-Approved
Inspector Disapproved
Date — —
CALL FOR RFINSPF,CTIOP'
C1 YES � O
INSPECTION NOTICE
7 City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection n =_- 7 ='
E e Requasted_ �l� — Time A.M. P.M.
��qq
Aodress _.. _��5� _ Permit
Owner�717 _ _ Lot #
Builder ! 'r
The folly Building Code deficiencies are required to be corrected:
Ac
r:r�
('19
('o krrn C7—– 00 1t4 V1
AJ
Presented to "Approyed
Inspector �/ a U Disapprovers
Date _ v
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.U. Box 23397
Tigard, Oregon 97223
Phone 6639-4175
Type of Inspection
Date Requested--/ ime_ A.M. P.M..
Address Z Permit
Owner_ _ - _ - Lot #_
BuilderThe following Build "g ode deficiencies are required to be corrected:
Presented to Approved
InspectorAisapproved
Date _.+-7 _
CALL POR REINSPECTION
YES ❑ NO
HISTORY: VIEW UPDATE DELETE ESC
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6AMASTER (a &
• :MST90-0098: PROJECT:ANTON PARK STATUS:I UPD:08/07/° PERMITTEE:AQUA-MARINE CONSTRUCTORS INC PRIM. . :MST• SITE ADDRESS:12450 SW NORTH DAKOTA ST � T���RD
bA CASE HISTORY AA$$$A$AAAAAAA$$$$$$$$$$Req/SentfiSchd/Due$End/Done$$ 1;A707 Wtr Proofing Bsm't Walls / / EGON
A710 Post/Beam Insp 04/12/90 KA710 Post/Beam Insp 04/16/90 KA713 Crawl DrainA717 PLM/Underfloor 04/10/90 M
A718 Ftng Drain Bsm't Walls
A720 Mechanical Insp 05/24/90 TLP APP
A722 Plumb Top Out 05/21/90 MS FAIL o
° A722 Plumb Top Out 05/23/90 MS PASS
° A725 Framing Insp 05/21/90 TLP FAIL °
A726 Framing <REINSP> 05/24/90 TLP APP
° A730 Fireplace Insp
A735 Gas Line Insp 05/24/90 TLP APP
A740 Insulation Insp 05/29/90 KS APP °
A740 Insulation Insp 05/25/90 GS DIS °
AAAAAAfi$$$$$$A$$$A$A$a$AA5fi5fi$Afifin$AAAAAAAAfififiA$AAAaAAfififiA$b$AAAAAAA$$AAAfiAA$Ai
HISTORY: VIEW UPDATE DFLETE ESC
Delete selected .item
6AMASTER FERMITA$AAAA$A5A5AAAfiA$fiA$AAiAA$AAAAAAAAAAAAAAAASAAAA$fiAfifibAAAAAA.�Afififi
° :MST90-0098: PROJECT:ANTON PARK STATUS:I : UPD:08/07/90: :JLH: °
° PERMITTEE:AQUA-MARINE CONSTRUCTORS INC PRIM. . :MST90-0098: °
SITE ADDRESS:12450 SW NORTH DAKOTA ST °
OA CASE HISTORY AAAAA&bAAAAAAAAAfifiA$AGAAReq/Sent$Schd/DL1efiEnd/DonehARyfiStat$5AC
° A707 Wtr Proofing Bsm't Walls
A710 Post/Beam Insp 04/12/90 r:S UIS °
A710 Post/Beam Insp 04/16/90 KS APP
° A'113 Crawl Drain
° A717 PLM/Underfloor 04/10/90 MS PASS °
A718 Ftng Drain Bsm't Walls
A720 Mechanical_ Insp 05/,' 1/90 TLP APP °
A722 PlsmU Top Out 0r,; 11/90 MS FAIL
A722 Plumb Top Out 05/23/90 MS PASS
A725 Framing Insp 05/21/90 TLP FAIL °
A726 Framing <REINSP> 05/24/90 TLP APP
° A730 Fireplace Insp
A735 Gar. Line Insp 05/24/90 TLP APP °
A740 Insulation Insp 05/29/90 KS APP
A740 Insulation Inep 05/25/90 GS DIS °
