11585 SW TIGARD DRIVE 11585 SW TIGARD Yf ttT )D9--
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PERMIT TO CONNECT
'14-gard Sanitary Ir istrict �l 4
PERMIT N° U73 DATE
PFhMIT IS GIVEN TO
OF
TO CONNECT A u .Gfw �•e,n ,,t_ f..
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT M;'ST BE POSTED ON THE DES-"RIBED PREMIS M UNTIL CON-
NECTION IS MADE AND INSPECTION Qr' CONNECTION HAS BERN COM-
PLETED.
PERMIT FEE PAID $_ ............................TIGARD SANITARY DISTRICT
By
CONNEC'.ION INSPE^TED AND APPROVED
i
Supertntende 4it
Y
Address-/—/- jiL.4�e� _ Permit No.� _
Permit charge__^� -
Owner �7 p G -i_ Connection fee2XV
_----- —_ Paid by
Type of Building / 0-1 _ __ — - Date connected /- L fe --C, y
Service Rate`_ —Y Inspuction fee 14
Contractor_ Paid by Date
Size of connection `' �__ ` __ Assessment Paid
i
j PTS MOMOA-NOT I C&
` ¢ Citg of Tigard Building Department:
13125 BR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phon4lr 639-4175 Business Phone: 639-4171
Inapectlonr
Foot.nq Plbg. Underslab Mech. bough--In Appr/Sdwlk
Found. Plbq. Top Out Gas Line FIpAL= )
Poet/Beam Struct. sail. Sewer Frdminq -Bldg.
J
Poet/Beam Mech. Rain Drain InaulatLori ir
_Pi -
Plbg. Underfloor WaterLineGyp. Dd. _ h,
ante rtequaatade / Timet AM�- p11
Address.-
Builder
ddress _Builder
ThE FOLLONf f7CRRECTION3 ARE REQUIRED \\\
r�
Je
ct-(7X �'.�� % �3F ,,,l�/GTFJ 13Y
Fes.
Inspector Datar _"/ __
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Call For Roinap.
INSPECTION NOTICE `
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested- — �li Tima A.M._ _P.M.
Address _._� �l.S /l tiL�� Permit # L'
Owner _ J Lot #
Builder
The following Building Code deficiencies are required to be corrected:
-
1 v'
Presented to _ Approved
---
Inspector ❑ Disapproved
Date
CALL FOR.REINSPECHON
ES IJ NO
INSPECTION NOTICE
l
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 6.19-4175
Type of Inspection
Date Requested Time x. A.M._ P.M.
Address
7
Owner� ��l.1-�G� ----.—___-- Lot #
Builder
The following Building Code deficiencies are required to he corrected:
Presented to — —/ Approved
-- f
Inspector ❑ Disapproved
Date L
GALL FOR REINSPECTION
Yes ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested _ Time A.M. P.M.
Address S •`� :. _ ��y/ 7T i
Owner-- - �— ----- -__—. — Lot #.---
BuilderThe following Building Code deficiencies are required to be corrected:
•� LT o �c�t Arr'—CYPA/.L/ —T--0
PLAC z
Presented to _ )�FApproved
Inspector H Disapproved
Date
CALL FOR REINSPECTION
❑ YES ONO
4
INSPECTION NOTICE 1
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Insnection -
Da':e Requested _.'4 _ — Time .A/.M. P.M.
