11872 SW 128TH AVENUE ADDRE S:
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081Y CSF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . IhST9 x-957'::
13125 SW Hell 71vd.Tigard,Oregon 97223-819P,; ,Qj fl9-,4171 DATE ISSUED: OC'/0 I/94
PARCEL: 1 S 133DD--17600
SITE ?DDRE:SGi. . . : 118"7:' SW 128TH AVE
3UBD 1 V I S I ON. . . . : VILLAGE AT SUMMER LAKE PARK 5 ZONING: R-4- 5
BLOCK. . . . . . . . . . . 1-01.. . . . . . . . . . . . . :�1c
BUILDING
' ISE T SSU- . DWE:L1_..I NG UN I T:E : 1 BASEMENT. . . . . . . . .0 s f
CLASS OF WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . .. . . . . :440 sf
1`YPE 01= USE. . . :SF 7l_OOFt AREAS_.____..____..-_ REQUIRED SFTBACKS_._.__..-._...__-_._.-
TYPE OF CONST. :5N FIRST. . . . :880 s f LEFT. . : 17 ft R I GHT. : 7 Ft
OCCUPANCY GRP. :R3 SECOND. . . :6C`0 S FRONT. :20 f', REAR. . :40 ft
STORIES. . . . . . . ::' THIRD. . . . :0 sf REG?UIRED-•---------._-__._.
HEIGHT. . . . . . . . :24 ft TOTAL--------: 1500 s f SMOKE DETECTORS. :Y
FLOOR LUAD. . . . :40 psi VALUE. . . . . $ : 76920 PARKING SPACES-
Remarks .- PATH I
FLUMBING
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :r7 BACKFLOW PREVN'T135. . :0
I-AVOTORIES. . . . . :- WATER HEPTE=RS. . . : 1 TRAPS. . . . . . . . . . „ . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WA1 E:R CLUSETS. . :3 SEWER LINE (ft: ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1. WATER LINE (ft: ) . : 100 OTHER FIXTURED. . . . . :0
GARBOGE DISP'. . . : 1 RAIN DRAIN ( ft ) . :0
WASHING MACH. . . : 1. SF RAIN DRAINS. . : 1
__ -_ FEES
MECHANICAL ---- -- ---_.__.
FUEL TYPES--._--_--.__..__._.. UNIT HTRS. . :0 type amol_rnt by date rer_pc
/GAS/ / / VENT'S . . . . . :0 TIF `!; 1520. 00 JH 02:/01/94 -
MAX INPUY:O BT'U VENT FANS. . :4 DPRT $ 364. 00 .JH 02/01
F URN ( 100K . . : I HOODS. . . . . . : 1 BP'LC $ 2_'36. 60 JLH 11/10/93 9.3-24��867
FURN > =100K . :0 WOODSTOVES. :0 B5F'C $ 18. c.0 JH 1412101/94
FLUOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 280. 00 JF 02/01/94 -
BOII_/CMP ( 31AP:0 OTHER UNITS: 1 P'AR100 J. 02/0.1./94 -
GAS OUTLETS: 1 MP'RT $ 43. 50 JH 02 /01/94
Owner: --.__..........._._ __..-._____.___.__-__._______-__....MP'LC $ 10. 88 JH 02/01/94 -
DON MORISSETTE HOMES M5PC t
='. 18 JH 02/01/94 -
15555 SW BAIVGY RD F•'P'R'T f 1:x2_. 50 JH 02/01/94
SUITE $`-c211 P'SPC $ 6. 63 JH 02/01/94
I-AK'-- 03WEUO OR 9711.,35
Phone #: E-20-753P
Contractor
D01J MORISSE.TTE BUILDER'S, INC.
5000 SW MEADOWS RL
SUITE 151
J_
1-(). KE OSWEGO OR 970 5
= P'hone #. 620--7538
n Reg #. . .355::13 •------_____--•------______.----_-____--•__-__
= 2864. 49 TOTAL.
