11764 SW TIEDEMAN AVENUE i
I
11764 SW TIEDEMAN STREET
W W W W 1F1W1tWWFAW1ffx1ffjWm
CERTIF'ICATE OF
C1�OF XIC�,�IRLQ OCCUPANCY
[IYOFTWARD) Pf:..F*MIT Po . . . . . . I MST90-10243
IE
COMMUNITY DEVELOPMENT C. 011111,
13125 SW Hall Blvd. P.O Box 23397,Tigarc: Oregon DATE ISSUEDi 111/05/90
'311k ADDRESS- -' 11764 SW TIEDFAIAN AVE PARCELv IS135CC-00702
1A.H.11DIVISION. . . . I ZONINGS
1"'I OCK. . . . . . . . . . C LOT. . . . . . . . . . . . . I
GLASS OF WORK. sNEW
TYPE OF USF. . . I F-r
OCCUPANCY GRP. sk3
OCCUPANCY LOADiI18 4
I ENAN
Remarks I
KAOI Z HANJ
145W5 S KIRK RD
ORLIGON CITY OR 97945-0000
Phone 04s 503-632--3846
Contractor)
HANG KAUTZ
14565 9 KIRK RD
OREOCIN CITY OR 97045--0000
Phone #e 503--632-3846
Reg #. . 1 39903
Occupancy of the above TIPferenvied building is hereby given, tnd corttfiec
the compliance with the State Of Oregon Specialk:y Codes fo-,- tne grotip,
occupancy, and rase tinder which the referenced permit was iosmed.
IRE DEPARTMENT OU DINO 'INSPECTOR
PUIFqWO0 v ......
' ——�—1 c WL.
POST IN CONSPICUOUS PLACE
IMIt
1,
INSPECTION NOTICE
City of Tigard Building Department
artment
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Daze Requested Time A.M. P.M.
Ad-iress _LL %Lr?Z— '_�Z.� .��C�a� _ _ Permit -,1),2 y
Owr er ._---- _— Lot 11E
Builder ^—
The folln wing Buildingode' deficiencies are required to be corrected:
i% �. '��_ ...d/i4,;;T> L�•�/s ' i�'7��i ��zs`__�^-'u.zrc. i��T .[1Ps'�'��•al y
AV P i� --
i
Presented to
Inspector _ 1 Disapproved
Date
l CALL FOR REINSPECTION
YES E-I NO
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of inspection c -
Date. Requested Time-A.M.-P.M.
Address u 74� ye/ Permit # ��
Owner ..___ _� _ Lot #
BuilderThe following Building Code deficiencies are required to be corrected:
a
VA 0
kp r 3
404
Presented to ___ /J Approved
Inspector _ l� _ l isapproved
Data --� ---
CALL FOR REINSPECTION
[� Es ❑ NO
W i 1F i �1 Ill► p f�P Ir!'
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 9722.3
Phone: 639-4175
-Type of Inspection
Date Requested TimP.M.
e A.M. ..�L�/.__
Address __ Permit
_.�G���-�
Owner_ Lot
Bui:der Z/)'.�.�---
`Code deficiencies
T C1enc1Q3 required to be corrected:are
The following Building
--
�
Z hy v 5 E: —trL_t t7E�S TLS_
_ .:��vim�ALctL_ o d L _ c.=,•.rn
�Ad c1! ii D� .c�Q biC
A C7
Presented to _ _1LpyoT L-76G Approved
Inspector (/�!l iG disapproved
Date l� ✓ /��--
CALL FOR REINSPECTION
C7 YEs O NO
INSPECTION NOTICE f% 1
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 9727.3
Phone. 639-4175
Type of Inspection
Date Requested.T-� - ,� Time � A.M. P.M.
Address Le,? J Permit *.r/,/) �-
Owner---77 — Lotea
#
E;uilder —- —
The following Building Code deficiencies swtequired to be Corrected:
Presented to Approved
Inspector / Disapproved
Date
CALL FOR REINSPECTION
F1 YES 0 NO
INSPECTION NOTICE K
City of Tigard Building Departinont
P.O. Sox 23397
Tigard, Oregon 97223
Phone 634-4175
Tyne of Inspection
Date Requested _ -s em" Time A.M. �P.M. —
Address �� JI��L� _ T- L�I�G[.e>�zac_ Permit
Owner
1 �— ..._� Lot 0
Builder
t_.
