12595 SW FALCON RISE DRIVE 1y.��.-r1W.0 Yaw�LN4v2.pW+�MYt,G.-o41.�wN4P,LA'M.A4MI�AJ�uuik6YMMMiIYu/uM�l{Iw
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12595 SW FALCON RISE DRIVE
C1►tYOFTIFARD C,L:.R'll F I CATE OF
CFIYOF TWA
COMMUNITY DEVELOPMENT (DEPARTMENT0*16m 0(,'CIJPPNI-*,Y
11126 31W Hell Blvd. P.O.Box 23397,Tigivd,Oregon 9=(503)6304176 PFR til I F
j
'il IL ADDRESS. . . a 12595 cilW FALCON RXISE DR PARCEL I.3133DD-09700
3IJBI')I V I S 10114. . . . a VILLAGE (41' S(.lblMFFZ IJ-110" PARK 4 701\11N(,3; R-4.
BLOCK. . . . . I LOT. . . . . . . . . . . . . t 134
CLASS OF WOM< !NEW
1*YPE� OF USE. . . k 5F
CICCUPANCY UUP. R3
(JCCIJV,AN,,;Y LOAD t 224 4
FC1,1111,11, NAME. . .
kewHvPB5 PATH I
DON MOR ISSETTE I-10MES
t5555 SW BONGY RI)
:3UIIC- 201
I-AhlDSWr-.C:v0 OR 970353
Phune 0.- 503-6210-7538
OUN 140RISSET7E )-MJILDERSj INC.
15555 SW PANOY RD.
(If-MIA-Al OR 97035
41 7538
Fir ra 0,4. . . 35533,
tJL'CUpAf)C'%/ of the &bcive referenced btrilding ic; herpby pivpn„ and certifies
the compliance with the State Of Oregon Speriali y (,,jri*q For the gromp,
occ,upallcy, and use under whic-h the refeventpd wars itiqi.ied.
F T 14;' DEPARVIVNI SUILDINC) INSI'll"CITIR
BUILI)IMS ()FFJ(Asli_
POST IN CONGPfCUOU,"i F*,I.ACF.*
ItiSPSCTIgN NOTICF.
City of Tigard Ruildx.ng Deoartm_nt
13125 SW gall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Businee9 Phone: b39-4171
Inspect:
Footing Plhg. Underelah `----Y�-��`------'--_y
Mech. Rough-tn Appr/Sdwlk
Found. Plb Top P out Gas Line FINAL-
Poet/Beam Struct. San. Sewer
Framing -Bldg.
Poet/Deem Meet].
Rain Drain Insulation 1/42 -
-plumb.
Plbg. Underfloor Water Line
Gyp- Bd. -Mech.
Date Requested-
Timet AM
ddreia• � PM
- - Pormit
Builder=
THE !'OLI.OWINO CORRECTIONS ARE REQUIRED:
Inspector:-
- Date: 19,3
____ APPROVED DISAPPROVED G/
_ - APPROVSD SUBJL',`T To ABOVE
Cell For Asinsp.
INfPR:C7'�ON NOTICE �
City of Tigard Building Department �>
13125 BN Nall Blvd. Tigard, Oregon 97223
Inspection Line (nec-O-Phone): 639-4175 Buef_nena Phone: 6.19-4171
Inspection• V_
<rooting Pl.by. Underelab Mech. Rough-in Appr/Sdutk
Found. Plbg. Top Out Gas Line FtAAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Ineuiation -Plumb.
Plbg. Underfloor Water LiGne1, Gyp. Bd. -mech.
Date Requested• ' _ 1 / Times SAN —PM
Addreest -�C�� �1�7� Yet Permit
Builder: (L 1 J LJ U
THE FOTAAMING CORRBCTIONS An AtOURDS
SM
Inspector:_ /T/� _ Dater
,APPROVED DISAPPROVED `�/�iPPROVFD SUBJECT TO ABOVE
Call For Reinap.
•+rt yar
INS�'YC�TION N�YPICE J .
city of Tigard Ralldi-ng D-Va•trent
13125 SW Hall Blvd. I.igard, Orogon 97223
Inspection Line (Rec-O-Phone): 639-4175 Buoinese Phone: 639-41'11
Inspections_ - - -- —
Footing
Plbg. Underslab Mech. Rough-in Appr/edwlk
Found. Plbg• Top Out
Gas Dine FINAL:
Poet/Beam Stcuct, San. Sewer
Framing -Bldg.
