9400 SW 70TH AVENUE I
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APPLICATION -- STREET IMPROVEMENT/EXCAVATION = - COPY TO:
X (WHITE)-FILE
ORDINANCE NO. 74-14 �, /� ® (YFLLOW)-INSP.
I. (INSTRUCTIONS ON SEPARATE SHEET) (PINK)-G APPLICANT AGENCYb C�•
� � (BLUE)-APPLICANT
APPROVED ,A APPLICATION NO.: - 4-77
c;rry 01' "I IGARD, OREC-ON ��_ /Z TO
NOT APPROVED 13 FEC AMT.. E _.- s
PENDING FEE. PMT. ❑ Cl IA' IIALL RECEIPT 4- Z
PENDING SECURITY 13 PUBLIC WOR&S DEPARTMENT BY DATE 9�
PENDING AGENCY ''OK" ❑ application and ProgTess Record MAINTENANCE BOND
PENDING (FORMATION [3FOR STREET IMPRCVEMENT/EXCAVATION AS REQuIREI)
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE:PERMIT NO.:NO.: _Z.. i`�` DATE ISSUED: BY �_ --
(' ) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTAL(_ CCX'C ""i6 DRIV Ai APP..R.44CH
AiaiinamwAS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT ` CX" RoyerS KC box Wl51 i'yClLcit�L L:t ++�1ts� `+��-Ei/lJ
NAME— - ADDRESL cITV PHONE
CONTRACTOR WeetSide Concrete —_-- �
NAME -- -- ADDRESS CITE/-- PHONE
PLANS BY ____ Per City �:3n3arcls & Scxecifications
._ {
NAME ADDRESS ,�,wo d-R CIT PHONE
ESTIMATED IMPROVEMENT I'OTAL VALUATION ( COST): $ L'---
DOLLARS
_FOR OFi10E USE: --lw 12.le MIN.
(2) EXCAVATION DATA: O 04 X S - S --_
STREET _ DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY _
STREET
_
PENCD _
70th Ave .3et: d tache( � IN PEC-
TION
E —
ESTIMATED STREET OPENING DATE: S
ESTIMATED STREET CLOSING DATE. —__ E
_ D
EET
(3) SECURITY NO. -- SECURITY AMT.: w, c 3LOSED _
SURETY CO.: _ FINAL -
CERTIFIED CHECK CASH 1� BOND r INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS / CONDITIONS
FEATURES; EXCAVATION LOCATION ANDS TENT. ,
I SITE: 9400 '3F1rM►-Ave.
- MLP `, -- .14 Applies
I 1 1
1 I fwork area I 1
I I I I 1 (Concrete T. il Approach
I �' I is required
Ue - - _1_;-
�— S. W. 7(JTH AVE. `\` ALbUFL�
to A 0
1
' h
.0
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERL
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE /
DATE_ / /
\QJ
£NSPECTION NOTICE
City of TL46 srd Building Department
13125 Sit Hall B,vd. Tigard, Oregon 97223
Inspection Lire (Rec-O-Phone): 639-4175 Businean Phone: 639-4171
Inspection:. --------
Footing P)bg.. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out G.te Line F�NALt)
Poet/Ream Struct. San. Sewer Framing
Poet/Beam Rech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Nech --
Date Requenteds /3 19 �e Time: AM PN
Address: 1J �' __ __ Permit
BuildersTHE FOLLOWING CORRECTIONS ARE REQUIRED:
r
"9
In• tors L _ Dates__
1?�
APPROVED _ DISAPPROVED —_ APPROVED SUBJECT TO ABOVE
Call For Reinap.
