12415 SW 129TH AVENUE .1�
v
k�
Fill r I
C'7YOF TIGARD CERTIFICPTE OF
OCCUPANCY
COMMUNITY DEVELOPMENT DEPAM, WWT onew Pr--RMJT *. . . . . . . .. M G T 9 0 7--'5
13126 BW HmP BWA P.O.Sam 23397,TipW,OmWn 75
L)RfF- ISSUED: 05/13191
SITE WDRFSIS— i 12415 SW 129TH AVE PARCEL: 2SI04AA--11500
SUBDIVISION. . . . : BELLWOOD 3 ZONING: R--4. 5
. . . . . . . b LOT. . . . . . . . a * . . * e134
CLASS OF WOPK. :NEW
TYPE OF IJSF.-:. . . :BF
OCCUPANCY GPP. :R3
OCICUVANCY 1..04ilDi325 4
11-NANT NAME. . . i
Pmat ks.-
Clwnert
1101 WHAM KIM VU
11050 SW GAARDE ST #V5
TIUARD OR 97224
Phone #1 503-639-8749
Contract ore
JOHN GRUND
32i.n1lb SW 17571.4
HLOHA OR 9'7006
7006
Phone #1 642-9897
RON 4- 1 33793
Occupartry of the abr)vo rrFerenu,ed building is hereby given, and certifies
the nompliance with the !--)tate Of Oregon Specialty Codes for the group,
OCCI-106111cy, ar;tj use and which the rpferpnco-d pormit was issued.
0.1
FIRE DEPARTMENT IL.D,TNG__.WF3PEC-7'OR
BUILDI clF ILIAL
POST IN CONSPICUOUS PLACE
I
Mono= WTICE
City o! rigors BaiUWW Departfaat
13125 M Ball Blvd. Tigard. Oregon 97223
Inspection ;ins (Ree-O-Phona)i 639-4175 Business Phonal 639-4171
Inspections -
Footinj Plbg. Underelab Hach. Rough-in Appr/Bdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Better Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb•
Plbg. Underfloor water Li Oyp. Bd. PH
Date Requested: Timet
Address: 42 VZZE Permit
r
Builder:
TBE FOLLONING OORRECTION.S ARE REQUIRED:
tJ Irl F't 1A�QC h-!3L VA
t
t
EE a
Inspect�-ti: < Date:
AP?ROVED __ DISAPPROVED APPROVED SUBJECT TO ABOVR
Call For Rei.nsp.
I,
v
i
I
City of Tigard NaLUUAg Deparbm—t
13125 Bw Nall Blvd. Tigard, Oregon 97223
inspection Line (Roo-O-Phone)s 639-4175 Business Phones 639-4171
Inspections
Footing Plbg. Underslab Necks. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Poet/Beam struct. San. Hewer Framing -bldg.
Post/Beam Koch. Rain Drain insulation
Plbg. Underfloor /Water Line Gyp. Sd. -Koch.
Date Requesteds
TimesPK
Addrasss_ /sT� / Permit f s���
Builders
TRE FOLLOWING CORRECTIONS ARE REQUIRED%
.41
Inspectors.."// Dates N
/_ APPROVED DISAPPROVED AP"ROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPNCTION NOTICE
City of Tigard Building Departmmt
13125 OR Ball B vd. Tigard, Oregon 97223
Inspection Line (Rec-O-Pho ): 619-4175 Business Phone: 639-4171
Inapection: \
Footing Plbg. iderslab Koch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line =
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Koch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Koch.
Date Requested:_
Time: PN
_ AN
Address e 1Q'j/7��,J L `�—� Permit #t
Buildersrl� �z
TNN rOLLOMING OORRECTIONS ARE REQUIRED:
�,uZ_ i
n
Inspector: -� -[_ :�� D
ate:APPROVlD DISAPPVED SUBJECT TO ABO{/E
Call Por Reinap.
