10660 SW TITAN LANE ADDRr.--SS:
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IiArecords\mic -)flrn\targets\building.doc
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(XRT IFICATS
CITY OF TIGARD QCC`UPANC
F'cRMIT W. . . . . . . .
COMMUNITY DEVELOPMENT DEPARTMENT DATE I SSUED z 08/10/94
13126.W H&H 31vd.Tigard,Oregon 07223+9160 (503)639-4171
DgrlGFLs 2G1150A--01 .00 �
'.,ITE ADDRESS. . . a 10660 ;3W TITAN LN
"_,USL:V IS I ON. . . . : BE RKLEY E!-;T TEs ;UN I NG i
OLOCH%. . . . . . . . . . x LOT. . . . . . . . . . . . . 1005
CLAsr OF WORK. a AIiD
TYPE OF USE. . . ;SF
OCCUPANCY GRP. s R:3
,_)CCI. FANCY LOADr222 4
TE W;Nl" NAME. . . .
Remcrksi P14TH I
Owner's —..._ ......__ . .. _..___.-._
I._AL)P I JOHNSON
10660 SW T I TANI.N
iIGARD. . . . . . . . . OR 9709
phone #x .5398-96PP4
Contrac-tnra _ _._.._ .......... . .._...._.._
BABY PETERSON
i
1968c SW MURPHY
ALOVIA OR 9.701A7
Phone 0: 64c'--2986
Renu k. . a 84f 17
C?rruiency of the above r ef-erenc-er; building as hereby given, and c ertifxC�
tli►� �.()mpliance with the State 01 Oregon cper,ialty tracf�es for the gtoI.rp,
of'r-olpancy, and usw mndpr- which the r ei Wr ",wed pet-mit wat• issued.
0LJI! I INSP' OR
� _17.iNG3 OFFICIAL
POG 11 N CONSPICUOUS PLACE
I
i
INSPECTION NOTICE /
City of Tigard Building DepartAeent
13125 SW Ball Blvd. T1garA, Oregon 97223
Inspection Line (Ree-O-Phone): 639-4175 Business Phone: 639-4171
Inspection°
-- - — --- —-:�i
Footi.nq Plbg. Undeselab Mech. Rough-in Appr/Sdwlk
P und. Ow 1bg. Top .gut Gas Line ��=i
q.t/Beam Stru San. Sewer Framing 1
Post/Beam Mech. �' Rain Drainx� y� Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. C
-r-,/ &
Date Requested/t Timet ] AN PN
Address: D(oG C� 1 t-C- a'1ti.r PermitrY7t< -�l�
Builder: a
_ 20 ta' e
TBS POLI.0"ING CORRSCTICMS ARE REQUIREDt
WJA
1
Inspectors Date: a�g 4
_e APPROVED DISAPPROVED APPP.t7V8D SUBJECT TO ABOVE
Call For Reinsp.
CITY OF T I iii ARD M A S'T I.--,R P I..R III I I'
COMMUNITY DEVELOPMENT DEPARTMENT 1:T 0., .. , .. .. .. .. :: 111 1':14- 01.8 i.
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (903114t11111-41,11 D()TE ISSUED: 05/24/94
10C,60 SW T1TAN LH
3UBDIVI14310N. . . . . BERKLE''( ESTAI'ES Z C)I 11.N C-)
]"L01.1:., . . . . . . . . . .•. L 07 . . . . . . . . . . .005
--
F'.I"S S I J E DWK'A._L1N6 UNITS91 f
:LASS OF' WORK. 04DD HL.X)RMS: 1 1.,!ATH 8 10 S-f
y P L C)F (.I i]i L '. . . .1.3F F L u 0 R ()R L'--()G REQ1J1.RI:D S A(,KS ..........