1 v
CITY OF TIGARD CERTIFICATE OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hall Blvd.Tigard,Oregon 97223e8199 (503)639-.4171
PERMIT #. . , , . . . : M5T94--0163
v39--4171 DATE ISSUED. 09/13/94
PARCEL: IS125DA- 00001
SITE ADDRESS. . . : 09400 5W 70 AVE
SUBDIVISION. . . . : ZONING:
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .I
CLASS OF WORK. .-NEW
TYPE OF USE. . . :SF-
OCCUPANCY GRP. I R3
"Ir'CUPANCY LOAD:`c.,'3 4
I'LNANT NAME. . . I
Remorks : PATH 8 - ---NEED A STREET OPENINO' PERMIT FOR APPROACH/1.73IDEWALK.
ACCESSORY STRUCTUR!:S ON PROPERTY MUST BE REMOVED PRIOR OCCUPANCY.
Owner
'TOM ROGERS
P 0 kox 80152
PORTLAND OR 97280
PhOTIC- #. 45EI-13725
Contractor:
TOM ROGERS
P 0 DOX 8011521
PUPTLAND OR 97280
Phune #t 452--8725
lieu #. . 1 95900
Ucc"-kpancy of the above v,efprenced building is hereby given, And certifies
the compliance with the State Of Oregon Specialty (--.odes for tlie. W10upq
or — -)ancy, and USO Under which the referenced permit wir: issued.
t'Vl PECTOR
U L.1 f ILIAL_
CL POST IN LONSiPICUOUS PLACE
LR
CITY OF TIGARD PERMIT#. . .. . . ITM31-94-0 6':,
COMMUNITY DEVELOPMENT D&ARTIVI-ENT DATE ISSUED: 05/06/94
1312.5 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)939-4171
PARCEL : 1 S 12,5DA-00001
`.SITE (IDDRESS. . . : 09400 SW 70 AVE:.
SUBD I V I S I ON. . . • : Z]N I NG:
(:,LOCK. . . . . . ,. . . . . L_OT. . . . . . . . . . . . . .
BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENI.. . . . . . . . :0 sf-
CLASS OF WORK. :NEW BEDRM5.3 BATHS:3 GARAGE. . . . . . . . . . :440 sf
-YPE_ OF USE. . . -SF FLOOR AREAS----- ----------- REQUIRED SETBACKS------------
TYPE OF CONST. :5N FIRST. . . . :610 s f LEFT. . : 15 ft R I GHT. : 16 ft
OCCUPANCY GRP. . R3 SECOND. . . :6Bc s f FRONT. :cO ft REAR. ., :79 ft
L;TOEIIES. . . . . . . :2 THIRD. . . . :0 S REGIUIRED--__..-----_________.._-_
HE:lGH7'. . . . . . . . :23 ft 1OTAL---------: 1292 sf SMOKE: DETECTORS. :Y
f-LOUR LOAD. . . . : 40 psf VALUE. . . . . $ : 67352 PARKING SPACES. . : 1
Remarks : PATI-! 8 -----NEED A STRE=E'T OPENING PERMIT FOR f1PPROACH/EIDEWALK. AC;CEG)._
PLUMBING --- _- - _______._.___.____._______.________•__.._
)INKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :O BACKFLOW PREVNTRS. . :0
i.-AVATORIES. . . . . :3 WATE=R HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
I US/SHOWERG. . . . :2 LAUNDRY TRAYS. . . :0 CATCH 1:3ASINS. . . . . . . :0
WATER LL_OSETS. . -3 SE=WER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASI-IERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DI51-'. . . : 1 RAIN DRAIN (ft ) . :0
WASH ING MACH. . . : 1 SF RAIN DRAINS. . : 1
_ ----------------- MECHANICAL -•.___.__._________________.____...._..... _...._._ FEES
�-ULL TYE'ES-_---_______ UNIT HTRS. . :0 type amol_int by d<_ate reept
GAS/ / / VENTS . . . . . :0 TIF $ 1520. 00 SW 05/06/94 -
MAX INPUT:O ETU VENT FANS. . :4 BPRT $ 337. SW 0 5106/'34 -
URN ( TOOK . . : I HUUDS. . . . . . : 1 HPLC $ 219. 05 GW 1414/14/94 94-251300
URIC• ) =,100K . . :0 WOODS7OVEG. :0 Brf'C 1, 16. 85 ,SW 05/06/9,4 -
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 280. 210 SW 05/06/94 -
