15555 SW 123RD AVENUE F:
ADDRESS:
I err!6E65 . SW ! 3"A
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PLUMBING PIERMIT
CITY OF T I GARD DATE ERMIT .
P, -it. . . . . . . F-' M 9 h..ISSUED: 08/08/L 9660 c:9
CCMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Orogon 97223*6199 (503)639-4171 PARCEL- ..-S 11 OCB-0 1,20i,,A
517E P.DDRESS. 1,35,153 5W
SUBDIVISION. . . . : ZONING:
B L 0 C h�. . . . . . . . . . : LOT. . . . . . . . . . . . .
CLASS OF WORK. . :ADD GARBAGE DISFJOSALS. : 0 MOBILE I-AOICES. : 0
TYPIE OF USE. . . . :SF WASHING MACH. . . . . . : BACKFLOW
F,R S. . 0
0 BACKFLOW P1 ..
OCCUPANCY GRP,. R3 FLOOR DRAINS. . . . . : 0 TRAPIS. . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
FIXTURES-----___—___-__ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP'S. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHI:--R FIXTURES. . . . : 0
'TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . 0
WATER CLOSETS. . : 0 WATER LINE (ft ) . . . 0
L).' -)HWASHERS. . . . : 0 RAIN DRAIN (ft) . . . 0
Rem,ar-ks : Adding one water- heater.
Owner: FEES
RUTIA EDWARD type amol-trit by date r-ec:pt
15555 SW IL3RD P,RMT $ 25- 00 CJS 08/08/96 KING CITY
5P,CT $ 1. 25 CJS 08/08/96 KING CITY
KJNG CITY OR 97224
Phone #:
Contr-ac--tor:
COLUMBJA HEATING
P"C" BPly 230397
TIGARD OR 97281-039-7
Phone #: 6�4-2704 $ 26. 25 TOTAL
Req #. . : 76359
-------- REQU I RED INSPIECTIONS ---------
This permit is issued subject to the regulations contained in the Water, Line lrisp
Tigard Municipal Code, State of Ore. Specialty Codes and all other htisc. Inspection
applicable laws. All work will be done in accordance with Final '.Inspection
approved plans. This permit will expire if work is not started
within 1811 days of issuance, or if work is suspended for more
than 180 days,
P'et-mitlbpe
By :
cz
1--
V) Call For inspection 6391-4175
MAR-02_-'00,FRI_07:39 ID: FAX N0: #160 P03
Ci of T"i and P MBING PERMIT APPLICATION PlanoPe�it # rijE t �`l
City 9.
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Ndw glna IF� amlN Re—sldencrsOnbL
fwm HOUSE$140.00 ❑ 2 BATH HOUSE 5195.00
r� p 3 BATH tiOUSE$225.00
Job / r. ��._.�- Fee includes 311 plumbing 1tYtums in the dwelling and the fimt 100 feet
Address sewer and au)fm sewer. See fees below.
!�� ul vnater servlcb, sanitary
r„ _ �.NRBg pT'f PRIDE AMT
. 9.00
Sink
Lavatory 9.00
w +.•� -� 9.00
r
Tub or Tui�ISlsower Comb. ----�-.
Owner shower Only 9-00
oyer.
