14820 SW 103RD AVENUE . t
. . ..
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 6394171
BUP
Date Requested �L� AM _,PM BLD
Location ( �� -� .�C)3r Suite MEC
Contact Person Ph 3L� Cr�ZZ PL�My-2�fiXy`�-
Contractor _ Ph
BUIL IQ NG Tenant/Owner _ ELC
Retaining Wall ELR -
Footing Access:
Foundation FPS --
Ftg Drain SG,N
Craw! Drain Inspection Notes:
Slab _ SIT _
Post& Beam
Ext Sheath/Shear -
Int Sheath/Shear
Framing -_-_- - --
Insulation
Drywall Nailing 7 -
Firewall
Fire Sprinkler
Fire Alarm �' 7
Susp'd Ceiling - L"
Root
Misc ___ --- '
Final
PART FAIL
UMBIN
Post& Beam
Under Slab
Top Out -
Water Service _ •
ni
Ra ew -
am rains -
Fin
A; PART FAIL � -
CHANICAL
Post& Beam -- ------ - _-�- -___--
Rough In
Gas Line ---
Smoke Dampers
Final -------_ ---- ---- -._ ---
PASS PART FAIL _
ELECTRICAL
Service
N Rough In
UG/Slab --_-__-- -- - - ---
Low Voltage
` Fire Alarm - --- ----- --
Final
L,
PASS PART FAIL. ------ - - --
SITE _
Backfill/Grading --
Sanitary Sewer
Storin Drain [ ] ReinspEction fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE: [ J Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk (, / �-7 fl
Other Date Inspector i ", , i, Ext
Final
PASS PART FAIL bO NOT REMOVE this inspection record from the job site.
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES0, PERMIT#: S22/00 00052
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-41 DATE ISSUED: 3/22/00
SITE ADDRESS; 14820 SW 103RD AVE
PARCEL: 2S111CB-00600
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5
BLOCK: LOT: 005 JFIRISDICTION: TIG
TENANT NAME: PAEPIER
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSV!R IMPERV SURFACE:
Remarks: Connection of existing house to newly installed sewer lateral. Septic tank must be pumped, filled
and inspected for proper abandonment. Reimbursement fee of$8,000.00 paid on 3/22;00, receipt#
0000871.
Owner:
- FEES
PAEPIER, MARGARET A TRUSTEE
14820 SW 103RD AVE Type By Date Amount Receipt____
TIGARD, OR 97224 PRMT DEB 3/22/00 $2,300.00 0000871
INSP DEB 3/22/00 $35.00 0000871
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
I Iiis Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
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 measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If riot so located. the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-0 1-0080.
You may-obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued by: t � Perm ilea Signature: i r z
�' Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next slness day
i•
CITY ®F T I G,A R D __ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00094
PARCEL: 2S11106-00600
13125 SW Hall Blvd., Tigard, OR 997223 (503) 639-41���(^ DATE ISSUED: 3/22/00
SITE ADDRESS: 14820 SW 103RD AVE ��
SUBDIVISION: DEL MONTE SUBDIVISION � ONING: R-3.5
BLOCK: LOT: 005 J DICTION: TIG—
CLASS
CLASS CF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: ;NATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY 7 RAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to newly installed sever lateral. Line work is approximately 40 feet.
FEES _
Owner: –!
Type By Date _ Amount Receipt
PAEPIER, MARGARET A TRUSTEE $50.00 0000871
14820 S1\' 103RD AVE PRS"T DEB 3/22/00
TIGARD, OR 97224 5PCT DEB 3/22/00 !_ $4 00 0000871
Total $54.00
Phone 1:
Cc%itractor: `
PHIL PAULSON EX.";AVATION
1 x'39 SE BROOKWOOD AVE
HILI_SBORO, OR 97123 REQUIRED INSPECTIONS
Phone 1: 693-6610 Sewer Inspection
Reg #: LiC 141383 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
I his pemnit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
Yot *iay obtain copies of these rules or direct questions to OIJNC by calling (503) 246-1987.
Issued By: r l� I t � M Permit`.ne Signature: 7 -
Call (503) 639-4;75 by 7:00 P.M. for an inspection n.Qedea +he next btwiness day
all
:ITY OF-tIGARD Plumbing Permit Application Plan c
13125 SW HALL BLVD. Commercial and Residential Recd 6y am.
TIGARD, OR 97223 Date Recd
Date to P.E.
