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16681 SW QULEN ANNE DRIVE
—KING CITY
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INBPECTIfYN NOTICE
City of Tigard Building Department
13125 SM Ball Bled. Tigard, Oregm 97123
inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-41,1
e
Inspection:
Footing Plbg. Underelab Mach. Rough.-In Ai:ypr/Sdwlk
Fcund. Plbg. Top Out Can Linn PIVALt
Poet/Beam Struct. San. Sewer Framing C �
Poet/Beam Mech. Rain Drain Insulat'on -Plumb.
Plbg. UnderfloorJJ Watteer Lino Gyp. Bd. --Mach.
(
Date regtteetedt 0'" I�- 1I _—� Tir:et _/I Ari PM
Address: �lU'(jL L�Q4r�•/�YW� �rmit �tg1
Builder:` v
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inrpec tor:_--^_�- -- —T —i Datat
l APPROVED -_ _ DISAPPROVED -� APPROVED SUBJECT TO ABOVE
--Call For Reinap.
I
CITYa'cTIFARD
BUILDING PERMIT
C17YOFTWIID PERMIT #. . . . . . . : BUP91 —01'6
COMMUNfTY DEVELOPMENT DEPARTMENn' 01"m
13125SWN IIBlvd r.O.Box 2334";,iipwd,Or*go,97M (FM)63 176 1 DATE ISSUED: 10/09/91
S I TE ADDRESS. . . 166t'-A2 SW (IiJEEN ANNE AV PARCEL: c'S 1 1'_.BC--17A00
SURD I V I S I ON. . . . , Kit) C s Z Crim f NG
BLOCK. . . . . . . . . . ,, LOl.. . . . . . . . . . . . . s
REISSUE: PL:IOR AREAS------ ---- EXTERIOR WALL CONSTRUCTION--
CLASS OF WORK. :ALT F I RST. . . . s s f N: S: E: W:
TYPE OF USE. . . :SF SF_CO14D. . . : sf PROTECT OPENINGS?-----------
TYPE OF CONST. :5N THIRD. . . . : s f N: S. E: W.
OCCUPANCY GRP. :R3 TOTAL---------: 0 s f ROOF CONST: F I RE REFIT"? :
OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOP. : HT. : ft GARAGE. . . : sf OCCU SEP. RATED:
HSM`f?: MEZ Z?: REDD SETBACKS-----------. REQU I RED------------------------
FLOOR LOAD. . . . : psf LEFT: ft RGHT: ft FIR SPKI-.; SMOK DET. . .
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM: HNDICP AGC:
BEDRMS: BATHS: IMP SURFACE: F'RO GORR: PARI-ZING:
VALUE. E : 3000
Remarks : 43KY1_IGHT INSTALLATION
Owner-: -__-----__.__._-----._..___.-------______ ___.____ FEES
ROBERT WINDEEXER type amolrnt by date t-ecpt
166Ei(2, SW QUEEN ANNE PRMT f 38. 50 JLH 10/09/91 -
SPCT $ 1.. 93 JLH '09/91. -
I••.I NG CITY OR 97224
Phone #: 620-8057
Cuntractor: -----.___.
OF I I_- KELLY CO
604 N. ALBERTA ST.
PORTLAND OR 97217 _-__-_.__..___--_-.-__--_---____._.___._.__
phone #: 5O3-L88-7461 f 40. 43 TOTAL
0. . . 01663
--- ---- REQUIRED f NSPECT I ONr
This perar s issued subject to the regulations contzined in the V r-a m i n g Ins p
Tigard Municipal Code, State of Ore. Specialty Codes a•,d all other Final 1 n s pest i o n
applicable laws. All work will be am in accordance with
approved plans. This perait will expire if work is not started
within 180 days of iss,iance, or if work is suspended for more
than 18N days,
Permitted Signat'.rre :
I sv_red By : -- ----_--- --_ ______..._____._
Call for insper.^tion - 639-4175
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17 Y OF T I GARD RECE IPT OF POYMENT RFCEIPT 110. 191
(-'HFCI-( AMOUNT a 40. 43
MIME WINDECKER, ROBERT irASI.-i AMOUNT
J6682 SW QUEEN ANNE PAYMENT DATE a 10/09/91
SIJUD I V 15 I Oil,'
LINO CITY, OR 9Plc 4---
iRpOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PA I T)
1
I It m 38. 450 ST. BUILD V -'R . 93
�il4YUIGHT PEPMI T
I'(HAL Ah OUNT PAID 40. 43,
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BUILDING PERMIT APPLICATION KING CITY DATE ,gto 1291
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE b39-3101
OR AS SHOWN AND APPRO,.ED IN THE ACCOMPANYING PLANS AND SPECIFIrA MONS. OWNER PHONE-_
LOTNO-D-K.ina City 26
OWNERTualatin Day. CO. JOBADDRESS iUbUIL SW u-jawi Anne Nvunue
ARCHITECT
ENGINEER
BUIL DER i 8MU ADDRESS15300 SW 116th DESIGNER TUC
STRUCTURE &] NEW U REMODEL ❑ ADDITION 1:1 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
/❑ RESIDENCE' X ObWJ-1 EDUCATIONAL ❑ GOWT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT 0 GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY h -L LAND USE ZONE I` 7 PD BLDG.TYPE �! FIRE ZONE -- PLAN CHECK BY hW 11 HEAT 9160•
Construct single family owellinU w/atta+:h9fj garage 1 Ht draoRia 2 8atha,
SCE ('ORRECTION SHEET ATTACHED.
