16412 SW 109TH PLACE U o u L(Uto U vol j r
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16412 SW 109TH PLACE
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INSPECTION NOTICE
City of Tigard Building Department
P.O. 3ox 23397
Tigard, C regon 97223
Phone: 639-41775�5
Type f Inspeolion '`_, ---'L CSC>/�C •��LU`
n-t Requested �-� `f0 Time_ A.M. P.M.
Address _ fU
Owner - -- — --- Lo. # —
Builder ---
The following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector .--------- I Disapproved
Date —e7: ,17 __—
C,,iLL FOR REINSPECTION
its ❑ No
tll�
-F-_ Permit No:
Address: - --- --
t Issued by:.-. Date:
= -- - -FOR OFFICE USE ONLY- - _._-_--_--
STATEMENT:
INF'ORMA'TION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION _IESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
follc wing statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:
1. !1 -] I own, reside in, or will reside in the completed structure.
2. A. = My general contractor is
Contractor registration number
I �vill Instruct my general contractor that all subcontractors who work on
tf.e structure must be registered with the Construction Contractors Hoard.
OR
B. �_ I will be my own general contractor.
If I hire subcontractors. I will hire onlsubcontractors registered with the
Construction Cuntractors P,oard. If I cNrge my mind and do hire aeneral
contractor, i will contract with a contractor who is registered with the
Construction Contractors Board and 1 will immediately notify the office
issuing thin building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Inturmation N Aice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Signature< Permit Applicot Date
CnNSTRUCTION CONTRACTORS BOARD
02,AJ 1/90
WHITE COPY TO ISSUIN(., AGENCY PERMIT 7-ILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE. This Information Notice to Property Owners About Construction
ResPties was Ped Y eConstruction
acco dancelwith ORS 01 055(5), passedby the 1989
Oregon Board in
Legislature.
If you are acting as your own contractor to const.uct a new hon1^ or make a substantial improvement
to an existing structure, you car prevent many problems by being aware of the following responsibilities
and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing
or assisting in the construction or improvement of a reesiderWel structure, you will, in most instances,
be ruled to be an "employer" and the people you hire w;II be "employees". As the employer, you must
comply with the $ollowing:
Ore -un's Withholding Tax Law: las an employer, you r, ist withhold income taxes from employee wages
a' the time employees are paid. You will be liable for the tax payments even if you don't actually withhold
the tax from your employees. For more Information, call the C.egon Department of Ravenue at 378-3390.
Unemployment Insuiance Tax: As an employer, you are required to pay a tax for L-nemployment insurance
purposes on the wages oli employees. For more information, call the Oregon Employment Division DHR
at 5783224.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensa-
tion Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may be. subject to penalties and will be liable for all claim costs if one of
your employees is injured o,7 the job. For more information, call the Workers' Compensation Division DIF
at 37:--7434.
U.S. Internal Revenue Service: As an employer, you must withhold federal Income tax from employees'
%,.ages. ou will he liaele for thF tax payment even if you didn't actually withhold the tax. For more informa
tion, call the Internal Revenue Service at 221.3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance As the permit holder for this project, you are responsible for resolving any failure
to meet code requlrements that may be brought to your attention through inspections,
Liaolitland Property Damage Insurance: Contact your insurance agent to ;ee if you have adequate
insurance coverageor�iccldenfs eriaomisslons such as falling tools, paint overspray, water damage
from pipe punc:turPq, fire, or work that must be re-done
Time to Pupervise Emolc,yees: Make sure you have �,ijffi.:ent time to supervise yuui employees.
t�x�;► Ise: Make sure you have the expertise t,) act as your .wn genei.a contactor, to coordinate
the work of rough-in and finish trades, and to Notify building officials at the appropriate times so
they can perform the rey6!,—cd inspactloos.
If you have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310.0151
Phone 503.374-4621
0244J 10,;:4199
CITYOF TINA
C rnrY COXFRD
COMMUNITY DEVELOPMENT DEPARTM04T 0920014 P E R PI I 1 -0 J.13126 SIN HWI Blvd. P.O.Box 33397.Tigwd,Oregon 972x1(503)6,1^4175 01: T R III]'' 14. — - - .. :: ILly"M
'T' tt.. Z r t.i, TVY-
6,3'-.14 17 1. 09/24/9 PJ
316-1412 EM 109TH PIL
' 1'T E ()D 1)R E. Z(.11-4 1 Iq G-
:;UBD1:v19T0N. . . 1. .