Address
r�r 57--
Owner Lot #
Builder
The following Building Code deficiencies 1Ired to be corroded:
60-0,,J o 47-10 A—) fir~M7:�
cyT71-frn� DNc% OF C'yi2,r�:Z3
Po C�T'5
i
i
Presented to f Approved
Inspector
Disapproved
Date / f I
CALL FOR REINSPECTION
0 YES ❑ NO
CIIYOFTIFARD 1 .,�PERMITO
COMMUNITY CEVELOPMEn Q PARTMENT ' • ' ' ' MST90-0046
13125 SW Hall Blvd, P.O.Box 23397,Tipurd Or .. Z23 (503)639-4176 ''R A MST90-0046
6�9 171 D E 01/30/90
SITE ADDRESS. . . : 11585 SW TIGARD DR PARCEL: 1S134CD-09400
SUBDIVISION. . . . : BURLWOOD NO.4 ZONING: R-4.5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :24
----------------•----------------- BUILDING
REISSUE: DWELLING UN1TS:1 BASEMENT. . . . . . . . :0 of
CLASS OF WORK. :ADD BEDRMS:1 BATHS:1 GARAGE. . . . . . . . . . :0 e`
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS----------
TYPE OF CONST. :5N FIRST. . . . :317 of LEFT. . :O ft RIGHr. :O ft
OCCUPANCY GRP. :R3 SECOND. . . :0 of FRONT. :O ft RF.AR. . :O ft
STORIES. . . . . . . :0 THIRD. . . . :0 of REQUIRED------•-------- -----
HEIGHT. . . . . . . . :16 ft TOTAL------:317 of SMOKE DETECTORS. :
FLOOR LOAD. . . . :40 psf PARKING SPACES. . :O
Remarks:
--------------------------------- PLUMBID:, -----------------------•---------------
SINKS. . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . .I WATER HEATERS. . . :O TRAPS. . . . . . . . . . . . . . :0
1'WSHOWFRS. . . . :1 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :( SEWER LINE (ft) . :0 GREASE TRAPS. . . . . . . :0
IDISHWASHERS. . . . :0 WATER LINE (ft) . :O OTHER FIXTURES. . . . . :0
(GARBAGE DISP. . . :0 RAIN DRAIN (ft) . :0
WASHING MACH. . . :0 SF RAIN DRAINS. . :O
--------------- MECHANICAL -------------- ------------•---- FEES --------------
FUEL TYPES------------ UNIT HTRS. . :O type amount by date recpt
VENTS . . ,. . . :3 PRMT $ 1.04.50
MAX INPUT:O BTU VENT FANS. . :O PLCK $ 67.93
FURN < 100r, . . :0 HOODS. . . . . . :0 5PCT $ 5.23
FURN ?=1JOK . . :0 WOODSTOVES. :O PF14T $ 19.00
(FLOOR F0RN. . . . :0 CLO DRYERS. :C PLCK $ 4.75
BOIL/CAP < 3HP:0 OTHER UNITS:O 5PCT $ 0.95
GAS OUTLETS:O PRMT $ 25.00
Owner: -------------------- ------•-------- 5PCT $ 1.2.5
MIKE ROSHAIC PAYM $ 7.28.61 JLH 01/30/90 107138 `,
11585 SW TIGPRD DR
TIGARD OR 97223
Phone #: 503-620-0411.
Contractor: ------------------------------
OWNER/CONTRACTOR
Phone A:
Reg #. . : OWNER
$ 22P.61 TOTAL.
This permit is issued subject to the regulations contained in the ------•- REQUIRED INSPEC
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Gas L
applicable laws. All work will be done in accordance with approved ost/Beam Insp Insul
plans. This permit will expire if work is not started within 180 Plm/urdelab Insp Gyp B
days of issuance, or If,work is suep�9pded for more than 180 days. PLM/Underfloor Rain
1 -Mechanical Insp Water Line Insp
Permittee Signature: -'/� � - ----plumb Top Out Appr/Sdwlk Insp
Framing Insp Mechanical Final
Issued By: _ Fireplace Insp Plumb Final
Call for inspection - 639-4175
CITY OF rIGARE, RECE IPP OF PAYMENT PEC NOt Or.)10"7 17.9
CHEU. AMOUNT —8 61
NAME s MIKE ROSHAK CASH AMOU14T s .00
ADDRESS: IL585 SW TIGARD DR PAYMENT DArE s 01.--.'0-90
TIGARD, OR P7223 BLOC[ NO/AlKiRt
PURPOSE OF PAYMENT AMOUNr PAID PUPPOSE OF PAYMENT Aholilff, PAID
