10765 SW 106TH AVENUE r
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10765 SW 106th A,,(�
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DOUG REMMICK/NORTHWEST STONE, INC.
NATURAL. STONE • METAL FIREPLACES
.._.TALI SUSINESS PARK
1"20 SX TETON AVE. DATa:
TUALATIN,OREGON 97062
503/692-0234 TIME:-
FAX Y 503 691-2106
FAX
TO, ���C._ T1i L. FROM:_ Hcy L ("'Y
Number of pages to
If you do notreceive all of the pages, please call.
Ask fo.: � Lam/
Operator ! _
ssr eo � w w w w w ca w
TAN — r ' &1 F F' I 1 ea 2e NW ST U --
71
777
I`'1
GET M[TAL
aCR[w COMBUSTIBLE MATERIALS
{ ARMOVE KNOCKOUT..�
" TAN IN NOTCH
AIR INLCT TU[6
Fla. 1aall
,
AW A A>I11111%MOLY 14"
4'owMr asnmbly li available for use with this fireplace as an 1Z„ �,•�,'.; I
llonal acce"My, They are designed to be Installed on FMI
stnry'prawired fireplaces only. The blower assembly model
IK-E an be installed prior to, or after installation of the fire-
6e. Use of blowers or fans other than manufactured by FIRE.
TOP OF LOUVER OPENING --�"
AC Mfg, Inc.voids the warranty.
is METAL FIREPLACE FACE blower is operated by a swlt,;h ill the fireplace face. Pushing
I switch In, turns the blow;,rs on, The reverse turns them off, FIG. 17A MANTLE LOCATIONS
ITE; Fireplace must be wired to the house electrical system in
lar for the blowers to operate, This bl.wer system does not
Imre a wall switch, Refer to the CBK•E blower assembly Irscall• FIG. 178 EIDE FAAMINri
in instructions for Installation details,
ctrical connections are made through the cover on the side of }
coraaustlele
fireplace illustrated in FIG, 16, Use 14 AWG copper wire for MArERIAL
Anriect!ons. Be certain the fireplace Is properly ariundc X.
.�,�....,�
4..
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BLOWER fIAEPLACF FACE
K!Q PLATE EIOt OPENING
A COMBU5TIBLE MATERIAL NOT # I
ELECTRICAL TO OVERLAP FIREPLACE FACE. I f
COVED PLATE
OROLIND SCf1LW
6LOWLR ON/OFF sW1 rCH
G. 16
ISHING YOUR FIREPLACE:
rbustibie materials may make direct contact with the sides i
the top of the fireplace face, It is important that combust•
materials do not overlap the face itself. Brick, the or other
tornbustible materials may be applied to the face provided
any pap between the material around the firrplace,open ng
calked to prevent the seepage of combustible products.
IItLE;
antle may be installed if desired. See F,G. 16/. c. 168 for
mum heights above and beyond opening of frroplace face '
i
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01/12/90 17:37 0503 684 7297 CITY OF TIGARD f�001
ACTIVITY REPORT
/ J1
RECEPTION OK
TRANSACTION #t 3264 Q 7 _�~ (� 77)
CONNECTION TEL 6912106
CONNECTION ID G3
START TIME 01/12 17:36
USAGE TIME 01' 37
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Tvpe of Inspectiony'^��, --
Date Requested Time—A.M.—P.M.
Address _/ �J 7 4 Z �1'K _ Permit
Owner .. -- --- — — ---- Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector ❑ Dlgpwoved
Date
CALL FOR REINSPECTION
❑ YEa ❑ NO
i
IfF ® #► I� � �' IfB i�
1
INSPECTION NOTICE
ty of Tigarl lbuilding Department
n P.O. Box 23397
Tigard, Oregon 97223
type
o175
of Inspection Z — — —
Date Requested Jam_ ��' J �I Time A.M. P.M.
e � I^
Address ! U( L� �� �Ac— Permit # & T(l
Owner — Lot #
Builder ___—_._ - -`3&
The following Building Code deficiencies are required to be corrected:
t _ .•4
Z AO-614 ,.�TL�,�e�.tGta. t'
Presented to _ ❑Zlupprovvd
red
Inspector �,f J _ _ _
rate - / z- Z f —8
CALL FOR REINSPECTION
LST YFS D No
I
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{ r--eLSPECTION NOTICE
ity of Tigard Building Departmertt
P.O. Box 23397
( Tigard,Dragon 97223
u n : 6.30_4175
Type of Inspection ?LA—
ate
ate Requests _ L Time M. P.M.
