10845 SW 109TH AVENUE I
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT PLUMBING F'E RM I T
13125 SW Hell Blvd.Tigard,Oropon 97223.0199 (503)639-4171 PERMIT #. . . . . . . : F'LM94-0104
639-4171 DATE ISSUED: 07/�C-/94
PARCEL: 1S134AC-04700
SITE ADDRESS. . . . 10840 SW 109TH AVE
SUBDIVISION. . . . : HART' S LANDING ZONING: R--4. 5 FID
GL..00K. . .. . . . . . . . LOT. . . . . . . . . . . . . :018
CLASS OF WORD.. . :ADD GARBAGE DISPOSALS. . : MOBILE- HOME SPACE S.
TYPE OF USE. . . . :SF WASHING MACH. . . . . . ., : BACKFLOW F'REVIJTRS. . : 1
OCCUE'ANCY GRP. . : iR- FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH BASINS. . . . . . . :
FIXTURES--- --- -- -- -- LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . :
S INKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAP'S. . . . . . . .
LAVATORIES. . . . . : OTHER FIXTURES. . . . . .
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . .
WATER CLOSET'S. . : WATER I__INE (ft ) . . . . :
DISHWASHERS. . . . : RAIN DRAIN (ft ) . . . . :
Rein ar-F(s,. BACK FLOW DEVICE
Owner,: -------------------------------------------------- FEES
KIMBE=RLY SAUNDERS type amol.rnt by date r-ecpt
10845 SW 109TH AVE PRMT $ 15. 00 SW 07/26/94 —
OPCT $ 0. 75 SW 07/26/94 —
TIGARD OR 9'7223
Phone #: 598--7899
OWNER
k,h o n e #: $ 15. '75 TOTAL
Reg #. . : 00000
REQUIRED INSPECT IONS -----This permit is issued subject to the regulations contained in the RP/Ba0(f 1 ow F're v
?roard Municipal Cone, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 188 days.
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Permittee 13ignatur-e:
I s s i.1 a
Call for inspection — 639-4175
City otiigard PLUMBING PERMIT APPLICATION Planck/Rec. # _
13125 SW Hall Blvd. Permit # X169-t- .►��I
Tigard, OR 97223
(503) 639-4171
MINIMUM $2500 PERMIT FEE + ST. SURCHARGE
wm.W D.,W f «,t New Single Family Residences Only
A" ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00
Job ❑ 3 BAI H HOUSE$225.00
Address ckyisn,. Ib Fee it eludes all plumbing fixtures in the dwelling and the first 100 feet
of water seriice, sanitary sewer and storm sewer. See fees below.
+•^•�«^•^•w a�^^•+ FIX'URES QTY PRICE AMT
S28 7899 c*,nk 9.00
M••hg ba... p10^• Lavatory 9.00
OwnerG c -, ;�,,_ I �, t e, Tub or Tub/Shower Comb. 9.00 -^
Gyle•t• Shower Only 9.00
q r�
if - -7 z 3 Water Closet - 9.00
s•m•�« •m• +�••�••� Dishwasher 9.00
Garbage Disposal 9.00
Occupant M.a„"k- -- PtW0 Washing Machine 9.00
Floor Drain 9.00
(;•y1FW. zip Water Heater 9.00
Laundry Room Tray 9.00
N•m. Urinal 9.00
Other Fixtures (Specify) 9.00
9.00
Contractor
9.00
zip 9.00
Sewer 1st 100' 30.00
St.,.a.a.e.aon N. CKr 9-T."• Sewer-ea. Addit. 100' 75.00
Q Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 75.00
informat?uri given is correct, that I am the owner or authorized agent of -
the owner, that plans submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 30.00
1 am registered with the Construction Contractor's Board, that the Storm u Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please - - --
give reason below.) Mobile Flog o Space 25.00
f` l Back Flow Prevention
II ,!7 Device or Anti-Pollution Device 9.00
s+un•h••j...,«.0 Wnq D•'• Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new @ a4dition Q alteration 0 repair Q Catch Basin 9.00
to be done residential Q) non-residential Q Insp. of Exist. Plumbing 40.00(hr
- � Specially Requested Inspections 40.001hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices15.00 I j �?
Proposed use of
building or property _. %Except residential hackfiow
prevention devices)
NOTICE 'Minlmum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION _
AU rHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%SURCHARGE x, 5
CONSI RUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PLAN REVIFW 25% OF SUBTOTAL
TOTAL.
