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10761 SW TITAN LANE C7 �t CJS r u� -3 H r t� I i I i I �. 10781 i► -91TA14 LANE `" CITY OF TIf�IRD CM'OFr,64RD * COMMUNITY DEVELOPMENT LEPARTMENT c ON 13126 SW HWI Blvd. P.O.Box 2339-,T*M,OrsWon 97223(W)53r&4176 Zt-..RTTf;- .t%.ATE- OF OCCUPANCY b,*?0 4171 DATE Iss'UH)k VIP/03/93 'ATU­. ODDRESS. . . : IOJ61 SIA' " I T'AN I Iq PORCEA-o SUSD 7 V I S I ON. . . . 9 SEAKI.I.- Al Es FALOCK. . . . . . . . . . r (_CIT. . . . . . . . . . . . . 323 (A-ASS OF WGRI-I. ,,,qEW lYr"#E-- OF USE. . . a SW GUPANCY (: RP. e R3 U-C-L)PANCY 1.AYADIc-,!24 4 (E,NONT W-eME. . . j kemmrkt; i MILLER 1 ,110no #3 t. o lit rocA or I JAY MILLER !ID BOX 23t,:191 �1, 10ARD OR " /Ial. t'hojip Ov 684-7343 mutt 0. - 3 30701) Occupwicy Pf the above referenced bui Idinij i v hvreby 41ven, and cirvt tho complianoa wi4J1 Vie State W Ureqon Iipocialty CufAvia fors the grof,111. ort',upmoic,V, and usp under, whivh the refer-onced periwit wag imvi-iod. FIRE. DEPAH1M1---NT OFI fl. 1111. f0SI* IN CONSPICU(JUS PLACE J INSPECTt011 NOTICE City of Tigard Building Ik"rt&Mt 13125 SN Ball Blvd. Tigard, Ore00n 9722.. 7 . !nspeation Line (Rec-O-Phone: 639-4175 Buainees Phone. 639-4171 Irspec Ucn ---— - — ---- Footlny Plbg. Underslab Mech. Rough-in Apr.r/Sdwlk Po,,nd Plbg. Top Out Gas Line }INALs ..L/Beam Struct. San. Sewer Framing dg• frit/(Pf.im Mech. Rain Drain T­.ilation Plba. underfloor Nater Line Gyp. Bd. ell-�Data Requested:_L'- � y Times ______AM PM Acdreees_ /'.).Z /z , Permit fs �- �•Z Builder: THE FOLLOWING CORRECTIONS ARE REQUIREDs I Inspectors` — Dates _ M APPR!VED DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinsp. N;!LF LOIN LOT City of Tigare Building Department 13125 BW Ball Bled. Tigar.l, Oregon 97223 Inspection Line (Rec--O-Phone): 639-A175 Busi.ne,aa Phone: 639-4171 Inspections_______`_ Footing Plbg. U eralab Hoch. Rough-in �ppr/Sd-1 k Found. Plbg. Top Out a=as Line FINALS Post/Beam Struct. San. Sewar Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Piba. Underfloor Water Line Gyp. Bd. -Hoch. i Date Requested:_ :: �--:l pmt AM PM Address:- /cc1+=7Z �__ Permit Builders TRS FOLLOWING conRECTIONS ARE REQUIRED: C Inspectors,_ 13 lz--PROV6D DISAPPROVED -_ APPROVFP 6URJRtn TO Asovs _,Cell For Reinap i, i i 1VSPF.cT M'lOTICF CK City of Tigard Depart-eat 13125 SW Fall Rl-rd. Tija•1, Oregon 97223 Inspection Linn ((Rec-O-P¢one)i /63/9-4175 Business Phone: 639-4171 :nspectioni__ \=CrY�CiY F->oting Plbg. Underslab Mech. Rough-in Aper/"wlk Found. Plbg. Top Out Gas Line PINALI Post/Beam Struct. San. Sewer Framing -Bldg. Poet/9eam Meth. Rain Drain Insulatl.on -Plumb. Plbg. Underfloor Water Line Gyp. Bd. ••Noels. Date Requested: )2, G J r-1 Z Times �L.AN PN Address s ( lh���(f l_ Permit Hui]3e_s THE FOLLOWING CORRECTIONS ARE REQUIREDs LIA Q LID 6_27 Inepsx!tors �-_ rHA :2 /ym 4-5 Dates APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Rainsp. I N-S�'RCT I L.