' YPE OF' CONST. »5N FJ RST. . . . 268 Sf LEF''T., . :0 ft RIGHT. -.7 f
GRIJ. »R.3 SE(0 N 1). 14 f FRON'T . :0 f t RE AR., 44 f
JOR I ES. . . . . .. . ttC TH I RD. . . . C0 taf R E G U I R E 1)
1k; 161141. . . . . . . . . 22 1 t 0'1'A 1 437 vi f G11C)KE DETU.CTORS. -.Y
LOUR L.0AD,, . . . "40 p�if VAI UE. $ 0 0 1.0 2 PARK.lNG SPA(,ES. I
e ni i.A,(,P.sii 01 H I
PLUVID1.1--Ki
I NKS. 0 FI.-OC)P DRAINS. . 0 1'.4()CKF*LOW I._'R*EVNTR1i;., . :0
PVA`TOR1E.1'3. . . . 0 WA'T'ER HEA'TERS. . . -.0 TRAPS. . -.0
;1JEA/SHOWERS. . . -.0 LfIJNDKY TRAYS. . . -.0 1EPTCH B(.111311.4s. .0
14A TER CLOSETS. . .0 SEWER LINE ('ft) . 0 GREASE TRAPS. . . . .. . . :0
01SIAWOSHEF"3. . V) (J(•)1 E1-01 L J`11 L, ( t t) » »W U1 1-4 E R F I XTU R[_-5. . . . . »V)
ARDPOL DISH'. ., (d R01N DRPJ.N ('tt) . -.0
)P)SH1NG* V) SI: FAIN DRA1HS »0
................................ F'E L 13
UE1. I*YF,E,.,..,)....--...—.-.-.,....,.......-... JN I F H TRS. « -.0 typ ramat.tnt by data -recpt
?!1;.•i/ VENTS :3 T I F $ 0. 00 JF' 05/24/94
111(•1X 114 F,UT-0 P T U VLN'T F*ANS,. '(a K"R 1 $ 146. 50 JF' 05/24/94
F URN < 1.OOK :3 I-IOC.)DS. . . . . . .0 LA P L C I. 9b. c.'.:3 SW 05 (80,/94 94-252111
J F W c:4/1.)11
FURN )=100K 0 WOODS I L)VI.:S. 0 1i 15 P(., `h I I
1-1-C)OR F'URK' C1.0 DRYERS. » 0 MPR,I $ i_"..7. 00 J F 05/24/94
A L -)
l'.4C.).*I.*L./(.'MP < 3HPC P) 011 -N lJNJ. I !�:0 MIJ I I(-' 1� t , J I- 05/k�4P
GPS OUTLETR-0
0 w 1-1 e-r, ............. .......
LAUR1 JOHNSON
G)W 1111,01,11-1\1
T 1 G()R D.. 0R 9 i(4 9
Caritracto-ro
Ci Y 1::'L TE RS 0 11
) SW MURPHY
(11_01.1(•? 0 R 9 100/
q 0 84117
$ 2/5. 31,
finis permit is issued subject to the regulations contained in the REOUT.RED iNsr,cuiciNs
igard Municipal Code, State of Ore. Specialty Codes and all other F 0 0 t f 0 U 1(J .11'1!4 p Me:=haiiieal Fiiir0
loplicable laws. All work will be done in accordance with approved Past/Beam 9t-rt.ict Pt.iil(ftrig I"irial
Mans. This permit will expire if work is not started within 180 Post/fiieAni Meehan L-rc)s-Loii Gorit-rc)l
-ays of issuatice, or if work is suspvndedoT� more th )l@ da).. Mec.,haiiie,-41. liisp Crawl D-r-A.111
F'.ramillq J.nsr)
it P nii t t v e 1:i i.q .1.1-1 is U J.ilk t i 0 1-1 1 n S p
Gyp Irisp
...................
..............
i ir,39 -4 1 '5
v li
Residential Building Permit_l plication t,;VVV
City of Tigard
13125 SW Hall b,vd.
Tigard, OR 97223
(503) 639-4171
Jobslte Address: , �'-cS� ['�A) �`•/
ge, Office Uso O1
Subdivision: E, ,~ Lot #
.L Planck/Rec # r __ L
Valuation:- -
Owner. _�_C'i GC - 1 _T .- Reissue of -
Address: G�1 t /� L' /�_ Map & TL # ' `:, f l 'S
j Approvals Required
Phone. '� Z --
Plannin��
Contractor: —t Engineering ---- -----
Address: GJ Other
_� / ry / Items Required
Phone: �— y C' _J —_ -
—�� Subcontractors
Contractor's License #
(attach C(4 of current Oregon license) Truss Details— —
Subccntractors: Other
Plumbing:_ 'f=-, -- —_ —
Mechanical. &' '
(attac.-h copy of current OR Cot cbr's License)
Atchitect/Engineer:
Address.-
Phone:
ddress:Phone: —
COMMENTS: �� ----- --
!icant Sigi ure & Phone number
Received by: D..te Received:.—_ —_--
Permit st Account Description Amount Amt. Pd. Bal. Due
/ns -Ul L Bldg. Permit (BUILD) .$C1 �Vy ' ►/
Plumb. Permit (PLUMB)
Mech. Permit (MECN) vZ�}y•
State Tax (TAX) �rt
Bldg:
Plumb:
Mech: ' z y V
Plan Check (PLANCK)
Bldg:
Plumb.