The following Building Codn deficiencies are required to be corrected:
I.l�lL �I
— 'L4 AfE
— —
_- -
_1� 12AL _
- -
Presented to _
Approvr.-i
Inspector �i9i.ppruvel
Date �t — 2.� '�C
CALL FOR REINSPECTION
PE! 0 NO
WW
XW
XWLIR W
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone- 639-4175
Type of Inspection
Date Rtiquested--- Time A.M. P.M.
Addr-ess
Permit
Owner
Lot #
Buildor ?, 'c5e-C
The following Building doMe deficiencies are require, orrerted:
riesented to
A
A pproved
Inspector U, Disapproved
Date
CALL FOR REINSPECTIOAT
0 YE! L—J no
INSPECTION NOTICE
City of Tigard Building Department
P n. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of InspectionJ�= �`�cLl�.e�li� --- -- --
Date Requested.. — Time A.M._ _P.M.
Lf
Address �—j1 Permit 46�' �
Owner_-. � U� -
Lot&
Builde• —_
The following IEuildirtg_I e deficiencies are required to be corrected:
Presented to -- __ ___- - --- FrApproved
Inspector /_ _ __- _--- ❑ Disapproved
Date X —/ _. .- -- -
CALL FOR REIINSPEC77ON
❑ YES NO
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 233W
Tigard, Oregon 97223
Phone: 939-41�75�"
Type of Ir.spection
Date Requested yam- Time
n A.M. P.M.
Addrasa � Parmlt
Owner __ Lot #t
Builder —'L3 –
The following Building` ' e deficiencies are required to be corrected:
Presented to --- Approved
Inspector _ ❑ Disapproved
CALL FOR REINSPF~TION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-41175
Type of Inspection
Date Requested Time A.M. --- P.M.
Address
Permit
Owner Lot #�—
Builder
r
The following Building Co&. deficiencies are required to be corrected:
Presented to _ _ �T Approved
Inspector _ �_� Disapproved
Date.
CALL FOR REINSPECTION
El YES C] NO
yes
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection
' / - - -
Date Requested r "'�oGTime ��' P.M.
Address __ _��7G� ��i�S '"c '� Permit #1
Owner _ — --- - Lot —
Builder ---
1
The following Building Codwieffciencies are required to be corrected:
Presented t _ l� f+pproved
Inspector ( ❑ Disapproved
bate
CALL FOh REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE P
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection - '- ?- e--
Date
' _Date Requested
� �
_ _ Time /1'A.M._ P.M.
�1
Address _ ' _1_C� 2LG�-tom/ Permit
Ow+ier 71— _ _ Lot # _
Builder
The following Building (Dade deficiencies are required to be corrected:
Presented to Approved
Inspector Disapproved
Dolts _,_
CALL FOR RFINSPF,CTION
171 Y E 8 (_] NO
i
i �
� I
I
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 -- Permit
Owner Lot #.
Builder � �.�- - -- —
The following Building Code deficiencies are required to be corrected y//f
-- r►
Presented to _ Approved
Inspector _ __ _ ❑ Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
I
I I
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection
Date Requested=7 I q el 0Time_ A.M._`��P.M.
�
Address 1 L01-/ 1 1 eAC-WI AAV Permit �O-
Owner Lot # y 3
Builder_
The following Building Code deficiencies are required to be corrected:
i
v
Presented to (J Approved
Inspector —
_ Disapproved
Date l`
CALL FOR REINSPECTION
❑ YES 11 NO
C11YOFTIIFARD PIASTER' PIERMI T
COMMUNITY DEVELOPMENT DEPARTMENT � oN'4� FBF R'PI I T' #" " ^ " ` " " ° MST'"�rd-(324 3
11126 SWHall BW. P.o.Box 233397,Tigard,Oregon 97J.q(¢03�m3m-A17B R'R:CI*I. il, a MST9O�-0243
, ;'J 4 % DATE ISSUED' 07/1:3/90
SITE. ADDRESS. . . e 11764 SW TIFIDE::PIAN ST PARCEL. J.S:135CC--•OO7O2
SUBDIVISION. . . . %; ZONI:NU.-
BLOCK. . . . . . . . . . e LUT. . . . . . . . . . . . . .
BUILDING
REISSUE: DWELLING UNIT'Se1 BASE=MENT. . .. . . . . . eO sf
CLASS OF' WORK. «NE::W BE 1)R11S e:3 BATHS e 2 GARAGI::. . . . . .. . . . . :440 s f
TYPE OF USE. . . "SF F"LOOFA
TYI:'E OF CONST.. «;:i hl F-IRST. 1.472 sf L.EF'T. . «9 ft FLIGHT. 217 ft
OCCUPANC=Y GRP,. «R3 SE.COND. . . e 0 sf V RONT. «20 ft RIEAR. . 139 ff.:
STORIES. « 1 THI=RD. . . . «0 1a RE64UIRED----
HEIGHT. . . . . . . .
