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LOT. . . . . . . . . . . . . ..0,31 Fr^aject Oescr••iption : Instill one br^anch cirCr_rit. l _-_-RESIDENTIAL UNIT-.._._.- ._._.--TEMP SP.VC/FEEDERS- -- _ ------MISCELLANEOUS----- 1000 SF= OR LESS— . : 0 0 200 amp. . . . . . . : 0 1-UMP/IRRIGATION. . . . : 0 EACH ADD° L 500SF. . . : 0 201 - 400 amp. . . . . . . 0 GIGN/OUT LINE: LTG. . : 0 LIMITED ENCRGY. . . . . : 0 .11.01 - 600 amp. . . . . . . �rr SIAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 60.1 'amps- 1iZ100 vc+Its.4 /� &GN R LABEL ( 10) . . . ; int_-.___SEPV lCE=/FEI. DE.R-_.._.._ _.___l3C;ANCI i CIRCUITS._-_..___ DD' L INSiDEC T'I ONS .. 0 - 0k' Z.mp. . . . . . . 0 W/SERVICE OR FEEDER: ID PER INSPEC-TION. . . . . : 0 ,`'01 - 400 amp. . . . . . : lj ist 1410 SNVC OR FDR. : 1 PER 1•40UR. . . . . . . . . . . : 0 4.01 6Q10 amp. . . . . . : Q. -A ADD' L BNNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 !.•01 1000 ramp. . . . . ; 0 --._.._.__._-_._-_.--- -.-PLAN REVIEW SECT ION----__..___---__.__... 1000•+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect -•nly. . . . . : 0 SVC/FDR ) _ 225 AMP15. . : CLASS AREA/S1'EC OCC. : (]v)ner•• ; -____.____.___.___.___._____.__._____.__.-____.____._..____.___.----_- -- FEES I_OPI DUFFIEILD type am01.1nt by date r^ecpi- 1415fs SW 121ST AVE PRMT $ 35. 00 CJS 04/15/96 96-.2781.68 5PCT $ .1. 75 CJS 'Zl4/ 15/96 96--278166 T I GARD OR 972'03 Phane #: Contractor-: REDS ELECTRIC CO INC $ 36. 75 TOTAL X002 SE CLINTON ST ----- -- REQUIRED INSPECTIONS -_- I'ORTLAND OR 0, 1202 Ceiling Cover, -1hone #! 503•-233-6467 Wall Cover• r- 11e g #. . . 04443 This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of Ore. Specialty Codes and all other Per-mittee gnatar e applicable laws. All work will be done in accordance with apurcved plans. This permit will expire if work is not started "ithin 180 days of issuance or if work is suspended for more �C,_1,��..........:��tj2r than IBI days. 1 ssued by ---._._._...____.__._._..._._._.__._..._._._---•--._.OWhJI:IZ IN5TA0._Ar10N the installation is being made on property I own which is not intended fo+, ale_ lease-, ur r-ent. [;WNER' S SIBNA'TURE: _ DATE: INSTALLAI`ION ':i I GNATURE OF SUF'R. ELLC' N- DATE.: -' I--I C:E:NSL IVO: Call 1 inspection - 6139-4175 I ' Commurtdty Development ELECTRICAL PERMIT APPLICATION 13,125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # 9vr d7r�'IG.�' Permit # Fi L 4C o -)3 y Phone (503) 639-4171 Date Issued VG _ FAX (503) 694-7297 Issuers by _Ch c• /rs �1�n,_f.- CITY Ow TIGA D TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: Complete Fee Schedule Below: Name of Development _i Number of Inspections per permit ellowecl Address 4)z,e—' Service includctd Items Cost(ea) Sum City/State/Zip_ / � �� ����_ 4a. Residontial- per unit ( 1000 eq ft or las: S11000 _ Eadr additional 500 rq ft or Name (or name of business Di, i portionlhoreof $2500Limit _. Commercial El Each energy $2500 Residentlalp— _ Each Manu7d Home or Modular 2 Dwelling Service r r Feeder $6000 2a. Contractor installation only/: 4b.Services or Feeders .Tt // //_� / Inslallauon,alteration,or relocalion Electrical Contractor `��-)1 •c l /`"ice'" 200 amps or lose $6000 Address CC ,vfr)–� 201 amps to 400 amps $8000 r 401 amps to 600 wnps $12000 City '7State : ZipL 301 amps to 1000 AMPS $180 co � j=j Phone No. _j �f�/ Over 1000 amps or volts 534000 Contractor's License No.