Poet/Beam Mech. Rain Drain
Insulation -Plumb.
Plbg. Underfloor Water Lina Gyp. Bd.
-Mach.
Times AM PM
Date Aequeatiidt._ — / _e
�f (' itPI-1�7 f:
Address:
Builders 4� -
THY FOLLOWING CORRECTIONS ARS RNWIREDs
17
e�
'7 [ f
a
�.�_ Date:�� •-�
In�p�tor t
APPIIOVSD V11' QISAPPROVNV APPROVED SUBJECT TO ABOVE
call For Reinap.
INSPECTION NOTICE
Cltp of Tigard Building Departneut
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bu9lneas Phone, 639-4171
Inspections
tooting Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbq. Top out Gas Line
FINAL:
Post/Beam St:rurt:. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain
Insulation -•Plumb.
Plbg. Underfloor Water Line
/ Gyp. ad. -Mech.
Date Requestedt
AM
Addreen: ,�
Permit is
Builder;
MR FOLLOWING CORRECTIONS ARE RSQUIREDs
Inspectors � �.'.T J
A_APPROVED
� � if DISAPPRcvRn !APPROVRD 5UB.7RC[' TO pBpVR
__ Call For Reinep.
IN6PRCTTO rOT7 X r
city of Tinard Building Departsoent
13125 SN Ball Blvd. Tigard, Oregoe 97223
Inspection Line (Ree-O-P:sone): 639-4175 Business Phone: 639-417:
Inspect ion:^ _..---- ---•—
Poatin9 Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Gas Line FINAL:
Pound. Plbg. Top
Out
PoetFrsmin./9eam Struck. San. Sewer g _
Poet/Beam Hnch. Rain Drain
Insi:latLon �'
-Hech�
Plbq. Underfloor Nater Line Gyp. Bd.
PM
Date Requested:
C Permit:
Address:
Auilder: ---
_. 1r - 15
THE FOLLOWING CORRECTIONS ARE REQUIRED: --
Inspectors
�pP1eOVjp DISAPPROVED APPROVED SUBJECT TO ABOVR
'oo'—A—call. For Reinsp.
Y
I1 PRCfION ROTICE
City of Tigard Building Department
13125 RW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Foot ine) P1Dg. Underslab Mech. Rough-in ppr/S —
Found. Plbg. 'Cop Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Meeh.
i
Date Requested: ` Time: AM PM
a
Address:- #rmit 1: �� �4L
Builder: a1
THE FOLLOWING CORRECTIONS ARE RI.'}UIRED:
1,01 51'cte
LvCtr��9�c; / t- t� ►� /�C, I� �Tl lDf a 7'�_7�
inspector: �G�l�/� Z�--f C�1 j Dato:., 4-— _ i
APPROVED DISAPPROVED APPROVED SUBJRCT TO ABOVF,
i,—'Call Fnr Retnep.
�NBpECTION NOTICE
city of T.i9a-d Building Departinent
13125 SRI Ball Blvd. Tigard, Oeec.-
n 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspect Lon:_
Footing Plbg.
Underelab Mecl, Rough-in Appr/Sdwlk
Fund. Plbg. Top Out
Gas Line iINAL:
Post/Beam Stnlct. San. Sewer
Framing -Bldg.
Poet/Beam Mach. Rain Drain
Insulation -Plumb.
' -Koch.
Plbq. Underfloor Water Line Gyp. d�.
Date Requested:_,
2
1 1 b I
11dd-'eges �� � SrEM1f� Permit-
Builder: Mm .
THY FOLIAMUMC COBROC' 1008 ME RNWIR=DR
Date: l
O-
AI'PRO'FD SUBJRCT TO ABOVE
APPROVED DISKPPRCWED _
Call you Reinep.
JNSPECTION NOTICE
City of Tigard Building Department
13125 BW Ball Blvd. Tigard, Oregon 9723
Inspection Line (Rei--O-Phone): 639-4175 Business Phone: 639-4171
Inspr,.ctiona_
Pouting Plbcy. Underslab Meoh Rough-in Appr/Sdwlk
Found. Plbg. Top tktt Gae Lina 1 FINAL&
Poet/Bpatn Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation .-Plumb.
