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CITY OF TIGARD CERTYFICA'rE OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hall Blvd.Tigard,Oregon W22398199 (503)'60WA171 PERMIT ##. . . . .. . . : MST93--001cY
DATE ISSUED: 02/07/94
XIARCEL.: 2SI11eA-08700
1TE PY)DPF-.':). I41;:4 S W )7TH A V L
13-UBD I V f S71 ON. . . . TI(:ART)VILLE HEIGHTS ZONI I NG:'R-4. 5
BL,OCV. . . . . . . . . . . LOT. . . . . . . . . . . . . :20
i,'LASS OF WORK. MOV
; YPF- OF USE— iSF
1,)CCUPANCY ORP. :R3
OCCUPANCY L0ADz22P- 4
I E:'NANT NAME.
Re mar ks
ROB & DINAH ROGERS
1.'WF
5 SW RALE:IGHVIEW OR
PORTLAND OR 97225
Phone #z
Conti-actors
01MCIRT INTERNATIONAL
11811 SE WY 212
CLACKAMAS OR 97005
Phone Ot 6555-7191
Flew 0. , * 001305
Occupancy of the above refer,enced building is hereby given, and certifies
the compliance with the State Of Dr-eyon Specialty Codes for, the gi-ot-1p,
accupancy, and use under which the t-ercv-eTicppermit wan issk.led.
FIRE DEPORTMENT 8 L,01N . SPECTOR
EIU'[LUINO OF - I IAL
;7,
Ln POST IN CONSPICUOUS PI.ACI:-.
__j
ter
INSPECTION NOTICE
City of Tigard BuD.dlug Departi>�t
13125 811 Hall Blvd. Tigard, g=,?On 9T
Inspection Lina (Ree--�Phona): 639-4175 Businesstj39-417.1
Inspertions ( .(10
— —
Tooting Plbg. Underelab Mach. Rough-in Appr//Sdwlk
round. Plbg. Top Out Gas Line 11I1f11Lt
Poet/Beam Struat. San. Sower Framing o1dQ.
Post/Beam Mech. Rain Drain Insulation 1
Plbg. Underfloor Nater Line Gyp. Bd. M
Date Requesteds _ , r I I —Time: _AN
2 /�Dice/�_PH
Address: L Lf �/' Permit #s� g
% i J 3
Builder: r,rZ - 1 7 3
THE TOLLAWING CORRECTIONS ARE RRQUIPMDs
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Inspectors _ Dates 2 T
APPROVED DISAPPROVED APPW/RD SUBJECT To ABOV!
call For Rainsp.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13128 8W Hall Blvd.Tigard,Oregon 97223.0190 (603)630-4171 W-i L
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F1'tap0c1;jb1) i;.69-44�t
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 6722.34199 (503)636-4175
,.+•, � ; riV._ -`�rit�.,l:L_ �_:.�t 1 rA.�i-•I...k:c1 .
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_. .. . . . . . . . . . . _u f. . . . . . . . . . . . . . 6
. . . . . . . . . r 1.X TURL UNI T",. . . .
i.,.Y_'.^%: i •. Irl1,-i. ..)I•- BUILDING:..
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Merl., t
iA/t)IMIH NU. J.' t:YJae aslc+.irr,, iiy ci:�I:�
075 SW RA1_E:I6li+,' LLW. DR PIRMT t E,100. 0(b JN 1/418c'/
w, x 31. 4:'G i lJ f f i
Req y]f L
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fhi! tiipimant agrgLs t0 (:('aplr oit` alt tt ruie5 A-v! rquiai)ons
7` t`ic J�tlfilG' :;tw8yf Ayer'cy. �'ie �e''Nit E•,�li 'E5 iC«� ,'dy5 fr'0� ,_______4 ........... ..... _...___._...._.....__.,._._..�___..._..._ ._.