water Ctoe+st 9.00
Dtahasher 9.00
vr
i
�1 V Garbage OAposal 9.00
(/ A.... asning Machine 9.00
Occupant ,.r ..�,... W9.00
Floor Drax
=y Water Heater 9.00
I sundry Roorn Tray 9.00
00
Urinal
r..�. Other Fixtures (Specify) 9.00
9.00
Ng"a•^ 9.00
Contractor �y 2
n 9.09
mow. ! sewer let too, 30.00
Sewer-ea. Addit 1 W 25.00 -
rJn
C) Water Service tat 100' 30.00
� _( LLQ
2500
road
I herby eclrnowlecfgA Mat I have d this applicatton, that the Water Serviu ea.AAdit 200' 3000
Inrvnnalion givnn ie eorrnct that I am the owner or at�hslat43 agent of Storm 3 R9,in Pilln lit 100' —
ttle Domer. that plans submitted are in Compliance with State laws, that 25,00
I am registered vim the Construction Contr2cloYs Boand, that the Stotm +�Rain ---i- AddiL X00 __ 25.00
number given Is convct (If"tempt from State m9istr2tlon, Pi"aae Mobile Home Spacs
gN" re2non hal,ow.1 --.— Beek Fkw Prevention
9.00
Cevke or Anti-Pollution Device
nr. Any Trap or W24t" Not 9.00
sr+•l4aw V Connected to aFbdure
900
— Calch 8291n
p"vcribo Mork ^ adrfttion C alterob^^ repair l) ar]-00Rir _—
Insp. of Exist PIumDMg
to be dorso resldentlat (� non-,v%idrndal 7 40.00Rv
Speraaly Reauested Impechons
Illn 30.00
Exietin9 lice of Rain Drain. single family dwe g
a building or property _ ---- -- Rcsiden*81 bsrknow prev"ntion
1500
devices
Ln Proposed use of — —
budding or proPerty ._--- '(Otcopt rVivs/denda( bac" wo —
�- prwd"don devlceg)
'Minimum Feo $25.00 SUBTOTAL (C
LU l,,Z5
PERMITS BECOME vOIC IF vyURK OR CON5IRUC O
,1 SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 190 DAYS, OR IF —
FCNSTRUCTION O8WORK IS SUSPENDED
R A PER OD OF 190 DA7 AT ANY TiMFO rER WWORK E5 PLAN REVIEW 25% OF SUBTOTAL —
COMMENCED
TOTAL
Spec*ol Condnlana _ _
Oats issued by,�-Ste_._[[—
-(CITY OF TIGARD BSL &b I G I PE ON NOTICE
Inspection Line (Rec-C-Phone); 639-4175 Business Phone: 639-4171 lt�
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech, Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. Sari. Sewer Gas Line
Flby. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation
Underflr. Insul. Shear Wa I Gyp. Bd. --Elect.
Date Requested:_ �' Time: AM PM
Address: / 5�
Builder: Permit #; 1 c
THE FOLLOWING CORRECTIONS ARE REQUIRED:
- _.-
t
J
Inspector: — Date: !Y'
APPROVED DISAPPROVED P<APPROVED SUBJECT TO ABOVE
V` f _Call For Reinsp.
e,to O
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling Plu
Post/Beam Mach. Shear/Sheath Framing `Meeh.__:'
Plbg.Und!Flr/Slab Plbg.Top Out Insulation Elect.
Post/Beam Struct. Mach, Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line �y
Appr/Sdwlk Reins.
Other:
Date: 9 ',A...M`` P.M, try:
Address: �j ,�T SW / 2,3
� `
Tenant: `Ste::, MST:
Con/Own: t fit. ��- "��" f MEC: 71)
Z� ,J 3 PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _.
Inspector: �!y _. — Date:
APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO
P,E RM I T
. . . . . . . M E C 9 6—Q) 7 0
CITY OF TIGARD DATEPERMIT ISSUED: .
0
08/ 8/'�6
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639.4171 1-DARCEL: 2S I I 0CB-01 200
SITE ADDRES:.'). . . I r D HVL.
SUBDIVISION
ivL-
SUBDIVISION. . . . ZONING:
BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . . .
——----———————————
CLASS OF WORK. . :ADD FLOOR FURN. . . . : 0 EVr-,P COOLERS. 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . . 0
O(--'ClJPANCY GRP. . R3 VENTS W/O APIPL: CA VENT SYSTEMS: 0
STORIES. . . . . . . . 0
i BOILERS/COMPRESSORS HOODS. . . . . . . c 0
FUEL 0-3 HID. . . . : 0 DOMES. ;INC IN. 0
: ."GAS/ 3-1.5 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15..-•-30 HP. . . . : 0 REPAIR UNITS: 0
P I RE DAMPE R1.3.?. . 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . 50+ HP. . . . : 0 CLO DRYERS. . .- 0
NO. OF AIR HANDLING UN I TS OTHER UNITS. : 0
PURN ( 100K BTU: 1 (:::L 10000 cfm : I GAS OUTLETS. - I
FURN ) =100K BTU: 0 ) 10000 cfm : 0
Remar,l(s : Alteration of a fi-ir-nacre to 100K BTUs, addition of a air- handling 1-tnit
0
10K and gas Piping to fOU" OLktletS.
