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-CITY CSF T I GARD [_A_`RT IF"I COTE OF.
OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MG)T940103,
13125 SW Hall Blvd.Tigard,Oregon 97223e8199 (503)639.4171
3 r 9-4171 L)AT :. I;35L1[.D: 06/ 14/94
PfIRCEL:. 113136HU-0330.1
I I L I LAC,8 i 5W k,9 T)A A V L
VILLA RIDGE Z OP41 NG R.-t2
;kLOC1.1. . . . . . . . . . . LO'T. . . . . . . . . . . . . . ..3
,,LA91,S OF WORK,. :NEW
I YPE. OF' LISE. . . -.S!",
9CCUPANCY GRP. :R3
�XCUPPNCY LOAU iI13 4
FENAN'T NAME.
11
;,,ernatl(s : PATH 6
jwn f,
W9
I-om PNOGERU
T , 0 Box 80152
i_jR1TLANL) Of? 97280
i1hnne #.- 45;�-8725
OM RQUERS
0 Box 80152
, 1011T[J)"D OR 97280
1h o vie 0 1 45i? -0725
95900
iLC'Uf3AIICY of the above referenced be-ildiny is., hereby given, And Lertifies
; he compliliance with the !-.AaLo (If Oreqon Specialty Codes for thol g1l"C'Up
,r7t_Qpancy, and wre k-udder, thich the refereticted perwit was issi.ted.
l�UlAt _NC'D INSN'UTOR
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i. ; INSFF.CTION NOTYCE
City of Tigard Building Departaient
13125 SA Ball Blvd. Tigard, Oregon 97223
Inspection Line (Re/ncc-O-Phone`): 639-4175 Business Phone: 639-4171
Inspection:_-___ .._ ``��QC /�- /LCL- / (r)_j
Footing Pl.bg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Flbg. Top Out Gas Line2-Bldg-
Pont/Boam
Post/Beam Struct. San. Sewer Framing Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor /Water Line Gyp. Bd. -Meeh.
Date /Request'�edt_ CL "�j9!z rrLme; AmC)qG�ppl
Address: 0(`�LiC�7 �JL/D Perm�It: #I 003 /
Builder: / m teJDa er� � ' 7 5
THE FOLLOWING CORRECTIONS ARE REQUIRED:
--P/it rh 00,5,5 E
M e C 5Dc(,5 sixc� S (c 9,/ QL-T
Inspectors _ --_- -- -- - Date:
APPRO�'tD DISAPPROVED APPROVKD SU:IJECT TO ABOVE
Call For Reinsp.
CITY OF TIGA.RD MASTER PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . JYJ 5 T 13 4-0 IZI
13125 SW Hall Filvd.Tigard,Oregon 97223.8199.'(503)630 4171 DATE ISSUED: 02/18/94
PARCEL : 151346AD-03301
SITE ADDRESS. . . : 10687 SW 69TH AVE
SUBDIVISIUN. . . . : VILLA RIDGE ZONING: R-IC-Z
13LOCK. . . . . . . . . . .I LOT . . . . . . . . . . . . . .:.3
BUILDING
RE I Gc;UE. DWELL I NC UN I TS): I BASEMENT. . . . . . . . :0 s f
CLASS 111" WORK. :NEW BEDRMS:3 BATHS.2 GARAGE:-*' * * . . . . . .-472 s f
TYPE OF USE. . . :SF FLOOR AREPS•----------- REGUIRED ,SETBACKS-----.----.--
TYPE OF CONST. :5N FIRST. . . . : 1 1:_,8 s LEFT. . : 10 ft RIGHT. :37 ft
UCCUPONCY GRP. :R3 SECOND. . . :0 sf FRONT. :0 ft REOR. . :28 ft
SIURIES. . . . . . . . 1 THIRD. . . . :0 s REUUIRED----------------------
HE I GHT. . . . . . . : 133 f t TOTAL..._.._--- - - ; 1133 S f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . 9; : 6OB44 PARKING SPACES. . : 1
Remar[(s : PATH 8
--------------------------------- PLUMBING ------------------------------------ -
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :Q, BACKFLOW PREVNTRS. . -0