Plbg. Underfloor Water Line Gyp. Dd. -Mech.
Date Refiteeteds � � Times
Address: OE
-Z2� — -Permit ft
Builder:
THE FOLLOWING CORRF'_TIONS ARE REQUIRE :
tnapector:_ Data&
v _APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
INSPIOji NOTE_
city of Tigard Building Departaryrtt
13125 Sw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Fluainesn Phone: 639-4171
Inspection:---_-- --- ------
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found.
Plbq. Tog Out Gar Line FINAL:
Poet/Beam Sr_ruct. San. Sewer � Flaming
-Blumb.ldg.
ru
J
Pont/?eam Mech. Rain Drain InlAtion -P
Water Line Gyp. ed. -Hoch.
Plbg. underfloor /]
Date Requested:
�. _�7 - Timss �i►M _ _PH
Address:
Rullder: _
TRE FOLLOWING OORRECTIONS ARE 1EQUIRED:
Inspector: Date:
___„L, ----
APPROVEn DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
}
INSPECT';ON NOTICE
City of Tigard Building Department
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueine3e Phone: 639-4171
Inspe:-tion:
Footing Plbg. Underslab Mech. Rough-in A r
pp /Sdwlk
Found. Plbg. Top Oct Cas Line FINAI.s
Post/Beam Struct. San. Sewer / Framing -Bid
L� g.
Poet/Beam Mech. Rain Drain Insulation ) -Plumb.
Plbg. underfloor Nater Line
Gyp. ed. -Mach. !
Date Requestedt � - —� �y�� _Times AAM
Addreses / D� M
rmit 1 tc7_�_L� (O
Builders i
THE FOLLOWING CORRECTIONS ARE REQUIRED: i
:�
Inspector: r Date.
APPROVED ` DI3APPgp1/gD APPROVED BU"CT To AM"
For Reinep.
City of Tigard Buildlui De�part:vvvsnt.
1.3125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueine oc4 Phoney 639-4171.
Inspect ----
f
Footing Plbg. Under.alab Mech. Rough-4.- .^.ppr/Sdwlk
t
Found. Plbg. Top Out Can Line FINAL:
Pont/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Ruin Drain Insulation -Plumb.
Plhq. Underfloor Water Line Gyp. Bd. -Mech.
L.
Data ReguFeted: Times P14 P!L
Addtenat__ � t �^Q c� s`1 ca-'v : Permit #1
Builds-•
TRE FOLLOWING CORRECTIONS ARE REQUIRFD:
Date:
APPROVED DISAPnROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
WIN
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection /11
Date Requested Time P.M.
AddressPermit 6
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector 1+bisapproved
Date 7
CALL FOR REINSPECTION
Pr'YES 0 NO
----------
INSPiR 19M NOTICE �"o
City of Tigard Building Department
13'25 sw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
1nslwct.Ion:
�_ _ - ---- — --�
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg Top Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rein Drain
Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
_7 jl Timo: AM PM
Date Requested:_ —,l—L_.l -- -- -'
Address:
Builder 's
THE FOLi.oWING CORRECTIONS ARE REQUIRED:
Inspector:__// - --- - _ Date,--
APPROVED
ate,-APPROVED DISAPPROVED _-_ APPROVED SUBJECT M ABOVE
Cell For Reinsp.
�FeC'TIUN NOTIg
City of Tigard build]-Dg DePart8*MMt
13125 gn Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4171
Inspections — ---- —
Footing
Plbg. Underalab Mech. Hough-in Appr/Sdwlk
P
To Out Gas Line FINAL:
Found. Plbg.
Framing -Bldg.
�l6et/Beam Struct. San. Sewer
Insulation -Plumb.
rt/Beam Mech. Rain Drain
Flbq. Underfloor War-or Line OYP• ad. -Hoch.
AN PN
Date Requested:.
—�� 7 —Times
L �G •'v1 AL[ .f Ci __ Permit �—
Addres•s-LIL— -- �'--
Builders __ --------
THE IOLLOWINfi CORRECTIONS ARE REQUIRM --��
Inapecto-re
�-T'��' _l._..r--.---- -------.-
�i Ap' pROyED DTSAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
IN£PBCfLCN NOTICE �1/~
City of Tigard Building Department
13125 911 Ball Blvd. Tigard, Oregon 97223
Inspaetion Line (Roc-o-Phone): 639-4175 Business Phone: 639-4171
Inspection: — ---
Footing Plbg. Underslah Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Koch. Rain Drain Insulation
Plbg.JUn r Nater Line Gyp. Bd. -Koch.
