15279 SW THURSTON LANE I
- 15279 SW THURSTON LANE -
INSPECTION P40TICE
City of Tigard Buildiory Department �1
P.O. Box 2339'
Tigard, Oregon 9722;.
Phone: 6394175
Type of Insper.,ion —
Date Reques/ted 6- 1 _ Time _ A.M.__gyp_P.M.
L
Address � .2 -7 y Z� _ Permit
Owner _ Lot #
–'
Builder
The following Building Code deficiencies are required to he corrected:
Presented to _ Approved
Inspector �- _. E) Disapproved
i
Date
CALL FOR REINSPECTION
❑ YEI ❑ No
CI7YOFT167ARD *Q( BUILDING r�F—,Pra,r
(C'T'Z TW
ARD
PF`nMTT NO . I-UE)90984COMMUNITY DEVELOPMENT' DEPARTMENT OREGON
13125 S.W !!all Blvd P.0 Hos 23397.Tigard,Oregon.',1223.(503)63941175
------ DATE ISSUED: 5 9/89
PP-rFF—PMT—.NO
,-P-10 ADDPF.'.S'i 1 5V*19 SW LN
TAX W11111/1-01, `51-113: ASHF(:)PD OAKS LT I A BK
I AND USI:-:'
LUT S'LZE: VALUATTON: 6:1. 349 SETBACKS
FPUNT: 20 REAP: 5
WORK CLASS : NEW DWELL .UNITS : I LEFT : 9 PIGHT : 30
USE TYPE: SINGLE FAMILY N0. 81TOPOOMS : 3 EXT. WALL.. GONST -,
CONST . TYPE: VN NO. BATHS: 3 N: S : two: : W .
(:)C(1'3JP-GPP, P3 PRO T .OPENINGS :
OCCUP. LOAD TOTAL AREA: 13z10
N: 5 : E W
:
NO - STOP'LES . 2 IST: 708 ROOF CON'iT: C FIPE PET7
20 2ND: 632 AREA SEPAP7 PATED :
BASEMENT7 3PD : OCCUP- SEPAP7 PATED :
MEZZANINE7 BASEM''T
V'I—OOP LOAD: lqo GAPAGE : AOO FIRE SPPKLP7 ALARM
FLOW(GPM) DETECT7 YES
PLAN CHECK BY: r,lt
REMARKS :
PEISSUE OF NO.
LAST
VV FEES :
N MILLER JAY PERMIT'
F p. 0 . BOX 23291 $319. 00
11 TIGARD PLAN REVIEW
LJP FIRE DEPT
STATE TAX $15 . 95
IS OTHER
0 DEVELOPMENT CHARGES :
N MILLER
T JAY SDCI1STOPM) %250 . 00
R JAY MILL.EP BUILDER
A SDC( STREET)
C P . C . BOX 23291. PDC(*2 $"too . 00
*211.%o . 00
T TIGAPU OR 97223
0 PHONE (503) 68,14-75413 PREPAID 4-10 . 00>
L
TOTAL: $1 ,576. 58
This permit is issued subject to the requiations contained in Title 14 RECEIPT NO, 16) 7:5'(:)
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done in accordance with the plans;and PEQUTRED INSPECTIONS
specifications and in compliance with all applicable codes and FOOTING SEWER
ordinances The issuance of this permit does not waive restrictive FOUNDATION WALL PAIN DRAINS
covenants. Contractor and subcontractors shall have Current city POST & BEAM
business tax permits. This permit will expire and become null and WATER LINE
void if work Is not started within 180daV3,or if w-)rk is suspended or PLB. UNDEPSLAB CITY APPACH/SW
abandoned for a period of 180 days any tlmg after wbrk has St.-AD FINAL
commenced It shall be the responsibility of the parmittee to assure PLB. TOPOUT
all required inspections are requested and arproved FRAMING
FIREPLACE
GAS LINE
INSULATION
Permittee Sign GYP . BOAPD
Issued By:
FOR INSPECTION 639-411,75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
witwim
CITYOF ����RD !�No : PERMIT
I��E:RMI'T No . :. 5Et891043
(Cr"NZ�40
COMMUNITY DEVELOPMENT DEPARTMENT DATE .T.SSUE D� / 9/89
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,(503)63�4 4175 Pr2I M . PMT .NO. 8909014
JOB ADDRESS : 1.9279 SW THURSTON LN USA NUMBER: 037507
TAX MAP/LOT SUBS ASHFORD OAKS LT : 1A BK :
LAND USE :
LOT : `ZE:
SECTION: 12 TWP : ?s RNG: 1w
WORK CLASS : NEW
USE 'TYPE: SINGLA-.. f AMI.I._'Y
The alaPl ic;ant ayreefl; to c::nmpl.y with 01.11 rl.;lees and riegi.t:la1.t.ions Of the Unif:i.ed
Sewerra.gee Agesnr.-y . The pearmit expired 120 drays; from the d01.te i.s;MuOd - 'The tot.atl
i:tmnunt paid will he fr)r• Fe i ted :if thr-. I.acerm:it exp:ir est . 'The Agency loess not •guar.-..