:t.e cal.e 19sued. Thf tuta aovsit p,,,d will be forfeited ;i the
perdit tr.Nires. the Agercl does rat Quaram'ee thi accura,:y of tht
i,de sewn: is erai�. if it)$ sewer 15 n-t icrated at tht xeasul•eaent
it directions frut
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MASTER PERMIT
CITYOFTIVARD Cifff Y COX)F 'A RD PERMIT #. . . . . . . .. MST93-0005
COMMUNITY DEVELOPMENn' DEPARTMENT 04100N
13125 SW HAI Blvd. P.O.Box 23397,TV3A,OrogDn 97223(503)&*41 JS L7 DATE ISSUED: 01/20/93
SITE ADDRESS. . . : 14124 SW 97TH AVE PARCEL: 2SI11BA-01100
SUBDIVISION. . . . : TI'GARDtILLE HEIGHTS ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . o . . . . . ..28
BUILDING
REISSUES DWELLING UNITS: 1 BASEMENT.. . . . . . . . :0 sf
':LASS OF WORK. 010V BEURMS:13 BATHS:2 GARAGE. . . . . . . . . . ..424 sf
TYPE OF USE. . . :SF FLUOR AREAS--____–___ REQUIRED SETBACKS----------
TYPE OF CONST. :5N FIRST. . . . : 1 1 17 sf LEFT'. . : 10 ft RIGHT. -.5 ft
OCCUPANCY GRP. :R3 SECOND. . . :503 sf FRONT. :20 ft REAR. . :20 ft
STORIES. . . . . . . :2: THIRD. . . . :0 sf REQUIRED---------------------
HEIGHT. . . . . . . . :22 ft TOTAL------: 1620 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . 140 psf' VALUE. . . . . $ : 7500 PARKING SPACES. . .' t
Remarks: THIS PERMIT FOR A FOUNDATION ONLY.
------------------------------------- PLUMBING --------------------------------------------
SINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . *.0 BACKFLOW PREVNTRS. . :0
LAVATORIES. . . . . :O WATER HEATERS. . . :0 TRAPS. . . . . . . . . . . . . . ..0
1 UB/SH06FERS. . . . :0 LAU1-1T)RY TRAYS. . . 10 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :O SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . -.0 WATER LINE (ft) . s100 OTHER FIXTURES. . . . . 10
GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :O
WASHING MAC14. . . :0 SF RAIN DRAINS. . : 1
----------------- MECHANICAL FEES ------------
FUEL TYPES-------------- UNIT HTRS. . :0 type amoLtnt by date recpt
VENTS . . . . . :0 TIF $ 1460. 00 BCR 01/20/93 –
MAX INPUT:O BTU VENT FANS. . cO BPRT $ 66. 50 BCR 01/20/93 –
FURN ( 100K — :101 HOODS. . . . . . :1Z1 BPLC $ 44. 53 BCR 01/20/93 –
FURN ) =100K . . I:0 WOUDE-TOVES- :0 B5PL $ 3. 43 BCR 01/20/93 –
FLOOR FURN. . . . :0 CLO DRYERS. : 0 SSDC' s 280. 00 BCR 01/20/93 –
BOIL/CMP ( 3HP:0 OTHER UNITS:0 PARK $ 500. 00 BCR 01/20/93 –
GAS OUTLETSs0 PPRT s 35. 00 BCR 01/20/93 –
Uwnert -------------------------------------p5pC $ 1. 75 SCR 01/20/93
BOB & DINAH ROGERS
3075 SW RALEIGHVIEW DR
PORTLAND OR 9-7225
Phone #s
Contractor: ------------------------------
EMNLRt* INTERNATIONAL
11611 SE HWY 212
CLACKAMAS OR 97015
Phone #c 655-7191
Rey #. . - 00805 -------------------------------------
$ 2393. 21 'TOTAL
This permit is issued subject to the regulations contained in the -------- REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes ;.nd all other Foot/foiand Insp Water Line Insp
LLapplicable laws. All work will be done in accordance with approved PLM/Underfloor Appr/Sdwlk Insp
plans. This pereit will expire if work is not startedithin 180 Mechanical Insp Mechanical Final
days of issuance, or if wo;,k is suspended for more th 14 days. Framing Insp plumb Final
Gas Line Insp BUilding Final
P Lrmittee SignatLire.3 �J , Insi-ilation Insp
Gyp Board Insp
ISSUed By: Rain drain Insp
Call for inspection 6.39-4175
/ ,NSPECTION NIC
OT
City of Tigard Building Department ���--�����J-'
bl G.0 13125 SW Ball Blvd. Tigard, Oregon 97223
;S-
Footing
po-tion Line (Rec-O-Phone: 639-4175 Business Phot to
InapBati
Plbg. Underslrb Mech. Rough-in Appr;Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Point/Beam Struct. San. awer raming -Bldg.
