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is\records\mlcmflm\targets\building.doc
CITY OF TIG- AR®
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 9722398ing (503)639-4171
r I;
r
-�1LI'
Residential Building Permit App ion
City of Tigard
13125
SW.Hall Blvd.
Tigard, C,R 97223
(503) 63j-4171
LJobsite Addrm: I ►_�
� (��'' Office Use Onjy
Subdivision:,14rl It odw)`-?
Planck/Rec # 5- 80 r
Valuation: Z6 0 --
,/,� Permit #
Corner Lot? ( Y,► N
� Reissue of
Flag Lot? Y
r Map & TL#
�vvneR alt IC�4`� � Approvals_Reauired
Address: Planning
Engined ing
Phone: �' � _� Uther
Contractor: - Items Required
Address: _ -- Subcontractors
Truss Details
Phone: _ Ocher
Contractors License it
fiftach copy of cun-ent Oregon license)
Contact Name & Phone:
Subcontractors: Arch itecUEr,gineer:
Plumbing: __ __ Address
i
Mechanical. — -- 1
(attach copy of current OR Contractor's License) i
Phone: j
t JOB DESCRIPTION
Applicant Signature & Phone number
_ �C �C/
Received by: � � �-��... � _ Date Received:
Permit fi Account Description Amount Amt. Pd. Bal. Cue.
Bldg. Permit (BUILD)
'
Plumb. Permit (PLUMB)
Mech. Permit (MECH) _
State Tax (TAX)
Bldg: -IL—IL—
Plumb: t
Plumb:
Mech:
N
' Plan Check (PLANCK)
Brig:
Plumb:
Mech:
Sev er Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF ('nF-R)
Mass Transit TIF (TIF-MT)
Corravercial TIF (TIF-C) _
Industrial TIF (TIF-I)
Institutional TIF (T1F4S) _
Office TIF (TIF-0) _
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
l
CITY OF-' T I f-)PF?F.'1 -- prX V I F'T IIF r'r, mi•::r•J T RF.1;E I PT ►!C). :S!l;--2t,!5807
CW-CK OMr7I.JNT s ;_'h. 25
NAME JAY M ILLF.R Iiu J I. r)ER, T rJr':'. (.ASN AMOUNT 0. 00
ATJI)RrSS a PO Box 23C-91 PAYMENT DATF: s 05/24/9 y
PORTLAND, OR `31. BD T V I a I 17N
a,/"?f)1•--
PURPCI,,,E CIF t='AYMtrNT tlMOUNT LAIC) l:li_ G.,,(4YMCN,T AMOUNT PAID
LJIi,I)INI� F�ERt1 AIIF'y 0� "_ `a. 4� 1. P.5
1.3 8") SW ROSY CT.
TOTAL AMOUNT Pf)I i:)
C 11 Y C1F' T I(i(WO RUi 101' OF- PtaY'MFrJT RF'(.,, I O'T t 0. 195-2t'1660
C HPC,V, Alyn t,!N T : 16. e°;
Ni}r if p JAY M It-I_.L.R INC; t_nSt•t b1M0(..JN;' a 0. met
Iv, CI An c'3r ) I r.,OYMFNT r)0Ti s 05/19/45
PORT1_.AND, OR, Suno i v T'_i ION
C)F PA*y Nf Pl l i iMU P JNT PO I D PURPOSE OF' POYMENT OWN-INT PA 11.)
Sw Rclsv' C,(JURI,
j r+r- AMOUNT PA IT) _ > I
_ I
CITY OF T I GARD L,Ef?OCC OCCUPANCY
;
nCCUF'!�N(:'Y
PERMIT #. . . . . . . . MST95-0121121E I
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/2 /9n
13125 BW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
ITE ADDRESS. . . ;; 13789 SW P05Y i._ I F'A(?CGL r aJri 1,�4Ia17 RM411 r�
UEfUIVISION. . . . s ROSE MEADOWS LONING:11-i
BLOCK. . . . . . . . . . L01'
. . . . . . . . . .
CLA 39 OF WORK. :NEW
TYS,,,E OF USE. . . :SF
��CCUF'ANi:Y CRA. :R3
OCCUPANCY l_L)ATI:i?c'4 4 I
TENANT NAME. . . s
Remarks : PATH I
Owner: _ _._...._...._.._..._.. ,..._._._..._.___,..._._..__._
JAY MILLER
P C) BOX 23291
TIGARD OR
Phone #: 684--7543
Con t:ractor,I ____.._ .._... .. _ _._.. . ___.. __. __.._...._ __ ... _ .....
