Loading...
13472 SW 107TH AVENUE W a CER'rIFICAiE OF CITYOFTIRDF OCCUPANCY CITYOfTiG.4RD PERMIT N. . . . . . . a PUP8`2516 COMMUNITY DEVELOPMENT DEW1 T OREGON PRIM,. PERMIT M. a 892516 13125 SW Hall Blvd. P.O.Box 23397,Tigare,(kepon 97 (G03) x.15 DATE I:58UE D e 06-/15/90 SITE ADDRESS. . . a 13472 SW 107T11 AVL PARCEL: 2SI 3DA•-. SUBDIVISION. . . ,. a ZONINge BLOCK. . . . . . . . . . e LOT. . . . . . . . . . . . . I CLASS OF WORK. sNEW TYPE OF USE. . . eSF OCCUPANCY ORP. eR3 OCCUPANCY LOADe TENANT NAME. . . e Remarkse 45 ft yard setbark req. by planning Owners PAT d TOM ODEA 15180 3W 187TH ALOHA OR 97006-0990 Phone 0a 503-591-5918 Contractors HAROLD COOPER COOPER MANUFACTURING CO. 6540 SW ALFRED TIGARD OR 97223-0000 Phone #a 503-246-2051 Keg N. . s 28545 Occupancy o* the above -9ferenced building is he-reby given,, and certifies the compliances with the State Of Oregon Specialty Codes for the graup, occupancy„ and t.tsp under which the referenced permit was issued. � FIRE DEPARTMENT IN 'TUR BUIL HO OFFICIAL POST IN CONSPICUOUS PLAUE INSPECTION NOTICE City of Tigard Building Department P.O. Box 2397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested .� - Time-'A.M.._ P.M. Address ---��=�1-z� � _ Permit Owner Lot # _ Builder The following Building Code deficiencies are required to be corrected: Presented to _r Approved Inspector _ [_] Digapproved Date CALL FOR REINSPECTION Cl res 0 No -_..•^,„•7r'n^+�:+�,.!m:s•.w.iRs.^seg-,.�F�w•vcT'''R17'I�'r"'Y��.R�".(.rr..:,�j�-+�..._. �..._..��_.•.—.T..-. .. �•w.�R..-n7^nIm'Me+rer.a-:�mm,ryrn.+r•-....--..-.,..-.-.v--•--- APPLICATION -- STREET IMPROVEMENT/EXCAVATIOPy TO: ORDINANCE NO. 74-14 -1"1 (WHITE)-FILE Y _ .i” '(YELLOW)-INSP. f L �� (PINK)-OTHER AGENCY (INSTRUCTIONS JN SEPARATE SHEET) I �jje_(BLUF_)-APPLICANT JJ APPROVED N�w A PLICATION NO.: NOT APPROVED ❑ CITY Y O I IGARD, OREGON -- FEE AMT.. S PGNDING FEE. PMT. ❑ CI7'N, IIAI.I, RECEI*N :PENDING SECURITY 11PUBLIC WORKS DEPARTMENT BY � DATE l C5PENDING AGENCY "OK" ❑ Appli(mionand Progress Record — Mr, NTENANCE BOND PENDING INFORMATION i� FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED �. ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE: irA1lA � PERMIT NO, 7 �� - DAZE ISSUED: a� �- _ --- BY I I ) APPI_ICATIOIS HEREBY MADE TO EXCAVATE FOR AND INSTAL!_ �'A�- ,\,�4t " ____ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICAN i _�L�rv1� 1 ►- G,� C V..� n11� cr�1 1 c . 1,-� Dr 46o'Zy� NAME - ADDRESS CITY PHONE CONTPACTOR i Iwo - _____ _ A T ADDPES CITY PHONE PLANS BY �Ii Lf- LIn ek � J ` TY I NA [ A 1 PHONE _ ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E DOLLARS FOR OFFICE USE: (2) EXCAVATION DATA: 004 x III__ � = s w y MIN _ 1' ) STREET _DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACECUTCUT CUT MATERIAL INSTALLED ITFM DATE REMARKS/TYPE BY TYPE LFNGTH WIDTH DEPTH ITEM AI QUANTITY -- -` STREET -- -t PEN D _ �^1 -- ---- INSPEC -- --- -- JL� �* I 6 TION OU ESTIMATED STREET OPENING DATE ( / E• ESTIMATE D STREET CLOSING DATE: _� / E - - D STNFET — ��---- (3) SECURITY NO. _._ SECURITY AMT. ._. _=_ CLOSED SURETY CO FINAL