A ress f�' .� �w ( PermitC� 4L
Owner_ _ Lot (#
Builder
The following Building Code deficiencies are required to be corrected:
o
Presented to ❑ Approved
Inspector r%� o� 0 Disapproved
Date �
CALL FOR REINSPECTION
Liras ❑ IVO
t
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
9L Phone: 639-4175
���Lt& L f
Type ofi Inspe;9. oma'
Date Requested , f f_ Time A. P,
Address ,/U 6.5- Pe- 376
Owner _ _ Lot #
Builder L� 2z��y+
The following Building Code deficiencies are required to be corrected:
I Presented to — -------------- —-
I � Apt,,,,v,,,l
Inspector
Date
CALL FOR REINSPF.CTION
C7 YES ❑ NO
i
i
r
I
i
i
,� INSPECTION NOTICE
f
�u 'City of Tigard Building Department
P.O. Box k:397
12, Tigard, Oregon 97223
Phone 639-4175
Type of Inspection1L
Date Requested Xn=4L—d'!2 Time—A.M.--P.M.
Address —, U S �U Pe;mit # 7
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to (_J Approved
Inspector — C] Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
FENN
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspectione �� -1f r
S
Date Requested -oc S- 8 Time V A.M. P.M.
Address Z6 ;Z Ik Jew IQ66 bV 15P ___ Permit #—Y11._
Croner Lot #
Builder / �hle—,"
The following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector �� !Y-approvwd
S 1
Uaro -
CALL F4 REINSPECTION
0 YES L-1 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 C I
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —.—.-- .
Date Requested Z Z Time — A.M. P.M.
Permit
Address
Lot #
Owner
Builder
The following Building Code deficiencies are required to be corrected:
t ' r
07
r
� 1
/ 7
Presented to r] Approved
Lj Disapproved
Inspector
r
Date —
CALL FOUR REINSPECTION
❑ YES ❑ NO
IF AF WNWWj
INSPECTION N101ACE
City of Tigard Building Department n pry*-
P.O. Box 23397 N
Tigard, Oregon 97223
Phone: &39`--41175
Type of Inspection
ALL '
Date Reqs ted Time A.M. ��__P.M.
_ � -— nn
Address
� S l� J Permit
Owner �} _ Lot #
BuilderThe following Building Code deficiencies are required to he corrected:
2
--
j
Presented to Approved
Inspector — - U Disapproved
Date
CALL FOR REINSPECTION
O YES 0 NO
tt< �
JOHN McDONALD ENGINEERING l
SOILS-CIVIL-GEOTECHNICAL
Ground-Penetrating RADAR
10116 S E. STANLEY AVENUE
PORTLAND, OREGON 97222
(503) 7740077
1989City of Tigard April 19 , 198
Building Department
13125 SW Hall Boulevard
Tigard, Oregon 91223
INSPFCTION OF EXCAVATION AT LOT 31 WINDSOR PLACE
The address of this lot is 10765 SW 106th Avenue. Part of
the lot has „ foot or more of fill on it , judging by the rocks
that are visible and io, previous investigations of the entire
subdivision. No buried organics were found anywhere in the
subdivision .
A hydra-hammer weight dropping machine was used to pound
every square toot of the house footprint so that if weak soils
were found they could be given extra pounding to firm them up.
After the hammering, the entire surface was tire rolled in
different directions to ^mooth and firm the soil surface.
In my opinion the response of the soil to this testing was
affirmative and the excavated surface is stable andO suitable for
suppart of the house footings.
Very truly yours,
C\�T1N
, FF
C G41/
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0 O
ti H P
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APR 2 14F49
Community 00011OW -1
PI I.JM8TNG PE.'J1M3:T`
CITY�►� G�'I:F2M:f.'T'T167ARDNO. : PL.890d432
CIrf OF TWA 11111)
COMMUNITY DEVELOPMENT DEPARTMENT weoorr I)A*TE: 3:S5lJEl:): /I/27/89
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)6394175 r,wi:m. r)m r .NO . E'9O.5
JOFJ AGURE:515 . 1.076,5 '5W -1.0611-1 AVI;
'I A- X MAI-*, L.0'1* 1.!j1. ge.l()o
1 AND
1 01, SIXE .
