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CITY GF TIGARD CERTIFICATE OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hall Blvd.Tigard,Oregon 97223.81,99 (503)639-4171 PERM1 K' #. . . . . . . ; MST93-'111368
-39-41 ,'l DA-fE ISSUE:15: 03/03/94
I
iPORCF_L..: 2S1 1 1CLQ--ME.010
SITE f-
SITADORF SS. . . ; 15-665 GW 103RD AVE
SUBDIVISION. . . . . MARION c.al'A"FFS. ZONINGGR--3. 5
BLOCK. . . . . . . . . . s LOT� . . . . . . . . . . . . ..010
CLASS OF' WORK. I Nr-.W
TYPE OF USE:. . . :Sr
OCCUPANCY GRA'. �t?
OCCUPANCY L'OA10 r 22q 4
f[�'JNANT NOME. . . r' ,
Remar,ks: PATH I
DESS ALWAY INL
`4300 S'rnF'F ORD RD
i UAl_AT IN OR 97061,
Phone #1 503-638- 0716 '
(. ontt^eclat•• _._.... .. ...__.. ..__....• . .... _._._._. _......._..__._-. _..... /,, _..
JE:S:i AL WAY INC
24-300 ;jW GTAFF'0PD RG
TUALAT .IN OR 97062 �.
Phone IA-- 03•-636 -0718
Reg it. . . 3910127
1lc:ctI,p,tnc:y of the •:Abovv refer uncetl bi.ti ldinr} is hereby given, and reit i Pies
the r_:owriliance with they Statr. Of Octagon Speci-alty Codes for thr. gr-"uta,
ocf.l.tpancy, And Ure utid=r which the r efer-erired pe:-mit was i-,5Uerl.
F-IRE DEPARTMENTT' 3U[ NSPEcl ok
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__. BUILDINC.l FF IC1AL-.__
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INSPECTION NO. CE C
City of Tigard Building Departmentlll �
13125 BR Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phono)s 639-4175 Business Phone: 639-4171
1nsIwctLon s
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out vias Lino AL:
t,_s-
.•.tet/Beam Struct. San. Sewer Framing -B 7
Post/Beam Mach. Rain Dzain Insulation
Plbg. Undotlloor Water Line Gyp. Bd. �-'Pc..h.�
Date Requested: 3 - 3 — Y Times AN PM
c J 3 Permit s� 036
Builder:�_-+ �S S /`//
THE FOLLOWING OORRECTIONS ARE REQUIREDt
ft
Er
N
Y
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CO
1..
W
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Inspsetors Detet 3- 3
7vAYPram DISAPPROVED APPROVED SUBJECT TO AI.OVIt
,Call For Aeinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SM' Hall Blvd_ Tigard, Oregon 9722J: 3
Inspection Line (Rec-O-Phone): 639-4175 Rusineas PI14
Pootir4 Plbg. Underslab Mech. Rough-in `Appr/Sdwlk
Pound. Plb7. Top Out Gas Line
Poet/Ream Scruct. San. Sewer Framing -Bldg.
Poet/Ream Mech. Re.in Drain Insulation Plumb.
Plbg. Underfloor Water Une Gyp. Bd. -Hoch.
Dat" Requested: Z;�- Times __1W PH
Address: t !f (� O✓� Permit #8MSt ��-4
THE FOLLOWING JORRECTIONS ARE REQUIREDs
N
F-
G7
LL7
Inspector. _^ `—J -- - _ Dates
—� APPROVED DISAPPROVED -.: APPROVED BOWIM TO A4WE
_____Call For Retnsp.
711SPECTION 1:OTICE,
City of Tigard B,iildi.ng Department -
1125 5W Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inapecti.on:_
Footing Plbg. Undorslab Hoch. Rough-in App=/8dwlk
Found. Plbq. Top Out Cas LineIIfALt
Poet/Beam atruct. San. Sewer Framing
Post/Beam Hech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line J Gyp. Bd.
Date Requeetedt . / Time: L-yAM(. �h QPM
Address: ]`r 4 Jn tI IL,I��`- Permit �f (' J1 f 3py4e
Builder: 11�_) tt
THE FOLLOWING OORRSCTIONS REQOIREbt
i b Vee 2 1yq
CD
LLJ �
Inspector$ j _ bate$ 3 1 moi _
APPROVtb _XAISAPPROVED APPROVED SUBJErT TO ABOVE
-416.11 For Reinsp.