a.ntee the a1.ccs.sras.c-y Of the :Looatt.i.on of the r-ii.de sewer la.te.ral.% . 14' the sewer i.!.4
not located at the me;;ra!31.11.cemcant give" , the :i.114tas.:I.Ier mhalI prosspeet :3 Feet :in
all directions From the di%tance given . Tf nc►t so I.nc a;.ted , the inssta1.:I.1.Fr �uhal.l.
purcl•l(twe ;a " ral:) and 51dez Fjewer" Pearini.t. 411-1(:1 the Agency wi:l.l insstrxll a lis.tera1.:l
INSTALL... . TYPE: BUILDING SEWER IMPEFIV IOUS AREA:
FIXTURE UNITS : '1 TENANT IMPROVEMENT :
DWELLING UNITS :
FEES :
O MILLE14 JAY PERMIT *35 Ori
W
N P . O . Box 23?91 CONNECTION CHARGE $1 , 1()0 .00
E TIGAAD OR LINE_' TAP INSTALL .
R
('.)'THE.P
O M I I_LF R JAY
N JAY MILLER BUILDER
T
R P . O . BOX 23291
A TIGARD 012 97223
C
T PHONE (503) eiez4 7943
0 REGISTRATION NO. 30105) TOTAL: '1.11 , 135 .00
R _J
RECE.I PT NO.
This permit Is Issued subject to the r.rgulations contained in Title 14
of the TMC, State of Oregon Specialty Codes, zoning regulations REQUIRED INSPECTIONS
and all other applicable codes and ordinances, and It is hereby ROUGH--IN
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all apps cable codes and
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if wor,,Is not started within 180 days,or If work Is suspended or
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved.
Permittee Sfgnaturell
Issued By l 1tiJ l.'V FUIJ -1N6WL(::T 143N rf.A9-a;L -5 —
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
-- PLUMBING PERMIT
CITY OF TIGA RD PE:RMIT NO. : PL891031B
COMMUNITY DEVELOPMENT DEPARTMENT oftem I.--,,)TE ISSUED: 5/ 9/89
13125 S.W.1 ill Blvd-P.O.Box 23397.Tigard,Oregon 97223.(503)639-0175 P PIM. PMT .NO . 8909841
JOB ADDRESS : 152.79 SW 'THURSTC)N LN
TAX MAP/1-0T SUF:? AtihIF 1:1111:) OAKS I_T: 14 SK :
LAND USE: :
LOT SIZE.
1 TEM NO: NO
WUPK CLASS: NEW WATER CLOSET 3 T'Rt kP
USE TYPE: SINGLE FAMILY URINAL BK11_OW G'RVNTR
CONST . TYPE:: LAVORATORY :3 TR4F) PRIMER
OCCLIP . GRP . R3 TUB SHOWER ? GF* :ASE TRAPS
DISHWASHER 1.
