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INecotds%rrnicrollm\largelsV)uilding.doc
MASTER P,ERMIT 7
IDERMIT MST1160233
V
C IT`1 OF TIGARD DATE ISSUED: 05/14/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL-: IS135CD-00901ZI
* TIg old,f�to'qor -4171
lj3lft"�t�
IS39
SIT.-
SUBDIVISION. . . . : BURLWOOD ZONING: R-12
BLOCI-:. . . . . . . . . . L.D I . . . . . . . . . . . . .
Remarks: ADDING I BATH AND ONE BED ROOM 315SO FT PATH I
--------------------------------------------------------------- BUILDING ------------- ---C------------------------------------
REISSUE: STORIES.......: I FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETEACKS---- REQUIRED-------------
CLASS OF WORK.:ADD A,HEIGHT........: 13 FIRST....: 315 sf GARAGE.....: 0 sf LEFT........... 0 SMOKE DETECTRS: i
TYPE OF USF...;SI<r FLOOR LOAD—.: 40 SECOND...: 0 sf FRONT...,.....: 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: I FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 BDRM: I BATH: I TOTAL------: 315 sf VALUE.. 20368 REAR..........: 27
--------------------------------------------------------------- PLUMBING -----------------------------------------------------
SINKS......... 0 WATER CLOSETS.: I WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........:
LAVATORIES....: I DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...: I GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE it: 0 BLKFLW PREVNTR: I 6R-ASE TRAPS..: 0
OTHER FIXTURES: 0
-----------------------—--------------------------------------- MECHAN!CAL -----------------------------------------------------------------
FUEL TYPES----------- FURN ( 100K 0 BOIL/CMP ( 3HP: @ VENT FANS.....: I CLOTHES DRYERS: @
/GAS/ I FURN 1=100K 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP. 0 BTU FLOOR FURNACES: 0 VENTS.........: 2 WOODSTO',IES.... 0 GAS OUTLETS...: 0
---------------------------------------------------------------- ELECTRICAL ----------------------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ----BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADDIL IN91ECTIONS--
1it!A SF OR LESS: 1 0 - 200 amp..: 0 0 200 amp..: @ 4/SVC OR PDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADDIL 500SF.: 0 201 - 400 amp..: 0 211 400 amp..: 0 1st WIG SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 600 amp..,, 0 401 600 amp..: 0 EA PDDL BR CIA: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANIF HM/SVC/FDR: 0 601 1000 amp.: 0 601+81ps-1800 v: 0 MINOR LABEL -10; 0
IN@+ amp/volt.: 0 ----------------------------------- PLAN REVIEW SECTION ----------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR1=225 A.: ) 600 V NOMINAL, CLS AREA/SPC OCC:
--------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ------------------------------------------ -----------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL-----------------------------------------------------------------------------
AUDIO A STEREO.; VACUUM SYSTEM,.: AUDIO I STERE".: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: BOILER....... . HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OP'ENZR.,: CLOCK........ . INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS:
Owner: ----------------------------------Contractor: ----------------------------- TOTAL FEES:$ 460.11
CAHN PROPERTIES LIMITED PART. OWNER
5795 SW CRANBERRY LT
BEAVERTON OR 97007
'hone #: 627-0151 Phone
Reg
a�
!his permit is issued subject to the rey,ilptions contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
to applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than 180 days,
-----------——--------------—--------------- REGOIRPD INSPECTIONS ------------------------------•----------------------------
Erosion Contol Underfloor insul Electrical Servi Rain drain Insp
Footing Insp Crawl Drain Electrical Rnugh Electrical Final
Foundation Insp PLM/Underfloor Framing Insp Mechanical Final
Post/Beam Struct Mechanical Insp Insulation Insp Plumb Final
Post/Beam Mechan Plumb Top Out Gyp��o Insp Building Final
Pet-m i t t e --;I on-it I-We I -,s 1-i e d By 3
Call for inspection - 639-4175
14
-�' �t�'CZj 05(G`l(v ��''n Clkfti (zC-Ct f7
Residential Building Permit AApplication.
