12757 SW FALCON RISE DRIVE-1 I
+�
f
- -aa asi� uc.Terl MS /_5!ZT --
CITY OF TIFA RD CF:pTIFICATE OF
WYOFTNAM) OCCUPANCV
M
COMMUNrTY DEVELOPMENT DEPARTMENT MOO" ERM I T #. . . . . . . 9 MST91-000.1
13125 SW Hell Blvd. P.O.B"23397.Tig",Oregon 9?M.F""176
C---1
G 1 TL A D D R E S-S. . . s Is"15i 5W FALCON RIGE DR PARCEL: I ci I 33DU
SUBD I V 19I CIN. . . , n VILLAGE AT SUMMER LAKE PARK 4 ZONINth s R-4. 5
BL . . . . .. . . . . . n LOT. . . . .. . . . . . . . . : 127
CLASS OF' WORK. -NFW
Typr OF LISE--. . . :SF
OCCUPANCY GRP. XR3
OCCUPANCY LOAD: 116
r(--.1,444T NAME. . .
Homey-ksv
Owners
DON MORISSETTE BLDEAS, INC.
P U BOX 195L4
PORTLAND OR 97219
Phone #1 503-620-7,538
untractor:
()ON MOR1,133ETTE DUILDERS, INC.,
J.5555 SW BANDY RD.
"20J
1,AKE 06WE'(30 Ok 97035
i-,hpiie #t 620-75136
11ccupenry of Che abovp referenced hi.lilding is hereby given, and
Uhp compliam-e with the 5tAte Of OreUon avec-Jolty Codes for the group,
e)m-opancv, and use under- which the I-efPV'PTW0d r)PY'Mit Was iS,s. .tec1.
BUILDING I NSPEr-rov
fir I W.
POET IN CONSPICUOUP3 PLACE
ITRP PLC TIO N971C9
l Cit!- of Tiq&rd Building Depacteat
1.3125 SII Ball Blvd. Tigard, Oregon 97223
Ira-,action Line (Rec-O-P'iooe): 639-4175 business Phone: 639-4171
Inspection: --
Footing Plbg. Underslsb Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Poet:/Seam Struct. San. Sewer Framing
Poet/Boam Mach. Rain Drain Insulation
Plbg. Underfloor Water Line Gyp. Bd. ^Mach.
Date Raquestedt /! TLmt
Address: rmlt #t !
Bu i lder t,-26y THE FOLLOWING CORRECTIONS ARE REQUIRED:
pit
1(
Inepectort Data: �[z!ezz __,
.b DIHAPPROVED APPROVED StJ&7ECT TO ABOVE
Call For R*P.ntrp.
INSPECTION NOTIQB
City or Tigard Building Depwrtwent
13125 8M Hall Blvd. Tiqard, oregsm 97223
Inspection Line (Rec-o-Phone)t 139-4-175 Business Phone: 639-4171
inspection:___ ---
Footing Plbg. Un r0lab Mech. Rough-in / wppr/AdMlk
Found. Plbg. Top out Cas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam v.:uh. Rain Drain Insulation -Plumb.
Plbg. Uaderfloor Water Linneej Gyp. Bd. -Mech.
Date Requesteds__ -- Ti�� ---- —PM S
Address:— �� C`— •'• / �rw�lt t:
Ilullder:._. L2M
TIDE FOLi.XX:INC CORRECTIOH9 ARE REQUIRED:
a
Inspectors l L1Y ��1i.1��';, Dat'at .-
U
S"pROVRD DISAPPROVED __ APPROVED S11B1ECT TO ABOVE
Call For Reinsp.
w ow WMJLMWMMAIwil yr lw �[ G
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Sall Blvd. Tigard, Oregon 97".3
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:,
Footing 21bg. Underelah Hoch. P.ough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Sine FINAL:
Post/Beam Struct. San. Sewer Priming -Bldg.
