11920 SW 127TH PLACE 1
I
i
t`1
I
.r 1.w •
SI% '
N
'r
I'I '
�I
14ar,
r
uwrIFICATU OF'
CfTY OF TIFA RD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENrl l,ERMIT ti. . . . . . . .. 11ST91
13125 SW Noll Blvd. P.O.Hcw 23397,Toud,Oregon 9i2J59T�vlr,
nATE' MIJET' 01/2-T'92
'3111-1 ADDRESIG— z 119pi3 .31W 127TI-I PL PARrm—
'WBDIVIGION. . . . t VILLAGE rtT SUMMER LAKE PARK 4 70NINUt R--4- 5
LALOCK. . . . . . . . . . s LOT. . . . . . . . . ..
CLAS„ OF WORI-',. sNEW
TYPE OF USE. . . :SF
OCCUPANCY GRP. -R3
OCCUPANCY LOAD:2'22'
TENANT NAME.
Re m,�rks
Ownor:
DON MOR IGGETTE BUILDF--'Rr,, 1111C.
13555 SW BANGY RD.
0201
i-AKE OS;WFG0 OR 97035
Phone *: 020-7538
OON MORISS17TTE BUILDERS, INC.
115555 SW BANDY RD.
44301
I-AKE OSWEGO OR 91035
(1horte #. 620-75,33
[?.ep 0. . c 35533
lAccotpanry of the above referenced bull(ling is hereby giverl, and Certifies
che q::ompJjanu@ with the State OF Oregon GptcialtY C0d9s fot" the group,
m.,cupancy
r , and use under wt-i:k refer the refepocepermitt wAs iKZLlLPd-
.
FIRE DEPARTMr-NI /-StIll-DINS lNcJlF-CT9
I C,I AL
PU I t-El I Ncl
IN CONSPICUOUS PLACt.:-
INSPECTT1i NOTICE
City of Tign-1 Buf_ldinq Dep%rtsent
13125 SW hall Blvd. Tigard, oregon 97723
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-•4171
Inspection: ---
Footing Plbg. Underslab Hoch. Rough-in Appr%Sdtilk
Found. Plbg. Top Out Gas Line ►IKALt
Poet/Beam Struct. San. Sewer Framing -Bldg.)
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Wates. Lina �j Gyp. Bd. -Hach
Date Raquestedt _T —•
Address: 4,2 / '�4- zfJ Permit R:�1 �7�
Builder:-.fes /1._1)i - _::3
THE FOLLOWING CORM TONS ARE REQUIREDt
Inspector= . _ -_. _ Date L X r J L
APPROVED DISAPPROVED APPPOVEn SUBJF!.`T TO ABOVE
__ ^all For Reinap.
r
tman
INSPE4TION NOTIr_E
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueineee Phone: 639-4171
Inspection:_
Footing Plbg. Undaralab itech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rein Drain Insulation -Plu�mli )
Plbg. Underfloor Water Lina Gyp. Bd. -Mach_.
Dater Requested: �_ �' Timet _CJ � A/M' PM
Addreen: 7 a� !ermit it
Builders _ yh �_� 65 S Ar
THE FOLLOMING CORRECTIC 18 ARE REQOIREDt
rt ,
Data:
APPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE
Call For Reinap.
y�K, t41�l�J1✓(,.
Y"•;I
INSPECTION N01 iCE /
City of Tigard building Orpartafent
13123 Std Hall Blvd. Tigard, oregon 97223
Inspection Line (Rec-O-Phone), 639-4175 Businena Phone-. 639-4171
Inspection:_ — ---
Footing Plbg. Underelab Mach. Rough--in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL.
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: z .2L= Timet _SAM PN
Address (j 7 046. ele-e- Permit #tC&-a11/ 1
Builder:
T.49 FOLLOWING CORRECTIONS ARE REQUIREDt
.� -�-
Dates _
i
t
APPROVED DISAPPROVRD APPROVED SUMdMCT TO AMDVM
Call For Reinsp.
INSPECTION NOTICE
city of Yigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175 Busineer Phone: 639-4171
inspection: '0��5 9,� '
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underll.ror Water Line Gyp. Bd• ,-[Mach.
- ' fJ ��� Time: /—AM PM
Date Requesteds�
Addresse �.n6�^� �� T�" Permit is =� I
Builders
THE FOLLOWING CORRECTION3 ARE REQUIRED:
Inspectors __-- Date:L_ __1,,(l
APPROVEL DISAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinsp.
w F Fe.