USPECTION NOTICE `V
City or Tigard Building Department
1312S SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection r_
Footing Plbq. Underelab doth. Rough-in Appr/Sdw1k
Found. Plbg. Top Out tins Line FIMALs
root/Beam Struct. San. Sewer Framing -B-'_dg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Oyp. Bd. -Hoch.
DAte Requestedr / (( �� _--Time: _AM __PM
Address: ` 7 id J V ���
Builder:
THE FOLLOWING cORRACTIOHB ARE REQUIREDs C" L- CA 2— -
-1-�-
CL
�l
Inepec,toc� ��� Datsr � � 1 _
APPROVED APPROVRD SUBJECT TO ARM%
V n A, ij �Call For Rainep.
13125 sw Ball Blvd. Tigard, oragon 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phones: 639II4 m: �J
Inspection _ — - --- -- --
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Found. Mg. Top Out Gas L1:4 FINAL:
Post/Beam Struc-t. '_Ilan. Sevrer) Framing -Bldg.
Poet/Beam Hach. $¢in Drain) Insulation: -Plumb.
Plbg. Underfloor 4
iter Lina_ Gyp. Bd. -Hach.
Data Requestedt r/ O _- -Timet AM
Addrese: 1 7
l (` — L•�l Perit t,
m
Buildersi`�' (p lel -"(f
THE FOLLCMING CORRECTIONS ARE RBWIRZDt
PigJ
Ll
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Inspector: Datat _
APPROVED DISAPPROVED - APPROVED SUBJECT TO ABOVE
Call For Relnsp.
INSPECTION NtTICE
City of Tigard Building Department
13125 NO Hall Blvd. Tigard, Oregon 97223
Inspection Lina (Rec-O--Phone)s 639-4175 Bueinaee Phone: 639-4171
Inspection:
ttip\ _ Plbg. Underelab Mech. Rough-in Appr/Sdwlk
nd.! Plbg. Top Out Can Line FINAL:
Poet/Beam Struct. San. Sawer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underf.laor Nater Line f Gyp. Bd.
Date Requoute�dy: 4. L ! Time:
Addrees: JL�� �D'7`" Permit #ss�l/"lJ��(
BuUder:
THR FOLLOWING CORRECTIONS ARE REQUIRED:
1
Inspectors Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO '.BOVI
_,Call For Reinsp.
INSPECT.N N-_ Off,
city of Tigard Builditg Dapartmant
13125 SW Ball Blvd. Tigard, '3rogon 97223
Inspection Line (Rec-o-Phone)s 639-4175 Business Phones E39-4171
Inspections -
Tooting Plbg• Underslcb Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lune FINALS
Post;Ream Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plblg.()Underfloor Water Line (3yp• Bd. -Rech.
Datb Rzqu eds ' J
Times AM PM
1—'
Address: � JY Permit Is
Builders `)`?
THE FOLLOWING CORRECTIONS ARE REQUIREns
_ I?FmCvF R6
c S T LC!' O/=
l
/4 Fe. A MP 6A�/�
M F,
co —
Il 1
Irepectors
"PROVIp -_ DISAPPROVED _ APPROVED SUBJECT TO ABOVE
Call For Reinep.
1NSP4CTI0 NOTICE i
City of Tigard Building Daps*-*me+t4-V
13125 SW Hall Blvd. Tigard, Qr�txlon 97223
Inspection Line (Ree-O-Phoney): 639-4175 Business Pho71
Inspecaion:_
Footing Plbg. Midorslab Mech. Rcugh-ir Appr/Sdwlk
found. Plbg. Top _lut Gas Line FINAL:
Post/Beam 8tru San. Sewer Framing -Bldg.
Post Rain Main Insulation -Plumb.
1bg- Underfloor' �t /Water Lina Gyp. Bd. -NFch.
Date ReQuestedt_i�t/ / �~ i ince s Allf_AM PM
Addreasf / 7 Permit I s /?Y I.G 36 fy'
Bci.lders /�0 s
11M FOLLOWING CORRECTIONS ARE RBQUIREDs
Inspectors_M��4ft—V bate$
AtP*0Vlr0 DISAPPROVED APPROVED S"BJECT TO ABOVE
Call For Relnsp.
INSPEM01 NOTICE
City of Tigard Building Department
1.3125 SN Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4176 Business Planx 639-4171
Inspections_
Footing Plbg. Underslab � 11ppr/Sdwlk
Found. Plfsq. Top Out �a1s• L1^�U FIN11Ls
Post/Beam Struct. San. Seier Qrra—Dminq -Bldg.