Post./Beam Mer_h. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
i r
Date Reyuestedt s y TTimei /� AN PH
Address: 7-5 7 rmit
Builder: _
THE FOLLOWING OOP"CTIONS ARE REQUIRED:
r i
inspector:_ Date:
�/— APPPOVRD DISAPPROVRD APPROVED SIJRJR(-r TO ABOVE
Call For Reinap.
� >wr •wa +� � �
I I
INSPECTION IiOTIC6
City of Tigard Building Departsent
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Busineen Phone: 639-4171 t
Inspectiont—
Tooting Plbg. Underelab Hoch. Rough-in �Appr/Sdw k
a
Found. Plbg. Top Out Gas Line FINALt
Poet/Ueam Struet. San. Sewer Framing -Bldg. j
POE t/Beam Mech. Rain Drain Insulation -Plumb.
P).bg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requested,_.
Addregat Q 76 2 rmit +s
Builders��/: 1 _
THE FOLLOWING CORRECTIONS ARE REQUIREDt
Inspector: Dates
APPROVED DIRAPP?44 �APPAWRD BUBJECT TO ABOVE
_Call for Neinap.
FNS1_,-- ON KOTICR
Tigard Building pepari t
city o! Sig 9"Y223 !
13125 SW Mall Blvd. Tigard, Oregon
Inspection Line (Rea-O-Phone): 639--4175 Businews Phonn+ 639- 17d
Inspect Lont__�--- -
Underslab Mech. Rough-in Appr/Sdwlk
For'_'.t:g P lbg. _
Caa Idne i FINAL:
Fc und. Plbg• Scp Out`';jJi{r' —
Sar.. sewer
Framing -Bldg.
p-,et/Beam etrvct.
!ort/beam Much- Rain Drain
Insulation -plumb.
plbg. Underfloor Nater. Lina
Gip. Bd. -)eachTime I .
7
Date Requestedt
r .Permit
Addrees t
Builder: ----
SNR FOLLOWING CORRECTIONS An REQ111RRD1.
Dater
Inspector/t— ---
\---APPROVKD DISAPPROVED —__ _ APPROVED SUBJRCS 7'0 ABOVE
Call For Reinnp.
INSPEG'TION NOTICF. 1
City of Tigard Building
O
13125 aw Ball Blvd. Tigard, re��t
Inspect:ion Line Re
•O_ Oregon 97223
( ?honed: 639-0175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underalab
Mer_h. Rough-in Appr/Sds-A
Found.
Plbg. Top Out Can tine IT
FINAL,
PoeI/Beam Struct. San. Sewer
Framing -Bldg.
Poet/Beam Hoch. Rain Drnin
Airuletion _ply
Plbg. Underfloor Water Line
P. Bd. 1 -Hoch.
Data Requested,
Time: lAe -
Addreea:
Perait
Buildor�/�.��LJ/f/ii !
THE FOLLOWING ODRRECTIojIS ARE R6QUIYIF,D: `— ------_._�.-_--
------------
d N
Inspector,_
---- Date,,
L/11P'PROVED DISAPPROVED
APPROVED SUSYNCP TO ADM
Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
19125 SM Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-41.75 Business Phone: 639-4A71
Inspection:___
T.otinq Plbg. Underelah Mech. Rough-in Appr/:dwlk
Pound. Plbg. Top Out Cas Line FINAL:
Poet/Ream Struct. San. Sewer `?c Framing� -Bldg.
Poet/Benm Mech. Rain Drain / Insulation -Plumb.
Plbg. Underfloor Water Line Qyp. ed. -MOON.
Date Requested: ( Z 1 Timet __ L_AM PM
Addrees: k2,151 �G� L�?� f�ks� r PAerlmit1/t: 91-- Ono]
Builder: P' �y I s5f-���J. 7 Lf
THE POLLOgINO CORRECTIONS AAE REQUIRED:
Inspector:_ DatO: - :7�1��
_—APPROVED -� DISAPPROVED ^— APPROVED SUBJECT TO ABOVE
---Call For Reinep.
pw +w 7A ane +. �.