SEWER PERMITML %t7 1:;:luOCi b LISA L -.j--U0) - t *- —
OCC.LOAD FLOOR LOAD 4El HEIGHT 12 NO.STORIES 1 AREA .111 V NO.BEDROOMS
BUILDING DEPARTMENT SETBACKS FRONT REAR 'Il — LEFT SIDE l RIGHT SIDE
Permit_ 1E]1•00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CO'!E, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 90.50 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN Cf MPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal _ 271. 50 RESTRICT'VE COVFNANT'i CONTRACTOR ::J SUB CONTRACTORS TO HAVE CURRENT CITY EUSINESS
7. 24
LICENSE.SEPARATE PERMITS REOUIRFD FOR SEWER,PLUMBING AND HEATING.
State Tax
- -- SDC- xs!(.+*6AYf!
Total .'27 +.74
By I'L PDC# APPLICANT OR AGENT
Receipt No.
Approved dub " � �� ADDREW PHONE
DATE INSP.I TYPE INSPECTION REMARK$ PLUMB1140 DATE —
M Contractor
Permit No.
Rough-fn
/J�✓ r{C� _.—._ Fixtureor
Final
HEATING
Contractor 15 l
Permit ? /J
Gas or It •CS_Z_
Rough-in
-' Final
SEWER
--- - Final
DRIVEWAY
—' Final
Storm Drainage
;Rein Drain)Final
-- - - - Sidewalk
Curb&Street Final
— _. --_--- _ Approach
BLDG.DEPT. FINAL TEMPORARY CERTIRICATE OC CUP CY Final
CERTIFICATE OCCUPANCY ��_�/ ---------------- - "-
Landscaping
y V—!y �_� Znnlnp Final —
•� � �11`r 'yam,,,, .qty
y( ' rt/n'1�.y ,�'hx s� ,W.• .�yf}la�`dro�` ' 7\
D'1 I�'�•rr• ,�,yy�"'-�'�,' ""',:;� �'�•�(w ,s �1,.
al!"q
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AD 71
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'� � .� � �1 ��� iW w ' 1�,1� ,,,,,���,�{ �'1 �n,�' � � d R�I►) .tf8,•.�.y"��..��y'.y����I,,fir{'' fh..1�f�, :�{ �
r,yrs' {!�.�r,+ •`�� ,. ,y�^:u 49F, � �'; � ���+tNY•I�r y���fE�lhy..n,�� MI��.' �"`�� ,'�P 4.^if F�'�7t,���',�V `p- ���
,C •1•!� 'I1•.. � � � dp 1Fi 1,dy.'�,�I.y�:'T' ..�.M �w•�.- „�4 ,��qy� ���'�•�. 1�
.��� Y'• 9�..et6Y ''l` ��R7�f' y �_ ,,Mw �, ���:�w'__T»�T aa�� •
•A�. �1'b.`�f.�^�, .ti wa' �_ k '^�J.. ���.-✓'\.�M ..`�.�_ w.�.�a � .4, •"':n�'y
City of Tladr'd Mechanical Permit its? Permit
Fee -
tiav+ InV.allation tG Replace ❑ Relocation [� Addition E] -� 4A -
C) Alteration 4% State
HEATING j - r TOTAL
CCiNTRACTCR -� ' - --- i
u OWNER I
<.!1DR= _ �_ WORK ADDRESS040
5.�.
PHONE •• _— APPLICANT _ E
8'eat Input Rating (BTU Psr H Vent Size w _.-
Flue Size
i
U E L OIL ❑ GAS ELECT ❑ ' OTHER ~� _ ----------
ITEM N0. FEE
_ ITEM
.-or Issuance of Permit ...___ a -- "- N�_ FEE
E,, ABQVE _ Air Condition Compressor 15 to 30 HP
Naw-un to & in�lQQ�000 BT'U N� q,00 Air Handling 10,000 CFM --- ----i- +
Naw-100 001 BTU s & ova t 5.00 Air Flertdling Over 10,000 CFM 3.00
Floor Furnace ---- 5.00
__
400 Evaporative Cooler __ 3. 0
Oisli- Floor-Sus ended �_ 4.00 Range Vent Fan
Install Vents Only -- 2.00 '
2.00 Ven I
t System 3.00
Repair•Heat& Coaling 4,O�i Hood Commercial
Air Condition; Compressor Under 3 HP 4.00 Commercial Duct System 3.00 I
Air Condition Compressor 3 to 15 HP - 7.50 _ 10.00
!N::PECTOR'S COMMENTS
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS
r PPROVED BY DATE ISSUED BY
DATE
''„CF_IPT N0.
ri:
Signature of App' ant �� �
BUILDING DIFP'"-RTPAENT, TIGARD �Tn
+ PLUfill B IV+3 PERMIT b
ha;,Jar of a valid p!umbing contractors license: is hereby i
autho zexi to "Ur!