bAbAAAAAAAfi$$$$AA$$A$$AbAAA.AAAAAA$AAAfi$$$$AEl$sSAAAAAAAAfifiAAfi$$AAAAAAAAAAAfififiAAbi
HISTORY: VIEW ►IPDATE DELETE ESC
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b$MASTF.R PERMITAAAAAAAASAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAA5AAAAAAAAfiAAAAAAC
• :MST90-0098: PROJECT:ANTON PARK STATUS- 1 : UPD:08/07/90,- :JLH: °
• PERMITiEE:AQUA-MARINE CONSTRUCTORS INC PRIM. . :MST90-0098:
• SITE ADDRESS: 12450 SW NORTH DAXOTA ST
bA CASE HISTORY A$3AAAAAAAAAS66AAAA:iAAAARec;/SentASchd/Due&End/DoneiiByAStatA$AC
Ai9'Y2�S�VI�Ih1t�BpGb?� t►s ?P934�,4igarc� i regon97223 (503)639-4171/--.----- ----
HISTORY: VIEW UPDATE DELETE ESC
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6&MASTER PERMIT&&&&&=+�.AAA&&AAA&&&&&AA&AAAA&&&&&&&&AAAA&AAA&&&AAA&&&AAAA AAAAC
:MST90-0098: PRUJECT:ANTON PARK STATUS:I : UPD:08/07/90:JLH: °
PERMITTEE:AQUA-MARINE CONSTRUCTORS INC PRIM. . :MST(APP
SITE ADDRESS:1245J SW NORTH DAKOTA ST
6A CASE HISTORY Abdh&hdhA&&&&A&A&&&AAAA&Req/Sent&Srhd/DueSEnd/Done&&
A722 Plumb Tor, Out 05/21/90 M Q"OFTIVARD
A722 Plumb 'iup Out 05/23/90 M
A725 Framing Insp 05/21/90 TREGt�N
A726 Framing <REINSP> 05/24/90 T
A730 Fireplace Insp
A735 Gas Line Inep 05/24/90 TA740 Insulation Insp 05/29/90 K _�
A740 Insulation Inep 05/25/90 GS DIS °
A745 Gyp Board Insp 06/05/90 KS APP °
A755 Rain drain Inep 04/11/90 MS PASS °
A760 Water L.ne Inep 07/20/90 MS PASS
A"165 Appr/Sdw1k Insp
A795 Mechanical Final
A797 Plumb Final 08/09/90 MS PASS °
A799 Building Final
&SAA&&&AASSAAAAA&&&&&A&AAA&ASSASSSSSSSAASSASSSSSAA&AAA&AS&&AAA&AAAASSA&ASA&SSSi
HISTORY: VIEW UPDATE DELETE ESC
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64MASTER PER NIT&AA&AASASA&SAAAAAAAAAAAA&AASASAAASA&&&&AAAA&&AAAAAS&SAS&SSAAAAAG
:MST90-00'18: PROJECT:ANTON PARK STATUS:1 UPD:08/07/90: :JLH:
PERMITTL,E:AQIJA-MARINE CONSTRUCTORS INC PRIM. . :MST90-0098:
SITE ADDRESS:12450 SW NORTH DAKOTA ST °
Cis CASE HISTORY AAA&SSSAa&AAS.ii&&h&&&AA&Req/Sent&Schd/Due&End/DoneS&ByAStataSaG
A722 Plumb Tap Out 05/21/90 MS FAIL, °
A722 Plumb Top Out 05/23/90 MS PASS °
A72.5 Framinq Insp 05/21/90 TLP FAIL
A726 Framing <REINSP> 05/24/90 TLP APP °
A730 Fireplace Insp
A735 Gas Line Insp 05/24/90 TLP APP
A740 Insulation Inep 05/29/90 KS AFP
° A740 Insulation Inep 05/25/90 GS DIS °
A745 Gyp Board Insp 06/05/90 KS APP
A755 Rain drain Insp 04/11/90 MS PASS °
A760 Water Line Insp 07/20/90 MS PASS "
A765 Appr/Sdw.lk Insp
A795 Mechanical Final
A797 Plumb Final 08/09/90 MS PASS
A799 Building Final
ASSSSSAA&AA&&&&&&&!4&AA&&ASSF�Ab55SAAASAAASA5555ASS&StiAAAAAAAA&AAA&&AAS&AAaSAASSi
HISTORY: VIEW UPDATE DELETE ESC