City of Tigard
13115 SW Mall Blvd,,
Tigard, OR 97223 l�PJ�' v
(503) 639-4 f 79
11 - �qtl
Jobsite Address: � �
Offire Use Only
Subdivision: A' �cWnIUI3`�i �a,�tifs Lot L
� Contact Date -/ / .t? Initials ('T�
Valuation: Result _ 1 C
1' + 1-1,(5 127•
New Construction Only: (Square Footage) Planck/Rec #
V y Permit # r)s-- -L?..?3
Rouse Garage: _ Reissue of
Garner Lot? Y Flag Lot? Y
Map
pe& TL ZI`�I
Plat # A_V"ko `
Owner: C Ft N Arca Tt E� i _
fi Ar vi h C f\vcty lr,F_cv Approvals Required
Address: q E S W C e Fl H cr E.V Y CT
�. Planning Setbacks _ Solar
LEAU c 2 S G c.► CSR_ ��1Oc�rl- Enginee,ing
�
Phone: j .rte G 3" ) (, �.,rI L l 3 Other
_
Contractor:
Items Required
�wl�. E,R _
Subcontractors
Address: _ Truss Details
Other
Notes
Phone:
Contractor's Licenr,e # --
Mn tattach copy of current Oregon license)
Contact Name. 1=1��,'J +'_k r, IN y�
Contact Phone: L 6 .1�
Subcontractors: Architect/Engineer: �� �F_ ��dr;:�s_o ►. _
=
Plumbing-
Address: ?
Mechanical: _�r3�-Lc� h Z-)
�- (attach copy of current OR Contractor's License)
Phone: 6 ��8
co
iLD JOB D E S C gI PT I O N: zr t)cl a o S`� t t std►T j,�j_►�-�-n E,k F i i*,,V_, j ty Ig ��T M_ '�
Applicant Si nature Applicant Phone number
Received by: _ `��.:_.,�' Date Received: L; �.
N p hnfCO
Permit# Account Description Amount Amt. Pd. Sal. Due,
MtL6 . 3,3 Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
,�� '
Mecr. Permit (MECN) .2 J'
Uabl6Zau.-. "XI G �
Bldg: _._1: -�}_ -17, 3,Y
Plumb: 3 3 v
Misch: / Z
F: 5 3
Flan Check (PLANCK)
Bldg: S .�
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF MF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF
Office TI,: (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
L
TOTALS: �� ' ' y�V
Permit
Address: S Slt)
Issued by: V -1,t Date: rj —
Statement: Information Notice to Property owners
About Construci`ion Responsibilities
Note: Oregon Law, ORS 701.055(4), re(p,ices residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following.statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registratiot7 under ORS 701.010(7),
need not submit this statement. This statement will be fr/cd with the permit.
Fill in the appropriate blanks and initial loxes 1 and 2,and either box 3A or 313:
R11. i own, reside in. or \\ill reside in the completed structure.
EY] 2. I understand that 1 must register as a convtruction contractor if the structure is sold or offered fol sale
��''==�� before or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
i will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
i23B. I will be my own general contractor.
Ifi hire subcontractors. I will hire only subcontractors registered with the Construction Contractors
Board. if i change my mind and hire a general contractor. i will contract with a contractor who is
registered with the CC13 and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certifN that the above information is Correct and that I have read anal do understand the Information
Notice to Property i ners�hout Co struction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (bate)
(White copy to issuing agenct,permit file,
pink copy to applicant)
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-1':'5 Business Phone: 639-4171
Footing in Dralnnn Cover/Service FINAL:
Foundation Water Line Ceiling Plumbj
PosVBeam Mech. Shear/Sheath Framing Mach.
Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer ,� Gas Line ppr/Sdwlk Reins.
Other:
Date: /� � A.M. `.P.M. Entry:
Address: 1-4) QG4k �+
Tenaot: d�- ---�y _ Ste: MST:
G_ BUP:
Con/Own: �� �6-1 PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
�,:
J
W -
t�1
l..
