12619 SW FALCON RISE DRIVE ADDRESS:
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i:�records\micrcflm\targets\building.doc
*xarscTION WTTCZ
city of Tigard MULIAing Department
13126 M Ball tiled. Tigard, Oregon 97223
Inspection Line (Mac•.0-Phone)` 4639-4175 Business Phone: 639-4171
Inspection: /
Footing Plbq. Dnd��-b �M—�hRo-'gh-in 11ppr/Sdwlk
Found. Plhg. Top out Gas Line
rIK11L:
Poet/Beam Struct. San. Sewer Erasing -Bldg.
Post/Beam Mech. Rain Drain Insulation
-Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requesteds-t -
Time: AM �
1Wdresss Permit is - U
Builders
THE 70-LOWING OORRSCPIONS ARE RNQUIRZDr
CA C L Fr�IZ l�l/5� _—(pie /c►2_�_
C/ Ac to—rr,
ApPRCriIlD `� plBppPRpyRD APPROVKD stl8
.71t1'T TO ABOVE
_-G-rot!
For Reinsp.
CERTIFICATE OF
CITY OF T c i�M, r 0. . . CIPA. 5 MST93--0027
COMMUNITY DEVELOPMENT DMMR-0MNT DATE I SSUEP s 0-1 ,'27/93
IN25 SW Hall Blvd.Tigard,Orapoa 07223x6109 (503)639-4171
PARCEL..t 1 S l;:.3DI) -0961VdQ+
'.�I.TE ADDRE::S��,. . . a 1,21619 5W FALCON RISE DR
SUDD I V I S l ON. . . . e VILLAGE AT SUMMER LAKE PARK 4 ZON I N .R- 4. c5
BL..00K. . . . . . . . . . . LOT. . . . . . . . . — . 1133
CLASS OF WORK. tNEW
TYPE OF USE. . . :SF
OCCUPANCY GRP. t R-7
OCCUF'ANI.";Y L.QAD a c'4 4
TENRN T NAME.. . . a
Remarks€ PATH I
DON 'MAR I SSETTE HOMES
15555 1 BANDY RD #201
LAKE OSWEGO OR 97035,
Phone #t 620-7536
contractor-4
DUN MORISSETTE BUILDERS, INC.
15555 SW SONCY RD.
#201 I
LAKE 0SWE00 OR 97035
Phone #s 620--7538
Reg *- 1 35533
Or:cupancy of the above rNferenced building is hereby Riven, and cert; iften
the compliance with the !.Aatm Of Oregon Specialty Codhq for the gv-oty,
occupancy, and 1.tse under w`@ich the r"'PPPrenced permit war, issued.
~171 RE DEPARTMENT TLDINC3 SPECTOR
1 L
17,F-i N- C)-F.. '.CAL
j
POST IN CONSPICUOUS PLACF
IN�Ytrcrlor► r.rlcs
City of Tigard DOLIAI29 DwPa�tz23
1912!% NW 11all Pled. Tigat . def»
Inspection Lina (Rec-O-Phone): 639-4175 Susiness Phone: 639-4171
Inspections_ --
Tooting Plbg. Onderelab Mach. Rough-in Appr/Sdwlk
round. Ylg.bvyp Out pas Line FINALt
Erasing -Bldg. J
Post/Seats Strutt. San. 8eurer
Fain Drain Insulation -Plums•
poet/Seas+ 16001.. -----�`
Ylbg. Underfloor Nater Linepyp. Bd. '-Meth.~
AM
estedr -� T>me: PK
Requ ti-
�i reit
Addresst
Bu. lde�: i "
THE FOLD MING 0D1tRECTIONS ARE RRQOIRED: r-
Datat�
Inspectors - — -_—
APPROVED DISAPPROVED APPROVED SDEJRCT TO ABOVE
Call For Reinsp.
INBPECPffi1 (rtmrr. ���
city of Tigard HaUding Department
13u5 " Nall Bl-d. Tigard, 0-9— 97223
Inspection Line (ROC-O. Phona)e 639-4175 Buo_near Phonal 639-4171
Inspeotion,
Footing Plbq. Undaralabh.