INSPECTION NOTICE
City of Tigard Wadding Dep►-taeat
13115 ell Ball Bled. Tigard, Oregon 97323
Inspection Line (Rec-O-Phones 639-4175 Business Phone: 639-4171
Inspectiont
Footing Plbg. Underelab Hoch. Rough-in CEHl
Found. Plbg. Top Out Gas Line FINAL&
Post/Beam Struct. San. Sewer Framiag -Bldg.
Post/Beam Hoch. (lain Drain Insulation -Pl'unb•
Plbg. Underfloor Nater Line �j Gyp. Bd. -mech.
Data Requesteds -�S - ` Timet -&f& M PN
G _
Addrerss
/ Permit tt�� ,D.•�a,s'
Buildert 1'
TBE FOLLOWING CORRECTIONS ARE REQUIREDs
1
Cc
`I
Inspectors ILL Date 1_.
APPROVED DIBAPPRO D APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Bnild3ny Deparbm-t j
13125 811 Hall Bled. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 ;
Inspection:
Footing Plbg. Underslab Mech. Rough-inAppr/Sdwlk
Found. Plbg. Top Out Gas Line ILNAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd. -Mach. l
Date Requested: I Z _ Time: AM ` PM
Address:
1 y `> I I ormit
- r
Builder: _.f.'�� `1 2- 11`61
THE FOLLOWING CORRECTIONS ARE REQUIRED:
til
I
I
Inspectors—CILtJ
APPROVED DISAPPROVED APPROVED SUSJECP TO ABOVE
Call For Reinap.
I
I
I
and Construction Services, Inc.
9025 Southwest Center Street
P.O.Box 23784-Tigard,Oregon 97223
(503) 620-2086 • FAX (503) 684-3636
March 6, 1991
Mr. Ken Schreindle
Building Inspector.
City of Tigard
13125 S. W. Hall Blvd.
Tigard, Oregon 97223
RE: Hoi Pham Residence
-1.2425 s. -W -_-*t
Dear Mr. Schreindle:
The contractor has requested to substitute surface dry
material in lieu of kiln dried under the concrete slab. This
request was granted.
Sincerely,
amen R. Nicoli, P.E.
JRN:mlh
i
=.e>ncrsoN NOTscs
Cit? of tiyard Neildioq ��t
13125 M Nall Blvd. Tigard, Oregon 972.!9
Inspection Line (Ree-O-Phoneli 639-4175 Business Phones 639-4171
i� 1
Inspections
Footing
Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
mune.
Plbg. Top Out Gas Line FINALS
Poet/Beam 8truat. Ban. Sewer
Framing -Bldg.
Post/Beam Koch. Rain Drain
insulation -ply.
Plbg. Underfloor Water Line /
�oyp. Bd.
-Meeh.
_ //�l Time°"'_ �' _PM
Date Requested: '— r,j�/`
Permit
Address&
Builder: np
THS FOLLOWING CORRECTIONS ARE REQUIREDs
-
�4
��---
.s-
ra
i
_ Date: ZL_S.L..__
Inspectors _�__
APPROVED DISAPPROVED APPROVED SUBJNCT TO ABOVE
C:11 For Reinep.
ILA
INSPECTION NOTICE
Cit! of Tigard Nalldieq Department
13125 Bw Nall Blvd. Tigard, Oregan 97223
Inspection Line (Rea-O-Phone)s 639-4175 B,.Aness Phones 639-417 '
i
Inspectiont T
Footing Pluq. Underslab Mesh. Rough-in Appy/Sdwlk
Found. Plbg. lop Out Gas Line FINALt
Post/Beam Struat. San. Sewer Q_L?ra ing� -Bldg.
Post/Beam Merh. Rain Drain InsulationD -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Mech.