___N�IJT Z CR City of Tigard Building Dbpart:arant 13125 SM Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rer..-O-Phone): 639-4175 Business Phone: 639-4171 Inspection:—^. ----- __ ----- ---- _-- ----- Footinq Plbg. Undera.lab Mach. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Strutt. San. Sewer Framing -Bldg. Post/Beam Mach. Rain Drain Inattlati.on -Plumb. P1bg. Underfloor Water Line Qy�. B) -Mach. ?� Date Requentedds' I `1 Z- Timet _—AM ✓� PM Addressz—j,, o ( (A�.Q'VN Permit #t Builders \.1 , THE FOLIA.`NINO CORRECTIONS ARE REQUIRED. Inspector: �� W - --- — ---V- natal APPROVBD DISAPPROVED T` APPROVED SUBJECT TO ABOVE F-ir Teinsp. JMSPECTION NOTICE City of Tigard Building Department 13125 SN Nall Blvd_ Tigarri, Oregon 97223 Inspection Line (Rec--O-Phon -): 639-4175 Business Phone: 639-4171 Inspection: -- Footing Plbg. Underelab Mech. Rough-in Appr./Sdwlk Round. �JPlbg. Top Out/ Gas Line FINAL: Pont/Ream Struct. San. Smmr Frmning -Billy. Post/Bean, Mech. Rain Drein Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Koch. Date Requested:] �lJL-` F'I _—_Timer AM _PM Address: �' ! -- - s\�C-cy\ LA" Permit #s Builder: THE FOLLOWING CORRECTIJMS ARE REQUIRED: Inepec or ' Deter APPROVED DISAPPROVED APPROVED SUBJECT To A30VE Call For Reinsp. a� MAjjff INSPECTION NOTLO City of Tigard fti.l.ei-ng reparts--t 13125 SN Ball Sled. Tigard. ore7on 9/223 Ins)•ection Lino (Rec-O-Phone): 639-4175 BuoinenB Phone: 639-4171 Inspect ion:_—_ ----- -- ---- —__ -— Footing Plbg. Jndeeelab F•ech. R)UJ,I-ill Appr/sdwlk Found. Plbg. Top Out Can Lina FINALt Poet/Rc3am St-urt. San. Sewer Framing -Bldg. Pont/Beam Mech. Rain Drain IMulation -Plumb. Plbg. Underfloor Nater Line Gyp. 8d. -M'ta . Date ReGueataAs /4— // Z. --•. Timet ___AM C.K _rH permit ft�L. �GZ3n :HE FOI.I!%iING COHRECTI,.)NB ARE REQU1REDs IL Inspectors, _� Datet .�— APPROVED DISAPPRO A PROVED SUBJECT Tn ABOVE 1 Call For Reins�- INSPECTION NOTICE City of Tigard Build n,, "part, 13125 SW Ball Blvd. Tigard, Oregn Inspection Linn (Rec-O-Phone): 639-4175 Bueinens one: 639-4171 Inspections Footing Plbg. Underelab (��ech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Liao Line FINAL: Poet/Beam Struct. San. Sewer /naming) -Bldg. Poe!-./Beam Hoch. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. Nech. Date Requested:_ — / ! Time: AM PN Address:1-=�/] �- ^ermit #:_ Builder: TNR FOLLOWING CORRECTIONS ARE REQUIRED: i -7 Inapnotofi Date..�L APPROVED DISAPPROVED APPROVED SUBJECT Tn ABOVE Call For Reinep. a+Al w1 INSPECTION `!OTIC1; City of Ttgard Building Department 13125 SW Hall Blvd_ Tlgan:, Oregon 9727.3 "�-�- Inspection Lire (Rec-O-Phc.e): 63'-4175 Business Phone: 639-4173 Inspect ion t Footing Plbg. Underslab Mech. Rough-in A q ppr/Sdwlk J, Pound. Plbg. Top Out Gas Lige 1 FINALt Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Hater Line Gyp. Bd. -Mech. Date Request:/ed:__ _' Time= AM __PM Address: v/l Permit #lel,--D� _-3Builders THE FOLLOWING CORRECTIONS ARE REQUIRM _. Inspectors - Date t _' PROVED i_ DISAPPROVED APPROVED SUBJECT 73 ABOVE Call For Reinsp. w INSPE=Off NOTICE City of Tigard Bui.Id-nq Department � 13125 SR Hall Blvd. Tigard, Oregon 97223 Inspection Line (It:xc-O-Phone): 639-4175 Business phone E.