LAVATORIES. . . . . :2 WATER HLAfERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/GHOWERS. . . . :c LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :2 SEWER LINE (ft ) . :O GREASE TRAP'S. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :I'll
GARBAGE DISP. . . : 1. RAIN DRAIN ( Ft ) . :O
WASHING MACH. . . : 1 SF RAIN DRAINS— : 1
MECHANICAL ---------------------- FEES ----------
FUEL. UNIT HTRS. . :0 type a m a 1-(n t by date reept
/63AS/ VENTS . . . . . :0 TIF $ 1520. 00 JH 02/14/94 -
MAX 1NPUT:0 ETU VENT F, AS. . -3 1A PR T $ 316. 00 JH 02/1. 4/94 -
FURN < 100K . . : I HOODS. . . . . . : 1 BPLC $ "'05. 40 JLH 01/28/94 94-248203
FURN ) =10VJK . . :0 WOODSTOVES, :0 B5PC $ 15. BO JH 02/14/94 ••-
FLOOR
FLOOR FURN. . . . -O CLO r)RYERS. : I GSDC $ 280. 00 JH 02/14/94
LIOIL/'�;IP ( 3HP:0 OTHrT_R UNITS: 1 PARK $ 500. 00 114 02/14/94
GAS OUTLETS: 1 MPRT $ 40. 50 JH 02/14/94
Owner: $ 10. 13 JH 02/14/94
TOM ROGERS M5PC $ 2. 03 JH 0-2/14/94
P 0 BOX 80152 PPRT $ 11. 7. 50 JH 021' 4/94 —
P5PC $ 5. 86 J1 1 02/ 14/94 —
PORTLAND OR 97280
Phone #: 452-8725
cuntractor: —————---—————---_._..._._—_---
TOM
-------------TOM ROGERS
P 0 BOX (30152
PORTLAND OR 97P80
Phone #: 45e--87 '5
Reg #. . i 95900 -------------------
$ 3013. 24 TOTAL
This pervit is issued subject to the regulations contained ir, the ------- REUUIRED INSPECTIONS
Tigard Municica! Code, State of Ore. Specialty Codes and all other Foot/foi_(nd Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam StrLict Gas Line Insp
plans. This peroit will expire if work is not started within 180 Post/Beam Meehan InsLilation Insp
days of issuance, or if work is suspended. Insp Gyp Board Ivisp
sort t 411 Be days. Plm/t.indslab
PLM/Underfloor Rain drain Insp
Permi'l tee Signati.Are : Mechanical Insp Water Line Insp
Pll.tmb fop Oi-it Appv-/'.-)dwll< Insp
1 5 S t.1 0 d B Framing Insp Mechanical F anal
Call for inspection 639--4175
CITYTICOOF GARD SEWER PIE R 11 ITNNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . r SWR94-00ii ,
13-125 SW Hall Olvd,Tigard,Oregcn 97223*8192_{503},619,41711 DATE ISSUED: 02/18/94
PARCEL: IS136AD-03301
SITE ADDRESS. . • : 10687 SW E,")T! : (-iVl-
3UBDIVISIUN. . . . : VILLA RIDGE ZONING: R-12
13L.00I.. . . . . . . . . . :
---------------------
TENPNT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . .
CLASS OF WOR:-',. . . -.NEW DWELL I NG UN I TS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :BUSWP IMP,ERV SURFACE. S f
Remarks: P'AT'H 8
Owner-: FEES
TOM ROGERS type am,)!.int by date V^ecpt
V-1 0 BOX 80152 PIRMT $ 2200. 00 FILL 02/18/94
NSPI $ 35. 00 PILL 02/1B/94
PORTLAND OR 97280
Phone #: 452-8725
Contr-actor-: --------------------------------
CONTRACTOR NOT ON FILE
I'hone #: $ L235. 00 'TOTAL
Neg i
REUUIRED I NSPIECT I ONS
This Applicant agrees to comply with all the rules and regulations Sewer, Inspection
of the Unified Sewage Agency. The permit expires !80 days from
the date ,ssued. The total amount paid will be forfeited if the
oprBit 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 I will install,aL)lateral.