Mech:
Sewer Connection (SWUSA)
Sewer It-ispection (SWINSP)
Parks Dev Charae (PKSDC)
Storm Drainage Cher (SDSDC)
Residentia! TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (T-IF-C)
Industrial TIF (TIS-i)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WOUAL)
Water Quantity (WOUANT)
Fire District (FIRE)
TOTALS: �: S'
■
CITY" OF TIGARD LL H I I i I L W k. OF
OCCUPANCY
COMMUNITY DEVELOPMENT DEPAR"MENT PERMIT' 14. . . . . . . i MST`92-025A
13125 SW Hall Blvd.Tigard,Orqgc 1 97223*8199 (503 $30-4171 DATE ISSUED 08/ti/93
PARCELt 2SI1`SAA-07300
[TE ADDRESS. . . a 10660 SW TI VON L.N
SUBDIVISION. . . . x PERMLEY ESTi:,'rES ZONING:
BLOCK. . LOT. . . . . . . . . .. . . . s 005
[;LASS OF WORT;. :NEW
TYPE OF USF. . . tSF
OCCUPANCY GRP. oR3
OC'CLIPAN(-',Y LOOD2222 4
*1 UNANT NAME. . . I
Rpm;4rks : path I
Owner s
JAY MILLER 1+L.013 INC
Phone #.-
Contractors
.TAY MILA-ER
PO BOX 23291
*TIGAPD 0117 '37c'81
Phone 684-7943
Req N. . v 30109
Cic:cupakricy of the above referenced builditig 1 % hereby giVot-1, Arld certtfier,
the campliali(::lm wits the State Of Oregon specialty Crudes for the group,
occupancy, and k4se under which the referenced permit Wag i5l§Lled.
FIRE DEPAPTMENT
DUI G I fECTOR
S n T I T
DUTI T 1, b I A0
UTLbI ICIAL
P,]9T IN CONSPILUOUS PLACE
INSPECTION NOTICE
city of Tigard Building Department �l41
1.3125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-1Phone): 639-4175 Buaineas Phone: 639-4173
Inapectlor.: --- __-.-
Footing Plbg. Undorelab Hoch. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAI.:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Inau. -.Plumb.
Plbg. Underfloor //Mater Line Gyp. 1- -Hoch.
Date Requestedt O -�' 93 TLOW1 AH
Addreeel Permit Ie02 -Q��I
Builders`�`'?I
THE POT-WING COP"CTIONS ARE REQUIRED:
Inspectors _ _-�--- Dates `
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
�� Call
For Roinsp.
Pigs No. 1 t486 HISTORY FOR. CASE NG.: MST92-0254
JAY MILLER BLDR INC
10660 SW TITP.N LN
09/09/99
Action Description Req/ Schd/ End/ Action Notes Die,: by Update !q i
Code Sent Done Done Date by
MSTA007 Application received / / / / 10/29/92 PASS JLH 02/01/93 KE
MSTA010 Plan check deposit paid / / / / 10/29/92 ]PASS JLH 10/29/92 BLT
rISTA020 Plan check by 10/29/92 / / 10/29/92 PASS RT 10/29/92 BLT
MSTA030 Check to- prel. restrict. / / 10/29/92 10/29/92 PASS hT 10/29/92 BLT
MSTA092 (F) Issue combination permit / / / / 11/04/9? PRNT JH ♦7/04/92 ill
MSTA097 Issue plumbing signature form / / / / 11/04/92 JLH 11/1.'/92 JH
MSTA097 Issue plumbing signature form / / / / 11/04/92 JLH 11/23/92 JH
MSTA705 Foot/found Insp / / / / 11/06/92 PASS TLP 11/12;92 TLP
MSTA710 Post/Beam Structural / / / / 11/20/92 PASS T!.P 11/25/92 TLP
MSTA711 Post/beam Mechanical / / / / 11/12/92 PASS TLP 11/25/92 TLP
MSTA715 Plm/uncilab Insp / / / / 11/18/92 PASS TLP 11/19/42 TLP
MSTA720 Mechanic-' Insp / / / / 12/28/92 PASS TLP 12/29/92 TLP
MSTA722 Plumb Top Out / / / / 12/22/92 oASS TLP 12/28/92 TLP
MSTA725 Framing Insp / / / / 12/30/92 APS OS 12/31/92 GES
MSTA735 Gas Line Insp / / / / 12/22/92 PASS TLP 12/29/92 TLP
MSTA740 Insulation Insp / / / / 01/08/93 G1/08/93 TLP
MSTA745 Gyp Board Insp / / / 01/14/93 APP GS 01/14/93 GES
MSTA755 Rain d-ain Insp / / / / 11/16/92 PASS MS 11/17/92 MRS
MSTA760 Water Line Insp / / / / 11/16/92 PASS MS 11/17/92 MRS
MSTA765 Appr/Sdwlk Insp / / / / 01/21/93 1 Regrade sidewalk to provide required PEND LT 02/01/53 KE
full 4 inches of concrete. 2 Compact
sidewalk 6 approach prior to placing
concrete.