DOIL/CMF' ( 3HP:0 01-I1ER UNITS: 1 PARK 1, 500. 00 SW 05/06/`)4
GAS OUTLETS: 1 MPRT $ 43. 50 SW 05/06/94 -
Owner: --.__._W____..______ _.._______.___.____-•-_HE'LL.: $ 10. 60 SW 05/06/94 -
TOM ROGERS M5PC $ 2. 18 SW 05/06/94 -
P 0 BOX 80152: PPR'T $ 132. 50 SW 0'-1/06/94 -
P5PC $ 6. 63 SW 05/06/94 -
P(DPTLAND OR 97280
Phone #: 452-8725
Contractor : -_.....___-.________________.-------
C OM ROGERS
�-' U B0X 80152
F'ORTI_AND OR 97280
Wri o n e #: 45e''-6 725
a Reg #. . : 95960 ______...----.-___._________________.__..__._____
n $ ;3068. 59 TOTAL
v~ -is perrit is issued subject to the r•epulations contained In the --- - - -- RFOUI RED INSPECTIONS --- - -
i--
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
- applicable law_. All work will be done in accordance with anoroved Post/Seam Strr.ict Gas Line Insp
plans. This permit will expire if work is not started within 180 Post/Hearn Mechan Ins�tlat ion Insp
days of issuance, or if work is suspended for• re than 180 days. F>im/1_indsl.ab Insp Gyp Board Insp
PLM/Underfloor Rain drain Insn
permittee 5ignat:,-tre : -�''_ Mechanical Insp Water Line Iris,
��� Plumb Top Out Appr/Sdwlk Insp
l sso_ied 13y : �lll `^' - -. Framing Insp Mechanical FFiria I
Call for inspection - 639--4175
r
SEWER CONNECTION
CITY CSF TIGARD PERMIT
F'CRMI'(' #. . . . . . . SWR94-01E7
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/06/94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171
PARCEL: 1 S 125DA•-00001
S I TIS ADDRE:SS. . . : 09400 SW 70 ST
SUBDIVISION. . . . : ZONING:
L+LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
TENANT NANE. . . . . :
USA NO. . . . . . . . . . . FIXTURE UNITS. . . .
CLASS OF` WORK. . . :NEW DWELL I NG UN I TS. . : 1
TYPE OF USE. . . .. . :SF NO. OF BUILDINGS: 1
T'\1 TALL 'TYPE. . . . .BU SWR I MPERV SURFACE. . : : s f
;rmarks : F'A"fH B
i.)wner -- --________._._y______._...._______ FEES -------------_..
TOM ROGERS type amol_rnt by date r^ecpt
U BOX aoiblw PRMT $ _'200. 00 SW 05/06/94
INSP $ 35. 00 SW 05/06/94 —
I"'ORTLHND OR 97280
-'hone #: 452-•8725
Contractor—. __--.-._---
'7n1\!TRACTOrR NOT ON FILE
$ 22 35. 00 TOTAL.
------- REUU I RED INSPECTIONS
'his Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency, The permit Erorr•es 180 days from
the date issued. The total amount paid will to forfeited 1f the
permit expires. The Agency does not ouarar,ter, the accuracy of the
c•ide sewer 'laterals. If the sewer is not lscated at the measurement
raven, the installer shall prospect 3 reet in all airections from
the distance given. If not so located, the installer shall nur•chase
"ap and Side Sewer" Permit and the Agency will install a I teral.
rn i a, t e e 5 i g Ti at 1.u•,e : . �l...... :
I s,sr.1�>d By
Call for inspection — 639-4175
l
Residential Building Permit Application
City of Tigard -
1.3125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Office Use Only
Subdivision: X11 +' Lot#
Valuation. / S L ` Planck]Rec#
Permit # r
Owner: 1 ' Reissue of
Address: t-, Map & TL# _`� 125
Phone:
_� � -� Approvals Required
C-
Contractor: e � 1 �eC�E'. �� .