Orr; as herein noted to be installed in accordance with the plumbing code of �
Tigard. Such insta!lations require inspection by the City Insnector who s.lall be notified not less than four i
1 (4) hours prior to the tirne the installations are ready for inspection. City of Tigard Business License required
for all contractors and subcontractors.
Owner
NUM3;R OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITE?dS FEE ON EACH AMOUNT (Office We Only)
-RESIDENTIAL
Singh Family-1 ba-.h-each 25.00 'X5 — ti
Ou Ie+-Each 1 bath unit _ 25.00
Addkianal b_tthrnums-ajch f 10.00 /U
Mcbils Hama S ace-jach 15.00 s
IND IVIOUAL FIXTURE FEES _ _
to_ 50 Fistur.;t in 1 buitdir,,;e;ch _ _3.00 ,
5 i to 100 Pix'u•4; in 1 buN,'ir.;_Lch
101 1:0 200 Fixrurei in 1buil li^.y 7:it 2.01 .
201 or more Fir_ures in 1 bu:lrl:0.
0-11ScELLAN50US _ f
B.,ildir� 5a.•�er�1; 50 ft. y T _ 1000
r � � � � rY
Sewer-e±eh es4+i;ional 100 ft. t0.G0
WA.'er 5arvire to b0dir. _ _ S.GU
PrivateLyar.,-Svstetr;-evch 100 ft. ..____—�� - 1000 _ �__� _ �_-
Othar t
PErA?+11T �� C ForMumbinl in:;c•:`::�^Kior-2 6394ill
.a State �� Plumbing Contractors ' /
y
TOTAL ��'�� RECEIPT NO. Issued By
SEWER PERMIT
� N° 22,529
UUnified Sewerage Agency
of Washington County CITY OF _ DATE
OWNERS
' PHONE
OWNER 'S ADDRLSS: I � ' ` L ! 1 �• __,, ,
TYPE OF INSTALLATION:
❑ SIDE SEWER ❑ LINE TAP AND SIDE SEWER CJ LINE TAP
T'r'rt OF OCCUPANCYs
❑ NEW ❑ EXISTING EI SINGLE FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS '
ADDRESS OF STRUCTURES (rt - ,!
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer to the Permit Number, The Application expires in one hundred twenty (120)
days, The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals, If the sewer is not located at
the measurement given, the installer shall prospect three feet in all directions from the distance and depth given.
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 at the location specified by the installer.
FEESi
PERMIT FEE
CONNECTION CHARGE
i
LINE TAP INSTALLATION
OTHER
ISSUED BY
TOTAL s _
APPLICANT DATE
CYINof rrT1C `�n u�zsswiiAil3na. PLNCK/P.ECT #
TICPO Box 23397
COMMUNITY DEVELOPMENT'DEPAR'T'MENT Tigard,Orcgon97721 PERMIT #
(503)0144171 DATE ISSUED
-.2S/15-6C - 17 ------
JOB ADDRESS: 2 S.kJ Zj"j, p TAX MAP/LOT ,
Sul{. _ LOT : LAND USE:
VALUATION:
OWNER SPECIAL NOTES_
NAME: _�LI'L�YI- �i /I�2GlCP/� REISSUE OF:
ADDRESS: 11U r��L S/tJ� �v��G-L /�li�P _ LAST REISSUE:
A,Ll Gi C�i ��f��7Y 1- 000 PLAIN/
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: PLANNING:
ADD-,--SS: _ ENGINEERING:
FIRE DEPT:
PHONE: _ ^ OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRE(
SURCJNTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCHLNGINEER CAL(UL.ATIONS:
NAME: _ _— TRUSS DETAILS:
ADDRESS: --------- — OTHER: -------_�___. —_ -
PHONE:
PROPOSED BLDG. USE:
CG`1MENTS:
APPLICANT S I GNl';TURE -----_-----—�w----
Received BY __ _—___. — —_. _—_ Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
� �.
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
wilding
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building —_
Plumbing
Mprhanical
10-230 06 Fire
30-202. 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25..448-04 Industrial 11F Fees
25-448-06 Institutional TIF Fees
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 Sys'. Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
4-445-02 Water Quantity (Fee in lieu of)
TOTAL !Z61,11 3
nm/3587P.WPF