12903 SW VILLAGE PARK PLACE w
L2903 SW U LLAGE PARK PLACE
fr� �w re► ere• rs► �e wP e� � t
AFARD
CITY' OF CERTIFICATE CANC OF
rCinlyOFTi ARD OCCUPANCY
COMMUNl1•Y DEVELOPMENT DE QT�n ` oinoo►+ K`f:RM1'T' M. . . . . . . a MST90- CdtAi':�
13125S1Vl1eIIHhd. 4'.O.E3or1L?97,7i�ard,OraSpD �c6G3) a 6 , PRIM. PERMIT M. a M5T90 001`5
--- --- -DATE If305UEDc 6'TLu196
SITE ADDRL'iS. . . t 1._'900 5W VZL.LAGE PARK. L.!•1 PARt"Ll._e 15133DD•-025691 '
SUBDIVISION. . . . A ZONTNOD
BLOCK. . . . . . . . . . t LOT. . . . . . . . . . . . . 164
CLASS OF WORK. %NEW
TYPE:' OF USE. . . a 5F-
OCCUPANCY GRP. iR3
OCCUPANCY LOADce20 4
TE NANT NAME. . . c
Rem arlfsI
DON MORISSETTE BLDERS, INC.
P 0 BOX 19524
VAOR t'LAND (1R 97219
Phone #fit 50J-P44-9314
Con trac,tor c
CONTRAC IOR N(i-f ON FILET
Phl-me He
Reg ". . 1
Occupancy of the abc)%,e referenced tr-..ri ld.ir',q is hereby given, ar)d certi f ie -S
the compltence with the State Of Cragon spec.! ally Codes fr_)r the v,-coup'
occupan-y, and use .ruder which the referenced permit was Issued.
FIRE, DEPARTMENT BUILDING INSPC7R
BUILDI OFFI
POST IN CONSPICUOUS PLACE
INSPECTION NOTICE
City of Tigard Bu 'ding Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested A,M,^ P.M.
Address .__ Permit
Owner
Lot # _
Builder
The following Eludding Code deficiencies are required to be corrected:
Presented to_ _ pp'�*ved
Inspector - ❑ Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building ' epartment
P.O. Box 23391
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspectiony,, --
Date Requested_ 2 Time
/' �rJ� R.M._y P.M.
Address 1�7 U S l /�f/ Permit #'4&
Owner.,-- Lot #
BuilderThe following Building Code deficiencies are required to be correcred:
Presented to _ __ ?,pproved
Inspector ElDisapproved
Date _ �
CALL FOR RF,INSPECTION
Cl YES Cl NO
I
NINON
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested ����� �,y_ Time A.M,�.—P.M.
Address ,�a 9 0 ,Af—eepermit #5P.0 -4'zz"
Owner_ ___�___ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
1 I V'l a `o_ ,C 1.Lk
Presented to _ (� Approved
Inspector M Y `e JN'Disapproved
Date _ (C r n
CALL FOR REINSPE N
YES f NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box
Tigard. Oregonon 97 97223
phone: 639-4175
Type of Inspection -J491') e2i4vggg /
Date Requested _ G �Tim _ A.M. ^ P.M.
Addresst 9 60— ---hermit #ezZ -- I—
Owner_ --- -- Lot #
Builder ��Y�[ l9711�/SS.�r7c
The following Building ';ode deficiencies are required to be corrected:
Presented to - _— _..— .�flpprnved
Inspector
_ ...__ � Disapproved
Date
CALL FOR REINSPECTION
❑ YEs 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested S Time P.M.
Addresses y a 3 V ��� Permit # -
Owner-- --_—.—�—� --- Lot #
Builder ---
The following Building Code deficiencies are required to be corrected:
7 ie ev
Presented to _ pproved
Inspector _—_ ❑ Disapproved
Date
CALL FOR REINSPECTION
❑ YE! 0 NO
INSPECTION NOTICE f
City of Tigard Building Departm/nt
P.O. Box 23391
Tigard. Oregon 97223
Phone: 639-4175
Type of Inspection — _ — W.,
Dote Requested Time� AAf�.MM.�._ P.M.
Address 2 a 5;7
Owner _— Lot # —
Builder
The following Building Code deficienciex are required to be corrected:
--tic s fir!r
Presented to 2 _ Approved
Inspet.tor — Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department ,
P.O. Box 23357
-" Tigard—Or0Wn 97223
Phone: 639-4175
Type of Inspection _ - --- — -
Date Requested } ° ) Time___--_ A.M. P.M.