TNSpE2T10N NOTICE
city of Tigard Building F*psrtarynt
13125 871 Ball Blvd. Tigard, Orfegon 97:23 t
Znepection Line (Rec-O-P tse)s 639-4116 business Phone, 639-417 *, i
Inepiction:_
Foot ng t % Underelab Mach. Rough-in APY r/Sdwsk
Found. Plbg. Top Out Gde Line FINAL:
Poet/Baam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation
-Plumb.
Plbg. Underfloor Nater Line
Gyp. Bd. ._Mach.
Date Requeetedt___ l —Times /�
� YN
A..
Builders
THE POLL0WING CORPEC.T IONS ARE RSQIJ I RED S --�--
Insp*ctors
Date t "'
_ --"PRO"D Dl :"PRMW APPRO'V!D SVWNCT To ABO'VU
Ca11 For NaLaap.
NM SPECTJON NOTI
r.ity of Tigard Building Department
E425 SM Ball Blvd. Tigard,, own 97223
Inspection Ll.:e (Rec-o-Phone)t 639-4175 Business Phone: 639-4171
Inapac:tion t ---- --
Fcotinq P1bg. Underelab Mech. Rough-in Appr/Sdwlk
round.
Plbg. Top Out Gas Line FINAL:
-Bld
,•_f"'aL/Ream stru�� San. sewer Framing g'
s-- -Plumb.
Post/Beam Hoch. Rain Drain lneulation
Plbg. Underfloor Water Line Gyp. Bd.
-Merl,.
-C Time: _L_.AM ._PM
Date Requestedt_ — y
Address:
Buildor.
THE FOLLOWING CORRgCTIONS ARE REQUIRED:
Inspector: — - Date-��_
-el,-APPROVED tiISAPPROVED APPROVED SUB.IECP TO ABOVE
call For Reinsp.
IN6PBCTION NOT,�r6
L
City of Tigard Building Department
1.3125 SM Plan 1°'_-d. Tigard, Oregon 97223
Inapection Line (Rnc-O-Ptone): o39-4175 Buoi-nese Phone: 639--4171
Inspactior.:- ---- -- - ----- ------- —
Footing Plug. Underslab Mech. Rough-in Appr/Sdwlk
Found. Flbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Hewer Framing -Bldg.
i
Post/Beam Mach. Rain Drain Insulation --Plumb.
Plbq. Underfloor�, Water Line Gyp. Rd. -Koch.
Date Requeoted: -,Timet _'k—AM PM
Address: � _ � C_�Ftirmit #t
�Q
Builder:
TNS FOLLOWING OORRECTIONS ARE REQUIRED:
Inspector. _ Dates
PROVED DItlAPPROVRD APPROVRD SUBJBCT TO ABM
Call. tar Sainsp.
ELMUMM
Milli
INSPECTLoN NOTICE Z
City of Ti,yard Building Department
13125 SR Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rev-o-phone): 639-4175 Huainer-, Phone: 639-4171
Inspections
Footing Plbg. t7nderslab --- --- --
Hach. Rough-in Appr/Sdwlk
Fund. Plbg. Top that Can Line
FINALS
Pgat/Ream Struct. San. Sewet
-_ Framing -Bldg.
Post/Beam Moth. (train Drain , Insulation _ply
Plbg. Underfloor Water Lin' Gyp. Bd.
vcl-.
L.te Rc,gueekeds—��� � (:�
Time: M PX
Address: _ — —
n1silders �
T"M FALLOWING CORRECTIONS ARE REQUIRED:
Inspector: i -
__ Dates / 7/
APPROVED DISAPPROVED - - APPROIVED SUBJE'r(-T--TO'L [A►lOyg
____—Call For Reinsp.
r�
...............
�NS:ECTIOY_NOTI� ��
city of Tigard Building Department r
Oregon 97223 f
13125 SW !tall Blvd. Tigard. T
Inapectian Line (Rec-O-Phone)s 63)-4175 Bueinass Phone: 639 x171 \
Inspections -
- : Sdwlk
Footing ) Plbg. Underelat !�ech. Rough-in A pp '/
}_C; FINAL:
Found Plbq. Top Out Gee Line
Poet/Beam Struct. San. Sewer
Framing -Bldg.