Poet/Beam Her-h. Rain Drain Insulation -Plumb.
Plbg. Underfloor WaterLineGyp. Bd. -Neth.
Date RequestedsTime: -_PM
Address: '�yZZ V . Permit Isy1�
Builder: n f
THE FOLLOWING CORRECTIONS ARE REQ?IRED:
G c1ElZ S
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W
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- J � �Gd F Lam'
Inspectors ` — Datc:
r
APPTA)M _ DISAPPROVEn APPRO1BD S.;BJECT J1S011t
Call For Reinap.
1NSPE MON NOTICE
City or Tigard Building Department
13125 SII Hall Blvd. Tigard, Oregon 972,
Inspection Line (Roc-O-Phone)t 639-4175 Business Pho 639-4171
Inspectiont
Footing Plbg. Underslab Mech. Rough-in Apps/Sdwlk
o'rnd• (_75-9-
Tbc. T p Gas Line FINALt
Post/Beam Struct, San. Sewer Fraa Lng 1 -9149.
Post/Seam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. Mach.
Dais Requested: 6 ." / Y► ` Tim6l/o" -�_ AN ----PM
Hddrea s t AZZ, / 7 Permit #S_Builders _
THE FOLLOWING CORRECTIONS ARE ARQUIREDt
6.
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-
Inspecto t ,--- - ---- Dates L��
APPAOVRD DISAPPROVED APPROVED SURJECT M AWrJR
CA11 For Reinsp.
iNSPeGTION Nance.
City of Tigard Building De
13125 SN Hall Nlvd. Tigard, Oregon 972
Inspecti, Line (Rec-O-Phone): 639-4175 Business ^`.,uv. .19-4171
Inspections
Footing Plbg. Underslab Mech. Rough-in Aper/Sdwlk
Found. Plhq. Top Out Gas Line FINAL=
Post/Beam Sr_ruct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain ♦.:OLlation l -Plumb.
Plbg. Underfloor Water
�Line
/ Oyp. Ed. -Koch.
Date Requesteds U ('1 _Time: AN
//
Addresss�+`1� i Permit to
Builder: 1"!, f+
THE FOLLOWING CORRH IONS ARE REQUIRED:
Inspectors _ Date:
Inspectors
D78APPROVED APPROVED SUBJECT TD ABOVE
_Call For Roinsp.
INSPECTION NOTICE
City or Tigard Building Dapartsent
13125 SW Hall Blvd. Tigard, oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171
Inspectlow
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL!
Poet/Berm Struct. San. Sewer Fraying -Bldg.
Post/Ream Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Linepyp, iQ, -Hoch.Date Requested/!_ 2 -/4/, --/ Tiaess ( AN pN
Address! , 7 .Z '-/ 70--perslit #a.
Builderr_ �!'1
THE FOLLOWING CORRRCTIONS XQUIRED:
n
J
1
11
V
J
Inspectors C�
Dates
_i PROVBD DISAPPROVED APPROVED sn CT TO ABOVIt
Call For Reinsp.
INSPECTION_NOTICE
Circ of Tigard Bailding Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Pho i 639-4171
InspectionsCfi _U„�,
Footinq Plbg. Underelasb Mach. Rough-in Appr/Sdwlk
Found. plbg. Top Out Cas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Aiin Ora Insulation -Plumb.
Plbg_ Underflwir Nater Line Gyp. Bd. -Hoch.
Date RequestaclsTimes AM PM
Address:� `-y /v' �/ v - Permit #1
L _C•'
Bt,l iaer t �7_
THE FOLTMING CORRECTIONS ARTS REQUIREDs / f
d ^�
ry
F-
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J
C_7
W
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Inspeotort _ Dater t=
APPRt7ViD DISAPPROVED APPROVtD SUBJSC! TO ABOV=
Call For Reinep.