;503) 639-4171 Date to DST -----
Print or Type Permit#P,�N''�c,-�-
Incomplete or illegible applications will not be accepted Related SWR# 'u' �
Called
-
QTY Name of Clie, lopment/Project FIXTURES (indiv!dual) QTY PRICE AMT
1Ji3 Sink _
Street Address Suite Lavatory 11.50
Address14 - --" 11.50
, )� - u ��, - Tub or Tub/Shower Comb.
Bldg# City/State Zip Shower Only 11.50
'r 0y Water Closet 11.50
Natpe /: (c r Urinal 11.50
c
Owner Malling Add ss(( Suite Dishwasher 11.50
Garbage Disposal 11.50
City/Slate Ziu Phone Laundry Tray 11.50
�1. v Washing Machine/Laundry Tray 11.50
Name c - Floor UrainlFloorSink 11.50
T4-
Occupant Mailing Addre Suite _ 11.50
:� 14° •- 11.50
CttylState Zip one Water Heater O conversion O like kind 11.50
Gas piping requires a se crate mechanical permit.
rime MFG Home New Water Service 32.00
Mailing Addfess Sulte� MF3 Honrc New San/storm Sewer 32.00
Contractor
-, U)C('zf{ C Hose Bibs y 11.50
ILIEPrior to permit Ity/State Zip Phone roof Drains 11.50
Issuance,s copy 1 L / r !J1G• f I i Drinking Fountain 11"50
of alt licenses are Oregon Const.Cont.Board Lic.# Exp Date parer Fixtures(Specify) 15.30
required It t 1 _y-C 1' -
expired In COT Plumbing Lic.
database
Name
Architect Sewer-1st 100' 38.00
Or Mailing Address Suite Sewer-each additional 100' 32.00
Water Service-1st 100' 38,00-
Engineer City/State Zip Phone ce 32.00
I Water Service-each additional 200'
Describe work to be done. Stomt&RHin Drain 1st 1010' 38.00 _
New O Repair O Replace with like kind. Yes O No O Storm&Rain Drain-each additional 100' 32.00
Residential O Commercial O Commercial Back Flow Prevention Device 32.00
Additional description of work. Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping,moving or repla:Ing any fixtures? Insp of Existing Plumbing or Specially Requested 50.00
i
Yes O No O Inspections perthr
1� if yes, see back of form to indicate work performed by Rain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 61.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
t I hewhy acknewteda that I have read this application,that the information
9 Isometric or riser diagram is required If Quantity Total is >9
e49lven Is correct,that I am the owner or authorized agent of the owner,and *SUBTOTAL
M
thaFlans submitted are In con lian with Oregon State Laws
t`r Slgnat+re of OwnerfAgent Date 8%SURCHARGE 00
Co"tact Persa Name Phone **PLAN REVIEW 26%OF SUBTOTAL
i '" Re ulred only It rudure qty total is>9
1 BATHHOUSE$178.00 TOTAL
OUSE..���,�,, 60y00r _
O S 1285.00
t nelude i1! UI b 'Minimum permit fee Is S50+8%wrcharge,except Residential PrJlbw Prevention
san 6 1�,p 1 Device.which Is$25+6%surcharge
All New Commercial Buildings requint plans with Isometric or riser diagram at t
plan review
1 YrstsVorm siplurnapp doc t i11 e199
PLEASE COMPLETE:
Fixture Type !' � _Quantity by Work Performed
_ New Moved Replaced Removedivapped
Sink
Lavatory _
Tub or Tub/Shower Combinaticn
Shower Only
Water Closet
Urinal —
Dishwasher
Garbage Disposal _—
L_aUndry Room Tray
Washing Machine
Floor Drain/Floor Sink 2" _
3„
V z:4ter Heater
Other Fixtures (Specify) _
COMMENTS REGARDING ABOVE:
INthVormtWwnat+( �t,t1R/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection L Me: 639-4175 Business Line: 639-4171 �—
BLIP
Date Requested�11 AM- (,;&,l, _ BLD
Location �.� �lJ_� ���' / -� Suite fi MEC r'���� OC-D' 4 el
Contact Person Ph7 2 Z PLM
Contractor Pit SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Ftg Drain SGN
Cmwl Drain Inspection Notes: -- -
Slab _- SIT
Post&Beam
Ext Sheath/Shear
Int Sneath/Shear
Framing - - --------- - -_
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - --- -- --- -------- _ ---- �_ - ---
Roof
Misc: --- -- ----------- -- --- -— -- — - ----
Final - -.--- --
PASS °ART FAIL
PLUMBIr..'