Engineering
Address: (-AL 1t Other
Phone: SA Items Required
C c Subcontractors
::ontractor's License # --
(atGach copy of current Oregon license) Truss Details
ubcontractors: Other
Plumbing: � � ��►r"^,'�1J — — —
Mechanical: +
(attach copy of current OR Contractor's LI nse)
Arch ltect/Englneer:
Address-
Phone:
ddress Phone:
COMMENTS:
�- 4C--- .22L
L
Applicant Signature & Phone nLimbe'
Received by: . Date Received:
Permit # Account Description Amount Amt. Pd. tial. Due
o (o 3 Bldg. Permit (BUILD) .33 400 53 Z,- C•, V
Plumb. Permit (PLUMB) Z3 Z,,v 3Z• )z ✓
Mech. Permit (MECH) ,5y �v �✓
State Tax (TAX) .Z 5-,66
2
Bldg: �' '> V
Plumb: %I
Mech: _;2 %/
Plan Check z rte•C
(PLANCK)
Bldg: cZ1s
Plumb:
Mech: /01
Sewer Connection (SWUSA) `� 1-r v ✓
Sewer Inspection (SWINSP) 3 �
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC) v
Residential TIF (TIF-R) / y/ U
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial,TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
ti
TOTALS: .�U $ — % L S0.5_l
PLUMBING PERMIT
Y IYISTI '
CITY OF T ICARD DATERMI ISSUED: 05/06/94)4016
COMMUNITY DEVELOPMENT DEPARTMENT PORCEL: IS1,25DA-00001
13126 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
31 : w ADDFR:_-.SS,. _ il')400 ,W 10
';3UBDIVI'SION. . . . ZONING:
BLOCK. . . . . . . . . .. . L0'T.. . . . . . . . . . . . .
CLASS OF: WORK. . :NEW GARBAGE DISPOSALS— : 1
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . :0
0L(.*Ur-`ANCY GRP. . : R3 1'-L )OR DRAINS. . . . . . . :IZI TRAPS. . . . . . . . . . . . . . �0
'31ORlES. . . . . . . . ..2 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :L71
F I X7*URES------------------ LAUNDRY TRAYS. . . . . . :0 SF RPIN DR(AINS. . . . . : 1.
31114 K S. . . . . . . . . . : 1 GREASE TRnP5. . . . . . . :0
LAYATORIES. . . . . :3 OTHER FIXTURES. . . . . :0
rUS/SHOWERS. . . . . SEWER LINE (ft ) . . . . :0
:DATER C'LOSETS. . :3 WATE R I_I NE ( ft ) . - - . . 100
DISHWASHERS. . . . . 1 RAIN DRAIN (ft) . . . - :0
.
Remarks : PAT!--' 8 -------NEEU (A SIRLL- 1 Uk1ENING PPRIVIl"T FOR Af-JPR0(-)CH/SIDEWAL1-'1. ACCE'-j"j
UWNER: _.__.__ __-_.___..____.___..__---____-- _.._.__.____.___-__-.--FEES.-----._----_---_
TOM
----FEES.---------------TOM ROVERS 1 b2LA. 00 SW Ob/06/94 -
U BUX 8015P BPRT $ 337. 00 SW 05/06/94 -
B 'LC-,
BF'L-(-, $ 219. 05 SW 0,4/14/94 94-251.