C_FRlIFIFD(HEu. - ' �. __ DIs INSPEC (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS/CONDITION FEATURES; EXCAVATION LOCATION AND EXTENT, _ �J I I I I (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL. PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WOMK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPL ICANTS ACTIONS. APPLICANTS SIGNATURE- we= 'G " �- DATE Cal Co ot Olt cc - CL - �l IL DY IL In eu 00z�i _ J,a, INSPECTION NOTICE 1 Citi of Tigard Building Department P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-4175 Type of Inspection Final Plumbing Date R,:quested 6 6/90 _ Time XX A.M. i P.M. Address - 13472 107th k,enue 89-2535 - - Permit # Q-.pier -� _ Lot #_ builder D & B Plumbing The following Building Code deficiencies are required to be corrected: /000� - — . 0 j Presented to — ❑ Approved Inspector � ./7 iapprowd Date CALL,fbR REINSPECTION Ai YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _ Date Requested urime A.M. P.M. Address _�. �2 _—.�� �� ,`� Permit Owner Lot # Builder The following Building Code deficiencies are required to be corrected: / _ Y Presented in Approved Inspector � [� Disapproved Det. `��- '24'— `�� a CALL FOR REINSPECTION ❑ YE8 El NO INSPECTION NOTICE v City of Tigard Budding DepaIment 7 a P.O. Box 23397 Tigard, Oregon 97221 Phone: 639-41 15 Type of Inspection Date Requested �"� �d �.. Time A.M. P.M. `-� Address .����7� �C� 7 ' Permit #� Owner Lot # Builder The following Building Code deficiencies are required to be corrected: IAIS 0A 1)LAO& Presented to Inspector ❑ Dlapproved CALL, FOR REINSPECTION [ I YES I:.i NO } i jt,4,J INSPECTION NOTICE L -, City of Tigard Building Department -tie P O. Box y f igard, Oregonon 97 97223 Phone. 339-4175 Type of Inspection Date Requested T �� Time—2 —A.M. + P.M. Address Owner _ _._ _ Lot # Builder -------re��"-. - The following Building Code deficiencies ire required be corrected: C'6-17e�qL 7- A Ccc e_ - Presented to Approved Inspector w _ U Disapproved Date CALL FOR REINSPECTION Cl YES ❑ NO I INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date Requested Time A.M. P.M. Address l3 'Z_. la,/ O _-- Permit #. 2,7-5-1Z. Owner_ —_ Builder The following Building Code deficiencies are required to be corrected: Presented to Approved_ Inspector _ C � Disapproved Date Z U CALL FOR REINSPECTION ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Department / P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-4175 Type of Inspection -- Date Requested Time A.M. P.M. Address Vz /� 7 Permit Owner__. _ �- Lot # Builder The follow;ag Building Code deficiuncies are required to be corrected: 24 Presented to 77 t"taved Inspetstor Ifepproved Date FALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection -7 — Date Requested L - l& Time A.M. P.M. Address —T 3���� �~' 7— Permit Owner Lot # Builder_ 't The following Building Code deficiencies are required to be corrected: CI-A F. - Presented to / — ❑ Approved Inspector [?Iillgpproved CALL FOR RFINSPFCTION (3'{IES NO INSPECTION NOTICE City of Tigard Building Departme \ i P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested_ —/ Time A.M.