Date Requesteds —`t� Times AM �} PM
Addresat _ >?"L Permit 0
Builders
— Ae�A%= 'er
TAE FOLLOWING CORRECTIONS ARE REQUIREDs
e
t
Inspectirt//_ Dates
<:::-"PROVBD nlSAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPBCTION NOTICE
City of Tigard en31dlag DepartMOnt
13125 w Hall olvd. Tigard. Oregon 97223
Inspection Line (Roc-O-Phone)s 639-4175 Business Phones 639-4171
Inspections `
1 �
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam struc,_. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
qu
Date Reested11s — z'1^'1711 Times )�_AM
Address s l z`i I S o 24- Permit 1 sZZ
Builders� � • 0 �� - 'J�
TBS FOOLLLLO-WINO OORRECTIONB ARE REQUIREDs
Inspectors Dates 2 _
11
ROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
i
f'
i
i
I
city of Tigard Deildieg Department �`�''
13125 gw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Reo-O-Phone): 639-4175 Business Phone: 639-4171
i
Inspectic:l:
looting Plbg. Underslab Mach Rough-in Appr/Sdwlk
Round. 1bq. Top t Gas Line FINAL:
Post/Beam Struct. San. Bower Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Meeh.
Date Requested: f "--7 Z imes _ AM _ PM
Addreu: Z
ZX.5- !2 =" Permit 1:� �—
Builders
TBE FOLLONING CORRECTIONS ARS REQUIRED:
C.
I
i
Inspector:_ ^Date:1�_sr l
x APPROVED DISAPPROVED APPROV2D SUBJECT TO ABOV3
Call For Reinap.
i
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i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection 45 reg vM 11-oerONoo
Date Requested��►�'/S%b Time A.M. r P.M.
Address _���f / S t 2R'T- Permit - S
Owner Lot #
Builder 'o AJ q7—'
The following Building Code deficiencies are required to be corrected:
_7 � E-iiYrsl' L�G'T AA-L(264rizrl GdS �f�OcU�,
Y
—4Presented to pproved '
InspectorDila
_.. pproved
Date
CALL FOR REINSPECTION
C7 YES C7 NO
i
I
f
I
Q.tr o. :sv. d Malldlas Department 1�
13225 s0 a'all vd. Tigard. oregon 97223
Inspection Line (Rec-O-Ptw:_j)1 639-4175 Business Fhone. 39-4171
1
Inspection:
Footing Plbg. Underslab Mach.. Rough-in Appr/Sdw"
Found. Plbg. Top Out Gas Line FINAL.
Post/Beam Stcuct San. Sewer Framing -Bldg.
et/Beam Kec Rain Drain Insulation .-Plumb.
Plbg. Underfloor Nater Line Cyr. Ed. -Koch.
Date Requested: �Q -3 c' Time: AK 1RK
Address: �.> _..,�� Permit � Y
Builder:—
THE
uilder:-TEE FOLi.091?NO CORRECTIONS ARE REQUIRED:
�•l
�wr iw/a 5
�/F 2 : •��7 C L �[Jlr /3/c:G /1.biyiG'!�L Si�FCTT�/� 'Z
-L '-Zp i�h.L"moi.v CJ
i
i
4
r
1
Snepactor:„ _ Date:
�RppEQ1/Et DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rel.nep.
w ,
n.s.i,wtm NGTILs
City of wlga Haileia0 Bepa�
13135 ell Hall Blvd- Tigard, Oregon 97233
inspection Line (Roo-O-PhoAle)2 639-4175 Business Phones 639-4171
pmt
Ise foss
Pooling Pibg. Onderalab Noah. Rough-in Appr/Sdwlk
Pound. Plbg. Top Gut Gas Lino FINAL#
Bost/sem Struat. San. Bower Prmfng -Bldg.
post/rem Neah. Rain Drain Insulation -plumb.
i
..•-, �
pi 1�bO ndoril�
Water Li pe Oyp. BA. -Noah.
Dote mwoqLer I_
p.rmit
Address -
Builders
TBE v=.#MING CORRECTIONS ARE RNMIRSDs
r
/ r ,
ZZ
t.;
thapsators _ Dates
APPROSRD 018APPROVND APPROVED BUBJEM TO ABOVE
Call For Roinsp.
INSPECTION NOTICE .
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 /✓ ��
Type of Inspection
Date Requested 5;7e Time_�A.M. P.M.