*46-1171 Inspection: Footing Plbg. Underelab Mech. Rough--i Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAU st/Beam Struc�i Ban. Sewer Framing -Bldg. P''ost99/Ream ! Rain Drain Insulation -plumb. Plbg Underfloor Water Line Gyp. Bd. -Mesh. Date Regsseeteri:__.. —Times !1N pp Address- rmit Builder:— THE FOLLOWING CORRECTIONS ARE REQUIREDs r Inspecrtors Dates "PROVED DISAPPROVSG _-- "PROM SUBJECT TG A'SOVB --..Call For Reinep. ' o MEN Z INSPECTION AiCTICE � City of Tigard Building Department 13125 SLI Ball Blvd. Tigard, Oregon 97223 Inspection Line (Reo-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: __ ____—_--- Footing Plbg. Underslab Mech. Rough-in A,pr Sdwlk Fkund. Plbg. Top Out Cas Line FINAL: C-foot/Beam Structs San. Sewer Framing -Bldg. Pest Mec Rain Drain Insulation -dlumb. `bq. Underfl r' Water "no Gyp. Bd. -Mach. 2- Date Requested! G! - '� 7y�Z- __ Timet - PM Address: / Permit is GJ 30 Builder: TRE FOLLOWING CORRECTIONS ARE REQUIRED: v Ci /ISL. _J <. ^1Jr.-s'4�,� � �t,,it,w � •� Z Inspectors` Date APPROVED DISAPPROVED APPROVED SDBJECT TO ABOVE y Call Por Reinep. MW INSPE'"TION NOTICE City of Tigard Building Department 13125 89 Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Plbg. Underelab Hoch. ough•-in Appr/Sdwlk Found. Plbg. Top Out Cas Line FINAL- Poet/Beam Struct. San. Sews`?1 Framing -Bldg. Poet/Ream Hoch. Rain Dr& ) Insulation -Plumb. bg. Underfloo. Nater Line Gyp. ad. -Hoch. Date Requested- /� Times ` AN PH Addreae: — —v �� �� _ Permit Ru i l der s_ THE FOLLOi1ING OORREMIONS ARE REQUIRED- --- --- ----- Inspactor_� rve="=APPROVED -- DISAPFROVED f._._._-. APPPOVED SUPYRM- TO Aliavv, Cell For Reinep. i jNSPEGSION NOTICE City of Tigard Building Depa-t--t 13125 SW Ball Blvd. Tigard, oregan 9721.3 Inbpection Line (Rec-O-Phone)s 639-41.75 Business Phone -4171 Insp-e-cttiions _ -. --- ing 1 Plbg. Underelab Mech. Rough-in Appr/Sdwlk. t—.d. PIbg. Top (Nit Gas Line FINAL: Poet/Beam Struct. San. S,._�wer Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Lino Gyp. Bd. -Mech. Date Requested: Z..- Times -t/ � — PM Ada--a. /(2 Permit Builds,.:-_��j t_ THE rorLOWIl10 rARRECTIONS ARE REQUIRED: -- -- Inspectors ` Date: –_ –_.. APPROVED DISAPPROVRD APPROVED SUBJ.CT TO ABOVE call For Rainap. 1 aw CITY OF TIGA RD i' COMMUNITY DEVELOPMENT DEPARTMENT MN0 13126 SW Hall Did. P.O.Sm W�23397,TlgsM,Oregon 97223(66310-41715 MASTER PERMIT PLRMIT #. . . . . . . a MST9a-0L 639-4171 DATE ISSUED: 10/1.3/92 SITE ADDRESS. . . 1 1.0761 SW TITAN LN PARCEL: 25115AA—BEc',s SUBDIVISION. . . . : BERKLEY ESTATES ZONING: BLOCK. . . . . . . . . . : Lor. . . . . . . . . . . . . :23 BUILDING REISSUE: DWELLING UNITS- 1 BASEMENT. . . . . . . . :0 sf CLASS OF WORK. cNEW 9EDRMSc4 BATHS:3 GARAGE. . . . . . . . .1 . 