�.M. Address L�7 1� — Permit # Owner Lot # BuilderThe following Building Code deficiencies are required to be corrected: rl L 1�,i7iCt? TGA t,C7u7F f ig{l/l7 %112C-7-154-7 Presented to r� Icpproved Disapproved Date CALL FOR REWSPECTION Cly YES I_ I NO W N 9 I I � INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection �V Date Requested '�/ c� 7 I Time A.M._ Q�P.M. Address 7 7; �Ze '2Yn " __ Pc rmit # J I Owner Lot # Builder The following Building Code deficiesicies are required to be corrected: Presented to __ _ pproved 7 Inspector �' [.� Diapproved Date CALL FOR REINSPECTION ❑ YES Ll NO WW 1W Pff ON INS'ECTION NOTICE City of Tigard building Department P.O. Box 23397 ,1 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date Requested �_��—/9 d _ Time ✓ A.M.--P.M. Permit Owner—__-- _..._. Lot # -- Builder _---- — ---- --- -- -The following Building Code deficiencies are required to be co,rected: 1 Presented to Approved Inspector /% tl _ _ ��{ Disapproved Date Z— 7_c�— 70 � CALL FOR REINSPECTION PYYES ❑ NO INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested '-2 ;�,1`6e/0 __ rime �,M._ P.M. Address __ 57 /�J ^ Owner _ Lot Builder The following Building Code deficiencies are required to be corrected: 417 s I Presented to _ _ _ _._ Approved Inspector Disapproved Date r CALL FOR REINSPECTION ❑ YES CA NO W W ! ! ! W IN FW INSPECTION NOTICE City of Tigard [wilding Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection O�a �'� Ae ----- - - Date Requested__+' -249 Time✓ A.M. P.M. Z'� Address 1'' �__S _ -)e .. --- Permit # -• - Awr.er -- -- -- �. Lot # Builder -� _ --- ----- -- -- The following Building Code deficiencies are required to be corrected: Presented to _ Approved Inspector _ ���! ❑ Disrnproved Date c. t - ,��• _ CALL FOR REINSPECTION D YEs fJ No w w wX= w 1w INSPECTION NOTICE City of Tigard Etiiilding Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection 14-1-11�.&'111✓ Date Requested 2 -zz� %, Time A.M.----P.M. Address Z At Permit Owne, L-t # Builder — The folInwing Building Code deficiencies are required to be corrected: Presented to Approved Inspector Disapproved Date CALL FOR REINSPECTION YES L] NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 f Tigard. Oregon 97223 / L Phone: 639-4175 Type of Inspection _ - ��_/'✓- ------- ---- — Date Requested Time—. A.M.._ __P.M. Address Permit Owner—_ _ _ Lot # Builder -- ---- The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector Disapproved Da CALL FOR REINSPECTION 0 YES [=1 NO W N N If C17YOF TIFA MITNBUILDING: PERMIT c OFr�A�F�ER .iT N0, BU592516 COMMUNITY DEVELOPMENT DEPARTMENT TE t S5UED: 12/ 6/89 13125 S W Hall Blvd..P.O Box 23397.Tigard,Oregon 97223,(503)639-4175 JOB ADDRESS: 13472 SW 107TH AVE TAX MAP/LOT 2S1 3DA 5688 SUB: LT: BK: LAND USE: R3.5 LOT SIZE: VALUATION: $ 86,964 SETBACKS FRONT: 45 REAR: WORK CLASS: NEW DWELL.UNITS: 1 LEFT: 11 RIGHT: 100 USE TYPE: SINGLE FAMILY NO.BEDROOMS: 4 EXT.WALL CONST: CONST.TYPE: VN NO.BATHS: 3 N: S: E: W: OCCUP.GRP. : R3 PROT.OPENINGSS OCCUP.LOAD N: Ss Es W: TOTAL AREA: 1882 NO.STORIES: 2 1ST: 929 ROOF CONSTs C FIRE RET? HEIGHTS 20 2ND: 95;3 AREA SEPAR? RATED: BASEMENT? 3RD: OCCUP.SEPAR? RATED: MEZZANINE? BASEM'T FLOOR LOAD: 48 GARAGE: 440 FIRE SPRKLR? ALARM? FLOW(GPM) DETECT? YES HEAT TYPE: GAS Hnrp_AGCFgRl rnRki PLAN CHECK BYs rlt REMARKS: 45 ft yard setback req, by planninq REISSUE OF NO. LAST REISSUE o FEES: W O'Dea Pat R Tum PERMIT $394.00 N 1580 SW 187th PLAN REVIEW $256. 10 E R Aloha OR 97006 FIRE DEPT PHONE (503) 591-5087 STATE TAX $19.79 OTHER C DEVELOPMENT CHARGESs O COOPC,? HAROLD SDC(STORM) $250.00 N COUdER MANUFACTURING CO. SDC(STREET) $680.00 A 6540 3W ALFRED PDC(MI ) $250.08 C Tigard OR 97223 PREPAID < $100.80) T 0 PHONE (503) 246-2051 1111 REG1'.-JTRAT10N NO. 25545 TOTALS $1,669.50 ;�(� G This permit is Issued subject to the regulations contained in Title 14 RECEIPT NO. ( of the 7MC. State of Oregon Specialty Codes, zoning regulations ---------------___--- and All other applicable codes and ordinances, and It is hereby REQUIRED INSPECTIONS Agreed that the work will be done In accordance with the plans and FOOTING SEWER specifications and In compliance with all applicable codes and FOUNDATION WALL RAIN DRAINS ordinances The Issuance of this permit does not waive restrictive POST R REAM WATER LINE covenants Contractor and subcontractors shall have current city huriness tax permits This permit will expire And become null and PI.B.UNDERSLAB CITY APPRCH/SW void it work is not started within 180 days,or If work is suspended or SLAB FINAL ahandoned for a period of 180 days any time after work has PLB.TOPOUT commenced It shall be the responsihility of the permittee to assure FRAMING all required inspections are requested and approved FIREPLACE GAS LINE INSULATION GYP. BOARD Permittee SlgnaturP N,uled Py SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE SEWER PERMIT CIIYOFTIFAPFR111TRD N0. : SE892537 CITY OF TIG-ARD O.IOON COMMUNITY DEVELOPMENT DEPARTMENT 1� IF ISSUED: 127 6789 13125 5 w mall Blvd_P.O.Box 23397,Tigard,Oregon 97223,(503)639-417 5 C j II.PMT.NG. 892516 JOB ADDRESS: 13472 SW 1.07TH AVF USA NUMBER: TAX MAP/LOT 2S1 3DA 5600 SUN: LT: BK: LAND USE: R3.5 LOT SIZE: SECTIONs 3 TWP: 2s RNG: lw WORK CLASS: NEW USE TYPE: SINGLE FAMILY The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. The permit expires 120 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not quar- antee the accuracy of the location 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 not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. INSTALL. TYPE: BUILDING SEWER IMPERVIOUS AREA: FIXTURE UNITS: TENANT IMPROVEMENT: DWELLING UNITS: 1 NO. OF BLDGS. s 1 FEES: W O'Dea Pat 6 Tom PERMIT $35.00 N 1580 SW 187th CONNECTION CHARGE $1,258.00 E Aloha OR 97006 LINE 1AP INSTALL. R PHONE (503) 591-8087 OTHER C COOPER HAROLD N COOPER MANUFACTURING CO. R 6540 SW ALFRED A Tigard OR 97223 T PHONE (503) 246-2051 R REGISTRATION NO. 28545 TOTALS $1,265.110 This permit is issued subject to the regulations contained in Title 14 ------------RE:CEIPT------. NO. of the TMC. State of Oregon Specialty Codes.zoning regulations REQUIRED INSPECTIONS and all other applicable codes and ordinances, and it is hereby ROUGH-IN agreed that the work will be done in accordance with the plans and specifications and In compliance with all applicable codes and ordinances The Issuance of this permit does not waive restrictive covenants Contractor and subcontractors shall have current city imsiness tax permits This permit will expire and become null and old if work Is not started within 180 days,or If work Is suspended or ihandoned for a period of 180 days any time after work has nrnmenced It shall be the responsibil,ty of the permittee to assure ll required inspections are requested and approved / 7 PfWlndtee Signature Issued By -! CALL_ FOR TNSPFCTTON 63'1-4175 SEPARATE PERMITS RFOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF T167A RDPLUMBING PERMIT COMMUNITY DEVELOPMENTMM DEPARTMENT M MP MIT NO. : PL892535 13125 S.W.Hall Blvd..P.O.Box 23397.Tiyard.Oregon 97223.(503)639-4175 TE ISSUED: 12/ 6/89 JOB ADDRESS: 13472 SW 167TH AVE TAX MAP/LOT 2S1 3DA 5600 SUB: IT: BK: LAND USE: R3.5 LOT SIZE: ITEM: NO: NO: WORK CLASS: NEW WATER CLOSET 3 TRAP USE TYPE: SINGLE FAMILY URINAL BKFLOW PRV,ITR CONST.TYPE: VN L.AVORATORY 4 TRAP PRIMER OCCUP.GRP. : R3 TUB SHOWER 2 GREASE TRAPS DISHWASHER 1 GARBAGE DISPOSAL I NO.STORIES: 2 WASHTNG MACHINE 1. DWELL.UNITS: 1 LAUNDRY TRAY BLDG.DRAIN (D10 FLOOR DRAIN SINK 1 SEWER (FT) WATER HEATER 1 STORM/RAIN (FT ; OTHER REMARKSII FEES: N O'Dea T'at. (t Toni PERMIT $1 8.00 1580 SW 187th Aloha OR 97006 FIXTURES PHONE (503) 591-8087 STATE: TAX $7.00 � ------- -- -__ OTHER 0 N T R D B PLUMBING A PO BOX 686 i Oregaii City OR 97045 t) FI _ lUl. -3-1Alph TOTAL: $14.7/.00 This permit is issued subject to the regulations contained in I itle 14 RECEIPT N0. /O C1a of the TMC State of Oregon Specialty Cooes. Zoning regulations _.---------_.--_--_—_—_ and all other applicable codes and ordinances, and it is hereby REOUIRED TNSPECTIONS agreed that the work will be done In accordance with the pans and specifications and in compliance with all applicable codes and PLB.UNDERSLAB ordinances. The issuance of this permit does not waive restrictive POST d BEAM covenants Contractor and subcontractors shall have current city WATER LINE business tax permits This permit will expire and become null and PLB.TOPOUT void if work is not started within 180 days.or if work is suspended or RAIN DRAINS nhandoned for a period of 180 days any time after work has commenced It shall be the responsibility of the permittee to assure F T NAL all required inspections are requested and approved Pw tee Signature �j 1 01 L EOR INSPECTION 639-417`., SEPARA"TE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY of TIFA MECHANICAL ME89 T CITY oF� 'aa 'EtMIT NU. : ME892536 COMMUNITY DEVELOPMENT DEPARTMENT o#rte 13125 S IN Hall Blvd_P O Box 23397,Tigard.Oregon 97223,(5031630-4175 TE ISSUED: 12/ 6/89 -- --- ---- ---._.._. .__— M.PMT.No—. 8 : JOB ADDRESS: 13472 SW 107TH o:)YE TAX MAP/LOT 2Si 3DP 5600 SUB: LT: BK: LAND USE: R3.5 LOT SIZE: ITEM: NO: N0: WORK CLASS: NEW FURNACE (100K 1 AIR HANDLR (10 USE TYPE: SINGLE FAMILY FURNACE 10OK4 AIR HANDLR 10K CONST. TYPE: VN FLOOR FURNACE EVAP.COOLER OCCUP.GRP. : R3 HEATER VENT FAN 4 VENT VENT.SYSTEM BLR/COMP (31;P HOOD I NO.STORIES: rP BLR/COMP 3-15HP INCINERATOR(DOM DWELL..UNITS: I BLR/COMP 15- 30HP INCINFRATOR(COM FUEL T`f 'E GAS BLR/COMP 30-`OHFr REPAIR'. UNITS MAX. INPUI BLR/COMt' 50+HP OTHER 2 F-IRE DMPRS? GAS PIPING OUTLETS 1 HIGH PRESS?! REMARKS: O FEES: N O'Lea Pa.i R Tom PERMIT $10.00 N E 1583 SW 187th PLAN REVIEW $10.88 R Alcoa OR 97006 FIXTURES $33.50 PHJNE (503) 591-8087 STATE TAX $2. 18 _._ O' ER C O N A R HFAIING H DIAL ONE, ACE HOLDING A 14915SW 72ND T tigard OR 97224 H PHONE (503) 684-3355 - 313:43 - TOTAL: $56.56 This permit is Issued subject to the regulations contained in Title 14 RECEIPT NO. of the TMC. State of Oregon Specialty Codes,zoning regulations – �vv 77 and all other applicable codes and ordinances, and it is hereby REQUIRED INSPECTIONS igreed that the work will be done In accordance with the plans and ,pornccatlons and In compliance with all applicable codes and GAS LINE rdinances The issuance of thI3 permit does not waive restrictive POST & BEAM ovenants Contractor and subcontractors shall have current city ROUGH–IN business tax permits This permit will expire and become null and F INAL oid it work Is not started within 180 days.at If work is suspended or ibandonerl !or a period of 180 days any time after work has nmmenced It shall be the responsibility of the permittee to assure ill required inspections are requested and approved Per nu;W�pSignature a Issued By CALL FOR INSPECTION 639-4175 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR'nED ABOVE i CITY OF T1671 RD cmr�n l� PLAN CHECK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT Q� PLAN CHUCK N // - 3 S lt2- 13125 S.W.Hall Blvd_P.O.Box 23397,TigMd.Oregon 97223.(50.7)639-4175 C PERMIT # :? S DATE ISSUED JOB ADDRESS: _ .j zr= �- S ``J I o _ TAX MAP/LOT SUB:T 1 {�' I ,w/ = v' Q /� LOT: S" DD LAND USE: VALUA ION: OWNER SPECIAL NOTES NAME: _ PA r - Ta&I � � �� C�� REISSUE OF: ADDRESS: /-5-SU 15L.4j /Lf 7'n` LAST REISSUE: — _• FLOOD PLAIN/ SENSIIIVE LAND: _ PHONE: APPROVALS REQUIRED CONTRACTOR PLANNING: NAME: / .�1/�D CLQ C.CZO�r ENGINEERING: ADDRESS: FIRE DEPT �' l OTHER: ,A PHONE: _ �{j, - 1n 5`� ITEMS REQUIRED BUILDERS BOARD M: 41, S� EXP DATE: LIST/SUBCONTRACTORS: BUS TAX: ARCH/ENGINEER_ CALCULATIONS: _ NAME: _ T TRUSS DETAILS:'— T ADDRESS: OTHER: PHONE: COMMENTS: SUBCONTRACTORS: PLUMB: _ MECH: 4v -3 _ 131 F' � , e7 PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DIIE 10-432 00 Building Permit Fees 10--431 00 Plumbing Permit Fees 10- 431 01 Mechanical Permit: Fees v = ' _ ._ .51) 10-230 01 State Building Tax (!ix) Y Building Plumbing Mech _ _ ✓ _ c< 10-433 00 Plans Check Fee '� .1�i:^►`1� lU d� [It iIding Plumbing Mech "-/ 30--202 00 Sewer Connection ..)s J s J 30--444 00 Sewer Inspection _ —_- 51-448 00 Street System Dev Charge (SDC) e 0 52 444 00 Parks System Dev Charge (PDC) / J u .a 5 u 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) 10- 230 06 F i r•e _ TOTAL_ �> REC N 7 APPL CANT SIGNATURE �w Received By: %� Date Received: cn/3587P/I8P