F This permit is issued subject to the regulations contained in the ---- ----- PE QUI RED INSPECTIONS ---- -
Tigard M+micipal Code, State of Ore. Specialty Codes and all other Foot/founj Insp Fi�•eplace Insp
J2 applicable laws. All work will be done I cordance with approved Post/Beam Str'_tct Lias Line Insp
G plans. This perait will expire i work rs no started within 188 Post/Beam Mechan ITISI-elation Inco
J days of issuance, or :if work is uspended far Gore thart,188 days. ' 'lm/l.indslab Insp C. Board Insp
p� 'LM/Under-i-loon Rain drain Insp
p,.,-mitt,ee Signat� im,e : \ n�a��t=.. Mechlanical Insp Water Line Insp
Plumb Top Oo_1t App,,/Sdwlk Insp
1.ied SyFraming Insp Mechanical Firlal
1;al i for- inspection - 639•-4175
CITY OF R IGARD SEWER CONNECTION
I PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . SWft93-0499
13125 SW Hell Blvd.Tigard,Oregon 97229.819E {¢�3)��9A�71
DATE ISSUED: 0 /Q11/94
PARCEL: 1 S 13 ,DD--17600
SITE ADDRESS. . . : 11872 SW 1213TH AVE
SUBD i'r I S I ON. . . . : VILLAGE AT SUMMER LAKE PARK 5 ZONING- R-4. 5
BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . . : 12
------------------------------
TENANT NAME. . . . . :
USA NO. . . . . . . . . . . FIXTURE UNITS. . . .
CLASS OF WORK. . . :NF;.W DWELLING UNITS. . : 1
l YPE OF USE. . . . . :Si NO. OF BU I LD I NGSi: 1
INSTALL 'TYPE-_-. . . . :BUSWR IMPERV SURFACE. . ; : S1-
Remarks : PATH I
Uwner": FEES
DON MORISSE:TTE HOMES type amol.rnt by date r,ecpt
15555 SW BHNGY RU PRMT $ L200. 00 JH 02/01/94 -
5uirE #201 INSP $ 35. 00 JH 02/01/94 -
LNKE OS:;WEGO OR 97035
Phone #: 6201-7538
Contractor. _—___ —_- ---- --�---------. - -
CONTRACTOR 140T ON FILE
f'I,orte #: $ 2235. 00 TOTAL
q #. . .
REQUIRED INSPECTIONS
--This Applicant agree= to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
pei�it expires. The Agency does not guarantee the accuracy of tha
side sewer laterals. If the server is not located at the measurement
given, the Installer shall prospect 3 feet in all directions from
the distance given. If not so lecated, ,ltie in aller shall purchase _
a "T�p and Side Sewer" Permit and th�Rgency w 11 i >ttalateral. — - - --
V,e r m i t t e e S i g r1 a t Lt r,e :
1 s s 1.t e d B Y • _. __ _ ___ _— - --—__—___
Call for- inspec* ion - 639-4175
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CITY OF TIGARD CCROC IC�G-N OF
Occu��uCY
COMMUNITY DEVELOPDF_NT DEPARTMENT
PERMIT #. , s 06/ MST9s-�i�a7',
DATE IS5LJED: N6/.';=x/94
13125 SW Hen Blvd.Tigard,Orepjn 97223.8199 (503)839.4171
PARCEL: l S 133DD-17600
SITE 41UC)Rk...,a. . . : 1 113 i,w ;AJ 12.8'M AVE
SUBDIVISION. . . . VILLAGE: AT SUMMER LAKE: PARK 5 ZONING-R-4. 5
BUICK. . . . . . . . . . : LOT. . . . . . . . . . . . :2 J,r:
CLASS OF' WORK. :NEW
TYPE OF USE. . . :SF
OCCUPANCY GRP. : U
OCCUPANCY LOAD s 224 4
TVINANT NAME. . . P.
Remark a : PATH i
Owner:
DON MOR T SSE:"TTF1 HUMES
15955 SW BANGY RD
SUITE:: #201
LAKE OSWEGO OR 970:35
Phone #: 620--7538
(...Cent rac't'or 7 -_....--_...._.__ .. _
SHOEMAKER' S PI_.I..1MS I NG
P 0 Pox Z150
LtiTACADA OR 970g23
Phone #: 630-7700
Reg #. . : 56135
Or:V-MPM1Wy of the Above referenced building i % hereby given, and rertifies
the compliance with the State Of Oregon Specialty C:crrfea for the tlroarp,
occupancy, and trsA under which the referenced permil.jw � ied.
_...........�....�..__._ U L. _.1 INBPE[:TpR ..._._____..._
laU I.!_[)I N � F•f-1 C:T AL.,
POST IN CONSPICUOUS PLACE
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INSPECTION NOTICE V
' City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inepacti.on Line (Rec-O-Phone): 639-4175 Buainens Phone: 639-14,1,71
Inspection:_____��Y -- ---- �C C &M —
Footing Plug. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Poet/Beam Struct. San. Sewer Framing
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water
`-Linn G/yp. Bd. -Mech.
