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CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MST95---00'_
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171 DAIL ISSUEL: 02/06/95
PARCEL: 2S114A0--WE9.:*_-'1
")TTE ADDRESS. . . 1665,3 SW 881-H PL
t.V.p -12
WAVERL*Y'LbTATE ZONING: R
• :021
LACIS OF WORK. W 24,ppfflE DISPOS,74LS. . : 1
SPE Oil- USE. . . . :tUF G MACH. . . . . . . : 1 BACKFLOW F-'RLVN'VRS.
'CUPANCY GRP. . : R3
f-1-0013 D R A 1 N G. . . . . . . :0 FRAPS. . . . . . . . . . . . . . :0
TO R I ES. . . . . . . . :2 WATER HEATERS. . . . . . : I CATCH BA51NS. . . . . . . :0
I X LAUNDRY TRAYS. . . . . . :0 SF RAIN DRAINS. . . . . : 1
.1 NKS. . . . . . . . . . . 1 GREASE TRAPS. . . . . . . :0
iIVATnRIES. . . . . :4 OTHER FIXTURES. . . . . :0
Jb/SHOWERS. . . . : SEWER LINE (ft ) . . . . :0
WATER CLOSETS. . :3 W A R LINE (ft ) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN kft) . . . . :0
-"1'1ks . PATH I
)NLR:
W PARTNERS C I P $ 1550. 00 JF 0 /06/9
..b40 SSW 68TVI PRKWY SWM t 180. 00 JF 02'/06/95
SWM $ 100. 00 JF 02'/06/95
GARD OR 972ES BIDR T $ 548. 014) JF 0,2/06/95
)one SPLC s 356. 20 JF 01/11/95 952C,�9'i
B 5 r-,C $ 27. 40 JF 1212/1116/95
Plumbing PARK $ Joo. oo ir 02/06/95
MPRT $ 45. 0 1 JF 02/06/95
M L_ -ACl/mR..CXXZMM,, TNr- MPLU -1, 11. 2J JF 02/1116/95
Jdress :_]?_J.dP_sk) (0j 4we mbPC $ 2. 25 JF 02/06/4b
-
ty : :-3 ta t e 8TH $ 00 JF 02/06/95
P5PL $ 1I. E5 JF @E/06/95
P..
ndditionzl fees not shown here. . . . . . . .
------- REQUIRED INSPECTIONS
its permit j ; issued SlAbject to the reg--
rations contained in the Tigarci Municipal Footing Insp Insulation Insp
1oe, State of Ore. 5pecialty Codes and all Found,-.ition ln,.�p Gyp Board Insp
her applicable laws. All work will be done Post/Beam Struct Rain drain Insp
accordance with approved plans. This Post/beam Mechan Water Lt ,,e Insp
�rmit will expire if work is not stai,ted Crawl Drain Water, Sit-vice In
, thin 1.80 days of issuancc., at- if work is Plm/undslab Insp Appr/1Gdwlk In,;p
,spended for more than 180 days. PLM/Underfloor Mechanical Final
MechAnic-al Insp Plumb 1"inal
Plumb Top Out Building F' insl
Framing Insp Lro3ion Contrn].