Address _ /s / i Permit C07 5
Owner_ � Lot #
Builder`-�, j
The following Building Code deficiencies are required to be corrected: I
t
G.
i
Prerenled to -Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
❑ YEs ❑ NO
i
dj 1
.I
4
c`I
INSPECTION NOTICE
y of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
41�/n Phone:839-4175 �
7epe Inspection
Date Requested Z4 — Time _A.M._,.P.M.
Address Permit *ca'
Owner Lot #
Builder
1
The following Building Code deficiencies are required to be corrected:
AACi� .4 aw Po l ar, ✓rr�a, �•3
l�� �ac.VI o�= ✓LL ' f�:�1a�-� �� ���+w, PQC (tea •S
^l3LAw A111iL
f
t
Presented to _ ❑ Approved
Inspector �*1�approved
Date
CALL FOR REINSPECTION
t..
YEi C.] No
i
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested ��d"T Q Time A.M. P.M..
Address 7 �1 _ Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
i
Presented to _ fJ Approved
Inspector - L] Disapproved
Date zio
CALL FOR REINSPECTION
El YEI CJ NO
i
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 '
Tigard, Oregon 97223
' Phone: 639-4175 '
Type of Inspection ` `— ff
Date Requested Timt � �M. P.M.
Address �� �l/S /.a.1 `? Permit �'—
Owner HL2 i _H__Q M t K'W VU Lot
Builder / ,t �� G y� - 9 7
The following Building 06de deficiencies are required to be corrected:
s
Alfl) iTA i.v
EAn'FAJl ---'/w/<ei2Q. -t-i
Wow iblA,rrAI.v.
/�(yAL L f'e� ca.ia cc, i N S!-i,�C`.Ta� /PJrie2 ru
-Iry AjoZLL
Presented to (� Approved
Inspector ❑ Disapproved
Date
CALL FOR REINSPECTION
C7 YES ❑ NO
C'TYOFT'FARDPERIIII'T CFTV'C)FTM it. I-IST90 0 2 2':-i
COMMUNITY DEVELOPMENT DEPARTMENT F:11--'.RITIIT 0. MST 90--0225
13125 SW AM BK-d P.O.Bam 23921,TOW,OmW 97RP 003M.0,41
?S DATE ISSUED: 09/18/90
TE ()PDRESS. 12415 SW 12'.)14-1 (.)Vr.-:: PARCE L 2SI04AA :1.150(•:1
3
, UBD I V 1!`3 1 ON. B 1::L I WOOD 3
LOT. 1.34
'U' LDING ............----
DWELLING UNITS: 1 BASEMENI.. . . . . . . . :0 Sf
C,LASS OF WORK. -NEW D E D R M S.-13 [A()rIA S).4 GOROGI-* . . . . . . :399 -1
TYPE OF USE. . . -SF FLOOR P4RE0S--- RE"(AUIRED
OF CONS'T. -','-j N 1-1.R, a'T. . .: : 1.0 41 S f LEFT. . :! ft R I G H 17 f L
(:)C1,'(:',U[:1ANCY GRP.. :R3 SECOND. . . : 1027 S f FRONT. :20 ft RE(IR. . :32 ft
I .. ITRD. . -.68F2 sf R 1*-.-0 U I R E 1).........
S T 0 RIES. . . . .. . . ::,:) I I..
I-IFKIGH'T. . . .. .. .. . . -,25 f-t -.2750 S-f SMOKI:. DET*ECTORS. iY
1;:L-0(1 R L 0 A D. . . . ::40 psi f: Vol UL. . . . . $ 1012682 rl()Rl/,ING SPIACES.. 0
R e niA r k S-.
... .... 1--.'l UMBIFIG
ST H K S. . . . . . . . . . .. I. F1 OOR DRr4TN5. . . . :0 BA(.'Kl:'LOW PREVNI*RS. . :il?)