._.HEIGHT. . . . . . . . x16 ft T'C)7AL. « 14'72 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . .'40 psf V01 UE. . . . . 69744 PARKING 91=10CE S„ . «0
Rema•rF,s e
_.___._......... ...._ .._._.._.._._.._._.__.._._....__.. ........_.. .._._._. PLUMBING _._..._.._._.__._._._.__..__.___..
SINN.!ii. . . . . . . . . . « 1 FLOOR DRAINS. . .. . «(d BACKFLOW I-'REVNTRS. . «0
LAVAT(]RI S. . . . . e2 WATER HEATERS. . . 31 T'RAPIS. . . . . . . . . . . eO
TUX:+/S SOWERS. . . . «2 I...AUNDRY TRAY'S. . . -0 CATCH BASIN S. . . . . „ . ttO
WATER CLOSETS. . e2 SEWER LINE (ft) . :0 GREASE" TRAPIS. . . . . . . eO
1)1:S11WASHERS. . . . .. 1. WATER LI:NI (ft) . : 1O0 OTHER FIXTURES. . . . . «0
GARBAGE DISF'. . . : 1. RAIN DRAIN (ft) .. «0
WASHING MACH. . . « 1. SF' RAIN DRAINS. . « 1
_.___._..._.... ....__.._ ME-CHANICAL - _.._.._._....___._._... FEES
FUEL. TYPE a _.........,..__....__ ._....__ UNIT HTRS. . eO type amount by date reept
/GAS/ / / VE=NTS . . . . . e0 F'AYM $ 100. 00 JLH 06/29/9O 2O2228
MAX INF'1I.)T«0 BTU VENT FANS. . «3 BPI RT $ 343. 00 ! i
F URN < 100K . . e 1 HOODS. . . . . . e 1 BF'LC $ 222. 95
F'URN >=-1O0K . , e O WOODST OVES. :H B5R'C $ 17. 15
FLOOR F'URN. . . . aO CLO DRYERS. : i STDC $ 600. 00
BOIL/CMF' ( 3HP e 0 OTFIER UNITS-.0 SSDC Ai 3 75. 00
GAS OUTLETS: .,[ PARK !g 250. 00
Owrier.e _._.._........__......._._........._....._._..... _...._......_____._.__.._._........._._.__ MF'I:T t; 36. 00
KAOTZ HANS MF:'LC: $ 9. 00
PI aR'f.: $ 1..60 /
1.4563 S KI=RK RD f'F'RT to 117.50
OREGON CITY OR 97045-0000 P5PC $ 5. 68
F'hJlle #.- 503 632-•3646 PIP YM $ 1676. 26 JLH 07/1.:3/90
Carit:ractor a
VAOTZ HANS
1.41565 S KIRK RD
ORE==GON CITY OR 9'/045...00OO
r-'hone #e 503-•632-•3646
Reg #. . « 39903
$ 1976. 26 TOTAL
This permit is issued subject to the regulations contained in the - ---- - REQUIRED I NSPEC'T I ONS -
Tigard Municipal Coder State of Ore. Specialty Codes and all other Foot/found Irisp Mechanical Insp
applicable laws. All work will be done in accordance with approved Wtr F'•roofinq B!sm Plumb Tap Out;
plans. This permit will expire if work is not started within ld6 Past/Beam Struct F'raminq :Cusp
days of issuance, or if work is sus for re 186 days. Fast/Bwam Meehan F'i rep:lar..e Insp
L_.� Crawl Drain Gas I_i.ne Insp
I"'ermi.ttpe " ignat�.rr'ee Plm/r.tndslah Tn,p Insulation Cusp
1 '!3t.rera Dy.- GILM/Underfloor Gyp Board Insp
-
__.._._..r.._..._..........................................._._.. ..__...._ F*t Drairi Bsm' t Rain d•rai.ri Insp
G
Call for ivispection 639-41.'7 5
SEWER CONNECTION c
CITYOFTIGrARDr-'ERM IT
CETYOFTWARA r-'ERMIT #. . . . . . . ; SWR90 0':'.03
COMMUNITY DEVELOPMENT DEPARTMENT « FRIM, PERMIT N. ; P11ST90- 0'4.3
13126 sw fwi Blvd. P.O.Box 23397.Tigard,tar eon 911 4 �6
„sA + i1 DATE: ISSUED'; 0.7/1:3/90
SITE:*. ADDRESS. . . ;; 1. 1764 SW TIEDEMAN ST 1=DARCE:.L; 1S135CC--00702
]:>UDDIVIGICIN. . . . ; "I_IJNINGe
1:11..0CIIS. . . . . . . . . . . LOT.. . . . . . . . . . . . . .