INSPECTION NOTICE
City of Tigard Bailding Department
13125 SBO Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phone: 63Q-4171
Inspection:_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbq. Too Out Gas Line FINAL:
Poet/Beam Strict. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. nd. -Mech.
Date Requested._ •� ^�� _l� Tin1eS� AM PM
n
Address: '�- — Permit
guilder:_
THE FOLLOWING CORRECTIONS ARE PEQUIRED:
fi
in
.-r
Ct;
W
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Inspector: Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
' Mp ECTION NOTICE
City of Tigard Building Department
13125 SN Ba11 Blvd. Tigard, Oregon 97223
Inspection Lino (Rec-o-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing _ Plbg. Underslab �h. Rough-in Appr/Sdwlk
Found. Plbg. Top Out �.Gam Lie; FINAL:
Post/Beam struct. San. Sewer Framing eldJ.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Na(�tez jinn* Gyp. Rd. -Mach.
Date Requested: (� '^ / 1 Timm AM _PN
Address: lrain.
Builder: «�4 ��v� v�d\.Q a KS;")-e C/t
TBE FOLLOWING CORRECTIONS ARE REQrrIRED:
JAJ
, T a"
if. 77-
U a%r o-_
V)
LO
w CALA, IL
Inspectors \ �
APPROVED DISAPPROVED APPROVED SUR.IECT TO AROVE
��call for Reinsp.
INSPECTION NOTICE '(�l
City of Tigard Buildlaq Department J
13125 an Ball Blvd. Tigard, Oregon 9722.3
1: 639-4175 Bueineeo Phone: 639-4171
Inepec
Footir Gi�% �-y� - kb Mach. Rough-i Appr/Sdwlk
Found. Gas Line FINALt
Poet/1 traminq -Bldg.
Post/1 �? Q Q L(1f�7iy�^Y cI aA Insulation -Plumb.
Plbg. Underfloor Mater Line 0". 1M. -!tech.
Date Requented:— Time: AM PN
�� .��
Addreoa: V 2,�}- l Permit
Builders _
TEM FOLLOWING CORRECTIONS ARE REQUIRED: 2 r
5 P
.^ 2 c,a�
Inspectors
APPROVED
DISAPPROVED APPROVED SUBJECT�TO ABOVE
C
call For Rel.nnp.
CITY OF 'TIGARD RECEIPT OF PAYMENT RECEIPT NO. 193-243131
CHECK AMOUNT a 56. 18
NAME : PIONEER FURNACE CASH AMOUNT a 0. 00
ADDRESS a PAYMENT DATE 08/11/93
SUBDIVISION
,ijRPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
il-
-CHIANICAL PE 25. 00 MECHANICAL PE 28. 50
1 . BUILD PER 1. 25 ST. BUILD PER 1. 43
11
14124 SW 97TH AVE
685 SW INEZ ST
OTAL AMOUNT PAID 56. 18
;j!_t:Ljaa i1t.f _.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW H&H Blvd.Tigard,Onpo•, 97223.6199 (503)039-4171
It,
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ENNA
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+ 13In SW hall Blvd. P NICK/RECT #
CITY OF TIGARD PERMIT # `33
COMMUN111'UEVELOPMEN'['DEPARTMENT Tigard,Oregon 97713
(503)639-4171 DATE ISSUED
JOB ADDRESS: i /%Z `/ - <-i "� /��/ TAX MAP/LOT "
SUB: OT: _ LAND USE:
VALUATION: --,-, 0 z-)
OWNER 11A C��C4 l)I I'I(IH fol(
v SPECIAL NOTES
NAME: DCVI rind Yl(b ( 6LkYI l REISSUE OF:
ADDRESS: 30n ,�ti f'
it ol uo L1�1 IIS LAST REISSUE:
I IL ANb Or,- gg1l2 s FLOOD PLAIN/
PHONE: _( 2-"111 ' llSENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: C;(�lrY1�( I � . �0��� PLANNING: _
ADDRESS: ENGINEERING: _
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: n' 5 EXP DATE: -s
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB 11'���(', LIST/SUBCONTRACTORS:
MECH �� Il�zyll�li _ BUS TAX:
ARCH ENGINEER / CALCULATIONS: _
NAME: TRUSS DETAILS: _