GARBAGE DIrPOSAI_ 1
NO . STORIES : 2 WASHING MACHINE 1
DWELL . UNIT'S : LAUNDRY TRAY BLDG. DRAIN ( DIA
FLOOR DRAIN
SINK 1 SEWER (FI ) 30
14AT'EP HEATER i STt'RM/RAIN ,F T T30
OTHER
REMAPKS :
FEES :
O MILLER JAY PERMIT $132.50
W
N PO BOX (..•'3291
E TIGARD OR 9722:3 F'IX'TURES
R 9�6 6 3
PHONE 15031 6FJtl '7'::>�3 STATE TAX
OTHER
O WATTS KEN
T KEN WATTS PLUMB I:NG
T
R Pa ROX. 230925
A tigard or 97823
T PHONE: (503) 694-6626
14EGISTRATION NO . 50979 TOTAL: !139 . 1:3
n
n _
RECEIPT NO. iC):37 !50
This permit is Issued subject to the regulations contained in Title 14 -----•-----------------—
of the TMC. State of Oregon Specialty Codes,zoning regulations REQUIRED INSPECTIONS
and all other applicable codes and ordinances, and it is hereby PLB UNDEPSLAB
agreed that the work will be done in accordance with the plans and Pllril BEAM
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive WATT.:R 1._INE
covenants Contractor and subcontractors shall have current city PI_.B.TOPOUT
business tax permits. This permit will expire and become null and RAIN DRAINS
void if work is not started within 180 days,or if work is suspended or FINAL
abandoned for a period of 180 days any time after work has
commenced.It shall be the responsibility of the permittee to.pssure
all required inspections are requested and approved
Permittee Signetur
Issued By' -R��"� �,:AI,� _J•�(lA adaf+PE�TIt�M--���#-7�R
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
C11Y OF T'GA RD �,
MECHANICAL PERMIT
k4l PERMIT NO. : ME891036
CIVOIFTWARD
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 5/ 91819
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 PRIM.PMT .NO. 890984
JOB ADDRESS : 13279 SW THURSTON LN
'TAX MAP/LOT SUB: ASHFORD OAKS LT: 14 13K :
LAND USE :
LOT SIZE:
ITEM: N('.): NO:
WORK CLASS : NEW FURNACE (100K 1. AIR HANDLQ (10
USE TYPE : SINGLE FAMILY FURNACE 100K+ Alfa, HANDI..P 10K
CONST .TYPE: VN FLOOR FURNACE FVAP COOLER
OCCUP.GRP. : A3 HEATER VENT FAN
VENT VENT . SYSTEM
BLR/COMP (3HP HODD
NO. STORIES : 2 BLP/COMP 3-13HP TNCINEPATOP(DOM
DWELL . UNITS : nLp/('-,(]Mf) 1530HP INCINEPATOP(COM
FUEL 'TYPE GAS BLP/COMP 30-50HP REPAIR UNITS
MAX . INPUT DLR/COMP 50+HP OTHER 2
FIRE DMPPS7 GAS PIPING OUTLETS
HIGH PRESS'?
LOW PPESS7
REMARKS .
FEES :
0 MILLER JAY PERMIT $10 .00
W
N PO BOX 23291. PLAN REVIEW $12 . 00
R
IE TIGAPO OR 9722.3 FIXTUPEri 111138 . 00
PHONE (503) 684-7543 STATE TAX $2 . 410
oTHFI4
C;
n HEDIN POF*.-_PT
HEDIN' S HEATING
SA3 NW 231ST
A hil.lsboro or 971e3
(R)JPHONE (50 ) 648-131%9
REGISTRAT0ION NO. 47' 211 TOTAL . $62.410
3
RECEIPT NO.
This permit Is issued Subject t,)the regulations contained In Title 14
of the TMC, State of Orogun Specialty Codes,zoning regulations pEQUIREr.) INSPECTIONS
and all other applicable codes and ordinances, and It is hereby
agreed that the work will be done in accordance with the plans and GAS LINE
specifications and in compliance with all applicable codes and POST & BEAM
ordinances The issuance of this permit does not waive restrictive ROUGH--IN
covenants. Contractor and subcontractors shall have current city FINAL
business tax permits. This permit will expire and become null and
void if work Is not started within 180 days,or it work is suspended or
abandoned for a period of 180 days any time After work has
commenced. It shall be the responsibility of the permittee to assure
all required Inspections are requestr-J and approved
Pei rni,tee Signature 4-1
jktIssued By QA1 11-- F014 1N4Pt-.-(;;1j 74
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
PIAN CHECK APPLICATION
CITYOFTIGARV- PLAN CHECK N
(Cffy TWARp PERMIT M —
COMMUNfTY DEVELOPMENT DEPARTMENT owes DATE ISSUED'
U125 SW Ha BMi P.O.ea■2'"97,Tipwd.OnQon 977ZI(SM)e99 1176
308 AJDRESS: �-SJ 7 9 S w• 7 hu STN, ___ TAX MAP/LOT _
SUB: 04kJ LOT: LAND USE:
VALUATION:
OWNER — SPECIAL NOTES
NAME: — REISSUE OF:
ADDRESS: — �_� LAST REISSUE.