1438 1 . 1436 Sf TYPE OF USE. . . :SF FLOOR AREAS----------- REQUIRED SETBACKS---------- TYPE OF CONST. e5N FIRST. . . . . 1034 sf LEFT. . e5 ft RIGHT. -6 ft OCCUPANCY GHP. : R3 SECOND. . . :896 sf FRONT. s20 ft REAR. . -.50 ft STORIES. . . . . . . :2 T14IRD. . . . :0 sf REQUIRED_________________--_ HEIGHT'. . . . . . , . :24 EQUIRED--------------------- HEIGHT'. . . . . . , . .'24 ft TOTAL-------'. 1930 sf SMOKE DE1ECTORS. :Y FLOOR �_OAD. . . . :40 psf VALUE. . . . . $: 960164 PARKING SPACES. . : 1 Remarks : PATH I ­1----------------------------------- PLUMBING SINKS. . . . . . . . . . .. I FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0 LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . :0 TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH SAS I 3: :0 WATER ULCSETS. . :3 SEWER LINE (ft) . i@ GREASE TRAPS. . . . . . . 10 DISHWASHEnS. . . . : 1 WATER LINE (ft) . .' 100 OTHER FIXTURES, . . . . 10 GARBAGE DISP. . . j1 RAIN DRAIN (ft ) . sO WASHING MACH. . . .- 1 SF RAIN DRAINS. . sl ----------------- MECHANICAL- --------------- FEES ---------------- FUEL UNIT HT RG. . s 0 type amount by date teept /GAS/ VENTS . . . . . :0 TIF $ 1460. 00 JH 10/13/92 — MAX INPUTi@ BTU VENT FANS. . :4 BPRT $ 424. 00 JH 10/13/92 — FURN ( 100K . . : I HOODS. . . . . . : 1 BPLC $ :'75. 60 JLH 09/28/92 232097 TURN ) =100K . . :0 WOODSTO')ES. .-O B5PC $ 21- 20 JH 10/13/92 -- FLOOR FL1RI,,(. . . . -0 CLO DRYERS. : I SSDC $ 280. 00 JH 10/13/92 — BOIL/CMP ( 3HP:0 OTHER U1\1ITS: 1 PARK $ 500. 00 JH 10/13/92 — GAS OUTLET6sl MPRT * 43. 50 JH 10/13/92 — Owner: MPLC $ 10. 88 JH 10/13/92 JOY MILLER M5P( 2. 18 JH 10/13/92 PPRI 155. 00 JH 10/13/92 P5PC $ 7. 75 JH 10/13/92 Phone #: Contractor: JAY MILLER P'a BOX 23291 TIGARD OR 97281 Phone #: 684--7543 Reg #. . 1 30109 3180. 11 TOTAL This pet-sit is issued sub'iect to the regulations contained in the REQUIRED INSPELI JONS Tigard Municipal Code, State if 0". Specialty Codes and all other FU0t/f0Und Insp Fireplace Insp applicable laws. All work will be done in accordance with approved Post/Beam Struct Gas Line lyisp plans. This permit will expire if work is not started within IN Frost/Beam Mechan Insulation I%isp days of issuance, or if work is suspended for sure than IN days. Plin/undslab Insp Gyp Board Insp �K 4 PLM/Underf I oat- Rain drain Insp Pprmittee Signature : Mechanical ITISP Water Line Insp Plumb Top Out Appr/SdwIk Insp Issued By : Framing Insp Mechanical Final Coll for inspection 639-4175 CITYOFTIOARD Cf011100" F-ET�MIYOF11 n R9 SEWER COMMUNITY DEVELOPMENT DEPARTMENT 000n ERMcTION T 13126 3W FWI Bbd. P.O.Banc 23397,Towd,Oregon 97223(W)8361176 `� / PERMIT #. . . . . . . SWR92--031 a 639-4171 DA1E ISSUEDt 10/13/92 SITE ADDRESS. . . : 10761 SW TITAN LN PARCELt 2S115AA—BE2:; ',SUBDIVISION. . . . : BE:RKLEY ESTATES ZONING: BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :23 T'ELVAi-4T NAME. . . . . . USA NO. . . . . . . . . . : F=IXTURE UNITS. . . : CLASS OF WORK. . . :NEW DWELL I NG UN I'TS. . : 1 rY PE OF USE. . . . . :SF NO. OF BU I L_D I NUS: I £NSTALL TYPE. . . . :BUSWR IMPERV SURFNCE. . : : sf RpSiorks: PATH I Uwner- : _-___-_ __..