TE.M: NO: NO:
WOWK CA..ASS : NI5 'ii:lkl WAI E44 GI (RA..'T '13 T R A i
TN(.-#LI'--. F*AM11 Y U141NAL. BKFLOW F"141VINI'VP
CONS"I . '1YI**4:;. : VN L AVOPO-11:44Y q PAlMEP
(:)(XUP . GPP. : P3 '111D UPAPS
D1511-11WASHER I.
0:11:51-NOSAI .1.
NO . F-51'OP111:1 S 14-2 WASI-LENC, Mo('I--I:I'Nl.'-:: .11
DWELL. UNT'Vili 1. 1 (it.)NI)PY 1,PPly HI DG 1)14A:I*N l PIA
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9 T.N K :11. SEWE.,1141 (F-1,
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0 F 1--i IK:P,
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W AZI-410 1.70TI-1 AVE SE'.
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F"V NO
This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes,zoning regulations PP::(:1I.lYQL.I:)
and all other applicable codes and ordinances, and It is hereby V11 I I)NDE3451-AF3
agreed that the work will be done In accordance with the plans and IAI 0EKAM
specifications and In compliance with all applicable codes and L T NE"
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and 1.4 1 1 D 1:4 A I NS
void it work Is not started within 180 days,or It work is suspended or F 11,14111'..
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to as%ure
all required inspections are requested and approved
Permittee S Fgnature
Issued By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
(4k.*:(',I--I(1N I G At V:11-041`111
CITY OF TIVA RDI:*+:PM.I: T' NO. ME8904133
CITYOFTIGAV
COMMUNITY DEVELOPMENT DEPARTMENT 01100N DAU-. 15SUEU: A/P7/69
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,(503)6394175 I:)A11M . PM*T* .NO . 8903,70
JOB ADDPE.'SS : 10765 SiW 1.0671-1 AVE,
fAX MAPILUT, I.S1 9/100 WENDSOF-4 V"I A(:,I::., 1-'Y* :3:1. Hl< :
',.AND USE P7 P D
1:-1 h.M: NO: NO:
WOPK CL.ASiG '. NEW F(.1I4NAC.E <100K :1. A HANDL-14 <10
USE T*yPl:**: SlNGLE 1!:*AM1:i Y P-1.11PINACE" 1.001<+ A144 HAND11-14 3,01<
CONST .1*Y1'-',I*;:.* : VN FLUOP F"ORNACE. EKVAP . EX101 E*P
CHICILIP".UPI:` P3 1-111-ATEP VI:::N1' FAN 2
Vr-.:N*I* VE:N'T , SYS"I'LKM
BI W/COWN <31-11:) HOOD .1.
NO. !iii OInILS : a ElL.P/cOMP 3-1511-111:) XNCXNEPA*TC)P(DUM
DWE'Ll... . UNXTS : 1. UI A/It:101,11P 1-15-301-413 3:NG,3:Nk:*AA'T(:)Il(GOM
14113-1 'TYPE, ("WIS DI-II. /COMF, PE PASP 111,41'1`!i
MAX . INPUT I: I A/(.1OMI::1 504-1-11=' OFFIE:11:1 2
F:IJIF. DIVIP-Ps'? l;-`1'P1'NC3 O1.1TLE15 .1
II-EGI.-I PAESS7
LOW PIPES$'?
0 KTM IjN(.' $1.0 . 00
W 111/11/110 '1 70*1 H AVE. . SE 1:'-11..()N PI;.V.1A.:W 1119. 3H
N .1:545AQUAI-I WA 98027 i 1 X Y,1,J 1."1 11127 .50
E
.1 PHONE 12000 I.:i I ATU: I AX $1 .(3113
0
0 C DON
N 1:41(31'11 ZACHEAW
T !i r: i s,r r)v r,
A ilk 1'11:141 C)1,* 97 01:5
C
T
o NO 1,41000 11:11 11,10 . "4,.)
