Case File i � x
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CITY OF T I CARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
CERTIFICATE OF:
111CF.A.IPANCY
A
4171
i I TF." OUVRESS. . . t JbIV0
) 143W 13RL) AVE_ F=ARCA11—
3081)1 V I S I UN. . . . .. Q1Q.`:
INSPECTION NOTICE
�. City of Tigard Building Department
13125 BU Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing Bldg.
Post/Beam Mech. Rain Drain Insulation Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Reyuesteds `I l� /� J TimesAN PM
Address:--/Z1/z) / U3 ✓d Permit #s/,/�1 1"&33/
Builders
THE FOLLONTRO RRECTIOMB ARE REQUIREDs
'0?E'
ow-
. `
Inspectors Dates 71.2—.
APPROVED DISAPPROVED 1--"APPROVF.n SUBJECT TO AP.)VE
,_Call For Reinnp.
INSPECTION NOTICE t
City of Tigard Building Department vJ
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec--O-Ph de): 639-4175 Business Phone: 639-4171
Inspections
Foot'.ng Plbg gnderslab Mech. Rough-inl Appr/9dwlkj
�5, 1
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp, 8d. -Mech.
Date RequeRteed: e � -,-A _Time: AM PM
Address•/CO ` �Ci�~3s Permit �Z 33
Builder: '
THE FOLLOWING CTIORS ARE REQUIRM
.A L EAyf—ddF---eLZ fATGi&I�-4�y
Inspector: ;=i ;r. Datsr ;?.-2s _
APPROVED DISAPPROVED—];�APPROVRD SUBJECT TO Awwx
Call For Relnsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 BN Hall Blvd, Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Pech. Rough-in Appr/Sdwlk
Fouad. Plbg. Ton Out Gaa Line ) FINAL:
Post/Beam Struct. San. Sewer Framin^�1 -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requested: �!—/ _ ��� `Times / AM ___PM
Address: /[/���� �, Permit
Builder:
THE FOLLOWING RRECT ONS ARE REQUIRED:
_—B V j r (-y (� d
Jeler- hole
i/El
Ln
J
W
J
Inspector:
APPROVED DISAPPRO _ APPROVED F;UBJECr TO ABOVE
L/ Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Buniuens Phone: 539-4111
Inspection:
Footing Plbg. Underelab Mech. Rough-inAppr/Sdwlk�
Found. Plbg. Top but Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underflpnr Water Line Gyp. Bd. -Mech.
Date Requested: _Ti., AM _PN
i
Address:_ /'/0 Permit 1:e?
Builder-
THE FOLLOWING M 70 ARE REQUIRED:
d
R
J
LLJ
J
Inspector: l f7G'/� �? Date:
APPROVED DISAPPROVRD ` A' PPROVRD SUBJR'r TO AFIOVF.
Call For %einop.
INSPECTION NOTICE
City of Tigard Buildi W Department
13125 SW Hall Blvd. Tigard, Grogan 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Tough-in Appr/Sdwlk
Found. Plby. Top Out Gas Line J FINAL:
Poet/Beam Struct. San. Sewer Fuming -Bldg.
Poet/Beam Mech. Rgin Drain Inaulat.lon -Plumb.
1
Plbg. Underfloor water Line Gyp. Bd, _ -Mach.
Date Requested: �X, Z- Time: AM PM
Address: ,/ ) ` d- Pormit is 3-3 _
rullders
THE FOLLOWING MARECTIONS ARE REQUIREDs
Inspector pas es
APPROVlD DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
Civ of Tigard Building Derartment
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-•Phone): 6:9-4175 Business Phone: 6_ 171
Insper_tion: _ y
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cee Line FINAL:
Poet/Beam Struct. San. Sewer Framing -nldg.
Po9t/Beam Hech. Rain Main Insulation -Plumb.
Plbg. Under:loor Water Line ) Gyp. Bd. -Herh.
Date Requested: /`c Time=
---AM ,. PN
G
Addressc 6 o C Y C, Permit #-4'/ `L� 3
Builder: c.-f
THC FOIItniINn 00 CTION3 ARE REQUIRED:
C� ail
F--
6 IV ler!
C3
Inppector: y Data:
APPROVED DISAPPR APPROVED SUBJECT 'V ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall- Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
I•aspeation:
Footing Plbg. Underelab Mech. Rough-i,: Aopr/Sdwlk
Found. Plbg. Toy Out
�t raining Gas Line FINAL:
Post/Beam Struct. San. Sewer �/` -Bldg.