,JAY W1L..LE;P
PO BOX 230459
TIGARD OR 97288.
F'hnnp ##: 6A4---7"43
Rena #. . : 30109
Occupancy cif the above refer•entvd building is heccby given, and certifies
the compliance with thy+ Str-Ate Of Oregon Specialty Cados for the yrOUP9
Occupancy, aria use under which the referenced permit. wits 141STled.
I(.L)INi3 INSPF'(_1OP i�UIl_L)1N8 c►f i i ini
POST IN CONSPICUOUS P='LACFW
I
i
i
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Busines Phone: 639-4171/
Inspection-.
1�
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line Id .tAj
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Request9d: s � Time: AM PM
Address:
Builder: `'Permit p: t^ — C)cU
� �
s
THE FOLLOWING CORRECTIONS ARE REQUIRED:
d
�c
i
Inspector: Date:5Z 2 —9S�
PPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639.4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in INAL
Post/Beam Mach. San. Sewer Gas Lire
Plbg. Underfloor Rain Drain Framing
Alarm Water Line Insulation ech
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: L Time:,KAM PM
Address:
Builder: Permit
#:
THE FOL-OWING CORRECTIONS ARE REQUIRED:
Inspector: Date:_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NO ':E
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in _ NAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing Plumb.
Alarm Water Line Insulation Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: S- -moi Time: AM PM
Address: �� Cjk� ,
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
c.
Inspector.� Date:
1 APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam struct. Plbg. Top Out Elec, Rough-in FINAL,
Post/BPam Mach. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing lumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wallnn Gyp. Bd. -Elect.
Date Requested:_ j ' �'"-1� Time:�AM PM
Address:1 f21kcA t , 0 S ti-, ck-
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Dater
—, E ROVED _DISAPPROVED ,APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm !Eater Line Insulation -Mech.
Underflr. Insul. Shea. Wall Gyp. Bd. -Elect.
Date Requested: Time: AM PM
Address j 3 �D�r
Builder: _ _ Permit #; "47TdT,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:��
APPROVED DISAPPROVZ�� PROVED TO AB,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspecticn Line (Rec-O-Phone): 636 4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-inr/Sd
Foundation Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mach. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: � � Time: AM PM
Address: 13 T's-
Builder:
!
Builder: Permit #: <15—
THE
STHE FOLLOWING CORRECTIONS ARE REQUIRED:
!!25;_
Ca r✓..c c�F�m1S
Inspector: s Q J Date:
_APPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspoci;on Line (Rec-O-Phono). 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in QA�ipr/d k
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Strutt. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
UndedIr. Instil. Shear Wall Gyp. Bd. -Elect.
Date Requested: Time: AM PM
Address: 3,
Builder: Permit #: / _ c�-�,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
/
.� nheIC-- - jKC
-- u� Kx�
Inspector:_ C, i � CT A44)_t Date: ,
APPROVED k,IDISAPPROVFD —APPROVED SUBJECT TO ABOVE
`� AL-II For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE Q
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 '
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Flbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Undertlr. Insul. Shear Wall ^i.t? _ -E!e^I.
Date Requested: Time- AM PM
Address: 1,j _% �
Builder: Permit #!. 7 51
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: / Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
C11-1 Or TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Filing. Underfloor Rain Drain (ti Framin -Plumb.
Alarm Water Line 'Tnsulafion.% -Meeh.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: C/ l S Time:_�-_ AM PM
Address: 1 ��
Builder: 6/permit p:,1�; C C. �.
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: _ Dater —`35
APPROVED DISAPPROVED `MPROVED SUBJECT TO ABOVE
_Call For Reinsp.
1 f,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough in Appr/Sdwlk
Foundation Plbg. Underslab ech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech, San. Sewer Gas Line Jl -Bldg.
Plbg. Underfloor Rain Drain ,Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: `Z1311-5 Time:-L,(—, AM PM
Address: I
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
�•�iy9c_-
IIl
4441C& 1141,0 -7
Inspector: J'3 ' Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
"TD /.ti.S✓/r,4 �G� /�.�' 7 %,,mss=��r
j--
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Roc-O-Phone): 639-4175 Business Phone: 639 471
Inspection:
Footing Susp. Ceiling Sprink. Rough-in � Appr/Sdwlk
Foundation Plbg. Underslabch Rou h in ` Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
(4
1ti
Post/Beam Mach. San. Sewer asLi�`)J �q -Bldg.