TENANTNAME. .. . . . »
l.lt]A NCI. . . . . . . . . . :42340 FIXTURE UNITS. . . s
CLASS Of'. WORK. . . .14EW DWELLING UNITS— : I.
TYPE OF USE. . . . . ;fSf" NO. OF BUILDINGS' 1.
INSTALL TYM. . . . ..DUSWR IMF ERV SURFACE-9 ;!s f
(3wrie'rg _._______w_.__....._.._..._..__..._.....__. .._.__..... ._.......__._ _ ___.__...____.____._ FETES _.._.._._...........
KAOT1 HANS type '7mot.trit lay date -rrc:l:)t
r'RM T $ 1500. 00
1,4565 ;S KIRK RD INSI $ .35. 00
OREGON CITY OR 9704"5--0000 VlAYPI $ 1 535. 00 JL14 07/13/90
171ha1ie #.- 503 G31'--3846
Cc)rit•racta•rt ...... .___-____.__._.•_..-.__....._.._......____._.._.___._...__....
CONTRACTOR NOT ON FIA-1w
P"har►e Ng 15:35.00 TOTAL
_..........---_...-
REQUIRED INSr,ECTION5
This Applicant agrees to comply with all the rules and regulations 5e_we-r ?.nspecti.al7
of the Unified Sewage Agency. The permit expires 128 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 lorated at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer sha1T purchilse
a "Tap and Side Sewer" Permit and the Agency toil] install a
............._._...............___.__.__....._.... .. .......
1 e•r m i t:is e F•a 11J.q r1<a is I r r e»
I.SSUe(1 I•:+Y o ............ ....... ......... ........ ..........
_.
Call fa-r i.vis;per.tir)ri _ 639--4175
I
I T'Y OF" "r I ripRD - RECEIPT OF P -YMr N-r. REE E:I P T NO. :,;0--,4-,f.:)26.216
CHECM AMOUNT x "441:!. "
tiplMF VAUTZ, HANS (.,ASH A."OUNl t:' CIO
AD DF'ESS t 1456!7, a. h1Pr • FST) PAYMENT DATC- +7? 1 w
CcURDIVISjON
ORI CGON CITY, OR 97045,— 11?64 GO T I EDE.:MAN
i"UFS POSE OF PAYMENT AMOUNT PAID PURPOSE OF PA Y'MENT riMOUNT PAID
Fail I LD'C hJCa F'E:F�M Mu r"?a.�—%t�4'" "1143. 00 PLUMPING PERM 117.50
MECHANICAL PE: -6. 06 `•l" BUILD FEN x'4.87
f:•I,_HN CHECh:: F:'E 17.1 . 95 SEWER LISA
i Wr,F' INSPECT .C.)Ct ."_*TFiE:E:T ".-.VC
!" •FI :; SCLC, STOPM DRAIN SDC
I
1
'TOTAL AMOUNT PAID - 4t. . 2S
Ii! � � i• i• � / � �
-11-9y0 WED 9 :35 DAVID TRAVIS FLOORS 5035324577 P. 01
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�t JUL 199 90014416
Recto list?
�11Y Uf IGAKP 04/241990 01I219110AN
aLANNINr DEPT,
J11L- 1 1 -90 WED a :36 Dwv I D TP"V 1 S FL.CIQRS 503E.3246 i r a
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M •1 sA • r.trt !sea+as N1t•avr. sumo ria11 a1 on "od"M ewe uau sat atlKvt r11
Nml 10MOM 1fM M mid iwrtdar * M41' Jews &-,VtM A Ata
� tleai4. 39. et+rr•• aw
b rive eeagelfae N I.r. 'rle6�gR/ Aroyee q. wets •fi Mit b +,
emsorline tar%sf f0"u'!!t' feat an.10 tees sa Ilaa1 tie
tMte+ •Sass e4o rse` ilr+•/ ordt 6wQ f W ell meprelr 111114 gs �M it rod •
4 �•ees�iais Ier !N. /►-94Rtl. Mm$ 1/"!6'109 MI 191.10 tit„ L/1 IoM im 1110 in
1 /arab 11"!1 Le as% 111.
