10925 SW 108TH AVENUE pm
10925 SW .108TH COURT _
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CITY OF" TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
l TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
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C G�
Permit NO.
Inspector
CALL FOR REINSPECTION
C.: ty of 11066 a 14�ectitIrf1lt"at vern11[
�r-�-7
Rel:ace �1 nelocat.on LJ :.cid�t,On � !.Aeration � � 2%Stott •�Z-
New Ihs:aGa!ion TOfAL
?ACTOR C1%,NER oW A 15►.1'1 Ose-0. bt2t�.
C^>:T.
)� IVORY, ADDRESS W. " '
Ap7^nEc� 1- B t.,A-c -
�S� A�TLICAr�7 '�, =
PHC1Nc -- -
Meat Input Rating 03TU Per Hour)—_— Vent Srze
Flue Size _
FUEL. OIL ❑ GAS 53" ELECT Cl OTHER
ITEM NO. FEE ITEM NO. FE
0D Air Condit on Corn_-ressor 15 to 30 HP
. For Issuance o1 Peri-nit �� -
.` New-Un3e' 100.000 FTU
4.00 Air Handling IU,000 CFM _ J_ 3•L
i? New• t00.ODD BTU & over Air Handling Over 10,000 CFM 1 5•L
4.00 Evaporative Cooler _3 i
Floor Fu,nace — �4.00 Range Vent Fan 2.(
Floo: Suspended -� — 3.1
.� Install Vents Only 2.00 Vent System _ • _
Reps Neat &Cook^9 I 4.00 Hood Commercial 3 1
_epa , ----- 4.00 Con n�rcial Duct System 1 10.(10•L
k _Air Condition Compressor Under 3 FSP Y j 50 — '--
fr • Condition Compressor : to 15 HP g
INSPECTOR'S COMMENTS --
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR Sl1B CONTRACTORS
DATE ISSUED b'. TE
APPROVED BY-__—
RECEIPT NO.._._
1. 774 Signature of Appl' ant I _ ~-7
JOHN [. P.EItIRhEDi Ft�i!?P.�NS, J"t BUILDING DEPARTMENT, TIGARD
NO.
f. PLUMBING PERMIT i
holder of a valid plui ibing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City Of Tigard Business License required
for all contractors and sub-contractors. 1
,4,
Address /6 ,�- � j ZGP _ Date—�9_r
-. NUMBER OF TO" _ PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE ON EACH AM JNT (Office Uw Only)
Single Farnhy-1 bath-each 25.00
Du lex-Eich 1 bath uni, 25.00 _
Additional bathrooms--each 10.00
Mobile Hnme S i!Sa-eochM 15.00 _
INDIVIDUAL FIXTURE FEES _
1 to 50 Fixtures in 1 bulldin -each _- 3.00
51 to 100 Fixtures in 1 building-each 2.50
101 to 200 Fixtures In 1 building-each 2.00 _ _—
_201 or more Fixtures In 1 building-each 1.50
MISCELLANEOUS
Building Sower-1st 50 ft. 10.00
Sewer-each additional 100 ft. 10.00 _w ,
Water Service to building 6.00 c _
Private Water SX1temf--each 100 ft. 10.00
Other (Specify): _
PERMII R :5 6 0 For Plumbing Inspection Phone 6394191
% stategoly Plumbing Contractor ;�y
TOTAL _j,, 116 RECEIPT NO. Issued By �%
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rn,,yr5,�;..„pGM>fi1•,r;;,W.ifJ'+9��w7 >. �,:.��",.,...�.�;..r�..........
CITfoo
BUILDING PERMIT APPLICATION ofrIGwRD
Sxi•'aL43
THE UNDERSIGNED HEREBY APPI.IES FOR APERM1T FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING; PLANS AND SPECIFICATIONS. OWNERPHON`
LOT NO.
OWNERRrrow."Ised Uyye JOB ADDRESS10925 JW 106th HOME ADDRESS _
ARCHITECT
ENGINEER
BUILDER LtIPIIQ ADDRESS 1 '785 5W 1.16th DESIGNER
STRUCTURE ❑AIEW ❑IgFMfJDEL ❑ADDITION ❑-�REPAIR ❑RENEWAL �QFIRE DAMAGS ❑DEMOLITION
[DMEESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GAR.AGE [--]STORAGE❑SLAB ❑FENCF
BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY I :_LAND USE ZONE. " ' —BLDG. TYPE ��`I FIRE ZONE_ PLAN CHECK BY ” t' HEAT ��Aft
I.onstruct single fe Ily cf>.aping W/ut�t�rh*U ur,l IF4. — lsmadx'uotr. — :; flstfleJ�.
SEE rnRkECTION :;hLf'T ATTALHE .40
HEIGHT dam&IS1RI AREA ----_�L4�EQfl44MS_ VALUE
BUILDING DF ARTMENT SET BACKS FRCNt 5 REAR 49
LEF T SIDE ��' RIGHT SIDE it
Permit w,19 t,.0o
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check (37,50 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 2192. Dfj ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State fax .i T,{)(a LICENSIE• SEPARAJ,� lf6REOUIREL, FOR SEWER, PLUMBING AND HEATING.
Total 01120.30 P!I' 1 ti,10 I,00
By P1 2 3 APPLICANT OR ACIF 'JT
Approved ���� Receipt No
- ,. ... ,.-.wr¢•rww..,r+.r.+... .. . u,. .. ......aYlr.. .,..se.�rr.,.r.w,+. _......r.r:w..�..+wn..... LIl1NF -___....�_____..
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE __
L _ -- - --- Contra,for - --- /
Permit''o.
r- Rough-in
Fixture
Final
HEATING
Contractor �D
Permit No. �t�() �qZ -�'�� •
S r ti Gas or Oil
Rough-in -
Final
.�__.._ ----- --- SEWER
--- Final
DRIVEWAY
Final
Stotvn Drainage
(Rain Drain)Flnal
Sideval k
Curb&Street Final
Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OC�C--IPANCY Final
CERTIHCATE OCCUPANCY !? 1 �A ,-'J -
d Landscaping
Zoning Final
I
BUILDING PF.:RMIT APPLICATION of TICITY ,ARD DATE ____ _ 6��C�y)-�Q��/�
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HER FIN INDICATED
BUII_D6R pHONE,L1.L,y:.SLL.��
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PL S AND SPECIF ICAT IONS. OW ----
NCR PHONE
LOT NO
Arrowhead Dev. 10925 SW to rAve. �,o�,EAUDREss Black Bu11 Park
`_R r JOA pDUR658 -'- ARHITEG
ENGINEER
Same 15785 SW 116th Ave es,��45. John Adams
C,UpE�— NEW C�REM_O�E� _C�AOUITIbN CDpEfAIR LjRENEWAL_ COFIRECAMA04_ []DEMOUTIOr
`� �IpENCE COMM EDI GATION.AI C�GOV'T 0p!1 ICIpUS L.JHHPATIO CAR PbRT��C ARAOE D Sry_�TORGE LJSIA �FENCE
nn APPROVED SIGNS
I�aONp��yI,,,JMOVING _ OCONDITIONAI USE C]bEtICNF1fV1EW MrOtJNCI, �S
'CUPANCY. FR ELAND USE ZONE _.BI DG TYPE — FIRE -ONE_l PLAN CHECK
- Hem- - -�.� ------�-----� ----
06
c�S�G..1.SZ9Q,_____..F.LS?.p.f� _..Z++<._.__._!CLQ.3l�.�'•I�..,''t.--.2.--A�1E�8�..I�.N9.�b�.C?8IIDm6..,.�....YALU�s3,-'S"SO-
__ BUILDING DEPARTMENT E _ _9+ � E _RIGHT SIDI
ET BACKS FRONT 25 REAR 4 LEFT SIDE 1
•0 �_�----ter_—�
Permit`
THIS PERMIT IS ISSUED SUBJECT To THE REGULATIONS CONTAINED IN THE BUILDINO CODE, ZONIN(
Plan Check RFGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREf:D THAT TH,
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONR AND IN COMPLIANCE WITI
Sub-total �,q ,Z L ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THI/ PERMIT DOES NOT WAIVI
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINES
State 78x �O LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total3 y
BY D� ^ Avoi 1CAN1 0Q AGENT
App�ovod Receipt No _--
�__ A1�D-p€-Sy- ARROWHEAD DEV CQ, INC,
—15785 S. W. 116th
TIGARD, OREGON 972.23
S'DG PH. 639-0243
P D C
Sawa*. Goo
SEWER PERMIT N! 13911
Uf
nfied Sewerage Agency
of Washington County CITY OF Tigard DATE --- '-
i
OWNER: Allen W. DreW PHONE :
OWNER'S ADDRESS:
TYPE OF INSTALLATION:
XXXAWILDING SEWER []BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
9NE':: XEX SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) ❑ MULT. RES. [] INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNITFIED SEWERAGE AGENCY. WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT' PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE $_ 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION
ISSUED BY
2 /I
OTHER
TOTAL 625.
APPLICANT D TE
NOTICE: LaO—DAYS OF
ABOVE GATE. SEWER SERVICE ��TT
CHARGE WILL BEGIN FOR THIS SEWER PERMIT V?
PERMIT.
ADDRESS OF STRUCTURE 10975 SLI 108th Ave.
r TAX MAP _ TAX LOT 5 YSTLM fr�nnu
L01 11 BLOCK OF
ku) 42-!L , " 0 -al-D
APPROVED BY ATE ISSUED BY DATE
REMARKS bldg-J1891
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CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM L'EVELOPMENT CHARGE
DATE : .2//S //a"/ ESTIMATED SALES PRICE
APPLICANT NAME
f �h TELEPHONE #
C�N .(��
JOB ADDRESS C' BLDG. PERMIT
AMOUNT OF FEE FOR P. D. C.
DESCRIPTION OF IMPROVEMENT_
EXEMPTIONS - PER ORDINANCE #77-71
FEE RATES:
A. Single family dwelling unit under $40,000.-------------$ 75.00
B. Single family dwelling unit over $40,000.-------------�_.__�
C. Mobile Home Court Space New Development) ------$ 50. 00
D. Multi-Family dwellings--per unit-----------------------$ 50. 00
CONSTRUCTION IS LOCATED ON 5.E. ��7—N.W. SIDE OF S.W. PACIFIC
HIGHWAY . N.W . is Park District #I. S.E . is Park District #II .
CITY OF TIGARD
ORDINANCE #77-26
STREET JYSTEM DEVELOPMENT CHARGE
DATE: ESTIMATED SALES PRICE �' S 70
APPLICANT NAME c' Com__,.. �� s C^4. TELEPHONE
JOB ADDRESS : .z BLDG. PERMIT �� /
AMOUNT OF FEE FOR S. 0. C.
DESCRIPTION OF IMPROVEMENT-
EXEMPTIONS -PER ORDTF,"IJCE 7/-77-26
FEE RATES:
A. Single family dwellinc unit under $60,000.--------- 5300.00
B. Sirgly futmi.ly dwellinj i!nit over '560,000.--------- $400.00
C. Mobile Homu Court Space (New Development)---------- $150.00
D. Multi-Family Cwellings--per unit------------------- $240.00
E. Commercial, Industrial & Institutional(Park. Space) $ 50.00 each
F. Single family unit under x;40,000. ----------------- $250.00
C
_jJ11_DiNG PERMIT APPLICATION c0F T1GA,,RD DATE � -�____. ,92�'. Na
+ 1tgD[ HSiGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUIL-DERPHONrreWS1'4' 'y -
` I AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWrNLV.-H
I LOT NO 1
�� ARCHITECT
JOB ADDRESS S��e�• HOME ADDRESS Wo. A / i��
ENGINEER
ADDRESS 1QQr1 _ —DESIGNER
,,RE �'�EW OREMODEL_ OADDITION -OHEPAIR —_CIRENEWAL ❑FIRE DAMAGE ODEMOLITION
X rNCE [.jCC,MM OEDUCATION_AL _0G_0_V'T ORELIGIOUSOPATIO OCARPORT OGARAGE ❑STORAGE❑SLAB [:]FENCE
71POND 0MOV_ING _ OCONDITIONAL USE YO ESIGN REVIEW -OCOUNCIL APPROVED OSIGNS
IANQUSE 20NE.'�_—•--.B—L—DG TYP _FIRE ZONE _PLAN CHECK BY_._- HEAT4C1—eC- _
(z-
L H_E1_GH7� ..___.NQ.JTDBIES._ _._�RF�/ N_S?.@�12NS29MS VALU g�'?0
:c- ;JAU-_- — FIQQFlJ.4H�_k�
- -BUILDING DEPARTMENT SET HACKS -FRONT v-igEAR �� _ LEFT SIDE RIGHT SIDEt-ImIt Lt 0-0
-- — TH!S PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check __ -'/� ,,-,� REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
�-r--Y WORK WILL FE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND INCOMPLIANCE WITH
S Ib total All APPLICABLE CODES AND ORDINANCES. THE I,SUANCE OF THIS PERMIT DOES NOT WAIVE
��--L- REJIHICTIVF COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
ate Tax rr�� LICENSE SEPARATE PE RMITS REQUIRED FOR SEWER, PLUMBING A� HEATING.
T M a I
Fly
_ i Pl i N -0-4 G N
iapproved Receipt No.
I'PHON
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