� Reconnect only $5000 Contractor's Board Reg. No. -71-1'-1 4c.Temporary Services or Feeders Installation,alleration.or relocation Slgr atlJrr3 Of Sllpr. EIeC'n 200 amps or lees E5o 00 w ` License No. b7 95 5 Phone Na. 4 c 201 amps to 400 amps $ 0000 _ � 401 amps l0 600 amps (100 00 Over 600 amps to 1000 volts 2b. For owner installations: ese'h•above 4d. Brnnch Circuits Print Owner'3 Name _ New.alteration or extension par panel Address Y a)The fee for branch circultc With (;I ty State Zip_ _ purcha"of a kir or Header W. Each branch circuit f5 00 Phone No. __ b)The fee for brar ch circuits v ffhu..' The installation is being made on property I own which is purehaaa of"envie''or"''dir e. First branch 0141 E 00 not intended for sale lease or rent. r $5 r rash arldsio�•nl branch circuit $.500 Owner's Signature 4e. Miscellaneous (Service or feeder not included) 3. Plan Review section (if required): Ea:1 pump or irnghtion circle _ too 00 r Ead1 sign or outline lighting F40 00 I Signal circuit(s)or a limited energy Please check appropriate item and enter fee in section 5B panel,afterabon or extension _ _ $4000 _ 4 or more residential units in one structure Mmor Labels(10) $10000 _Service and feeder 225 amps or more I 4i. Each additional inspection over System over 600 volts nominal the allowable in any of the above Classified area or structure containing special occupancy as described in N E C. Chapter 5 Par inspection $35 00 � P Per hoer $5500 _ vt In Plant $5500 Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fees: J NOTICE 5a. Enter total of above fees $ S _ L 5%Surcharge(05 X total fees) $ Subfofal LO PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A for $ AUTHORIZED IS NOT COMMENCED WITHIN 190 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec.3) $ A PERIOD OF ISO DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED. 10-111.1st Account f► $ rBalanre Due $ ]LI .rlr'fAle.r.M««,.reyap CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Roc-O-Phone): 639-4175 Business Phone: 6'j9-4171 Inspection,: Footing Susp. Ceiling Sprink, Rough-in A^pr/Sdv;Ik Foundation Plbg. Underslab Mecn, Rough-in Fireplace Post/Beam Struct. Plbg -fop Out Elec. Rough-in FINAL: Post/Beam Mech. San. Sewer ;as Line �81 Plbg. Underfloor ain Drain Framing Alarm Water Line Insulation <-Mech) Underllr Insul. Shear Wall Gyp. Bd. !� Date Requested: 2 '� �] (�, Time: PM Address: JL� ��-- Builder. Permit ;7: 7 C) �- THF FOLLOWING CORRECTIONS ARE REQUIRED: r_. vi r J LJ J Inspector._ Date: 2_ APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinep WE Ll A W I C C41 PERMIT PER #. . . . . . : CITY ®F TIGARD DATEMIT ISSUED:. 05/14MEC96-0015 /96 COMMUNITY DEVELOPMENT DEPARTMENT PORCEL: 2SI10BB-05-400 13125 SW Hall Blvd.Tigard,Orarn W223*81 99 (503)639-4171 C- I TE ADDRES',J. 14 ,0 W I-,I 1 1:4V1:_. SUBDIVISION. . . . : ARLINGTON RIDGE ZONING: R-3. 5 BLO('-K. . . . . . . . . . : LOT. . . . . . . . . . . . . :031 CLASS OF WORK. . :ADD FLOOR FURN. ILI EVAP COOLERS: 'A TYPE OF USE. . . . :5F UNIT HEATERS, . : 0 VENT FANS. . . : 0 OCCUPANCY GRP'. . :Al VENTS W/O APDL : 0 VENT SYSTEMS: 0 STORIES. . . . . . . . 0 BOILERS/COMPRESSORS HOODS, . . . . . . : 0 FUEL 0-3 HP. IZI DOMES. INCIN: 3-15 HP. 0 COMML. INCJN: 21 MAX INPUT: 0 BTU 13--30 HP. 0 UNITSQ : , F71 RE DAMPERS?. :i0-50 HP. 0 f4m,ihir. 0 GAS FRESSUR.E. 510+ HP. 0 CLO DRYh 0 110. OF AIR HANDLING UNITS OTHER UNITS. : o FURN ( 1001JN BTU: 0 10000 r-Fm : I GAS OUTLETS. : Q) FURN ) =100K BTU: 0 > 10000 cfm : 0 Pemar,ks . inSTALL ARI HANDL-114U UNIT TO 1.0, 00CM Owner: FEES ---------------- - LORI DUFFIEecptID type amoi-int by date r 14�58 SW 121ST AVE PR MT $ 25. 00 J11H 05/14/96 96--279403 F WICT $ 1. 25 JMH 03/14/96 96-27940.;, TIGARD OR 97223 Phone -#: contv-ac.,tor: CLIMATE CON1'ROL IW: 3315 NW 26TH FORTLOUD OR ------------------------------------------ Phone #: $ 26. 