Plbg. Underfloor Rain Drain �f amingl) -Plumb.
Alarm Water Line Insulation -Meth.
Underfir. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: _ J Time: AM PM
Address: 7 � _c1�C� t -
Builder: _ V1 Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED: /
e1j
Inspector'-- �._ �. \.i -`"�.._ Date:
APPROVED \-ASAPPROVED APPROVED SUBJECT 10 ABOVE
-,`Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab ONA chi Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer (mss Line -Bldg.
Plbg. Underfloor Rain Ura;n Framing -Plumb.
Alarm Water L ne Insulation -Mech.
Underflr. Insul. Shear Wail / Gyp. Bd. -Elect.
Date Requested: a( ,' Time:--AM PM
Address:
Builder: / Pe' rmit #: T`� �✓ _
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_ Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTIO OTICE
Inspection Line (Rec-O-Phone): 639-41-75 Busin s P one: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. hear IF' J Gyp. Bd. -Elect.
Date Requested: `�1�� % / � Time: AM PM
Address: / 3 ' a L
Builder: Permit q: `
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Z/y
w� zz _
Inspector: _ Date:
CO—PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171
Inspection: _
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct, TI-6g. Top Out EElac. Rough in FINAL:
PostiBeam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
L�—
Date Requestod: Time:c AM FM
Address:
Builder: Permit #:
THE FOLLOWi`IG CORRECTIONS ARE REQUIRED:
Inspegtor: Date:
41-APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
crTY Of- TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone) 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg, Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Mg. Top Out Flec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �?/� /i 5 Time.—.—AM -
Address:—/---5 �' 1--t. --
Builder: Kermit #: �r 5 c,C>c
THE FOLLOWING CORRECTIONS ARE REQUIRED:
PC a
Inspector: Date:21
APPROVED /--91SAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-0 'hone): 639-4175 Business Phone: 639-4171
Inspec!ion: _
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. Agan_Sewe►- Gas Line -Bldg.
Plbg. Underfloor iAiii t-F3rttm Framing -Plumb.
Alarm f11Vater—lao" Insulation -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. -Elect.
Date Requested: Time: AM PM
Address_ .�� 71
Builder: Permit
THE FOLLOWING CORRECTIONS A'AE REQUIRED:
Inspector: / Date: 21
APPROVED _DISAPPROVED APPROVED SUBJE TO ABOVE
—Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-ir Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Bag earn 5- frb8' Plbg. Top Out Elec. Rouqh-in FINAL:
.P-eat/Beam Rc , San. Sewer Gas Line -Bldg.
Cg�Ude-rrilRain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underllr. Insul, Shear Wall Gyp. Bd. -Elect.
i
Date Requested: j Time: AM PM
Address: 2 a-Cl, (f f,
Builder: �� ;� �� Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:—Z/
`APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE n
Inspec!ion Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:.,�L()Z_ 1 , e,-
Footing Susp. ,,eiling 5prink. Rough-in Appr/5dwlk
r
ou�Cti.'-K� Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg, Top Out Elec. Rough-in FINAL.
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: c 2 13Z S Time: AM PM
p n
Address: �� 7S2 2 A—,,, =-1. �_� -•�i�C;
Builder: �j % —4- f l �{�EF�L(1•< Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
4S" •-
1
J�
L i� i�.-a l �' / Of T��'ic!"i-•-c C (V' L�X-U fi�:V'il77Uh ,.
4
0 C i 2/'i, ^� �J�s �� -(..�.f.✓
Inspector:_y�� Date:
APPROVED DISAPPROVED C_AP.PROVED SUBJECT TO ABOVE
_Call For Reinsp.
��.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection ne (Rec-O-Phone): 639-4175 Business '3hone: 639-4171
Inspection: -e t 1
C_Footin Susp. Ceiling Sprink, Rough-in Appr/Sdwlk
Fo Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg, Top Out Elec, Rough-in FINAL:
Post/Be,m Mech. San. Sewer Gas Line -Bldg.
Plhn. '„iderfloor Rain Drain 'Framing -Plumb.
Alarm Water Line Insula!ion -Mech.
Underflr. Insul Shear Wall Gyp. Bd. -Elect.