Date Requestedi; y LP ��/� - L 7 Timer AN _ PM
Address: a Permit +, 9-3 9 17,
,lldar: - 7l ;L
THE FOLLOW1 CORRECTIONS ARE REQUIRED:
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Inspector: Datet��
_ PROVED DISAPPROVED APPROVED BUBJIM To ABOVE
For Reinep.
INSPECTION NOTICE
City of Tigaid Building DepaxA:ment
13125 BW Ball Blvd. Tigard, :-ogton 97223
Inspection Line (Ree-O-Phone)s 639-4175 Bucineae Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mpr:h. Rough-in Appr/sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hach. Rain Drain Insulation Plumb. -
Plbg. Underfloor
Water Line Gyp. E.l. -Mech.
Date Requested► ,f/ �� Time t _ A!fPM
'ddr e�e s w (O' r� rSe�rmit i G `
Builder: �� 6
THE FOLLOWINr, COPP.LCTIONS ARE _.tQUIREDI
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Inepec�tor/fJ
1/ APPROV 1) DISAPPROVED A APPROVED SVBJltrT TO AAUVE
- -Call ror Reinap.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Res-O-Phone)s 639-417; Business Phones 63c--4171
Inspections --
rooting Plbg. Undersl" Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Ou Can Line rINALs
Post/Beam Struct. SLs.. sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Iasulation -Plumb.
Plbg. Underfloor Waster Line Gyp. Bd. -Mech.
Data Requested/s �(/� ' Time: ____9_AH PM
Address:— / L d'" / d d_�_ Pa✓rmit i s ,t?3
Builders , ��J _�Z[// Q� P'7 q-
TBS FOLLOW O CORRMCTIONS ARM RSQ'1IREDs
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Inspector 2 Dates
APPROVED - DISAPPROVED APPROVED SUBJE TO ABOVE
Call For Rainap.
INSPECTION NOTICE
City of Tigard Building Depart3ment
13125 SW Ball Blvd_ Tigard, Oregon 9722'
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: _
Footing Plbg. Underalab Mech. Rough-in Appy/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Poet/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb.
P.bq. Undorfloor Water Line Gyp. Bd. -Mech.
Date Requested:_ l ([J �r Time: c/�1 AM j��_PH
Address: llld �d' tT V e Permit it /J - 7o7-5
Buildert a!7
THE FOLLONINO CORRECTIONS ARE REQUIRED:
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[nspector: Date=-
APPROVED _- DiSAPPROVED _ )//APPROVED SURJBCT TO APXNR
_—Call For Reinnp.
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INSPECTION NOTICE
City of Tigard Building Department
132.25 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspect ion:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. P1bg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Dratn Insulation -Plumb.
Plbg. Underfloor Water Line Opp.
Rd -Meeh.
Date Requeeteddl -7 & / I/ Times AM _ PM
Address: Q / �~ ell,c' PeCmit t. 93._ Zj5-_
Builder:��� �7� �t1)11 FJ
THE FOLLOWING CORRECTIONS ARE REQUZREDs
Inspect �_ _
Dates �i�
�/APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
���TTT Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SIN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspection:__
Footing Pl.bg. Underslab Hech. Rough--1-, Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Poet/Beam S"-ruct. San. Sewer. �Y'rraming -Bldg.
Post./Beam H,+ch. Rain Drain �_Xn�e.lati-. -Plumb.
Plbg. Underfloor Water
r Lina q Gyp. Bd. -Hoch.
Date Aequestedt v /�C'/t..L/ Times 1M PH
Address s_).4JM1 ,` Permit /s�_,7�z5
Builder: f7-)a-i_ k — /)/77
TPE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: _ — .� Dn.tas 67
APPROVED V1 DISAPPROVED �^ APPROVED SUBJECT TO ABOVE
_Call For. Reinap.
YNSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-4-Phone): 639-•4175 Business Phone: 631-4171
Inspection:_ _. _.
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Str+:ct. San. Sewer r,Fminq -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Unterrloor Nater Line Gyp. ad. -Mach.
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Date Requ.ueted: - / Times ^_XAM PM
Address:j T ✓epeCmit 7�:_/�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector _ Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
-Ns PECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone: 639-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found, Plbg. Tap Out Gas Line FINAL:
Poet/[eam Struct. San. Sewer Framing ��� - -Bldg.