ADDRESS: OTHER:
PHONE:
- PROPOSED BPG. USE: ��Q�"� 4 /`%'o X Gc7/<2
COMMENTS: �-�1, z p "A i�z 'A s
�i C i�r< �< ��ti .i t r /i-1 T r� .'C �i�✓�/� aK/ 4� / L✓f7.�iii h f 1
APP ICANT SIGNATURE
Received By: _ Date Received: __ z i'-Z
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432. 00 Building Parmit Fees
10-431 00 Plumbing Permit Fees _ 3 5
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) l c�
Building y's
Plumbing
Mechanical
10-433 00 Plans Check Fee
S� —
Building
Plumbing
Mechanical
10-230 06 Fire _
>�,y30-202 00 Sewer Connection
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 Parks System Dev Charge (PDC)
31 -450 00 Storm Drainage Syst Dev Chrg
(SSDC) _ X3=0
�L
24-445-01 Water Quality (Fee in lieu oF) A _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL L
z OOU
nm/3581P.WPF �-�T
TI GAS ���u sw ww owa PLNCI(/RECT # _. ....—
CITY OF ,,,��,,7 PERMIT 0,
COMMUNnT DEVELOPMENT DEPARTMENT (SW)094171 DATE ISSUED
JOB ADDRESS: 14124 v_ —j TV T{(�ARZ cn 2.2.4 TAX MAP/LOT
SUB: LOT: LAND USE: —
VALUATION: _
OWNER SPECIAL NOTES
NAME: b DlanWQ( r< % (IN ( I/���k� RREEtSSUE Of-:
ADDRESS:
V-
"1.aST REISSUE:
�75��n n.L4����1
Topnp-Nb C.�rj Z2`� FLOOD PLAIN/
PHONE: (q 2-99- -j w8 SENSITIVE LAND:
CONTRACTOR APPROVALS F'.EQUIRED
NAME: PLANNING:
ADDRESS: — _— ENGINEERING:
FIRE DEPT: --
PHONE: OTHER: _
CONTR. BOARD EXP DATE:
ITEMS REQU I RED
2 Bf.ONTRACTORS: PLUMB: LIST/SUBCONTRACTORS: —
MEC.: BUS TAX: —
ARCH/ENGINEER CALCULATIONS: —
NAME: TRUSS DETAILS: —
ADDRESS: OTHER:
(L"
PHONE:
PROPOSED BLDG. USE: � 1 L
7
" COMMENTS: � —
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A L{cANT rGra u �.---
Received By: __ �.._ _._. Date Received: _ —
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE"'
10-432 00 Building Permit Fees
10-431 00 Plumbing •Permit Fees—i-( .l Ir
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5x)
Building _
Plumbing _
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing �.
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Cormercial 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 Parks System Oev Charge (POC)
31-450 00 Storm Drainage Syst Dev Chrg
d (SSOC)
K
N 24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lied of)
►, — - —
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TOTAL
nm/3587P.W('(-
COFIGARD
ON
PERFORMANCE ASSURANCE AGREEMENT
Re: 14160 :;W 97th Ave, WCTM 2S111B,'1-, Tax Lot 1100
I, Robert Rogers, deposit the sum of $2000.00 with the City of
Tigard, for the purpose of a guarantee of performance (to the
satisfaction of the City) of the following work on the above
referenced property:
Compliance with TMC 14 .20.070, placing house moved onto the lot on
an approved foundation system.
The above shall be completed by February 18, 1993. Failure to
complete the work on the specified date shall constitute forfeiture
of the cash deposit, and authorizes the City to expend the cash
deposit for the purpose of hiring a competent person(s) to complete
the described work, or remove the structure as permitted by TMC
14 .20.070.
I understand that the cash deposit will be refunded in full upon
satisfactory completion of the described work.
