11997 SW 113TH PLACE ADDRESS:
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CITY aF TICARD CF f,' I [i r.l,.��rr iiF.
COMMUNITY DEVELOPMENT DEPARTMENT PERM 17 M:)I Oc, ','t
13125 SW Hall Blvd.Tlgard,Oregon 9722398199 (503)639.4171
DIP I T F.- I u 11':Ajf_;,D 0,4 06i'+
3 1 1 L A D DR I 1 7 S)W .1-1.3 T I-I PL PARCE-1 2SJ.03AS 1040-
SUBDII)TSION. 11LAU-)WIC-33LADE ZONING:
B;_0 C:I.. . . . . . . . . . I.-Li T. . . . . . .
o-noss or' WORF. 4 NEW
TYPL OF LJSL. . . i 6V
OCCUPANCY OPP. tR3
Of"A",L)PANCY LCIAD:e25 4
I'--1ANT NAMF
Remarks a POTH f
U..OYD C OLSON
1,4141 SW TEME.A.. PULL RD
BEAVIEPTON OR 971710."-'
MGM DEVE.I.OPMENT
RT I FJ(JX ')48
EickvERION UP 97005
Phone Mo.- W?(3 -r-'420
Reid #. . z
Occupancy of the i.kbwve building is herFohy given,
the c�.ompliAncrz with the Stm-l:e Of Ow-eUnri SpecAa).ty Codec, fat-, Ui(,? !lv floll.j.
occupalicy, &md us tonder which the refei-viced ppy,mJ-1; war, issuvA.
F.A.RL DU.PARTWINT BUTLPING
fUJILDING 01,"i' lCUAL
POST IN CIOWPIcuoucs m-nuk
® w
r 5 ` �TYOF T'GAR I. MBINGY PERMIT
CffYOF11S M hIIT 0. . . . . . . .. MST9c•-0241'
COMMUN('''i DEVELOPMENT DEPARTMENT ernoon
13'26 SW Hol Blvd. :1.0.Baer 233x7,TOW,Orepon 972 (603)83x4176
S I TE ADDRESt=
INSPECTION NOTICE.
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4171
Inspection:_
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Daae Requested: � Timet AM � _PM
Addrese:� I < (L 1 Permit tt�c�'�1�
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:_ 7T P7-j.> ---- .T-- - Datet Y'S� 5 —
V APPROVED DISAPPROVED APPROVED SUB.IP.CT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Buninesas Phone: 639 7
Inspection:
Footing Plbg. Underalab Mach. Rough-in Appr/S;dwlk
Found. Plbg. Top Out Gas Line INALs
Poet/Ream Struct. San. Sewer Framing -Bldg.\
Poet/Ream Mach. Rain Drain Insulation -Plumb. 1
Plbg. Underfloor Water Lin Gyp. Bd. -Hoch.
L
Date Requentad: _ ct _ Times ,AM PM
llddrePos _ 1 z1. _ Permit s_��c� t-/c �4 I
Builder: �r
THE F01$.UWING CORRECTIONS ARE REQUIRED-
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inspector: -_- �� _- — DntR�✓
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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Call For Rainsp.
INSPECTION NOTICE V)
City of ]Tigard Building Department-
13125 SR Hall Blvd. Tigard, Oregon 7727.3
Inapection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4173.
Inspec`ion:- �—
tooting Plbg. Underslab Mech. Rough-in �App./Sdwlk')
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. Mech.
Date Requested: 7 - ' Timet ✓7�/` AM PM
Address: , e4 4 ./ , Zf Permit #:.eX"
Builders
THE FOLLOWING CORRECTIONS ARE REQUIREDt
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Inspector: �� - Datet
APPROVED -� DISAPPROVED v_ APPROVED SUBJECT To ABOVE
__Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd_ Tigard, Oregon 97223
Inspection Line (P.ec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection•__.
Footing Plbg. Underelab Mach. Rough-in iAper/Sdwlk�
Found. Plbq. Top Out Gas Line FINALS
Post/Beam struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
P.lbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requente11d(s I_ �-9! P!3 Time- _4- _Am 11 r/PM
Address: l`!/1 1 �� +� ` �Q Permit #1
Builders
THE FOLLOWING CORRBCTION8 ARE REQUIREDI
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Inepaotors_ ! I - Dates �Vy 1'7_ J1..2
APPROVED nISAFPROVRD APP?40vn 898Jom TO ham
call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: -
Footing Plbg. Underalab Hoch. Rough-in Appr/Sdwlk
Focnd. Plbg. Top Gut Gas Line FINAL-
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Ream Hoch. Rain Drain Insulatic., -Plumb.
