12550 SW PRINCE PHILLIP COURT ADDRESS:
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i:\records\mic
roflm\targets\bu ilding.doc
INSPECTION NOTICE
City of Tigard Building Deparbpent
13125 Bw Ball Blvd. Tigard, Oregon 97223
rnapection Line (Rec-O-phone): 639-4175 Business Phone: 639-4171
Inspectionr_
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINALS
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Post/Beam Struct. Sen. Sewer ��Fradll4g, � �Bldq.
Poet/Beam Mech. Rein Drain Insulation _plumb.
Plbg. Underfloor Water Line Gyp. Bd. Meeh,
Dat" Requeated: C}- z Times 717 -AM PM
Address:_ /2:� y /Merm(�t l i
Builder:
TRE FOLLOWING OORRECTI ARE REQUIRED;
rattttt _A Z� a �
APPROVED DISAPPROVED APPROVED IIMTXCT To ABOVR
Call For Reinsp.
CITY CSF TIGA RD 0 NV4 CA WD
COMMUNITY DEVELOPMENT DEPARTMENT FAUILDING PERMIT
131258WHffW8?vd. P.O.Box?WQ7j1gwd,Oregon 0722315W)650-4175 r-E R M I T #. . . . . . . : LAUF-192-009.L
u TE -A-4/20/9 2
jA . I E;SUI-.:.L)-- L
SII'E ADDRESS. .. . 1�'7.'550 �3W PRINCE 'T tARCEL: 29109DD---@*eft
SULIDI VISION. . . . KING CITY ZONING: 03700
BLOCK,. LO1.. . . . . . . . . . . . . ..
REISSUE: FI-OOR EXTERJOR WiLL C(INSTRUCTION—
CLASS OF WORK. :ADD FIRST. . . . S N: IS: E: W:
TYPE.' OF USE. . . .';P SGOND. . . : ';f 0R- OTr(.'T
1YPE OF CONS'f. :5N THIRD. . . . .i S N-. S. F: W.
OCCUPANCY GRP. R3 0 S ROOF ::ON9T: FIRE RET? :
OCCUPANCY LOAD: BASEMEN"r. S AREA SEP. R,74TED:
S T 0 R. : HT. : Ft GARAGE. . . S-f OCCU SIEP, RAI ED.
SSMT? : MEZZ? : RE OD EETBACKS----------
F;-nOR LOAD. . . . : P�s f LEFT: Ft ft FIR SPRL.: SMOR DET. . .-
DWLLLING UNITS: 1 FRNT: ft REFER: ft FIR OLRM: HNDICP ACC:
BEDR145-. BATHS: J MP !7:,URFACE: PRO CORR: PARK I NG-
VALUE. $ : 425
Remarks : PA'ffA I ADDITION MOVING MAIN! DOOR
Owner-: FEE-S
RUSSELL BEASLEY type amc)'.ilit by date rec�pt,
1255C-'; SW PRINCE PHILIP Cl' PRMT $ 25. 00 JLH 04/20/92 .
PLCK $ 16. 25 JLH 04/17/92 2:26 16
KING CITY OR 97224 5 PC T $ 1,. ;]:5 JLH 04/2'0/9E
Pho"e #.- 285-7781
0 W N P.-R
Phone Wi 11 42. 550 TO(AL
Req 0 0 V,1Z 0
REQUIRED INSPECTIONS
This permit is issued sub.iect to the regulations contained in the Fr-amirlq ITIE'p
Tigard Municipal Code. ;tate of Ore. specialty Codes and all other ITISI.Alatit)ll ITISD
applicable laws, All work will be done in accordarica with Gyp BaAr'd Irlsp
app,oved plans. This pet,mit will expire if war4 is not started FitiAl Ins.reutic)n
within 180 days of issuance, or if work is suspended for voi,e
than 180 days,
—----------
Isst.ted Fkv -.
Ca ' l for- inspertic)n
Permit No:
N�• : Address: / 'S �
o ,L
Issued by: — Date:
...�•' '••••• ---.. -----------FOR OFFICE USE ONLY.
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be i,3sued Licensed Architect
and Engineer applicants, exempt from registration under onS 701.010(7), need
not suomit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:
1. �] I own, reside in, or will reside in the completed structure.
2. A. ��I My general contractor is
Contractor registration number
I will instruct rn;, general contractor that all subcontractors who work on
the structure muEt be registered with the Construction Contractors Board.
OR
B. '� ) I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and do hire a general
contractor, I will contract with a contractor who is registered with the
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
raverse side of this form.
Signature of Perini App ' tf Date
-
CONSTRUCTION CONTRACTORS BOARD
0244J 1190
WHITE COPY VO ISSUING AGENCY PERMIT FILE
PINK COPY TC APPLICANT
1317-5 SW IlaU Blvd. PLNCK/RECT # _
CITY OF TIGARD PO[lox 23397 PERMIT # ' 00
COMMUNITY DENELOPMENT DEPARTMENT Tiprd,Orcgon97M —�
(503)639.4171 DATE ISSUED
JOB ADDRESS: ��, SO S 2a," Li Y.. TAX MAP/LOT :LS�U y Dl7 U U�`'y
SUB: ice, � l��— LOT: / LAND USE:
VALUATION:
06+ ER SPECIAL NOTES
•a-� �c REISSUE OF:
NAME: —ADDRESS: /,J�f S 17 J`(e� ,� � LAST REISSUE:
FLOOD PLAIN/
PHONE �r _ ` ��',P�- SENSITIVE LAND:
G„ 1 _
CONTRACTOR APPROVALS. REQUIRED
NAME: --T �) �1Z,� 7-L-4(_.k---' — FLANNING: —
ADDRESS: ENGINEERING: _
FIRE DEPT: _ _—
PHONE: __. OTHER: —
CONTR. BOARD #: , _ EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: — ��_ _�___ _ TRUSS DETAILS: _
ADDRESS:: — _ __ OTHER: Co4e4, „- �
X"l f
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SPINATURE
Received By: — Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
,B 4t-093 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) 2 7 1'
Building
Plumbing
Mechanical
i
10-433 00 Plans Check Fee
Building 6. c ►�
Plumbing
Mechanical
10-230 06 Fire _ —
30-202 00 Sewe, Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees —
25-448-06 Institutional TIF Fees
?.5-448-03 Office TIF Fees _
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) _
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
z_s
TOTAL Z• 5�' �_ G5J
nm/3587P.WPF
I- y3 P4
//0,
LIP .UTY: The (,'Ity of Tigard, Uregon, ui it's
ernpluPec, "ii;l:: not be responsible fo,
discrepancys which may appear hereon.
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C T'TY C.31-: T I'Cyi=►F{37 F'F.:l":1::.3:F"'T OF PA YMFN7 RUrt:I PT No.
CNE CK AMOUNT ti 2A. 25
4AME MEASLE-N, JEAN E. GAC3N AMOUNT 0. 00
i3 DRE SR a 1:' -'50 SW PRINCE' PHIL I P t..i. PAYMFN"T T)GI?E: t 04/20,19E
Tifi(lRD, OR GUM)
47 ; 4
UP,I~'C]SE. OF t=rAYMG`N'( AMC:3UN1' FIF1 I J F'I.JFtt'I J::;C: C)F- E',FIYMI-N'T AMOUNT PAID
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AMUNT E'►a(C) `'