Address
Owner Lut #
Builder
The following Building Code deficiencies are required to be corrected:
_ ------ ----
PresenteApproved
Inspector �_-_ ❑ Disapproved
Date —
CALL FOR REINSPF,CTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Departrr..;nt
P.O Box 23397 ,l!
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested /�Q Tim P.M.
µ � /
Address � e mit #�
Owner _ Lot #
Builder
The following Building rode deficiencies are required to be corrected:
i I
d
Presented to -_-_ /CT Approved
Inspector = _ ❑ Disapproved
Date
CALL FOR REINSPE( TION
❑ Y%3 E] NO
f
INSPEC_ION NOTICE
City of Tigard Building Deparlm3nt
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —
Date Requested
l /1 �Time� A.M.`_ P.M.
Address _��` �y� UC.�i � ���_ Permit #_
Owner— _ __ Lot #—
Builder �Ji"��!�� � _
The following Building Code deficiencies are required to is corrected:
Presented to Approved
Inspector �, _. _ Disapproved
Date / D
CALL FOR REINSPECTION
0 YES ❑ NO
INSPECTION NOTICE !, �
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Typa of Inspection
Date Requested � �� —��— Time A.M. P.M.
Address &2 10,5--- LZ 'Permit
Owner _ _-- --- Lot #_—.----
------- - --- —
Builder - --a1.� -- 'L --- ---- ---
The following Building Code deficiencies are required to be corrected:
Presented to _ .Approved
Inspector ❑ Disapproved
Date _ d
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection -__—.-- // --.-------y------_—_--- _
Date Requested �� �7 Time A.M. P.M.
Address ��-3 -��1J .1 � � "f`a` Permit * _
Owner_.. "' y Lot
The following Building Code deficiencies are required to be rorrected:
Presented to Approved
_ i
Inspector — ----__-------^---_---___ - C Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
C17YOF71GARDv
CHYOF_ PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT Tri' N . . . . . : MST90-0015
13125 SWHWIBKd.P.O.E14rk23397,Fgad,OrWod==(5W)639-4175 \,-PRIM. IT I. : MST90-0015
<;-4U-4171 ---i4in-ISSU Da 03/ 2Y9O - ------__._____---- __--
SITE ADDRESS. . . : 12903 SW VILLAGE PARK PL PARCEL: IS].33DD-64
SUBDIVISION. . . . : ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
--------------------------------- BUILDING ---------------
REISSUE: DWELLING UNITS:1 BASEMENT. . . . . . . . :0 of
CLASS OF WORK. :NEW BEDRIIS:4 BATHS:3 GARAGE. . . . . . . . . . :451 sf
TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS----------
TYPE OF CONST. :5N FIRST. . . . :1350 Bf LEFT. . :7 ft RIGHT. :9 ft
OCCUPANCY GRP. :R3 SECOND. . . :1672 of FRONT. :20 ft REAR. . :29 ft
STORIES. . . . . . . :0 THIRD. . . . :0 of REQUIRED-------------------
HEIGHT. . . . . . . :20 ft TOTAL------:302.2 of SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf PARKING SPACES. . :O
Remarks:
----------------------•------------- PLUMBING ---------------------•----------------
SINKS. . . . . . . . . . :1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . :3 WATER HEATERS. . . :1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LIME (ft) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :1 WATER LINE (ft) . :1 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . :1 RAID DRAIN (ft) . :0
WASHING MACH. . . :1 ^F RAIN DP.AINS. . :1