Date Requested: `�� ' ' Time: AM PM
Address:
Builder: j( �[ (r, . r ( � �1�.':'l Permit #: . : C C-C rr
THE FOLLOWING CORRECTIONS ARE REQUIRED:
ci-
Inspector: \/ V' Jam--— - Date: L Z
APPROVED _DISAPPROVED _ _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CIT' OF TIGARD PLUMBING PLHMli
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : msT95-0ou,
13125 CW Hall Blvd.Tigard,Oregon 97223*6199 (503)539.4171 DATE ISSUED: 01/30/95
PARCEL: j-_1S1048D--RM010
SITE ADDRESS. . . : 13789 SW ROSY UT
SUBDIVISION. . . . : ROSE MEADOWS ZONING: R-7
BLOCK. . . . . . . . . : LOI.. . . . . . . . . . . . . :010
ULPSS OF WORK. . tNEW GARBAGE DISPOSALS- 11
IYPIE OF USE. . . . :SF' WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. I
(.)L.( UPANCy r'RP. R3 !.00R DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . .
0 H 1 EEL). . . . . . . . ..2 WHTER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0
FIXTURES-------------- -- LAUNDRY TRAYS. . . . . . : 1 SF PAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 GRSASE TRAPS. . . . . . . 30
1. HVf41 UNILS. . . . . :4 OTFII-R FIXTURES. . . . . :10
IU13/SHUWERS. . . . i SEWER LINE (ft ) . . . . :0
WAIER CLOSETS. . e3 WAI V LINE ( ft ) . . . - - 10111
DibHWASHERS. . . . : 1 RAIN DRAIN (ft ) . - . . :0
kevrlarkS: PATH I
UW14LH: - ._.__-..__--._-_____FEES___......_...__...___--_.
,Jf.-iY MILLER T IF" $ 1';50. 0L71 JF 01/30/95 -
F' 0 BOX 23291 GWM $ 180. 00 JF 01/30/95 --
SWM
SWM $ 100. 00 JF 01/30/93
116"RD OR BPRT $ 498. 00 JF 01/30/95
Phone #i; 684-154,6 BPLC $ 323. 70 KAR 12/29/94 94-2612104,_-;
05PC $ c4. 90 JF 01/30/95
Plumbing PARK $ 500. 00 JF 01/30/95
Nam c, A_ j_P__ LA_)&�4 IT 1 (0-1 ok, MPR7 $ 4:3. 50 JF 01/30/95
MPLC $ 10. 813 JF 01/30/95
Addy, PC &)e .2,309.2s- M5PC $ 2. 18 JF 01/;30/9:3
-
_ it `11).qcArd - .k, 1. 3LA 1-H $ 2,25. 00 JF 01/;3411/9;3
1.P Phone#:&T
DSPC t 11. 25 jp 0I/30/95
00-33(w Additional fees not shown Mere. . . . .
REIQUIRED INSPEcTIONS -------
TF) is permit is issued subjert to the req-
? 1ations contained in the Tigard Municipal Foot/found Insp Rain drain Insp
de, '3tate of Ore. Specialty Codes and all Pst/bt-am Struct Water- Line Insp
her Applicable laws. All work will be done Post/Beam Mechan Appr/Sdwlk Insp
Accordance with -Approved plans. This Plm/undslab Insp Mechanical Fina)
- r-mit will expire if work is not started FILM/Underfloor Plumb Final
, thin 1130 day$ of issuance, or if work, is Me=hat;ical Insp Building Final
spended for more than 160 days. PlUmb Top Out Erosion Control
Framing Insp Wtr Proofing T1,:;rr
Fireplace Insp (7,'rawl Drain
Gas Line Insp Ftg Drain Bsmlt
Insulation Insp
Lilip 1.10a)"d Insp I z.ed i umbin It Ure
L a 1i i or inspection -- 639-4175
n-l. rautur Notes :
M
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639.4171 C'ERM I T #. . . . . . . : MST95--0006
639-4171 DATE. ISSLED: 01/3Q/95
PARCEL: 4cyiO4BD -RMQiI.IZI