I-AVATORIES. . . . . :4 WATER HEATERS,. - . : :I. -T R 0 1-"S. 0
T(.)P/5HOWERS. . . .. ..4 L..AUNDRY I'R(-)Y,-.). . -.0 CATCH B n 9 1'.ISI 1.5'. 0
WATER C,L 0 S k"TS -4 SEWER LINE ( ft) . -0 GREASE 'rR(4PS 0
1)1 S H W(I S H 1:_:R1 S. . .
: I WF)Tl:'R LINE:: (ft) . : I b(a OTH -14: FIXTURES. -0
(30RDOGE DISPI. . . I RAIN DRAIN (ft) . :0
W013HING 11013H.. . ., c I. 51" RAIN DRPINS. . I
ME (.,HPN1C(iL FE LS
;.kniomit by da-to r e c.,p t
FUEL. UN11' HTRS. . .0 type
/GAS/ VEN*TS . . . . . :b P,A Y 11 $ 1.00. 00 JLH 06/11/90 201526
III()X I H I.-,UI 0 D'r L J V E N I' F(4 N 1:1). . :5 BPR T* 41 490. 50
I::(JRN < 100K 0 HOODS. . . . . . : I KI- .; $ 318. 8.3
I"URN >-100K 1. WOODS'TOVES. .0 P51-'(: $ 24. 5";
FLOOR FURN. 0 C.;LO DRYERS. a I S'T 1)(1 11; 600. 00
POIL/01P ( 31-1P.-,0 011-4 ER UN 1: T G-0 (111)f.-i D C $ 250. 00
GAS OU'll-EI'Scl PARK $ 250. 00
0 to i I to-r I ..............-- MPRI, $ 43. 150
HOT PHAPI KT.I`l VU 11PL(* Il; 10.88
13W GAARDE ST #15 115 P C' $ 2. 18
PPR'T $ 1.62. 50
TIC30RD OR 97224 1-'S1-'(: $ 8. 13
Phovie #-. PAYM $ 2061. 05 JL.H 09/1.8/90
coril;rat:tort
JOHN GRUND
3220 SW 17514-1
ot-OHA OR 97006
P,hoviv.-s (Ac 642-9897
Req 1$. . - 33793
$ 21.61..0b TO T()L
This peroit is issued subject to the regulations contained in the REOUIREY) INSPECTIONS
Tigard Municipal Code. State of Ore. Specialty Codes and all other Font/found Insp MechAiiit^al. Irifsp
applicable laws. All work will be done in accordance with approved Wtr Proofirig Fism Plumb 'Top (JL%'t
plans. this persit will expire if work is not started within 188 Poc;t/EfeiAm Strutt Framing iiisp
days of issuance, or if work is f
cusp ded or more than It@ days. Plost/Bri eam MechaF: -X- re epla(� Ivimp
usp ea TC Crawl. Drain Boks Liiie lvisp
Permittee Si.qviatt.iret. t,IA- f-'11m/t.mdsl.ab Iiisp Illsck.l ;kt-"joll 11191)
ILILM/Uriderf loor Gyp Board Iiisp
Isstmcl Byt ........*-*,-,-,**....... 639 '417"
ri
Ftq DrAiii Bsm'11-� Rain IrAirl 11-1sp
m-i -
Ual.l far i.i1sipecti639 4 175
CITY OF T I CARD - RECEIPT OF PAYMENT RECEIPT NO. :90--.204872
CHE Ck; AMOUNT t 1 e 1 1. .05
NAME t GRUND, ,IJ.IHN CASH AMOUN*r t 0.00
40DRE.05 a PAYMENT DATE= t 09/10/90
SUBDIVISION t
ALOHA, OR 97006—
PUPPOSE OF F AYMENT AMOUNT PAID PURP05E OF PAYMENT AMOUNT PAI D
BUILDING PERM �MSTWOwC�."t2� 4Y0.✓C1 EUMH I Na PERM �W 162. 50
ME('HAN I CAI.. PE 43.50 ST. BUILD PER =4.04
PLAN CHECK FE '229. 71 G1 REFT ODC 600.00
F-"ARKS SDC 250.00
1'241x; SW 129TH AVE
T 0TAL AMOUNT PAID - 1 e] 1 .05
I�
I
SE WER CONNECTION
ERMIT
0FTW
CITY OFTIFARD 41D P. . . . . . .. SWR90-0239
COMMUNITY DEVELOPMENT DEPARTMENT 0"Mme"" 1::1 *
131268WHidlOW P.O.6a 2=17,74",Oregon 91 RIM. PERMIT MST90 0025
Mr. —41st" DATE *.I.'SSUED-. 06/27/90
G111--. ADDRESS. . . -. 1241.5 SW :1.29TH AVIH.* PARCEL: 2S1Fj4A0—,J. 1,.-)00
S U 14 D I V I'S 10 N. 1.4 L".I LWOOD 3 ZONING: R- 4. 5
1'.4 L 0 C K. . . . . . . . . . « LOT. 134
TEAAAN'r NAME. . .