This inst nt wa cknowledged before me on November 18, 1992
VBY
Date
Notary
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My dommission Expires -el.
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (503) 684-2.772
NEW
OVERSIZE LOAD PERMIT
CIT- YOFTIGARD PeL-mit #: Wiz" Q o /
CHYOFUCARD Date Issued:
WMMUNITY DEVELOPMENT DEPARTMENT Move Data:�f-22�- 9�?
13125 SW Hat Bled.Q.O.Bac 23394,"Vied,Oregon 97223 175
Item to be MovedO
Use or Purpose of Item (If to be located in the City):
�l
Construction of Item:
rall Dimensions (Loaded on vehicle):
-J 31114 0G ® 8 'L
Widto. �1 b lobe of Heigh . 1.1 �, Length ed� a(
a5 fiut cj e
Item to be moved From: �7 I S WCA Ly-r-Q
Item to Moved To: kq\(0050qr1 ^`
Exact Route of Hove: M nA, 0-VIN ��\Ai/y�Sll � C-y'_ c �0 m_14a
Proposed Date of Hove: N --'r!-Proposed Time of Hove:
Tow Vehicle: (s-!_.Q_
Years Makes Licf: PUC#:
Fee: $/�� J
Owner: �'�p�r� +Q1�hr7� f)aQA A
Address:
�_ p ,r , Receipt #: �� 2- X33 _5 O
City: P
State: r Q Zip: q-t aZs
Phone:_ --W:;ICA-4 - 1,p-j This permit is issued subject to the regulations
rcontained in the Tigard Municipal code, State of
Moving Contractor: TV�A 1L _ Oregon and all other applicable law. All work will
2be does !n accordance with the provisions of this
_ Address:_\Xq SE "A.y 142 _ permit. The issuance of this permit does not
R City: ��Ac llwa.rn_t1 authorize the alteration, removal or endangerment of
State: �7 t zip:-!3-10 LS _ am public or private property without first having
Phone: tog--; - I 1 obtained written permission from the prcperty owner
t or public entity. This permit expires attar the
Contractors Board f 4 pS^T- indicated no" date.
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L' Insurance Company: _
(Current copy of an Acord form 25-•S certificate of insurance must be- attached)
Permittee Signature: Date:_
Approved by: v Date: // A 12 _
48 03URS p0?IC8 RXQOIRBD PRX0K TO "WE
NOV 12 '92 17:44 EMMERT INT'L 5036553933 P.2
CITf �� � OVERSIZE LOAD PERMIT
®� T'O Permit
CM(OFT16ARD Date Issued:
COMMUNRY DEVELOPMENT DEPARTMENT con Hove Dater
e312s6WH48ka.PM.sca .Tiprd.O,eow o72M t i
Item to be Moved; _� C+
Use or Purpose of Item (If to be located in the city):_
� cbasttucti.oa of Item: taa��
0--all Dimensions (Loaded on ve le):
Wid49-1•TI b�}obi Ueight 1-11(, T,ength a l
frJue.