Plbg. Underfloor Water Line O Gyp. P�:� -Mech.
bate Requested: �� :�`/,")� —_,__Time: AM --__SPH
Address✓/2 9 z Permit
Builder: —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inepectur:— � � _ Uata:
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APPROVED DISAPPROVED APPROVED BUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4115 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line PP!AL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain D::ain Insulaticm� -Plumb.
Plbg. Underfloor / Water Line Gyp. Bd. -Meeh.
Date Requeste/dsG - 102. -_Times AM PH
Address:_ I/1 ,� �
// / / Permit �!
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:
` APPROM DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175 Dusiness Phone: 639-4171
Inspection:
Footing Mg. Dnderslab Mech. Rough-in Appr/Sdwlk
Found. T Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing > -Bldg.
Post/How Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Lint Gyp. ed. -Mech.
Date Requestedt ' �` I Z _Time: �M�AK ([ P!I
Addreso:j\`l�j �� l l: Permit
Builder:
THEFOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:- -- f ', -- --- - npit e 2- 'L:.3`
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinnp.
INSPECTION NOTICE /
City of Tigard Building Departe:ent
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41.71
inspections
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struc:. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumh.
Plbg. Underfloor Nater Line Gyp. ed. -Mech.
Date Requested:_ L ' 1 -Time: _ AM __PM
Addresa:,//Y� / _ ` Permit /:_21-07- '11
Builder:
THE POLLOW114G CORRECTIONS ARS REQUIRED:
Inepecto
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
�T� Call For Reinep.
INSPECTION NOTICE_
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection• _--
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwl.k
Pound. Plbg. Top Oat Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. UndArflnnr Water Line Gyp. Bd. -Mech.
Dste Reguented:�z-?Z z Time: AM PM
Address: I I�l��� Permit #: N��7T �(1 {11 T
Builder:_ �1 1 i 1 l — liy (C) _
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspectors
./Z__APPROVND DISAPPROVED i APPROVED SUBJECT TO ABOVE.
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Departa:ent
13125 SN Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Bueineas Phone: 639-4171
Inspections _
Footing Plbg. Undernlab Mech. Rough-in Appr/Sdwlk
Found. Plbg. 'op Out Cas Line FINAL:
et/Beam Btruet.l San. Sewer Framtng -Bldg.
tt/Boom Rech. Rain Dain Innulation -Plumb.
Plbg. Underfloor hater Line Gyp. Bd. -Mrch.
Date Re(:uested: / 2— Timet _ _AM PM
Address: � L/Pstmit f:C/ ) Z L
Builder: l
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_ Dates
AFPR"D DISAPPROVRD (/ APPROVED SUBJRCT TO ABOVE
— Call For Reintp.
INSPECTION NOTICE.
City of Tigard Building Departar_ut
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslah -' Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out: Gaa Line FINAL;
Poet/Ream St-uct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Ineuletion -Plumb.
P !t . Underfloor Water Line Gyp. Rd. -Rech.
Date Requested: / l4 L Times �AM PM
Address: Z Z
Builder:
THE FOLLOWING 0ORRECTION8 ARE RtQUIRED:
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APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
call For Reinep.
INSPECTION NOTICE
city of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspect ion:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINPL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Dnderflaor Water Line Gyp. Bb. 7AM
h.
Date Requestedt f/` 7 —� Time: PH
7
Address: 7 3 Permit 1:1� 12 2- ``l
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: __�_ Date:__
APPROVED DISAPPROVED APPROVED SUBJECTTOABOVE
_—Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sq Bail Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Undernlab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gan Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Seam Mach. n Drain Insulation -Plumb.
Plbg. Underfloor er Lino Gyp. Bd. -Hoch.
Date Requested: Ao U-� Times ZJ�2_ AM PM
Address* // oo'lL Permit fs c.7
Builder:
THE FOLIOWINO CORRECTIONS ARE REQUIRED:
F--
Ln
F--
CA --- - —
Lo
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i nnlK+ctor• Dater,-
4- APPROVED DYSAPPROVRD APPROVED SUBJECT TO ABOVE
---Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Depert-t
13125 SW Ball Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections,__
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb.
Pl.bg. Underfloor TT Watec Line �j Gyp. Bd. -Hoch.
Date Requested: V r Z" __Time: _ AM _PH
address:�I
Builder: �//__ ` Permit
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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_ Dater_____`_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE.
Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW [call Blvd. Tigard, Oregon 47223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections __
Pcoting Plbg. Underslab Hech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water/Line Gyp. Bd. -Mech.