1NSPMCTIOH NOTICE
City of Tigard Buildiny Departsent
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phonel: 639-41.75 Brininess Phone 639-4171
Inspections - -----__--- --_-- -----------
Footing Plbg. Undecslab Mach. Rough-in A[,pr/Sdwlk
Pound. Plbg. Top Out Ga■ Line FINAL:
Poet/Ream Struct. San. Sewe ' Framing -Bldg.
Post/Bram Mach. Rain Drain Insulation --Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requersted:- 1�-_�(i !^%�� Timet AN PM
Address:-_ )�� 1�F7+� Z.� ) / /'_� Pormit
THE FOLLOWING ODARZCTIOZZ ARM RZWIRZDI
lnapectort-_---._ ` _ _ _--- Date: zj-
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Ca'.1 For Relnap.
� '� ►1!F It ® O � �'
INSpF.cTIO NICE
City of Ti7ard Building DeP--t—t
13125 Sit H►11 Blvd- Tigard, Oregon 97223
Inspection Line (Rec-C,-Phone): 639-4175 Business Phone: 639-4171
inspection:
p r
bg, Neck• Rough--in PPSdwlk
/
Footing t+nderelab
Found. Ylbg• Top Out
Cas Line FINAL=
��.'Ftamin�1) -Bldg.
poet/Beam Struct. San. Sewer � -�
Rain Drain
insulation -pl .
Post/Beam much.
plbq. Underfloor water L:nr
gyp. Bd. -Mect:.
Time: --AM
PM
Dat" Requested: r
'� �C Permit #:
pddroeel
Lailder: —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1napector: Dat
_____
APPROVED DISAPPRO•!ED APPROVED SUBJE!'T TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Departt:ent
13125 SA Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639--4175 Business Phone: 63I-4171
Inspection• —
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Ream Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
`
Date Roqueeted: �(' ( //�� Tis
Addreaa• 7 �`� 7 /-� Permit
Builder
THE F=ONING CORRECTIONS ARE REQUIRED:
ZA 0444A04 9-'
Inspectors ! Y Dates_ / 1. - i e,
APPROVED __ DIBAPPROVED APPROVED SUBJECT TD ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Pec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footinq Mg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Pl Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb. g
Plbg. Underfloor Water Line � Gyp. Bd. -Hoch.
Date Requesteds --5-
C r��
% _-_Ti..TiAM PM
` Q
Address: '/J_2 7 `�� � _ Permit #s,12"
Hullder:
TTIP FOLLOWING CORRECTION8 ARE REQUIRED:
Inspectors Date t 2 rK T
APPROVED DISAPPROVED APPROVED 8VW2CT TD ABOVE
Call For Reinap.
LNSPECTTON NOTICE
City of Tigard Building Departaent
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineso Phone: 639-4171
Inspections - -- -
Footing Plbg. Underslab h. Rough-in Appr/Sdwlk
Found. Plbg. Top Out ine FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation --Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requesteds /-;:? - J eF/ Time: AM _/ PM
Address: LLZ2Z;2 :z 1'_2 �x.r 'Permit #1=&
Builders ZQZ22
THE FOLLOWING OORRECTIONS ARE REQUIRED:
Inspectors 2 ---- -- - Date: 2
A. m "j-1 nTSAPPROVED APPROVED SUBJECT TO ABOVE
1 Call For Reinnp.
Ulm
INSPECTION NOTICE
City of Tigard Building Department f
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-J-Phone): 639-4175 Businees Phone: 639-4171
Lumpections
Footing Plbg. Unde:slao Mech. Rough-in Appr/Sdwlk
Found. Pibg. Top out Cas Line FINAL:
et/Beam Strutt. San. Sewer Framing -Bldg.
oat/Beam Meeh\` Rain Draln Insulation -Plumb.
Plbg. Underfloor Water Line / Cyp. Sd. -Hach.
Date Requesteed/s_ zo �aS'_ !lTimes PM
Address:_, // �7 /� Permit #t �r
Bu i lder12 ----
THE POLLOMING CORRECTIONS ARE REQUIRED:
Inspettort _- Dates fG)
APPRMD DISAPPROVRC APPROVED BU .?ECT TO ABOVE
call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Gregor) 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:—�
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. P1Lg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -81.dg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
P Underfloor�l Water Line Gyp. Bd. -Mach.
Data Requested! ZL) �-s � Time: AM _.PM
f/rlaJ /�,rL
Addreus ` ._ Permit
Buildert.L ,�3� fJ/7LJ
THE FOLLOWING CORRECTIONS ARE REQUIRED: c7
Inspectore Date$
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
_,Call For Ralnap. i
j
a
i
INSPECTION NOTICE
City of Tigard Building Department
13125 OW Hall Blvd. Tigard, Oregon 9722"
Inspection Line (Rec-O-Phone): 639-4175 Business none: 639-4171
Inspection• _ —
� -)oting Plbg. Underslab Mech. Rough-in Appr/Sdwlk
F r,nd. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. an. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line 1 Gyp. Bd. -Hoch.