Flet-mittee Signati-tr-e - Y
1 _-, 31_led By
Call for inspection 639-4175
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12- 1
Residential Building Permit_Application '
City of Tigard
13125 SW Nall Blvd.
Tigard, OF 97223
(503) 639-4171
iN
Jobsite Address:
Subdivision:�11 l-- Lot# Office Use Only
Valuation: -'* j ) Y, PlancWRec # —
/. 'e:reit # /YL
Owner: /h.y Reissue of
Address: Map & i L # -- —
Approvals Required
Phone: /
Planning _
Contractor: Enginee ing_
1
I,ddress: "_ Other
Phone:
�-� �- items_Requlred
•z,� , a t ,_
�',, �Un /_G _ Cl� Subcontractors
Contractor's License #
(aftaU7 copy of current Oregon lice nse)�' Trt ss Details
Subcontractors: Other
Plumbing: /� �i�Z,s.T+4it/ ��*�'�Li✓V�,
Mechanical: �ii' C , �,�i v _ elj.�✓r L
(attach copy of current OR Contractor's License)
Architect/Engineer:
- Address:
n
v. A 7 q
H-
�' Phone: _ 2'/i // > l
li.
r.:OMMENTS: T
Applicant Signature & Phone number
Received by: __ Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
-OU.3 Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAC) c tzl 71 ?(
Bldg:
Plumb: .5
Mech: 3 %
Plan Check (PLANCK)
Bldg:
Plume:
Mech:
Sewer Connection (SWUSA) Z_Z oy
Sewer Inspection (SWINSP) -3 .)
Parks Dev Charge (PKSDC) S vet e,Z)
Storm Drainage Chg (SDSDC) �?J
Resi(,-;ntial TIF (TIF-R) /Z/O
Mass Transit TIF (TIF-MT) r' U
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
" Office TIF (TIF-0)
r
Water Quality (WOUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
TOTALS:
APPLICATION --- STREET IMPROVEMENT/EXCAVATION COPY TO:
A (WHITE)-FILE
• ORDINANCE NO 74-14 �, 1 . [7g (YELLOW)-INSP.
TE SHEET)
(INSTRUCTIONS ON SEPARA �I''j (PINK)-OTHER AGENCY bld
LA (BLUE)-APPLICANT
APPROVED A PLICATION NO.:
NOT APPROVED ❑ CITYOF TIGARD, OREGON FEC AMT.: S 32.00
, '
PENDING FEE. PMT. 11CI�I�CITYILALL RF.CF.IPT,pJO.: _ j-+ � III k. -
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY= DATE + I�1
PENDING AGENCY ''OK" ❑ .Application and Progress Record L�
MAINTENANCE BOND # --
FOR STREET IMPROVEMENT/EXCAVATION AS NEOUiHtu
PENDING INFORMATION ❑ ANNUAL
EXPIRATION DATE. /
PENDING VARIANCE ❑ —
PERMIT NO.: _"-jS DATE ISSUED: __L_-1-'__'_ �, BY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ SILI SEWER (BLDr-.) SERVICE_AND
MAINLINE TAF' AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT TOM F2oyers P.O. Bax 80152 Portland, OR 97280 629" 452-6725
NAME ADDRESS CITY PHONE
CONTRACTOR A-Sava (Bob Moore) 5642 SE 115th Ave. Portland, OR ___ 760-4055
NAME ADORES CITY 'PHONE
PLANS BY - per City Starviards & Fpecifications
---- - -
NAME ADDRESS CITY PHONE _
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 800.00 __..
DOLLARS
'.
(2) EXCAVATION DATA FOR OFFICE USE:0.04 X S_P00•� 32.00 MON.
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL, INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET
_ OPENED
69th Ave (aee attach (:1) - INSPEC- —A
R TION
E
Q
U
E
ESTIMATED STREET OPENING DATE: _- __-L.__ -__-L.- _-___— S
T ---
ESTIMATED STREET CLOSING DATE __-_-_ __-_L_____L_--- ____.- E
--- - ------ D
800.00 STREET
(3) SECURITY NO. SECURITY AMT.: $ ._ �.. . LOSLD
SURETY CO.: FINAL
C HECH _ CASH a 1SOND r INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL �— _ SPECIAL PROVISIONS / CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
- See attached
1 ( I I
—
t
_ 3. w. 69th Ave
Lx
I 11
I work area I n 1
I SITE: 106A97 S.W. 69th A e 1 1
r
- ___ �..� _. , _-_.� � __�__. ,-.- :-.�-- - -------:-•--- _ __..
(S) NOTE THE CITY OF TIGA -140T. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAV JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGRlOES TO DEPOSIT THE REQUIRED SECURITIES. TO COMPLY WITH ALL PERTINENT LAWS ANn
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY
YIIP"URY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
/f
APPLICANTS SIGNATUA: DATE
,