USA NO. . . . . . . . . . ..41636 FIXTURE UNITS. . .
("LASS OF" WORK. . . .-NEW DWELLING UNITS. .
I'YPE OF* USE. . . . . l:SI", NO. OF* BUILDINGS.- I
J.N,E3Tn1.-L '1YPF--'.*. . . . .-BUSWR 1:111--.1ERV SURF ACEE. .
Remarks a
Owrierc F'EES
H01 1---1HA11 KIM VU tyl)e aMOU11t by (late reC.,P
1:1.050 SW GAARDE ST 01S P R MT q, 1250. 00
INSP $ ;:35. 00
TGARD OR 97224 F AYM $ 1.285. 00 JLH 06/27/90
IDlic),lie #% lz503-639-8749
CONTRACTOR NOT ON F*:[LE
1, 1285. 00 TOTAL
.........-- REOUIRED INSPECIIONS
This Applicant aly,.vs to comply with all the rules and regulations Sewer 111sper.tioll
of the Unified Sewage Agency. The permit expires 120 da'Ys from .. ........
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy
y of the
side sever laterals. If the sewer is not L;cated at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a "lip and Side Sever" Permit and the Agency will install a lateral.
................
Perniittee S i i3 I'latUrei .............
.............
.............. ........
Ca.11 fo-r iiis;)ectiari w 639--41'75
i
` :ITY OF TIGAFI) RECEIPT OF PAYMENT RECEIPT NO. 90-202 o2
CHECk, AMOUNT c 1531�5.0.a
1 NAME i K:I M V1.I CASH AMOUNT c 0.1►�,►
ADDRESS SW GAARDE #lis, PAYMENT :GATE c 06/27/90
SUBDIVISION s
TIrARD. OR 972',"a- 12415 SW 129TH
PURTOSE OF PAYMENT ANOUN'T PAID F L)PPOSE OF PAYMENT AMOUNT PAID
SEWER USA .12 0.(K(,) SEWER I NSPE:C7: .5. 00
STORM DRAIN SDC: 250.C►t►
`I
I
I
1
i
Ir0TAL AMOUNT PAID 0c)
w ..L
C17YOF T , _ � PLN M APPI.SCMCNIGARD ilo PLAN Ef
COMMUNITY DEVELOPMENT DEPARTMENT ram&W-4171 ar # e syU-d 5
/a2 o//a DAZE ISSUED
308 ADMESS:1-41S 5O 1441 i7CVZ" TAX MAP/IM _...25/— 5,4/1 /l Sew
SUB: IAT: /3y LAND LW:
VAILMMCN: /,z z C's z ,
NAM: 1 f Lt� SP!E r NUM
REISSUE OF:
ADQi �S: LAST MUSSUE:
HOOD PLAIN
S1�I= LAND:
PHONE: - 9744
ao -mit pry:
NAME:
Pit=: -
Bv1zDFRs eoARo if: DAA:
ARCH/IIVGn1mz Bos mac: ;Lel
NAME: ADM ViC' 3 Baa:•
� nous.