Onto Requested: - -•/�� Times AM ��PH
Address: 1 Permit
Builder:
THE FOLLOW100 OORRECTIONS ARE REQUIRED:
Inspectors 1 Data: /C- �~'
t
i
INSPECTION NOTICB
City of Tigard Building Departasent
15125 SN Hall Blvd. Tigard, oregon 97223
Inspection Line kRec-O-Phone): 639-41.75 Business Phone. 639-4171
Inspection i__-- — - `--
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
�IpWnd Plbg. Top Out Gas Lisle FINAL/
Post/Beam Struct_. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation
Plumb.
Plbg. Underfloor hater Line Gyp. Bd. -Mach.
/ �7 _ f.
Date Reyuenl'std• O—AM
-
Addrees:� '' .ti I" Permit #1' "/
Builder:_ --.- --
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
Inn t rn Date A:>
Ln,
API'RI,Vr L! I71.`7AI'I`P(7V rI! API'n•T✓Pn $ORJ1M TO wIM
`fro
CITYOFTIGARD MASTER PERMIT
CnyOFTWARD' IDERMT T #. . . . . . . : 1*1ST91 •-0l61
COMMUNITY DEVELOPMENT DEPARTMENT onoa, �
131:26 SW FWI Blvd. P.O.Box 23307,TOW,Or"m 07223(603)8,90-4176 �/
6,,4-4171 DATE ISS = • 1 /
SITE ADDRESS. . . : 1. 19,='0 SW 1. _'7TH PL_ P'4RCEL: 1 S 133DD--136OV
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE FARE, 4 Z A I NG: R-4. 5
BLOCK. . . . . . . . . . . 1-01.. . . . . . . . . . . . . : 173
BUIL DING -------------------------------------------
REISSUE:
--____--__.-.- ._-.__------------__.__-___REISSUE: DWELL-I NG UN I T 5. 1 BASEMENT. . . . . . . . :0 s f
CLASS OF WORK. :NEW PEDRMS:4 PATHS:3 GARAGE. . . . . . . . . . :-9C of
TYPE OF USE. . . :SF FLOOR AREAS ---__._._..._.___.._ REQUIRED SETBACKS - -----•----
i•YPE OF CONST. :5N FIRST. . . . : 1170 sf" LEFT. . :5 ft RIGHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . : 1,390 s f FRONT. :-:'O Ft REAR. . :40 f-t
STORIES. . . . . . . :E' THIRD. . . . :0 S REOUIRED-
HEIGHT. . . . . . . . .22 ft TOTAL--•--•---:E:560 sf SMOKE_ DETECTOR5. :Y
FLOOR LOAD. . . . :40 ps f VAL.UE. . . . . $ : 128461 PARK I NG SPACES. . : I
Remarks : construct SFD. See VAR 91-0015 for variance to solar access ord.
PLUMBING
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PRL-`VNTRS. . :O
LAVATORIES. . . . . :3 WATER HEATERS. . . : i TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . : LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE (f•t ) . :0 GREASE TRAPS. . . . . . . :0
G I SHWASHERS. . . . : 1. WATER LINE (ft ) . : 100 OTI4E'R FIXTURES. . . . . :0
GARBAGE D I SF'. . . : 1 RAIN DRAIN (ft ) . :0
WASHING MACH. . . : 1 SF RAIN DRA1NS. . : 1.
_______________ ME"CHANICAI.. -----________--_ _______.___---__.__ FEES
P"UF_L. TYPES ------_ --- UNIT HTRS. . :0 type amount by date recpt.
/GAS/ / / VENTS . . . . . :0 TIF $ 1380. 00 JLH 10/14/91 --
MAX INPUT :O BTU VENT FANS. . :3 BPP.T f 505. 30 JI__H 10/14/91 --
FURN ( ' )0K . . : I HOODS. . . . . . : i BPLC f 328. 58 JLH 10/14/91 -
FURN ) =1.00K . . :0 WOOD31-OVE S. :0 P5PC $ 25. 28 JL.H 10/14/91
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC E 375. 00 JLH 10/14/91
BOIL/CMP ( 3HP:0 OTHER UNITS:O PARK 4 250. 00 JLH 10: 14/91
GAS OUTL.ETS: 1 MPRT $ 36. 00 JLH 10/14/91
Owner: ---_---- •-_.___________._._______.________ MF'LC f 9. 00 JLH 10/ 14/91 -
DON MORISSETTE BUILDERS, INZ. M5PC f 1. 80 JLH 10/14/91 -
15555 SW BANDY RD. PPRT $ 132. 50 JLH 10/14/91 -
#201 P5PC $ 6. 63 JLH 10/ 14/91
LAKE: OSWEGO OR 97035
I-'hone #: 620-7538
(].ontractor: -------------_.__ .--__
00N MORISSETTE BUILDERS, INC.