------__.__.---.__._____.__----___.__-- —_______.___._..__.._.__- FEES ___.._..._._...------.....-._ , FAY MILLER type amoi.Int by date recpt PRMT * 2100. 00 JH 10/13/92 — INSP $ 35, 00 JH 10/13/ )2 — 1-11tone #: (-ontractore I:ONTRACTOR NOT ON FILE Ifinne #: f 2135. 00 TOTAL --- ---- REDU I RED INSPECTIONS _- ---- lius Applicpnt agrees to comply with 311 the ra►tr and regulations Sewer Inspection of the Unified Sewage Agency. The permit empires 180 days from the date issued. The total amount paid will be forfeited if the permit @spires. The Agency does not guarantee the accuracy of the side sewer laterals. 11 the sewer is no: 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 Agency will install a lateral. K'erm:i. F,tee t7i9nat:atr Issi,ted BY : Call for inspection — 639-4175 I i ITS' OFTIFARD 01YOF11fi ID P1 V I NG V-4.-RIVI I r- COMMUNrrY DEVELOPMENT DEPARTMENT V, IT #. . . , , . . : 13126 SW HNI Blvd. P.O.Box 23397,Thpwl,Orsom 97223(SM)6394175 S I*7'f.-'- F41)DRFISS. 107 C,I SW T ITAN LN PARCE-'-'L c ..-3 1 15AA--BEP'- SU111)I V J S I ON. . . . c BERKLEY EluTATF� 7.ON I N(3., BLOCK. . . . . . . . . . . LOT. . . . . . * . . . . . . s23 CLASS OF' WORK. . cNEW GARBAGE DISPOSALS— : 1 TYPE Or USE. . . . i SF WASH I NG MACI 4,, . . . . . . I 6HCKFL.OW PREVN'rRcs— to occupnicy GRP. . :R3 FLOOR DRAINS, . . . . . . cls TrU-4PH. . . . . . . . . . 0 F�rwR i . . . . . . . . c i? W01'E-R HEATF P'n. . . . . . c COTCH :0 F1 X L OUNDRY 'T RVIY3 I SF RAIN DRO MS. . . : 1 tiTNKG. . . . . . . . . . a I GR1-:Ac3F--- TRAPS. . . . . . . ..Q) I.AVATORIES. . . . . o4 0 I'k IE R FIXTURES. . , . . :0 I UB/SHOWEPS. . . . - SEWFP I TNE ft ) . . . . 0 WOTER CLQrjFT$. . 4 WATER LINE ( ft ) . . . . 100 DISIAWASHIIRS;. . . 'r I ---t-RAI-N DRHIN (ft Remarks PATH I JAY NIL-L.FP TIF $ .1'460. 011A JI-I 10/ BPRT $ 424. 00 JH 10/1,1/92 - SPLC 4 .275. (,0 JLH 1T9/213/92 23209 , B5,171c 9 21 . is!Q, JH 10/ 1 3/q2 -- ' "lone #a GGI)c $ ;Rao. 00 JH 10/13/92 PARK $ 90((1. 00 JH 10/13/92 1711utphing Contrar-to mPkT $ 43. 50 JI-I 10/13/93*-' th. 88 'TH lo� 13/92 N iR m e 3M5P1- 3.'.. 18 JH 10/ 13/92 H d I I.,e S 5 Pf"RI, f 155. 00 J I I I ka/13 9 2 t., i y : stater P5Pc 4 7. 75 JH 10/ .13/92 lipc o n e Heg HEM-11 RED T IONS fle4'10it i ,i I.—mmed suh.ject to the reg- ulations contained in the liqmrcl hunivi pa I Fulot/found Insp paiql drain Crisp Code, c3tate of Ore. SpeL:ialty CodeT"And all, Past/Beam L,.1tk-1Ar-t Water Line Insp other Applicable ]awu. All work will be cione Post /seam lylechan APPv-/'c5cjwlk Incl, in .accordance with Approved plans, This Plm/undslab Inip Mechantral rin,_0 r-ppr-ffif'-will P)tpjr,e if work is i,ot StRYAPLI r-'I.m/Ij1)dPy-f I not, f- lmmb Final Within 180 clays of issuakric-P, or, if wo, it i �' Merhanical Insp Buildint.4 Pinal ,cispencied for mbre than 180 days. 1--1lumb Top Put F-ro s i o n Control Framing Insp Crawl Drain rireplare 11-1--p Gars I-ine Insp 4In9LIlAtIOrl Inch poard Insp SiItnr z rd P) Umb i ng ConfrarS gnat UrP tor (7mll fov ii-vippc-tion 63'4- 4175 Lontract or Not P�: Awl CITY OF TIGARD -- RECEIPT nF rflYMENT RECEIPT NO. a'3 •-P326 4 CHECK AMOUN I : 5065. 