Post&Beam - ----------._-_-.------- ----
Under Slab
TopOut -----------. .-�� ---- -..-_-- -___—_--- --
Water Sarvice
Sanitarl Sewer -_-- ---__ - ------_._..-
Rain�rains
Final - ------
PASS PART FAIL
MECHANICAL
Post& Beam - - - - - --- r- -.
Rough In r
,as Line ----- ---- -.-- �_ -___ --_------_._
- ---
Dampers
AP PART FAIL
rEECTRICAL
c_
r- Service
Rough In - - -
ti UG/Slab
J Low Voltage
Fire Alarm
• Final --- -- - -
L PASS PART FAILSITE
Backfill/Grading -- _.---�- -~� - - -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$_4 - required befo a next inspection. Pay at City Hall, 13125 SW Hell Blvd
Catch Basin [ ]Please call for reinspection RE: [ )Unable to inspect-no accpss
fire Supply Line
ADA
Approach/SidewalkDate 1' Inspector i,/�% Ext
Other _
Final �-----
PASS PART -FAIL J D NOT REMOVE %his inspection record "rom the jab site.
x (�
CITYO F TIV A R D MECHANICAL PERMIT
DEVELOPMENT SERi/ICE PERMIT#: MEC1999-00504
4/e//V
DATE ISSUED: 11/22/99
13125 SW Hall Blvd., Tigard, OR 97223 (5 . PARCEL: 2S111CB-00600
SITE ADDRESS: 14820 SW 103RD AVE A L
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5
BLCCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANG:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
S TORIES: BOILERS/COMPRESSORS _ HOODS:
_ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP:
GAS PRESSURE: 50 + HP: WOOD
STOVES:
< 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN >=1001' BTU: <= 10000 ;fm:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: InF'allation of gas logs and associated gas piping.
Owner: _ FEES
PAEPIER, MARGARET A TRUSTEE Type By Date Amount Receipt
14820 SW 103RD AVE PRMT DEB 11/22/9 $50.00 99-319935
TIGARD, OR 97224 5PCT DEB 11/22/99 $4.00 99-319)35
Phone:
Total $54.00
—
Contractor:
HOLMES INSTALLATION SERVICE
RAYMOND FLANDERS
33535 NW VADI5 ROAD REQUIRED INSPECTIONS
CORNELIUS, OR 97113
Gas Line Insp
Phone:647-930 Mechanical Insp
Reg #:LIC 00102473 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of Ore.
Specialty Codes and all other 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 th'an 180 days. ATTENTION: Oregon law reqs ,res you to follow rules adopted in the Oregon
Utility otification Center. Those rules are set forth in r)AR 952-001-0010 through OAR 952-001-0080.
You ay obt in copies of th*s ry s or di ect questic,is to OUNC� ailing (503)246-9189.
Issue y: Permitter Signature:
Call (503) 639/-4175 by 7:00 P.M. for Inr pections nee ed the next business day
PI
CITY OF TIGARD Mechanical Permit Application Recd B k�
13125 SW HALL BLVD. Commercial and Residential Date Rec' I Gd i
TIGARD, OR 97223 ` l Date to P.E. ------
(503) 639-4171, x304 -'t I� J Pate to DST
it#
Print or Type e Vic ' f
Incomplete or illegible applications will not b ccepted Called
Name of Developmenl/Projeci Description
C � d ( P� P Table 1A Mechanical Code Q Price Arnt
Job Stree!Address suitex A) Permit Fee
� � including duds
Furnace to 100.010 BTUAddress
Bli,,dg# City/Stale zip ds&vents _ 9.65
/ — 2) Furnace 100.000 BTU+
v
including ducts&__vents 12.00
Name(or name of business) n 3) Floor Furnace
Owner M a R V&,eer if rV (" including vent 965
Vallling Address 4) Suspended heater,wall heater
or floor mounted heater 9.65
ly�d ZD ✓� U 5) Vent not included in appliance permit 4.75
Cily/State zip Phone Check all that apply 'Boiler Heat Air
2
u ,� Gl 712 3 For Items 6-10,see or Pump Cond Qty Price Amt
NLme(or name of businss) — footnotes 1,2 _ Comp
6)Repsir units
LY 8.40
Occupant Mailing Add . 7)QHF;absorb unit to
100K BTU 965
city/stale zip Tpt,ine 8)3-15 HP;absorb unit
100k to 500k BTU __17.65
Contractor (Jame 9) 15-30 HP;absorb
n unit.5-1 mil BTU _ 24.15
f .ae [ r",7(u�� �C vi 10)30-50 HP;absorb
Prior to permit arling Address /J / unit 1-1.75 mil BTU 36,00
issuance,a copy �✓�U / /SC( 11)>50HP;absorb unit>1.15 mil BTU
of all licenseeCity/State zip Phone 60.15
are required if nNL'- /L/` cL o 37G 171 Air handling unit to 10,000 CFM
expired in COT Oregon Const.Curd Board Lic a Ex Date 7.00 —_
database G/ 7 ��-7 13)Air handling unii 10,000 CFM+
Architect Name 11.85
14)Non-portable evaoora'i cooler
or Mailing Address
15)Vent fan connected to a single duct
4.75
Engineer Cily/State zip Phone 16)Ventilation system not included in
appliance ermlt 700
Describe work to be done 17)Hood served by mechanical exhaust
7.00
New(k Repair O Replace with like kind Yes O No O 18)Domestic incinerators
Residential(a. Commercial O Modification O _ 12.00
19)Commercial or industrial type incinerator
Additional information or description of work 48.25
20) Other units,includinQod stoves
,_, . '.-1 r 7.00 J.