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64MASTER PERMITSAAAAAASAS&AAA&AASAAAAAAAAAAASa555555aSSSSAAAAAAAAAAaSSASAAAAAAC
:MST90--0098: PROJECT:ANTON PARK STATIIS:I : UPD:08/07/90: :JLH:
PERMITTEE:AQIIA-MARINE CONSTRUCTORS INC PRIM. . :NST90-0098: °
SITE ADDRESS:12450 SW NORTH DAKOTA ST °
6A CASE HISTORY 3bSAAAAAAAAAAAAAAAAAASAbReq/Sent&Schd/Due&End/Done&&By&Stati6AC
A722. Plumb Top Out 05/21/90 MS FAIL
A122. Plumb Top Out 05/23/90 MS PASS °
AI��+PIP'c Sox 23397,Tigard,Oregon 97223 (503)63v1.'A1/98 'FEP-SII --� ---
INSPECTION NOTICE ✓
City of Tigard Building Department j
! /
P.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
UL
Date Requested — e — lJ Time _ AN,--4 P.M.
Permit #`
Address 7, -e-1)I�
Owner__.. Lot #
_�—
The following Building Code deficiencies are required to tiq corrected:
_ 1
Presented to _ Approved
Inspector 4�z- l El Disapproved
Date
=Zs�-
CALL FOR REINSPECTION
1 YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department moi'
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection ._........_..._ Drywall Nailing
Date Requested - 6/5/90 Time XX A.M. P.M.
Address — 12450 North Dakota _ Permit # 90-0098
Owner_ Aqua Marine Const i _ Lot #
Builder ---
The following Building Code deficiencies are required to be corrected:
vam
Presented to Approved
Inspector Disapproved
Date &
CALL FOR REINSPECTION
YES ❑ NO
INSPECTION NOTICE ._
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 839-4175
Type of Inspection —�l
C "? ';
Date Requested _�_+��`f—7lJ-� Time A.W,, /
,
Address �a_V, Q *__. l�A Permit
Owner . __ _ _ Lot --
Builder _� ���-�1 z•
The followin Zlding Code deficiencies are required to be. corrected:
Presented to -__ _ Approved
Inspector _. �_� Disapproved
Date
CALL FOR REINSPECTION
El YES L-1 NO
INSPECTION NOTICE -
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection
Date Ret, iested s.—� -- Time A.M.__X P.M.
Address f _LL_ v --5.�=-- _—_.. Permit
Owner - — --- - ---- --- _ Lot #
Builder ---
The following Building Code deficiencies are required to be corrected:
Presented to / � __ -- _— Approved
Inspector " G� —.-_ -__—^_ isapproved
Date. --
CALL F�ORK�REINSPECTION
IP'rE3 Ll NO
INSPECTION NOTICE
City of Tigard Building Department
R.O. Box 23397
Tigard, Oregon 97223
hone: 6394175
u
Type of Inspection
Date RequestedTime__— A.M. —,Q/y—P.M. r/
Address L --,! —� Permit
Own _ _—_ _ Lot
The following Building Code deficiencies are required to be corrected:
i
Presented to __ XApproved
Inspector _ —_ —-- - Ll Disapproved
De•e ---
CALL FOR REINSPECTION
0 YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of InspectionJ �L�, ----
Date Requested_1�y _. Time. A.M. P.M.