Poet/Beam Mech. Rair, Drain / InnulatLo -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Nech.
Date Requested: _/L� `1�7 Time: _ AM PH
Address: /" d _ Permit. #:q/
Builder:
THE FOLLOWINGCTI NS ARE REQUIRED:
/'�/D yi �c� ��S,�rCriCl�'S SCJ�� %3c� �?•c� P_
T -
1
Inspector
I-APFROVlD DISAKPR')VF.D _ r APPROVFD SUBJRrT T4 ABOVE
Call For Reinsp.
-NSPECTION NOTICE j
City of Tigarl Building Department
13125 SW Ball Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone): 639--4175 Businesso e D6 - 1'11
Inspection:
Footing Plhg. Underslab Aech. Roug'.i-i.n Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL-
Post/Beam Struct. San. Sewer -Irraming -Bldg.
Poet/Beam Mech. Rain Drain Insulation -:lumb.
Pibg. Underfloor Water Line Gyp. Rd. -Mach.
Date ReTjogted: �— __ Timet __ AM PM
Addrean:_ /Z., , _. Ll/ , Permit #:��
r
Builder:
VON]
�nn CO CTIONS ARB REQUIRED:� n T
I
Inspecto. : . _ Date-
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
Y
UPS
INSPECTION NOTICE
City of Tigard Building Depart:oent ��
13125 SW Ball Blvd_ Tigard, Oregon 9722
Inspection Linc (Rec-O-Phone): 639-4175 Businead Ph 639-4171
Inspection: °-
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out uas Line FINAL:
�"
Poet/Seam Struct. Sa ,. Sewer 'Framing -Bldg.
Poet/Bean Mech. Rain Drain Insulation -Pl•:mb.
Plbg Underfloor Water Linq Gyp. Bd. -M-c".
Date Roquouted: s✓�_J;o'C�� Time: �AH PM
Address: l/C y��✓� Permit 0:- 3
guilder=
TH? FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:
tPROVED DISAPPROVED APPROVED BUBJEC: TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
city of Tigard Building Department (/
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__ _
Footing Plbg. Underslab Me-:h Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Stvuct. San. Sewer Framing -Bldg.
Poet/Be4 p Awj Rain Drain Insulation -Plumb.
`bg. dertloor arer Line Gyp. Bd. -Mech.
Date P:yueetodi U ^C 7/-`�„�. Time: AM _PN
.ddresn: �(O�C/ �C�� y� /Permit?#: __
Builder'
ME Fil-LLOWING CORRECTIONS ARE REQUIRED:
Inepector: �j Date
CZ_"PROVtD DISAPPROVED APPROVED 808JECT TO ABOVE
Call Por Reiaap.
INSPECTION NOTICE !!'�
City of Tigard Building DepartA�ent
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)r 639-4175 Business Phone: 639-4171
Inspection•
Footing Plbg. Undernlab Hach. Rough-i.. Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. an�rl
Framing -Bldg.
Poet/Beam Piech. iInaulation -Plumb.
Plby. Underfloor er , Gyp. Bd. -Hoch.
Date Requested: � � ,_,Times PH
Addreaa: r- / `7 Q3 Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
APPpctVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Reinso.
ww
INSPECTION NOTICE
City of Tigard Building Department
13125 S8 Hall Blvd. Tigard, Oregon 97223'
Inspection Line (Nr :-O-Phone): 639-4175 Dusineas PhonK: 639-4171
Inspect.ion:._
Footing Plbg. Undera]ab Mech. nough-in A,ppr/Sdwlk
Found. Plbg. Top Out: Gea, Line FINA'.t
Pgwt/Beam Stru San. S3wer Framing -Bldg.
(I'-oet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. 'Inderfloor Water '.ins Gyp. Bd. -Mech.
Date Requestedd/s Time= _AM PH
Address:_ /v/) � r"� Permit it -/J .3_3,�l
Builder
THE FOLLOWIN/i (JOKMMONS ARE RSQUIR201
Inspector: _ - -- _ Dater
APPROVED DLSAPPROVED APPROV60 SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Departmen%.
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (ROC-0-Phone): 639-4175 Business Phone: 639-4171
Inspection: _ ---
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwll:
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framinc -Bldg.
Pont/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Lire Gyp. Bd. -Mech.