Y.41..00K. , - — - - -'. LOT.. . . . . . . . . . . . :24
..........................-.-'---'---...............................
GLASS OF WORK. . -.ADD GARBOGE DISPOSMI-S. - [-JOITIE SPAGES.
T*Y 1. W(-)SHING II(PIGH. .
, -I F 0 F IJ 16 S r'
(:IF,C;L)1.1(-)N I',Y GRP'.. . R3 FLOOR DRAING- . . . . . 'TRAPS. .. . . . . . . . . . . . . .
:ii'T 0 R 3'.ES;. W0,144"R HE0 ,11'.RG).
1::'.T.X*T IJ R E S......................... LAUNDRY TROYS. . . . . . .. SF R(-Illq DRA'[NG.
NK!"'. UR I NAL G R F(I S E 'I R PI P 13. . .
L.PVP '(')RI'ES. O'TH U R F1 X-T U R E S. .
;IAoWEF:S. SEWER L.INL: (ft;) -
W�TE L'L 0 6 F1,S WAI*ER LINL
T).i ",111,10SHERG. . . . .. RAIN 1)R 3'.N (i't)
I I:e 11)iA v t:4-
(.Tw vi e-r _............_.»_._._ F E.E.Si
RANI)OI L NT.N(3111YO type A III C)Lk 11 t -r e c,r-.t
GW 10 9'T I I P L Pnyll 15. ?5 J:.1.4 09/22/90
P R N'T 1.5. 00
'T3'(])()RD OR 97024 5 P(11 1' 0. 15
11 C))'I c--? t#a 6c'4-F.19` 9
.. . ... ...... ...--
0WNF:'J;:/(,'ONJ'RAC',TOR
$ 15. 75 TOTAL
Reg OWNER REOUIRED I N S I--'E C,'1`1 0 N-
This permit is issued subject tc: the regulations contained in the JVISP ».-_.•---•••
Tigard Mvicipal Code, State of Ore. Specialty Codes and all other Ins'le(-,tiol-I .........
applicable laws. All work will be done in accordance with ---..............................
approved plans. This permit will expire if vori, is not started ....... ...... ......... ...
within 189 days of issuance, Or if work is suspended for more
than Iff dayF„
.................
..........
Pernil.ttev ------ .............. -.............
T51 r,k I e cl F3 y ..»..»»......._...»..............__......__._ ............
L;all fa-r inspec"Lia" 6,J9--41'75
i
i
I
CITY (IF T'IC)Allr) — R1:.1-C-11''T Of! PAYMENT RECEIPT ILIO. :90——2()5090
CHECk: AMOUNT 15.75 f
N,-;ME : NINUMIYA, RANDALL C:A.i11 AMO(INI n C►,�.►�.;
l ADDRESS 1641.2 SW .109TH F'I_ PAYMENT DATE t 09/24/90
0
SURD I VI,IL7N n
T IGARD,OR 97 211
I ►_„1F1=LIE OF F'AY71E:N1” ��MULtNT I'F;11) f'tIF,["'USE CIF- PAYMENT AMOUNT PAID
F''l_LIMEr1NG F'F1tM F'L.M90-_r;117C► 1�.r:►r:► <,.'� . FH..Ii!..1J r'C"Ft r-r•"%�
1
i
l
1,,,VIDTAL AMOUNT V'AIC> 1'
CITY OF TIGARD
PLUM 131 NG PERMIT 13125 SW WALL BLVD.
P. O. BOX 23397
Aj4AicanK must mold Oregon Registration to Co4rdJUCI a plumbing; TIGAI'.D, OR 97223
Iwtitxst,w must be proper'yowner/operator not hiringoulside help.
N ofDevelopme (503,1639-4175
--- � /y --� --` Plumbing Permit No.
_ J7 puycriptian
ORS 814-21-010 OUAN. PRICE MAT.
Job Tax Lot Map.No.