Address --yja. �-L'I Permit # Z_
Owner _ —_ —__—__— Lot # —
i �
Builder _The following Buildin Code deficiencies are required to be corrected:
ir► -
-
------ ----
Presented to _----.- - --- --------- Approved
Inspector Disapproved
Date u L -2
CALL FOR REINSPECTION
0 YES El NO
I
�3Sa
P
J
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone! 639-4175
1/9�
Type of Inspection 4-1 Tim
Date Requested.
7- Time A.M. P.M.
Address
Permit
_�� --
Lot # --
Owner
Builder �� —,�-F. --
The following Building Code deficiencies are required to he corrected:
I
I
Presented to
�q,Approved
.—_---_ - - --'— v
i-:J Disapproved
Date --
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223 '
Phone. 639-4175
Type of Inspection I -4�L `
Date Requested Z/ 3 �� TimN(`r -A.M. P.M.
/ � 7
Address 12
Permit
Permit
Dwner
Builder
The, foil
owi Building Code deficiencies are required fo be corrected:
Presented to —_ I Approved
i
Inspector i - - ,__ J Disapproved
Date —
CALL FOR REINSPECTION
CJ YES �_7 NO
CITYOFTIFARD MASTER PERMIT
G1Y 11AIRD PERMIT q, . . . . .. . : MST90....0098
COMMUNITY DEVELOPMENT DEPARTMENT offlem PRIM. PERMIT t1. : MST9O•-OO98
( } i /�
13125 BW FWI Blvd. P.O.Box 23307,TOM,Oipon n7M IE
SITE AI)DF:I::I:i' . . , : 124`)0 SW NORTH DAKOIA ST PARCEL: 1S].34CB--O("j100
SUBDI:V.ISION. ANTON PARK
ZUNINCi: R7
BLOCK. . . . . . . . . . : LOT. . . . . . . . , . . .. . ..2;3 _.._.._....._._.._......_..._..._..._....._ ....._............._.............._.
BUI1 DING __..__.._. _.....___
RE ISSI.)E:
DWELLING UN11 S: 1. B0 .*iE::ME:N'T . . . . . . . , :0
sf
CLASS OF WORK. :NEW BEDRMS:3 CiAI'H5:3 GARAGE:. . , . . , . • • • :500 i
'' _..
$
RE_I:4UIRF.D SE::TBA(:;1'.
TYPE: OF USE. . :SF FLOOR AREAS-9.38 -.._ � fi r�T(iWT. :5 f
TYPE OF CONST. :5N FIRST'. . . . «93sf LcFT. . « , ,., l,
OCCUPANCY 6RT'. :R3 SECOND. :'103 sf FRONT'. :2O ft PEAR. . :34 ft
THIRD. , , , :0 <.: f REQUIRED.-•._._...._..___._.__...__.__.
STORIES. . . . . . . :0 SMOKE DETEC'T()RS. :Y
HEIGHT. . . . . . . . :20 ft TOTAL..-. _....._._...._, 1641. 15f'
FLOOR LOAD. . . . «40 psif VALUF: 7192.2 PARKING SPACES- 20
Remarks:-------------
_____.. _....
PLUMBING
SINKS. . . . . . . . . . .. iFLOOR- DRAINS. . . . ..0 BACKFLOW PRr'VNTRG. .. :0
WATER HEATE.RS. . . : 100 'TRAPS. . . . . . . ., .0
LAVATORIES. . , . . :3
TUB/SHOWERS. . . - :2 LAUNDRY 'TRAYS. , . : 1 CATCH BASINS. .
WATER CLOEiE T'ca. . : 3 SEWER LINE (ft) . :0 GREASE TRAPS. .
DISHWASHERS. . . . .. 1 WATER LINE" (ft) . : 1.00 OT1-4f:R F'IXTLJRF,S.
0
GARBAGE DISP- 111 RAIN DRAIN
WASHING MACH. . . : 1 SF RAIN DRAINS- 0. 1;.E.:E.S �__........_.....
MECHANICAL -~_---__._.__....__.__.. _...._._...__..__.._.______._.......