I1"t" ADDRESS. . . : 13789 SW ROSY CT
s.>UBD 1 V I S I ON. . . . : ROSE MEADOWS ZONING:
R-7
LALOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :010
BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . .0 sf
LLHbb OF WORK. INEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . ..400 sf
I Yl-'[-- Cj1- USE. . . :SF FLOOR AREAS_ --- -- --- REQUIRED
! Y'PL. OF CONST. :5N FIRS"x. . . . :970 sf LEFT. . .- 11 ft RIGHT. :6 ft
OCCUPANCY GRP. -R3 SECOND. . . :864 sf FRONT. :20 ft REAR- 133 ft
I Uk IL•:S. . . . . . . :2 F I NPSMENT:0 sf -`--
I iF 1 GH T. . . . . . . . :24 ft T01'AL ---- - : 1834 s.h SMOKE DETECTORS. :Y
F LOUR LOAD— . 140. 140 pssf VALUE. . . . . $: 125094 PARKING SPACES. . : 1
Itemar,l.(s : PATH I
-.___________________-.--.____- PLUMBING
NK3. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 IkACKFLOW PREVNTRS. . : 1
WATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
!b,`(iHOWERS. . . . ..3 LAU14DRY TRAYS. . . : 1 CATCH BASINS. . . . . . . 30
iLk LLUSE'f5. . :3 SEWER LINE (ft ) . -0 GREPSE TRAPS. . . . . . . 10
5'l-AWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
,kL�ACiL DISP. . . : 1 RAIN DRAIN (ft) . -0
a�F!1fVG
MACH. . . : 1 SF RAIN DRAING. . . I
__._.._-__---__..._ MECHANICAL --- -_..________..__-______.______.___---- FEES
JEL TYPES--------._._._.._ UNIT HTRS. . :O type amo1_tnt by date rhrr.t
AS/ / J VENTS . . . . . :0 TIF $ 1550. 00 JF 01/30/95
-IX INIDUT:O BTU VENT FANS. . :4 SWM `F 180. 00 Jr 01/30/95
,.1kN ( 100K . . : I HOODS. . . . . . : 1 SWM $ 100. 00 JF 01/30/95 -
RIV ) =100K :0 WOODSTOVi.S. :0 SPRT $ 498. 00 JF 01/30/95 -
UUk F URN. . . . :It7 CLO DRYERS. : 1 BPLC: $ 323. 70 KAR 12/29/94 X34-260043
,11_/EMP ( 31AP:O OTHER UNITS: 1 LA5PC $ 24. 90 JF 01/30/95 --
GAS OUTLETS: 1 PARK $ 500. 00 JF 01 /30/95 -
---MPRT $ 43. 50 JF 01.'30/95 -
�r' MILLER MPLC $ 10. 88 JF 01/30/95 -
0 BOX 23291 M5PC $ 2. 18 JF 01/30/95 -
B'FH $ 225. 00 JF 01/30/95 -
G(aRD OR P5PC $ 11. a5 JF 01/ 30/95 -
-)f]T"le #: 684-7543 EROS $ 64. 00 JF 01/30/95 -
cnt'.,actor: -- _.w__.._._ ____.__.___.---.__.__. $ X30. 130 JF 01/30/95
IY MILLER ERPC $ 20. 190 JF 01/30/95
BOX 23291
i Lj(4RL) OR 97281
�,nne #: 684-7343
'Py #• • 30109
This permit is issued subject to the regulations contained in the -- --~- REQUIRED INSPECTIONS - -- - --
T,aard Municipal Code, State of Ore. Specialty Codes and all other Foot/fol.lnd Insp Fireplace Insp
applicable laws. All work will be done in accordarce with approved Post/Beam ;Strltct Gas; Line Insp
pians. 'his permit will expire if work is not started within 188 post/Bea^s Meehan InSUTAt ion Insp
days of issuance, or if work is suspen ed for more a j180 d ys. Pim/Lindslab Insp Gyp Boar-d Insp
} PLM/Underfloor Vain drain Insp
���� Lyt
Mect)nnir_al Ina Water Line Insp
i ..,rmitLee E�iynatUr r . p
( PlUmb Top Ol.1t Appr/Sdw1k Insp
;pb Lay ° I- r•Aming Insp iylecllxnxcal Final.