Special Conditions
__ Date issued ,� ,� �c �l�I by �
CERTIFICATE Or-
'CITY OF TiGARD PERMI-r #OCCUPANCY MGT)3 -04 1!,
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUEDi 12/1-4/93
13125 SIN Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
PARCEL: IS1,34AC-04700
01)DRE'i.S. . . : 10845 SW 109TH AVE
'USD I V I S I ON. . . . e HART' S LANDING ZONING:P-4. 5 PD
OLOCK. . . . . . . . . . L07. . . . . . . . . . . . . 1018
':LASS OV WORK. -NEW
! YPE OP USE. . . -Sr'
()('-'CUPr4NCY GkP. :R3
,.)('CLJV,PNCY LCIPD:226 4
1 CNAN r NAME. . . r
'emarks . PATH I
!,ENAISSANCE HOMES
67" WILLAMET,rE FALLS AVE
;Jr�17* LINN OR )7068
11hone #. 5'9713000
'EN(IIGGANCE DEVELOPMENT
li72 13W WILLAMETTE F:P(.LG OR
IlEST LlNr: OR 97068
''hone #e 51J-7- 800
,i*-U #. . : 41)955 5 r
�lccupanry of the above referenced building is hereby given, and c,ertifiev
!.he complience with the btate Of Oregon 1-31)ec.,isity 1_� s fat-, the group,
0C*c:UDkAnCv, and use und,>r, which the reference, E,e xt; c.,
t.- NO ..ECTOR
QU1I..D1NC3 T I AL
Pl_)'.�;l IN CONSPICUOUSs PLALE
INSPECTION NOTICE
- e City of Tigard Building Departaeut
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_ _
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post-/Beam Struct. San. Sewer drawing
Post%Beam Mech. Rain Drain Insulation lamb.
Plbg. Underfloor [��f Wartier Line Gyp. Bd.
Date Requested: /Z -A cC 3 Times AM _ ^ PM
Address: /(� ��!L� /0 Permit t
Builder:_ =4 S^{ //y CC'
TNR FOLLOMIMC CORRECTIOAS ARE REQUIRED:
Inspector: Date:
��1►PPROVED DISAPPROVRD APPROVRD SUBJE/T TO ADMI
---Call Por Reinap.
CITY OF T I GARD ).ani<i�11 N;� it�1 � �� :::`
COMMUNITY DEVELOPMENT DEPARTMENT DATE
13125 SW Hall Blvd.Tigard,Oragoo 97223*8199 (603)839-4171
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. . . . . . . . . . . .
BUILDING . ......
-L'Zj VWL i-L I S1,40 JN V'S: i B .4:3E On".N"1'. . . .. . . .�
uF Wukr'�', f'%,1EW BEDRMS;4 SA"FHs (SAR0GE. . . . . . . . . . .783
i LUOR REDUIRF-.1) ... . ......-
C L'f'J S 1'. b N F I R L� 935 LEFT. . : 10 f 0 Ft
lvjlsf F f�(.!I Ni 1 0 ft V;E'AH. 1/1
H I L G. . . . . . . TH 1 RD. . . Q, s f REW 1 REI.)-.----
f t I U I"A' - — .. ' — L 4..,r."I
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14 1A p f VALUL.. . . . . EWACES;- . : I
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URHIN"". . . 0 BAC-'KFL..LJW IJREVNTRG
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W Uiq.1 LS. 4 �44 T E R 7 RAPS. . . . . . . . .
8.88:1/';at-l.WL-:;Wi. , ;_kJNDRY FRAYS. Lj-'j'j-GJLJ . . .'
-'';TER LLUSE1,L. . ,S SkWI-7R L I NL (f t GRLH6L TWIPS. 0
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"R6. W,'VE, R LINE (ft ) ,. ^ I Ov 0`!°E•ER F IX ", URE*,'.`.�. . . . . c if,
W%'DAUF- DISH''. . , : 1 RAIN DRAIN (ft ) . :0
'vWjHING WICI.A. Sl:-' RAIN
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UN17 HTH".). . :4 t ypel 'z.%ITI a�.l n t by rjRt e reupt
VLNI',-5 . . . . . '1*1 F $ 0(p
N,V" 1 0 B'I"U VEN! 41 ,j Al 4. -�c 0 J L H 07 1 1)
( 100K HuuDb. . . . . . $ 40 013 JLH
) I OOK to W 0()D 73 T U10 .13.. 0 p F-j r-1 C $ e2 13 jt:4 W
FURN. 0 CLO DRYERS. t I bbl)t' $ -'80. V Jf- W7
L U T H't'-'-R U N'A'T!; I 1:4"'Wh s b160. Q) A JtL w
1305 ULITLE36- 3 F.-yJ�-j J, $ 7' I�f
1)0 68 .1'F:
e 18 j F 0 /.s0/93
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isrd Mvic-pai C-Mv, State of Oro, '.'ncrj and a'j other F-'oot/ found Insp r*lv-eplatce 1visr
101"s. Al; wo"p, will bt ^ -8th approvet uins Line Insp,
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13125 SW"au dlv4 PLNCK/RECT I � 1_1 /
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CIrfYOF 1 1G.�RD PERMIT @ j 3 //
COMMUNITY DEVELOPMENT DEPARTMENT 'gacd,Oreson97M
(503)6'9"" DATE ISSUED _
JOB ADDRESS: _1084 - , _ TAX MAP/LOT
SUB: Barts Landing_ LOT: 18 LAND USE:
VALUATION:
OWNERSPECIAL NOTES
_ r
NAME: Renaissance Development Corp. REISSUE OF: 1-4 ) "!i-U/ _
ADDRESS: 1672 Sw Willamette Falls Dr. _ LAST REISSUE:
West Linn, Or 97065 FLOOD PLAIN/
PHONE: 557-8000 __ SENSITIVE LAND: _
CONTRACTOR APPROVALS REQUIRED �ki3 rJZ-DOD
NAME: Renaissance Development : x-a._ - __ PLANNING:
ADDRESS: 1672 SW Willamette Fa11s .Di,___ ENGINEERING:
West Linn, Or. 97068 , IRE DEPT:
PHONE: 5574000 __ OTHER:
CONTR. BOARD #: 49955 EXP DATE: Uj' 'br �4 _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: Eagle Plumbing LIST/SUBCONTRACTORS: _
MECH: Tri-County_ Temp. Cnntrnl BUS TAX: _
ARCH NGINEER CALCULATIONS:
NAME: Alan Mascord TRUSS DETAILS: _
ADDRESS: L5-15 NW 23rd OTHER:
Portland,Or. 97210
PHONE: _2�,-9161
PROPOSED BLDG. USE: SFR -
uj ,
-'
COMMENTS: ��
AP CANT SIGi�.4' URE
Received By: Date Received:
PERMIT k ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10- 432 00 Building Permit Fees i
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit fees
10-230 01 State Building Tax (5q)
Bu; ding
Plumbing �r3�
Mechanical o�
10-433 00 Plans Check feed
Building c 0 f!�
Plumbing /
Mechanical /�� Y�� ✓
10--230 OG Fire
Sw/1�i3.0350 30-202. 00 Sewer Connection 0 �Zw
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 ./ ' /j/ 0
25-448-05 Mass Transit TIF Fres
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) / -fJ— --
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
o
5224, �
_ r-
nm/3587P-WPF
NG
- CITE' OF TIGARD P RMIJ. #. . .. . .. T. MGT'S.
COMMUNITY DEVELOPMENT DEPARTMENT DATE IEiE34,X'J.71: 07/30/03
13125 SW Hah Blvd,Tigard,Orogon 87223.8199 (503)839-4171 1
F�NF�Gk'I._: l a 1;34AC•-111_01 E3
'..il'FE ADDRE::GS. . . 10E345 5111, 109TH AVC'..
SUTAD I V 1.S I ON. . . . : H(1RT' r5 L,.AND T NG [ON I NG: R--4. 5 PID
BLOCK. . . . . . . , . . . LC]'.. . . . . . . . . . . . . a 01 L)
CLASS OF WORK. . :NEW GARBAGE DISPOSAL S. . : .1
TYPE UF" USE. . . . :r:` WASHING MACH. . . . . . . : 1 BACKFLOW V'RL VNTRS. . :0
OCCUP,gNCY 0-RPI. . xR3 FI..00R DRAINS. . . . . . . ..0 TRAPS. . . . . , . . . . . . , . :0
STORIE:S. . . . . . . . :r:' WATFR m.--AFE RS. . . „ . . r 1 CATCH DASTNS. . . . . . . .0
FIXTURES_....__.._----...._ __. _ .... LAUNDRY TRAYS. . . . . . ..0 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . . I GRE=ASES "f RAF'5. . . . . . . :171
LAVATORIEG. . . . . :4 O'T'HER FIXTURES. . . . . ..0
TUB/SHOWER;, . . . : SEWER LINE. (ft ) . . . . :0
WATER CCLOSF '5. . :3 W(:)T!:R I_.I NE. (ft ) . . . . : 10111
1)T SHWASHERF3. . . . : 1 RAIN DRAIN ( Ft ) . . . -0
ui.:rk�a :
PAT[! I . .,.,.
OWNER.- _._.._.. _ _... _ ... _...._.__. _. __._...__..._ ._. .._.... . FLE:S.. ._.. _...-..... ..__.. .. _...
RENAISSANCLL, POME17.1 TIi= $ 15 Vi. ill JF 07/30/93
1672 WTL_L_AME'i TE: FrAUJ V1VE APRT s 44 y. 00 JLH 07/19/93
BP'L..0 $ 40. 0171 JI_.H 07/1'3/13 3 1) 24 '
WE:S1 I_..JNN OR 970613 85P'C $ 2.21. 1.5 JIB 1117/30/93 --
P'horre #. 557--8000 ISS DI-. $ i,_E30. 00 JF' 0.7/30/93 _
I I > PARE: 1, 500. 00 JF 07/:30/93 _
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