Post/Beam Me^h. Rain :.rain Insulation -Plumb.
Plbg. Unlerflour Nater Line Gyp. Rd. -Meeh.
Data Requested/s� ' _T Times Am (�PH
Addressslp� (�. l —_. _ Permit. f:: ('AAA q�l'C�O
Builders_
THE MLLONING CORRECTIONS ARE REQUIREDs
Ac/Aill(frf I- IrI5.
4-7 c t''c_
Inspectors_----/ '� Date?L/ �S- j
�PROVtD DISAPPROVED APPROVED SURJECT !O ADO"
4—Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department -�
13125 BM Ball Bled. Tigard, Oregon 97223
Inspection Line (Ro,--u--Phone): 639-4175 Business Phone% 639-4171
Ins»ectionS_�`
Footing Plbg. Underslab Mach. Rjugh-in Appr/Bdwlk
Found. I,lbg. Top Out Can Line FINALS
Post/Beam Struct. Ban. Bower Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Unlerfloor Nater Line Gyp. Bd. -Hach.
� 1
Date Requeet/ryt- L"( ( _Time: ,^ /AM _PH
�
Addreee 1 `.� �` Permit Otl `5v -I-3
Bi:'_lder:
TNR FOLLOWING ODRRECTIONB ARE REQUIRRDS
Inepecto Datet y[ L
i
APPROVED DIBAPPAOVEb APPROJRD SUBJECT To ABOVE
Call For Reinep
INSPECTION NOTICE
City of Tigard Building Depart-wt
A--"/
13725 871 Ball Blvd.
Tigard, Dragon 97223
inspection Line (Rec-O-Phone)z 639-4175 P •siness Phone: 61-4171
Inspection:
Footing Plbg. Underelab Nath. Rough-in Appr/Sdwlk
Found.
Plbg. Top Out Oas Line FINAL:
Post/Beam L`_ruct. San. .Sown[ Ff;Yitlg
-Bldg.
Poet/Ream Koch. Rain Drain Iesulatioe -plumb.
Pl.bg. Underfloor Water Line gYp•
-mech.
Data AaqueatedfTinel AN PN��L
Addreae:
Lb'A
Builders
THE FOLLOWING CORRECTIONS AAE REQUIRED3
is
Dat71, 1p -
inepeators
i
1)1PPR0VED DISAPPROVED _ APPROW-D SUBJECT TO ABOVE
Call For Reinsp.
Icl=►
INSPECTION NO-TICS
City of Tigard Huilding Departamt
133-25 SA Hall Blvd. Tigard. ChvmWo 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
I nspact iou:__
Footing Plbg. Underslab Hoch. Rough-in hppr/Sdwlk
Fou-nd. (Plbg. Top Out Gas Line FINAL•
Poet/Benin Struct. Ban. slomr Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Untterfloor Water Lin-e� Gyp. Rd. -Hoch.
Oates Request/e-d1t. ' v , J Timet rt�Cr jAN vw
Address:_ 1C��S ' Permit
Builder:
THE FOLLOWING CORRECTIONS ARE R.RQUIREDt
CL _
n..
M
Y
J
M
W
J
Inapsotor natal �
APPROVSD Drs"PROYRD APPROVED SUBJECT TO ABOVE
-Call For Reinsp.
PLUMnING PERIll"
PERMIT #
'CITY OF TIGARa DATE ISSUED. 09/"20/93
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639.4171 PARCEL 1, 1 LB-MC01
1506�� Z:jW HVL
'SION. MARION ESTATES -
30 IV ZONING. R
. . . . . LO T. . . . . . .
or- WOR:'.. :NEW GARDAUE 1)10PU"3ALS. . 1.
'IE OF USE. . . . :SF WASI-IINQ MACH. . . . . . . : 1 BACKFLOW PREVNTRS. :0
'( 4'ANCY f:Ri`. . .03 r-1-00P DRAIN11D. :0 TRPPS. . . . .
P I EG. �. . . . . . .2 WO ' LER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . .
L.A U N D R Y TR A V3). . . . . . t3F RPIN DRPIN -.). . . . . . .
GREASE TRAPS. . . . . . .
IA TOP tj
01-Vit..j? F IXTUREL jO
SL WE`!2 LINE :0
CLOSLTU., Wf)TL.R LIN[-- (ft ) . — : 100
.41ASHER3I c . . . . : 1 R
i;lu\.i DRAIN 'ft ) . . . . :0
—
k Pr-ITI f I
NER.