Naich. Rough-inFou
s APPr/8dwlk
�' Mg. To;, we Gas Lina ��
FINALS
Post/Bean Struct. San. Sower
Framing -Bldg.
Post/Bsam Nech. Rain Drain
Inaulatlon -ply,
Plbq. Dndsrfloor Water Lina
GYP. Bd. Time h.
Deka Ro>'qusatsd,��_�_ ,`
AAdrssa: � '� A �
Permit �j Z,�
Builder. --,�
TBE FOLI ODkREC'TI(>wS JLRL RNWIAEDt
Impactors L" IFTlf� sfn�n
_ Date,
APPRD�/fD _ DI8/1PPROyED
- APPROVED SURTZ"T yip ,#ppyE
Call For Rainap.
alt? or Tigard BuLIdiaq Departmeat
13125 M Sall Blvd. Tigard, oregoe 97223
Inspection Line (Ree-o-Phone)e 639-4175 Business Phones 639-4171
Inapeations
rooting Plbg. Underolab Nech. Rough-in Appr/8dwlk
Pound. Plbg. Top Out Gas Line FINALt
host/Bears etruct. San. Sewer pressing -Bldg.
I
Post/Beau Nech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line • b• h.
Date Requesteds� Tlass AK P9
Addreaas ._„)
Builders
TQM Y<nJANING OORRECTIONS AM REQUIRM
t�
/ �� ~-� `
Inapectors Dates—
�APPROVEO DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
Citi or Ti"Cd Building Departamnt
1312S On Ball blvd. T19atd, Ocagon 97223
Inspection Lina (Roc--O-.Phona)e 639-4175 Business Phone? 639-4171
Inspections-_____ �-
Footing Plbg. Onderslab Mach. Rmgh-!.n Appr/Sdwlk
Ftnind. Plbg. Top Out Gas Lino FIMALt
Pos BOANm Struat. San. Rawer Framing -Bld
9•
Post/Beam .Hoch. Ra:a Drain Insulation -Plumb.
Plbg. Dndmrrlocr taster Line Gyp. Bd. �/J -�h.
__ _
Cats Requested -� Timee
PM
Permit —
Buildor��+
THR FOLLOWIMIi ODRRECTIOMS ARE REgUIRSD3
Inspector: _ v r
'V APPRO_ VID ATSAPPROVED
APPROVRD BU&QCT TO ABOyE
_--Call For Roinsp.
jNSPiCTION NOTICE v
City of Tigard Building Department
13125 gM Ball Blvd. Tigard, Onagon 97223
Inspection Line (Rec-o-Phons)t 639-4175 Business Phones 639-4171
Inspections
rooting Plbg. Underelab lbod. hough-in-) Appr/&Wlk
am—
round. Plbg. Top Out s Line FINALt
Post/Bean Struct. San. Sewer rreminq -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbq. Underfloor Mater Line Gyp. Bd. -Nech.
Date Requestedt , Time: AM PM
Address ' C Permit is ��
Builder: f ln
TR= FOLLOWING CORRECTION'S ARE REQUIRED:
InspectoFs.__ry� ��—
APPROVED DISAPPROVRD APPROVED 9"BJECT TO ABOVE
Call For Reinap.
Cit, of Tigard RuiIdUin DepattMent �I
13125 611 Baal Blvd. Tigard, O—VOn 97223
Inspection Line (ROC-O-Phona)t 639-4175 Business Phonat 639-4171
InsPeations
Footing Flbq, Underelab _
Mach. Rough-in Appr/Sdwlk
Found. Plbq, Top out
Gas Line FIMALs
POet/Beata Struct. Ban. Sewer 'r_--_ -
�( �Mi�� -Bldg.
Post/Beam Mech, Rain Drain
Insulation _Plumb,
Plbq, Underfloor Mater Line
EYP. 6d. -Mach.