FUEL_ TYPES-------------- UNIT- HTRS. . :O type amot.tnt by date reept
/GAS/ / / VENTS . . . . . :0 F'AYM !F 100. CdO ;ILH N3/1O/9O :10777:1
MAX INPUT:O B'T'U VEW1 FANS. . :3 BPR1 $ :3(:;7.00
c BPI_(:: � 23 8. 5
FURN < ].001'. . . : l HCIC)Da. . . . . ,. « 1
FURN >-1.00K . . :0 WOODSTOVES. :O HSPC `h 1.8. ''35
FL..O(:)R F'URN. , . . :H CLO DRYERS. : 1. STDC $ (,00. 00
BO 1:1.../C;MP < 31.41=1:0 OTHER UNITS:O '3SI)C: `K 2'.50.00
GAS OUTLE::TS: 1 PARK $ 250. 00
Owner:
_.._
_'RT $ 36.OO
AC4UA.••MARINE CONSTRUCTORS INC MSPC $ 1. 80
1='
6 4i.9�,
�_ F f R T t 1.40. 00
F''5E'(11 $ 1. 00
PORTLAND OR 97201. MPI...0 $ 9. 00
Phone tl: `jO3.-241-•$35$ PAYM $ 1817. '7O :TI._F•1 O3/20/9O
Contractor: _.__.._ _......___..__........._._...__.._.._._____...__._
ALIUH- MARINE CONSTRUCTORS INC
P.O. BOX 691.95
PORTLAND OR 97201
T'hor,e 0: 503-241 $35$
Req N. . a 471115 $ 1917. 70 TOTAL
This permit is issued yublect to the regulations contained in the
REOUIRED INSPECI IONS
Tigard Municipal Code, State of OPP. SPecialtr Codes and all other Foot/found Ins,p Plumb Top Oi-tt
APPI)cable laws. All wort will be done in accordance with approved Wtr Proofing Bsm F'raminq ITlsp
plans. This permit will. Prpire if work is not started within 16@ Post/Beam Insp Fi.re)p:Lace 11-ISP
days of issuanre, or if wor1f i5 suspended for 1)Ore than 188 days. Crawl ncD1'al dh 1 ny3n Tnst)lAteonl1ps>p
I'ermitt:ec ign4�ture: PLM/Underfloor Gyp Br.,ard Insp
Ftnq Drain Bs;m' t Rain drain :L1
15sued By: Mechanical Insp Water I._i.ne Insp
C, 11 fc)�r inspection - 639••-4175 _
SEWER CONNECTION
PERMIT
_RMIT
SWR90 0106CITYOFTIGARD CfOFTrAD I'E
COMMUNITY DEVELOPMENT DEPARTMENT owooN I PRIM. PERMIT a. : MST90-••00913
13125 SW HIM Blvd. P.O.Bax 23397,Tigard,Oregon 97M IW 175 DATE ISSUED: 03/`0/90
SITE: ADDRESS. . . » 12450 SW NORTH U11K(:1'rfl T PARCEL: iSI.34CF.4 •06100
SUBDIVISION. . . . a ANTON E'AR11 Lf.1NIN(a: C� 7
BLOCK. . . . . . . a LOT. . . . . . . .. .. ., . . . :23 _ _....__._........
TENANT NAME:. . . . . a
USA NCJ. . . . . . . . . . :40620 DWELLING
UNITS. . .
CLASS OF WgF�I;. . . :Nf:_W DWELLING IIIJZTf:i,. . : l.
TYPE OF' UST. . . . . nSE• NO. OF F.+UILDTNGSa1
INSTALL T'YI'k_. . . . :BUSWf; IMF'E.F:V ialJF1FA(:I=:. . : 'f.
Remarks:
Ow rt a•r: _._.._..__.._._._._._._.._........._._..._.._.
AQUA--MARINE CONSTRUCTORS INC tyke <Amot.trtt: by d�Ate recpt:
p. O. BOX 69195 PRM'T $ 1250.00
INSP $ 35. 00
PORTLAND OR 97201 pAYM $ Ii:?85. U0 J1 03/2Oi P.10
11h(:)rte a» 50.3-.241 8358
( t:)t•tt•racto•r; _._........_......__....__..__.___-__.