ttu O'n•r «*" •t .d� ""I tw.• .to A:.... li.. .e aw Ina+ Iwna � "t
st/" floss real t)./l teat! %be"* rrwtll N0l6 31+' r$vs6 1!.11 ta", e3tatM�gt1e1► � •
+ k 33o34'3ow pert 61.3! real tbw" 3lreth 10"09'!0" Orae .11 hue 01 N eb Few leen F7;ti1
t`l Ttl/61t11t11 ern as 4tfall art aali�idad ts-nsrtar Wets" im eaMe4l1/ � ttlde4s0•InRs ,"t� • �
M that lad 6eaisseeed to Isnot A. Not tapesa. 61iff" rad MtUtadtma. 40rar. etNeo r! r};,
i •area the follovisl deeetihod irawt A+ ti
4 r .
�. M1Mie0 at $ /wise 10eotod u tell.... aerwrls/ at the Lr. freer•. N aril Ia.tito
3!. tb.re• d.a/ the era iW et ore's
ties 33. bore W"33'W rets 16'S.t1 ttn•t a , �'
An. (Crwtt Red AaS1: :here• a3ays abs "Wo'live
rho maat•tlis• of O.M. ribso es hrrre.gr of wit w s1 elt4s00 $Sons alma
festh 30"36'33• Imre 411./0 feet to ebe •erel'v"I �
a•tR► lis• •t Mid Let 1. amt to rertb it" of that Stell do-Ir the 3o h•6 t!�►It�+q
tee R•. 11-'1431!. Booth q"36'10" L.e 314 teat is . ►wh /ea
toN Net i• (30 toot mat right •este• to maid owatetlise) •M ►siyl t6w 00"l�9' !041 ' r
be/aaiart ebwM• •wsclmie iia?, 16"56'10" tare lo3.40 Intl tw+$ /+rt1m
!tat 11,11: teats thw•ea /owe. 3d 3! l0" 94rt 10.00 test' ttosa• 01 fere
107.At t••1 to the M foot tilbt M "'r! lips of /. t. tiodow Awl trarq N•trth
3092601!0 feat 94.11 test !r tie tree Mint et b*1120406.
1APM it
Portion of ;.0t 1 et the dnl7 rnaeNe/ ;IP
Oho telieaiss deaeri6ed peNe1 et lend belts • pr vtwt of /emtL" �•:.
plat •t t1laZrwlUb RutaRt'/ ADolT101e. 4104 sieaoted 1D tow ao•tewoCi y ��
al. Twoobit 1 /meth. lees• t Neat of tie 1L11arotte 11•till.ty. Cite t.t
Nan%amltea Cometr. 0re/e10•
tali/s"b at 6 pelat t•oated u tmllwr, em�a velar •t tM b M4211et $ert40`1 3 "is
1•otiaa 35. tb•a•o time the hoot him of gold Iwatiot Il41ttb 00.31.06" fast Sri•N het
to ti• •eee•tiU$ of 1.f, tiNraan Mwia• (0es*t7 Read A-9!)' brat• s!ee� wbt
~8111s6 fort► )0"16'13. Ort 151.63 terve to the lm meet eeralrr of "1/ Loa It
tbmr4e 6i•as Ria 1140th lint d paid Let,$ all the stb ties •r dmatiis pl.t of
is Owe/ ;
Meetdlsl poo We. WJ441=' 1000Aro•,6' •e
10" Nan 340.3! tm•e to the tt+ a
byiaslntt t%*"* Nerti 00"01'M' far! I).1 tMtl tbW* *"I, 11"i6'3o" Nowt 93.40
feotl tbwam• fortis !6•)S")00 toot Mat tbeet• Nath »'34'10" wt 61.33 row
tbome atatl+ N036'109 tact 13.11 bertilm6 IN Ar. "•541131 thea•• 3.
teat to tt114seer lis• et that laved datrlbod is tJe41
atoms ell lout line of 11.14 00011 teeth !10.01'0,0 tart 13.71 feat to • 3/A trete leer five
do ommmot $*crew of 044 0es41 tbeaee R*rtb W164100 Nmet 101.15 tort to Rbe Y
h'r• point of ►pirrtme. t
TM4tMr eitlm r "Oak pal trdlofded Orr ta•tt•t inter"t u woombit ad raitmt$aaa•o
of tint lend derllvvatM u Tr•mt A. amt inataas. greog uI rtUitia•. s+tvt. etcdte awl c
"tete the tellwing d•oerliot Tract A.