../ —AAM PM
pate Requeated:_�_i — _Time
Address: ) /Zy , / Permit Is
Builder: //lam/
THE FOLLOWING CbRRECTION3 ARE REQUIRED:
Inafx�ctor:_ l c��_ .� -- --. nate r =� ----
—A APPTTTTR���O ID DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
1 PLUMBING PERIYIIC'TY OF TIFA
RD CITY4RD 1=1
LRM I r #. . . . . .
. : MST91-43:3 i
COMMUNITY DEVELOPMENT DEPARTMENT oneou
13126 SWHoll Blvd P.O.Box hl97,ngcd,Ongon97223(503)6394175 DATE ISSUEDs 07/27/92
;ITE_ ADDR'.:SS. . . : 16109 SW 103RD AVE PARCE=L: 2S114BB--RV 7,f;
31_11aDIVISION. . . . s RI.VERVIEW E3"rATE'S -7.0NING: R--7 PD
rDLOCIi. . . . . . .I . . . : LOT. . . . . . . . . . . :.:�6
CLASS OF WORK. . ;NEW GARBAGE OISPUSAL.S. . : 1
TYF'E OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . ;0
OCCUPANCY GRP. . ;R3 FLOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :0
c3TOR1ES. . . . . . . . .2 WATER HEATERS. . . . . . : 1 CATCH
LAUNDRY TRAYS. . . . . . ; 1 SF RAIN DRAINS. . . . . : 1
31 NKS. . . . . . . . . .. : 1 GREASE TRAPS. . . . . . . :0
LAVATOR I E5. . . . . :6 OTHER FIXTURES. . . . . :0
TUB/'5HOW1'RS. . . . : SEWER LINE (ft ) . . . . :0
WATER CLOSF_1"S. . :4 WATER LINE (ft) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ` . . . . :0
Rem4rksqj. solar ak by keitM
OWNER:
'.SKYLIGHT HOME. BUILDERS TIF $ 1380. 00 .11-1 07/27/92 -
P. O. PDX 2315 BPRT $ 545. 50 JH 07/27/9_'
BPL.0 $ 354. 57 .JI-14 12/ 1/91
1.-AKE OSWEGO OR 970.-,5 85PC $ 27. 27 JH 07 7/9i-
i.-,hone 0: 636-2994 SSDC $ 280. 00 JH 07,%27/92 -
PARK $ 300. 1710 JH 07/ /92
L umbing Cont Tact or e- __,._..._._.._____.____ PPRT $ 185. 1710 JH 07/ 7k. 2 -
P5PC $ 9. 2!, JH 07/27/ -
14ama : �C _�. �__...._. MPRT $ 48. 00 JH 07/27/92,. �
MPLC i. . 12. 00 JN 07/27/92 _.
Ci,tY � .__ .__..__. State: MSPL' $ 40 JH 07/27/1)0! -
Reg
------- RE QU,1PE'D INSPECTIONS
This permit is issued subject to the reg- !
,,slat ions c ontaained in the Tigard Ml.tn iri pal. F'oo0for.tnd Insp RA' in drain Irisp
Code, :tate of Or-H. Specialty Codes and all Pust/Beam 8tr1.tt:t L-ine Insp
of,her applic-able laws. All work will he done Post ABeam-•M'echaan Appr/!7�*dw.lk Insp
in ,a c:c2cr^d.snci± with appy-overs plans.. 'This Plm/r_tndg•lab Insp Mechanical Final
permit will expire if work is not Started PLM/Underfloor Plumb r incl
=- oithin 1(30 days of issuance, or if work is MechAnir_Al Insp Building Final
-.1_tsvopnded for more than IVO days. Plumb 'rop Out E=rosion Control.
Framing Insp Crawl Drain
i Fireplace Insp _.. __.�..._.