ADCRESS: onm
PHONE: S03 o A�/
auris:
L tley-)A
SUBOONTRA�S: KKR:
PST # ACI= CRIPTIM /r,i
10-432 00 Building Permit Flees - j r AM7Cl�rr PD.� ' BAL. D r
10-431 00 Plumbing Permit Ids /4' S� /G2, sa
10-431 01 Mechanical permit Fees !f 3 s v J 3 5-p
10-230 01 State Building Tax (5%) 3 y Y',r
Building
Plumbing
Meech
10-433 00 Plans Check Flee „�,A`,' ��y-u .2 J
Building IY, f-3 ✓'.
Plumbing
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3G-444 00 Sewer Inspection 3
511-448 00Charge (SDC)
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52-449 00 Parks System Dev charge (PDC) Z r v
31-450 00 Storm Drainage Syst Dev C2mg (SSC), -'Z" T
10-230 06 Fire
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APPLICAP" SIG"=
laeoeivedl�r: ��
Date Iaeoeived:
of/3587e,.WF /
UKRULEUKE
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CITY Oir TIGWW'D RECEIPT OF PY=iYMENT PECE..IPT NO. :wQ--201`..' 6
MiEC V, AMOL.IP,IT c 100.DO
14AME : HOT LSA PHS ,1/k:Ill VU CASH AMCIUN'T 0. CIO
ADDRESS A 11050 SW 6AAF VE, 015 PAYMEN7' DATE 0(-%/ 11 ;YO
SUFAD I V I S 1:nN
T I CMRV, OR 97'21 4--
F'1.1F"tPOSE OF PAYMENT AMOUNT' PA 10 F'I.IRF•I]S Of: PAYMENT AMCIUN-f PAI D
F'l_AN
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JCil at'?pF;i:..;;Se 112425 SW 1.:2
STH
TC)TAL. AMOUNT PA 10 - µ 100. 00
GRADING/EROSION CONTROL INFORMATION .
GE R-t CO ACTOR NAME ADDRESS: CASEFILE NO.L.
62 PERMIT NO.:
APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME&ADDRESS:
OWNER NAME AND ADDRESS:
,24s – 1co if
TELEPHONE NUMBERS: PROPERTY DESCRIPTION:
APPLICANITL G, ¢� — Q 7 STREET ADDRESS AND CROSS STREETAMATED
OWNER-
GENERAL CONTRACTOR: 6 4-2
EXCAVATION CONTRACTOR_(�4
SITE,/IOB• - LEGAL DESCRIPTION:
24 IWAFTER HOURS EMERGENCY TAX LOT NO.-
CONTACT
O.CONTACT PERSON,Mr,.E,TELEPHONE: 1/4 SECTION*
SITE SIZE,ACRES-
7, 2-7 `I 1l 47
DISTURBED/WORK AREA,ACRES:
LOCATION&ADDRESS WHERE SPOILS
SITE RUNOFF DRAINS TO:(CIRCLE ONE)
LEAVING SITE WILL BE TAKEN
gore PtsRI��SMAYBEREQUIRfiD) CATCH-BASIN DITCH PIPE CREEK
(CIRCLE ONE) PRIVATE PROPERTY
PUBLIC RIGHT OF WAY
�ROS10 41SEDIMENTATION CONTROL (ESM MEASURES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION F_ACILI'iIES S'fABI m EXPOSED SURFACE
ST786CONSTRUCTION EN'iR–A–N-M REMOVE AND RESTORE TEMPORARY ESC
PERIMETBR RUNOFF _--- FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCTION SEQUENCE OTH[•;R
OTHER
PLA4L I N FOR EROSIO�1 COfS`I'RO�PREPAAND SUBN.fITED W ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWINO,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE.IN IN EMERGENCY
PHONE NUMBER, SCHEDULEISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTR'lcr AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE FONSTRUCIION
acv e
OWNER SIGNATURE APPLICANT SIGNATURE
OFFICIAL USE ONLY.
RECEIPT DATE ACCEPTED
FEE NUMBER RECEIVED BY
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