R14 1�00' t 1 a:m M.iii-1
CITY OF TIGARD SEWER CONNECT i ijiti
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
13125 SW Hall Blvd.Tigard,Oregon 97223.6109 (503)639-4171 PERMIT #. . . . . . . : SWR95--0007
6,,':l v 1 /i DATE ISSUED: 01/30/95
PARCEL: E'S104Bl)-RM010
SITE ADDRESS. . . : 13789 SW ROSY Cl'
i bUBUIVISION. . . . : ROSE`. MEADOWS ZONING: R-7
6LUCK. . . . . . . . . . : LOT. . . . . . . . . . . :010
TENANT NAME. . . . . a
USA NO. . . . . . . . . . s FIXTURE UNITS. . . :
1-i-0 13S OF WORK. . . :NEW DWELLING UNITS. . : 1
i Yi-'L OF USE. . . . . sSFF NO. OF' BUILDINGS: 1
INSTALL TYPE. . . . :BUSWR IMPGRV SURFACE. . : : sf
Remarks : PATH I
Uwner, _ .___---__..________.__.______.___ __._. FEES
JAY MILLER type amcirnt by date recpt
P 0 BOX 23291 PRM"r s 2200. 00 JF 01/30/95 -
INSP t 35. 1710 JF" 01/30/95 -
T I GARD OR
E-'hone. #: 684-7543
Lontractor,s
t-oiliTRACTOR NOT ON FILE
l i o n e #s 4 2235. 00 TOTAL
-------- REUUIREU INSPECTIONS
ibis Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the (hlified Sewage Agency. The permit empires 168 days from _
the date issued. The total amount paid will be forfeited if the
permit empires. 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 purchaee
a "Tap and Side Sewer" permit and the fgency will install a lateral.
i
t m i t t•e e Si gnat Ure
ed LAy: -
Call for inepec-tion 639-4175
��
Residential Building Permit Application i
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Ld Office Use Only
',ubdivlston• � :k' � Lot#
Valuation: "'v. [r�
—� Permit #�5T7-S'(�OC1
Owner: I 1 1 Reissue of
Address: i�L� �X >� �J.��2` _ Map& TL #. `7 ; ; `4 r !_ /` 1
I /`I Approvals Re uired
Phone: i I 7 1t��1
Planning �-t- ��•'�f r-A �''�
Contractor: 'C tip• Engineering .
Address: `.- Other
! Items Required
Phone:
/ (� Subcontractors
Contractor's License # _3 Flo 1
(attach copy of current Oregon license) Truss Details
Subcontractors: Other
(• ng:
���'lumbi �•�
(4-Mechanical:`?V, I MA V C
;attach copy of cvrrent_QP Contractor's License)
Arch ltecUEngIneer: C l,�. I l 1� LJt Cnn Vr ►�[� 1�t V��
Address:
t 1Ct yj(j 1 21
Phone: � � I,3 bo 1
COMMENTS:
Y"/Ii
Applicant Signature & Phone number
Received by: Date Received:
Permit # Accou-?t Description Amount Amt. Pd. Bal. Due
M505 -tivv Bldg. Permit (BUILD) _�� � ✓
Plumb. Permit (PLUMB) ;2 2s,
Mech. Permit (MECH) y3. c y j • y ✓
State Tax (TAX) Y,3 ✓/
Bldg: _' J D
Plumb:
Mech: .2.I�' ,✓
Plan Check (PLANCK) .s.V• SAY_
Bldg: 3J 3.
Plumb: /
Mech: Yft J
,,5u,DZyS 0vo 7 Sewer Connection (SWUSA) :" z u�'
Sewer inspection (SWINSP) 3
Parks Dev Charge (PKSDC) S o L'
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R) 3v / 3u
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
U54
IrAw1*0MF
IA.i A
aAM�TiF ( ) 2-e 's-V
Water Quality (WQUAL) / k"U /A'y f
Water Quantity (WQUA" 1 u e G v
Fire District (FIRE) _
TOTALS: .��I C' 5 ) /
CITY OF TIGARD - RECEIPT OF PAYMENT RECEIPT NO. C95-261097
CHECK AMOUNT 5561A. 01
NAME c JAY MILLER BLDR INC CASH AMOUNT 0. 00
ADDRESS PAYMENT DATE 01/30/95
SIJBD I V 191 ON
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 498. 00 PLUMBING PERM 225. 00
MECHANICAL PE 43. 50 (ST. DUILD PER 38. 33
PLAN CHECK FE 84. S8 SEWER USA ._Rovl. 00
SEWER INSPECT 35. 00 PARKS SDC 500. 00
RESIDENTIAL TRAFFIC FEES 1430. 00 MASS TRANSIT TIF' FEES 120. 00
H2O QUALITY FACILITY FEE 180. 00 H20 QUANTITY F-"nCIL.ITY FEF 100. 00
FROSION CONTROL PERMITFEE 64. 01A EROSION CONTROL PLAN CK ;?0. 80
FROGION CONTROL
MST95-0006
13-789 SW ROSY CT. LOT 10
TOTAI. AMOUNT PAID 01