11 MILLER. JAY CAIGki-i AMOUNT Q1. 00 PAYMENT BATE t iO/13/'q,:, "AJB0TV!8T0N PURPOSE OF PAYMENT AMOUNT P011) PURP9SE OV Pf,; 'MENT AMOUNT PAID AUILDINGI PERM 4-='.4. 00 PLUMB INF-3 PFRM 155. The CHANICAL. PE 43. 50 ST. 9-'..1lLro PER 31. 13 i4N M4ECK FE 36. 41.1 srwEp USA 8 1 INA. 140 ,LWFR INSPECT 31Z. 00 PARKS SIX, ":00. 00 :.-I- - Tr?AFFIC FEFS 1 1-510. 041 .' iORM DRAIN GDC 280. 00 REGI.DENT IAL MASS TRANSIT TIF FEES 11 q.t. 00 LOT 23 BERKLEY E5,TATES j0-761 SW TrrPN LN T(TVAL AMOUNT Pfall) 50619. 11 �r 13125 SW I loll W& PLNCK/kECT # CITY OF TIGARD PO B'oi 2397 PERMIT # �� COMMUNITY DEVELOPMENT DEPARTMENT TVwd.Omwn9rW (%3)&W4171 DATE ISSUED — JOB ADDRESS: /07&/ 5. v) `1�ta0 L-r) _ TAX MAP/LOT 2S//_5.¢A SUB: ria C5tc,te s LOT: _ 3 LAND USE: — VALUATION: �> >� OWNER SPECIALMIES IJAME: REISSUE OF: _ ADDRESS: P, y , gox -Z.3 2•q 1 _ LAST REISSUE: — V .7. �(A.rd. 01Z �� 1 2-� _ FLOOD PLAIN/ PHONE: _ '� �� _M ___ SENSITIVE LAND: CONTRACTOR APPROVALS REGUIREQ ' uBri/-ou;� NAME: 'n� ,•lle r _ PLANNING: -- ADDRESS: ?arnK ENGINEERING: FIRE DEPT: — PHONE: _ �. OTHER: .`. CONTR. BOARD #: . EXP DATE: — ITEMS REQUIRED SUBCONTRACTORS: PLUMB: "' / �vl 4L-2 LIST/SUBCONTRACIORS: MECH: BUS TAX: _ AR.0. ENGINEER CALCULATIONJ: NAME: __. _ _ TRUSS DETAILS: - ADDRESS: _ OTHER: PHONE: PROPOSED BLDG. USE: COMMLNTS: /hV 111 Gory 414 APPLICANT SIGNATURE Received 6y: ._ — Oate Received: PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. OUE ct2- U.z3v 10-432 00 Building Permit Fees15 10-431 00 Plumbing Permit Fees r; 10-431 01 Mechanical Permit Fees - 10-2'30 01 State Building Tax (5%) — Buildin, l Plumbing Mechanical 10-433 00 Plans Check Fee Building ?}' 60 ' .- Plumbing Mechanical _ L6), 10-230 06 Fire 30-202 00 Sewer Connection .35- — 30-444 00 Sewer Inspection —Silt 25-448-02 Commercial TIF Fees 25-448-04 Industrial TIF 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) 31-456 00 Storm Drainage Syst Dev Chrg 24-445-01 Water Quality (Fee in lieu of) - 24-445-02 Water Quantity (Fee in lieu of) TOTAL 53 J 1 �( `$o nm/3587P.WPF i ..,.,:.wLJ'" • Y%•af..Y.11fYGbitlYlk;M'rlWf:bWfiX1Y�:My{. • a�WiMMwM+.iY�4Yk1Uti�{y'.�6LyyM1M•=' ... CITY OF' T I GAFtD F?F(,F.I F1'T Or F'AYMF'NT REC:E I P'T NO. NWME x MILLER, JAN' CHECK AMOUNT ��.°i�. Nib AD1)RE'SS t CASH AM01..INT 0. 00 PAYMENT IDl1TV 09/c'C1/q; SUBDIVISION » ►IURPOSV--' OF P"AYMENT AMOUNT PA I n PURPOSE OF PAYMF_•'NT AMOUNT PA I U F-�I__AN CHECK FE-__.__... ., ..-vim LOT v�-'3 P RKI._F:Y W31-RTES AMOI.JNT t''A I U - - > 250. 00