(::ON'TRIACTOR NOT ON F"ILE.
('ht3nte tt W $ 1R85.00 T'OTAL..
Req a. . .:
._...._,._...._._ F:E Ci l.J I R E:I) INSPECTIONS -..-••..........-.._
This Applicant agrees to comply with all the rules and regulations Seaoe•r Tnsp e tion __„. __._..._.._._...____._........
__ _.
of the Unified Sewage Agency. The permit expires 120 days from _.._.__.....__......_............ ......._...._._.
the date issued. The total amount paid will be forfeited if the __......
„.__.._.__..-.__..___.._..._._....__. _ _..-.-•-.�•••-_- ••••••- ---••-
permit expires. The Agency does not guarantee the accurart of the -•--••-•--_--- -- --- -
side seller laterals. If the sewer is not located at the measurement ____. __..._._.....__.__......__...._....__._
given, the installer shall prosppct J feet in all directions 'roa __..-___ _�._._.____.._ ._._...._...
the distance liven. If not so located, the installer shall purchase __•_-__. ....................
___..___.....__........_._.___.
a "Tap and Side Sewer” permit and the Agency will install a lateral. --- •---••••••• .... -- -„ --
T'a•(•rat i.t t e e S i.q t7,t is t a r e .................._....__.____._..._.....__. _......__. ____..___..__.._.....__.__....__._._......_.....
I S S tat e d B y tt __..._. ............ _._......___._....._._.... ._.................
_-..__..__.._......„._._..._.._...
Cat11 fc)r ir►spect:ion f.,:: 9 417'5
I
I
I
CITY OF TIBARD — RECEIPT OF PAYMENT REC N01 00107910
CHECF: AMOUNT a '146. _'1
UJ ME a AQUA MARINI: CONSTRUCTORS CASH AMOUNT s .011
i:,D1jFE St PO BOX 69195 PAYMENT DATE a 0'—'.0--90
PORTLAND. OR 97201 Ell_UCI N0;ADDR:
12450 SW NORTH Di4i.OTA
PURPOSE OF PAYMENT --._—_ (AMOUNT PAID PURPOSE OF PAYMENT--_.______ AMOUNT PAII1
HUILCJIPJ(v PERMIT i90-0098) 362.00 PLUMBING PERMIT 140.00
?6.00 �JATE SUILD PgPMIT TAX (5%) ,:", 1C
I
MECHANICAL PERMIT �,,_
FLAN CHECF.: FEE 147.'5 SEWER USA (90-0106) 1.4 0.00
SEWER INSPE:CTON ?5. 70 STREET SDC 250.00
i:-ARKS SvSTEM DEVELOPMENT CH 250.00 STORM DF�AIN 'SDC 2��C1.0
I
TOTAL Cill0tiNT PAID _ 7.'�. 146.2t
CITYOFT167ARD
w PLAN CHLCK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT J PLAN CHECK N
11125 S.W.Hall Blvd..P.O.Bow 23.197,Tigard,Oregon 97223,(SM)639.417s PERMIT N
DATE ISSUED
JOB ADDRESS: /� `� U_ ,.) NaIM L A"TA TAX MAP/LOT
SUB: &MPLJ fp#04, --- L071 : 23 - -- LAND USE: -- -
VALUAfION: -
OWNER SPECIAL NOTES
NAME: � - REISSUE OF:
ADDRESS: LAST REISSUE: -
FLOOD PLAIN/
- - -�- SENSITIVE LAND:
PHONE: _.____. -
_ _ APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: A-=AA �'I��P1a� IA)� -_ ENGINEE=RING: _
>G 1IRE DEPT
ADDRESS: ��✓ - -
- �1 AA Q r 6Z I OTHER:
PHONE- •��' _ - ITEMS REQUIRED
BUILDERS BOARD N: 4116-,I EXP DATE: ILI t4tZf 0 LIST/SUBCONTRACTORS: _
BUS TAX: -
ARCH/ENGINEER CALCULAI"IONS: _-- _-
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
COMMENTS: -_-- -- -SUBCONTRACTORS: PLUMB: U,)*.FC 1►1GOAKXL�'%f MECH: 1 AcjT,r 8z&nzl46,
r
PERMIT N ACCT N DESCRIPTION �` AMOUNT AMOUNT PD. BAL. DUE_
10-432 00 Building Permit Fees
_ 10-431 00 Plumbing Permit Fees L'
10-431 01 Mechanical Permit Fees �'---
10-230 01 State Buildina Tax (5%)
Building !,5, 3'� ✓"
Plumbing ?