Date Requestoda 1 �- ^—Times 7—AM / PM
Address: e Permit #t�d �� Y✓�
Builder:--
THE FOLLOWING OORRHCTIONS ARE REQUIRED:
Inspector:_.� ;,tT_ Date:
f�
_APPROVED —� DIS„PPROVED APPROVED SUBJrrT To ABOVE.
Cr11 For Reinap.
AI
INSPECTION NOTICE
City of Tigard Building Department
V1125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-C-Phone): 639-4175 Business Phone: 639-4171
Inspections- ----------- ---------. ___ ---
Footing Plbq. 'lndernlab Mech. Rough-in Appr/Sdwlk
Found. Plhq. Top out Gas Line FINAL:
Poet/Beam Struct. ,-�San�j'wdr Framing -Bldg.
Poet/Ream Mech. Rain11LrAiJP Insulation -Plumb.
Plbg. Underfloor Hater Lind Gyp. Bd. -Mech.
Date Requested:_____— _ _ Time: _/J��AM ____`—PM
Address:1 _�2_s1 _c-f'J (aj t' t � Permit #:<?
. --
Builder:
THE FOLLOWING COFRECTIONS ARE REQUIRED:
Inspector," sr Date:��_�- �1
APPROVED DISAPPROVED —_ APPROVED SUBJECT TO ABOVR
_ Call For Rainsp.
a
INS RCTION NOTICE
City of Tigard Building DegartMOnt
1.3125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspection:_Footing Plbg.Plbg. Underelab Mech. Ro�agh-i.n Appr/Sdwlk
(noun' Plbg. Top Out Gan Line FINAL:
Post/Bean, Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. UnderfloorNa��77r ne Gyp. Bd. -Nech.
d.
Date Requeste : 4 x __Timet AN _ PN
Address:
Builder:
THE FOI1,OWING CORRECTIONS ARE REQUIRED:
Inspector: Z Date, / S
__APPROVED _ _ DISAPPROVED _— APPROVED SUBJECT TO ABOVE
call For Reinep.
CITY of TIFA RD
Cffy TWO MASTER PERMIT
COMMUNrTY DEVELOPMENT DEPARTMENT no on PERMIT #. . . . . . . : MST92-0164
13126 SW Hdl Blvd. P.O.Box 23;1117.TOwd.OrwoDn 97223(603)0*4175
639-4171 DATE ISSUED: 09/30/92
L.,ilE ADDRESS. . . t 1,595 SW FALCON RISE DR PARLELs IS133DD-09700
:juBuIVISIUN. . . . : VILLAGE AT SUMMER LAKE PARK 4 'LUN INGs R-4. 5
bLUCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 134
BUILDING -----------------------------------
iiF-ISSUE3 DWELLING UNITS: 1 BASEMENT.. . . . . . . . 10 Sf
CLASS OF WORK. :NEW BEDRIY15:3 BATHS-3 GARAGE. . . . . . . . . . 9400 s
VYf-'E OF USE. . . i SF FLOOR AREAS----------- REQUIRED SETBACKr.-i----,
TYPE OF CONST. 1.5N FIRST. . . . .* 1659 s LEFT. . .-5 ft RIGHI'. :5 ft.
UGLUPHNCY ORP. IR3 SECOND. . . c448 Sf FRONT. :20 ft REAR. . :36 ft
S1 UR I LS. . . . . . . :2 THIRD. . . . :0 s
HEIGHT. . . . . . . . :24 ft T'U*TAL.--------:2107 S f SMOKE DETECTORS. 11Y
FLOOR LOAD. . . . :40 pSf VALUE. . . . . $ : 104122 PARKING SPACES. . : 1
Remarks: PATH I
------------------------------------- PLUMBING ------------------------------------------
SINKS. . . . . . . . . . 11 FLOOR DRAINS. . . . %0 BACKFLOW PREVNTRS- 10
LAVAIORIES. . . . . :3 WATER HEATERS. . . 11 TRAPS. . . . . . . . . . . . . . 10
TUB/SHOWERS. . . . *3 LAUNDRY TRAYS. . . :0 CATCH BYGI1\18. . . . . : A
W01'ER CLOSLIS. - :3 SEWER LINE (ft) . s0 GREASE RAPS. . . . . .