NO
...................................
This permit Is issued subject to the regulations contained In Title 14
of the TMC. State of Oregon Specialty Codes,zoning regulations PIA41-11'.144E.1) TNSl*-)F.:*C'1 1XIN5
and all other applicable codes and ordinances, and It is hereby I—XISIE-
agreed that the work will be done In accordance with the plans and POS I & Il"P.:AM
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does no' - alve restrictive
covenants. Contractor and subcontractors shall nave current city
business tax permits This permit will expire and become null and
void If work is not started within 180 days,or If work is suspended or
abando-ied for a period of 180 days any time after work has
comme iced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Permittee Signature
Issued By OR TISISPLA-1 TON 639 Al:1 15
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
111111 Eli
IEI
CITY OF TIFA RD A�� I-*,F-.*.PM]:'T" NO. 13L)8903'10
C117YOFT11011111111
COMMUNITY DEVELOPMENT DEPARTMENT DA111.1 3 SSIJED; -11/:L 9/H9
13125 S.W.Hall Blvd..P.O.Box 23397.Tigard,Oregon 97223,(5031639-4175 P-141M., 1:)M*r .NO. 8901,570
J(7I-D ADOPESS : J.0765 SW 1.0611-1 AW.-
TAX l!AP/L(:)'1 15:1. 3161) 9/100 SUE) ; WINDSOP PL.ACE I T :3:1. ki l<
LAND Lft;r::: 1."471111:)
1.01 SUE.I. VALUMTON: il; *79'ObO SEA1.11ACKS
F'RON'r : 2,44 F I E A 1"4 15
W(:)PK C L.ASS : NEW DWEL.I....UN1*1'S : 1.7 11IGI-11' : 5
L1SF1 'T'Yl>E: : STW.41...E. NO. F)EKI)POOMS : ZI kiXT Wol L CONSI
(:,0NS*T' . 'T'Yl-"1E-* : VN NO . E.WFFIG : 3 N W
P*3 171 OT UPEENINGS :
('.)CC11J17 . LOAD N S W
'I(TIAL. AREA : :1.7,70
NO. GTOPIES : I Si 1*: 899 1:4001::' CUNST C NET..
'r,'.'0 (3'71. AI:41:::A SEIJAP? PA'I I:;:D:
F!1 001:1 L.OAD: lei() G A Vi A I I.:, ql.8 I::A:Ai"-: til:4410-1-17 Al-(-)nM'!
F-1.014 (.-,PM l D V.T I.,.:("'T
1-11;:'A 1, .I y V'I
1:1 AN DY : r-:1 I.
PEKISSUE (:)I::' NO .
LWIVT
O DON
W *37'.1s . 00
N I.)(:' E.--'0X 1.(1,36 PLAN I'I;.V.IA:.W P/I;'-1 "l!")
E
R
I;:: 'I AX $10 6".)
01 H L-K 1:4
C
0 1-0:11LMAN 25 0 . 0
N
T DON-1-ION't COWi 1, CAI ";iDC $600 .
1743 BOX 11036 PLA-Allitt !Ii 0.5 0 00
C Oil P WL'DAT D < qi:1,00 00 )
T 634a.. Y911
0
R TOO Al.. 6.3A1. 11.0
NO .
This permit Is issued subject to the regulations contained In Title 14 V9 -
of the TMC, State of Oregon Specialty Codes.zoning regulations
and all other applicable codes and ordinances, and it is hereby I ki 1:1:4 In'E) I Wi P 1:.: 1 T.0 N S.
agreed that the work will be done In accordance with the plans and (KI 1 *11,11. 51 V W 11::1.4
specifications and in compliance with all applicable codes and 11— );, 1 ION WAI I PA.I:N 17l:-)A1N!:)
ordinances. The issuance of this permit does not waive restrictive
covenants. Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void If work Is not started within 180 days,or If work is suspended or :l:NAL..
abandoned for a period of 180 days any time after work has 1:11-H 101:)(MIT
commenced, It shall be the responsibility of the permittee to assure I"IW4-1 J.N(!,
all required Inspections Are requested and approved I' 1:1-4177 PLACE-'
GAS LINI:-
INGUI .AT IMN
Permittee-Signature 0---4-4
Issued By.