ALWAY IN(- T I F` $ 14 E QI. Q+0 J11 0f) 9;3 Y
;00 E;7AFr-;IJR..) RD BPRT $ 505. 50 JH 09/-20/9.x, X
BPL.0 $ 3828, 53 JLH 2r&/25/9
i%
ILATIN OR I BSPU 1� a 5. ..:;.1 11-; 09 L0. 1:7
1-3 6 D c $ 280. 00 JH 09/.=:0/93 X
P AR K t SOO. 00 JH 09/20/93
MPRI $ 415. OVI Jtl 0')/:::0/9
3
MPI-C $ 11. 25 JH 09/cL'1211/93 X
9/5a !413r-:1c'1 $ 2. 25 JH 219 120!93 X
.;A)P1,&ttVet- Of. POR-1 $ 155. 00 JH 090/c 3 X
RLU.0 i RLI) I N-',ILL i I 01%11�
Th. t; permit iii -:,ubject to the reg.
.>Irntiurs cont -,ined in the TigArd M�.tnici-.�l FUOt/fOlAnd Insp Rain ch-ain I n s'In
'-'ode, t _#. r, ,f- Cine. Spcc--j.olty (;od@s An(- -11 Post/peam Water Line Ins
vther rfaplica�i:.e law-.-,. All work will be done Post/Beam Mechan Appv-/�idwl k I ris,
an ,h ,Appi,oved plans. 11-i !i Plm/undslah lrisr.-) Mechanical Fins:,
p.'I-fllit will explt-e if wor}( is not mtarted r"LM/Linderf I oor Piumb r-inal
within 180 id.,Jy-; of or- if wat-l-, is Muchanical Inset P,-t3 Iding Final
t)0;--,d fo t- more g
oan 180 d,-,%y,#. Plumb Top Out Er-.05ion contro,
1:,,,'�p Cii!kwl Ui,ain
c
r,ivepiap insp
Gas Line Insp
Insulatio-i Insp
G)yP poal"i 111cp
C.2
Insper-tion
t
ASTuR
CITY CSF T I GARD P r-R!yl:MI T #.
. . I..'ERMI-T. . . M1 ST 13 3 L713 C.,
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED; Oq/20/93
13125 SW Hall Blvd.Tigard,Oregon 97223e8199 (503)639-4171
AVF.
1 b Vic', c '4
,UKADIVISION. MARION ESTATES 7CINI N07 P-3? 5
k-0c).... . . . . . . . . . LOT. . . . . . . . . . . . . :010
BUILDING
13SUE DWELLING UNITS. I BASEMENT. . . . . . . . .
`SGS OF WORK. -NEW BEDRMS.4 B A T I-I S-3' GARAOU. . . . . . . . . . :550
Or-' 03L. . . :43F FLUOR AREAS-- REQUIRED 5E BACKS ----
OF CONST. :5N P I RIST. . . . . 1635 s LEFT. . :38 ft RIGHT. ft
".C.,UPANCY GRP. : R 3' SECOND. . :8'16 sf FRONT.. : '0 ft RF n R. 10 f
TORIES. . . . . . . ...--' THIRD- -@ Sf REOUI
. . . . . . . . .�. 7 1:t TOTAL. ...._._ 4134 f SMOKE DETECTORa. :Y
JOR L
-0(11). :40 psf VALUE. . . . . s 128 124 PARKING SPACLS. . : 1
PAT; ! I
PLUMPING
i. .. . . . . . . . . : J.-OW r
� 1 FLOOR .0 13ACIF -`RLVIqTRS. . -10
5 WATER HEATERS. . . : I TRAPS. . . . . . . . . . . . . . :0
'J"I/ShOWERS. . . . :3 LAUNDRY 'FRAYS. . . 021 CATCH BASINS. . . . . . . :0
jr,rLR CLOSETS. . :3 EXW(-R LINE (ft ) . :0 GREASE TRAPS. . . . . . . :O
ISHWASHERS. W(47 L,R LINE ( ft ) . : 100 OTHER F �XTURES. 0
qRl3AG;F- D13P. I RAIN DRAIN (ft) . :0
f4SI-A I NG MCICI 1. . . c I OF' Rn T N DRA I NIS. . : I
MUCHANITCAL -- FEE-6
JLL 1"YPEl- UNH 1 0 type alva I-tnt by date r Pt
C�As/ VENI 5 . . . . .. :0 TIF $ 1460. 014 JH 09/20/931 X
X " I NIP U T 10 STU VENT FANE3. . -4 BPRT $ 505. 50 JP 09/20/9,3 x
JRN ( 1016K HOODS. . . . . . . I FPLC $ 328. 53 JLH 06/25/93 93- '4 1. 8(
11RN 1 -100K *-'5. ji'l 09/"'0
WE)ODSTOVES. :0 B 5)P c $ " . /93 X
-(JOR PURN. . 10 CLO DRYERS. : I SGDC $ a60. 00 JH 09/F0/9--` X
CITHE R, UN 11*5: J. F1nRK $ 500. 00 JH 00/L 0/�) X
GA6 OUTLET5: 1 MPRI 1, 45. 00 JH 0 9/J-O/93 X
-MPLC t I .1. 11-*_1 T) j1q 01)/4:0/`3..(, x
!38 FAL WAY INC M5Pc $ E. 25 JF1 09/20/'33 X
J+':"QjjZ STP!:7FORD RD PPIRT $ 135. 00 .111 09/20/1)4 x
j14 09/po/133 x
� 101-fll IN OR 970LE'
,- aria #-.