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE D I SP. . . i I RAIN DRAIN (ft ) . sO
WASHING MACH. . . : 1 SF RAIN DRAINS. . : l
IILLHANIC14L ------------------- F.EES --------------
FUEL *rYr-'ES-------------- UNIT HTRS. . 90 type amount by date recpt
/GAS/ VENT'c E . . . . . s0 TIF $ 1460. 00 JH 09/30/92 -
MAX INPUT:0 BTU VENT FANS. . .-4 BPRT $ 445. 50 JH 09/30/92 -
i-URN ( 100K . . sO HOODS. . . . . . : 1 BPLC $ 289. 58 JLH 07/29/92 230023
TURN ) =100K . . : I WUODSTOVES. :O B5PC $ 22. 28 JH 09/30/92 -
FLUOR FURN. . . . :0 CLU DRYLRS. s I GSDC 4# 280. 00 JH 09/30/92 -
BOIL/CMP ( 3HP:O OTHER UNITS: 1 PARK $ 250. 00 JH 09/30/92 -
GAS OUTLETS: I MPR1 $ 45. 00 JH 09/30/92 -
Uwnery MPLC $ 11. 25 JH 09/30/92 -
DUN MORISSL- TTL HUMLS M5PL $ 2. 25 JH 09/30/92 -
15555 SW RANGY RD F-,PRT $ 140. 00 JH 09/30/92 -
bull*k 201 P5PC $ 7.00 JH 09/30/92 -
LAKE. OSWEGO OR 97035
Phone #s 503--620-7538
Contractors
DON MORISSETIE BUILDERS, INC.
15555 GW RANGY RD.
#&101
LAKE OSWEGO OR 97035
Phone #-. 620-7538
Rey 4- 1 35533
$ 2952. 86 TOTAL
This pernit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS
ligard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace In5p
applicable laws. All work will be done in accordance with approved Post/beam Struct Gas Line Insp
pians. Insulation Insp
p, This permit will expire if work is not started within 188 Post/Beam Mechan
days of issuance, or if work is suspended for more than IVdays. Pllm/undslab Insp Gy^ Board Insp
PLM/Underfloor Rain d-ain Insp
[--ermittee signature : Mechanical Insp Water Line Insp
Plumb lop Out Appt-/Sdwlk Insp
ISSI-ted By: Framing Insp Mechanical Final
Call fur' insprCttull - 639 4t:75
CITYOF TICr.�4RD rOF TMID SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PE R'iyl I T
13126 SIN HWI 6ki R0.Ow MV.ngaid,Or"m 97713(6W)6394175 PERMIT #. . . . . . . : SWR92-0261
639--4171 DATE ISSUED: 09/30/92
bl-IE. ADDRESS. . . i IP-595 SW FALLON RISE DR PARCEL: 1SJ33DD--(h97ih0
SURD IVISION. . . . : 911-1—ArY—p- AT SUMMER LAKE PARK 4 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 134
I ENAN1 NPlY1L. . . . . ..
USA NO. . . . . . . . . . . VA X TU RE. UM I I S.
CLASS OF WORK. . . .1\1E.W DWLLL I NU UN IJ S. I
TYPE OF USE. . . . . ..SF 1\10. 01- BU I LD I 1\166. I
INSTALL T YPE'. -LAUSWR 1111E RV SURFOLE.
1-1(?M.:IY,k5 : PA 111
uwner,: -------- FEES
UUN MURISSETIE HUMES t Y foe LAMOI..knt by ciate v-ecpt
15b55 SW BANUY RD P H 1Y1 1 4.
x'100. 00 JH 09/321/92
SUITE 201 1 NSP 1 3�j. 00 JH 09/30/1312
LAKE USWLUU ON 97035
Phone #1 503-620--7538
Lcintractcir,: -------------------------------
1—uNTRACIOR NOT ON FILE
fItlorle #: f 2135. 00 TOTAL
R116HJIRED INSVIECIIONS
phis kpplicant agrees to comply with all the rules and regulations Sewer Inspect ic)n
of the Unified Sewage kyency. The permit expires WO days "ros
the date issued. fhe total amount paid will he forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall pich",
a "Tap and Side Sewer" Permit and the Agency will install a I tPral.
t. t I.we
CFkil for inspection 639-- 41 5
CITY OF TIGARD
RECEIPT PAYMENT RECrlPT NO.