--------------- MECHANICAL -------------- ----------------- FEES --------------
FUEL TYPES----------- UNIT HTRS. . :O type amount by date recpt
/GAS/ / / VENTS . . . . . :0 PAYM $ 100.00 DEW 01/04/90 106725
MAX INPUT:O BTU JE14T FAN5. . :2 PRMT $ 0.00
FURN < 100K . . :0 HOODS. . . . . . :1 PLCK $ 339.95
FURN >=100K . . :]. WOODSTOVES. :O PRMT $ 523.00
FLOOR FURN. . . . :0 CLO DRYERS. :1 5PCT $ 26.15
BO, - ', MP < 3HP:0 OTHER UNITS:O STDC $ 600.00
GAS OUTLETS:1 SSDC $ 250.00
Owner: ----------------------------------- PARK $ 250.06
DON MORISSETTE BLDERS, INC. PRMT $ 34.50
P O BOX 19524 PLCK $ 8.63
5PCT $ 1.73 /
PORTLAND OR 97219 PRMT $ 1.32.50
Phone #: 503-244-9314 5PCT $ 6.63
Contractor: ------------------------------- PAYM $ 2073.09 JLH 03/12/90
CONTRACTOR NOT ON FILE
Phone #:
Regi. . . -------------------------------------
$ 2173.09 TOTAL
Thie permit is issued subject to the regulations contained in the ------- REQUIRED INSPEC
Tigaxd Municipal Code, Stata of Ore. Specialty Codes and all other Foot/found Inep Gyp B
applicable laws. All work will be done in accordincr tth approved Post/Beam Insp Sewer
plana. This permit will expire if work is not starts ithin 180 Plm/undslab Inep Rain
days of issuance, or if work is suspended for more than 3.80 days. Mechanical Insp Water
� � Framing Insp Appr/Sdwlk Insp
Permittee Signature: _L t�tL 1 01replace Insp Final Inspection
Gas Line Inep _
IBnued PI : Insulation Inep
_-- — ✓
CITYOF TIGARD C=0F
WER
COMMUNITY DEVELOPMENT DEPAMMENT oaEcou� ECTION
t 9125 SW Hall SNd.P.O.Bac 7!397,1i9Wd,0r09oiK W-#=(509)MA'75 RMI T
___639-41 7_t ----
PRIM. PERMIT #. : MST90•-0015
DATE ISSUED: 03/12/90
SITE ADDRESS. . . : 12903 SW V7LLAGE' PARK, LN PARCEL: 1S133DD-64
SUBDIVISION. . . . : ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
TENANT NAME. . . . . :
USA NO. . . . . . . . . . :40602 FIXTURE UNITS. . . :
CLASS OF WORK. . . :NEW DWELLING UNITS. . :1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS:1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . : :sf
Remarks:
-------------•--- FEES --------------
DON MORISSETtE BLDERS, INC. type amount by date recpt
P O BOX 19524 PRMT $ 1250.00 /
INSP $ 35.00 000
PORTLAND OR 97219 PAYM $ 1285.00 JLH 03/12/90
?hone #: 503-244-9314 PAYM $ 0.00 JLH 03/12/90
Contractor: -------------------------•----
CONTRACTOR NOT ON FILE
--------------------------------•----
Phone #: $ 1285.00 TOTAL
Reg V . :
` ------- REQUIRED INSPECTIONS -------
This Applicant agrees to comply with the rules and regulations Sewer. Inspection
of the Unified Sewage Agency. The per _t expires 120 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 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.
11 �I
Permittee -Signatures
Isaued By:
Call- for inspection - 639-4175
i
CITY OF T I GARD - REC1=I PT OF PAYMENT REC Not 001077:55
CHECK AMOUNT t 37.58.09
NAME: DON !XIR I SSE TTE, CASH AMOUNT t .00
ADDRESSt PAYMENT DATE t 0:--12
j PORTLAND, OR 9? '1'y NI.Ot:1. P►O!Al?DF't
12907, SNI t;II_I..AIjE PAFI-
PURPOSE OF P A v MENT AMOIJVT PAID PURPOSE OF PAYMENT AMOUNT 9'A I D
hU I I.II NO PEP111 T '90-0015) 323.00 PLUMBING PERP11'1 1'2.50
MECHANICAL PERMIT 34.50 STATE .BUILD PEPMIT TAX 05%1 7,4.51