In,,pector:' _ _ _ _ __ Date: d
APPROVED __. DISAPPROVED/CALL FOR REINSP. CSF CO
CITY OF TIGARD BUILD;NG INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Eiech
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlh Reins.
Other: ----
Date: ?-" ]j q 6— A.M. _'a�P..M. Entry:
Address: I 5 S n-) ` b -
Tenant; L-"44 - syt— Ste: _ MST: _
BU P: _
Con/Own J�L; 6 0 `l 6 MEC:_
PLM:
'GICLGLG�' Ci'-� ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: EL.R:
Al
rel c2 f�k
Inspector: -, — DH
APPROVED __DISAPPROVED/CALL FOR REINSP, CF CO
CITY OF TIGARD BUILDING INSPECTIO1I NOTICE /
In ction Line: 639-4175 Business Phone: 939.4171
Footi in Drain Cover/Service FINAL:
oundatf Water Line Ceiling -Plumb,
Post/Beam Mach. Shear/Sheath Framing -Mech.
PIbg.Und/Flr/Stab Plbg.Top Out insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas
}Line
D Appr/Sdwlk Reins.
Other:
Date: A.M. P''.M. Enlry.
Address: , �1�1 `M�7.►_ __ ,��
Tenant: _ _ Ste: _ MST.
BLIP:
Con/Own:— MEC:
PLM:
ELC: .__�
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Date:
APPROVED _DISAPPROVED/CALL FOR REIN SP. CF CO
CITY OF TIGARD BUIL ING INSPECTION NOTI!'�
Inspect;^^ ' ine: 639-417F Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
rr�
PPlbbg�.UUnnd//Flr/S Insulation -Elect.
sUBeam Str Mech, Flouyh-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other. _
Date: � cq , A.M. _�/PQM. Entry:
Address: � f J�� —�_g Th _i
Tenant: Ste: MST:
bZ
BUP: _
Conry? MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REC"1IRFD: ELR:
I
I�nspee r: Dater
APPROVED __DISAPPROVED/CALL FOR REINSP. CF CO
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 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: — ✓Time: AM PM
Address:
Builder: Permit t1:�. L l
THE FOLLOWING CORRECTIONS ARE REQUIRED:
In.pector: Date: Z— L
PROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
INSPECTION NOTICE
City of Tigard Bni.idiog Departae
13125 SW [call Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phune): 639-4175 Business Phone: 639-417
7
i
Inn tion:_
Fcw)tinq Plbg. Underslab Nech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Post/Ream Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rein Drain Insulation -Plumb.
Plbg Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: > Time: _PM
Address:. �' a T / �. ' Permit #06
Hsu t dor:
THE Fc)LLOWINO CORRECTIONS ARE REQUIRED:
rL
f.Y
J
m
W
J
Inspector: Date:
l
/ APPROVED DISAPPROVED` APPROVED SUBJECT TO ABOVE
Call For Reinsp.
/ 5 INSPECTION NOTICE ^
` City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Orogon 97223 v`
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171
4,t
Inspections„ • �__y_
Footing P1Gg. Underelab Nech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Lines�jr
Post/Ream Struct. San. Sewer Framing -Bldg.
Post/Ream Mech. In Draln y Insulation -Plumb.
Plbg. Underfloor Water
``��Line Gyp. Bd. -Neth.
Ante Requested: i — -1 ;L7
j f zz Time: AM PN
/ �i�i� )
Acl.lr.,3es / 1 �c�-r /Q 5 (�Q " Permit
j.
THE F(.ILLOWING CORRECTIONS ARE REQUIRM
__ '-�/.�,a,-,L,,.I(�l.c�.�. �.�) •,.-t,..�-Biu•-�_.•t',.t�..�-...Nr
t=
s�
G
Inspector: ,/ -_-- - - - AAte: t- i%
APPROVED N DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinnp.