25 TOTAL Reg #. . : 062196 REQUIRLD INSPECTIONS This pewit is issued subject to the regulations c3ntainpd in the Mechanical Insp Tigard Municipal Code. State of Ore. Specialty Codes and all ether Misc. Inspection applicable laws. All work will be done in accordance with Final Inspeceticm approved plans. This persit will expire if work is not started within 180 days of issuance, or if work is suspended for sore than 160 days. Pev,mittee SignatUt,ell I S S 1-1 e d By Call fc,v- inspection 639-4175 City of Tigard MECHANICAL PERMIT Planck/Rec. # 13125 sw Ball Blvd. APPLICATION Permit # vors Tigard, OR 97223 \C (503.)(593) 639-4171 •�^ escriotion i-� Table 3A Mechanical Code _ CITY PRICE AMT Ad*— Jab 1 G Vr 7 S I 1) Permit Fee -0- -0- 10.00 Adall"s •• 2) Supplerrrental Permit 3.00 m• d •^� Furnace to 100,000 BTU 1) incl. ducts &vents 600 a ••• - urnace iuu,000 BTU + Owner 2) incl. ducts &vents 7.50 •• oorurna'F nce — '- 3) incl. vent 6.00 ^•1.n•^'•^ •^••• ---Tu—spended heater, wa ea.er - 4) or floor mounted heater _ 6.00 • °• vent no: mc.. in Occupant 5) appliance permit 300 •• p epair o ea ing, re ig. 6) cooling, absorption unit 6.00 1� t Boiler or comp, heat pump, air cond. 1 7) to 3 HP; absorp unit :i 100K BTU 6.00 ••^p ••• Boiler or cump, iea pump, au con . F N 2 r,*1 p�a - `7� 8) 3-15 HP; absorp unit to 500K BTU 11.00 Contractor I 1 a of er or(.omp, eat pump, air cond. t , 9) 15-30 HF; absorp unit .5-1 mil BTU 15.00 of er or comp, e— amt pump,air Gond- •' �-•�` r •' 10) 30-50 HP; absorp unit 1-1.75 mil BTU 22.50 hereby acknovilel ge that I have Ilead this application. tat Me' Boiler or comp, heat pump,air con n,ormation given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 and BTU 37.50 agent of the owner, that plans ,ibrnitted are in rompiiance with it Eandling unit to State laws, that I am segiste er; with the Construction Contractor's 12) 10 J00 CFM 4.50 Board, that the number given is correct. (If exempt from Stets AF andling unit registration, please give reason below.) 13) 10,000 CTM + 7.50 Non po a e 14) evaporate cooler 450 Vent tan connected 15) to a single duct 3.00 f Ventilation system not 16) included in appliance permit 4.50 .,.�. ... .M .. Hood seryy —.. 17) mechanical exhaust 4.50 escr, a work ne%v jhF a(. 1Wn alteration repair U =6mmerciat or rn ustn;a to be done residd is nun-residential Q 18) type incinerator 30.00 Existing use o bier ;.e., woo s ove, water building or property 19) heater, solar, clothes dryers. etc. 450 Proposed use of 20) Gas piping one to four outlets 2.00 budding or property -- 21) More than 4-per outlet (each) 2 00 '= Type of fuel -oil Q natural gas l7 LPG Q electric lJ --- Vn ~ Minirnum Fee 525.00 sUETOTAIL (t, PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5°16 SURCHARGE „aG� cD IF : ONSTRUCTION OR WORK IS SUSPENDED OR ` ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL AFTER WORK IS COMMENCED. TOW' Special Conditions ^ Date issued L _^by CITY)f+ ^_ MU.00MD9TlMF.CNPM T Home 1--y-out 0 ..................................................... ............................. ....... . ........................................................... ............... ....... ...... ...........................7.....................I......... .......................... ............ ...... ...................... ........................ ....... . .................................................... =77�77:....... ... ....... ...... ..... ............................................ ......................................... ...... .............. ......I.......... ..............................I.................................................. ............ ............... ................................................... -40 . ........... .. ......I..........I............ ....... ....................................................................... . ..................... ..T........................................ ...... .............................................................. ...........I................................................ ..................................................................................................................................................... ....I......................... ......................................................... ............................. .. ................................................... ................. .............. ........................................................................................... ......................................: i0l, ..............................1 .................... ......*..".*.,.*.*.,.,.*D ...................................................I...... ..................... .......I ..................... ......................................................................... ..................................... ........... ............................. ...........................................................I...................... ..... ..................... ............................. ... .. ... ............... ......................................................... ........ jAu.. .................... ...............................................................................I...................... ................................................................................... .............. ......................I..............................I.................................. ......................................................................... .....................I......I................................................. ............... ..... .....................................I............................................... ......................................I.................................................. ...... ..... .....................I....... ....................................I............... .......j ...................................................... ........................... ...... ... ...................................................................... ................................. ..... ....................................................I.............................. .. . .. ... .. ... .. ... .. ... .. .. .... .................................... .. ..... .. .. ..... . ... ..I.. ..... ..... ..... .. ........... ... .. ... .. ... .. ..... .. .. ..... ..... ..... ..... ...... ..... ...... ...................... ....................................................................... ................................................... ....... .................... .......................................................................................... .......I...... ...........I....................................................................... ............. ............... ....... .......... ..... ............... .... ........ ..............)........ ......... ........ .... 0 Willdcms Windows Doors Walls Root Floors –— CITY OF TIGARD SERO CICANC OF CC'UE'AL_Y COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MST94--0411 DATE iSaUEU: V.12!2(3/9b 13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)639-4111 PARCEL: 2S110BB---05400 SITL HLURESS. . . : 14158 SW 12I S'T AVE SULAD I V I SI ON. . . . : ARLINGTON RIDGE Z ON I NC3:R-•-35. 