Past/Beam Mech. Rain Drain Insulation --Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: _J 13-.9 Time: ,-X--AH _ PM
Adr1i•ess: Permit 1t
Builder: Ma t k- -_;121) lel maj d /�/-
THIS FOLIA)WING CORRECTIONS ARE REQUIRED:
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Inspecto i --- Date 1
_ ._APPRUVEn DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For aeLnap.
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Business Phone: 639-4171
Inspection:—
Footing
nspection•__ —Footing Pl.bg. Underelab ` Mech. Rough-in / Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer ramin9 " -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requested: Time: AM PH
Addresei { Permit ft
Bu i ldert I �. ' 'I J 2 '7
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THE FOLI.OiIINO CORRECTIONS ARE RRQUIR$Dt
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Inspector: v` bates 2 I�
APPROVED - DISAPPROVED APPROVRD SUBJRrT TO ABOVE
/7L�` r Call For Reinap.
INSPECTIONNOTIC:E
City of Tigard Building Department
13125 Sw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-417.1
Inspection:_ --
Footing Plbg. Underelab �`Mech. Rough-i.--JK Appr/Sdwl.k
Found. Plbg. Top OutOas tin. FINAL:
Poet/Beam StrLct. San. Sewer Framing -Bldg.
PoRt/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfluoc wateer/Line / Gy-+. Bd. -Mech.
Date Requested: 7 -�/- V1 Time: AM PM
Address: 93-15' 71
/ ! O /� � � //y� permit �t
Builders n,u..� 22 5;2-23
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THE FOLLOWING CORRECTIONS ARF. REQUIRED: , C`�
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Inspectors /L 1JLkx Date:
ATPROVtD ___L,?ItSAPPROVED APPROVED SUBJECT TO ABOVE
l - ' �1 For Re' ,ap.
SPECTION NOTICE
City of Tigard Building Department
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_______
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requested _ Tissls AM _ PM
Address: .__ PI&rwit tt c2 5 ���•--
Builder.-
Tim 'FOLLOWING CORRECTIONS ARE REQUIRED: y�
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Inopaators^
_�__APPRMD lSAPPAOVBD APPROVED SUBJECT TO ABOVE
Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:___ Times —�—_AM _PM
AddresR: Permit 1:
Builder•
THE FOLLOWING CORRECTIONS ARE REQUIRED: i
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Inspector: Date: `
APPROVED SAPPROVED _ APPROVED SUBJEM TO ABOVE
Cell For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Bird. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
- 7
Inspection:
Footing Plbg. Underelab Hach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/ap■ Struct. San. Sewer Framing -Bldg.
Post/Beam Hach. Rain Drain Insulation -Plumb.
Plbg. Uiderfl,.-or Water Line Gyp. Bd. -Mech.
Date Requested: ( ,i �LTimei AH PM
Addres-s_ � /_�1 ,_ � Permit #t( '
Buildere��/Q�.
THS POLO AING CORRECTIONS ARE REQUIRED:
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Inspector: Z" natw:
11PPAOYlD DISAPPROVED l APPROVEb SUBJECT TO ABOVE
Call For Rainsp.
INSPECTION NOT'CE
City of Tigard Building Departeen'
13125 SM Ball. Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phone: 639-4171
Ins pec t ion:`—_-- —----
tooting Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Nech.� Rain Drain Insulation -Plumb.
Mg. Underfloor Nater]Line Gyp. ed. -Hoch.
Data Requestedth !7 L — Time, _q,�,__AN PN
Address: b`�Z ��t Permit tt-7(? J
Builder-
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THE FOLLowINc CORRECTIONS ARE REQUIRED:
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Inspector: - _ Data:
J�41►ROVlD DISAPPROVED 4 APPROVED SU&IErT Tt ABOVE
Call For Reinsp.
INSPECTION NOTICE }
City of Tigard Building Department
13125 SW Ball Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Phoue): 639-4175 Business Phone: 639-4171
'
Inapection•_ --- ( Iu b'�l 1 � D7S
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lino FINAL:
Poet/Beam Struct. Sen. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plt.q. Underfloor zWater Line Gyp.
Gyp. Bd. -Mech.
hat-" Requested
_1._�c�Z 1 7 TLmo: _L_
AM PM
M,Irllas: I J' 1 1= �1_,ptZ lj-t� � �/P�1ee`mit Ii / I�, GJ )s 7S'
B.:llvier: tv n155 1 v/,4(( �7`I' SGz3
TBF. FOLLOWING CORRP CfIONS ARE REQUIRED:
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Inspectojjjr:
APPROVRD DISAPPPovHr) APPROVED SUBJRCf TO ABOVE
_Cell For Avinsp.