D;te R+queatede - -
/ Tl�ter __Y__P):
Buildartr}�
T" FOLUM11'a CORRECTI—offs ARE R2QUIREDs -------------
_--_i-"-
f
---------------
-------
-.- .-_
Inspectors_
Dater
----APAOVtp --_.1 DISAPPROVEb
Lcall For Reinsp.
city of Tigard Building pepart"t
13125 SR gall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phonee 639-4171
Inspections —
q —
FootinXlbq._ Onderalab Mer:h. Rough-in kppr/Sdwlk
found. Cl Plbq. TOP Out Gan Line FINALS
�
Post/swam Struat. San. Sewer Framing -Bldg.
n
post/Swam Mach, Rain Cain Insulation -Plumb.
Pl.bg. Underfloor Water Line g1rP• Vd• -N&ch.
Times _ AM PM
Data Requesteds
Addresat - ^ G' Permit #i�l, D Z
Builder:
THE FOLIANINQ CORRECTIONS ARE RYWIRRDt
i
Dates
Inspectors_ ----- — -
11PpROVED - DTSAPPROVRD APPROVED SUBJECP TO ABOVE
Call For Reinsp.
INSpgCTFon noTzcR Ll:�
City of Tigard Buil:iing Departaent
13125 Sw Ball Blvd. Tigard, Or*Wn 97223
Inspection Line (ROC-O-Phone)c 639-4175 Busineos Phone, 639-4171
Inspection:
Footing MO. UbdkWSlab Hach. Rough-in Appr/Sdwlk
Found. Mg. !pp put vas Lino
FINAL,
Poet/ee&m Struct. San. Sewer Framing -.Bldg.
Post/Seam Hoch. Rain Drain Insulation -Pl:uob.
Plbg• Underfloor Mater Lim Oyp. Bd. -Poch.
Date Requested, 15 -11
Ther _ AN _PH
Addreas: _
Buildert
TAS FOLLOWING CORRECTIONS ARE REQUIRED: --
-
1,7
i
lnspectryrs i,
-- --- _ Date,
_APPROVED DISAPPRCrM APPROVED SUBJECT TO ABOVE --
Call For ROinsp.
.L!!@pi.
city of Tigard
1312S 611 Hall Blvd 97223 �i�,
Inspection Line (Roe•-O-Phone)s 63v-._._. ..uninews Phone: 639-4171
Inspections !.
Tooting rlbg. Underelab Nech. Rough-in Appr/Sdwlk
round. Plbq. Top out Gas Line FINALS
et/Beam Struct.� San. Better Framing -Bldg.
st/Beau Mech. Rain Drain Insulation -Plumb.
fslbq. Un"Irtls�Nia; `Water Lino Gyp. Rd. -Noah.
Date Itoqu�istedt /
L� xlmus J1H rel
Address s.L_" IC Permit
Builder: C`— "71 -7 ,
THR FOLLOMING CORRECTIONS ARE REQUIRED:
Inspector:
Fvlpw:LD —� DISAPPROVED APPROVM SUBJECT TO ABOVE
_—Call For Reinsp.
(K
V
IN PECTION NOTICE
City of Tigard Bui.diog Department
13125 SN Hall Blvd_ Tigard. oirogon 97223
Inspection Line (Rec-O-Phone): 639-4175 Buginese Phone: 639-4171
Inspectiont -- ----'— ��
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwl.k
Found. Plbq. Top Out
Gas Line FINAL:
i
IPost/Beam 5tcuct. an. eldBi� Framing -Bldg.
Poet/Boom Nech.
Inuulation -plumb.