Poet/Beam Mech. Rain Drain
Inoul.ati.on -Plusrb.
Plater Line Gyp. Bd. -Nech.
rltsg. Underfloor _
T tans:
Date Requeste•is_��— - � ___PM
--_—
Address: ,
Builder: ��'7 -.- -- ---- ---------
Tui rOLLOWING CORRECTIONS ARE REQUIREDt
��� /�I � ��tit ll�✓�I'T 3 —_� _—. --
Date^
Inopectors_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
call. For Reinsp.
I
CITY OF TWA RDMASTER PERMIT
1CtTYOF 4RD
COMMUNITY DEVELOPMENT DEPARTMENT ONGON PIZRMI T #. . . . . . . .. MaT91-00kt;
131 PA SW 1411 Blvd.P.O.Bac 23397,Tipud,Oregon 97223(603)630-1175
- - - —- �.6
L;1 TE ADDRESS. . . : 1,:.757 SW FALCON COi! Si T SE DR PA RCI 'L: 1 a 1;33DD . 090 00
,SUBDIVISION. . . . : VILLAGE PT SUMMER LANE PARK 4 ZONING: R-4. 5
BL.00K. . . . . . . . . . . LC1T. . . . . . . . . . . . . . 11"7
PUILDING
RE I SF.UE:M 7T90-0177 DWELLING UNIT'S: 1 BAE32MENT. . . . . . . . :1C sf
CLASS OF:' WORK. :NEW BEDRMS:3 PATHS i c GARAGE. . . . . . . . . . :42LA s f
TYRE OF USE. . . :SF FLOOR faRE.AS- -___.____.__. REQUIRED
TYRE OF CONST. :5N FIRST. . . . :2065 sf LE:FT'. . :5 ft RIGMT. :5 ft
OCCUPANCY GRP. : R3 SECOND. . . :0 s f F"RON1 . -20 ft REAR. . :40 f t
STORIES. . . . . - . : 1 TH 1'RL`. . . . :0 ti f REGIU I
HiIGHT. . . . . . . . : 16 ft T1.1TAl_-.--"---:20G5 sf SMOKE DLTE(_TORG. :Y
FLOOR LOAD. . . . .40 ps f VALUE. . . . . 4 : 102550 PARKING SPACES. . :O
1'�Amarks :
PLUMBING
SINKS. . . . . . . . . . . 1 FLOOR DRAINS. . . . . 0 DACKF'LOW PREVNTRS. . :0
! AVATORIES. . . . . :2 WATER HEATERS. . . - 1 TRAPS. . . . . . . . . . . . . . 30
TUB/SHOWERS. . . . :c LAUNDRY 'TRAYS. . . :0► CATCH BASINS. . . . . . . .0
WATER CLOSETS. . s2 SEWER LINE (ft ) „ :0 GREASE TRAPS. . . . . . . :0
U1.-HWASHERS. . . . : 1 WATER LINE (ft ) . : 10+0 OTHER FIXTURES. . . . .. :0
GARBAGE. DISP. . . : 1 RAIN DRAIN (ft ) . :O
!BASH 11,16 MACH. . . : 1 SF RAIN D RA 1 NS. . : 1
MECHANICAL --_.__..__._..___..__._ _-_44____44__.__.____._ ._ _._ FEES
FUEL TYPES-------•----_- LINIT HTRS. . :N tf.e amot_1nt by date r(?r_-pt
/GAS/ / ! VENTS . . . . . :0 PAYM $ 40. 00 JLH 01/02/91 201835
MAX INPUT:0 PTU VENT" FANS. . &I E{PRT $ 4/-!T. 50 /
F URN < 100K . . :@ HOODS. . . . . . . 1 FPLC $ 40. 00 /
F=URN ) -100V, . . . . WOODS FOVES. :0 BSPC $ E'.2. 01.; i
-LODR FUR.N. . . . :01 CLO DRYERS. : i BPLC $ 30. 00 / !