Date Requestedt_ C)/ _
�1c�v� ^_Times AM PH
Addreno.&!L� 7 --' Permit f:
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD — RECEIPT OF PAYMENT RFCE:IPT Nb. :92-232907
CHECK AMOUNT ; 4967. 76
NAME OLSON, I..LOYD CASH AMOUNT . 0.00
ADDRESS ! PAYMENT DATE e 10/21/92
SUBDIVISION .
PURPOt"sE OF PAYMENT AMOUNT VIAID PURPOSE OF PAYMENT AMOUNT PAID
i --C iM�� PERM~ 376.00 F'LUMBINO PERM� 140.00
MECHANICAL PF 43.50 ST. BUILD PER 27„ 98
PLAN CHECK FE: 5.r`8 SEWER LISA 2100.00
5FWER INSPECT 35.00 PARKS FDC 500.00
STORM DRAIN SDC ''280.00 RESIDENTIAL TRAFFIC FEES 13`so.00
MASS TRANSIT TIF FEES 110.00
LOT 9 MEADOW GLADE
11997 5W 113TH Pl.
TOTAL AMOI.INT PAID — ' 4967. 76
CITY OF TIGARD -- RECEIPT (1FPAYMENT REC- IPT NO. s92-232780
CHECK, AMOUNT s 250.140
NAME s OLSON, LLOYD CASH AMOUNT 0.40
ADDRESS s PAYMENT DATE s 10/16/92
SUBDIVISION s
PUPP09E OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
vii PLAN CHECK FE 250.00
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LOT 9 WADOW GLADE
11997 SW 113TH PL
TOTAL AMOUNT PAID - ? 250.00
CITY OF TIGA RD
,COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW HWI Blvd. P.O.Box 23397,TOW,Oregon 97223 (603)6394175 7��7 MASTER PERMI1
PER!Iff #. . . . . . . .
639-4171 DATE ISSUED: 10/21/92
SITE ADDRESS. . . : 11997 SW 113TH PL PARCEL: 2S103AB—MG009
SUED I V I S I OIG. . . . : MEADOWGLODE ZON I NG
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :9
BUILDING
REISSUE: DWELLING LIN I TS: I BASEMENT.. . . . . . . . :0 s f
CLASS OF WORK. :NEW BEDRMS:4 BATHS:3 GARAGE. . . . . . . . . . ..440 sf
TYPE OF USE. . . :SF FLOOR AREAS__--__----- REUUI RED SET BACKS--.---------.—
TYPE OF CONST. :5N FI RST. . . . :743 S f LEF-r. . :5 ft RIGHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . :843 s,F FRONT. :20 ft REAR. . :60 ft
STORIES. . . . . . . .2 THI RD. . . . .0 s REQUIRED-
HEIGHT.. . . . . . . . :25 ft TOTAL--------: 1586 s SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 80876 PARKING SPACES. . : I
Remarks ; PATH I
------------------------------------- PLUMBING
SINKS. . . . . . . . . . : I FLOUR ORPINS. . . . :0 BACKFLOW PREVNTWj. . -0
LAVATORIES. . . . . :4 WATER HEATERS. . . . 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER ULUSETS. . :3 SLWLR LINL (ft ) . :0 GREASE IR"PS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIX'TURES. . . . . ..11i
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :0
WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1
MECHANICAL ---------------- f:7EES
FUEL -------- U 1\1 IT H T R S. . :0 type amoi.int by date recpt
/GAS/ VENTS . . . . . :0 TIF $ 1460. 00 JH 10/21/92,
IvIP.X INIDUT :0 PTU VENT FANS. . .4 BPRT $ 376. 00 JH 10/211/92
VURN ( J.00K . . : I HOODS. . . . . . : 1 BPLC $ 244. 40 JLH 10/16/92 232760
FURN ) =100K . . :0 WOUDSTUVEb. .-O B5PC $ 18. BO JH 10121192 -
FLOOR TURN. . . . :N CLO DRYERS. ; I SSDC $ 280. 00 JI-A 10/al/92 —
BOIL/ClylP ( 3HP:0 OTHER UNITS: 1 PARK $ 500. 00 JH 14121192
GAS OUTLETSel MPRT $ 43. 50 JH 10/21 /92
Owner : HPLC $ 10. 88 JH 10/21/92
LLOYD C OLSON M5PC 1i 2. 18 JH 10/21/92
13141 SW TEUFEL HILL RD PPRT $ 140. 00 JH 10/21 /92
P5PC $ 7. 00 JH
10/21!92 -
BEAVERTON OR 9701Z17
Phone #: 628-2420
Contractor: ------------
OLSON DEVELOPMENT
RT I BOX 948
BEAVERTON OR 97005
Phone #: 628-2420
pet) 5&968
C'm
$ 308d. 76 'TOTAL
U! This permit is issued subject to the regulations contained in the ------- RLUUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/foLind Insp Fireplace Insp
applicable laws. All wurk will be done in accordance with approved Post/Beam StrLICt Gas Line Insp
plans. This per, Post/Beam will e%ire if work is not started within 180 ost/Beam Meehan InSUlation Insp
days of issuance, or if Nor is suspended fm more than 180 days. PlM/Undslab Insp Gyp Board Insp
PLM/Underf I oor Rain drain Insp
V,erm i t t e e Si gnat 1-tre r L4, 1V1e(_J1AniCz,1 In3p Water Line Insp
L PlUmb To? Lji.tt "ppr/Sdwlk lnsp
Issi-ted By : Framing Insp MectiAn i CA I F I n I
Call for inspection 639-4175
�
CITYOFTIFARD ,
����
COMMUNITY DEVELOPMENT DEPARTMENT ommoon SEWER CONNECTION
13126 SW HWI Blvd. P.O.Baer 23307,Tipnd,OreWn 07223(503)8304175
-- R H H 0. . . . . . . w 8 W R 920 03...
G39-4171 1)01E ISSUED: 10/21/92
::;ITE ADDHLbb. . . : 11997 EM 11:51H 1-'L F'kkL EL: 2S 1015kb-M6009
tDUBDIVISION. . . . : 11EADOWELADE ZONING:
I,LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :�4
------------
IENANI NAML. . . . . :
USA NCI. . . . . . . . . . . F- IXTUHE UNITS. . . .
(-LASS OF WORK. . . :NEW DWELLING UNITS. . : 1
I YF'E OF USE. . . . . :SF IVO. OF BU I LD I NGS: 1
.INSTALL TYPE. . . . :BUSWR I hIF'ERV SURFACE. . : S f
kemarks . PATH I
Owner: --------_,_____-_---_.__.______._----__-.__ ---------------- FEES
LLOYD C OLSON type amol.tnt by bate recpt
131.41 SW TEUFEL HILL RD PRMT $ 2100. 00 JH 10/21/92
INSF' $ 35. 00 JH 10/21/92 -
BEAVERTON OR 97007
Phone #: 628-2420
I ontractor:
1 .0NTRACTOR NOT ON FILE
-----------------------------------
111n n e #: $ 2135. 00 TOTAL
REQUIRED INSPECTIONS
This Appiicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 188 days from i
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not 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. _
1-1er m i t t e e (5iynat1_tr'e :
I55lte(I Ey : -
Call f'or inspection - 639-4175
13W SW Hall BtW.r/ PLNCK/RECT # A� �'
CITY OT TIGARD TigaPO rd.Oregon 73397
972L3 PERMIT # {'I'-5 92- 0241
COMMUNITY DEVELOPMENT DEPARTMENT
(50.,)63"171 DATE ISSUED
JOB ADDRESS: 1 f �1� '7 S.K/. 113 Y C.. TAX MAP/LOT -M rs
SUB.'"-Y� �' �' -�►-��.1'""t +& LOT: LAND USE:
OWNER SPECIAL NOTES
NAME: L-• REISSUE OF:
ADDRESS: I Ll I S.LN* . I.a.-AAL H X APO—' LAST REISSUE:
�1Ga-t. rZ.-Aj FLOOD PLAIN/
PHONE: ' a../ w'I ^� r / SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED 50671-"l
NAME: :. _� �' t_1 �u PLANNING:
ADDRESS: /�^ �- _ _ ENGINEERING:
FIRE DEPT:
PHONE: OTHER: -7/r-
CONTR. BOARD #: S f--Cl �� EXP DATE:'
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: t^ 4,g , BUS TAX:
ARCH/ENGINEER CALCULATIONS: _
NAME: (_.1 'r _� . � 1 TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
.° PROPOSED BLDG. USE:LLI
Z
COMMENTS:
APPLICANT SIGNATURF
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
C►1 ¢�fZ-c� ��ll 10-432 00 Building Permit Fees ,3ZG- 37 '
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees 3 �� 3 )-V
10-230 01 State Building Tax (5%) _ 2
Building ��• �' ~
Plumbing -�1
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire
1-0 34 3 30-202 00 Sewer Connection �/cl /` �o
30-444 00 Sewer Inspection .3
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 /3 3 u Z3 s-V
25-448-05 Mass Transit TIF Fees l/ y l/U
52-449 00 Parks System Dev Charge (POC) 50.)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) ./
24-445-01 Water Quality (fee in lieu of) —
24-445-02 Water Quantity (Fee in lieu of)
TOTAL _S�.I ?. �G -='
nm/3587P.WPF