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' CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT DHI L I"ciSU_j i c 04i
13125 SW Hall Blvd.Tigard,Orogon 9722:+•6199 (503)839.4171
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CITY OF TIGARD CERTIFICATE OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
131k5 SW Hall Blvd.Tigard,Oregon 97223.8199 (503J'W9`071 PERMIT #. . . . . . . : MST93--f&:0,.
DATL: I SSLIFI)s 1
/7., /7/ct -3
PARCEL s 2Sl09AB--04301W71
SITE "i)DRESO. . . s 14tit,—+ GW 1,_,4TH DR
SUBDIVISION. . . . : T11REC MOUNTAIN ESTATES TUNING:R -7
BLOCK. . . . . . . . . . s LOT. . . .
CLASS OF WORK. s NEW
TYPE OF USE:. . . :SF
OCCUPANCY ORP. :R3
OCCUPANCY LOAD i e30 4
TENANT NAME— :
Remarks# path I
Owners -•-.__._._.. __._....._.._____.__._._ .____.__�._...ri__
FOUR D CONSTRUCTION
P O BOX 1377
BEAVERTON OR 17075
Phone #1 641-0935
FOUR D CUNs RUCTION
PO BUX 1577
E?E`F�;1-01
rn Nf�N OR 7075
Phone tis 641-0931,
Reg #. . . '1037
Occupancy of the above referenced br.ti lding is hereby given, Arid certifies
the compliance with the Gtate Of Oregon Sperialty Codes for the group,
occupenc_y, and use under which the rrferenced permit W.u. issued.
FIRE DEPARTMENT DINO ,IbIROECTOR�
BUIL. I J. FICIAL
POST IN C:ONSPICUOUE; PLACE
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CITY OF T i GARD # ".� `� Ip R r I �.`
DERNIT
COMMUNITY DEVELOPMENT r)EPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)039.4171 p,*r T 'J') JS
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DIVISION. THREV- K.1-)NTAIN ES)TOTES zc1l,,4jNGg R
.. . . . . . . . . . . . .
...... ...... LAU 1 LD I ING
DWELL-ING I iY]LJ"i i'
I LP15G LArr •:CW LAE ORIVIS.4 BA TI--IS:'.;' GARAGE. . . . . . . . . . 720
• REGOIRED 16ETZY-40-(�
6c� OF 1JI-3L., ;–l'
L. UI fa(JNGI F1 RIS I . 106 L� f LEF'f. . :20 ft R i 61-4 F. 231 1 t
i' GNP. I, I*-'G Q IN u. . . 1 ti.10 i4 f FkCINT. ft IREJAR. It, i
R I ES. . . . . . . . I H I RD. 0 1
f Elf--'C) I RED—,
'AL
Lr. OR LUAL). . . . :40 psi- 1176.10 PARKING SPACIL'S. . I
e fit a r k s : C7 ea v 1'1 I
PLUMB INA)
UNAIW_2'. . . . -ii., 60CVS�L.Uw
j• VATON I ES. . . . . .4 HE ETERS. . . » I i RAPS. . . . . . .. . . . . . . . .0
tr'13"'t'Jj ILIWL!�Z�. –'.N 1)1 t`� I R We 5. . A T L,H BAS 1.i
"kErb CLOL;L'[c:i. J) "A-WER LINE (ft ) . .0 GREASE TRW'-,S. . . . . . . .
1 R LINE : 14"V1 0 11AAE R F I �� I
i1RBAGL DIS�1. I RAI N DRA I IN (f t 70
'3 H I N V) 14f.4LA f. .1 i R"IM L)HPINS. .
j1jL,Gt-10i,,jlC(41_ - - -'- .-
4 k I t
AS, VENTS IV., 0. 00 JH 6 93
A.VT U VLAT FAI`43. . eA-i1:11 00 111-1 4 6, Z'
1000 » :0 HJUDE,. . . El PL 11- 3116. 70 1.."