Owner-: FEES
I-WTH EDWARDS type a M o 1.(11 t by date r-ecpt
5
1555 SW 123RD PR*!T $ 25. 00 CJS 08/08/96 KING CITY
5F'CT $ 1. 25 CJS 06/08/96 KING C ITY
KING CITY' OR 97224
Phone #:
Contractor,:
COLUMBIA HEATING
PO BOX 230397
TIGARD OR 97281 --------------------1-----------------
1-f-ione, #- 624-2704 -.'.E•. 25 TOTOL
Reg #. . : 76359
REUUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mecclan ical Insp
applicable laws. All work will be done in accordance with 11`13-SU. Inspection
approved plans. This permit will expire if work is not started Final Inspection
within IN days of issuance, or if work is suspendea for more
than 180 days,
i ,er-mittee Sioff nati.tt,e:
Issf-ted By:
Call fat- inspection 639-4175
MHR_02--'00_FR-I 07:39 IV: FAQ hJC+: t#160 P02
-- MECHANICAL PERMIT Pianck/Rec. #
.City of Tigan; Permit #
1312.5 SW Hao Blvd. APPLICATION
Tigard, OR 97223
(503) 639-4171
ascription pTY PRICE AMI
r Table 3A Mechanical Code —�
J
�.
.0
t) Permit F•te -0 10.00
Aub
AddresS 2) SuPplemental Permit 3,00
umac 4TWTM-31a —
6.00 t�
1) incl.ducts a vents —
urnace r
7.50
y ;) incl duds&vents
Owner • or u(nanca 6.00
3) Incl,vent
-S—.—.Peneater,w-ja eater' 6,00
nn 4) or floor mounted hearer
-LSA on n6rvW.in 3.00
occupant5)_ appliance permit
Pa r o "tj,. re ng. 6.00
cooling.abr:orpalo(`unit
��.._ i er or c ump, ea pump,air con B.00
71 to 3 HP;ebsorp unit', t00K 8111
r er or comp,-T1oa pump.err can 11,rJ0
R) 3.15 HP;absory unit to 500K BTU
COntrOC'.Or (�• .IL.1L.L. r or or comp.na11 A pump, arr Cort1500
A) 15-30 HP;absorp unit.5-1 mit EiTU
' !I Wr`ar comb, eat pump,air ron
U to) 3o-50 HP;absap Wit 1-1.76 mil 6TU 2Z•50
1 5, . L.
I - ✓ to E�oiTer or comp. a pump,err can .
care Y ec rte i+ ya is avn 3 'x sg��eYon' t 1 >5o HP.absorp uttil 1.75 mit BTU 37.60
inforrnailon given is coITact,U,at I am the owner or authorized sg"m ) it T7an unit oi—
of the owne(•that plans suhminad are in complianon with Starr CFM 4.50 tel/
laws,that 1 am rogistsrwd with the Consiniction Contractor's Board, 12) 1irT7a Funi —�
that tho number given Is correct. 13)exempt hom State registration, 5i;zillill13 10,000 CTM+ 7 SO
laasv a reason below) ) ---�--"-
P 9�v —_.__..__._--------•------- on I,oita a 4.50
14) evaporate cooler
3,00
15) to n single duct
/-- - V-ettdlauon system not A 5Q
lO' -7 �� 1G) inoluded in appliances P-rmrr.
- J.50
17` R1BGhaniral exhaust
Z"ortrnierua o1 r whau+td4T 30,00
esus w—orTc–'neW a uon eTiora en II—rt+yair 1g) typo incinerator
to be done residential( non-resldardiai O
er t e.,Wo s ove,wa r 4.50
Its by use 0T� 1r• heater, solar,ciottes dryers.Mc. _-
�" building or property
in on*to row Outlets 2.00
20) Gas piping ,-- -
Prepnsed use of
`) building of DroPei'ty ,— _
21) More than 4-per outlet
Olectnr (�
Type of'JOI oil Q natural gas d LPG O --
r. --- FJa -- sUP-OTAL _ S
Minimum Fee nuo
c� -
w
-i PERMITS BECOME vOtD IF WORK OR CONSTRUCTION SX SURCHARGE
AUTHOgIZED IS NOT COMMENCED WITHIN 180 DAYS,OR
IF CONSTRUCTION OR WORK 15 S1.ISPEN0E0 OR
ABANDONED FOR A PERIOD OF 16o DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
APTFFA WORK IS COMMENCED. TOTAL
- - -
Special Conditions
Data Issued (�- _�.�..-
CITY OF TIGARDMASTERF'ERMIT 4 + PERMITIhST94-01Lr0
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/19/94
13125 SW Hail Blvd.Tigard,Oregon 97223.8199 (503)339-4171
- PARCEL 2S110CB-01 :00
SITE ADDRESS. . . : 15555 'SW IL3RL AVE
SUBD1V1510N. . . . : j6 h Cy T ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
_______._____________._____.___----•-_-___. BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :ADD BEDRMS: 1 BATHS:O GARAGE. . . . . . . . . . :0 sf
TYPE OF USG, . . :SF FLOOR AREAS---------- REQUIRED SETBACKS-----------__
TYPE OF CONST. :5N F.IRST. . . . : 162 sf LF;FT. . :0 ft RIGHT. :`; ft
OCCUPANCY GRP. :R3 SECOND. . . :0 sf FRONT. :25 ft REAR. . :0 ft
STORIES'. . . . . . . : .1 THIRD. . . . :0 sf REG?UIRED ---___--__---__._._____._.