Plbq. Underfloor
tar a Gyp. Rd. -Koch. i
px
Date Roquestedt _L Timat
�j , a
Addrees:1l /_A�� T
�� •� �� Po�rmit
`1
THE FOLLOWING CORRECTIONS ARE REQUIRED:
� hater
Inspector: -
1 APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
`r�'� call For Rainap.
e
PEKIIT # ACCT # DESCRIPTION AMOUNT .AMOUNT PD. BAC. DUE
tj13� �fi?7 10-432 00 Building Permit Fees .'�.5 S+ Su _ C
10-431 00 Plumbing Permit Fees U G" _ l4�u, •
i
1D-431 01 Mechanical Permit Fees
10-t30 01 State Building Tax (5%)
Cuilding �, /
Plumbing
i
Mechanical ._ Y
10-433 OJ Plans Check Fee
Cuilding
Plumbing
r
Mochanical P.L� ;
10-230 06 Fire
; R )-ur►xk130-202 00 Sewer Connection !�� ���
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees _
25-448-04 Industrial TIF Fees
1_5-448-06 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)
31-450 00 Storm Drainage Syst Dev Chrg
(ssoc) to_ _
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL .fid?7Z ,8� .S O �40 t2
1 �
nm/3581P..WPF
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, 01-911- 97223
Inspection Line (Rec-O-Phone): 639-•4175 Business Phone: 639-4171
Inspection:
rcotii Plbg. Underslab' \ Mach. Rough-in A
ppr/Sdwlk
ound.
Plbg. Top Out Gas Lina
FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation
-Plumb.
Plbg. Underfloor Nater Line Gyp. Sd.
-Meeh. _
Data Requested: 3 C 1
/ Time: AM / PM
Address:�/T����C�j�J9
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
--------------------
Inspectors-----rt =�1
f_
� - Data:
__APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
___Call For Reinep.
CITY OF TIFA RDA ./
ny
COMMUNITY UEVELOPMENT DEPARTMENT ORi A MAGI ER PERMI , rt y
131P&W14d&A P.0.6=7"X1.T4Wd,0mm1pn V=(SM)639-4176 . . . . . . .
I S U F'D, , 02, 13%93,
:moi i L vi 0 1) t)W I HLL(J1\i k1;.-)L bi', i4iricL�- 1,. 11331)0 09b,Z(0
LiUBDIVISION. . . . VILLAGE AT SUMMER LAKL PARK 4 ZONING: R--4. 0
BLOCK. . . . . . . . . . : LO'-.'. . . . . . . . . . . . . Z133
BUILDING
[REISSUE: DWELLIN(.; UNITS: 1 BASE11FIEN'T. . . . . . . . :10 s
CLASS OF WOR11- *NEW DEDRMS c 4 1:iwms,3 GARAGE. . . . . . . . . .. ..4-40
7'YPE fJF* UGE. . . :SI: i'LOOR AREAS------- REL,'!IJ114ED
, YPE OF CONST. g 5;N FIRST. . . . . 1568 ,f LL-.F 5 rt RIGHT. :5 ft
-f t REA R. . - 4
320 4 f t
,)CCUPANCY G D. IR3 (S-E.00ND. . . 14 10 Sf F R JNT. :
13TORILS. . . . . . . :2 THI RD. . . . 0 S f RE.UUIRED_
HEIGHI.. . . . . . . . :�,+ f't TOTAL---. -- 2970 S f SMOKE DETLUTORS. -Y
f=!-OOR LOAD. . . :40 P;f VALUE. . . . . 144540 PARKING SPALES— il
F�emav,ksi PATH 1
PLUMBING
SINKS. . . . . . . . : 1 FLOOR DRAINS,, . . . .0 BAC'KFI-OQ PREVNTRF3. . 90
;-,AVATORIES. t3 WOO ER HEATERS. . . il 7 RAPS. . . . . . . . . . . . . :0
LAUNDRY TRAYS. . . :0 CAICH UPS i As. -10
WATER CLOGIETS. . :3 SEWER LINE (ft) . :0 GREASE TRAPS. . . . . . . .0
,iISHWAIBHERS. - 1 WATER LINE (ft ) . % 1@0 OTHER F I X1
.ARBAUE D.19P. . . 1 RAIN DRAIN (ft ) . :O
MACH. . . : 1 3F FRA IN DRAINS. . : 1
MECHANICAL FELS
f--IJEL UN 1 T H'(RS. 0 type amolint by date V,LU r-P t