MSTA770 Misc. Inspection / / / / 11/13/92 PASS TLP 10/04/93 TLP
MSTA795 Mechanical Final / / / / 08/11/93 PASS TLP 06/12/93 TLI
MSTA797 Plumb Final / / / / 08/11/93 PASS TLP 08/12/93 TLP
MSTA799 Building Final / / / / 08/11793 PASS TLP 10/04/93 TLP
MSTA960 (F) Issue Cert, of Occupancy / / / / 08/11/93 JF 09/14/93 JF
MSTA970 Case Pinaled / / / / 08/11/93 PASS TLP 10/04/93 TLP
Page No. I CASE HISTORY FOR CASE NO.: MST94-0182
LAURI JOHNSON
10660 SW TITAN LN
09/09/98
Action Description Req/ Schd/ End/ Action Noes Disp By Update Upd
Code Sent Done Uone Date By
----------------------- ------------
MSTA007 Application received / / / / 05/06/94 PISS SW 05/09/94 BLT
MSTA010 Plan check deposit paid / / / / 05/06/94 PASS SW 05/09/94 BLT
MSTA020 Plan check by 05/09/94 / / 05/09/94 PASS RT 05/09/94 BLT
MSTA030 Check for prcl. restrict. / / 05/09/94 05/09/94 PASS JLO 05/09/94 P:I'
MST'A092 (F) Issue combination permit / / / / 05/24/94 JF 05/24/'4 JF
MSTA705 Foot/found Inep / / / / 05/26/94 Not ready; plans unavailable. FAIL WEW 1,/26/94 RB
MSTA705 Foot/found Insp / / / / 05/27/94 Footing and foundation wall are PASS 3iEW 05/27/94 RB
monolithic,
MSTA730 Poet/Beam Structural / / / / 07/15/9-1 sheath pony wall less than 14" in FAIL RB 07/18/94 RD
height; lap vapor barrier.