Arlrirnma __ FIXTURES
1,04 Ukxtk Sutdiviakxt - -
S,.., 7.SU
caw or name sates lavatory 7.50
/7 Tub or TubNyjwe.r 04W). 7.50
Mailing Address Slower Only 7.50
(?canerClty/Stale J Tip
- -- Water closet 7.50
Dishwasher. 7.50
r Phone Garbage Disposal - -- -7.50
--- Name Wash 1 Macfune ,X7.50
Flnor lxa m 7.50
to '—Address Frhor e - W.:+r Heatr 7.50 _
Occupant _.—. Laundry Room Tray - 7.50
p city/State --
Urinal 7.50
NaMe Mane, Ott w- Futures(Specify) 7.50
1 r /� DSe ase 'f� 7.50_
r 7.50
C,om riK.1or CI W/Stato Zip 7.50
MISCELLANEOUS_
City Stm Tax No Sir 1 sl 100• 30.00
State Board No. tate s. o. Semw-ea.Addit.100' 15.00
M( dential) Water Service 1 St 100' 20.00 -
1 hereby aclvowledge tat hI have reed Owl a VWAtkx%that the intonnalion Water Service ea Addit.MDr 15.00
given is correct dut 1 am mosiered` M the State Bu4dses Board.and also Storm 6 Rain Drain 1 st 100• 3e 00 -
he"a State Pkxnbh0 license OW tho numbers grmn are correct titat ati --
pkxnbirq work will be done in tuxxx der roe with app:icabld provisions CA Ore- Storm 6 P.-in Drain Addd.100' 15.00
gon Revised Statutes ciutptera 447 and 633 arvi applicable codes mrd ttvt Mobile Horne Space 25.00
no help wl"be employed wools kw sed-LimUo ORS Wo1(It eKempt from -
State regisLratlon,please give reason below). Back Flow Prevention
HOMEOWNERS-I tweby oerwy dw a am the owner of the property oo Device or Anti-Pollution Device 750
scribed at; e.at whktr location 1 propose to make a slumbin0 inetaYmtlon for Arty Tran or Waa%Not
rtty own use and 044 property b not bekq crrabvc+ed for$ale.tease of rent C wwwofed to a Hxu" 7.50
Caklt[task+ 7.50
kW.of U--xW.PkxftbhV 40.00 Per He
---- _ •4. i alty Regseeted inspections 40.00 Per Hr.
_ Itain Drain,
Single Pam. Dw1q. 15'00
AUTNORIZEn SIC NATURE Dme ----
DemcTibe wrxk new❑ aditus Q altwetxw--LJ m)-alt(_
tp be dorm- residential n_ rton-tr•rlde loaf ]-
Exts"uve0 MINIMUM PERMIT FEE 25.00
btNdklprxproperty------ _ .._._ SUB-TOTAL
l�p?� of 5% SURCHARGE
lh2r+0 or WDSettY -- ---- —-- J 2 51 Pt.AN RI V I EW-
Ura pamM tmon»a ntAl and void 0 rrorlt a ooneen.eion autforttad Is not coo TOTAL
416im d wklrkt 1 tf0 Jaya er ft orxsdnx�k rn rr oak M suapanfad a abarxi.a+ef for
a partod to Ian do"at ony tin"~'rnw•,'•r rxxrrnanoecl
Data IAsued _,-_ by -----
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. X P.M.
Address Permit
Owner Lot
The following Building Code deficiencies are required to be correct*1:
J
Presented to 44.Approved
Inspector Disapproved
Date
(ALL FOR REINSPECTION
FI N Es I-A NO
ItUALWWWAWAKMARWKWAW EFW
CERTIFICATE OF'
CITYOFTIFARD OC�UPANCY
CITYOFTWARD PERMIT M. . . . . . . i BUPS92506
COMMUNITY DEVELOPMENT DFVAp "' PRIM. PERMIT M. s 892506
13125 SW HallBlvd. P.O.Boz29.'!97,TiVsrd,Oregon97 (503► �i 5 DATE ISSUED: 0!6/29/90
SIVE ADDRESS. . . s 16412 SW 109TH PL PARCEL c 2S115AA-06100
SUBDIVISION. . . . s ZONINGS
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . or4
CLASS OF WORK. cNE:W
TYPE OF USE. . . c5F
OCCUPANCY GRP. sR:1
OCCUPANCY LOAD n
TENANT NAME. . .
F'emarF+.s a
JUDY RUDISHAUSER
47,35 SW TROY
PORTLAND OR 00000- 0000
Phone IFI 000-000 -0000
Contractors ---.__-,..-___--_._-..___----...__.-_
JUDY RUDISHAUSER
ACCENT CUSTOM HOMES
4 735 SW TROY
DORTLAND OR 97219-0000
'-�,onP Ms 583--244-35:19
Rep p- - s 61564
Occupaocy of the r.bovv referenced bulldinp is hereby pi -en, and certifies
the compliance with the ':Mate Of Oregon Specialty Codes for the group,
oc,cupancy,o and use under which the -referenced permit was issued.