'GAS/ VENTS . * . . . Q, "IF 1 1460. 00 P[-L 03/19/W
MMX 'ANPUT:0 r,'(U VENT FANS. . :4 BPRI $ 1545. 30 PI-I- 03/ 19/': -," -
FORN % 100K . . -.0 HOODS. . . . . . : 1 B P L G $ 354. 58 JLH 01/05/9.3 93-2235288
(:URN ) -100K . . : 1 WOODSTOYES. :0 B5PC $ 27. 28 PLL 1153/19/9:3 -
FLUOR FURN. . . . :O CLU DRYERS. : I BPLC $ 15. 00 PLL 03/19/93
-
BOIL/CMF C SHPIVI OTIIER UNITS-. 1 IS S D C' $ 280. 00 PLL 03/19/93
GAS OUILETSol PARK 1, 250. 00 PLL 03/19/93
Dwnpr- 45, 00 PLL 03,119/93
DUN MOR ISSETTE HOMES NPI-C 11. L5 PLL 03/19/93
-
IS 555 5W BONGY RD #6:201 M'-9PL c::. 25 PLL 03/19/93 -
PPRT 4 1-+0. 00 FILL 03/19/93 -
LAKE OGWEGO OR 97035 P5PC a 7. 00 PLL 03/ 19/1-)3 -
Phone #: 620-7538
Contr,actot-:
DON rvJ0rx113SEJT-E BUILDERS, 11\1r
15555 15W DANGY RD.
#C-10 I
LAKE OSWEGO OR 9703t�
PI-ione #: 6r:0.-.7538
Rep 35533 ---------
S 3137. 86 TOTAL
This ptreit is issued subject to the regulations contained in the REUUIkED INSPECTIGNS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp F0-pplAt--e Incip
applicable iaws. All work will be done in accordance with approved Plost/Beam Stri.tet (jas Line Insp
plans. This persit will exiif ml kis ,t started within 180 Post/Beam Meehan Inskilation Insp
dayi of issuance, or if war . n
0ed `or more than 186 days. Plm/undslab Ins) Gyp Boar Tnsp
�
PLM/Un d e r-f I o ci t-- F'ail-I drain Insp
Pet-mil:tee I- Insp Water, Line nsp
,;i gnat 1.�I PlLimb Top O�.it iAppv�,/Sdwlk Insp
is ;-ti-d By , r,t-amillq Insp yv- 'Finsi
Call for inspection - 639-4175
CITY OF TIGARD AJ60 SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT MOM PERM IT
13125 BW Hall BNd P.O.ft 2=7,TlWd,Ompn 07 (SW)636-4175 PERMIT #. . . . . . . . .WR93-002,4
b39--41.7 i DATE ISSUED:
ITE ADDRESS. . . t 12619 SW FALCON RISE DR PARCEL 15133L)D-09600
:3UBDIVISION. . . . V VILLAGE A1 SUMMER LAKE PARK 4 ZONING: P-4. 5
R'.00K. . . . . . . . . . .. LOT. . . . . . . . . . . . . 3133
ii,'NANT NAME. . . . . .
USA NO. . . . . . . . . . i F!X1 U RE UNITS. .
CLASS OF WORK. — tNEW DWELLING UNITS. . -. 1
7vPE DF USE. . . . . :SF 1140. OF BUILDTNGS: 1
1 NSTALL TYPE. BJGWR IMPERY SURFACE.
Remav-ksi PATH
Owner: 1: LLS
DON 140RISSETTE HOMES type ar .aunt by date recpt
15555 SW RANGY RD #201 PRMI $ 2100. 00 PILL 03/19/93
IN13P $ 35. 00 PILL 03/19/D3
L(AKE OSWEGO OR 970,Y",
Phims? #* 620-7538
ULint race or:
CUNTRACTUR NOT ON FILE
$ 21 ;:,5. 00 TOTAJ_
REQUIRED INSPECTIONS
his Applicant agrees to cosply witli all the rules and regulations Sewer inspection
of the Unified 3swage Agency. The pervit expires 180 days froi
the date issuer,. The total asourt paid will be forfeited if the
pereit expires. The Agency does not guarantee the accuracy of the
51ce sewer laterals. If the sewer is not located at the smurement
given, the installer shail prospect -i et it all directions frov
installer
the distance given. If not so loc ,Qd, . ler shall purchase
a "Tap and Side Sewer" Pervit an the Agen y will irstali a lateral.