,.5555 SW RANGY RD.
#2161
LAKE OSWEGO OR 97035
: 'hone #: 620-7538
Peg #. . . 35533 _--•_______.__________ —__ _..._._.___...___._.
$ 3050. :�9 TOTAL
This permit is issued subject to the regulations contained in the -------- REQUIRED INSPECTIONS -- - -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Fro s t/BP a m St rust Gas Line Insp
plans. This permit will empire if work is not started within 180 Prost/Beam Meehan InBUlAtion Insp
days of issuance, or if work is suspended for more than 180 days, F'?m/undslab Insp Gyp Board Insp
PLM/Underfloor Rain drain Insp
i>ermittee Sign4urem� n�+ �.l?l» G_ Mechanical Insp Water Line Insp
__....__.,�..._.__.._.... "�-'r---
Plumb T o Out t A
Top ppr/Sdwlk Insp
t:. ..u e d By: _.._.___._......__ _. F r a m i ng Insp M e c h a m c:a.1 E' i n A I
Call for inspection - 639-4175
CITY OF TI A RD SEWER CONNECTION
PERMIT
WYOFTWA�10 iDF-..RMI,( #. . . . . . . : SWR910166
COMMUNITY DEVELOPMENT DEPARTMENT OR14M
13125 SW Hell Blvd. P.O.Box 23397,Tip",Oregon 97223(503)6394175
4 -11 11 "j, DATE 1S5UFD* 101141�)1
SITE ADDRESS. . . : 11920 SW 1 "7TH PL PARCEL: IS133DD-13600
SUBDIVISION. . . . : VILLAGE AT SUMMER Li4',E PARK 4 ZONING: R4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 173
IENANT NAME. . . . . :
LISA NO. . . . . . . . . . : FIXTURE UNITS. . .
CLASS OF WORT-:. . . :NE_W DWELL I NG LIN I TS. . :
TYPE OF USE. . . . . :SF NO. OF BU I LD I NGS 1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. S f
Remarks:
Owner-, : FEES --------------
DON
-------------DON MORISSETTE BUILDERS, INC. type amol-trit by date recpt
15555 SW RANGY RD. PIRMT $ 1900. 00 JLH 10/14/91
#201 1 NSP $ ?,5. 00 11—H 10/ 14/91
LAKE OSWEGO OR 97035
Phone #: 620---7538
Contractor:
DON MORISSETTE BUILDERS, INC.
15555 SW BANDY RD.
#i-01
LAKE OSWEGO OR 97035
Phone #.- 620-7538 19135. 00 TOTAL
Reg #. . : 35533
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 120 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not IOC3tPd at the measurement
given, the installer shall prospect 3 feet in aE directions from
the distance given. If not so located, the installer shall put-chase
a 'Jap and Side Sewer" Permit and the Agency wi'l install a lateral.