Item to he Moved From:
Item to Moved Tos lq` o so q i"L-
SY.lct Route of Move 1 m3r1. 4aa I V d'
__—�l 11)0 S C'►'� \'r tI�f c�V � I1" �y �l{�G`7
Proposed Date of Moves tl� =Proposed Time of Hover
Tcwv Vehicle: ��GZ_ Dal Ili r►. a
C_
Year:_ Make: Lic#: POC#:-_
Pee: $
owner: ' Err, 6�Ic�nh
AddrPBs- ' 7
uo eLAU,6,\, Receipt #:
City: - ---
State:
Phone: 2Ct-} - �-1 (�� Tei. Pesalt is ineuea subject to the raqulatioas
+ ooataLnM is the Tigard emnicipal Crime, state of
Moving Contractors E(Y1YY�t.f l IL oregext and all other applicable Law. All te)rk will
Address be 4000 L's `LOOK"20e with the pev.isteas of tete
peridt. The issuance of this peewit does sot
c tY= r VL`�G.1C��..r��t1 aatbarise she alteratLos, rro►al or e.d,,V n ,t of
State: b(j_ _ Zip: g70 ty -W p"bll- oe pwi.ate propwer_r .dteont first ha.iny
Ph��ne:
�O S - oetarep i"IarA Witt— perriisLaa ream the propeorser
-i or pvbiLo entity. This per*it f+apires atter the
Contractors Board # 4 0,T' Ladior.ced ina"
Insurance company:
(current copy of an Acord form 25-5 certificate of insurance munt bo attached)
Permittee Signature: -Dom!_ _/ 'L Dates`-_L
Approved by: Date: 1�,/�-� U
48 HOURS narrCB R OI!® PRYOR To MVR
(AT"Y' OF TIGARD Rr-.CElr,T OF PAYMENT RECEIPT NO,
CHEM< AMOUNT 44. )3
ROGE'RS, P01W.RT CA�Ai AMOUNT 1p. 00
(401)RESS z 3075 SW RALEISHVIE'W DRIVE F;IAYiylf-.'N'f DPT*F a 1P.,'22 9 2
PORTLAND, OR SUBDIVISION
9'7225--
F-IMJOSRE OF PAYMENT AMOUNT PAID PURPOW-F. OF PAYMFN,r AMOUNT PA I D
4 4. 53
cc
TnrAL AMOUNT PAI0 44. 93
CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NCJ. 192—P33833
CHECK 01101 INT 1 iRN100. (ala
NnMF-- : CLACKAMPS BARK0081- INC CASH AMOUNr 121, 00
ADDRESS t PO BOX 418 PAYMUNT DATF 1 1 1 /16/92-
qUSD I V I E31(IN
PI IRPOSIF Or PlOYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
Un ...........-........
c 00
47
ul
ul
PF'PF ORMANCE ASSURANCE AGRE-EMENT
14150 c.:,w 97'rH AVE
TOTAL AMOUNT PA!D — — — —> 00
CITY OF TIGORD PrEli"IPT OF PAYMENT RECEIPT NO.
CHECK AMOUNT a x'::'4!-].:3. 66
')NE a C1-i.'4CFAMAS BARKDUST INC CASH AMOUNT a IA. 00
L)DRESS t r10 BOX 1118 PAYMENT DATE a 04/22/9?.
SUBDIVISION
CLACKMAS, OR 9-7013—
�t1W."OBF OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
_.-.6H. 50 STORM DRAIN SDC 280. 00
L 14 V�R USA ,-100. 1110 SEWER INSPECT 35. 01121
LUILD 0. 18
LD
LL)
14124 SW 97TH
VICKI COURTNEY
107AL flMOLJNT PAID 2,483. 68
w 4F
(:1 I Y OF T I BARD — RF""CE 1 P T OF PAYME NT FREC'F I FIT NO. s 92—J-'.,3 3r350
CHECK MIOUNT ; 10. 00
NAME s E.MME NT I N I-FIRNAT I ONAL CASIA AMOUNT 0. Ize
AIJI>RFSS s PAY`.,IF'Nl` WITF
SUBDIVISION
PURPOSE OF= PAYMENT 0MOUNT f.011) PURPOSE OF PnYMF.NT AMOUNT PAID
1 I T SCELI._.ANFOLIS
OVrPc-,IZF= L-001_ MOVING PERMIT
7'7,'O SW MI..IPP lY "TO 14160 SW 97TH 014
TOVIL Ah1(]UN1' F'AID -- — 10. IAO
FLAG CAR REQUIREMENTS: NONE ONE TWO RIDER
Make of Equipment ID Number PUC Plate # License # CO #
Frejghtliner CB413HP173937 MNA 694 T434041 50
CCC (Brutus) DDO18164TI2424 MJT 576. T434040 71
Int '1 Pay tar A9057EGP17552 MJ,�_581 T433995 118
Chevy Pull-Truck CME675VI24393 MJT 579 T434033 75
Applicant hereby certifies that the information submitted above is
correct and understands that , if fraudulent , the permit issued hereto
is void. Aplicant further states that the equipment described herein
in all other respects complies wit.h the Oregon Motor Vehicle La�..s
and Motor Transportation Code .
EMMERT INDUSTRIAL CORPORATION
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