15535 SW 123RD AVENUE ADDRESS:
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223.6199 (603)639-4171
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INSPECTION NOTICE*
City of Tigard Building Deparboent
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Linn (Rec-0
0-)Phone): 639-4175 Business Phoi4r 619-4171
Inspection:
Footing Plbg. Underslab Meeh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL%
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rai, Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requested% G ��) -- - _ -Tiat L
___AM LLPM
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Addrn ass
Buildor:__ 1/y� �,1 D.y��fl�.
THE FOLLOWING COR^r.CTIONS ARE REQUIRED:
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Inapttctors Datat_--�
APPROVED DISAPPROV20 APPROVED 89IIJRC4 TO Rao"
Call For Reinap.
OF
( T �l13125 sw Hsu Ulwi PLNCK/RECTCI 1TY �,1�Tt ARD PERMIT # ---
COMMUNITY DEVELOI'MEN'I'i11-,PAIt'1'Kli,'Nl' T7(503)6cg1-4171on 3
(Sa3,639-.17' DATE Issuro
JOB ADDRESS: if r�� lam'' /�� �1 TAX MAP/LOT
SUB: _ LOT: LAND USF:
VALUATION:
OWNER SPECIAL NOTES
NAME: �� ��� C�[.�r REISSUE OF:
ADDRESS: I �l �� fGL' /�„� LAST REISSUE:
FLOOD PLAIN/
PHONE: SENSITIVE LAND:
CCONTRACTOR \ APPROVALS REQUIRED
NAMf� I'��ii•r =rG.".�/�.� ) ��s � PLANNING: _ --
ADDRESS: 2j (� % _ ENGINEERING: _—
�G -� FIRE DEPT: _
PHONE: - _ OTHER: —
CONTR. BOARD #: ` �� �7 � EXP DATE: y __
ITRIS REQUIRED
SUBCONTRACTORS: PLUMB: "'C�%t' __ LIST/SUBCONTRACTORS: .
MECH: __- BUS TAX:
ARCH ENGINEER CALCULATIONS: _
NAME: ;y%r! ---_ ---_-- _— HUSS DETAILS:
ADDRESS: — OTHER: _�----- --------------
PHONE: -- -- - —
PROPOSED BLDG. USE: --- -- _ .�___— _ -------- -- --
COMMENTS: — -- -- --
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APPLICANT SIGNATURE
Received By: _, a___ __— nate Received:
PERMIT # ACC-1 # DESCRIPTION AMrIUNT AMOUNT PD. BAL. DUE
,7 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building 1_�_
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire
30-202. 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Conunercial TIF Fees
25-448-04 Industrial TIF Fees
25-4,18-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees _
52-449 00 Parks System Dev Charge (PDC) _ _.-
31-450 00 Storm Drainage Syst Dev Chrq
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
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TOTAL 2J
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CITY OF' TIGARD RECEIPT OF PAYMENT RE CE I r.,"r NO. :93-243672
CHECK AMOUNT 40. 43
NAME ROCKWELL, ALLEN CASH AMOUNT 0. 00
A r)1)R E Sl- 15535 123RD PAYMENT DATE: 08/8'7/93
KING CITY, OR SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
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BUII,,.DING PERM 38. 50 ST. BUILD PER 1 . 93
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RE--ROOF
TOTAL AMOUNT PAID 40. 43
AU5-2'7-'97 FRI 13:35 ID:CITY OF KING CITY FAX NO:503 539-3771 4974 P02
KING CITY
e 1ts� i5300 SK! 116th Avenue.King City,Oregon 9—=4 Phone:639-408?
COMMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instructions an reverse)
DATE 6F 9 p
1. PiAME OF APPLI�i�'T: �n
_ P� ' c&4hone No. / " �
ADDRESS: r rc'✓ �l Aff –
ADDRESS OF POSED !KPROVEKOT fig-ow
2, TYPE OF C ANNE, IMPROVDOM OR CONSTRUCTION FOR WH I Ci NIAM I T IS REQUESTED-
DESCRIBE BRIEFLY - ATTACH TWO COPIES CF PLANS OR DPAWIIIGS OF
PROPOSED PROJECT: �tf'0y �x
tv r*n &Q e 2 Q -
3. NAME: AND ADDRESS OF CONTRACI'OR 0 -
-_--- PHONE NO._�L 1015E NO.
4. NEI(A-MORS WHO MAY BE AFFECTED BY THIS PROJECT WILL. BE NOTIFIED BY THE CITY.
S. APPLICANT OR HER/HIS REPRESENTATIVE MUST BE PRESENT AT THE PLANNING C31MISSION
MEETING NEXT HEIR ON— _
REPRESENTATIVFS NAME _ PHONE NO.--
(?he Ring Citl Planning Conuissioo Bill consider onll those applications received at least five (S) daps
prior to a meeting.)
SIGNATURE _
APPLICATION RECEIVED 8Y � ? DATE�Z
APPLICABLE FEE RECErM $_`�- _ TOTAL
PLANNING CcWISSION ZSCISION: Approved_-.�<,------� Denied
C1CVDTTIONS —
F _ spprnved app 'cations are valid for sir months call
Signature
Dente r
10TR: ore a 6aaebuilders 6a■ requires that all persons who contract for work a their residence be
registered with the Builders Board which scans the contractor is bonded and insured an the job site.
for your protection, he certain lour contractar is registered by Calling City gall Ph: 639-4007.
ROTE: A permit must also be obtained fr the City of Tigard Department of
Ccmnz-d ty De ve l o;n*n: Yes No
CITY OF TIC;ARD INSPECTION REPORT
The above listed project has been inspected and Approved_ Denied
Date _ Carmen ts, -----
Signature.
(&LUd mg .0 pe-ctm p an al A&tut.n one ( 1 ) copy to King C:U4)
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