SOIL/CMP ( .3HP:01 OTHER UNITS-0 SbDC $ .3.1-15. 00 i
GAS 0UTL.ETS: 1 PARK $ x'.50. 0101
MPRF $ s4. 50 1 i
DON MORISSETTE BLDERS, INC. MPLC $ 8. 63
P O BOX 195=4 MSPC $ 1. 73 i
RPR'T $ 117. 50 ! /
PORTLAND OR 97219 1-15FIC It 3. 8p-
Phone 0: 503-•620-7538 TIF 1350. 010
Conti-actor"r. -.._..__._ ._..__.__.._.__-._ . . rAISC 4 38. E� 3 I
DON MORISSETTE BLItERS. INC. PAYM $ 2674. 40 RLL 01/24/91
P 0 BOX 195,2.4
PORTLAND OR 97219
F,l-iane #: 5013-62101-7538
Reg #. . . 35533
$ 2171.4. 40 TOTAL
This perait is issued subiect to the regulations contained in the ---- ---- REDUIRED INSPECTIONS - -
Tigard Municioal Code, State of Ore. Specialty Codes and all othrr Foot/fot.rnd Insp F'ireola,:�e Inco
applicable laws. All Mork will be dr-1e in accordance with aooroved Rost/Eaeam Str•uct Gas Line Ir;sr)
plans, This pewit will expire if work is not tarted w'thi Post/Ream Mechan Inst_Ilation Inst:
days of issuance, or if work is su en d for �F than I days. f.'lmlundslah Jnsf_r Gvp Poar-•d In, p
f-'TRain drain Tns;n
P1�r^mi '.t ee J. . I titr.,f, r echanical Insp Water Line in np
Plr_rmb Tnp 01-1t, Appr/Sdvtlti Insp
i nst-led Env : _ Fv,amina SL. Merhanical Final
psi* i ars - fs 40-4 1. - I
Iffilllilii
SEWER CONNECTION
CITY of TIGA RD �CRYOFi16"r4RD PERMIT -
COMMUNITY DEVELOPMENT DEPARTMENT anncH� ='ERMI i_ #. . . . . . . a BWRy�1-044
19125 6W Hdl Blvd. P.O.Bax 23397,Tigard,omgDn 97223(503)e.394175
1 1'E ADDRESS. . . : 12757 SW F•ALCOr4 RISE DR PARCEL: 1 S 1:3.3,DD- V ii k c:.'
i.Jf;D I V I S I ON. . . . : VILLAGE AT SUMME RLAKE 2 ZONING.
"MLfJf;K. _._. _ _. wLOT_ _ t67__.__________.._________,_________
!-ENANT NAME. . . . . :
1SA NO. . . . . . . . . . :43155 FIXTURE: UNITS. . . s
(:1._)SG OF 140RK. . . :NEW D,-!E',_L I NG UN I TS. . : I
FYPE OV USE. . . . . :SF NO. Or SUILDINGS: 1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE— : :sf
Reme •ks:
)wnpr.: _ -________________ __..-__--__--__-_ __-------- _._._- FEES
I)ON MORISSETTE BLDERG. INC. type a.ma1.rnt by date r ecrr+
F' 0 BOX 14,ja4 F'RMT $ 1500. 00
I NSF' $ 35. 1-1171 11
PORTLAND OR 97219 PAYM $ 1535. 00 PLL 01/c'.4/c',l
1--,hone #: 543-620--7536
Contr-actor': ----.___.__.__._______..._.____._____.___.
rr1NTR"UTOR NOT ON FILE
hone tf" 17-35. 00 TOTAL
Peg #. : REQUIRE:D INSPECTIONS - _...- ._...
This Applicant agrees to cosoly with all the rules an+ regulations Sewer- Inspect ian
of the Unified Sewage Agency. The permit expires 120 days frog
the date issued. The total amount paid will be forfeited if the -
permit expires. The Agency does not guarantee the an uracv of the
side sewer laterals. If the sewer is not located at 'he meesurement _ _._ _____ _—_ -.•----- ---
given, thi installer shall prospect N feet in all di,•ections fromthe distance given. if not so located, the installshall rchase _ —--- -
a "Tao and Side Sewer" Perait and the Ag cv w 11 n,tall a . __ ---•------ ---
a• mit;tee Signat +re
3 ,�_r a ci P y :
Call fm- inspect, ian - 639-4175
PLUMBING PERMIT
C'TY OF TIGARPERMIT #. . . . . . . : MGT91--0O01
Cff YM—Tm
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 01/24/91
13125 SW HWI Blvd. P.O.Box 23397,TIOvd,01*90n 07223(5W)630-4175 �771 ---
'71ARCELs IS133DD-01000
A D 0 R E S G. 1x'757 siw—f-ALCON N R I S R
SUBDIVISION. . . ,, : VILLAGE. AT' SUMMER LAKE PARK 4 ZONING R-4. 5
RLOCF. . . . . . . . . . . LOT. . . . . . . . . . . . . 1127
----------
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. . : 1
TYPE OF' 1.1SE. . . . :SF WAfiHING MACH. . . . . . . It BACKFLOW P9EVNTRS. . %;0
OCCUPANCY GRP. . :R:3 F'LOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :0
STORIES. . . . . . . . : 1. WkTER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . 30
F1 LAUNURY TRAYS. . . . . . :0 SF RAIN DRAINS. . . . . : 1
SINKS GREASE TRAPS. . . . . . . :0
LAVAT�—RIL—S. OTHER F I XTURES. . . . . .0
TUB/SHOWERS....: SEWER LINE ' ft) . . . . 10
WATER CLOSET a. . :2 WATER LINE (ft ) . . . . : 100
1)1 C5HWASHE RS. . . . A I PAIN DRO IN (ft ) . . . . :0
Remarks :
nWNER.-
DON MORISSETTE BLDERS, INC. PAYM $ 441. 00 JLH 01/02/91 L207133')
P 0 BOX 195E4 BPRT 9 440. 50
BPLC $ 40. 00
PORTLAND OR 97219 n5pc $ 221. 0111
Phone #s 503-620-7538 SPI-C ♦ 30. 00
C
.;SDC f 3 7 5. Ott)
Olumbing Cant ract at---- PARK o:-1150. 00
MDPT $ s4. 50
Name : MPLC H. 63
(A(I re s s I M5PC It 1. 73
j t V Statee PPRI $ t17. 50
i P I Phone#:,.— P15PC $ 5. 88
req #' . . . Additional fees not shown heve. . .
REQUIRED INSPECTIONS
1 contained
pertiit .11;, iSSI.led subject to the reg- Foot /found Insp Framing Inspsp
-tlations rotained in the Tigard Municipal I list)
C.ode, Stitte of Ow-- Specialty Codes and all. Past/Beam St r Lic t Ft-
iePlace
other applicable lAws. All work will be done Post/Seam St t-Uct bas Line Intsp
in accordance with approved plans. This Post /Beam St r l..t r-t Insulation Insp
I)pl-mit will expire if work is not started post/pear Meehan Gyp Board Insp
within 1.80 days of issi-taT-1CO, at- if work is po a,t /Be,iuu Mechaii Rain drain Inst.,
—ispended for more than 160 days. Post /Beam Mechan Water Line Insp
Post /Beam Mect-iAn nppv-/Sdwlk Insp
Plm/undslab Insp Mechanical Final
PLM/Underfloor Plumb Final
Mechanical Insp Buildinq Final
Plumb Top Out Erosion Control
Plumbing a u t a ri q i7p7tt U V,e
Call for, inspection — 639-4175
Contractor Notes :_
i
CITY OF T I Gf1RD -• RECEIPT (IF PAYMENT Rp*c1":I P"C NC). t 91•-20C 9AO
CHECK AMOUNT a 4209. 40
DON MORISSET'TTF HOMES (NWI-1 1 0. 00
I ADL)R S,G 15555 SW .BANGY ROAD #201 PAYMENT DATE_: 0:1/j'4i91
SUBDIVISION
LAKC OSWE GO, OR 970:35- 12757 FALCON MISE: DR I ''
f
( PURPOSE:: OF PAYMENT AMOUNT PAID PURPOSE: OF PAYMENT AM(')UNT PAID �
ICUILDING_f�1~��tM MCTy:1--0001 4k0- 50 -'LUMBINC 1�E:RM 4 ui4 ~ 117. SQ
MECWANICAf._ r.'E 34. 50 0 ST. BUILD PER P9. 64
PLAN CHECK FF.. '77. 26 SEWER USA SWR90--0443 1500. 00
NEWER INSPECT 35. 00 STREET SDC; 1250.. 00
PARKS SDI' wSFu. 00 MASA; 'TRANSIT TIF FEES 100. 00
gTORM DRAIN SLAC 375. 00
I
C CiTAl_. Atwt11..INT PAID 4 0 �
r:.1TY UV 'r'[G►1P;1? - Cit`CaF 1F'1" OF' I'f�4'htk:h!'T hG:CEIPT NO. ay( ::t;►1ta.., , I
Wih i CHECK. Ar1f,'llJNT f 4f,'►, r►!►
<70N h111F2.l aSE f"f C:. INC. CASH AMOUNT
1DY►F�[i:«;i t i5555 SW BANGY ROAD s►,r';►t:►
f'AYMCNT DATI~ t 1 ] ."'7l'►
SI.11T #�' r►1 `31.1} C1IVC3�!
C 1e
I..AW::E fwECO, f'r� 97C)7rt 127V71-B. S!►1 hAl.[''.C1N
Or,--' f"'A' MC-NT AMOUNT FIA t D PURPOSE OF PAYMC N'r AMOUNT F-A 1 rr
'i'LLABE (+f!! SUMMERh_AVE/LOT
1 F)I'AL AMOUNT 40.iiC►
TIGARD
13123 5w Ilam[lkd.
ITS" OF PO Box 73397
CONlMUIg1'1'1'1)ItiI,I,OPAi1 N7'I)EPARTMI?NT Tigard Oregon 97223 PLNCK/R[C f # /1
(503)639.417, PERMIT q
DATE ISSUED
JOB ADDRESS: ]
. TAX MAP/LOT _/.5` 33 DQ VS /Z?
SUB: 1,\ �11
LAND USE:
ALUATION: _ _
OWNER SPECIAL NOTES
NAME: LX1 ��Cl^�� 1 �S REISSUE OF:
ADDRESS: ��-�- Qd-� # >1LAST REISSUE
_1 l: - . (- FLOOD PLAIN/
PHONE: ) t7 — _ _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ PLANNING:
ADDRESS: ENGINEERING: _
FIRE DEPT: _
PHONE: _ � � � OTHER:
CONTR. BOARD #: _ EXP D E:
SUBCONTRAC ur 7 y� 'ITEMS REQUIRED
TO_�. PLl1M6. ���c >. ���, ILTST/SUBCONTRACTORS:
MECH: >t'\1 ��c"i>11v�� _ BUS TAX:
ARLiVENGINEER /0_ '►: , 1�v)) CALCULATIONS•
NAME: _ L1ry C�rt�1-�r� TRUSS DETAILS:
ADDRESS: OTHER:
PHONE: It F-1771 , �k\-
PROPOSED BLDG. USE: ,
COMMENTS:
PERMIT # ACCT # DESCRIPT<ON AMOUNT AMOUNT PD. BAL. DUE
rrr ,+k � • 1 10-432 00 Building Permit Fees ✓ �. _ _ , y�.
10-431 00 Plumbing Permit Fees i i�•S c _ ; �,
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Bldg Plumb s,'S'S - Mech 7 ,� J —
10-433 00 Plans Check Fee X 5.4.3 � 1— _,.�Y, �,s
Bldg v 1L Plumb _ Mech u 1 3 .43 II 3f
//..5/5� 10-230 06 Fire 7, 2W
guf4� 30-202. 00 Sewer Connection
30-444 00 Sewer Inspection _ .j;-
25-448-C' Traffic Impact (TIF) ��� fir.— /260
52-449 00 Parks System Dev Charge (PDC-) 21-o ..Stye'- _ .a.e�er -2,5-61'
31-450 00 Storm Drainage Syst Dev Chrg rr[p55 j/'/► 'v
(SSDC) i" -3j>� 3 I�
24-445-01 Water Quality (Fee in lieu of) —�
24 445-02 Water Quantity (Fee in lieu of)
TOTAL el it Z —
�� '
A ICAN1 S ,NAT R
RE'( c,ived By: ----`-- - - - Date Received:
rill, '359-,f1.WPf
IiKA!)INI�/tKt1;�Y -Ainii-fluk, n� it%Ili . %yI
GENERAL C:Oi•JTRACTOR NAME& ADDRESS:
CASEFILE NO.---- —
PL=R AIT NO.:
` APPLICANT NAME AND ADDRESS:
EXCAVAnON CONTRACTORS, M G ' � - /!L x _
DAME& ADDRESS: �LI
-� I L-L O R NAME AND ADDRESS:
I Al
F'iX�1(A ►-��UF' r�
TELEPHONE NUMBERS:
r ' PROPERTY DESCRIPTION:
APPLICANT 1l 01 i ;�LTi C �L�
STREET ADDRESS AND CROSS STI�ET/LOCAT'ED
OWNEP;; 5�3, �� r.' L,1- - t - i
GENUAL CONTRACTOR:],- �I1� (fit 1 __1:��.�-1 -�1L �t•- l IS8
E}CCAV ATION _ONTRACTOR.i
SITE/IOB: LEGAL' SCRII nON:
24 }IR/AFTER 14011RS EMERGENCY TAX LO.- JO.:
CONTACT PERSON,TITLE,TELEPHONE: I/4 SECTION___ STTE SIZE,ACRES:
-- DIST11R13E1)/V.'ORK Al"EA,ACRES�__�__
L/JCATION& ADDRESS WHERE SPOILS SITL RUNOFF DRAINS TO: (CIRCLE.ONE)
LEAVING Sill WILL BE TAKEN kjt _ ASIN DITCH PIPE C.'RF.EK
(WOTT PERMIT'S MAYBE REQUIRED)
(CIRCLE ONE) PR VA1F.PROPE.RT'i
--- -- - UBLIC RIGHT OF WAl'
ERQS QN/SEDIMENTATIN NT_ (CSC)MEASURE.
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIRF.MFNTS
DURING CONSTRUCTION: FOLLOWWG CONSTRUCTION:
SEDIMENTATION FACILTITES STABILIZE EXPOSED SURFACE
STABILUID CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARWG AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COWER PRACTICES ENSURE OPERAnON OF PERMANT FACILI7TLS
CONSTRUCTION SEQUENCE OTHER. ._ — —
on-m-R__.. -
PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH-TECHNICAL GUIDANCE HANDBOOK-.
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
pIIO►NE NUMBFR, SCHEDULEISTAG114G FOR INSTALLATION AND REMOVAI.OF EROSION CONTROL MEASl1RES,AND
APPLICABLE STANDARD NO'1 i:S.
I HAVE READ AND WILL COMPLY� EB REIL � AS�ESC MEASURES AS NECESSARY
SA SEDIMENT THE CONSTRUCTION
OWNER SIGNATURE APPLlCAN 1 SIGNATURE
. • • • • • • • • • • • • • • • • • • • • • • • . • •O� • • • • • • • • • • • • • • • • . • • • • • • • • • •
TTCIALUSEONLY.
RECEIPT DATE ACCEPTED
FLL NUMBER RECEIVED . BY _`_
I
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16555 S.W. Bangy Road, Suite 201 �
' l Lake Oswego, Oregon 97035
Phone:(603) 620-7538
FAX: (603) 620-7485 `
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