Fireplace Insp
Gas Lyne Insp
t z P hm-C �
I u mj _n t r a c t a r Signature
_--_
Call for inspection - .639-4175
C..'ontractor
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13125 SW Hall Blvd.Tigard,Oregon 97223@8199 (503)639-4171 PERMIT #. . . . . . . :
DATE ISSUED: 02/06/95
PAREEL- 11S114A;;)---WE-"1Zl21
ITE ADDRESS. . . : 16653 SW BATH PL
Jbl)IV1SION. . . . : WAVERLY ESTATES ZONING: R-12
LUCK. . . . . . . . . . : LOT. . . . . . . . . . . . . 021
BUILDING
EISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
t-ASS OF WORK. :NEW BEDRMS:4 BATHS:3 GARAGE. . . . . . . . . . :440 sf
YPE OF USE. . . :SF FLOOR REQUIRED SETBACK S-
YPE OF CONST. :5N r.'I RsT. . . . : iogs sf LEFT. . : 15 ft R I GH'r. :7 ft
OCCUPANCY GRP. : R3 SECOND. . . : 1038 sf FRONT, :20 ft REAR. . .50 ft
STUR IES. . . . . . . :a FINBSMEN"r:o ci f REQUI
_._._.______....._----
HEIGHT. . . . . . . . *.L3 ft 133 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 145079 PARKING SPACES. . : 1
Remarks : PATH I
PLUMBING
5INKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . : 1
LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
IUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASING. . . . . . :0
WATER CLUSIETS. . -3 SEWER LINE (ft ) . :L71 GREASE TRAPS. . . . . . . :0
IDISHWASHERS. . . . : 1 wnTL1R LINE (ft ) . : 1 LAO OTHrR "I X TURES. . . . . :0
GARBA(3E DISP. . . : 1 RAIN DRAIN (ft) . :0
WASHING MOCH. . . : 1 SF-:' RAIN DRAING. . : 1
MECHANICAL FEES
UEL TYPES UNIT HTRj. . :0 type Amol.knt 1)y date V-ecpt
, GAS/ VENTF. . . . . . :0 TIF $ 1550. 00 JF 02/06/95
AX I N
'
:_.UT :Q VA L 0 TU VI_'NT FANS. . :4 SWM $ 180. Q
10 JF 02/06/95
t-UHN I iOOK :0 HOODS. . . . . . : 1 SWM $ 100. 00 J F 02/06/95
[- URN > =1001 . . : I WOODGTOVES. :0 BPRT $ 548. 00 J F OL/06/95
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SPLC $ 356. 20 JF 01 /11 , 5 95-26042,i
130IL/CMP i 31AP:O OTHER UNiTS: I 135PC 1. 27. 40 JF 02�/06/'
GAS OUTLETS: 1 PARK $ 500. 00 JF' 02/06/95
C/06/95
,qner,.- ___MPR*T $ 45. 012) Jr Ql
& W PARTNERS MPLC $ 11. 25 JF O::/06/95
12.540 5W b8TH PF?KWY M__1_1C #1 2. 25 JF 0fI,/06/95 -
3LATH $ 225. 00 JF 02/06/95 -
TIGARD OR 97L223 P5PC $ 11. x:,'- JF 022/06/9 5
Phone #: 639-2639 EROS $ 64. 00 JF 02/06/95
—
Contractor: .20. 84) JF 02106195
POR INERS ERPIC O. 80 JF 02/06/95
2300 1,13W 69TH AVE
IGARD OR 97223
rione it: 639-C"649
eg #. . : 80970
3661. ')5 TOTAL
-:s p@riit is issued subject tc the regulations contained in the REOUIREL) INSPECTIONS
igia-d Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Pl _tmb Top Out
;)PliL4ble laws. All work will be done in accordance with approved Foundation Insp Ft,nming Insp
-,
.ans. This permit will expire if work is not started within 180 Post/Beam Stt ,.let Fireplace Insp
,ys of issuance, or if work is suspended f otle,tq, 180 days. Post/Beam Mechan Gas Line Insp
Crawl Drain InSfAlat ion lnsF)
ln.ip ui$-p k3oakv,d Insppt-mittee
FLM/Undet,f I oot- Rain cit,ain ITISP
t4,,1..1Pd Fy : Mechanical Insp Water- Line Insp
. CITY OF T I GARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
13125 SW Hall Blvd.Tigard,Oregon 97223e8190 (503)639-4171
639-4113 DATE ISSUED; 02/06/95
PARCEL: 2SI 14A0--WEiZA21
_.ITE ADDRESS. 16653 SW 88TH I'L
)UBDIVISION. . . . WAVERLY ESTATES ZONING: R-12
BLOCK. . . . . . . . . . .. L...OT. . . . . . . . . . . . . :021
TENANT NAKIZ. TS.