NOTE: For Commercial projects only;Units over 400 lbs,located on the 21)Gas pi n one f^`sur outlets ^,
roof,require structural talcs prepared by icensed engineer i-- 3.75
Type of fuel. oil O natural gas P LPG O electric O 22)More than 4-per o.:tlet(each) .75
Minimum Permit Fee$50.00 SUBTOTAL r
I hereby acknowledge that I have read this application,that the information 8%SURCHARGE t
oven is correct,that I am the owner or authorized agent A ----
g PLAN REVIEW 259x,CIF SUBTOTAL.
the owner,that plans submitted are in compliance with Oregon State laws Required for ALL commercial permits only
ature of Owner/Agent Date TOTAL
S
Ls ` - ,(1 -),2 -Ir Other Inspections and Fees
Contact Person Name / Phone
I Inspections outside of normal business hours(minimum charge-two hours) S50 00 per hour
2 Inspections for which no fee is specifically Indicated (minimum charge-haif hour)
$50 00perhour
Foonotes for commercial projects only: 0 Additional plan review required by changes,additions or re0slons to plans(minimum
1. Provide full sLoematic of existing and proposed gas line and pressure charge-one-half hour)$50 00 per hour
2 Provide drawings to scale showing existing and proposed mechanical 'State Contractor Boiler Certification required
rnds. _ "Residential A/C requires site plan showing placement of unit
I Vnechpe,,m doc rev 11/1/99
CITY 4F T I GAR®
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13125 SW Hall Blvd,Tigard,Oregon 97223.8199 (503)939-4175
PERMI 1 #k. . , . . . . : MST94-038
639--4171 DATE ISSUED: 10/12/94
P( RUE:L: 2S I 1 1(w F3 00( Q1121
3ITE ADDRESS. . . : 148c O SW 103RD AVE
)'UBD I V I S I ON. . . . : DEL MONTE SUBDIVISION ZONING: R-.3. 5
BLOCK. . . . . . . . . . . LUT. ., . . . . . . . . . . . :5 1
BUILDING
RE I G13UE: DWELLING UN is T4:>:0 BASEMENT. . . . . . . . .0 SF
_;LASS OF WORK. :ALT BEDRMS:k BATHS: 1 13ARAGE. . . . . . . . . . :0 5f
-YPE OF USE„ . . :SF FLOOR AREAS.._.---------- REQUIRED
YPE OF CONST. :5N FIRST. . . . :0 sf L.Ff=T. . .5 ft R1 HT. :56 •ft
_JCC:UPPNC'.Y (.;RP. : R SECOND. . „ :Q1 s f FRUIV 1`. 0 f t HEAR. . : 15 f t
;TORIE'S. . . . . . . :0 FINBSMENT:o 5f REUUIRED-
i-1EIGHT. . . , . . . . : 0 ft TOTAL-•---__._:0 S SMOKE DETECTORS.
LOOR LOAD. . . . ..60 psf VALUE'. . . . . 61. 10 PARKING SPACES. . :0
2emarks : REDOING OLD DECK, BUILDING ONE NEW DECK AND REDOING BED ROOMS AND BATF!