Gas [Ams Insp _
I n s r.t l as t i ort Inst'
`o ' r y p Board Insp
�_j : :'tth rlreri Glr_tmhilig Contractor Signature
Call. for inspection - 639-4175
Contractor N o t e r1 :_.._—._...�::a::_..:.r:�...r...»_. :.,......___ i`{yYJ• ..W ____._._ ..._._._.,._. ._.—...._—
CITYOFTIFARD s, , ,
COMMUNITY DEVELOPMENT DEPARTMENT � rl m RD MT #. F E.. I T
13126 SW Hrl Blvd. P.O.Boot 231397,Tlpad,Orepon 97223(603)839-4176
7
SITE ADDRESS. . . : 16109 SW 103RD AVE PARCEL: GS 1 14-BB-RV-76
SUBDIVISION. . . . : RIVERVIE'W ESTATES ZONING: R-7 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . :3E
__.---------------------------------- BUILDING ----------------------------------------
[REISSUE:
-__.--__--.__________________._-_----__REISSUE: DWEL.I...T NG' I JN 1 Tr;: 1. BA'EMENT. . . . . . ... :o h f
CLASS OF WORK. :NEW BE=.DRMS:`a BATHS:4 GARAGE. . . . . . . . . . :532 s f
TY1='r OF' USE. . . :SF FLOOR ARCAS-- ------- REQUIRED
TYPE OF CONST. :5N FIRST. . . . .- 1386 s f LEFT. . : i 2 ft RIGHT. : 17 ft
OCCUPANCY (SRP. :R3 GECOND. . . : 1556 f FRONT. :120 ft REAR. . :20 F I
STORIES. . . . . . . :2 THIRD. . . . :0 sf REQUIRED------___..____---___..
HE IGH'r. . . . . . . . :26 ft TDTAL_--_ s f SMOKE DETECTORS). :Y
FI-OUR LOAD. . . . :40 psf VALUE. . . . . t:NY140? 0 PARKING SPACES. . : 1
(?marks : solar ok by keith
------------ ------------------------_--_--_.-------------- FLUME.{I NCS -----------------------------------------
MINKS. . . . . . . . . . : 1 17LOOR DRAINS. . . . :0 BACKFLOW r- R VNTRS. . :1ZI
LnvATORIE'S. . . . . :6 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . - . :4 I. PIANPRY TRAYS. . . - 1 CP'1TF:11 BAG T ISIS. . . . . . . :0
WATER CLOSETS. . ;4 SEWER LINE (ft) . -0 GREASE. TRAPS. . . . . . . ..0
DISHWASHERS- - 1. WATER LINE: (ft) . : 100 OTHER F I XTUPES. . . . . :0
614RBAGE DISP. . . : 1 RAIN DRAIN (ft) . :O
WASHING MACH. . . : 1 SF RAIN DRAINS— : 1
MECHANICAL __._..______.__.. _ _ ---------------- FEES _-_--_____--.__.
UNIT HTRS. . :0 type amol.tnt by date r,erpt
VENTS . . . . . s0 TIF f 1380. 00 JH 07/27/92 -
IvIPX INPUT:O STU VrNT PANS. . :5 SPRT $ 545. 50 JH 07'27.11) '
F-URN ( 100K . . :0 HOODS. . . . . . : 1 ElPLC $ .554. 57 JLH 12/31/91
FURN ) =1001 . . : 1 WOUDSTOVES. :O FS'iI 't;; $ r'1. i2Y JH OY/27/92 -
FL..00R FURN. . . . :0 CLQ DRYERS. - 1 CSDC $ 280. 00 JH 07/27/92 -
BOIL/GMP ( 3HF':@ OTHER UNITS-, 1 PARK f 900. 00 JH 0'7/27/%-J
GAS OU"I'LE:TS:c PPRT $ 185- 00 JH 0'1/27/9e -
0,4ner: __..____.__.____.__--..__________._______._____ P 5 P C 1 9. 25 JIA 07/27/9; _
SKYLIGHT HOME BU1LDFRS MPZT $ 48. 00 JH 07/27/92
1'. 0. BOX 2315 MPLC $ 12-- 00 JH 07/27/92
M5PC- s e'. 40 JH 07/27/92
()KE 0SWEGn OR 970:35
Phone #: 636-2994
Contractor:
f:ii;YLIGHT HOME BUILDERS CO
a U Box P-31.5
I-OKE OSWEGO OR 97113.`_'
Phone #: 503-6.36--2994
:34066 -----------------------------------------
$ 334:5. 99 TOTIai_
This pveit is issued subject to the re )at ons contained in the - ----- REQUIRED INSPECTIONS -----___-
'
Tigard Municipal Code, State of ire. 9pe ialty Codes and all other Foot/fottnd Insp FirPolare Inst?