FIRE. DEF'ARTMCNT 13-1_ aNC3 IN8F' k
BUILDING, FFICIA
POST IN CONSPICUOUS PLACE
I
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Dox 23397
Tigard, Oregon 97223
Pnone: 639-4175
Type of Insrection
Date requested -, - �D 1—'Time )e– A.M. ��P.,, L
Permit
Owner — _ Lot
Builder ` lip— –
'The following Building Code deficiencies are required to he corrected:
----r - -
.
^
Presented to _. Approved
Inspector [� Disapproved
Date --
CALL FOR R RL.WSPFCTION
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type if Inspection _Lye' 0e2 -
Date Requested / Time X A.M. P.M.
Address -._ _-/�o -e'/�- �LJ 1 '�`'' Permit # Sd
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
di-224
Presented to -. / Approved
Inspector
.� - -- - -- - --� �_ � Disapproved
Date at
CALL FOR REINSPECTION
C 7 YES 1-1 ,10
INSPECTION NOTICE
City of Tigard Building Department
p.0. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
639-4175
Type of Inspe-.,'^:r —
Date Requested :Iv ' op Time A.M. P.M.
Address �G �z / 0 9 / -T_ Permit
Owner __- _ Lot #
Bu'Ider
Tne followinq Building Code deficiencies are required to be corrccted:
Presented to _ Approved
Inspector /� w.,. ❑ Disapproved
Data
CALL FOR REINSPECTION
O YES C] NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, OregoM-97-22.3
Phone: 6394175
Type of Inspection � ---
Date Request9d Time_ A.M. P.M.
Address/� � 1 Permit # -�S
Owner _ Lot
Builder��^�� --���•- `�
The following Building Code deficiencies are required to be corrected:
-- - I
Presented to Approved
In:pector ____---__._.__-- -------_— Disapproved
Date _ ------ —__-- ----.__--
CALL, FOR REINSPECTION
Cl YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
' Phone: 639-4175 1
Type of Inspection \ \
Date Requested _ _ . Time //nn
��'A.M. P.M. .
Address . l- �� �� '- Permit # v
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
�` :'�(Nl d�lc= W ATS!L- �"ic.li�„ 'F o ►'2.v-•-�� -
-PV-j oCL - -V r4 Ot=
ISL K-vETz.L A L. a�
I.Ni—14.L L k'0 c._. -1;-40 i Nxr--IS �l
Presented •uApproved
Inspector [] Disepprovet'
Date �•��y� _
CALL FOR REINSPECTION
❑ YFv ❑ NO
i
A
I
. l
� I
CITY OF T I GARD — RECEIPT OF PAYMENT REC NOt 0010'7C109
NAME: ACCENT CUSTOM HOMF';CASH AMOUNT .00 CHECK: AMOUNT 7,20:1.88
:
ADDRESS: 4775 SW TROY PAYMENT DATEs 01-2-2-90i
PORTLAND, OR 97214 BLOCK" NOrADDR:
I z641y 5W 109TH PL
PURPOSE OF PAYMENT AMOUNT 1"AID PURPOSE OF PAYMENT AMOLffVT PAID
BUILDING PERMIT FcBY`506)--� —�—_-415.00 PLUMHING�P PMIT j592510>__
MECHANICAL PERM (8925tl) 45.00 STATE BUILD PI.PNIT 'TAX (iii TO, L
FLAN CHECM: FEE 1a1-00 SEWER USA t OK512
1.250.00
SEWER INSPECION
75.00 STREET SOC SCICT.00
F'ARti5 SYSTEM f.EVELOPMENT CH 250-UO STORM DKAIN 1) '750.00
PFF•lIT W LL. EF. MAILED T'0 CONTRACTOR
F'cat I NSF'1-C t IOj,jF C,Al.,L
TOTAL AMOUNT PAT[)
BUILDING PERMIT
CITYOFTIFARD ..::. . .. �. . r. .