INSPCCTION Nn1'ICE /
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Fmt,J.ng Plbg. Underelab Mech. Rough-in Appr/sdwlk
Found. Plbg. Top out Gas Line FINAL:
Post/Beam struct. San. sewer raining -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: / Time: AM �JPM
Address: Ir /o r U /f li —_ Permit
Builder: �"' --- --
TIM FOLLOWING CORRECTIONS ARE_REEQUIREDx
Ole j
C._
H
V)
J
C�
Inspector:___��/
APPROVED DISAPPROVEDy APPROVED SUBJRr"T TO ABOVE
----Call For Reinap.
�Z�T.ION NOTICE A f
city of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639 175 Bu inese Phone: 639-4171
Inspections
Footing Plbg. Underslab Mech. Rough-in (/Appp�rr//Sdwlk
Pound. Plbg. Top Out Gas Line fL14fe+�s^^
Post/Beam Struct. San. Sewer Framing
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp, Bd• -Hoch.
Date Requestedt_ -� _Time AM PM
qq
Address Permit ��-J C�
• r
Builder: c'? 7 Z-
V !�/ .
THE FOLI.OWING CORRECTIONS ARE REQUIRED:
a
rr '
J
CD
W
J
Inspectors nater'
APPROV=D L--VTSj pPROVEL�
D APPROVED SUBJECT To AHOV
4-It-all-For Reinsp.
INS CTION NOTI('E �
city of Tigard Building Departaent
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 3 -41 1
Inspection:—
!!ootina Plbq. Underslab Mech. Rough-in Appr/Sdwlk
und. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hech. Rain Drain Insulation -Plumb.
Pibg. Underfloor Water Line Gyp. Bd. -Hech.
Dnte Reque)s/t/eddt—_ 2L12 & / - T;met I'00AH PH
Addrasa: /( "j(��11 �"-Z. v- 'jPermit f 16(_"-7
Mil I der:
TIM FOLLOWING CORRECTIONS ARE REQUIRED: d`y
_
- �- �a - ------- - _ m.._------- -----
Cx]
U
Li)
Inspect - Date A -
I-e'APPROVED i- DISRPPROVRD ✓ "PROVED SUBJECT TO ABOVE
-_--Call For Reinsp.
CITY OF TIGARD T # . . . PERMIT
F'C.'(,'MI #. . . . . . . BUF'9..1.-0221
COMMUNITY DEVELOPMENT DEPAR,TME71 DATE ISSUED: 06/05/9405/94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)"639-41' 1 PARCEL: 1 S 1 3 5CD-00900
SITE ADDRESS. . . : 11461 SW 98TH AVE
SUBDIVISION. . . . : 8URLWOOD ZONING: R-12
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
REISSUE: F=LOOR AKEAS---------- E=XTERIOR WALL CONSTRUCTION-
CLASS OF WORK. :ADD FIRST. . . . :400 sf N: S: E: W:
TYPE OF USE. . . :MF SECOND. . . : 5f PROTECT -----
TYPE OF CONST. :5N THIRD. . . . : Sf N: S: E: W.
OCCUPANCY GR[-,. :Ml TOTAI-------: 400 sf ROOF CONST: FIRE RET? :
OCCUPANCY LOAD:2 BASEMENT. : sf AREA SEP. RATED:
`.: TOR. : 1 HT— 11 i. 1 ft GARAGE. . . : sf OCCU SEF,. RATED:
PIMT? : MEZZ?: REDD SETBACKS-------- REUUIRED--- -
FLOOR LOAD. . . . : Psf LEFT: ft RGHT: ft FIR GPKL:N SMOK DET. . :IU
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM:N HNDICF' ACC:Y
13EDRMS: BATHS: IMP SURFACE:00 PRO CORK:N PARKING:
VALUE. $ : 6500
Remarks : Garage/storage addition for a apartment (2omplex.