applicable laws, All work will be done in accordance with approved Post/F3eam Stri.tct Gas Line Insp
plans. This pereit will rvcire if not started Within 198 Post/Beam Mechan InsLtlation Ins,,
days of issuance, or if work is er-e thin 1 s. Plm/undslab Insp Gyp Boar-d Insp
PL.M/LlyderfI nor Rain dt-iin Tnsp
Mnchanit:-?l Inst Watov- Line Insp
J Plt-tmb Top ottt Appr/Sdwlk Insp
I=r.amintl Tn,p Mo(. hanir.al final
/ t fes,. .��_�F,._+ i n•, - .') .L I -`�
CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. a 92-2P9917
CHECK AMOUNT s 1713. 99
NAME a KYLIGHT HOMES C0831-1 AMOUNT 0. 00
ADDRESS o PAYMENT DATE 07/27i90,
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
rX BUILDING PERM 545. 90 PLUMBING PERM 00
MECHANICAL PU 46. 00 ST. BUILD PER 38. 9:
PLAN GHECR FE 116. 57 PARKS SDC SilA0. OLA
r;TORM DRAIN SDC 280. 00
0
W
LOT 36 RIVERVIEW EST
16109 SW 103RD
TOTPL AMOUNT Pnll) 1713. 99
TRAFFIC IMPACT FEE
Installment Payment Application and Disclo uro Statement
In the Matter of the Traffic Impact Fee for Skylight Home Builders Co.
Tax Map 2S114BB _ Lot Numbers) 36 Building Permit # MST91-0331
Site Address 16109 SW 103rd Ave. Subdivision Riverview Estates
_Case File # SUB90-0014 TIF Land Use District R-7 PD
To Be Billed To: Skylight Home Builders Co.
Address: PO Box 2315 Lake Oswego, OR 67035 Phone #: 636-2994
To the City of Tigard:
In accordance with the provision of Oregon Revised Statute 223.208 and Washington County Ordinance
No. 379 which relates to the imposition of a traffic impact fee for the financing of major collector roads and
arterials +f Washington County, I/we HEREBY MAKE APPLICATION AND AGREE, JOINTLY AND
SEVERALLY,to pay my/our traffic impact fee, as has been determined by Washington County Ordinance
No. 379 in 10 semi-annual installments of the amount financed together with one-half of one year's
interest thereon at a rate of 7.63 annual percentage rate on the unpaid amount owed. The lien date is the
first day of the month following the date the application is signed. The first payment is due six months
thereafter and at six (6) month intervals thereafter for a period of 5 years. Each installment payment will
include principal and interest.
If I\we neglect or refuse to pay any part of the installments provided herein, including interEst, within one
(1) year after the same shall have become due and payable, then the whole amount of the unpaid
assessment shall become due and payable at once and shall be collected in the manner provided by law
including foreclosure on the above-described real property.
The traffic impact fee, annual percentage rate of interest (7_63%) and finance charges which I/we agree
to pay are as follows:
HIGHWAY TRANSIT
1) Amount of Traffic Irnpact Fee . . . . . . . . . . . . . . . . $ 1280.00 100.00
2) Amount Financed . . . . . . . . . . . . . . . . . . . . . . . . . $ 1280.00 100.00 _
3) Equal Semi-Annual Principal Payments . . . . . . . . . $ 128.00 10.00
4) Interest on Balance at Rate of . . . . . . . . . . . . . . . . 7.630% %
I\We understand that the amount owed, as stated above, shall be a lien on the above-described subject
property purgl uant to Washington County Ordinance No. 379 Section 6 (D) and ORS 223.230.
DATE IN 27th day of July_, 1992.
F-
Signaiuri,6f Ptoperty Owners) Signature of Property Owner(s)
r� STATE OF OREGON ) Name (Please Print):
C ) Address:
CO f��r Z3i1 cA+�� �'J�-r•6 , c�z
County of Washington U 97 03 r
SUBSCRIBED AND SWORN TO BEFORE me this_day ofi�<
Notary'Public for Oregon
My Commission Expires:
?,j,W,L0,f
— a -0 ,--,
CITY OFTIIFARD C1 TIORD cSEWELJ
R i-' NN�-L-fJ.L:jN
COMMUNITY DEVELOPMENT DEPARTMENT ONO"
L
13126 SW HWI Blvd P.O.Box 23397,Thpird,Ompon 97 (SW)630-4176F' #. . . . . . . : SWR92— 2 'O
71 DATE ISSUED: 06/30/92
SITE ADDRESS. . . : 16109 SW 103RD AVE P,ARCEL: 25114DS—RV36
SUBDIVISYON. . . . .- RIVERVIEW ESTATES ZONING. R-7 PIE)
PLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . : 36
TENANT NAME. . . . . :
USA NO. . . . . . . . . . .. FIXTURE UNITS. . . .