Mech
10-433 00 Plans Check Fee 3 y,
Building
Plumbing
Mecil 4
30-202 00 Sewer Connections
30-444 00 Sewer Inspection
51-448 00 Street System Dev Charge (SDC) G-0 GL'
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage vyst Dev Chrg (SSDC) X3.5y "rz
10-230 06 Fire
TOTAL
REC N '
APPLICANT SIGNATURE
Received By: Date Received:
cn/3591P/19"
QlZn1)11_�Si I�'ROSIQN CON"1'K�)I, INTOIZMA'1'IOP1
GENERAL CONTR ACTOR NAME& ADDRESS: CASEI-11.1NO-:_�
PERMIT NO.:
jaww's.is
L-- APPLICANT NAME AND ADDRESS:
EXCAVATION CONT"RACE-OR
NA�^M``E& ADDRESS:
_i`QUGrA�R�I L lul��IATIt -
OWN R NAME:AND DRL-'SS:
IT:L.EPHONE NUMBERS:
APPLICANT__HbMJF12 2 "t _3c> PROPERTY DESCRIPTION:
OWNEK�_ li STREET L. L3 ADDRESS AND�"*�1L CROSS
�YLQ�LOCATED ----
GENERAL CONTRACTOR:�
EXCAVATION CONTRACTOR: -
SIIWJOB: NIA LEGAL DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.:
CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION:
SITE SIZE,ACRES'-----.—
I
CRES: — .—
op _ DISTURBED/WORK AREA,ACRES: _
LOCATION&ADDRESS WHERE SPOILS RAINS 1'O:(CIRCLE ONE)
LEAVING SITE WILL BE TAKEN
(NOTE:PFRMTTS MAY BF.REQUIRED) CAT'Cfi IIASI DITCH PIPE CREEK
u l►fp ftgb _
— ATE PRO L(CIRCLE ONE) P R7
PUBLIC RIGHT OF WAY
ER SION/SEDIMENTATION CONTROL 1E'iQ MEMA ES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY GSC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCTION SEQUENCE OTHEK _
OTHER___
PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WTTH'TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULFtSTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WLL.L,CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE.
OWNF IGNATURE Al !CANT SIGNATURE
OITICIAL USE ONLY.
RECEIPT DATE ACCEPTED
FEE NUMBER RECEIVED BY
i
i
CITY OF TIUAF'D — RECEIPT OF F'A's'MENT PEC NOt 00107777.
CHER AMOUNT : 100.00
AQUA MARINE CONSTRUCTORS CASH AMOUNI' t .00
ol) '1PESSt PO BOX 69195 PAYMENT' GATE t 0,.:..12"0
P'OR'TLAND, OR 97201 BLOCK NO%ADDFtt 1
LOT 23 ANTON FARM• I
F'i_if POST OF PAYMENT AMOUNT PAID PUE,'t-'U5F OF PAYMENT AMOUNT PAID
i
i_=atJ CHER FEE (7-28R) 100.00 i
i
i
i
TOTAL AMOUN1' PAID - '1 110.00
/00
Au
ev
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r"t LA-
-e
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RNEL I USS, OREGuN I A'
U-6-0. STANDARD
PFS �o
1 •r SECT. 25.1738 3.4 _
�: QUALITY AUDITED t
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