' 600calia a • polar looted u 1e11me. emrsa*el*t re tM remeMw•t teener •t Nf1
00 goot
laeelem 15. thence slams the rest ria• et sail I«tlea 3ed�4 ,)1 t0b merlgtwtt seater ism• r
feet to Rb• esstewline of t,N. lio4sma Ate. (Cemtl ,
forth 30.36')!" feat 431.10 feet to the •ertheert core er of raid Lot Itoire$ ales./ the a
soft% tike of role tot I rad the aertb Liao of Chst load u d4.OT004 it sa•i twoerliss R
poo Mo. /1•)431! Aeetb 66'36'1041 last 34.11 tett to the 10 toot ri6ht et sol lice (3C ,
feet 61tso to said esate-lime) raid bele! the tree pet"t of ►wsiadmst t►oer•
Ioaeb N•!�'l00 l rt 101.40 foots thane WA 00 0311 teoel ebsre• Ioeth
!6•!!' $00 Nut 1S.R0 164%1 tbesoe Retth 19•!6'109 Nest 101.W tr'30' Nest 11.ot le t►• .0 to" rtaht
of rV ILM 4f I.N. Ttedeame Aw"V61 014646 North 90.16411" Rj1111WrWot to It W4 err•
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i
:ITY OF 'TTGARD f*l'U7C'EIPT' OF f,p' 'Y'NUNT PF-;.CEIPT' 1'40. .2
CHEM':' AMOUNT ".0c). 'XI
KAUl 2 HoNS CASH 'AMIUMT Q.(m.'.
ADIDPESS t4565 S. KIM` RD PAYMENT, r)ATE 6 291,190
SIDD I Yl S I ON
OREGON L;ITY. OP 97045-
PUPrOGE Or PA'WFNT AM)I-INT 1"4410 Pt..IRPOSE OF PAYMENT AMOUNT PAID
P�.,AN CHEC� Fr i
.71F72R
AMOUNT 1"01r)
00.
PLAN C2 XX APIIIJC
C I TY OF T IGARD ��;= , .8 B� �`
(/ P.4.Bou23m 97 PLAN fZilX3C
.J ria o.oU«, 7223
eavd,;, PERMIT 11,)!: c Uy Z q .3
COMMUNITY DEVELOPMENT DEPARTMENT
DATE ISSUED
jou
JOB ADDRESS: d -76 (/y 5 `",J ;�- �'d� l �„ TAx mAP/u7r iS/-2- c c
SUB: _ _ 10r: IAND 1USE:
WaIMTION:
OMER SPDCIAL NOWS
v�
REISSUE OF:
AMPESS: IAST REISSUE:
_ FLOM PLAIN/
SENSITIVE LAND: _
PHONE: V b
�F?'PRt7VAiS RBOUIRED
)"4p E1JG31a3ERM:
ADMESS:J L/�� �,' � _ FIRE DEPT
alzlFst;
- —
PHONE: 1rFMSX7UII2ED
MMWERS BOARD 1: 9.10ESP DATE: LIsr/ .
BUS TAX:
tIENGINF v CAIfIZATICaNS: —
NAME: -� P-� r 1 _ TRUSS DETAILS:
A : C►IIIIR: - -- —
firm:
CX144ENTS:
SUBC0NIRAC"IC}RS: PIJUMB; I
PF144FT / AOCr ,¢ Df -4MTPrIC N AN IUM ANIM PD. BAL. DUE
Irl;r 9V c'av j 10-432 00 Building Permit Fees -� ' ' 7 N J0' -�
10-431 00 PlUlnbing Permit Fe(, �,- // / )v
1.0-431 Ol Mertanical Permit Foes- ^u
10-230 01 State Building Tdx (5%) x 3 F3
Building 7.15-
Plumbing f5-Plumbing
Mete
ns
10-433 00 PlaCheck Fee / (11 �.3 • 7
Building 1 9,
Plumbing
moc h
30-207. 00 Sewer. Connection
30-444 00 Sc-#x--rInspection
51.-448 00 Street system Dev rnatgp- (SDC)
52-449 00 Parks System Dev Charge ;PDC) rU 3 u
31 -450 00 Storm Dra]-nage cyst Dev Chrq (SSDC)
10-TIO 06 F re
IUTAAL. j 3 i3.
TZW
APP'LTCAW SICMUUM
Received By: _ Date Received:
of/3587P.WPF -
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