FLOOD PLAIN/
SENSITIVE LAND:
PHONE: APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: H,��'�1_ P�_ �� °�� ---- ENGINEERING: —
ADDRESS: X a i 4J FIRE DEPT
7- 14 „„ C' _ OTHER:
PHONE: -`�- (�Ll" 7 S YY I TEMS Rf_Ql1IRED
LIST/SUBCONTRACTORS:
ARCH/ENGINEER BUS TAX:
NAME: — �-�� T CALCULATIONS: _
ADDRESS: _ TRUSS DETAILS: _-
- PARKING PLAN: _
LANDSCAPE PLAN: _
PHOV E — -- ----(� `�f- a 3 0;� ____— OTHER: ---
COMMENTS: Is- 1 j -7q
------- _-
- C.
`a; PERMIT NJ ACCT N DESCRIPTION AMOUNT AMOUNT PQ. BAL. DUE.
c '- 10-432 00 Building Permit Fees _ _
10-431 00 Plumbing Permit. Fees
�11�Y le- 10-431 01 Mechanics). Permit Fees
10---230 01 State Building Tax (5X)
Building ( 1�i) .1 Is
Plumbing 40 L-3 �y3. $3
Mech 2_ clC)_ 2 � U �f
10-433 00 Plans Check Fee �� l '
Building Irk lc �
Plumbing T—
Mech
30-443 00 Sewer Connection (20X)
30--202 00 Sewer Connection (80X) Te 3
30-444 DO Sewer Inspection ,__,�
51-448 00 Street System Dev Charge (SOC) _ ,C.)
52-449 01 Parks I System Dev Charge (PDC)
52--449 02 Parks II System Dev Charge (PDC)
31--450 00 Stor:n Drainage Syst Dev Chrg (SSDC) — Z�
10-230 09 1RFD (95X)
10--435 00 TRFD (5%) _
10-230 06 Washington Cot .-ty Fire M1 (95X) _ —
10-435 00 Washington County Fire M1 (5X) _ _ —
10-220 00 Amort/Wedgewood _
TOTAL _ ;(
REC N z:1 3(pq 3
APPLICANT SIGNATURE - - -- --- -� - _--
Date Received:
RecPi%ed By: 5'•-�^�
w
����� BOARD- .
PLAN CHECK APPLICATION
PLAN CHECK M C`7'v7I APPLICATION-
PLAN
PERMIT 00 ?
COMMUNtTV DEVELOPMENT DEPARTMENT oaEooN 1. DATE 1, -o
1312S SW Hall Blvd. P.O.Baa 29397,Tig d.Onrdon 91 (SM)639.4176
JOB ADDRESS: ,� (^V,s iv1 L '. TAX MAP/LOT
SUk3: A th of • ag J LO'T: — _ _ LAND USE
VALUATION:
OWNER SPECIAL NOTES
NAME: _ _ REISSUE OF:
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHONE: SENSITIVE LAND:
APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: �� i I�� r�� C_ ENGINEERING:
ADDRESS: 2Q X FIRE DEPT ^
T��GJv-moi / OTHER:
PHONE: ITEMS RE UIRED
LIST/SUBCONTRACTORS:
ARCH/ENGINEER BUS TAX' -
NAME: CALCULAT.IONS: _
ADDRESS: _ TRUb3 DETAILS:—
PARKING PLAN ---__
_ LANDSCAPE PLAN!_
PHONE �v — A k OTHEk: ^
COMMENTS: 77-
PERMIT
N ACCT 00 DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
1
10-432 00 Bui Lding Permit Fees ,3 ss
$$, _
�O 7 10-431 00 Plumbirg Permit Fees - f1 .--
.4h ac ice- 10-431 01 Mechanical Permit Fees ?-
10-230 01 State Building Tax (;5X)
Building
Plumbing
Mech
10-433 00 Plana Check Fee ,2_�14'3 (z, `
Building 23u,
Plumbing _
Mech
30-443 00 Sel:sgr Connection (20%) ?