HEIGHT. . . . . . . . . 12 fit TOTAL----: 162 sf SMOKE DETECTORS.
FLOOR LOAD. . . . :40 psf VALUE. . . . . : 7452 PARKING SPACES. - :0
Remarks : ADDITION OF 162 SO FT
--------------------------------- PLUMBING -
SINKS. . . . . . . . . . :121 FLOOR DRAINS. . . . :0 BACKF LOW PREVNTRS. . :0
LAVATONIES. . . . . :0 WATER HEATERS. . . :0 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :0 LAUNDRY T RAYS. . . :0 CATCH BASINS. . . . . . . Z 0
WATER CLOSETS. . :O SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 WATER LINE (ft ) . :O OTHER FIXTURES. . . . . ..0
GARBAGE DISP. . . :O RAIN DRAIN (ft ) . :O
WASHING MACH. . . :2 SF RAIN DRA I:NS. . :0
--------------- MECHANICAL MECHANICAL -_-_--_._.__---__.-_ _--_.._.___.-__.___..---___.. FEES -_---_--__-.__-...
FUEL TYPES----------- UNIT HTRS. . :0 t/pe amount by date recpt
/UPS/ / / VENTS . : 1 BPRT f 66. 50 SW 04/19/94 -
MAX INPUT:O BTU VENT F-ANS. . -0 BPl_C $ 44. 5:3 JL-14 04/1 1/94 94-2'In I ;
F•URN ( 100K . . :0 HOODS. . . . . . .0 B5PC $ 3. 43 SW 04/19/94 --
T=URN ) =1.017.1K ,. . :0 WOODSTOYE:S. :0 MPRT $ i 15). 00 SW 04.E 19/94 -
FLOOR FURN. . . . :0 CLO DRYERS. : 0 M5PC $ 1. 25 SW 04/19/94 -
FOIL/CMF' l ;I TI=':0 OTHER UNIT5:0
GAS OUTLETS:O
Owner:
OLAF' ULF STAD
15555 SW 123RD
KING CITY OR 97224
Ph-ne it., 624-.9695
Co ,t react rrr: ----.__--..__.__-_--_--___---_----
I' iERIOR REVISIONS
vi BUX 1372
BEAVERTON OR 97075
Phone #: 781-7762
Req #1. . : 75988 -----------------------•---------------.
N $ 142. 71 1OTAI_
This art-sit is issued subiect to the regulations contained in the ------- REQUIRED INEF'ECTIONS -- --- -
Tigard Municipal Code, State of Ore. Specialty Codr, and all other Fact/found Insp Mechanical Fina,
applicable laws. All work will be done in a.cordarce with approved Post/Beam Struct Building Final
plans. Tbis cerait will expire if work is not started within 180 Post /Beam Mechan Erosion Control
days of issuance, or if work is !uspend for• eor•e than ;80 days. Mechanical Insp Crawl Drain
Framing Insp
F'er . i.ttee Signatur e : _Y _ Insulation Insp _
_
Gyp Board Insp
Issued By ` �. _.__. __......... - _ _ ----.._ Rain drain Insp
Call for inspection - 639-4175
Residential Building Permit Application
City of Tigard
131,Z5 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: � I 1 Z -)0-�:-'
Office Use Only
,/Subdivision:, � ' � lot #
cs_ PlandcfRec#
Valuation: �-
Permit # �- ( .