Owner.: ------------------------- -.--_-___.-.-.-.-.---_.----_------..-__•- FEES -___-_.._-_-._-.__..-._._.-
LAHN PROPERTIES LIMITED PART. type amount by date reept
' 795 SW CRANBERRY CT PRMT $ 62:. 50 JF 08/05/94 --
PLCK $ 40. 63 - 07/26/94 94-254912:
11E.AVER'TON OR 97007 F112E $ 25. 00 - 07/26/9 F 94-2'54912
!'!-lone #. 62.7--0153 5PCT $ 3. 13 JF 08/05/94 -
TIF $ 162. 00 JF 08/05/94 -
ontractor: -------_.-__.-.----_-_---_-.____-----.
HWNER
------------------------------------
Phone #: $ 29;3. 26 TOTAL
Reg A. . : 00000
------- REQUIRED INSPECTIONS
---- --This pe-sit is issued sub)ect to the regulations contained ,n the Foot/Found Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Slab Insp
applicable laws. All work will be done in accordance with Framing Insp
approved plans. This persit will expire if work is not started Final Inspection
within 180 days of issuance, or it work is suspended for sore Roof n a i 1 n g Insp
than 180 days.
f'e r••m i. t t e e Signature : 41
� f -
issued By :
J
Call for inspection - 639-4175
J
Commercial Building Permit .Application
City of Tigard
1312.5 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Andress: TI
TV l
Office use Only
Tenant: Suite#
Planck/Rec# -
valuaticn
Owner: y-J4, Lrw'L) Map s, TL#
i , ;Addrass: I:L3 ?5' r• c,- ^-t_ Approvals Regulred
j Planning t/t
Phone: :o 2 f, h- o 3 Engineering
btttor
Contractor:
1
Address:
Types^ of const: r rr
Occupancy class:
Phone:
Sprinklered? Yes (No)
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project:
Story (1 st, 2nd, etc.)
I /
Arcrltect/Englneer: ke,�^v�' �' �� < n` ' ? Proposed use:
Address: gG3asJET.�1� L?,r.� Previous use:
r
r
Note: Plumbing R n,:chanical plans
must be submitted at time of
Phone: - C `{ i - 75 114 building permit application.
COMMENTS: �� Z ^C*• -h 6.� urv., ,.A CrW c;IA--I A �
1 C
n �
Applic nt Signature & Phone number
Received by: Date Received: ) (v- 9
T
Permit# Account Description Amount Amt. Pd. Bal. Due
�j
v Bldg. Permit (BUILD)
J Plumb. Permit (PLUMB)
_ Mech. Permit (MECH)
State Tax (TAX) �• /
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSLC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) , )2• �
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
Office TIF (TIF-O) _
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life: Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) _
Erosion Planck/COT (EROSN)
TOTALS:
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DATE: PLANS CHECK NO.:
PROJECT TITLE:
COUNTYWIDE
TRAFFIC IMPACT FEE APP,UCAN :
WORKSHEET
(FOR NON-SINGLE FAMILY USES) MAILING ADDRESS.
C!. /ZIP/PHONE:
RATE PER -�.� .! l C7L)/)-7 13,
LAND USE CATEGORY TRIP TAX MAP NO.-
RESIDENTIAL $155.00 / 3, c, L) "0 !�
BUSINESS AND COMMERCIAL $39.00 SITUS NO.ADDRESS:
OFFICE143. S l L
INDUSTRIAL $150.00
INSTITUTIONAL $64.00
PAYMENT METHOD:
CREDIT INSTITUTIONAL ONLY:
BANCROFT PROMISSORY NOT LAND USE CATEGORY IDESCRIPTION OF USE EKDAY AVG. TRIP RA VYEEKEND AVE TRIP RA
DEFER TO OCCUPANCY
BASIS:
L
CALCULATIONS:
/ - L PROJECT TRIP AENEAATION:
FEE4 16, L!U
ADDITIONAL NOTES: FOR ACCOUNTING PURPOSES ONLY:
t `� ROAD AMT.
r
TRANSIT AMT.:
PREPARED BY: /
CC WASHINGTON COUNTY %
TIF NOTEBOOK
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