1 n t I'ZA .t Q
S54 AILAWv INC
ti
'WO :411-;T0"Fjku i,,ij
IMJATI�,,l JR 17'06L'
too 6 3C" '7 1 i i
4- 39'027
3320. 61 TOTAL
.s pfr"rt is iscurc subjrc' tc the regulations contained In the F77WIRED INSPEC'rIUNS
r
Q) ;am 01,xlmipa., LzdF, State of DP. 'Adt! aid All other Foot/found Insp Firepiahe Inst)
LL) 11"iutle lar:, All work klE' to "th approved rlost/Beaw :';tract (:),Rs Line 1nzj.!
.6ss. Tlus pe:-c:t wil! fXqjt.f If Post/Seem Mechan InsLtIat ion In' l
'is of issuance, or if Pork Ir, cusp n P1M/-.(Tir-JS11r1b Insp UyP Board I n f;rl
N
PLM/Underfloor Rain drain Ir.
M"Itrnr 1,; Mecl-icnicenl. Ince Water Line Irsc
r1lumb rop 01-it Appr/Eldwlk Itl
rr i n q .1,TA S P
9 41 75
CITY O F T I GARD 'E R )NNECT I ON
PERMIT
PEE RM IT #. . SW R9 3---0131
COMMUNITY DEVELOPMENT DEPARTMENT DATE I G S U E 0 !%.'0/9' 1')2
13125 SW Hall Blvd.Tigard.Oregon 07223.81 00 (503)639-4171
PARCEL- 2S111GB---ME011Z1
MARION ESTATES Z ON 1 NG R--3. 0
LL) ... . . . . . .. . . . . . . .010
1ANT
I NO. . . . . . . FIXTURE UNITS--
-'—OSS OF WORk. :NEW DWELLING UNITS. . . I
Or- LISE. . . . . ..GF NO. OF BUILDINGS: 1
K�1jC11j_ 'TYPE. . . . --1:5 USW R IMPERV SURFACE..:: s I
-!,Wk S . PATH I
eil : ---I..--..-.------,- .-I-..--.- .1....,-.—.....-.--.---..-----.—...--- FEES
f'iLW(-)Y INC type a m 0 un 1; Fay date i-e t-p t
STAFFORD RD PRMT $ 221'00. 00 JH 01)/"-rv93 X
I NSPI $ 35. 00 JH 0 9/2 0.1 f) Y
L P T 1 N OR 9Y 10 C.,L-,
re 503-638-0718
'::'N TRACTOR Nur ON FILE
11 e 4. $ 223r15. 00 TOTAL
RE I RED INSPECTIONi-
qpPlicart aGrees to Losply with all the rules and regulations Sewer Inspection
:F Linifted Sewage Agency. The pervit expiret 168 cays frov
-Ate iss,.od. The total asount paid will be forfeited if the
vy:i�'es, 7-he Phfrc� does nut ruarants&Af ACCO-Ky Of the
E
.cE Lower laterals. If thre sewer focatr' ' the "easurem
ire,
tip :rstallor shall prospect
r distanct give'. If not 5o loin
hdSe -
Tap enc pa*.-!f ar-d 1 lateral.