00RISS-ETTE, DOIN CHECK AMO!- 92-23P 178
i4DDREs3 4837. 6E,
CASH AMOUNT' a 0. 00
PAYMENT DATE og"30/cip
f7"-MPOS3E OF PAYMENT AMOUNT PAID PURP08F OF PAYMENT SUBDIVfSION
.......... AMOUNT PAID
BUILDING PERM
MECHANICAL PE 44`3PLUMB I NG PERM —......—
PLAN CHEr
.K FF. 45. 00 00 ST. BUILD PER 140.
SEWER INSPECT 050. 133 SEWER USA 31. 53
STORM DRAIN SDC 35. 00 PARKS SDC 2100, 00
MASS TRANSIT TIF FEE.-S 280. 00 RESIDENTIAL TRAFPIC FEES 2n0. ej0
-110. 00 1350. 00
I-OT 134 VILl-,AGE AT SUMMERLAVE 4
1i,595 SW FALCON RISE DR
TO'I'At.. AMOUNT 4837. 86
CITY OF TIGARD "Imfl.1fall 23397 d. PLNCK/RECT #
i'O Uox 23397
COA4MTIN ITY 1)EV('LOPMENT DEPARTMENT 73prd,Oregon 97M PERMIT #
(503)639-4171 DATE ISSUED
JOB ADDRESS: �,� � rJ ��
--�=-^= 't Jl f (l r 'r k�i< c i�k' .TAX MAP/LOT f5 3-3 �?-
SUB: '^1IIh�C�E �� �t''inf-P tW,tr1 L
LOT: LAND USE:
VALUATION: _�IL�� /Z Z ,
OWNER SPEC AL NOTES
NAME: LL MF. ._ / REISSUE OF:
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHONE: ' c' SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: K1� ��, Pkc v�- PLANNING:
ADDRESS: ENGINEERING:
--- _ FIRE DEPT:
�F�nn►�-; __.._ _ _. OTHER:
CONTR. BOARD #: _ EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: h C w+a �� � p ►�r"Q � LIST/SUBCONTRACTORS:
MFCH: _ T 1 P` k- L =,pr II BUS TAX:
ARCH/ENGINEER r
NAME: CALCULATIONS: - -
- - ------
_ ---
ADDRESS: TRUSS DETAILS: -��---�-
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OTHER:
PHONE:
PROPOSED BLDG. USE: 1
APPLICANT SIGNATURE
Received By: �
Oa'_e Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
rn��91"016� 10-432 00 Building Permit Fees , // -- 4�S, so
10-431 00 Plumbing Permit Fees / ��°� — l�/u , c�
v_ 10-431 01 Mechanical Permit Fees
10-230 01 State Building lax (5% 11.5 3� s
Building ��
Plumbing
Mechanical
10-433 00 Plans Check Fee f�3
Buildings •S
Plumbing _
Mechanical
10-230 06 Fire
.5w0ey1-()29 30-202 00 Sewer Connection
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 — /3 SD
25-448-01 Residential Traffic Fees o350 �,/
25-448-05 Mass Transit TIF Fees //0-C- _1 0 .
52-449 00 Parks System Dev Charge (PDC) ;[sy --
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) �� -- v
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL jF� `2T,' 83 7. fSly
nm/3587P.WPf
r
•
I,
CITY OF: T i CARD RECEIPT OF PAYMENT RE=CF I PT NO. a c.)2-2300,23
CHECK AMOUNT a 250. 00
NAME a MORISSETTF, DON CASH AMOUNT a N. (bill
ADDRESS a PAY14ENT DATE: a 07/29/42
SUBDIVISION a
I
i
PURPOSE OF PAYMENT AMOLJNT LA I D PURPOSE OF PAYMENT AMOIJI14T AA I D i
v,I..AN C1'1ECKF=E
i
i
I
1�'. 95 SW FALCON RISE DR
LC1T 134 VILLAGE=. A'f ,c,UMMF:RL_f.i(C: #4
TOTAL ()MOLIN'T PAID -- — — _) ?50. 00