5 BLOCK.. . . , . , . . . . . LOT. . . . . . . . . . . . . :031 CLASS OF WORK. :NLW 'TYPE OF USE. . . :SF OCCUPANCY GRP. : OCCUPANCY L..OAD: 1 I I remarks : PATI-{ I I Owner: CHARTER HOMES 10705 SW 153RD PL BEAVERTON OR 97007 Phone #s 579-0c.'16 t_:untractor: CHARTFR HOMES 10705 SW 153RD PL. BEAVERTON OR 97007 Phone #s 579—OC2,16 Rett #. . 1 64930 This Certificate grants occupancy of the above referenced building or portion thereof and confirma that the building has been inspected for compliance with the State of Oregon Gpec:ialty Codes for the gi,oup, oc.c".lpancy, and USe Under which the referenced permit was issued. _ _ ...:...... ... _...____._._ _._...--_..__ 41GOFFF16ALSF EC OR BUIL FROST IN CONSP 1 CUUUS PLACE Ln ti J W J CITY GF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon F'ERM #. .pon 97223.8199 (503)839.4171 PIASTER F . RM I T . . . . . . : i*15T94--0411 639-4171 DATE ISSUED: 11/28/94 PARCEL: 251 10BB- A 1 +131 iTE ADDRESS. . . : 141'58 SW 121 UT ()Vi=. 1HUIVISION. . . . ARLINGTON RIDGE ZONING: R-3. 5 LAL0C1 N. . . . . . . . . . . LOT. . . . . . . . . . . . . :031 BUILDING ----_ REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . .o sf CLASS OF WORK. :NEW E%EDRMS:4 BATHS:3 GARAGE. . . . . . . . . . :940 <.s f I r'PE OF l'SE. . . -SF FLOUR ARF-AS----__._____ REQUIRED SETBACKS--_-----__ I YPE OF CONST. :5N 1:1 RST. . . . : 174E s f LEFT. . : 10 f t RIGHT. : 1 7 ft ULCUPANCY GRA'. : R3 SECOND. . . : 1425 s f FRONT. :20 ft REAR. . :44 ft STORIES. . . . . . . : 1 F I NBSMENT:0 s f REQUIRED-- HEIGHT. . . . . . . . :24 ft TOTAL--•. -----:3171 s f SMOKE DETECTORS. :Y FLOOR LOAD. . . . :4Qr p5f VE4ILUE. . . . . 1. : .221331 PARKING SPACES. . : l Remarks : F=ATH I F'L.UMB I NG SINKS. . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVN'FRS. . : I LAVP'IORIE5. . . . . ..5 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0 -I UB/SHOWEIRS. . . . :3 LWUNDRY TRAYS. . . : 1 LA"I`CH BASINS. . . . . . . ..0 WATER CLOSETS-3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . ..0 DISHWASHERS. . . . - I WATCR LINE (ft ) . : 1.00 OTHER FIXTLIRE'5. . . . . :0 GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :0 WASHING MACH. . . : 1 5F RAIN DRAINS. . : 1 MECHANICAL - -_---____.___. _._ __. FEES F UEL TYPES -------- --- UNI T HTRS. . :0 type Amor_int by dat a r^ecpt /GAS/ / / VENTFJ . . . . . :o TIF S 1550. 00 JF' 11/26/94 - MI=aX INPU1 :0 BTU VE=NT FANS. . : 4 r•AF'RT 1 735. 50 JI 1 1/x:36/94 - FURI\i ( iOCAK . . :0 HOODS. . . . . . : 1 BP,LL $ 478. 08 JF 11/01/94 94-258312.' HURN ) =1001', . . : 1 WOODSTOVES. :0 B5F='C $ 36. 73 JF i 1 /� 8/94 -- LiJF_)R FURN. . . . :0 CLO DRYERS, : 1 SSDC 1; LBO. 00 JF 11/28/94 BOIL/CMF' ( 3HF':0 OTHER UNITG: 1 PARI'. E 500. 00 JF 11/28/94 GAS OUTLETS: 1 MART $ 4`" 00 JF 11/28/94 Owner-: ________ _______.--_--____._ ____.-.---- tKK't_C f 1 .. ._5 JF 118/1)4 - LHORTER HOMES M5F'C $ 2. 25 JF i l/2.'8/94 - 1.0705 5W 153,RI) PL 3B-r Fd 00 JF 11/28/94 - A•'5PC $ 11. 25 JF 1 x/28/94 - I3L;AVERTON OR 9 7007 EROS t 88. 00 .7F 11/28/94 - Phone #: 579-0216 ERF'C S 28. 60 JF 11/28/94 - l_.ontr,actot-- ---- ----------------------------ERPC 2'6. 60 JF II/� B/94 - _1-iHHTER HOMES 10.105 SW 153RD I-'L. a b-HVER I ON OR 97007 V' P-hone #: 579-0216 Reg #. . 64938 4020. 