FUTLOING PERMIT -Mli'r9r,'--00/0 104.51" PLUMBING PEPt9.'T00
MECHOW'- ,, F'F-RPII*f 19.00 STATE BUIL:- 0frRi'1TT TAX 4:7�
rl sfj DIF-0 FEE 72.68
11585 SW TIrjARD DRIVE
PUP LWOOD 4, LOT '24
TOTAL AMOUNT PAID 22 0 6 i
MOLZA
CITY OF TIG, Rte 4
CiYOFWARD PIAN (NECK APPLICATION
0 000
COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK N
u12ssw_H,Moa„n.Pn ro■7339f.Tiq�02y0,9Tm.(s03)c194175,1l� PERMIT y
D(11-E ISSUED
L JOB ADDRESS: - f. _ice L+� T)L-A(c'--0 b C,- TAX MAP/LOT
SUB: ! 4 _. LOT: Y' - I-AND USE:
VALUATION: _� -• '7-
OWNER SPECIAL NOTES
NAME: �_Jf<o�`-�J�I} �C- REISSUE OF
F100RL s L,+ Ab LAST REISSUE: -
7 Ix1r�1� "I "7 Z 2 3 _-- FLOOD PLAIN/
_ SENSITIVE LAND:
PHONE: __ 2 "7
APPROVALS REQUIRED
CONTRACIOR PLANNING:
NAME: --_ �� Mfr e�--)\J•jIjE"r�_ _ ENGINEERING:
ADDRESS: _ FIRE DEPT
OTHFR:
P14ONE-: ITEMS REQUIRED
BUILDERS BOARD #: � EXP DATE: LIST/SUBCONTRACTORS:
------ --- -
BUS TAX: ---------
ARCH/ENGINEER CALCULATIONS:
NAME: _ c U�r C TRUSS OETAII S:_---__
ADDRESS: - _ ---- - - - OTHFR: -
PHONE: --- -- -------------_---•
COP'Q1FN i S: --
SUBCONTRACTORS: PLUMB: MECH:
PERMIT b ACCT H DESCRIPTION AMOUNT AMOUNT PD. BAL. nUE
10-432 00 Building Permit Fees
-- 10-431 00 Plumbing Permit Fees �e^"lt�,.$ 2 - — 25-
_ 10-431 01 Mechanical Permit Feks
10-230 01 State Building Tan (5X)
Building -��—
Plumbing - � �s /• Z'�
Mech ys c/
10-433 00 Plans Check Fee
Building
Plumbing _
Mech _ f1, 5-
30-202 00 Sewer Connection _
30-444 00 Sewer Inspectionu-
51-448 00 Street System Dev Charge (SDC)
52-449 00 Parks 3ystem Dev Charge (PDG) _ -
31-45^ 00 Storm Drainage Syst Dev Chrg (SSOC) -
10-230 06 Fire
TOTAL '
6 / REC H
APPLICANT SIGNATURE
Received By: s44 , Date Received:
cn/3587P/18P - ✓
tAIji1 ERASION CONTROL INh'OItMATION
GENERAL CONiRACT'OR NAME&ADDRESS: CASEFILE NO.:
/�/1i Kc- R >if A X-_ PERMIT NO.:
'5 T I
-�-�A ^ t� '7 Z z APPLICANTNAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME& ADDRESS: -n e--}{-0 I Z z. _
OWNER NAME AND ADDRESS:
TELEPHONE:NUMBERS: - -
APPLICANT_, '�Zy -6'1/// _ PROPERTY DESCRIPTION:
OWNER. _ STREET ADDRESS AND CROSS STREET/LOCATED
GENERAL_CON-MA("I'OR: - �-
EXCAVATION CONTRACTOR:
SITE/JOB:
LEGAL DESCRIPTION:
24 HR/ALTER HOURS EMERGENCY TAX LOT NO.:
CONTA.CT PERSON,TITLE,TELEPHONE: 1/4 SECTION:
b �G�_e,y SITE SIZE,ACRES: _
DISTURBED/WORK AREA,ACRES:
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN Sillt RUNOFF DRAWS'N:.-(J`E' CLE ONE)
(NOTE:PERMITS MAY BE REQUIRED) CATCH-BASIN DITCH -f.!,"PIPEj CREEK
(CIRCLE ONE _PRIVATE PROPERTY
PI`RLTC RIGHT OF WAY
ER �EDIMEN'I'ATI _�QNTROL (ESC) MEASURE
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STA'IILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY FSC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICT!ONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PER MANTFACILITIES
CONSTRUCTION SEQUENCE OTHER
OT HER -
PIAN FOR EROSION CONTROL PREPARED AND SUBMITTED W ACCORDANCE WITH-TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER. SCHEDULEISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABI..E STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT'ON THE CONSTRUCTION SITE.
OWNER SIGNATURE APPLICANT SIGNATURE
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
OFTICIAL USE ONLY.
RECEIPT DATE ACCEPTED
FEE NUMBER---- RECEIVED-- BY- —