CITYOFTWARD f 1...R11I T 0. . . . . . . .. BUP8 92506
COMMUNITY DEVELOPMENT DEPARTMENT MIGOa FRIM. PERMIT ##. : 892506
13125 SW Hall Blvd. P.O.Box 23397,Tigard,Orepor .1223(s",► -4VI i � `, � DATE ISSUED: 01/22/7,',0
SITE ADDRESS. . . : 16412 SW 1091H PL. PARCEL: 2S] 15AA--08700
SUBDIVISION. . . . .. ZONING:
r REISSUE:BUP FLOOR EXTERIOR WALL CONSTRUCTION--
CL(4SS OF WORK. .-NEW F iRST. . . . : 13.35 s f N: S: E W
TYPE OF USE. . . :SF' SECOND. . . : 910 s f PROTECT
TYPE OF CONST. :SN THIRD.. . . . ". sf N: S: E: W:
OCCUPANCY GRP. :R3 1C)1'AL-.___.-...___. ti-f ROOF CONST:C FIRE RET?:
OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOR. : 2 HT. : 20 ft GARAGE.. . , a 420 sf OCCU SEF. RATED:
BSM1'?: MT-.::LZ?: RECD SETBACKS--------------
FLOOR
ETBACKS»---._---..----FLOOR LOAD. . . . : 40 psf LEFT:27 ft RGHT : '7 ft FIR SPKLs SMOK DET. . :Y
DWELLING UNITS: 1. FRNT:20 ft REAR".22 ft FIR AI-RM: HNDICP AC(:::
HEDRMS: 3 BATHS: 3 IMF, SURFACE: FIRO CORRs PARKING:
VALUE. $: 3:3630
Remarks:
Ow r1 e r: _ __....._. __....._.._._.._._.._._.._. ._._._ _._.... ..._...._.__.___._.. _.._._.__._._._._.__._..__._...__ FEES
JUDY RUDISH(dl.lGER type amount by date rc4r_pt
47;35 SW TROY 1-IRM'T' $ 415. 00 MAN
PLCK $ 269. 75 MAN
1='ORTLAND OR 00000 0000 " PCT $ 20. '75 MAN
Phurle N: 000-•000-••0000 F'AYM $ 110. 00 [ION
SSDC $ 250. 00 MAN
Cantractar s ..----..__._.__._-_..._._._......._..... _.._..._._.._........._._.._......__ STD[, $ 600.00 MAN
JUDY RUDISHAUSER PDCF $ 250. 00 MAN
ACCENT CUSTOM HOMES 1-'AYM $ 1705.50 JLH 04/20/90
47:35 SW TROY
PORTLAND OR 9'7219---00Cd0 _.....
Phare N: 50:3-244•-35,49 E 1805. 50 TOTAL
Req ##. . : 61564
- — RE0UIRE1) INSPECTIONS ___.._....._.... .
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other ...... -__._..___.._._.._..__..._ __.__.....__....__...._. ___...____._...._
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within IBB days of Issuance, or if work is suspended for sore
than 190 days.
Vlermi.ttee Si.grlature+:
Issued B y s
Call fur inspection 639-4175
PLUMBING [' EMIT
CITY®FTIGrARD
CITYOFTWA71PERMIT P1 11892510
COMMUNITY DEVELOPMENT DEPARTMENT ORIGM PRIM. PERMIT #. .- 892506
13126 SW Hadl SNd. P.O.Box 23397,TOM,OrW 91?,q
DATE ISSUED: 01/2E/90
SITE ADDRESS. . . : 16412 SW 109TH PIL PARCEL: 2S115AA--06700
SUBDIVISION. . . . : Z0111116:
BLOCK. . . . . . . . . . i LOT. . . . . . . . . . . . . :24
CLASS OF' WORK. . :NEW GARBAGE DISPOSALS. . ." I NUBILE HOME SPACES. :
TYPE OF USE'., . . .. ::;:;J:: WASHING MACH. . . . . . . : I BACKFLOW PREVNT*RS. . r
OCCUPANCY GRP. - -R 3 F'LOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . :
STORIES. . . . . . . . .. 2 WATER HEATERS. . . . . . . I CATCH BASINS. . . . . . . .
FIXTURE S LAUNDRY TRAYS. . . . . .. . I SF' RAIN DRAINS. . . .. . .
SINKS. . . . . . . .. „ . I URINALS. . . . . . . . .. . . . . GREASE TRAFIS. . . . . . .. .