NI SpRCTIOH NOTICE
City of Tigard Building Department
13125 BW Ball Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O--Phone): 639-4175 Business Phone: 639-4171
Inspection:_ �-
footing Plbg. Unders.lab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Lias Lino FINAL.
Poet/Beam Struct. Ban. Sowsr1 Framing -Bldg.
Poat/Beam Mech. Insulation -Plumb.
Plbg. Undorfloor or L!M Gyp. ed. -Hoch.
Date Request
ged: 7 �CJ / _Time: `I</']z A4�J PM
Address: I U L`" I�-�+� — Permit #: q3✓ `1 /J
BuIIdor s 7�
TSIR FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors, Dater_- 0
APPROVED DTRAPPROVEn APPROVED SUBJECT TO ABOVE
Call For Rainnp.
INSPECTION NOTICE
City of Tigard Building Depsrtwsnt
13125 gW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Ree-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: —
rootinq� Plbg. Underslab Mach. Rough-in Appr/Sdwlk
(rO1ttW.; S Flbg. Top Out Gas Line FI?IAL:
�Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd, -Mach.
Date Requested: --7 1 _Timet AM _ " PIR
Address: Permit #::7'-`
Builder:
THE FOEjOWING CORRECTIONS ARE REQUIREDs
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Inspector: Datec _�` c�
APPROVMD DISAPPROVED APPROVED SUBJECT TO ABOVM
Call For Reinsp.
CIlY M, "I PAORD kFUAVII 01., F4lYMf7".N1 RF(+ JWl MO. "94--e-40i-*�74
CHEC'K F410LJNT 9 4849. 49
.10ME s DON M(IH(9!.�lP.TTL HIAME'AS CASH HMOON'r 3 0. 00
PAYMV NA DA UE' p OP/Q11/y4
SUAD I v 181 t ON
IJPPOSI-!� Ck- PAYMIENC AMOUNT POTO PIjRPW;I Or- P(Aymr-.IIIT 111101 IN V i.1"t 1)
PF-RIl M S T li 3- 9 5Y 5 LAO P1 ,11MI311,41i PP-101
it 1,HONIU01 Vol- 4,A. ll"J(A X31 . SUILD ['-'Fk
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J-Wt, 14 1 NLA4. Cl 00 1.1141410; 11;111:,
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F L.S, 110. 00
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t f4L AMOUNT f101 i) 4849. rl9
13US SW Hal,Blvd PLNCK/RECT f ' 7-`'A� .
CITY OF TIGARD rOemzu97 PERMIT f )r 9-5
COMMUNITY DEVELOPMENT DEPARTMENT Twr40-4-"m
(50)639417' DATE ISSUED
JOB ADDRESS: ��� Ute_ TAX IMP/LOT 3 3 D 0- 71,e3
SUB:L ' �+ � � LOT: / LAND USE:
VALUATION: --je- '
OWNER SPECIAL NOTES
NAME: REISSUE OF:
ADDRESS: SRiaZo� LAST REISSUE:
FLOOD PLAIN/
SENSITIVE LAND:
ONS TRACTOR 9PPROVALS REQUIRED
NAME: PLANNING:
ADDRESS: ENGINEERING: _
FIRE DEPT:
PHONE: _ __ OTHER:
CONTR. BOARD f: EXP DATE: _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ II LIST/SUBCONTRACTORS:
MECH: -b _ T LrgUS TAX:
ARCH/ENGINEER T��P• /CALCULATIONS: _
�--
NAME: _ TRUSS DETAILS:
ADDRESS: r nok'ry3 OTHER:
" ! // V r
PHONE: �� 3 (45
PROPOSED BLDG. USE:
COWIENTS:
AP011 ANT ISG JTURE
Received By: _ Date Received: �_�
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
rnsfy- - 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees 13z, �U '� _ 3 2.,v
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5x) ?. �� _ IL
Building 2'c)
Plumbing
Mechanical '
10-433 00 Plans Check Fee
Building ,23 u
Plumbing _
Mechanical 0, "f)
10-230 06 Fire _
_sL,J(Z 3 Uq4 30-202 00 Sewer Connection 2u 2a o
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 Oev Charge (PDC)
31-450 00 Storm Drainage Syst Oev Chrg
(SSOC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3587P_Will