i i 'x00i, .1, wo(;t);."T.D,\) o b"JI-1.1 I. L 90 J, I"
3F4 FURN, 0 CLU bAYCIRS. s 1 '3.`11 L $ L430. 00 J FI 0.4/: 13/1j.,
(JTI,,IER UNITS.- I PORI� $ 500. 00 J 1 1 0 4 3
CIJTLET,: i iyjE )'1I- s 45. 11.121 J f 1 0,4
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Occc anri all ath�-r ru ut,, f 0 Urid I n a p vireplace Insp
(t G.1; j-,i accu,'dorce Mit 6;)( C',td Post/Beam Struct (34as Line Irfsp
14 coat -tArted wi*'� 'n 180 Posh Bc'�Am mectkan Insulation 1115P
10 days, F mi utirdis lab insp (3yp fluard 1r• ip
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CITY OF TIGARD �.r�F7rf�
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . 8W K9 tri
13125 SW Hall Blvd.Tigard,Oregon 97223*Bigg (503)839-4171
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it i4i)DRES'T'j, 144t%4 SW i:-;41+1 DR PARCEL: 25109AF-k-0430IIA
ZONING,., R-7
. .. . . . . . . . . . . . . ..16
k M-3. F 1 X'J URE -UN I TS.
DWLLL.11`A3 UNITS. . i
Y6`1' OF U511. SF NO. OF BUILDINGS., I
I MPT R,' tAJRFA('�'E. .
FLES
6clk L, type m 0 U ti t by LlAtfl- r fC:p I
L, BOX 1:Y1,I '(1 FIR M T MLAO.LAO. 014 JH 04/c f3/9;
INSP 3,:j. OQi jj-j JZ 41 t C)
iL(AVLR I Cji,i i T70715
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APP11cart 891-W to cutply with all tne rules &nJ i,-;1.16tions fewer I n pt?(-,t- i mi
th,v Un,fied Sewage Alexy, `he pervit 150 days frot
e date ;55,1N. The total Asount paid lmil bc forfpitea if tne
zrvit t4pirrt. Tt>p Agency does not juvartu accuracy of the
itif sgwftiate"FA5- If 'I sewer is not 1a,:ated at the smuremint
OW, i'le installer snail Frospect 3 feet, r all directions fros
�e dista,�,p given, 11f not sc located, tr�i shaii AurchaSp
'rap aryl Side 5pwv" Fermit and :pierai.
:L ri o p e C,t, i u,t 639-4 1 75
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Bell Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspections �Q
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FIN11Lt�
Post/Beam Struct. San. Sewer Framing 91dQ.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Mach.
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Date Recluoetedz 'L% Timet �11l1 :M
A,t JJ �� I•�f' �l �-b-�
Address, L�`"1 lY I 1 �/ Permit #s-7 3 '/�`
Builder, / r7`I _J
THE FOLLOWING OORRECTIONS ARE REQUIREDt
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Date
APPROVED DISAPPROVED AFPROVED SUBJECT TO AEOVE
Call For Reinsp.
INSPECTION NOT CF L
City of Tigard Building Departioent
13125 SR Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)c 639-4175 Business Phone: 639-4171
Inspection: --_�
Footing Plbq. Underslab Mech. Rough-in Appr/Sdwlk
Found. �7 .
Gas Line FINAL:
Post/Beam Struct. Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Nater Line Gyp. Bd. -Mach.
Date Requested: ` Time: AM PM
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Address:_ L ` Permit t:�� 4��U
Builder: 1 44
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THE FOLLOW47 CORRECTIONS ARE RRQUIRF.D:
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i nsFx�ctor:___ Date:
APPROVED DISAPPROVRD APPROVED SUBJRCT TO ABOVE
Call For Reinap.
1N52EECTION NOTICE `
I city of Tigard Building Departresst
13125 Be Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineas Phone: 639•-4171
1.1spec:t ion:
F:, ttnq Plbg. Underelab Mech. Rough-in �1ppr/Sdwlk
Found. Plbg. Top Out Gas Line 1IIp1Li
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Uneerfloor /Water Line Gyp. Rd.
Date Rec'ueated:i �IL' (/ /1 Time: wlt /1 PM
llddrefines , L(L�ll�
7 l��lt Permit 01�-,/)2-02
Builder: 4 LTLi �i \1 2 L7
TB6 FOLLOWING CORRECTIONS ARE REQUIRED:
1� ELU VI COAA-ELTE ,f L01V2 CA U l-1 9A 1A)
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Inspectors
71!lNOIISD DISAPPROVED APPROVED SUBJECT' TO ABOVE
Call For Reinep.
INSPLSCTION NOTI4'E
City of Tigard Building Department
13125 R' "All Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underalab Hoch. Rough-•in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line INALs\
Poet/Beam Struct. San. Sewer Framing -el
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbq. underfloor WaterLineGyp. Rd. -Koch.
Date Requeett*ds 1 ,Timet
Addreeas -1 l ?7 \\ Permit -02-��2 -
Buildert_� (�L�� ~i JGc' lac -7W S
TBR FOLLOWING OORRRCTIONS ARE REQUIRED:
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Inepect.ors V Dates./U 7 - 7
__11PPROWD L� DISAPPROVED APPROVED SUBJECT TO ABOVE
/Call For Reinsp.
NS EION NOTICE
Kitt of Tigard Building Departsent
13125 VIN 11m11 Blr-1. Tidlard, Oregon 97223
Inspection Line (Ree-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Hoch. Rough-in Appy/8dwIk
Found. Plbg. Top out Gas Line >rINALs
Post/Beam struct. San. Sewer Framing -Bldg.
POSL/Beam Mech. Rain Drdi:t Insulatlon Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -!loch.
Date Reques.sd2 (J� Time: AM PM
Addreses i ` �� I I Permit
7^i�= t UZ��
Builders Ft� `\� CCn�s ����1 !G
THE FOLLOWING OORRSCTIONS ARE REQUIRED:
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Inspectors _ Datet
AlIwOVSO DISAPPROWD A!lIIOVfO SUNJWr TO ADM
Call For Reiner.
IVSPECPXON NOTICE l
City of Tigard Building Department `
13125 89 Hall Blvd. Tigard, Oregon 97223
Inspe=Lion Line (Roc-O-Phone)t 639-4175 Dusinesa Phone: 639-0171
Inspections
Footing Plbg. Underalab Hoch. Rough-in � Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Post/Beare Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Mater Line Gyp. Rd. -Meeh.
Date Requent1e/dt Y,
Z L 3 _Time: AM
Addreeet_ �(iNU / 1 ;� Permit ,s
Builders "t i Y Cay � . -Z-Z.
THE FOLLOWING CORRECTIONS ARM RBQUIREDs
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APPROVED DISAPPROVED APPROVED SUBJRrT TO ABOVE
Call For Relnep.
INSPECTION NOTICE
City of Tigard Building Department
13125 on Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phone: 639-4171
Inspections�Zt�1__� —_--
Footing Plbg. Underelab Mach. Rcugh-in Appr/sdwl)c
Found. Plbq. Top Out Gas Line F1NALt
Post/Ream Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. - -Hoch.
Date Requestedt 1 _ Timet AH _ PH
Addreses / �_ --' Permit f:
Bulldersl ----__-------- -- -
THE FOLLOWING COMM70148 AAE REQUIREDt
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Inspectors
DISAPPROVRD APPROVED RURJRCT TO ABOVE
/�C Call For Aeinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 801 Ball Blvd. Tiyard, Oregon 97223
Inspection Line (Rec••O-Phone): 639-4175 Business Phone: 639-4171
I ispection:_ ---
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line FINAL:
Post/Beam Strict. San. Sewer Frmin -Bldg.
Post/Beam Mech. Rain Drain \ Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Ed. -Hoch.
Date Reques��te --7//d: : J�/~CZ@ Tuns AM PM
Address: �`7yG� ! �`l permit t
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Builder:
TRE FOLLOWING CON"CTION8 ARE PROUIRED:
7
Inepeotor �_ _ Oate1�
APPROVED 7ISAPPROVRD APPROVND iPjVJ Z To Asoye
Call For Reinsp.
7N&PECTL0N NOTICE
city of Tigard Building Department
13125 ON Sall Blvd. Tigard, Oregon 97223
Inspection Lino. (Rec-o-Phone)s 639-4175 Business Phone: 639-4171
Inspections_ !l2
i
Footing Plbg. U,:derslab Mach. Rough-in Appr/Sdwlk
Found. Pl.bg. To Out (Sas line FINAL?
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Lite Gyp. Bd. -Meth.
Date Roquesteds �/ � i Timet �AN PK
Address:��l .' L/ �--� Permitf
Builders—_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors bat•s�
_ZAPPYAOVND DIS"PRO /D APPROVED St1BJECT TO ABOVE
t . eor Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone)t 639-4175 Business Phone: 639-4171
Inspection:
Footing Flbg. Underslab Mach. Rough-in Appr./sdwlk
Found. Plbg. Top Out (Can Lina FINAL:
Post/Beam Struct. San. S.iw:r �Fr -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
state Requastedt_ '2 Time: —AN _ _PM
Adres"I Permit �t
Builder: �f
TBEE/'FOLLOWING CORRECTIONS/ARE REtlUIREDt
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APPROVED DISAPPROVED APFROVEP SUBJECT TO ABOVE
--Call For Rainap.