q (c�' 30-202 00 Sewer Connection (0014)-t .�
31:1-444 OU Sewer Inspection
51-448 00 Street System Dev Charge (SDC)
52-449 01 Parks I System Dev Charge (PDC) _
52-449 02 Parks II System Dev Charco (PDC) _
31-450 00 Storm Drainage Syst Dev Chr:) (SSDC) �> y
10-230 09 1RFD (95X)
10-435 00 TRFD (5X)
10-230 06 Washington County Firo Oil (95X)
10-435 00 Washington County Firer 01 (5X)
10-220 00 Amar•t/Wedgewood -- -
TOTAL
REC N
APPLTI;ANT SIGNATUREI
Received By: _ / �� Date Received:
r..
CITY OF TIGARD MECHAWCAL PERMIT
U.aartpucr, -� ATI t mce AMT
UTA.lA Mwhwnlcel
City of Tigard 1) Perm4:Fee -0• .0- 10.00
13125 S.W. Hall 131vdAll
- -- - - -
P.O. Box 23397 � 2) SupptemonlatPormtt _ -_-- -- -- ._ 3.00- --
Tigard,CH 97223 -
639-4175 VVV t 1) incl.ducts
s vents BTU � 6.00 �
incl.dtx,�ts 6 vents_
Fumace I o0,000 BTU + 7.50
2) ko.duds&vents
FkXX Fumam 6.00
Name old��,Y.io�,rr,..r 3) incl.vent
Suspended[water,wall heater 6.00
Job r4dteea-_�-- 4) orlkxxmounted heater
—
Address _ --- _ Vit incl.In
Tu lir —--- MaP No. 5) t 3.00
to' Mook -- AepakCAheatirg,refrkg.,
6.00
------__ t1rn.for name of buairwn) 6) pooling,absoir'tion and -- --
"10(or comp to 3 HP 6.00
Ownwf Me"Ad*"I - P}1pf1• _ 71 a".UM to 100,()00 BTU -- - _
Boiler or comp to 3 HP-15 HP 11.00
c:y/SL&te �^ zip t3) abs&p.unit to 500,000 BTU - -�-
_ Boiler tx comp 15-30 HP 15.00
absorp.tx*'h-1 million
Biller or oomp to 3()-50 l i P 22.50
N,y„V Addr*" - Pt,rrw _ 10) atuap.unk 1_1.75 million -�
Contractor Bolteror comp to 50 HP 31.50
utT�+� zip 11) absotp.unit 1.750,000 BTU --- —
_ Air harldlkv)unit to 4.50
pkt
sraw nratkx,No. .�_ tom.rax t+o.' 12) 10,000 CFM -
Alr handling unit 7.50
t t.ereby a.- #us I h.w r..e ws.ppwealion out ow koom.tbn tiwn M 13) 10,OOOCFM 4- -�_---- -------
"I act"I I am Its owrw or"tort ed so"or I»Uwnar,that plana s,M*W are N — --
crx .naa.atr,State sit".I-A,t t am nrglitrwith.d wthe seta tttAders*Board.tM+Ow t 4) Non portable 4.50
n,a
ntmtw pMn 4 rvrrecfl (M aarr,tN Irtxrr State ratFitralbn pleas.pM nafon bNaw). evaporate COo10r ._--_-- _-. - --
15) Vent Ian connected :` 3.00
--___ - ----------- to a single duct
- -- 16) Vertllation system not 4.50
included in appliance pennil
- Hood served by
- 17) / 4.50 f�,s 0
mocfianicsl exhaust
ston,nrre(mow or ao+Ml Dare 181Domestic type 7 50
incinerator -
Describe work O addition O alteration O repair F7 - -
o be done residential O non-tesidential ❑ 19) Commercial or industrial 3000
---- -- type incinerator
Existing use.of Other i e,woodslave.wale! d 50 ✓
Kidding or properly .__ _ - - 20) healer,solar,clothes n(vr•rs.clt
'roposoduse ol -- - ----
uilding or properly 21) _G-ts pgnnq ont!tri lout tit stir.
We of lurl oil I I natural gan I I LI'(i I I electric 1I / 1
2 i) Mow than A tua ratllr l
i
NOTICI )u 101AI T Jr U
AIS PEITMII IILCOMILS NULL AND VOID If W(1I1K 011 CON - r nen a�Sli11CIfA1',Gf
rRUCTION AUT140",r7_ED IS NOT COMMENCED WI1 HIN 100
%YS, On IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN nE VIEW 25%OF SUB-TOTAL
1ANDONIED FOR A PERIOD OF 1f10 DAYS AT ANY TIMF AFTER " TOM 5(0
JnK IS COMMENCED
eclat Cnndifirnt•.
a M
ki
CITY OF TIG,R D PLUMBING `�: O "''� ►3'�,
11g><ti OR 97723
1*1 K kAllb MA-A Fab (kcgon Rcglwation a con&cl a plumbing PER M IT GD-e-r)
/ bind,o(-n4 be propc(tyowncNopctato(not hl(ing NAS;(k hclp-
N�rTre d(3.v�(Oprtr(M 1'lumbrnl(Pc(mfl No. _
bavdon
CMS 1514-21-410 DUAN. PRICE AMI
Job Tax lit ---Map.
-
Adds v e a
FIXTURES _
ld t5kxdc $(bdvlalon Sirs r/ 1.S0 s'n
-no or name cl buiwwssjLAvalo(y 7.50 3•s�
— TW or TwSfwwef Comb.
'nG-mss Showef Only ).50
-r-
(-ner cWy/ fs —rQ Wafer Closel —_ •.S - -- 7.50 ,.7•�.5r.7
O shwailM( _-- _ _-7 50 7• J CJ
GatbageUisposal --- r ---r sow
——••--
NW ash4y MA.Ct w 7.50
ame _ •_ _
f ba C(a:n 7.50
ass w— f'ttone Wale(Neater -- - - 7.50
-- _
_ I Atm-WyRoom Toay 7.50 _ -
Uccupant /Biala !AP -
� -----j.50
P vone Utter r`<kxers($peat') 7.50— _-
- 7.S0
�+np�-Ir3dress — F'tr7ne — — 7.50
--
(%OfTtfeCtOf CtfylS'tote Xlp '-- -
Mi SCEI.LANEOUS
- •04M.Tax No. 5, er 1 d 1003000
due- f�oa�u NNo �SUIi rs. Seww.ea.Addit-100— - 15.00
(Resrden(iag -- --- Watex so vios 1 st 100' / 20.00
1 t»r�t7y
411411w{b0e teat 1 few road two*(V%rttlon,rhd t"klOnMatkxt Wale(Se(vioo aa.A&Mxo, - 15.00
V—u oorT«X awl l am fa9lsle(ed with tl w mate MAdoes Bawd.and also Storm a Rai+O(aln I al.100• 30.00
h` • Slate PkwnbkV to«tee hwt the m mbers Q#Yon ar OwrOM thsl all
-41.141,9 wprt(-4 be dome In socon Sano.•Idt apptlrahle Provkrxu 0(()re- Storm L P-in Orin Addil.100' — _- 15.00
1.xt Rev sed Statutes Cleprvs 447 and 1541 and eppfCebN axles and that IAA)4te Ibme S(MM)a 25 00 ^
nUM•p +Mf be—Vkr&d artless Noe(ae4 under ORS W3.(ff eKempt trtxn Flew Prv+rtlictn------- -- — -
te •�ao•a%0rL 1""ITS raaort bebw�. Oevloe a Preverobtiort Oevroe 750
1eOM(:0 wt4cRs-I herby O.Wr hal f ent rta ore w d rw prxwty d.- ----
ac v*l above,of wfikh bcatlon 1 pmpoee b make a pkerbkV kWAXNlOn kx Any Trap 0r Waste N01
my own u.e and aelo PrOP"1,enol bektp ox"kwaad Ow sale.lease Of rv(w_ Connected b a Fatu", 7.50