-1bwner. L,Nth. t> Reissue of
Address: 155,55 ',:)v4 I Z=', Q.12 Map & TL #
C.,—'`r
Approvals Required
Phone:
Planning
L,-16ontractor. Engineering
Address: �U,��'�'� 1'-'�Z Other _
Items Required
Phone: 7t31`�-TSL- _
Subcontractors
Contracts s license # CC-3 -1-A
(attach copy of current Oregon license) Truss Details
Subcontr, 'ors: Other —
Plumbing: _
Vechanical: KAn-n`_r _1 tAk: \t-% A "C- �W4:,rr..,..4.►)
(attach copy of current OR Contractcr's License)
2, �5
(Archlt2iFngineer-, -CAL-14- 1,J L. 1 aAM� uF
Address: %Z4Z?_ ���rl �ttAFc:�wAZ
~ Phone: (,44 -07_`1 q �_
J f
COMMENTS:
J
"licant Signature & Phone number
Received by: Date Received:
Permit Account Description Amount Amt. Pd. Bal. Due
Bldg. Perm.t (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH) J o'�_ _ v)� . Lir/✓
State Tax (TAX)
Bldg: .�• �� /
Plumb:
Mech:
Plan Check (PLANCK)
Bldg: -3 ci
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF MT)
Commercia! TIF (TIF-C)
Industrial TIF (TIF-1)
1 Institutional TIF (TIF-IS)
ti
Office TIF (TIF-0)
Water Quality (WOUAL)
t
Water Quantity (WQUANT)
J
Fire District (FIRE)
TOTALS: ,
lq2. ti
AP-'-_1-'`=%4 MOtJ 11: 17 I D:C 1 TY OF K I II, CITY` FAX N0:503 639-3771 4391 P01
Post-It"brand tax transr.dttai memo 7671 Nof peg_
KING CITY (t F\ F \ Fro�C SSC lL) I I U t
)�,Adco. Co.
�. ��� <d K
la?0O S.W.116th Avenue,king City.Oregon J.'..1 Phony �--� Phone N
COMMUNITY Dept. 4 �-A . L�i�n`�
APPLICATION FOR Fax
(Instructions on
DAM
1. NAME OF APPLICANT: k; (V l- t) Phcne No. Z S
ADDRESS: �� - Q �� c c! v, r 1�_ NC--.(
ADDRESS OF PROPOSED IM3?ROVD"IDVT Seek..
2. TYPE OF CHANGE, IMPROVDWn OR CONSTRUCTION FOR NMICH PEFMIT IS RE JESTED.
DESCRIBE BRIEFLY - ATTACH TWO COPIES OF PLANS OR DRAWiNG� OF
PROPOSED PROJECT._-—._--�r _r I- �_
3. NAME AND ADDRESS OF CONTRACTOR T t"\om .Aa K tZ�.0�5 ��S ��
PHONE NO. l l - :2,)&2 IC:ENSE NO. S` 2 S z��
<71 Irl 5
4. NEIGHBORS 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 COMMISSION
MEETING NEXT MELD ON__
REPRESENTATIVES NAME PHONE NO. _
(Phe King City Planning Comaission will consider onl ose applic ions received at least five (5) days
prior to a meeting.)
SIGNATURE
***************�r***************�*�•**�x*#****************�*,r****�*wry***�**�***�****
APPLICATION RECEIVED BY �1 —-` DATE zgj _
-
APPLICABLE FEE RECEIVED
PLANNING COMISSION DECISION: Approved_„-________.-__ Denied
CONDITIONS.`3�C.z 1
-
Approved applications are valid for sit months only r
Signature Date___ �"«
ROPE: Oregon uild s Law requires that all persons wbo cot,tract tot work oa their residence 1ie
tegistered vith the Builders Board which mans the contra:tor is bonded and insured on the job site.
for your protection, be certain your ccntractot is registered by calling City Hall Ph: 634-4092.