MSTA710 Post/Beam Structural / / / / 06/10/94 PASS RB 08/10/94 RB
MSTA711 Poet/Beam Mechanical / / / / 07/15/94 n/a PASS RB 07/18/94 RB
MSTA720 Mechanical Inep / / / / / / PASS 08/10/94 RB
MSTA720 Mecl,anical Insp / / / / 08/10/94 PASS RB CS/10/94 RB
MSTA725 Framing Inep / / / / 07/15/94 POST/BEAM STRUCTURAL; ELECTRICAL COVER; FAIL RS 07/18/94 RB
PLUMBING TOP-OUT- N/A; POSITIVE
CONNECTIONS; DRAFT STOP FURRED WALLS:
INSULATE FOUNDATION WALL W/RIGID; H-3
CLIPS REQ'D FOR VAULTED RAFTERS,
MSTA726 Framing <RSINSP> / / / / 07/20/94 PASS NEW 07/20/94 RB
14STA740 Insulation Insp / / / / 0'7/19/94 PASS WEW O7/22/94 RB
MSTA745 Gyp Board Insp / / / / 0'7/22/^4 PASS WEW 07/22/94 BLT
MSTA755 Rain drain Insp / / / / 06/02,/94 PASS TLP 08/10/94 RB
MSTA'155 Rain drain Insp / / / / 08/10/94 PAS nB OP/10/94 RS
MBTA'/95 M"hanica_ Final / i / / 09/10/94 PASS RB 08/10/94 RB
MSTA799 Building Final / / / / 08/10/94 PASS RB 08/10/94 RB
MSTA960 (F) Issue Cert. of Occupancy / / / / 08/10/94 MO 08/19/94 JG
MSTA970 Case linaleG / / / / 08/1^/94 PASS RS 08/10/94 RB
MSTB715 Slab Insp / / / / 06/21/94 this inspection for slab only PASS TLP 06/22/94 TLP
MSTB775 Rain Drain Insp / / / / 06/7.1/94 Pt SS TLP 06/22/94 TLP
46-
C17YOFTIGrARD
Cffy0FTWARDPERMIT #. . . . . . . : IYIST92-0254
wi J
COMMUNITY DEVELOPMENT DEPARTMENT
13125SWHWI Blvd. P.O.Box 23397,1 igard,Orwjon 97R23,(603)"-41f5 DATE ISSUED; 11/04/92
51TE ADDRESS. . . : 10660 SW TITAN LN PARCELS 2S115P.#4-BE5
SUBDIVISION. . . . : BERALEY ESTATES ZONINGS
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :5
-------------------------------------- BUILDING
REISSUEll DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :NEW BEDRMS:3 BATHS13 GARAGE. . . . . . . . . . ..440 sF
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS-----------
TYPE OF CONST. :5N FIRST. . . . :90:6 sf LEFT. . : 12 ft RIGHT. :7 ft
OCCUPANCY GRP. sR3 SECOND. . . s760 sf FRONT. :20 ft REAR. . :57 ft
STORIES. . . . . . . 12 THIRD. . . . 10 sf REQUIRED
HEIGHT. . . . . . . . :22 ft TOTAL-----.--•- 1686 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . 14@ psf VALUE. . . . . $ : 85476 PARKING SPACES. . : 1
Remarks: path I
PLUMBING ------------------------------------
SINKS. . . . . . . . . . . I FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :4 WATER HEATERS. . . 91 TRAPS. . . . * " * . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY 'TRAYS. . . :0 CATCH BASI�S. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE (ft ) . :O GREASE TRAPS. . . . . . . :0
DISHWASHLRS. . . . : I WATER L1NE (ft ) . : 100 OTHER FIXTURES. . . . . :127'
GARBAGE D I SP. . . - I FAIN DRAIN ift ) . :171
WASHING MACH. . . - 1 SF RAIN DRAINS. . : I
----------------- MECHANI-`01- --------------- -- FEES
FUEL UNIT HTRS. . i0 type amount by date recpt
/GAS/ VENTS . . . . . s.?l TIF $ 1460. 00 JH 11/04/92 233
MAX INPUT-0 B-Tu VENT' FANS. . 14 BPR1 $ 391. 00 JH 11/04/92 233
FURN ( 100K . . : I HOODS. . . . . . : 1 BPLG $ 254. 15 JLH 10/29/92 233225
FURN ) =100K . . :0 WOODSTOI,E--. -.0 B5P(11 $ 19. 55 JH it/04/92 233
FLOOR FURN. . . . �O CLO DRYERS. : I SSDC $ 260. 00 JH 11/04/92 233
O1*HER UNITS: 1 ['A R K, $ 500. 00 JH 11/04/92 233
GAS OUTLETS: 1 1y1PRT $ 43. 50 JH 11/04/92 233
Owner.: MPLC $ 10. 88 JH 11/04/92 233
JAY MILLER BLDR INC. M5PC $ 2. 18 JH 11/04/92 233
PPRT $ 140. 00 JH 11/04/92 233
$ 7. 00 JH 11/04/92 233
Phone #t
Contractors
Jf,Y MILLER
PC) BOX 2SP91
TIGnRD OR 97281
Phone #: 684-7543
Rey #. . : 30109
$ 3108. 26 'TOTAL
This persit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS
--- ---
Tigard Municipal Code, State of Ore. Specialty Codes end all other Foot/found Insp Fireplace Inep
applicable laws. All work will be done in accordance with approved Post/Beam Stt'L(Ct Gas Line lnsri
plans. This ppreit will expire if work is not started 0thin 180 Post/Beam Meehan Insulation 1n%p
days cif issuance, or if work is suspended for more than 180 days. PIM/ands lab Insp by Board Insp
PLM/Underf I clor Rain drain Insp
Permittee Signature A±i=21���--2-�&�:=, Mechanical Insp Water Lin,- Insp
Plumb 'Top Out Appt-/Sdwlk In,.-,p
Issued Sy : (21,,-- Framing Insp Mechanical F` irjal
Call for inspec.,tion 639-4175
SEWER CONNECTION
C11YOFTIGARD PERM17
cn RD PFP1,11T #. . . . . . . : c"WR92-0340
COMMUNITY DEVELOPMENT DEPARTMENT 0290MON
13126 SW Hall Blvd. P.O.Box M97,Tigard.Oregon 974:0 JBP4"TS C� DATE ISSUED: 11/04/92
�ff7
SITE ADDRESS. . . . 10660 SW TITAN LN VIARCEL: 2S115AA--BE5
SUBDIVISION. . . . : BERKLLY ESTATES ZONING:
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . ..5
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : F=IXTURE UNITS. . . :
CLASF; OF WORK. . . :NEW DWELLING UNJrS. . rl
TYPE OF USE. . . . . ISF NO. OF BUILDINi5'. 1
INSTALL T YPE. . . . :BUSWR IMDERI) SURFACE. . : - sf
Remarks: path I
Owner: FEES
JAY MILLER BLDR 1NC type amol.int by date reept
PRIYI T $ 2100. 00 JI-1 1- 1/04/92 233
IN SP $ 33. 00 JH 11/04/92 233
Phone #:
Contractor:
CONTRACTOR "401 ON FILE
Fah one It- s 2I.35. 00 rOTAL
Reg ti. .
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the ruies and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires IN days from
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 prospects feet in all directions from
the distance given. If not so located, the installer shall purniase
a "Tap and Side Sewer" Permit and the Agency will install a lateral
f,P v ni i L t. e e Si.rA n t 1 1 r e :'4rb__;t
Issi.ted By :(�
for inspection 639-4175
2_5
Cr •f
q s�
t ARD 13125 SW Ifall Blvd. PLNCK/RECT k /0-57 ?CITY OF
PO Ba.23397
C0MMIINI1T DI•:VEI,oI'M EN'r DEPARTMENT 7igar4Oregon 97113 PERMIT #
(503)6
J9-4171 DATE ISSUED
JOB ADDRESS: (L'(r J�Aj T1 L, L��ad . TAX MAP/1.01 ;1 S/ /5 4,q —L397 ;
SUB: IJ;f' /-�r L wr 1 LOT: _ t_AND USE:
VALUATION:
OWNER _ SPECIAL NOTES
NAME: C;_�� l L�o�, I�IC , -��c� REISSUE OF:
ADDRESS: 1� G . � CsL `Z �'L�3 \ LAST REISSUE:
l " CA�7� FLOOD PLAIN/
PHONE: �' - SENSITIVE LAND:
CONTRACTOR ,cam APPROVALS REQUIRED SLt R6/-UO/-ff
NAME: YY)L PLANNING: MA�_-K -
ADDRESS: _ ENGINEERING:
------ ---- -- - --- --
TIRE DEPT: —�r —
PHONE: _ OTHER: 1tic--V�C—
CONTR. BOARD 9: _ EXP DATE: _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: I'' I l 1Niil ' �� lY�� I IST/SUBCONTRACTORS:
MICE: --k l 1-If _ BUS TAX:
&RCH ENGINL_F_R CALCULATIONS:
NAME: — TRUSS DETAILS-
ADURESS: _ OTHER:
PRONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SI NATURE '���
Received By: ____ DaLe Received:
PERh111, # ACCT # DESCRIPTION AMOUNT AMOUNT P0. BNL. 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 (5Y) ✓ _
Building / yrs
Plumbing
Mechinicai _�oU
10-433 00 Plans Check fee -so
Building
Plumbing
Mechanical 104-Y �
10-230 06 Fire
WO 30-202 00 Sewer Connection
30--444 00 Sewer Inspection 35
25-448--02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees _
25-448-03 Officc- off Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (POC) ei0
31-450 00 Storm Drainage Syst Dev Chrg
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2.4-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
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