Catch B*-sjn
---- - kap d ExM P►r�.rq---- --- - - .40.00 Per Nr
SPea•M Re"eted Ina(»0tlons _ - 4000 P4w Nr
an Exls"000 -
N.w nag «a,w 1 Ae x+k,1 26 w n.u, - I
AVtltOIitICO SICIN4TTJIlE -- - n•fe
Oencrdle vqu L) addition I 1,•I I If I;
(] at3drtion() afteretlon() mt I
!kltlrrtN- rnsk5enliel( � rtC feaklarNtltt1 ]_ I I
--- -- i--
•lel:r
usO -
Ah}(�of Ixu(wrty - - OM-TOTAt / J G• $(J
Al,O uH of S��Q t+►atJftCltAlWC ��
TOTAL 137. 13
�pe(TnR b.cxxT►ea rtuM arra trvld r work a ooreatsotlon.ua�xued le nol oo(Tt -• -••-- - •_
nv.d wkh4ti I f10 e.i.w(a(�rdrsR�llort a w(xlf 10 euoperal.d or.r>rTM1a'•.d�
"I'd d 180 oeya w...y anw M►e(wo(k M axrtrrwnp.d
Ir1^1 (1(lrr(MTK1H1
C17YOF TIVARD
PLAN CHECK APPLICATION
GTYOf WARD PLAN CHECK
COMMUN" DEVELOPMENT DEPARTMEPfT .�a1EooN PERMIT #
1 125 sw mo ow P.o.Bay n 47.Tlg.i Omo n V=(6QJ16S0-4176 1 w -
_ DATE ISSUED
JOB ADn'+FSS: TAX MAP/LOT
SUB: —
- - ��- LOT LAND USE. •
r----
rALUATION: _ { - SETBACKS: I'VONT:y RFAR:�_ I.EFT: !7 RIGHT:
WORK CLASS: c HEIGHT: .n TOTAL AREA:
USE TYPE: FLOOR LOAD: iJ 1ST: '
CONSTR TYPE: HEAT TYPR: KS 2ND: .7
OCCUP GROUP: "k --, DWELUUNITS: 3RD:
OCCUF LOAD; _ _ NO BEDROOMS. BASEMENT:
NO STORIES: - NO BATHS: 15� GARAGE.! OG
IMP SURFAC';: - I
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: _ REISSUE CSF: LIST/SUBCONTRACTORS:
ENGINEERING: -- LAST REISSUE*. BUS TAX: I
FIRE DEPT.: FLOOD PLAIN/ _._ CALCULATIONS: _
OTHER.; - SEN IND.! TRUSS DETAILS:
i PARKING PLAN:
LAND^CAPE PIAN:
PLAN CHECK BY: OTHFR:
COMMENTS:,
• ACCT f DESCRIPTION AMOUNT
OWNER 10-432 B,nilding Permit Feec
NAME: _ "_3-431-600 T:..umbing Permit Fees S /3,? 30-
ADDR%S: 10-431-601 Mechanical Permit Fees S � T
_ 10-230-501 State Building Tex (5X)
10-433 Plans Check Fee
PHONE* 30-443 Sewer Connection (M)
30-202 Sewer Connection 01%) ! _
CONTRACTOR_ 30-444 Sewer Inspe.-Licn --
NAME: '— .51-446 Street Syetaem Dev. Che rge (SDC)
ADDRESS: 52-449-610 Parks I System De,r. Charge (PDC) f
52-449--620 Parks II System De.. Charge (PDC)
31-450 Storm Drainage Syst Dev Chrg(SSDC)
PHONE: - 10-230-505 TRFD (95x) !
10--435 TRFD (5%) S
ARCH/ENGINEER 10-230-506 Washington County Fire #1. (95X) !
NAME: 10-435 Washinvton County Fire #1 (5%) S
ADDRESS: 1.0-220 Amart/4edgewood ! ��
TOTAL !
PHONE:_
PREPAID
REC
BALANCE DUE s
APPLICANT SIGNATURE� � �-
"i,ceived By:—v Date Received: _