CLASS OF WORK. . . :NEW DWELLTNG UNITS. . - I
TYPE OF' USE. . . . . :SF NO. OF BUILDINGS:
INSTALL TYP,E. -BUSWR IMPERV SURFACE. f
Owne,^: ------------------------------------ ----------------- FEES —__________._._
SK%YLIGHT HOME BUILDERS type a M()Ia-I-)t by date t,er-pt
PRMT $ 1900. 00 JH 1716/30/92
-
T NSF, $ 35. 00 JH 06/30/92
i-T)one Ot
CONTRIACTOR NOT ON FILL-
Vlhone 1935. 00 TOTAL
Req #.
REQUIRED 11\19F ECT IONS --------
Thit Applicant agrees to :ovpiv with all the riles and regulation! Sewer Inspec-,tion
of the Unified Sewave Agency. The permit Pxoires 180 days from
the date issjed. The total Pacunt paid will be forfeited if the
permit expires. The Agency toit.s not guarantee the accuracy of the
_i.e sewer laterals. If the sewer .-10^
. ,o located at the measurement
1,, the installer shall pros.p 3 oet in all directions from
tr.t distance niven. If not so cit . the installer shall purchase
a "lap and Side Sewer" Permit iid e Aer—, will install a latera!,
P,et-m i tt ee Sian
Is,;,-tPd By -
Cal 1 fot• inspection 639-4175
l
RECT #
CITY OF TI G-A�RD 131LS SW Ball lSlvd. PLNCK/
I*7Box 23397 PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Oregon 9721.1
(503)639-1171 DATE ISSUED
JOB ADDRESS: da'-�- TAX MAP/LOT
SUB: ex7fo7cs LOT: LAND USE:
VALUATION: f-�,_�
OWNER SPECIAL NOTES
14AME: HOME 9u)(-,0E-ZS CC. _ REISSUE OF:
ADDRESS: Q 0 130,( Z3/I" LAST REISSUE:
C AKE 0sW4-60o;z 97099- FLOOD PLAIN/
PHONE: (50.?) 636-Z99y SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: CO- PLANNING: � Ole
ADDRESS: Po 130rK ZS,/J- _ ENGINEERING:
crs(�-F6t-), 02 97V3s- FIRE DEPT: _--
PHONE: D -Z 9 __ OTHER: r7f- -�-
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRE?
SUBCONTRACTORS: PLUMB: �/dCO'TT EC"h1rL./d_ LIST/SUBCONTRACTORS:
MECH: fbVEOF- t+lb Coe,- BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: SKk-CltH`r TRUSS DETAILS:
ADDRESS: _.0 9Q;4 ?Si s _ OTHER:
C6q►cu vft.w6c, o,z- e77'e3r_
PHONE: foy 6q, Zgi l-,l
PROPOSED BLDG. USE: s'F2
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COMMENTS., 6 >/L Sy4 ?0-Wiy
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APP I ANT SIGNATURE ^
Received By: �� Date Received:
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PERMIT ACCT # DESCRIPTION AMOUNT AMOUNT PD_ BAL.•OUE
ALL s3/ I0-432 00 Building Permit fees SyS Sv / 25 1/1-,5_y
10-431 00 Plumbing Permit Fees s �°
10-431 Ol Mechanical Permit Fees t.0
IO-z3O 01 State Building Tax (5%) Jr.
Building .2 7. z 7
Plumbing ?.2-
Mechanical .2 .go
10-433 00 Plans Check Fere
Building J64. S 7
d umb i ng
Mechanical
10-230 06 Fire
;+ .k'yI-ozso30-202 00Sewer ,Connection �v / 1,.G.
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 / 3�0 Q—L
25-448-05 Mass Transit TIF Fees /00
52-449 00 Parks System Dev Charge (PDC) 500
31-450 00 Storm Drainage Syst Dev Chrg
(SSOL) o old
24-445-01 Water Quality (Fee in lieu of)
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24-445-02 Water Quantity (Fee in lieu of) _
LLJ
TOTAL 3 S8,Q ��y• ``
nm/3587P.WPF