PLAN CHECI; PEE 148.58 SEOEP USA (90•-0015) 1.'2050.00
KWER I NSPEC I ON x5.00 STREET' SDC 600.00
!"Wit-S SYSTEM DEVELOPMENT C.H 250.00 STORM DRAIN SPC :'30.00
TOTAL AMOUNT PAID - - 3.358.0
CITYOF T117ARD
OFMA� PLAN CHECK APPLICATIOI1y
COMMUNITY DEVELOPMENT DEPARTME
41� PLAN CHECK N
u1zss.w.HriBlvd-P.o.Box u3v7.Tyisdo�eyon9rm,csaal �l1 PERMIT N /V57 •DU/S _
DATE ISSUED
JOB ADDRESS: 1 2 Q ?, S l Jf IS Sic e �'42 k C hJ. TAX MAP/LOT
SUB: Vt"4 �2 LOI F — _ LAND USE:
VALIJAfION: /-3� ,��/Z
OWNER SPECIAL_NOTES
NN 1E REISSUE OF:
ADDRESS: LAST REISSUE: -
� - FLOOD PLAIN/ -�--
SENSIIIVE LAND:
PHONE: ��9- 9.3 /4 _
APPROVALS REQUIRED
IRED
CONTRACTOR PLANNING:
NAME: ENGINEERING: _
ADDRESS: FIRE DEPT
OTHER: ---
PHONE: _ ITEMS REQUIREO
BUILDERS BOARD N: EXP DATE: _ L.IST/SI:BCONTRACTORS:
BUS TAX:
AR;.:H/ENGINEER CALCULATIONS:
NAME: 7(L 1 C I T TRUSS DETAILS:-
ADDRESS:
ETAILS:ADDRESS: _ iT —i OTHER:
PHONE: _--- �o s y 344 —
COMMENTS: ��---- -- — -- - - -----
SUBCONTRACTORS: PLUMB: MEC":
PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
_ 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10--431 Ol Mechanical Permit Fees
10-230 01 State Building Tax (5x) `tl,sl 5
Building " (, 15'
Plumbing _ -,y2
Mech ;/3
10-433 00 Plans Check Fee
Building
Plumbing
Mech -
�- 30-2.02 00 Sewer Connection iL j p c�
30--444 00 Sewer Inspection
51-448 00 Street System Dew Charge (SDC) p U
52-449 00 Parks System Dew Charge (PDC) ^ ail yy
31-450 00 Storm Drainage Syst Dew Chrg (SSDC) ,
10-230 06 f irt,
G 10TA1_ ,p ✓J�,UC,
RFC M
APPI T , T SIGNATURE
Received By _ Date Received:
cn/3587P/18P '-�-
gjzAr)I - ER SIGN ( OIYI'ROI TNI ORRIATION
GENERAL CONTRACTOR NAME& ADDRESS: CASEFILE NO.:
IJh r, 1�1 d r ` .� I'I:RMIT NO.: t-D <, r G a
rZf�/ jO t-)C `) t 12 APP1,1CANT NAME AND ADD S-
EXCAVATION CONTRACTOR LT—X) C n( )r i `iC'`t
NAME& ADDRESS: _
— ->i ��, F}►:v,i t� OWNER NAME AND ADDRESS:
TELEPHONE NUMBERS:
APPLICANT:) ,e 1�1[> I� 1=. £ �JLI IL DE PS PROPERTY DESCRIPTION:
OWNER 1 >if STREET ADDRESS AND CROSS STREET/LA)CATED
GENERALCONTRACTOR: `,L)Mr —/ ?`i`L :% -.`3ts : L , IIv ("t-, Lck ke Z') .
EXCAVATION CONTRACTOR: 'ii 1 L >e4-
SITE/JOB__
LEGAL DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX L'JT NO.: ,= r-
CONTACT PERSON TTTL$,TELEPHONE: 1/4 SECTION: t
SITZ SIZE,ACRES:
DISTURBED/WORK AREA,ACRES: _
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BETAKEN SITE RWOFF DRAINS TO:(CIRCLE ONE)
(NOTE:PERMITS MAY BE RF,QUI 'ED) ( PCH-BASIN ' DITCH PIPE CREEK
k Mlt
(CIRCLE ONE).PRjVATE_PROPERTY
PUBLIC RIGHT OF WAY—
ER "I N 't)NIROL (E��1—MEASURE
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER.PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCT ION SEQUENCE OTHER
OTHER--------
PLAN
THER — —PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED M ACCORDANCE Wfl'H-TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRI .T AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THF.CON5 -TION SITE.
C1/0.
OWNER SIGNATURE. APPIJCANI'SIGNATURE
OFFICIAL.USE ONLY.
RECEIPT DATE ACCEPTED
ITIT NUIv.BER RECEIVED BY ---
1 ,
' 1 P.O.Bax 19524
1 Portland,OR 97219
(503)244-9314
1h Foundation For Affordable Homes
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