C8- - 11rpest ion 6 4 175
CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. :93-244319
CHECK AMOUNT a 5305. 6t
NAME JESS ALWAY, INC CASH AMOUNT a 0. 00
ADDRESS PAYMENT DATE a 09/20/93
4300► SW GTAFFORDD RD SUBDIVISION
TUALATIN OR 97062—
PURPOSE OF' PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 505. 591 PLUMBING PERM y 1551. 00
MECHANICAL PE 45. 00 ST. BUILD PER 2B
PLAN CHECK FE 89. 83 SEWER USA 2POO. 00
SEWER INSPECT 35. 00 PARKS SDC 501A. 00
STORM DRAIN SDC 2180. 00 RESIDENTIAL TRAFFIC FEES 1350. 00
MASS TRANSIT TIF FEES 110. 00
15065 SW 103RD AVE, (MST9 3 0 36 8)
MARION F-'c.3TA'TFc3 Lr)T t(A
TZ)TAL AMOUNT PAID 5305. 61
CITY OF TIGORD -. RECEIPT OF POYMENT RECEIPT t4ti. :93--241,686
CHECK AMOUNT 2r-5.171. 00
NAME a At-WAY, JF SS COSH AMOUNT a 0. 00
D D R E7S G PAYMENT DATE 069 3
SURD I V 19 1 ON
IRPOSF OF 1_'jnYMEN1' AMULRJ -AID PURPM5E OF PAYMEENT AMOUNT PAID
AN CHECK FE 250. 00
OT 10 MAf?f(_)N PSTATFS
U101 AMO INT PAID !i)o
�!L11 13125 SW Half UN-& PLNCK/RECT #
1
1 O.1..' TIGARD o«g«,vn� PERM .3
IT # �Y� lj O !oY
4CAMUNITY DEVELOP MLNT DEPARTMENT
(5031679-117' DATE ISSUED
JOB ADDRESS: �.�QG>j" Sw /v 3 e-d A, - TAX MAP/LUT 2S 111C 6 - M t D i O
SUB: -,I Oh 'EsTAT�t LOT: LAND USE:
VALUATION: lZq114,q, G169q,?00T
OWN ER SPECIAL NOTES
NAME: _�T�a_ -,w�� '� REISSUE OF: _J.
ADDRESS: 57A�FD�D �D LAST REISSUE:
rTo�'z FLOOD PLAIN/
ONE: ����. V7i8 SENSITIVE LAND:
i
CONTRACTOR APPROVALS RE UIREO
NAME: _ 5 � �y rNf- PLANNING:
ADDRESS: a i Il l) ENGINEERING:
0tVAI AriN, U�C-G!i�i `� FIRE DEPT:
f'NONE: �'1 3 CST IBJ _ OTHER: _
CONTR. BOARD #: �f iT EXV DATE:
ITEMS RE U�IRED
SUBCONTRACi_1r;S: PLUM'S: �Wf-k M fc LIST/SUBCONTRACTORS:
—� MECH: G� =�-1- N I� BUS TAX:
ARCH ENGINEER CALC(.4ATIONS:
NAME: L_�_1 5 ��V tk- rr))(,N TRUSS DETAILS:
ADDRESS: r ?{ -- OTHER:
21
N PHONE:
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,� COMMENTS: Grerfr Lv 'I ��� '���- 4,pde�r/Y"j,IC i� i� i 5 co�Alcdr� (oc��c
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APPLICANTS TU
Received BY: Oa t.e Rece i ved: (� .2
PERMIT # ACCT # DESCRIPTION AMO�USSJJNT ' AMCUNT P0. BAL. DUE
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`1;3 3-a3rv�' 10-432 CO Building Permit Fees
10-431 00 Plumbing Permit Fees
_ 10-431 01 Mechanical Permit Feesi,�y =
10-2.30 01 ';tate Building Tax (5q) – -
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee /
Building _44
Plumbing
Mechanical
10-2.30 06 Fire ---- �
� �2u
Scv�CQj_y�rr 30-202 00 Sewer Connections U
/ ---
30-444 00 Sewer Inspection 3 s� .3 )-
25-448-02 Commercial TIF Fees •
25-443-04 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 (POC) "v Tv d
31-450 00 Storm Drainage Syst Dev Chrg /
(SSOC) Z�J �
L
24-445-01 Water Quality (Fee in lieu of) _ — ---
2.4-445-02 Water Quantity (Fee in lieu of)
0
TOTAL -
SSSS• G / S3ds, � f
nm/3587P.WPF