or in i t t e e S)i q n a t Lk V,e
1.t e d By
Call for inspection 639-4175
A
P0
A
CITY OF' Tl(.-3ARD RECEIPT OF' r-,AymFi\i-r RECEIPT NO. :9 1 18606
CHECK AMOUNT 4735j. 29
NAME a MORISSETTE, DON CASH AMOUNT 0. 00
ADDRESS a PAYMENT DATE e 10/ 14/91
SUBDIVISION
PURPOSE* OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 305. 50 PLUMBING P17.FIM 1312. 5)(A
MECHANICAL L
PIE 36. 00 ST. BU PER 'n. -?-I
P I AN CHECK FE 87. 96 SEWER USA 1900. 00
SEWER INSPECT 35. 00 PARKS SDC 250. 00
STORM DRAIN SDC 375. 00 RESIDENTIAL 'rRAFf-'IC F'F-'.ES I i-280. 00
MASS TRANSIT TIF FF*--*ES 100. 00
119P-0 SW lc-.7TH r";-
T'01AL. AMOUNT PAID 14735. PC)
CITY OF TIGARD REMPT OF PAYMENT RECE I PT 1\10. :91-.216584
CHECK AMOU:,'l s 250. 00
NAMI- s MORRIS SETTS, DON CA:iH AMOUNT 0. 00
A T.)1)R E PAYMENT Dn-rE os al? 1
YG.JSD I V I SI ON
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
(10
I tl-);::-'O SW 127TH PL
1 1-11 Al... (IMOUNT PAID 050. 00
MWANIM
C
PLNCK/RECT # =�
CITY OF TIGARD "'��233
e. � PERMIT /
T�
COMMUNITY DEVELOPMENT DEPARTMENT ����gm9
DATE ISSUED
JOB ADDRESS: J��� tr' Pi-- TAX MAP/LOT
SUB: 1 (�+ F% �Uf> lojti (:��`L�DT: - LAND USE:
VALUATION: --
OWNFR SPECIAL NOTES
NAME: Y)'1< REISSUE OF:
ADDRESS: � �� —�� +�lo� LAST REISSUE: --
_� FLOOD PLAIN/
PHONE: —�� _ _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ I�.)C" ,� /77u -_-_-- PLANNING: ---
ADDRESS: ENGINEERING: --
FIRE DEPT: -- ---
PHONE: _ _
OTHER:
CONTR. BOARD �: _ - EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: a LIST/SUBCONTRACTORS: _
MECH: �US TAX: _ _-
��' CALCULATIONS:
.--
ARCH ENGINEER o -
NAME: TRUSS DETAILS:
ACDRESS: OTHER:
�. Cho �L1A 1 -7 ^� _
PHONE:
PROPOSED BLDG. USE: 5 � — ----_ -- ---------
COMMENT S: _ - ----- -- --- --
AppLYZANT �IGMATURE
Received By: �(� Date Received: _—
' I
V
CITY OF TIGA.KD 13125sWtiauBlva. PLNCK/RECT #
PO Box 23397 PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT Tigmrc�Oregon97M
(503)639-4171 DATE ISSUED
JOB ADDRESS: !i ,:2 L2 -:�2 '' y'L' TAX MAP/LOT
SUB: LOT: / ? 3 LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME: -- ^� :,_� f c� 2 �, rE REISSUE OF: _
ADDRESS: _ LAST REISSUE: _
FLOOD PLAIN/
PHONE: U 3R SENSITIVE LAND: _
CONTRACTOR APPROVALS REQUIRED
NAME: _ _ , ;. . :� PLANNING:
ADDRESS: ENGINEERING: _
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ANIZENGINEER CALCULATIONS:
NAME: _ TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE -
Reccived By: _ Date Received:
UWAW W t !t t t
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees _sv
-- -
10-431 00 Plumbing Permit Fees
_ 10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building "� 2
Plumbing l
Mechanical
10-433 00 Plans Check Fee3.i�_ -
Building 3 ��
Plumbing ot __ _
Mechanical __
10-230 06 Fire
30-202 00 Sewer Connection 12-
30-444 00 Sewer Inspection — -
25-448-02 Commercial TIF Fees _ —
25-448-04 Industrial TIF Fees _
25-448-06 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) '
SSU
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) -�
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL 5�
nm/3587p.WPF
iw w iw w
15,565 S.W. Bang'Y Road,Suite 201
Lake Oswego, Oregon 97036
Fhone:(503) 620-7b3S
,tab
FAIT:(503)620-7486
0 �
rr�h SoNrvtt WnaoRUt`
4q 410
51N G,Le. A1ooK
)aTF-a TLB for 173 R LIAM-q'
PE R s u/.► j cF/�
/91 UM -rte
�,y1vac, cl (/ICGWGc�
04
4 c �gi� s W�SNIN6NN CouN
II
12-1PL .
s CVS U"
D2•ve wA_�
q ,A6,t3
Ff ' l 2.6So°
- �ih QArN D
Fes' Zu9.l z
— VI
vi
b
I
c 206
4.
A - _
_ r _ brsl4
lo' unur7 �AS�h'1g�
------------
III uumm
SHOEMAKER'S PLUMBING INC.
350 S.W. ZOBRIST
ESTACADA, OR. 97023 (P.O. BOX 250)
TO: CITY OF TIGARD
13125 S.W. HALL BLVD.
P.O. BOX 23397
TIGARD, OR. 97223
I
TO WHOM IT MAY CONCERN,
SHOEMAKER'S PLUMBING INC. GIVES THEIR i-ERMISSION TO
LET DON MORISSETTE HOMES INC. SIGN ALL PLUMBING
PERMITS FOR SHOEMAKER'S PLUMBING INC.
II
SINCERELY,
HAROLD B. SHOEMAKER PRES.
630-7728