_-_ PLUMBING
li
INKS. . . . . .. . . . . :0 FLOOR DRAINS. . „ . :0 BACKFLOW PREVNTRG. . :0
LAVATORIES. . . . . :2 WATER HEATERS. . . .0 TRAPS. . . . . . . . . . . . . . :0
7 Ula/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . „ :10
WATER CLOSETS. . : 1 SEWER L i NE (f-t ) . :0 GREASE TRAPS. . . . . .. . .0
DISHWASHERS. . . . .0 WATER LINE ( ft ) . :(A OTHER FIXTURES. . . . . :121
GARBAGE DISP. . . •rA RAIN DRAIN ( ft ) . .0
WASHING MACH. :0 SF RAIN URAING. . :0
ME=CHANICAL. _______ __.____. .___.___ .._._..__._. .___._._ FEES
1_UEL TYPES.-..•-.______.__. UNIT HTRS. . :0 type amol.tnt by date recpt
/GAS/ / / VENTS . . . . . .3 BPRT $ 6 2'. 50 JF 10/12/94 -
MAk INF='UT :0 BTU VENF FANS. . :2 BPLL; $ 40. 63 J1= 10/07/94 94--c'D76i2o
1=URN < 11110K . . -.0 HOODS. . . . . . :0 B5PE: $ 3. 13 JF' 10/12/94 --
FURN ) !-iQtOK . . :0 WC.IOI)STnVE'8. :0 11PRT $ :'5. 00 JF 10/12/94 -
F'LOOR FURN. . . . :0 CLO DRYERS. : 0 M5p'`C $ 1. e5 JF 10/12,'94 -
BOIL/CMP ( 3FtP-0 OTHER UNITS-0 pp RT $ 45. LAO JF 10/1 x/94 -
GAS UUTLETS:O P5PC $ 2. 25 JF 10/12/94 -
,;;U l f BELL.
',820 SW 103RD AVE
i LjHRD OR 97224
Phone it. 6;::O -7188
Contractor:
OWNER
Phone #ll
Recl #, . . _.------------------- ---------
171). 76
_-______________-- _____----17`). 76 TOTAL
This pereit is issued subject to the regulations contained in the - - --- REIDUIRED INSPECTIONS --
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp F'lLtmb Final
acplicable laws. All work will be done in accordance with approved PLM/Underfloor Br.t i 1 d i ng Final
pians. This it reit will expire if work is not started within 180 Mechanical Insp Erosion Control
da':< of issuance, or if work is suspent Bore than 18k3 days. 1- 1 .imb -Top Out _ y
_ firami.ng in5p
l n s u l a t i.a n I n s p
Board
nsp
Ts%,,ted By : I Mechnl
niQalFinal
a
ar Residential Building Permit Application.
City of "jard
13125 SW Hall Blvd.
Tigard, OR 97223
(503, 639-4171
Jobsite Address: .1yy')11 ^��■
Sub ..vision: f. Lot# �� Office Use QUse nS�
` Planck/Rec#,
Valuation: . (; r U - '—
Permit # _,16'151� -.03,F 1'Corner Lot? U N
Flag Lot? Y N Reissue of
Map & 1LC�
Owner:
Approvals Required
Address: -3ex-) o3leo Planning
k;4?ro . o/Z 27"2.�2Engineering
Phone: ��� 7��C� Other
Contractor: Items Required
Address: _ Subcontractors
i russ Details
Phone, _ _ Other
Ccntrac;or's License #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Arch itect/EngIneer:
Plumbing. `- _ Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
JOB DESCRIPTION: �� CA�
Applicant Signature & Phone number
Received by Date Received: _
N�WOROMCOMDEV�RESAPP
permit# Account Description Amount Amt. Pd. Bal. Due
5-f V- o 3y Bldg. Permit (BUILD) 5
Plumb. Permit (PLUMB' A- vU
Mech. Permit (MECH)
State Tax (TAX)
Bldg:/ I
Plumb: .2. Z-tr `
Mech: 2 i
Plan Check (PLANCK) a.6-3,
Bldg: 4/1). 6
Plumb:
Mech.
_ Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP)
Paries Dev Charge (PKSDC) _
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-PAT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1) _
Institutional rIF (TIF-IS) _
Office TIF (TIF-0) _
Water Quality (WQUAL)
Water Quern (WQUANT)
Fire District (FIRE)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA �ERPLAN)
Erosion Planck/COT (EROSN) — T
TOTALS: % U•(0 3 �� �\