31 TOTAL This permit is issued subject to the reoulations r•ontained in the ----- REDUIRE"D INSPECTIONS ------- G Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/fol.ind Insp Fireplace Insp � apNlicable laws. All work wi,l be done ir. accordince with approved Post/ueam Strr_+ct Gas Line Insp plans. This permit will expire if work is not started within 180 F'ost/Beam Ihlechan Insr-dation Insp days of issuance, or if work is sosrende fa,- mere than 80 day . A'1m/undsla�b Insp Gyp Board Insp y / �. ..._ _ FILM/Underfloor Rain dram Insp l-Nrmittee �:;i natr_�rF� ;: 1Q(�, Ihech<��nir_�•�1 Insp Watwr Lyne Insp 7 Plr.imb Top OUt Appr^/Sdwlk Insp IsGiled Eby : _ _..._._..__ .._..... _.__--_ Fr-timing Insp Mechanir_al. Final L2@111 019 if speem'-s— �. OF TIGAR® TION CITYSEWER CONNL,.. COMMUNITY GEVELOPMENT DEPARTMENT PERK I T 13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639.4171 PERMIT #. . . . • • • : SWR94- 036 4 DATE ISSUED: it/;-8/94 PARCEL: 251 10BB—AR0 31 SI I E ADDRESiS. . . i41: is SW 1L151' AV':: ZONING: R--3.5 SUBDIVISION. . . . : ARLINGTON RIDGE ----------------------------------- -I ENANT NAME. . . . . : FIXTURE UNITS. . . UUF4 NO. . • • • • DWC�1_L I NG UNI TS. . : 1 CLASS Of•= WOFRI-I.. . . :NEW NO. OF BU I l_D I NGSl: 1 I vl-'E (]F USE. . . . . :SF IMI'ERV SURFACE. . : sf INSTALL TYPE:. . . . :BU`.aWR Remarks : PATH I Own^r: ---._.________...______.____.___._________ FEES Ownc..,r: HOMES tYpe `�moi�nt Icy (i ate r•ecpt I-JANTSW 153RD PL 2000 $ 2200. 00 JF 11/28/94 — 00 Jr- 1. 1i 't3/94 - BEAVERTON OR 97007 Phone #: 579-0216 .ONTRACTOR NOT ON FILE '11nne #: Reg #. . — REQUIREU INSPECTION5 This Nppllcant agrees to caiply with all the rules and regulations Gewer- Inspection Lf the Unified Sewage RSency. The permit expires 100 dn.ys from _.-------- the date 15sUed, Thr, 'ctal amount paid will be forfeited if the — permit expires. The Ngency does not guarantee the accuracy of the -- :loe sewer laterals. If the sewer is not locatea at the measurement -- given, the installer shall prospect 3 feet in all directions from —�— the mistance given. If not so located, the installer shall purch -- a "Tap and Side Sewer" Permit and the Agency will instal 1 e r m i t t e e S3 iy n a t r-(r e •/ ._ lssttecl LAY it ( all for inspect ion — 639-4175 J t� liJ .J � S �`� gS r� k = Residential Building Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, GR 97223 (503) 639-4171 r .iobsite Address: =fig Office Use Only Subdivision: Ae/'ism - Zf/L,�) , Lot# y Q� j Planck/Rec # Valuation* ..0 � Permit# /ft �1��•0'`l(%� Corner Lot? Y Reissue of Flag Lot? Y Map & TL# 1-3 4 ,(61 Yj Owner: v �. Approvals Required Address: Planning Engineering _ Phone: Other .Contractor: c� .�► S lam- � �—� Items Required Address: ;�n )D s�Vz.) / 3' ����Y Subcontra�,tors truss Details Phone: / �1,�'Ud ._ Other Contractor's License # (attach copy of current Oregon license) �1 Contact Name & Phone: Subcontractors: Architect/Engineer: (/ Plumbing: 1, Address: C tilerhanical: �, �_ -- -_ - _Tg (attach copy of current OR Co ct6r's License) Phone: .s ,? JOB DESCRIPTION- 70,p a n ESCRIPI`ION Applican igna ur -& Phone nuKber i P,eceived by: ____ LL Date Received: N IWORMCOMDEV\RESAPP Permit# Account Description Amount Amt. Pd. Bal. Due M5L� 1-t If Bldg. Permit (BUILD) 735.5 0 ? .5•5v Plumb. Permit (PLUMB) vu ,'� L Mech. Permit (MECH) State Tax (TAX) Bldg: Plumb: // 2 ✓/ Mech: �-� �✓ Plan Check (PLANCK) Bldg: C_� Plumb: Mech: Sewer Connection (SWUSA) C7 Oj Sewer Inspection (SWINSP) 3f Parks Dev Charge (PKSDC) ,.5e, U S c- Storm Drainage Chg (SDSDC) 1,2ff-V Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) 2v__,_ Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-O) 2- Water Quality (WQUAL) Water Quantity (WQUANT) Fire Districi (FIRE) �c w Erosion Cntrl Permit (ERPRMT) "5�J Erosion Planck/USA (ERPLAN) �' a Erosion Planr•k/COT (EROSN) TOTALS: SS. / ' J US.3I