Permittee Signakiti-c-,
!i S,.k e(I By
Cal I for insplect ion 639-4175
&)
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT NO. z93-238031
('HFCK AMOUNT 502P. ac-,
DON NORISSETTE� HOMES CASH AMOUNT a 0. 00
ADDRESS a J5555 SW BPNGY ROAD PAYMENT DATE-' a ►3119193
SUITE #20t 9L)BD I V 161 CIN
LAKE OSWEOFI, OR 970351-1
Pl,.)RPOSr-- OF PAYMENT 0M1JUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
IltJ—IL D-i—N—ITPE--R,-M,— 545. 50 PLUMBING PERM 140. 00
MECHANICAL PE 45. 0q, ST. BUILD PER 36. 53
Pl-F-,N CHECK FE 130. 83 SEWER USA 21010.00
SEWER INSPECT 35. 00 PARKS SDC 250. 00
STORM DRAIN SDC 2180. 01A RESIDENTIAL TRAFFIC F(FES 1350. 00
MASS TRANSIT TIF FEES 110. 00
12619 SW FALCON RISE 1.)RlVf---
LCIT 0133
TOTAL.., AMOUNT PAID — — — —
CITY OF TIGA" U125 SWIMak,a. PLNCI(/RECT #� _
x08=23 9' PERMIT / /"
COMMUNITY DEVELOPMENT DEPARTMENT 71pr4or"m"m
(50)6394171 DATE ISSUED
JOB ADDRESS: + f � -� TAX MAP/LOT 1513 3 t)rD - v S z oQ
SUB: ��-� '�� } LUT: / 3 LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME: T)Ln_io]Drjf2sff lk Llomr- REISSUE OF: _
ADDRESS: rJSsS S) �� fir„/'W10/ LAST REISSUE:
.ad..Y FLOOD PLA I N/
PHONE: _11L_ SENSITIVE LAND: _
CONTR CTOR ,�- APPROVALS REQUIRED
NAME: PLANNING: —
ADDRESS: / 5 " .� 51-AJ � �^� ENGINEERING: eAY_ ��
_ FIRE DEPT:
PHONE: G� _' 3'� OTHER:
CONTR. BOARD /: _ EXP DATE:
ITEMS REOUIREO
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: j �US TAX:
ARCH/ENGINEER o '?"to' CALCULATIONS:
NAME: _ [ ./ �� TRUSS DETAIL.:
ADDRESS: P, ne OX 1 e 3 OTHER:
_
PHONE: C3
PROPOSED BLDG. USE: � �_ ��_ �• �! �- - ��
COMMENTS:
PLITA
APNT
Received By: _ Date Received:
L
.. � .. ..
y
��C./
+.rw,�...�. , . . �
r
CI� OF
mIGARD �3�zs Box 7.3397
PERMIT ECT #
1 �'�°a°`y'97 PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT Tprd.Orrgon9rzz;
(505)639 171 DATE ISSUED
JOB ADDRESS: �_ TAX MAP/LOT
SUB: LOT: LAND USE:
VALUATION:
OWNER =IAt. NOTES
NAME: REISSUE OF:
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHONE: _ SENSITIVE LAND:
CONTRACTOR APPROVALS R UIRED
NAME: _! PLANNING:
ADDRESS: __ ENGINEERING:
FIRE DEPT:
PHONE: _ _�. OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONT 0 S: PLUMB: LIST/SUBCONTRACTORS: _
MECH: BUS TAX: _
ARCH/ENGINEER CALCULATIONS:
NAME: _ _ — TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: —_
COMMENTS: -
APPLICANT SIGNATURE y
Received By: Date Received: