10760 SW 115TH AVENUE-1 10760 SW 115TH AVENUE
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Address -�7 i 1� permit No
Permit charge 22 0 12
Owner _._.!z� �;,, , - Connection fee -
Paid by
Type of building •_. . pate connected
Service rata 1 Ing;pectiun fee -
Contractor Paid by date
Gize of connection Assessment Paid �e
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- EWER PERMIT
S M 13768
Unified Sewerage AgencyT i �t3 rd DATE 9-13-77
of Washington County CITY OF
OWNER: _.m❑n �gram IhillLUS— — —
PHONE . 646-nl R6
OWNER ' S ADDRESS: —
TYPE OF INSTALLATION:
'[�J%ILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
Q3EW �ckINGLE =AMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7- 1-70 ) ❑ MULT . RES. ❑ INDUSTRIAL.
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS: THE APPLICANT AGREES TC COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TC 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
OTHER _
T TAL < F;9r;,
APPLICANT DA1 E
NOTICE: l�OAYS OF THE
VICE
t,HARGE OWILL REGINATERFOR ERTHIS SEWER PERMIT N°
PERMIT.
ADDRESS OF STRUCTURE 10760 SW 115th Ave.
TAX MAP TAX LOT — SYSTEM _Pannfi rran4
LOT BLOCK OF,
__.. APPROVED BY DATE ISSUED BY DA ' E
REMARKS Bldg. #1685
CITY OF TIEARD
ORDINANCE ,x77-26
STREET SYSTEM DEVELOPMENT CHARGE
a
DATE : 3//77 _ ESTIMATED SALES PRICE s - 64a �-
APPLICANT NAGE TELEPHONE
JOB ADDRESS /,P 7 d 0 41 //_S' �c.�-`- BLDG. PERMIT
AMOUNT OF FEE FOR S. (1. C.
DESCRIPTION OF IMPROVEMENT -S•/�
EXEMPTIONS -PER ORDINANC,= #77-26
FEE RATES:
A. Single family duelling unit under $60, 000.-- -------- 0
B. Single family duelling unit over $60.000. ---------- $400. 00
C. Mobile Home Court Space (Neu Development)------ --- $150. 00
0. Multi-Family Deullings--per unit-------------------- $240.00
E. Commercial , Industrial & Institutional(Park. Space) $ 50.00 each,
F. Single family unit under $40, 000- ------------------ $250. 00
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CITY OF TIGARD
ORDINANCE #77-71
PARK. SYSTEM DEVELOPMENT CHARGE
y DATE :
��.j /'J7 ESTIMATED SALES PRICE $ OQd�---
1
APPLICANT NAME-222&_w TELEPHONE #
JOB ADDRESS BLDG . PERMIT # l6�S'
o �
AMOUNT OF FEE FOR P. D. C .
DESCRIPTION OF IMPROVEMENT .S'• F' %�,
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. --------------$100. 00
C. Mobile Home Court Space (New Development)--------------$ 50. 00
D. Multi-Family dwellings--per unit-----------------------$ 60. 00
CONSTRUCTION IS LOCATED ON S.W. ✓ N.E . SIDE OF S.W. PACIFIC
HIGHWAY. .E . is ar 'i-:1 S.W. is Park District #II .
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BUILDING PEBMI i APPLICATION 1oF T IGARD DATE_. tg_- !
THE UNDERSIGNED HEREBY APPLIES FOR A.PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
-
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONr
7 l.o r NO.
OWNER Monoram Humes JOB ADDRESS10760SL{ 115th HOME_ADDF!ESS
ARCHITECT
ENGINEER
BUILDER aL31T1a ADDRESS_ DESIGNER
STRUCTURE VEW ❑REMODEL ❑ADDI•�TION ❑REP.IR ❑RENEWr-AL. ❑FIRE DAMAGE- ❑DEMOLITION
Q RESIDENCE ❑COMM ❑EDUCATIO-NAL 0GOV'T URELIGIOUSCIPATIO OCAR PORT QGAHAGE El STORAGE C1 SLAB ❑FENCE
❑BOND ❑MOVING [:]CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL.APPROVED ❑SIGNS
CCl1�AiJCY I _LAND USE ZONE_ h-•7 BLDG.TYPE 5N 11 FIRE ZONE 11 PLAN CHECK BY Stu HEAe Z
'-. JI1,:t. dievf�lc 1,-:Emily dwelllnrj wiatt&chod _;nrac,a rej.!Jzuw of Purmit
3 bedroom 2 bath garage 420 ey.
9"—LQD-- FLQ-QR LOAD__40 HEIQHj-_ 20NQ-STQIlIE$1___AH€.8 1 4 Ga NO.BEDROS2MS � yALUE36 r 000.
BUILDING DEPARTMENT SET BACKS FRONT 21 REAR 33 LEF T SIDE 13 RIGHT SIDE L+
Permit 14b,171
— THIS PERMIT IS ISSUED S'JBJF.CT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, 7.0NING
Plan Check 10.GI REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
- WORK WILL BF DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total :J;J.11 ! ALL APPLICABLE CODES AND ORDINANCES. 1HE ISSUANCE OF T141S PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 6.20 LIPIff. MPARAT,E PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
J y la i
Total 1fa1. 20 Fltark oevuluNlaent �-har:jt-
By –
•.,._._ APPI LCANT OP AGFNI ,.,...
Approved 1 Receipt No
AflDRE 55
i
DATE iNSP. TYPE INSPECTION REMARKS Tk PLUMBING DATE
Contactor _
rcl Permit No.
Rough-in
th-l'x-'11 T0 2c
4169 _ . Fixture
�
J?�Wi j Final
HEATING
_1�Y - - _k I Contractor
Permit No.
1
-tlt01 G r OK -1�' Gas or 06
(% <_, Rough-in
t (D zt2tzfinal T ��--
_� SEWER
lo- G�IEL. -
_� DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
81.DG DEPT. FINA1 TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
( I andscaping
Zoning Final
I
OUILDING F'LRMIT APPLICATION 1IT TIC ARD DATE-�1 _..!'L- ,s_�;L t1jQ
11i' LIND[ H: IGNFD HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE_ _
CCR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPFCIF(CATIONS. OWNER PHONE___ _
/, �/ LOT NO
JOB ADDRFSS &'S(yL J� HOME ADDRESS l I
ARCHITECT
RENGINEER
DESIGNER
S-�
Ji[ EN'q_-0 REMODEL— ❑ADDITION —_ _❑HEPAI_R-� ORENEWA! OFIRE DAMAGE DOEMOLITION
"I llr_i ❑(11MM CEDUCATIONAL OGOV'T ORELIGIOUSDPATIO OCARPORT ❑GARAGE OSTORAGEOSLAB []FENCE
�^ 'N ) �]n�r7VING CICONDITIONAL USE DDLSIGN REVIEW LJCOUNCIL APPROVED _ ❑SIGNS '
A LN_ USE ZONE,_1_._BLDG TYPE _ -_Ir ---FIRE ZONE� PLAN CHECK Bi _ HEAT_
t
[! . .IFi-�Cl.f __ CI----HF.I_GL�L /Ie --__----_ Q SLUR( $._ VALVE JbOOt1--
NIIILUWG DEPAIr,M NT `
---- - - -- -----�--.- SET SACKS FRONT 1.,) REAR Z� C. LEFT SIDE RIGHTRI,r,,Ery I
ermit
THIC PFRMIT IS ISSUED SUFI;ELT TO THE RFGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Iie 1 U REGULATIONS AND ALL APPUCApLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
—� tVORK WILL BE DOME IN AC%.ORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
duh !r'tal ALL APPLICABLE ;'ODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- - " - -- R:STRICTIVF COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
eta Tax . LICENSE SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
by
APPL ICAN, Op AGENT _.___-_ _ -•---.._..-_._...__.---..,._-----
t t" �L• Receipt No
.tet-+/l•iL'2� c�._ � � �.- _.. _ ...._ _____
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Ly 1 c_l a d 1` CC110111 C LI1 Pertmi � 0 Permit_-_.,._%3�w0,Q,,
J aFee-
--New Installation '+Palace i-, Relocation ❑ Addition ❑ Altbrehon 1.J �JA State___._
T OTA L------
CCNTRACTOR kL�tAL L9_ l,�t_✓ /� _ OWNER _ �_ ..Q7Ld
~A';r,• /� /� - . , __-__- ^.�� A L
vORK ADDRESSL6ApnRE55
l PHONE ������.G+ APPLICANT�� 111� LLt..-_
Heat Input Rating (BTU Per Hour)�� _ _ Vent Size -_-- Flue Size__
FUEL OIL C! GAS D ELECT OTHER.----------
ITEM
THER.-___-_ -_----ITEM NO. FEE ITEM NO. FEE
' .; For Issuance of Permit 3.00 Air Condition Compressor_15 to 30 HP 10.0f1
New• Under 100,000 BTU_-- -�/ - 4.00 -Air Handling 10,000 CFM
New• 100,000 BTU&over - 5.00 Air Handling Over 10,000 CFM J5A0
Floor Furnace 4.00 Evaporative Cooler 3.00
Wall . Floor • Suspended T -_4.0_0 Range Vent Fen - 2.00
Y' Install Vents Only -�___�_ -
2.00 Veni System -_— 3.00
fiepair - Heat& Cooling 4.00 Hood Commercial 1.00
Air Condition Compressor Under 3 HP 4.x10 Commercial Duct System 10 000
'f Air Condition Compressor 3 to 15 HP 7.50
INSPECTOR'S COMMENTS_.._—_._________.. _ __
CITY BUSINESS LICENSE REOUIRED FOR ALL CONTRACTORS OR SUBCONTRACTORS
COMMENTS_--—--
-
APPROVED BY �f -- DATE. - -----._.__— ISSUED BY __—_— - DATE
RECEIPT NO. -
77A Sig lure of Applicant
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