USH NO. . . . . . . . . . : F I X1 URE UN!DWELLING UNITS.
GLAS)S OF WORK. . . :NEW 1\10. OF BUILDINGES: 1
YPE OF USE. . . . . :
1','�3TALL TYPE. . . . :B US W R IMPERV 5URFPCE. f
.:emat-ks: PATH I
Jwnet-: FEES
& W PARTNERS -type amol-trit by date i-ecpt
IL540 SW 68TH PRKWY PRMT $ 2200. 00 JF 02/06/95
I NSP $ 3,7j. 00 JF 0 f2VAD 6/9 5
iIGARD OR 97223
,-,()ne #: 639—i2639
untr,actor':
',ONITROCTOR NOI ON FILE
#:
252 3 5. 00 T 0 T n L
RegREOUIRED INSPECTIONS
his Applicant agrees to comply with all the rules and regulations bewer Inspection
of the Unified Sewage Agercy. The permit c 4pires 180 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 veaiurelerit
giver, the installe- 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 0e Agency ins 11 a lateral.ins
y
Lon IS51.1ed L
Call for inspection 639-4175
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Residential Building_Perrn,it A,pi1licatio
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171 .
Jobcite.Address: L. 53 .L
t�ttic�tfs brtVr>
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Sutdivision:._Ls./:I tl1.5 Lot# -- €YM , <f j, g
W Plancic/ReC
Valuation: C! _
Corner Lot?
N� Permit#
Flag Lot? Y Reissue of
{ Map& TL#
Owner: Approvals Required
S' -
Address: 1,751-10 Sul Planning -
� . �.y 97� 3 Engineering
Phone: �f is--2 — Other
Contractoi-: _
;Items Ft_ squired
Address: Subcontractors
-- Truss Details
Phone: _ Uther
Contractor's License #_ C�=�02 7t-1
(attach copy of current Oregon license)
Contact Name & Phone: fJrv� /��7� 6- 2�5c
Subcontractors: Arch itect/EngInest:
Plumbing: C Addrpss:
Mechanical: -7-Rj ro. 7f,-i/7
(attach copy of current OR Contractors License)
LO Phone:
FW i ti•, ,
JOB DESCRIPTION: , // •�',
Appiic�fit tighatureA Phone nu-iber..
Received by: Date Received: -AWN
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yrsAPP ' ;1:, '�±+ i�i;�.;��,, ,. , 11, !� A
kVA)AMOMQ9-
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CITE OF TIGARD BUILDING INSPECTION NOTICE
Inspection '-,ae (Rec-O-Phonn):639-4175 Business Phone: 639-417(
Inspection: \\� I�"�
Footing Susp. 0eiling Spnnk. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Flec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line Hid
Plbg. Underfloor Rain Drain Framing Plumb )
Alarm Water Line Insulation ech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: c r4 Time: AM PM
Address:_ ,
Builder: Permit m ! S J U THE FOLLOWING CORRECTIONS ARE REQUIRED:
6'�vs
A,ti•F �iy S /�!1 ��
a _
W S /�
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Inspector:
_APPROVED ,DISAPPROVaI)l
_APPROVED SUBJECT TO ABOVE
or Reinsp.
w
CITY OF'CIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4
Inspection:
Footing Susp, Ceiling Sprink. Hough-in Appr/Sdwlk
Foundation (Plbg. Underslab Mech. Rough-in Fireplace
Post Beam Struc �'� Plbg. Top Out Elec. Rough-in FINAL:
--moo ' r San. Sev.,pr Gas Line -Bldg.
Underfloor �C`�Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: /�� Time:--tm PM
�c
�
Address: � _
Builder: Permit q:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
&_�__ _
Ae
e2 IZI
J -
Inspector:` -- Date: / /957
APPROVEDDISAPPVail
APPROVED S'.IBJE',T TO ABOVE
or Reinsp.
CITY C1F TIGARD BUILDING INSPECTION N01 ICE
Inspection l ine (Rec-O-Phone): 639-4175 Business Fi one: 639-41 1
Inspection:
Footing Susp. Ceiling Spiink. Rough-in Appr/Sdwlk
Foundation Ping. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbq. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas a -Bldg.
( _: �
Plbg Underfloor Rain Drain -ramin -Plumb.
Alarm Water Line sulat orl -Mech.
Underflr. Ir,sul. Shear Wail Gyp. Bd. -Elect.
Date R-.quested: ,Time: AM PM
Address:
C
Builder: Permit p: 1� CC) 31.1>'--
THE FOLLOWING CORRECTIONS ARE REQUIRED,
Inspector. Date:
PPROVED DISAPPROVED APPROVED SUBJEC r ABOVE
_Call For Reinsp
CITY OF TIGARD BUILDING INSPECTION NOTICE
�spection Line (Rec-O-Phone): 639-4175 Business Phona: 639.4171
Inspecti0,4_
Footing ��, Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab ec Rough n Fireplace
Post/Beam Str_ Plbg. Top Out Elec. Roug n FINAL:
_ j
os 7Bbarn Mec . San. Sewer as Line -Bldg.
p b. Un derfil1 Rain Drain aming - mb.
Alarm Water Line Insulation -Meth.
Undertlr Insul. hear Wall Gyp. Bd. -Elect.
Date Requested: Z� l Time: AM PM
Address:_ Z—
Builder: _ Permit#: 15�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
bt,a5
Sri/Gf/i� c. G�JT L/�S�.cit�� ✓k�F -
i TC 4 e.cy_
s" Sid ar
f- fir
rCi/ i'? O —
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-TO /V 1k r��►
I s oa.t 7 a�T y Date h
_APPROVED PROVED _APPROVED SUBJECT TO X1g9►JE
or Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
ection Line (Rec-O-Phone): 639-4175 Business Ph n 639-4171
r
Footing Susp. Ceiling Sprink. Rough-i Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace ,
Post/Beam SITuct. Plbg. Top Out Elec. Rough-in FINAL: /
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor ruin Drainramin Y�J -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. -Elect.
Date Requested: 1 ( S—
Time: AM PM
Builder: Permit #: 5
THE FOLLOWING CORRECTIONS ARE REQUIRED:
TdT4/
Ci 11-e
fFCT/OAC-/'
J
❑7 —
r•
x6C
Inspec r: Date: Z q —
APPROVED _L'DISAPPROVED _APPROVED SUBJECT TO ABOVE
444ea"I't For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone;: 639-4175 Business Phone: 639-41
Inspection: _ _
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in F'NAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall -Elect.
Date Requested S _3 r 5 Time: AM PM
Address:
Builder: PermitTHE FOLLOWING CORRECTIONS ARE REQUIRED:
l-,'
Inspector. Date:
APPROVEDDISAPPt
APPROVED SUBJECT TO ABOVE
For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Ree-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: V
WostlBea,'i
tiii ' Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Plbg. Underslab Mech Rough-in Fireplace
Struct. Plbg, Top Out Elec, Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underllr. Insul. Shear Wall / Gyp. Bd. -Elect.
Date Requested: ��— �Z Z ( I S TimeXAM PM
Address: S' &
Builder: Permit #: �j s —0C"
THE FOLLOWING CORRECTIONS ARE REQUIRED:
a
R
V1
>- r
I If
H-
J
(1!
_J
Inspector: Date::7
4AePR6VED __DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 6399-4175 Business Phone: 6 -4171 (/
Inspection: ( i y A�Le<
Footing Susp, Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation PI g.Vdeb Mech. Rough-in Fireplace
Post/Beam Struc . PI Elec. Rough-in FINAL:
Post/Beam Mech. S n Gas Line Bldg.
Plbg, Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear
Wal Gyp. Bd. -Elect.
Date Requested: ( Time: AM `_PM
Address. ic
Builder:_ Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED.
R'
N
H
J
Ca
I.
Lo
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J
Inspector: Dale: /
APP D `DISAPPROVED APPROVED SUB.IEC TO ABOVE
,Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE A ,
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 6 1 /�
Inspection:
Footing Susp. Ceiling Sprink. Rough-ins Appr/Sdwlk
Foundation Plbg. UnderslaV/ Mach. Rough-in Fireplace
Post/Beam Struct. g. Top Ouy' Elec. Rough in FINAL:
Post/Beam Mech, an. ewer Gas Line -Bldg.
Plbg, Underfloor Rain Drain Framing -Plumb.
Alarm Water i Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: S Time: AM PM
Address:
Builder: Permit#: �� C —CDC',
.3 L
THE FOLLOWING CORRECTIONS ARE REQUIRED:
0
Lon
r ��3 4
Inspector: Date:
APPROVE DISAPPRO D APPROVED SUBJ C TO ABOV
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICEInspection Une (Rec-O-Phone): 639-4175 Business Phone: 629-4171
Inspectian:_
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam StrLIC:t. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. an. Sg Gas Line -Bldg.
Plbg. Underflooram D' Framing -Plumb.
Alarm er LInsulation -Mech.
Underflr. Insul. Shear Wall Gvp, Bd. t.
� 1L_
Late Requested: pe_S Time: AM PM
Address:
Builder: i� G — �j Permit #: �—
THE FOLLOWING CORRECTIONS ARE REQUIRED:
e
v:
c.=
rl:
n
Inspector l� Dale:
APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
`Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sd k
o ddat��� Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg, Top Out Elec. Rough-in FINAL:
Cost/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ �� < < Time: AM PM
Address:
Builder: Permit #: ,7 C) �—
THE FOLLOWING CORRECTIONS ARE REQUIRED:
F-
J
rl)
Inspector. Date:
OVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
,Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in (F"A
Post/Beam Mech. San. Sewei Gas Line >
Plbg. Underfloor Rain Drain Framing ur
Alarm Water Line Insulationg
Underflr, Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: 12 Time: AM PM
Address: A/26 S3 r,.J. �_h C(�
Builder: Permit 9s'- 06)32
TNF FOLLOWING CORRECTIONS ARE REQUIRED
t-)1-t
L/
'octor: / pate:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rein,-p.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Spink. Rough-in Appr/.^ wlk
Foundation Plbg. Underslab Mech. Rough-in r lace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: / SQzG f—� 'rime: AM J_PM
Address 6(e 5 dW
Builder: Permit tt:
THE FOLLOWING cnRRECTIONS ARE REQUIRED:
�7
.J
C-7
J
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Inspector: 'Gdhrm� Date: ��.��•�
_APPROVED _DISAPPROVED5>187F61;-i
kPPf'tti7VElT �VE
Call For Reins .
City of Tigard Residential BuildingPumit Application
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Subdivlslon: Lot # Office Use Only
Valuation: Planck/Rec #
Corner Lot? Y N Permit#
Flag Lot? Y N Reissue of
Map & TL #
Owner: — Approvals Required
Address: Planning
Engineering _
Phone: Other
Contractor: Items Required
Address: Subcontractors
Truss Details
Phone: Other
Contractor's License #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Architect/Engineer:
Plumbing: _ Address:
Mechanical:
J (attach copy of current OR Contractor's License)
Phone:_
J
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by: Date Received:
N1W r0001OWPESAPP
-Permit# Account Description Amount Amt. Pd. Bal. Due �+
/rY ;_o u 3 L Bldg. Permit (BUILD) 5-14�, e $
Plumb. Permit (PLUMB) 22),
Mech. Permit (MECH) U) �✓ _,,
State Tax (TAX) go,
Bldg:
Plumb: //•t ,� i'
Mech:
Plan Check (PLANCK) 3G7 �. y�r Z f-V
Bldg:
Plumb:
Mech: Z
.Sc•�yj GNU 3�� Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dov Charge (PKSI)C) 5� }
Residential TIF (TIF-R) Z U 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) L'
Water Quantity (WQUANT;
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) �t "' �•�U
Erosion Planck/COT (EhOSN)
TOTALS.
