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10698 SW TUALATIN DRIVE ADDRESS: j iAtecords\microfIm\targets\buildinc;.doc CITY OF TICARD COMMUNITY DEVELOPMENT DEPARTMENT 7ERT..FICATE OF 13125$W Hall Blvd.Tirard,O,egon 97123*8199 (503)639.4171 OCCUPANC V PFRMIT #. . . . . . . s MG1"'- 4--l?l301' 639--4171 DATE: ISW-T: 1214/1215/9 .j prARrELs ITE ADDRESS. . . : 10698 SW I UALAT IN UR )UBDIVIF1ON. . . . : DOVER LANDING Z ON I NG:R--i., I-'.k L 0 C V. . . . . . . . . . LOT. . . . . . . . . . . . . I CLASS OF WORK. :NEW TYPL OF USE:. . . :SF 11CCUPANCY GRP. s R3 ICC'UV'(-)NC i LOAD t 0:30 4 ' ENANT NAME— I -4marksu PATH I Owneri 1A'Y MILLER 0 LOX 23291 TGARD nR '317281 � 'hone #c 684-7543 Gontracturt 1;Ay mil.-LER F-10 BOX X230459 TISARI) OR 97C'91 illolle 0: 684-7543 --pq #. . : 30101 !!cc,.ipmnc-y of the above referenced building is hereby given, and certifies ihe compliarme with the 113-tate of Oregon Specialty C,)dps for the group, and use under whicli thc- referenced lermit weksA issued. '33 P U ILDING IfiSPECTOR I'Allt-14. 1NUL, I I.C. IAl POS) IN CONSPICUnLIS PLAEL' INSPECTION NOTICE city or Tigard Building Department 13125 SM Ball Bled. Tigard, Oregon W22 'inspection Line (Rec-O-Phone)t 639-4175 Bun iae8a Ph ne 9-.117 Inspectlont -- Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk Found. Plbg. Top Out Cas Line /�rINALt t, Pont/Beam Struct. San. Sewer Framing ` Bid Poet/Beam Mech. Rain Drain Insulation -Plum Plbg. Underfloor Wa_ar. Line Gyp. ad. Mech. ---_ Date Requ9st�e'dL�'� !� _ PM Address: J LZ ermit� f Builder: THE FOLLOWIN3 CORRECTIONS ARE REI.)'IIRED: i Insfpctor:---�, __----------� Datet z APPIOVED DISAPPROVED APPROVED SUBJECT TO ABOVE Cell For Reinap. t� .• ---T-•-- •,•.,---tet Ya9*v� �}V�1AMI�R ew',.....,.. I APPL. '►N — STREET IMPROVENIENT/EXCAVATION CO : COPY PY TOTO.)•FILE ORDINANCE N!: 1-14 7 r (V(PINK)-OTHER AGENCY BldgELLOW)•INSP. 1 - (:NS7RUCTIOWS ON SEPARATE SHEET)) F. 1'�� (BLUE)-APPLICANT APPROVED � APPLICATIOA NO.: NOT APPROVED [] ('I IN' Oi: 1'IGARD, OREGON FEC AMT. t► -- PENDING FEE.PMT. ❑ C1IY HALL RECEIPT. NO.: _ �- PENDII G SECURITY Cl PUBLIC WORKS DEPARTMENT BY -- -- DATE_ 1 PENDING AGENCY ''OK'' D Application and Progress Record MAINTENANCE BOND X L�-• PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION Ac• RFUUI'.Fu ANNUAL. PENDING VARIANCE ❑ EXPIRATION DATZ / -- PERMIT NO.: 4- DATE ISSUED: _ LZZ1. BY (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL _ 2► ,Yfl-TlE."._-. ilA�..1�.1�t. ---- by>�1�11 AS DESCRIBED HLREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT _ �dY Millet Buildwr, lIli . P.O. &.)x 23291 2igacd, OR IT97281 NAME ADDRESS CONTRACTOR- PLANS ONTRACTOR_ A ADDREE — CITV PHONE r. City of Tigard Standards & _Sira PLANS BY- ------ ---�AMF9 ADDRESS cifv - ►+oNE __- ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ BOU.20 DOLLARS _ - - - - - PUH OFFICE W.R. '.MIN. (2) EXCAVATION DATA: 0.04 x s )�S2i2---- STREET r DESCRIPTION PROGRESS 8c INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE HY TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY _ -- -- STREET ?