'DORTLOND OR 97280 B5PC $ 16. 85 SW 05/06/94
-.1hone #: 452-8725 SSDC $ 280. 00 SW 05/06/94
PARK $ 500. 00 SW 05/06/94
I i..tm b I T-1 C On t 1-4ACt 0 ly1PRT $ 43. 50 SW 05/06/94
MPLC $ 10. 88 SW 05/06/94
A.-I"I e Lu.. 115PC $ 2. 18 SW 05/06,'94 -
L 4_.'��- -X_-
n d d r e s s PPRT $ 132. 50 SW 05/06/94 -
t
State : P5PC $ 6. 6'3 Pi W 05/06/94 -
y
Zip: Phone#. 6.5-_rj
Reg
REQUIRED INSPECTIONS
-----
This permit .; s issued sl..tbject to the reg -
ulations contained in the Tigard Municipal Foot/fuund Insp Rain drain Insp
Code, State of Ore. Spec.-ii-Alty Cudes and all Post"Beam :3truct WALet, Line Insp
other applicable laws. All work will be done Post/Beam Mechan Appt-/Sdwlk Insp
i.r, aur.zordance with approved plans. This Plm/undslab Insp Mechanical Final
ciermit will expire if wark is not started PLM/Underfloor Plumb Final
within 180 days of isso_tance, or if work is Mechanical Insp Building Final
qusoptided for more than 180 days. Plumb Top Uut Erosion Cuntr'l
FrAminq Insp l-raw). Drain
Fireplace Insp
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A u t hcl ed Plumbing Contractor Signature
Call for inspection -- 6339-4175
APPLICATION - STREET IMPROVEMENT/EXCAVATION `-� � , COPY TO.
(WHITE)-FILE
ORDINANCE NO. 74-14 (YELLOW)-INSP.
(INSTRUCTIONS ON SEPARATE SHEET) - (PINK)-OTHER AGENCYbIcIg.
(BLUE)-APPLICANT
APPROVED APPLICATION NO.: —_
NOT APPROVED ❑ CITY Y O I IGARD, OREGON FEE AMT.: E -
PENDING FEE, PMT. ❑ Cl 11' I{ALL RECEIPT NO.: `14 - 45 s 752% off,,
PENDING SECURITY ❑ PUBL./CWORKS DEPARTMENT BY _-_ DATE_
PENDING AGENCY "OK'' ❑ .Application and Pro){ress Record — — — — — — — — — — — — — — —
INFORMATION ❑ MAINTENANCE BOND u
PENDING
FOR STREET IMPROVEMENT/EXCAVATION AS rar,ouis7eu
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE:
PERMIT NO.: 4- `1 `14
DATE ISSUED: 1-_/1__ . BY
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ A (BLDG.) SIDE $AN. SEWM SERVICE
LATERAL & MAINLINE TAP AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _TOM P.O. BOX OU152 POrLiaria, OR y7280 452-'8725
NAME ADDRESS - CITY - f PHONE
CONTRACTOR (Bob Moore)Moore) A-S5642 SE 115th AVe. Portland OR 97066-39_04 # 760.4138 _
NAME ADDRESS CITY ��V- PHONE
PLANS BY — per City Standards/Specifictions -
NAME ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ __-� 800.00 _.
DOLLARS
- - ---' FOR OFFICE USE _—.- --_--~L'-MIN,
(2) EXCAVATION DATA: o.o4 x S f100�00 = f 32:00
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CL:T CU"f CUT MATERIAL. INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
STREET
PENED
70th Ave. - See 'V,tached -- INSPEC- ----
R TION
E
Q
U
ESTIMATED STREET OPENING DATE: �_ g
ESTIMATED STREET CLOSING DATE: ( / E
(3) SECURITY STREET
NO. - SECURITYAMT.: $ BW-00 � . CLOSED
SURETY CO.: —_ _ FINAL
- l►+�s"d�HEC1t_ CASH o BOND--- INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT-PLICAL -�z— SPECIAL PROVISIONS i CONDITIONS:
FEATURES: EXCAVATIfJN LOCATfl0N AND EXTENT.
I -- ---
MLP 94-UG1Q'+ 1!►F f't.>w► -
S. W. 70'd`H AVE. ALFRE -
STREFI
—
1
I I I 1 —
1 I ( I 1
(5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APP/. ITS TO CONDUCT WORK WHERE
RIGHT OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STAT. OREGON
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE �_ � DATK L)�+