10980 SW 108TH AVENUE I
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ADDRf:SS_ l ��� d 1. �.h6 PERMIT N0._
PERMIT CHARGE none
OWNER _ CONNECTION FEE 6 06
Plio BY
TYPE OF BUILDING -- FATE CONNECTED
SERVILE RATE �8�C2 INSPECTION FEE CPS,
CONTRACTOR r PAID BY DATE
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51ZE OF CONNECJION "SSESSMENT PAID
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3-8-76 : , .„7
BUILDING PERMIT APPLICATION 11T TIGARD DATE-- 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE
OR AS SHOWN AND APPROVED IN THE: ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE_._
LOT NO. _.___
`Trus a Pergey Ir.980 St.! 1 ! 9th
OWNER JOB ADDRESS HOME ADDREFiS _
ARCHITECT
ENGINEER
BUILDER _ ADDRESS DESIGNER
STRUCTURE []NEW ❑REMODEL ❑ADDITION ❑RE.PAIR ❑RENEWAL [.],`IRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑REL.IGIOUS❑PATIO []CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING []CONDITIONAL USE _ ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE BLDG. V _ FINE ZONE_ PLAN CHECK BY— HEATL _1t. rjin,�le -'rumily dwelling w/ittached garage 3 bedrt am batt; I:uraija
sewer permit a;l:.;800 auw ar coon. sower inap. $25.
OSS LOA1Z FlS�OP 1S?AD 40 —� HE1StHT ill _NQ..ETQBJJ.$__-_, AREA_ N_Q, BEDROOMS J VALUE�aQa"3Ui s
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR LEFT SIDE 9 LIGHT SIDE t
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULAT 01IS CONTAINED IN THE BUILDING CODE, ZONING
Plan Ch.:ck REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
M,51J WORK WILL BE DONE IN ACCORDANCE WITH THE P,ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb-total ALL APPLICABLE CODES AND ORDINANCES THE ISSUIkNCE OF THIS PERMIT DOES NOT WAIVE
A 10 RESTRICTIVE COVENANTS. CONTRACTC•R AND SUB CONTFACTORS TO HAVE CURRENT CITY BUSINFSS
State Tax LICIEMIE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBIN. AND HEATING.
Total 2 5. 1.11.i.. 1 t1JU*
By
ANI OR AGENT
Approved— t fiecelpt No• I
�— ADDR .SS — — r;ONt
I
W m M a ! W
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough in -
���'� PP2 OV�J—_ Fixture _ --- —
V U ✓✓ Final
HEATING
Contractor _
Permit No.
Gas or Oil
Final ------ —
1=1L_�pp -- — SEWERS-/S,W
Final -- -
DRIVEWAY
Final
i
Storm Draina e
(Rain Drain) Final
Sidewalk
Curb&Street Final
App
N BLDG DEPT FINAL TEMPORARY CERTIFICATE OCCUPANCY Final _
CERTIFICATE OCCUPANCY
r Landscaping {�
CJZoning Final
1-7 4 ctJ
U
SEWER PERMIT BTU 15800
Unified Sseserage Agency Tigard a n d 3-9-79
of Washington Count; CITY O F � DATE
OWNER: Bruce Bergey
PHONE :
OWNER 'S ADDRESSt
TYPE OF INSTALLATIONt
XQ BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCYt
x'0 NEW f1INGLE FAMILY ❑ COMMERCIAL
[] EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
ADDRESS OF SIRUCTUREt
PERMIT CONDITIONSt THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND ,
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION ,
PLEASE REFFZ TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AN' TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATIO' OCCUR.
FEESt
PERMIT FEE $ 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION
OTHER
ISSUED BY
TOTAL s 625.
APPLICA D TE
t.,�LQLDAYS OF THE
SEtiJFa SU'. c
CII;iflCE bVlll WiN F09 THIS SEWER PERMIT N? 15800
132p T
ADDRESS OF STRUCTURE 10960 5W 100th
CAX MAP TAX LOTSYSTEM fanno crook
LOT i n BLOCK OF
APPROVED BY DATE ISSUED BY D 'TE '
D. U. 'S 1 REMARKS bldg. j1937
4
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CITY OF TIGARD
OPDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE : E511MATED SALES PRICE
n
APPLICANT NAME TELEPHONE #
JOB ADDRESS ,'�� l0 a /�'l��t BLDG. PERMIT
AMOUNT OF FEE FOR P. D. C.
DESCRIPTION OF IMPROVEMENT
i
EXEMPTIONS - PER ORDINANCE #77-71 t
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FEE RATES:
A. Single family dwelling unit under $40,000---------------$ 75.00
B. Single family dwelling unit over $40,000.----------
C. Mobile Home Court Space (New Development)--------------$ 1;0. 00
D. Multi-Family dwellings--per unit-----------------------$ 60.00
CONSTRUCTION IS LOCATED ON S.E. ��!�-N.W. SIDE OF S.W. PACIFIC
HIGHWAY. N.W . is Park Dtstric`t #I. S.E . is Park District #I I.
r
Mill
CITY OF TIGARD
ORDINANCE 7177-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE: V7, ESTIMATED SALES PRIi.E
APPLICANT NAME ��_�ec, TELEPHONE _
JOB ADDRESS J_ (; `f X�? � � /�� BLDG. PERMIT #
AMOUNT OF FEE FOR S. D. C. hod
DESCRIPTION OF IMPROVEMENT
EXEMPTI9NS -PER ORDINANCE #77-26
FEE RATES:
A. Single family dwelling unit under 560,000---------- 3300.0
B. Single family dwelling unit over 560,000---------- $400:00
C. Mobile Home Court Space (New Development)---------- $150.00
D. Multi-Family Owe:lings--per unit------------------- $240.00
E. Commercial , Industrial & Institutional(Park. Space) 5 50.00 each
F. Single family unit under $40, 000. ----------------- 5250.00
"'UILDiNG PERMIT APPLICA-� ION cOF TIG".ISD DATE—_-.,,2__:Q —. _. 19 Np
HF LINDE RSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE,____-
CIR AS SHOWN AND APPROVED IN THE A%.COMPANYING PLANS AND SPECIF ICAl IONS. OWNER PHONE__._..__-....___
J - � -0 t Q �O/ MLOT NO_�- ..
-- _ -
OB ADDRESS rW I -
ARCHITECT - -
ENGINEER
ADDRESS - _ DESIGNER
C?URE EW �- - —__ ❑FIRE DAMAGE ❑DEMOLITION
__ 1 . __�ORFMODEL ❑ADDITION QHLPAIR ❑RENEWAL �r-�—
01'NICE ❑cnmm ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSQPATIO-OCARPORT GARAGE ❑STORAGEL.JSLAB ❑FENCE
�FC`NF) ❑MOVING ❑CONDITIONAL USE ❑DLSIGN REVIEW OCOUNCIL APPROVED []SIGNS
FANCY rL. L AND USE ZONE- _�� BLDG.TYPE_ /-f IRE ZONE_ PLAn'CHECK BY HEAT—_
-- _ -
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N.g-SIRIE;�_J.—.__A, 5� .'�SLBEpis?9M5 ve.L g 4v's'dv_
BUILDING DEPARTMENT *'
SETBACKS_ FRONT � REAR � LEFT SIDE � RIGHT SIDE
�1 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
MS
Ian Check N S' U REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
WORK WILL BE DONE IN ACCORDANLE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH I
Subtotal ry ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE V*: THIS PERMIT DOES NOT WAIVE,
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRAC70k. 10 HAVE CURRENT CITY BUSINESS
!,tail' Tax �� �� LICENSE SEPARATE PF RMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Tptal
BY
--- --- --- - APPI 'CAN1 QA LGi NI
Approved (fr: � -Receipt No
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City elf I lla d Mechanical Per;n)t \T(1 Pe:mit_�_�3;00 _
Fee
_--__ �
New Installation Realace l� Relocation [� Addition ❑ Al;i ration ❑ T State
' TOTAL
CC'N 6 -- ��CLt � 011'NER
?; __ /� -�•
ADnRESS s/ - 4r__ WORK ADDRESS V G s I
PHONE N E
�P-�W �' APPLICANT
� •—•LLlrl
Heat Input Rating (BTU Per Hour) _1 Vent Size �� Flue.Size
* FUEL OIL ❑ GAS F_J'r ELECT ❑ OTHER.__--,__...________.
4 ,. ITEM NO. FEE ITEM NO. FE
- . For Issuance of Permit 3.00 Air Condition Compressor 15 to 30 HP 10.
New- Under 100, 4.00 Air Handling 10,000 CFM000BTU
New- 100,000 BTU & over 5.00 Air Handling Over 10,600 CFM __ 5
4.00 Evaporative( -)oler Floor Furnace
h, Wall . Floor - Suspended 4.00 Range Vent-F ane 2•
Install Vents Only 2.00 Ve-)t System 3
�` Repair Heat & Coating _ _ _ 4.00 Hood Commercial
10
Air Condition Compressor Under 3 HP 4.0_0 Commercial Duct System
Condition Compressor 3 to 15 HP 7.50
.f
-Air Co
INSPECTOR'S COMMENTS______-- - - ----
r CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUBCONTRACTORS
B
APPROVED BY DATE ISSUED BY HATE
w+'i RECEIPT NO.