ROTE: A permit mus_ also be obtained from the City of Tigard Department of
Cam=Uty Developffmt Yes- �^ No
CITY OF TIGARD INSPECTI:_0�1�EPORT
w
-� The above listed projecthas been inspected and Approved___Denir-.d_
Date Ccmnents__
Signature
(Ru,i,lding AAAir atoa ptea4z Rahwt oniz ( 1) ropy is Kling N;tyI
CD 2-81
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . BUP94-006;
13'25 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)839-4171 DATE ISSUED: 0#/0f/'34
629--4171
PARCEL: I S136CD-0'&400
SITE ADDRESS— 1. 1660 SW 79TH AVE
SUBDIVISION. . . . : TWIN OAKS LANE: ZONING: C-iS
BLOCK. . . . . . . . . . . LU'T. . . . . . . . . . . . . : 18
REISSUE: FLOOR AREAS--- -- -- --- EXTERIOR WALL. CONSTRUCTION--
CLASS OF WORiK. :DEM FIRST. . . . : sf N: S: E: W.
TYPE UF. USE. . . :SF SECOND. . . : sf PROTECT - --
I'YPE OF CONST. :5N THIRD. . . . : sf N: S: E: W:
UC(:;UPATUC:Y GRP. : R3 TOTAL------: 0 sf ROOF CONST: FIRE RET'?:
UCLUPPNCY LOAD: BASEMENT : sf AREA SEP. RATED:
STOR. : i-if. : ft fiARAGE. . . : sf OCCU SEF'. RATED-,
DSMT? : ME7.2? : REDD SETBACKS-- -- REQUIRED--------------------
f-LOOR LOPD. . . . : p5 f` LEFT: ft RGHT: ft F'IR SPKL: SMOK DET. . :
DWELLING UNITS: FRNT: ft REAR: ft FIR 'IRM: HNDICP ACC:
13E DRMS: BA'i FIS I hiP SURFACE: PRO L,.,RF. PARKING:
Vf-1LUE. $ : 0
(Ze m ar"k s : SEPTIC TO 8E PUMPED, FILLED & INSPECTED. SEWER 1viUST BE CAP'P'ED OFF AND
I 'SP'EC*TE D
C;ommer,cial/Planned
Development ) . (WCTM 1S1 36CD, tar, lots 2200, 2300, '40Qr, 2500, 2600, 2:700, E,800,
2900, 3000, 3100, 3-200, 3300, 3400, 3500, 3600, 3700, 3BLAID, 3900, 4000- t , 'T0, �:,
1
LOA, tax lot c�00 and :-_'S1 IBB, tax ).ot 1201.
� r: caner: --__.___-__..___________________._.. FEES
COSI CCI WHULESAI_F' type amoi.mt by date recpt
1.0809 120TH AVENUE. NE PRMT $ 25. 00 Jfi 03/08/94
/]17.V_ 5RCT f 1. 25 JH 0?/08/94 --
K I RKLAND WA 98 ,33
'hone #: 206-828-8100
Contractor: -
k. LEE RUBINSON CONSTRUCTION
7320 SW HUNLIKER ST. SUITE 300
T'I CARD OR 97223
Phone #: 645-8531 $ 26. 25 TOTAL
Reg #. . : 63147
-------- REQUIRED INSPECTIONS
This perait is issued subject to the regulations contained in the Pl-tmp/Fi l 1 Septic
Tigard Municipal Code, State of Ore. Specialty Codes and all other Cap sewer line
- applicable laws. All work will be done in accordance with Final Inspection
�n approved plans. 'his permit -iill expire if work is not started
> within 180 days of issuance, or if work is suspended for sore
~ than 180 days.
J - -
W
ermittee Signatur^e:
Issi..led By: J
Call for, inspection - 639-4175
Pesidential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: 16W _ C( t"' / k
Subdivision: Lot # Z UC OWce Use Only
PI3nC"E G#
Valuation:
I Permit #
Owner: �f i C C C os4c• 0 Reissue of
Address: 6 A d N A Maly&TL #
K %A Gj-)A 901377
Phone: Approvals Required
Panning
Contractor: r�,ns o ►► Co��S�r�(cro�� 1,� , Engu,�e�i,g
Address: J r og Other. ,
Phone: .50 3 - 6 Y s Y' S 3 1 Items Required
Contractor's License # b .3 )y 7 Sub.Contractors
(attach copy of current Oregon tic Anse) cuss Details
Subcontractors: her '
Plumbing:
Mechanical:
i
(attach copy of current OR Contractor's License)
Architect/Engineer:
a .f.
Address:
w
Phone:
� COMMENTS: (U1aV ian
.d1d 6)0
Applicarn Srgnatur 8 F16one number