12435 SW 122ND AVENUE J
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UORESS PERMIT N0.
_ PERMIT CHARGE: _ none !
OWNER �Y�G� CONNECTION FEF
PAID BY --�
IYPE 9F 8UIl_9JNG pa c..Q_ DATE CONNECTED �_ I
SERVICE RATE /�� INSPECTION FEE -;2
CONTRACTOR P A 10 0Y � DATE:
SIZE OF CONNJECTION �, ,�_ n� ) ASSE:SSIIENT _ PAID
L SEXIER PERMIT NY 1588
j
Unified Sewerage Agency
of Washington County C I TY OF TiLj�li dr _ DA1-F �5-3-78
OWNER: Mika Mahon PHONE :
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
ick BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
xxQ NEW xxOSINGLE FAMILY ❑ COMMERCIAL
❑ EXIc-. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. [I INDUSTRIAL
FIXTURE UNITS r DWELLING UNITS 1
ADDRESS OF STRUCTURE : 12435 SW 122nd Ave.
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION,
PLEASE RErER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE—
HUINDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRA) ION OCCUR.
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE 600.
'TIDE SEWER INSTALLATION _ B. Greene
ISSUED BY
OTHER
TOTAL $ 625.
APPLICANT _ DATE
SEWER PERMIT M - 15885
f.ADDES5i 0V 'f �l"U�E 12435 3W 122nd. Ave.
TAX MAP TAX LOT SYSTEM fanny creek
LOT BLOCK OF
E. Walden
APPROVED BY DATE ISSUED BY DATE
D. U. 'S 1 REMARKS bldg. #2069
w N +wr iw eir o� A�r
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BUILDING PERMIT APPLICATION 1 FY TIGARD DATE_-__ _ 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHOIJF,
OF. AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECII ICATIONS OWNERPHONF ,—
LOT NO —.
OWNER Itilikia I1shilFi JOB ADDRESS h r_ 12?nd Av4_' . HOME..DDRESS
-� ARCHITECT
,� �� ENGINEER
13UILDER " ''me ADDRESS _ r'tw I DESIGNER _
STRUCTURE XLJNEW ❑REMODEL ❑ADDITION ❑REPAIR _❑RENEWAL ❑FIRE DAMAGE 1-� ❑DEMOLITION
C3 RESIDENCE ❑COMM UEDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO []CAR PORT [:]GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL ',PPROVED y ❑SIGNS –
OCCUPANCY ~LAND USE ZONE BLDG.TYPE IRE ZONE__ PLAN_CHECK. BY ~;CAT__
s,i.. tUngle famkly dwrrllln,, u/nc,t lac; y,•ira ,ks 3 t)bUI in , hath
s�F�I.Ir�T �ae�'ml ,; 1'Jt�ti:i
Ucy LOAfL�__F�.44R�gL7____ n HEICZHT L;...N-4.aTQBIE$_'� AREA�'4 :R _ NQ_
BUILDING DEP
ARTMENT V,SET BACKS FRONT 2� br REAR LEFT SIDC RIGHT SIDE 13
Permit -
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check ! 33,50 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT 1; HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Suh-total 400,b ' ALL. APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— - RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax .10.til LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING
Total 411.18 I 00.
By
APPLICANT OR AGENT
Approved Receipt No
�- REMARKS PLUMBING DATE
DATE INSP. TYKE INSPECTION _ -
-ti---- Contractor
— ��� ----- -- -- - -- -__ �/_7770 Permit NO./ �� 7Cr� 7� / '/
Rough-in
g -lLt-'ii8 _
Fixture
1O Final
HEATING
/ Con Sactor —_ o
PermitNo. 2? D'
or Oil _
Roughdn --
--
Find'
SEWER
Final
— i DRIVEWAY
--- — Final _
Storrh Drainage
- (Rein Drain)Final
Sidewalk
Curb&Street Final
Approach
T.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
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UILDiNG PERMIT APPLICA-1 �C 1�Y TSG-"RD GATE �- _- -�. ,s7c7 N°
a tINDF RSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE-
____ -_
cF, AS SH;)WN AND APPROVED IN THE A CNp N ING PLANS AND SPECIF ICAI IONS. OWNER PHONE �.
2 L� )� LOT NO.
-- HOME ADDRLSS 1&1-_ / (q � 4
k Q{/p�/(J JOEL ADDRESS 9,� Si wI1� , •�
ARCHITECT
R fn /^� ENGINEER
-4 _ ADDRESS I ,/ J DESIGNER
'l WE _ EW ❑REMODEL ❑ADDITION ❑HEPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
I NCI ❑ .r n�M ❑EDUCATIONAL ❑GOV'T ORELIGIOUSOPATIO ❑CAR PORT 9GAFAGE ❑STORAGE OSLAB• OFENCE
POND MOVING_ ❑CONDITIONAL USE DDLSIGN REVIEW _-- OCOUNCIL APPROVED ❑SIGNS
FANCY ^. AND USE ZONE_ " _.BLDG.TYPE__a1_�`l FIRE TONE_ PI AN CHECK BY ^ — HEAT
---- -3 -
N!?.STORIE5/_�� _L�REA__7 r—a►�4@EQ344 �?�1B1�x—�
BUILDING D—.-- ME N7 ,I SETBACKS FRONTyL ^_REAR! �1EF1 51DE w�-r, RIGHT SIDE
rrmit v
-----• ----- THIS PERMIT IS ISSUED SUBJECT 70 THE 110GUlAT10N5 CONTAINED IN THE BUILDING CODE, TONING
Flan Check , REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
---- — --1 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total n�� ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
_1c RE5TRICTIVF COVENANTS LONTRAC7OR AND SUB CONTRA`TORS TO HAVE CURRENT CITY BUSINESS
'state Tax + LICENSE SEPARATE PE RMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total / ,
by APPI ICANI OR AGENT
Approved Receipl No
AULiaESS
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CITY OF TIGARD
ORDINANCE 177-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE : ESTIMATED SALFS PRICE
APPLICANT NAME TELEPHONE _
DOB ADDRESS BLDG. PERMIT
AMOUNT OF FEE FOR S. D. C.
DESCRIPTION OF IMPROVEMENT
EXEMPTI7NS -PER ORDINANCE #77-26
FEE RATES:
A. Single family dwelling unit under 5j60,000. --------- 3300.00
H. Single family dwelling unit over. $60,000.--------- 3400.00
C. Mobile Home Court Space (New Gevelupmer,,;)---------- j150.00
D. multi-Family Dwe''llings--per unit------------------- 3240.00
E. Commercial, Indu3trial h Institutional(Park. Space) $ 50.00 each
F. Single fami y unit -oder $40,000. ----•------------- x;250.00
CITY OF TIGARD
ORDINANCE #77-71
I
PARK SYSTEM DEVELOPMENT CHARGE
DATE: ESTIMATED SALES PRICE $
APPLICANT NAML TELEPHONE
JOB ADDRESS BLDG. PERMIT #
AMOUNT OF FEE FOR P. D. C . _
DESCRIPTION OF IMPROVEMENT _._.
EXEMPTIONS - PER ORDIPANCE #77-71
FLE RATES:
A. Single family dwelling unit under $ 90,000.- ------ ..-----$ 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.E . __ N.W. SIDE OF S.W. PACIFIC
HIGHWAY . N.W . is Park Di, ;,71ct #I . S.E . is Park District #II .