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
5F�:Wl::.P PFAMT
CITY OFTIFARD V.I�J:4m]:,y. NO . : Sl�:X)90A,34
CITYOFTWAIRM
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 DAJ F., T 5 GI[A-K 1) -el/1.9/89
1076!5 SW :11.06TIA oVl::* tJ!:ii'v NUMIAHA:4
I Ix MAP/1 t ! 1 ' 'Il. 3/00 9/100 SUIR: WINDSUP PILAC,11-K
I-il"IND LISE :
0 S 1:Z E :
!.i E, I ON: :3<.I Twl,: 1w AW.., : 1w
MUM ("LOISS: NEW i
LISE-K *I*YPF.:: : STWA 1-:' FAMTL.Y
dipplic.ilk i-Ii, 1,cl C.cllnply wit'l-I a0l. I111eul alrlcl I-eut.13.ilk'L:i.c)1,1!:; 0.11 thwi, 131.19.-Fiecl
Ageric!y . Jhva J.'e."W (fin.yul 421-oln t.he clil-Le imult.tc.-)cl . Vhco wit.4-0.
cillic)1.111t pi-itid wail tw flal.-Fkail,qvd :iA, A,he pfor*ini-i. The Agwric'y ckslow I-Iml, 4"11.1iii1..
0-10 0("1 t.i(If" Of thf....) I-AA0 Illower, La.
IA. J.U As-t,it.)d 111.1. 1.1110.�� 1:15.vceo , I.h c' :i.ri tit i.,ik 1.:1.(i..-I- 9;1,,i a)1.:1.
i,1(311% 411--c.1111 M.1f,* dilstA.I.1cca givell . 1T 110t !I;(:) 3.11VULt0d , th(o 11)his.11
"Tiar.) iffild Sfiewc.1o" will irlilitw.].J. I;#. hiLtcel'iikl .
TAS Tol. 1, T*YPI:;. 011111,A)MG 15FULA4
FY�X*TIII,0I:_ IJN'111:') . '11I.AANU I.MI P0IA*.:A1i_'.NJ' :
W 111,3.5 . 00
N
F 13M I.,l i6 1 ! IN C.I.-IlArKAK. 11.1— :11.00 . 00
11 uIllww1p.) M, d I
C
0
N 110 MON I)ON
r
H D0NIA1JN1 CONST . C;0 .
A 1,)1:P OUX 1.036
C l.m.ke 4.)%wiim u 111 970-'.45
T .1
0 I'l I
R I I '. 11:11AIION T Al.. . !10. I_i"3 00
This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes. zoning regulations
and all other applicable codes and ordinances, and It is hereby 1.11 1.11 11. .1 ,11:,1.1.1, 1 1 M",�.
agreed that the work will be done In accordance with the plans and
I
specifications and in compliance with all applicable codes and )(.',I 1 .1 N
ordinances The Issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
husiness tax permits. This permit will expire and become null and
void if work Is not started within 180 days.or If work is suspended or
,abandoned for o ,eriod of 180 days any time after work has
commenced.It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Permittee Signature
Issued By
SEPARATE PERMITS REQUIRED FOR WORK nTHER THAN DESCRIBED ABOVE
PLAN %
�� �'�� r1t(K F'PLICATION
CITY ��- cmof', PLAN CHECK M
o.aoon r
C0MMUNITY DEVELOPMENT DEPARTMENT PERMIT y _ 4
13125S.W.F A6Wd,P.O.Box23g7,T1gai40regon97223.(503)G39�1r5 � DATE ISSUED
� �✓�, __ 1 AX MAP/LOT J
JOB ADDRESS: -_ LAND USE:
SUB: _ LOT:
VALUATION: _ -" SPECIAL NOTES
OWNER REISSUE OF:
NAME: ___ LAST REISSUE:
ADDRESS: ._�.-- — FLOOD PLAIN/
_ SENSITIVE LAND:
PHONE: _-— APPROVALS REQUIRED
PLANNING: _
CONTRACTOR ENGINEERING:
NAME: FIRE DEPT —.--
ADDRESS: ti Iy "' OTHER: _ --
- Ali Y �c ITEMS REQUIRED
PHONE: �► LIST/SUBCONTRACTORS: _
BUS TAX: -
ARCH/ENGINEER CALCULATIONS: -