LAVATORIES. . .. .. .. 4 OTHER FIXTURES.....:
TUB/SHOWERS— SEWER LINE
WATER CLOSETS.. .. .-, 3 WATER LINE
DISHWASHERS....: I RAIN DRAIN
kenia-rks:
Ownert. FEES
JUDY RUDISHAUSER type amount by date re C,pt,
4*135 SW TROY PRMT $ 147. 50 MAN
SPOT $ 7. 38 MAN
r-',ORTLAND OR 00000-.0000 1---,A Y M $ 154. 88 J I H 04/PO/90
Phone #c 000-000-0000
Cciiit-ra(ctcir:
ROBERT FOWER
1592 SF*.* 51ST
HILLSBORO OR 97123
Phone It: 503 640 5770 $ 154.88 'TOTAL
Reg 19907 REQUIRE-D INSPECT IONS
This permit is issued subject to the regulations contained in the ......... --.—...... ......
Tigard Municipal Code, State of Ore. Specialty Codes and all other .......
applicable lams. All work will be done in accordance with ..........
approved plans. this permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
........-------
Pe-f,nii.ttee
............ ........................ ......................
Call ft:)-r ivisppetinri 639-4175
MECHANICAL
C11YOFTIFARD 4� PERMIT
CA�'iL
COMMUNiTY DEVELOPMENT DEPARTMENT CnYOFTWARD� PERMIT t . . . . . . . .. MEC892513.
0""Mm
13126 SW HWI Blvd. P.O.BM 23397,Tigad,Or"m 97 03L83G.ai76 PRIM. PERMIT 8
92506
DATE ISSUED: 01/22/90
SITE ADDRESS. . . : 16,41 '2 SW 1.09T[i 1.',l PARCEL: 2S1.15AA--
SUBDIVISION. . . .
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :24
ZONING:
CLASS OF WORK. . :NEW FLOOR FURN. . . . 1:--.VAP COOLERS:
'TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . 9 4
OCCUPANCY GRP. . :R3 VENTS W/O APPI....- VENT SYSTEMS:
sToRIES. . . . . . . . .. 2 BOILERS/CL'MPREGSORS HOODS. . . . . . . : I
1::'U E L TYPE'S---- ..___..._.______ 0--3 HP. . DOMES. INCIN:
.-GAS 3-15 HP. . . . : COMML. INCINP
MAX INPUT BTU 1.5-30 HP— . - REPAIR ONITS:
FIRE: DAMPLRS?. 30 50 HP. . . • : WOODSTOVES— i
GAS PRESC'- 504- HP. . .. . . CLO DRYERS. . :
NO. OF UNC C41R HANDLING L)NI ['S OTHER UNITS. : p-
TURN ( 100K BTU., <= 10000 Cfn): GAS OUTLETS. : I
1::'URN )=:100K BTU: 1 > 10000 efilir
"e" CM-Ity"ACtOT I'M111be-r
Uwvie-r: FEES
JUDY RUDISHnUSER type anIOU11t by d-ate rerpt
4735 SW TROY PRMT $ 10- 00 MAN
PORTLAND OR 00000-00P)o
PICK $ 11. 25 MAN
5PCI $ 2. 25 MAN
Ptic)rle 0.- 000 000-0000 PRMT 1 35. 00 MAN
C01-It-raeto.r.- PAYM 4 :i8.. 50 JL-H 04/20/19(4
SKY HEATING & AIR CONDITION
16625 SE SUNRIDGE LN
r"LWA(LJKIE OR 97267
Phc)rie it: 50,32359083 $ 58. 50 TOTAL
Reg #. . c 50244
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with ..........
approve d plans. This permit will expire if work is not startod
within 188 days of issuance, or if work is suspended for sort!
than 180 days. .......
..............
ISSUed By:
Call fc)-v j-vispectic)ii 639-4175
® SEWER CONNEC'T'ION
CITYOFTIFAD7Cff Y , _ PERMIT . �:
OF11SAID F�ERM1 T 0. . . . . . . . SWR8 92512
COMMUNITY DEVELOPMENT DEPARTMENT + PREM. PURMIT a. . 892506
13126 SW Hall Blvd. P.O.Baa 23397,Tigard,Oregon 97223 A�Wj 8r4)76 DATE: ISSUED: 01/22/90
SITE. ADDRESS. . . : 16412 SW :-0911.1 P1. PARCEL: 2S115AA--06/00
SUI+DIVISICIN. . . . : ZONING:
BLOCK. . . .. . . . . . . =
TENANT NAME. . . . . :
USA NO. . . . . . . . . . ..3': 178 FIXTURE UNITS. . . :
CLASS OF WORK. . . :NEW DWELLING UNITS. . :
TYPE OF USE. . . . . ;SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . aBUSWR IMPERV SURFACE. . .- :5t
Remarkts c i-ieecl c-,crrlt•f,ac.,tc)•r rit.tmber
F'E:E::; __.._.__. _...._ ..._..
JUDY RUDISHAUSER type amcit.tni lay d •recpl
47;3* SW TROY PRMT $ 35. 00 MAN
P,F*0MT $ 1.25P. 00 MAN
PCRTL.AND OR 00000.._0000 PAYI". $ 1285. 00 JLH 04/20%90
Phone Hit 000 000-•0000
JUDY RUDISHAUSER
ACCENT CUSTOM HOME-i.13)
4'735 SW TROY
PORTLAND OR 97P19-0000
V'hnne N» 50;3•-.244--35;:39 $ 1.285. 00 TOTAL
Reg it. . : 61.564
_...._.___.._..._ REQUIRED INSPECT IONS -This Applicant agrees to comply with all the rules and regulations
of the Unified Sewage agency. The permit expires 128 days from ...........
___..._..._. _...
the date issued. The Intal amount paid will be forfeited if the _......................... .._........
peimit expires. The Aqency does Tint guarantee the accuracy 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. _ ,.-. ._...._ _•_.._•_
_...__..__._..._.........._._..__
PP-rnlittee Si.mrtatt.t-(,e:
1!all(i'd 11y:
Call fa-r ir1spec.,11.ic:)r1 G39__417":
CITYOFTIIFARD
CrrraFTRD PLAN CHECK APPLICATION
*atoCOMMUNITY DEVELOPMENT DEPARTMENT PLAN CI4ECK p //- 02 9�
13125 S.W.KWI Blvd_P.O.Box 23397.Tigrd,Omgon 97223,j5W)69.4173 PERMIT p
L DATE ISSUED
JOB ADDRESS: � ��j� � TAX MAP/LOT a ,s /-1 S* �4�
SUB: ���.Pi'(,,"TA -'-f"/A , LOT: LAND USE: --
VALUAI'ION: /•3030 _
OWNER SPECIAL NOTES_
NAME: _ REI.SUE OF : _
ADDRESS: LAST REISSUE_
6ti FLOOD PLAIN/
SENSITIVE LAND: _
PHONE:
APPROVALS REQUIRED
CONTRACTOR PLANNING: _
NAME: 'r7JT .✓l SpM,A,9 ENGINEERING: _ I
ADDRESS: TLL1)'-r EL __ I `� l�lif (`,�__I.'__ FIRE DEPT
-----�-T-7 3 r., �( L. �, / >✓' _� OTHER:
TlU C T UM_ c 1 `-7
PHONE: `�jZI- 7," •),-1 ITEMS REQUIRED
BUILDERS BOARD N: EXP DATE: j - ) LIST/SUBCONTRACTORS:r�
BUS TAX:
ARCH/ENGINEER CALCUI_ATIONS:�
NAME. he - I! TRUSS DETAILS: _
ADDRESS: 111 1 5l.. �; '_ �'i OTHER:
-LAC k A/l,L4s
PHONE:
COMM17NTS:
UBCONTRAC70kS: PLUMB: 4 IS MECH: Y d L kA I
l 1�1 1 '5().'
PERMIT N ACCT p DESCRIPTION AMOUNT AMOUNT PD. BAT_. DUE
10-432 00 Building Permit Fees !y/�
10-431 00 Plumbing Permit Fees �. ,�U __
10 131 01 Mechanical Permit Fees L ',au
10-230 01 StatL, Building Tax (5X)
Building
Plumbing
Mech __ r ✓
10-433 00 Plans Check Fee
Building
Plumbing
Mech
30-202 00 Sewer Connection
30--444 00 Sewer Inspection 1 !�
51-448 00 Street System Dev Charge (SDC)
52-449 00 Parks System Dev Charge (PDC) 1 u _ u
31-450 00 Storm Drainage Syst Dev Chrg (SSDC) .- 7 4'
10-230 06 F i ro
TOTAL =(717. __ /I,)L)
REC N -.�y/,/,f j
APPLICANT SIGNATURI
APPLICANT
By: _ Date Received: Z/ 1-
cn/3587P/18P —"