15 G'
,48` ., .. S 0.01'?2�E 154; 2146F
69.34• �
1 \ BY
1
:.........�........................... . � 1 J.T. GOTH CONST.
148; CiTV OF TIGA„D
WAVERLY ESTATES
LOT 21
i y
''a 9,766
t
go
144'
cq
i t MAIN ri.nt?R 1�
1
141' 1 ; u
I GAAAGE
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A L A n tiAlC0QD D t f I I M A / / 0C1ATf / IfiC
1_?05 N W. 18TH AVEENUr, PORTLAND, OREGON 97209 I5011) 225.g161 S C A l E y
i ' 20 ' p
CITY OF T I OARD - RE:CE 11=lT OF V'AYMl:NT RFCF T r,T' Nq. s 95--i?6141 N
CHFC:K AMOUNT s ;') +6. 9
NAME: a J T ROTH CA;31T nM0lJNT t 0. 00
ADDRESS s PAYMFNT DATF t K.,/06/9n
SUI3D I V I r I ON
f,IJI2POSE CIF PAYMENT AM AJINT PAID PURPOSE OF' PAYMENT AMOUNT PAID
ll_►ILUINO FkRM Mf;T9Ci N�13i'_ �t►A. O�� PLUMBING Pt:-'RM 225. 00
kCHANICAI. PE 45. 00 ST. BUILD V,F,'R 40. 90
,LAN CHECV F l..= 1 17. 45 SEWER U9A SWR95 -0(1.1:3"; i?:i?Q�0» 00
,F WUR INSVIEC"1' 1-39. 00 PARP'S T)DL r00. 0P
Ir'O QUALITY FACILITY FEE' 1H?. 00 RE'CiTDFNTIAI_ i'HAFFIC FEES 14:30. 00
1ASS TRANG I T T I F FEES 120. 00 HPO PUPINT I TY FAC I1.T TY FEF 100. 00
NOS I ON CONTROL 1=`E RM I TFEE 64. 00 EROSION CONTROL PLAN CK 20. Ar✓1
RISION CONTNO1. A0
l t:�6 5.i SW 8ATIA Vil-
rrr IHI., AMOUNT FOOD 5646. 9S
U.L 1 f i f�'J T L OF
CITY OF TIOARD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT PER111T #. . . . . . . . MST95-0032
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)839.:4171 DATE ISSUED: 06/27/95
PARCEL: 2S114AD-02200
'31 TE ADDRESG. . . : 16653 SW 813TH 1--11-
SUBDIVISION. . . . . WAVERLY ESTATES 2 ON I NG:R---I i2
BLOCK. . . . . . . . . . LO T. . . . . . . . . . . . . :021
CLASS OF WORK. RNEW
TYPE OF' Wi'L. . . :1,3F
OCCUPANCY GRP. :R3
0C(.-,'UPANCY LOAD:223 4
'rf.:NANI* NAME. . . :
Remarks : PATH I
Owner:
R & W PARTNERS
125/ A SW 66TH PRKWY
I IGARD OR 9'7223
Phune #: S39-2639
Contractor:
RW PARTNERS
I' 23V
WA SW 69TFI AVE'
TIGARD OR 972.23
('hone #-. 639-2639
r1eg #. . : 80970
This Certificate certifies that the above referenced wtilding or portion
thereof has been inspected for compliance with the Tigard BlAildiny Code
for, the grul.tp and division of occupancy mnd use for which the above
refF-renced permit was issued, and occupancy is hereby granted.
L. SING ------- IlE I\ISPLC I OF� �J(A)ING IIF MCIAL
FAT31 IN CONSPICUOUS PLACE--