NAME: _- TRUSS DETAILS:
ADDRESS: PARKING PLAN:
-- LANDSCAPE PLAN:
-_ --
OTHER:
PHONE:
COMMENTS: _—__---
PERMIT H ACCT N DESCRIPTION AMOUNT AMOUNT PD. RAL. DUE
i
I 10-432 00 Building Permit Fees ----
10--431 OU Plumbing Permit Fees ---- — -
r 10-431 01 Mechanical Permit Fees -
10-230 01 State Building lax (5%) -
Building / W4
Plumbing 7 u U
Mech
1.0-433 00 Plans Check Fee -Building
Plumbing
Mech /
30-202 00 Sewer Connection a -- ��
�GQ 3
30-444 00 Sewer Inspection
51-448 00 Street System Dev Charge (SDC)
52-449 00 Parks system Dev Charge (PDC) - U 31-450 00 00 Storm Drainage Syst Dev Chrg (SSDC) j-
10-230 09 TRFD —
la-•230 OG Washington County Fire M1 (95X) --
10-220 00 Amart/Wedgewood ��
TOl-AL
REC N
APPI.TI,ANT IGNnTURE -
Received By: _ Date Received:
cn/3587P/18P
CITYOFTIGARDr
PLAN CHECK APPLICATION
OFWWARD
COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK #
77� l
13125 SW HSI Blvd P.O.BOX 23W,719&d On m Of (600)630-176 PERMIT # aFr-
DATE ISSUED
1OB ADDRESS: 1076Y J14.). 106 Te Allo- , TAX MAP/LOT
;UB: W/A/hGf- LOY: / _ LAND USE:
IALUATION: SETBACKS: FRONT:_.2q REAR LEFT: J- - RIGHT:
WORK CLASS: HEIGHT: TOTAL AREA:
USE TYPE: FLOOR LOAD: 1ST:
CONSTR TYPE: HEAT TYPE: 2ND: _
OCCUP GROUP: DWELL/UNITS: _ 3R-D:
OCCUP LOAD: NO BEDROOMS: BASEMENT:
NO STORIES: _ NO BATHS: GARAGE:
IMP SURFACE:
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: RE73SUE OF: LIST SUBCONTRACTORS:
ENGINEFRING: LAST REISSUE: BUS TAX:
FIRE DEPT. : _ FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND.: TRUSS DETAILS:
PARKING PLAN: _
LANDSCAPE PLAN: _
PLAN CHECK BY: OTHER:
COMMENTS:
CCT I DESCRIPTION AMOUNT
OWNER 10-432 00 Building Permit Fees
NAME:{ w,4a -k,,4 /N C . 10-431 00 Plumbing Permit Fees S
ADDRESS: Xrf{0 ZQ -"A414 .TC 10-431 01 Mechanical Permit Fees
/S3 19U 1//, W4 9Xoj:Z 10-230 01 State Building Tax (5x) s
10-433 00 Plans Check Fee
PHONE: p /- y�q 30-443 00 Sewer Connection (20x) t
30-202 00 Sewer Connection (80X) 3
CONTRACTOR 30-444 00 Sewer Inspection
NAME: -/ J _ iva- .51-448 00 Street System Dev. Charge (SDC)
ADDRESS: _ �r- x,,'•52-449 01 Parks I System Dev. Charge (PDC)
-T 52-449 02 Parks II System Dev. Charge (PDC) s _
4iKE 402SL.JE31.-450 0 0 Storm Drainage Syst Dev Chrg(SSDC)
PHONE: ��G _QQt L 10-230 09 TRFD (95x) 3 -
10-435 00 TRFD (5x)
ARCH/ENGINEER 10-230 06 Washington County Fire #1 (95x) s
NAME 8Z,44_ 10-435 00 Washington County Fire #1 (52) s
ADDRESS* / / E 10-220 00 Amart/Wedgewood 3
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PHGNETOTAL
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PREPAID �L L
REC
BALANCE DUE q
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APPLICANT SIGNATURF,
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Received By: ; [ 1 Date Received: 5