INSPECTION Novo
City of Tigard Building Departsumt
13125 Sw Hall Blvd. Tigard, Oregon 97223
Inspection Line (A-c-O--Phons): 639-4175 Business Phones 639-4171
Inspections
Footing Plbg. Underolab Mech. Rough-in Appr/Sdwlk
Found. ` Plbg. Top Ou� Can Line FINAL:
Post/Beam Sttuct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor �J Matwr LineeOyp. Bd. -Mech.
Date Roquesteds_ / - 13 13 Time: �AN p1l
Address:
/ Permit is C�3-aZQZ-
Builders_ /JO
'FEDI FOLLOWING OORRMCTIONS ARE MUIREM
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Enepwctor: ! Date: /
APPROVED DISAPPROVED APPROVED SUBJECT Tn ABOVE
call Por Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 5W Ball Blvd. Tigard, Oregon 97223
7nepection Line (Rec-O-Phone): 639-4175 Businoss Phone: 639-4171
Inspections
Footing Plbg._Underalab Mech. Rough-in Appr/Sdwlk
Found. lbq. Top Out Gas Lina FINAL:
Poet/Bent Struct. San. Bower Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -rlumb.
Plbg. Underfloor WaterLineGyp. Rd. -Mach.
Date Requested: �1�`' Times AM PM
Address s `_ /•—� ��. Permit
Ftu1.Dior s_
THR FOLLOWING 'CORRECTIONS ARE REQUIREDt
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Inapectore f _ Datat ,
APPROVED ^_ DISAPpRc7VED APPROV
t— XD SUBJECT TO ABMN
Call For Reinsp.
INSPECTION NOTICE
city of Tigard Building Department
13125 .ZR Ball Bled. Tigard, Oregon 9723
Irspecti.on Line (Rec 4)-Phone)t 639-4175 Business Poonet 639-4171
Inspf-ction:
Footing Plbg. gnd4relab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer framing -Bldg.
Post/Beam Mech. Rain Drain �naulation 1 -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. Mech.
Date Requestedt_ T1d(�A4AM Pll
Address t L •L } Permit
Builders
ME FOLLOWING CORRECTIONS ARE MQUIRM
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Inspectort__ Date 4�
/ APPROVED --A DISAPPROVED APPROVED SULTRCT TO Anwit
Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SO Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)e 639-4175 Business Phone: 639-4171
Inspections_ T`
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plby. Top Out Gas Line FINALS
Poet/Beam Struct. San. sew:! Praming -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb,
Plbg. Underfloor ` Nater Line/ _ Gyp. Bd. -Mach.
Date Requested: �% _Times
Address: �iL!l / ' Permit #I
Builder:
THE FOtJ ONING CORRECTIONS ARE REQUIRED:
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Teapeot0lf Date:T,
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31P1V1C DISAPPROVED APPROY=D SUBJECT TO ABOVR
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INSPECTION NOTICE
City of Tigard Building Department
13125 811 Ball Blvd. Tigard, Orc,jon 97223
Inespection Lint (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspections_
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINwL:
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/Bean atrW San. Sewer Framing -Bldg.
Bean h. ; Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Meeh.
Date Requestrdt � __Time: AN PN
Permit 1:� ^
Builders L7 /
THE FO ING CORRECTIONS ARE REQUIREDt
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APPROVED DISAPPROVIUpf APPROVED SUBJECT TO ADM
Call For Reinsp.
MP09TION NOTICE
City of Tigard Building Department
13125 80 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspectiont
Footing Plbg. Underslab Msch. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Can Line FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mesh. Rain Drain Insulation -Plumb.
�`Plbq. Underfloor J Nater Line gyp. Bd. -Mech.
Date Requesstedtt//� -- _ PH
Perm
lt t Q �-
Builder:_
THE FOLLOWING OORRRCTIONS ARE RBQU'IRED:
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Inspector: Datat_
APPROVED L` DISAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Akar/Sdwlk
Found. I Plbg. Top Out Can Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Inaulation -Plumb.
Plbg. Underfloor :later Line Gyp. Rd. -Hoch.
Date Requested: - ,Time: AM PH
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Addreess
Builders L
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
APPROVED D15APPROVND APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Departaent
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
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Tooting+j Plbg. Underelab Hoch. Rough-in Appr/Sdvlk
oon Plbg. Top Out Gas Line FINAL:
Post/Beam SLCUat. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor JWater Li/o Gyp, Ad, M*ah.
Date Roque sted: C//.'3� / / Ti108! PN
Address: �f LLq l3 - Permi.t It �7
Builders. 2 a —/ '-1 y
THE FOLLOWING CORRECTIONS ARE REQUIREDs
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'APPROVED DISAPPROVED _ APPROVRD SUBJECT TO ARIM
Call For Reinsp.
CITY OF TIG-AFRI) — RECEIPT (IF: f--lAYML'NT RECEIPT NO, 03-23946k
CHECK ANI)LIN T 5 158. W,
NOME : VOUR D CONSTRUCTION CASH AMOUNT a 0. 00
k ri.,S 9 9 PAYMENT DATE a 04 218 9,.-
S 1
I JBD I V I S I ON
PURPOSE OF PAYMENT AMOUNT PA I0 PURPOSE OF PAYMENT AMOUNT PAID
478. 00 PLUMBING ;)ERM 155. 00
ME-CHAWICAL. PE 4 '.. 00 ST. SUILD VIER 33. 90
PLAN CHECK Fr::. 71. 9S r3EWFI4 LISA 2100. 00
SE14ER INSPFC-'r 35. 00 PARKS SDC 900. 00
51 ORM DRAIN SIX: a80. (A0 RFSTDENTlnl-- TRAFFIC FEES t350. 00
MASS 'TRANSIT TIF FE FS 110. 00
Lor 36 TIIRFP-' WIN ESTATES
14371 SW 133RD AVF
AMOUNT PAID 5158. 85
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1)175 SW Nall EWA& PLNCK/RECT #
CITY Off' TIGARD PERMIT ! �S�.�' O�U Z-
COMMUNITY DEVELOPMENT,9EPARTMENT Tigard,Oregon 97M
(503)6394171 DATE ISSUED
JOB ADDRESS: TAX MAP/LOT , 0.M6 =-Q>U.3e''a
SUB: - -t-ky p-c_ ✓-rQ Q:&Tl4TEy..OT: —9 LAND USE:
VALUATION: 6 C)
OWNER SPECIAL NOTES
NAME: �k-kdZ U) Co X3 S T-?tAk C-T— REISSUE OF:
ADDRESS: O. aX is 7 / LAST REISSUE:
9 075 FLOOD PLAIN/
PHONE: 4I ' C) 9 3 S _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: b"- �P-S 0 � � _ PLANNING,:
ADDRESS: ENGINEERING: _
FIRE DEPT:
PHONE: -- -- _ OTHER: _-
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: p l-Utyq N Q LIST/SUBCONTRACTORS:
MECH: `�►4 r` p V--Vk-nlW BUS TAX:
ARCH ENGINEER / CALCULATIONS:
NAME: MSI AsczR-c-�, _ TRUSS DETAILS:
ADDFESS: /�S /.5 111! w- Z12U _ OTHER:
R-T-LA N
L� 97. Z IC'
PHONE: Z 2-
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�- PROPOSED BLDG. USE: -------
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COMMENTS:
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APPLICP IGNATURE
Received By: y �-Gf _ Date_ Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL, DUE
� S-U?02 10-432 00 Building Permit Fees X1 755 _`N
10-431 00 Plumbing Permit Fees } S
10-431 OI Mechanical Permit Fees �/} -j ��%e
10-L30 01 State Building Tax (5%) %: _ � _3 3 0
Building
Plumbing
Mechanical .2•2 >
10-433 00 Plans Check fee
►wilding 3/G� jli
Plumbing
Mechanical 1/,Z 1�✓'`f
10-230 06 Fire
•�' � 30-202 00 Sewer Connection au utl
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 industrial TIF fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Pat s System Dev Charge (POC) v
31-450 00 Storni Drainage Syst Dev Chrg
(SSOC) '�
24-445-01 Water Quality (Fee in lieu of)
} 24-445-02 Water Quantity (Fee in lieu of)
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TOTAL.
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