�N — IhSPfL - rualatin Dc. e"a att Chert R TIO V) Q U -- E ESTIMATED STRILT OPENING DATE:_. I -- T -- ESTIMATED STREET CLOSING DATE: I ED — STREET (3) SECURITY N(), ---- SECURITYAMT: $ 800-U0 — CLOSED _ SURETY CO.: _ _ FINAL -- CHECK _ _. CASH 11BOND - INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS: FEATURES; EXCAVATION LOCATION AND EXTENT.] h7 Si�'H Atta; — Y :'lexi — - 1 I 1 I 1 ' 4 I -- (URS S. W. Tualatin Drive t—-- -----—--- — -- — — � _ xx I Cwuck area 1 I SITE: 10699 S.W. Tual4ty D ivel —�-- I - (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION T'O APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OP THE STATE OF OREGON. THE APPLICANT AGREES T'O DEPOSIT THE REQUIRED SECURITOES, TO COMPLY WITH ALL P,OTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE — DATE / / xm��w -M DEPARTMENT OF LAND USE&TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 155 NORTH FIRST,HILLSBORO,OR 97124 COUNTY, INSPECTION REOUESM 503/640-3561/693-4415 OREGON NOTICE. Title permit becomes null and 1rold If the work or construction for which It Is Issued Is not commenced within 180 days. Once construction hes started, the permit becomes null and vold If construction Is Interrupted for a period of 180 lays, I certify that the Information presented by the applicant and his agent or agents In support of this permit Is true and correct!o the beet of our knowledge. I acknowledge that the Building Department's reliance upon false and misleading Information may Invalidate thl-permit. All provisions of applicable laws and ordinances governing the construction and use of this building or structure will be compiled with whether or not specified on the plane or noted on the plans correction sheets. I acknowledge that the granting of a permit does not grant authority to access private preperty or to use saeemeits. I further acknowledge that the use or occupancy of the structure or bulldinq permitted depends upon my calling for Inspectln,�a at various times during the process of construction and the building Inspection staff verlfyer,g compliance with t a various codes. Use or occupancy of the buildhi j or structure permitted prior to approval by the B6:lding Department Is solely at the risk of the applicant and such use or occupancy Is revocable wrtii all Inspection requirements are satisfied and approval Is given by the Building Official. I further acknowledge that a Ilan may be placed on the title of the property upon which the permit Is Issued specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requirements. APPLICANT'!SIGNATURE WASHINGTON COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation Electrical Inspection Section APPLICATION 155 North First Avenue, 11350-12 Hillsboro, Oregon 97124 Information: (503) 640-3470 Fax: (503) 693-4412 Perini; r' �) Number � �T DatePLEASE PRINT Please complete all Sections, 1 throUgh 5. 4. Complete Fee Schedule below 1. Location of installation Number of Inspections per permlt allowed Addressy S �^-' 7LA,A ��ti n,' ,� Service inr luded: Items Cost(ea.) Sum �,. Building A. Residential -per unit City / A ,l,p Suite 0. / > S' loon Sq.n.or less _ -- $1 10.00 �� 4 Tenant Name Each additional 50C sq.ft (if commercial) c l - �� or portion thereof —_ $25,00 —J ' Limited Energy $25,00 Map No. Tax Lot Each Manuf'd Home or Modu!ar Dwelling Service or Feeder $68.00 Thomas Map Book: Page: . Section: _ B. Services or Feeders Installation,alterations or relocation 200 amps or less $60.00 2 Commercial ❑ Resideritiat � 201 amps to 400 amps $80.00 _ 2 401 amps to 600 amps $120.00 _ 2 2a, Contractor installation only: 601 amps to 1000 amps - $1 — 2 Over 1000 amps or volts $3440.00 0.00 2 Electrical CuntractorF /�` i_ Reconnect only $50.00 .— 2 Address 3 j 1� 4 ayj Date_ Job Number C. Temporary Services or Feeders Property Owner :T 61 j P) 4- Installation,alteration or relocatinn Contractor's License No. 200 amps or less $50.00 2 Contractor's Board Reg. No. ` 201 amps to 400 amps $75.00 _ 2 401 amps to 600 amps $100.00 _ Signature of Supr. Elec'n Over 600 amps to 1000 volts see'B'above License No.-;LA a Phone No. - D. Branch Circuits New,alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with purchase or service or feeder fee. -- Each branch circuit -_ $5 00 Print Owner's ams hone No. -- ---- ' b) The foe for branch circuits without Mdioss — — purchase of mrvke or feeder fee. First branch circuit $35.00 2 City -� Stale ip Each add'nl branch circuit_— $5.00 _ 2 E. Miscellaneous (Service or Feeder not included" The installation is being made on property 1 own Each pump or Irrigation circle $4000 2 which is not intended for sale, lease or rent. Each sign or outline lighting $40.00 _ Signal circult(s)or a limited Owner's Signature - — — energy panel,alteration or extension $40.1'10 _ F. Each additional inspection over, the allowab), in any of the abcve 3. Plan Review section (if required) Per inspection T $35.00 Please chec%appropriate hetn and enter fee In section 5B. Per hour $55.00 —_ In dant $55.00 4 or more residential units in one structure _Service and feeder, 800 amps or more 5. Fees _System over 600 volts nominal A. Enter total of above fees $ ' 9 Classified area or structure containing special5°� Surcharge (.05 X total tees) $ _0-_— occupancy as described In N.E.C. Chapter 5 Subtotal $ ne A for � Submit 2 sets of plans with application where any of the Plan Review iB. Enter 2E'fo of lirequired (Section 3) $ '�4 0 above apply. Not required for temporary construction Subtotal services. t_ess Bulk Label Fee $ Balance Due $ - For inspections call this pern,"becomes null and—id It the worts aulhorlred by the permit is not commenced 640-3561 or 693-4415 with.n 180 days from date of issuance of euct perm"or"the wnrh authorlred Is suspended or abandoned at any rims after wr M Is commenced to,a period d 1110 days. 24-hour recorder, one working day in advance of need €fectrlcalPermits aro non.retundobleand non-renderable. 4'94 rr , 1. ARTMENT OF LAND USE & TRANSPORTATION WASHINGTON j �ti� LAND EEVELOPMENT SERVICES DIVISION' #350-12 155 NORTH FIRST, HII_LSBORO, OR 91124 .-� COUNTY, Q PHOME: 503/640-3470 OREGON D INSPECTION REQUESTS (24 hours): 503/640.3561 or 693-4415 Permit # : 05059494 Project. # P0044609 Status APPROVED Flag 1 of 1 Applied 10/13/94 IW--ued 10/13/94 Expires 04/11/9x) 12/13/94 06 : 48 RESELEC Permit Title SFR - ELEC/NEW HOUSE OTH Description LKBX ' KAT' Begun 10/13/94 ,lob Address 10698 SW TUALATIN DR TI Owner Name INSPECTION - TIGARD Region Applicant Name T & M ELECTr'1 C Phone number 250-1596 Va.luatiola (? pprc,:ed Inspector Comments . ReJec IVR-RESULT: REQUEST ERROR ! Inspected by ��� _ Date 1�3 --- I nspe� -t ion Regaast ed . * Cover & Service 0403 E AP N 12/13/94 RI 1F I DEPARTMENT OF LAND USE & TRANSPORTATION � �wI>SHII\i�TQN LAND DEVELOPMENT SERVICES DIVISION #350-12 — +5i NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OF OON INS'►-'ECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 F,erm� Ir 05059494 Project, 4 P0044609 Status APPROVE?, Pagt- 1 of ;:>p lied 10/13/94 Issued 10/13/94 Expires 04/ 1i/95 01/19/95 05 ? 1 RESELEC ermit T.itl.r LFR - ELF''C/NEW HOUSE UTH e,=rcri.ption LKPX ' KAT ' Begun 10/ 13/94 cab Aadress I f)69A SW TUALATIN DR T1 caner Name N - T I CARD Req.z�;n U '�pplic.ant Nanr...• i & I'1 h;..III+.'TR1, Thane number 2S0- 1596 Valu ii .i :>n 0 Appr ve,d_..... __. nspectorr~,, „ants D�RIJ>f�►+ " S rob RP Icy : t.�,d__ ! --0_lw 7-4 . IVR-i�EsulTOO __ _ /4AX Im '4-"'f'vr 'r"w0A >'/f�� lJf�� it/c�� �� St' REQUFST ERROP I Tip -yGXIi,P ( `fes / �Y'`of�taf 'Of,, �/l� �'1��( ,l--A"It P? 4&4 c, A n se Ar Ow-0!l 1(e a�'f—fe 4 ' Plumbing Mec:hani cal Electrical Structrual General Ir,opPC_t:Fd by !. t6a,�.( y . 1tc�G/-4 Da I. Inspe, tion Requested final Elactr -aT�� 0499 E Ap L,N 1 v 30 Page No. 1 CASE HISTORY FOP. CASE NO.: MST94 0308 JAY MILLER 10690 SW TUALATIN DR 09/10/99 Acticn Description Req/ Schd/ End/ Action Nol.ea DisF By Update Upd r Code Sunt Done Done hate By MSTA007 Application received / / / / 07/27/94 PASS JF 08/08/94 BLT MSTA010 Plan check deposit paid / / / / 07/27/94 PASS JF 08/08/94 BLT MSTA020 Plan check by 18/08!94 / / 08/08/94 PASS RT 08/08/94 BLT MSTA030 Check for prel. restrict. / / 08/08/94 08/08/94 PASS JLO 08/08/94 BLT MSTA092 (F) l9sue combination petmit / / / / 08/08/94 JF 08/08/94 JF MSTA097 Issue plumbing signature form / / / / 08/08/94 JF 08/08/94 JF MSTA705 Foot/found Tnsp / / / / 09/06/94 Footing Inspection PASS WEW 09/09/9. TLP Jim Nicolai called and alerted me to detail calling for additional support for keyway in retaining wall. Additional boringe to keyway installed per detail. MSTA705 Foot/found Insp / / / / 09/08/94 TFIB INSPECTION FOR FOOTING WALL PASS TLP OQ/0904 TLP MSTA117 PLM/Underfloor / / / 12/29/94 PASS TLP 04/06/95 TLP MSTA720 Mechanical Insp / / / / 12/14/94 SASS TLP 12/14/94 TLP MSTA722 Plumb Top Out / / / / ':/29,'4 PASS TLP 11/30/94 TLP MSTA725 Framing Insp / / / / .2/08/94 add connectors to rafters over garage PASS TLP 12/14/94 TLP add support to end of ridge board... MSTA726 Framing <REINSP> / / / / 12/14/94 PASS TLP 12./14/94 TLP MSTA735 Gas Line Insp / / / / 12/14/94 PASS TLP 04/06/95 TLP MSTA740 Insulation Insp / / / / 12/15/94 PASS TLP 12/16/94 TLP MSTA745 Gyp Board Insp / / / / 12/19/94 PASS TLP 12/20/94 TLP MSTA755 Rain drain Insp / / / / 11/29/94 PASS TLP 04/06/95 TLP MSTA760 Water Line Insp / / / / 11/29/94 PASS TLP 04/06/95 TLP MSTA765 Appr/Sdwlk Insp / / / / 12/30/94 1) REMOVE FULL, DEPTH OF CURB ON BOTH FAIL LT 01/04/95 SW SIDES 6 DIG OUT FOR FULL DEPTH. 2) PLACE BOARDS FOR WINOS. 3) COMPACT ROCK IN BUBBLE FOR FULL 4" DEPTH. MSTA765 Appr/Sdwlk Insp / / / / O1/US/95 1. Place boards in wings (or felt) PEND LT 01/18/Qb NL 2. Be prepared to protect finish. MSTA795 Mechanical Final / / / / 04/05/95 PASS TLP 04/06/95 TLP MSTA797 Plumb Final / / / / 04/05/95 PASS TLP 04/06/95 TLP MSTA799 Building Final / / / / 04/05/95 PASS TLP 04/06/95 TLP MSTA960 (F) Issue Cert. of Occupancy / / / / 04/05/95 JF 04/24/95 JF MSTA970 Case Finaled / / / / 04/05/95 PASS TLP 04/06/95 TLP MPiSTER CITY OF TIGARD PERMI r #. . . ... . : MST94--0308 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUE=D: 08/08/94 13125 SW Hell Blvd.Tigard,Orugon 117223.8199 (503)639-4171 PARCEL: 2S?. 15AD-03800 SITE ADDRL.iiij. . . : 10698 SW TUALHT 11V Det SUBDIVISION. . . . : PrIVER LANDING ZONING: R-2 131-OCK. . . . . . . . . . . LO1.. . . . . . . . . . . . . : BUILDING REISSUE:MST94-0307 DWELLING UNITS: 1 BA5EMENT. . . . . . . .. :960 sf CLASS OF WORK. &':EW HEDRMS:3 BATHS:3 GARAGE. . . . . . . . . „ :609 sf TYPE OF USE. . . :SF FLOOR REUU I RED SETBACKS ----------- TYPE OF CONST. :5N FIRST. . . . :966 sf LEF1— :5 ft RIGHT. :5 ft OCCUPANCY GRP. :R3 SECOND. . . :660 si f FRONT. :`0 ft REAR. . : 15 ft STORIES. . . . . . . a2 'THIRD. . . . :0 s f RLUU I RE D__________________ . HEIGHT. . . . . . . . :30 ft TOTAL------- -- 1626 s f SMOKE DETECTORS. :Y FLOOR LOAD. . . . :40 psf VALUE. . . . . >f : 177119 PARKING SPACES. . : 1 Remarks: PATH I ---------------------------------- PLUMBING -..-._.____._.__________.---______.___._.__.___... SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . : 1 LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :@ TUB/SHOWERS. . . . :4 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . 10 WATER CLOSETS. . :3 SEWER LINE (ft ) . :IZ. GREASE TRAPS. . . . . . . :0 DISHWASHERS. . . . : 1 WATER LINE (ft) . : 100 OTHER FIXTURES. . . . . :0 GARBAGE DISP. . . : i RAIN DRAIN (ft) . :O WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1 MECHANICAL ________..___.__.______._______.____._._ FEES _.-_. ____---•-----___.. FUEL TYPES-- -__- --_--- UNIT HT'RS. . :21 type amount, by date .-ecpt. /GAS/ / / VENTS . . . . . :0 TIF t 1550. 00 JF 08/08/94 - MAX INPUT:O BTU VENT FANS. . :4 BPRT $ 628. 00 JF 08/08/94 - FURN ( 100K . . :0 HOODS. . . . . . : 1 BPLC $ 50. 00 JF 07/26/94 94-254923 FJRN ) =100K . . : I WOODSTOVES. :0 P"r 5 .31. 40 JF 08/08/94 FLUOR FUPN. . . . :0 CLO DRYERS. : 1 a 280. 00 JF 08/08/94 - BOIL/CMP ( 3HP:0 OTHER UNITS: 1 5011. 00 JF" 08/08/94 GAS OUTLETS: l APRT S 45. 00 JF 08/08/94 Owner: _..__..___...-.. _....._._._..___.._..__________.___._.-- --_-MPL.G $ 11. 25 JF 08/08/94 JAY MILLER M5PC $ 2. 25 JF 08/08/94 P 0 BOX 23291 3BTH 1. 225. 00 JF 08/08/94 - 17,5PC $ 11. 25 JF 08/08/94 -- TIGARD OP 97281 ,:ROS t, 64. 00 JF 08/08/94 - Phone #: 684-7543 ERPC >Z 20. 80 JF 08/08/94 - Contractor: _.._._.._.._.___._____._..________._._..__.__ERF'[ f 20. B0 JF 08/08/94 JAY MILLER PO BOX 23291 I f CARD OR 97231 1=hone #: 684--754; 30109 ___---__--_--___________________.-.-_-- f 3439. 75 TOTAL 'his perei.t is issued subject to the regulations contained in the -------- PEGlUIRED INSPECTIONS ---- Tigard Municipal Code, State of Etre. Specialty Codes and all other Foot/found Insp Fireplace Insp applicable laws. All work will b done in accordance with approved Post/Beam Struct Gail Line Insp plans. This permit will expire if work is not started within l" Past/Beam Meehan Insulation Insp days of issuance, or if work is sus pe ed for eo th 18@ days. Plm/1.lndslab Insp uyp Board Insp PLM/Under-' ' oor Rain drain Insp Permittee Signature : _ 1�V1�1 ✓� Mechanical Insp Water Line Insp 1) r Plumb Top Out Appr/Sdwlk Insp lss,_ted Py : Framing Insp Mechanical F it nl Call for inspection - 639~-4175 CIT` OF TIGARD SEWER ERMI .. SON r'CRMI T COMMUNIfYDEVELOPMENT D ,T PERMIT #. . . . . . . . aWR94-0`B�r F,AR TENT DATE ISSUED: 08/08/94 13125 8W Hall Blvd.Tigard,Orman 97223.8199 (503)639-4171 PARCEL; cS 1 15AD--Q)380Ql `:ii:TL ADDRES: . . . : 10698 SW TUALATIN ER UBDIVISION. . . . : DOVER LPINDI14G ZONING: R- BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . TENANT NAME.. . . . . : USA NO. . . . . . . . . . : FIXTURE UNITS. . . CLASS OF WORT;. . . :NEW DWELLING UNITS. . : 1 f YPE OF USE. . . . . :SF NO. OF SU I LP I NGS: 1 INSTALL TYPE. . . . :BUSWR IMPERV SURFt- X. . : : St" kemar•ks : PATH I Owner— FEES JAY MILLEh type amor.tnt tjy date r-ecpt 0 BOX 213c:91 PNMT $ 2200. 00 JF 08/08/94 _ INSP 9, .:35. 00 JF 08/0-e/94 TIGARD UR 97C-`61 684-7545 –ontt^actor: CONTRACTOR NOT ON FILE ------------------- $ 2235. 00 TOTAL -- -- – REQUIRED INSPECTION:3 his Applicant agrees to comply with all the rules and regulations Sewer~ Inspection of the Unified Sewage Agency. The permit expires 160 days from the date issued. The total anoint paid will be forfeited if the _ permit expires. The Agency does not guarantee the accuracy of the -ide 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 Ag ncy will install a ;Iteral. I>er,mittee .,i gnatures Issr-recd By : f. al l for- inspect ion - 639-41`75 f ■ LNUIRM Residential Building Permit A Iicatio City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 i ,Jobsite Address: Office Use O Subdivision: bQ tN ItY1jAM_r_ Lot#_� all� _ Valuation: Planck/Rec# L Corner Lot? Y N Permit # - Flag Lot? Y Reissue of L25 i G 3el 'f Map & TI_# / ) / Owner: AAprUvals Required Address: 1ACUZ Planning,, _ItUAM ,_ O 1 ZS I — Engineering .� Phone: ���"1 ��`7 Other Contractor: Items Required Address _._._—. Subcontractors --- — -- Truss Details Phone _ - – Other Contractor's License # (attach copy of current Oregon lirensc�) Contact Name & rihijne: Subcontractors: Architect/Engineer:L„ 1 _ f J Plumbing: _ � i Address: b IvLX /Mechanical: l _ _ I Y(( . �F- ��•Z.�S� (attach copy of current OR ontractor's Licsnse) / Phone: ' 4C 1 JOB DESCRIPTION: i _ [ _ {•_ ' (� ! /'- �i ,�,��, eta •y.., c Applicant Signature & Phone number Received by: Date Received: N MORMCOMDMRESAPP G r P.M Permit# Account Description Amount Amt. Pd. Bal. Due o-561,Y Bldg. Permit (BUILD) �•�� Plumb. Permit (PLUMB) - .2z )Mech. Permit (MECH) State Tax (TAX) .' �� y ° ✓ Bldg: J Plumb. /! " Mech: at / i Plan Check (PLANCK) 4z /J Z Bldg: —5(1 , V� Plumb. / Merh: J eSw1�J U�6Z1 Sewer Connection (SWUSA) ����' z Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) 5 v u i Storm Drainage Chg (SDSDC) 99 Residential TIF (TIF-R) Jct Mass Transit TIF (TIF-M-f) 2- Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) _. W,iter Quality (WQUAL) _ Water Quantity (WQUANT) i Fire District (FIRE) Erosion Cntrl Permit (ERPRMT) v� J Erosion Planck/USA (ERPLAN) 4v Erosion Planck/COT (EROSN) �' g kl) I TOTALS: