12999 SW FALCON RISE DRIVE ADDRESS:
i:\records\micrcP.m\targets\building.doc
CITYOFTICFARD
L7�,
COMMUNITY DEVELOPMENT DEPARTMENT
19125 SW I-W1 Blvd P.O.Bax 23397,Tigard,Oregon 97223(609)630-175
L rt-diiBftir,
PERMIT #. . . . . . : PLM(: 1-016(-)
639-4171 DATE ISSUED: 09/23/91
SITE ADDRESS. . . : 12999 OW FALCON RISE=: DR PARCEL: 1 S 133DD--079 0
SUBDIVISION. . . . : VILLAGE: AT SLIMMER LAVE PARK 3 ZONING: R- 4. 5
BLOCK. . . . . . . . . . . L-OT.. . . . . . . . . . . . . : 116
CI_ASa OF WORK. . -ADD GARBAGE DISPOSALS. . : MOBILE. HOME- SPACE,':,
`ISE OF USE. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . : TRAPS. . . . . . . . . . . . . . :
STORIES. . . . . . . . :2 WATE=R HEATERS. . . . . . : CATCH BASINS. . . . . . . :
FIXTUREc---•---------- LAUNDRY 'TRAYS. . . . . . : SF RAIN DRAINS. . . . . r
SINKS. . , . . . . . . . . URINALS. . . . . . . . . . . . : GREASE TRAPS. . . . . . . .
L.AVATOPIE3. . . . . : OTHER FIXTURES. . . . .
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . :
WATER CLOSETS. . : WATER LINE
DISHWASHERS. . . . : RAIN DRAIN ( ft ) . . . . :
Remat,I(s : BACKFLOW DEVICE -- SPRINKE-ER SYSTEM
Owner _._.— _._____..-------..._-- FEES
YOUNG type amor_rnt by date recpt
12999 SW FALCON RISE DR PRMT f 15. 00 JLH 013/23/91
5PCT $ 0. 75 JLH 09/2391 -•
TIGARD OR 972L7
Phone #:
Contr�aictor: ------------- -___------ _----
DIVF_RSIFIED LANDSCAPE CONTR.
1.6605 CAMELOT LANE
HILL.SBORO OR 97123 ------------------____. -•----_--.---___.-_—
P'hone #: 628-6158 f 15. 75 TOTAL
Rena #. . : 5677
---- --- REQUIRED INSPECTIONS
-- `--
This pe'ait is issued subject to the regulations contained in the Final Inspection
Tigerd Municipal Code, State of Ore. Specialty Cedes and all other
applicable laws. All work will be done in arcordance with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. �
f. Call for inspection 639-4175
1
r�r..rrra
CITY OF TIGARD - RECEIPT OF PAYMENT RECEIPT NO. :91-•.-'1775*5
CH(-CK AMOUNT - 31.50
NAME DIVERSIFIED LANDSCAPE Cl'`jH AMOUN*r , 0.00
ODDRESS • CONTRACTORS POYMENT DATE : 09/i?3/91
t8605 CAMELOT LANE SUBDIVISION :
HILLSBORO, OR 9712:-
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
�CUiBiW PERM 91-0169 15.00 PLUMBING PERM 91-0170 15.00
ST. BUILD PER 0. 75 ST. BUILD PEP. 0. 75
12999 SW FALCON RISE OR
12843 SW VILLA6F PARK LN
TOTAL. AMOUNT PAID .31.50
C17Y CF T160 k ) CERTIPICATS OF
C1nffyr4vmlD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTM MGM PERMIT 1'i. . . . . . . . MST9 I
13125tWHWBWd P.0.Bac nw,T"w,0rmpn"t;
DHiL 145.iULDI V11 / 11 /91
SITE ADDRESS. . . c 12999 SW FALCON RISE DP PARCELP 15133DD-16100
SUBDIVISION. . . . - VILLAGE AT SUMMER LAKE PARK 5 ZONTNOt R--4. 5
BLOCK. . . , . . . . . . LOT. . . . . . . . . . . . . 1197
CLASS OF WORK. tNEW
TYPE OF USE. . . vSF
OCCUPROCY GRP. -.R3
OCCUPANCY LOAD:C`20 4
-'ENV
i 4NT NPME.
Pomarksr.
Owner:
DON MORI SSETTE BLDERS, INC.
P 0 BOX 19524
PORTL"NI) OR 97215
Phone 0: 503-620-753,1*1
Contractor:
DON 110RISSE'lTE P'JILDERS, INC.
15315 SW SONGY RD.
#201
LAKE OSWEGO OR 97035
Phone #s 6i.20-7538
Rep #. . 3 35533
Occupancy of the above referenc-&,d building is hereby yiven, *nci certifies
thei compliance with the St ate Of Oregon Specialty Codes for the grol IPT
occupancy, and use uncipy- whi:-h r-ferevired pprwit wag iffisurd.
FIRE DEPPRTMENT F, DING IRIS' "'TOR
BUILDING F'I c,
POST IN CONSPICUOU9 PLACE
INSPEC'CINnoTICB
City of Tigard pnildieg "p t
13125 By Ball Blvd_ Tigard. Cwmj1p 97223
Inspection Line (Rec-O-Phore): 539-4175 Business Phone: 639-4171
Inspections.-----
Toot Ing
nspections - -loc.tinq Plbg. Undorelah
Hec1, Rough-in Appy/edw111
Found. plbg. Top Out
Gas Line fIN11l.�
Post/Beam struct. San. sewer
1►rdming
Insulation -Plumb'
Pont/Beam Meeh. Rain Drain
plbq. Underfloor Hater Line Gyp. Bd.
Y _ - / Time: -AM PM
Date Requested:_
7 t1 l c "Permit
Address:_
Builder: -
THE FOLLOWING CORRECTIONS ARE REQUIRED:
4
1
L�
Date:_?-
Inspectors
(r'iPPROVED DISAPPP OVRD _
APPROVED SURJECT TO ABOVE
Cali F,)r Roinsr.
yarzca �
N� uFcr'10 N —met
C1t1 of. Ti9� l a d Oregon 97223 639-,17?
11 Blvd' Tig � Phone=
13125 Bs BUSLneae
Inspection LLne (Rec O Phonaylt 639-4175
-
i
A r(Sdal),
Inrpwction,�--- oralab 14,sch. Rough-in �- -
plbg• l FINALS
Footing Gas Line
p)bg• Top Out -Bldg.
Found. Framing
Struct. San. Ste,' -Plumb•
post/Bea°° Innulatian
Rain Drain _Mach.
post/809"" Mach. 0yr. Bd. AM �-�-pM
plbg. Unde:'
floor Nstar Lina Tom=
Dat* Re4uested:1 ' . � t� P.rmit 1i
Addrsae=
Builders "" UIRED, ���----
TO FOLLOFIINO CORRRCTIONB ARE RSQ
k-A
j C J
_. -1.s��u+�-t'-_ Date
tnepectorsAJ
APPROVED SUSJBCT TO hbovr
DISAPP D
APPPOvFD
Call For ReinnP• '+
zNSP1___NOTI
City of Tigard ruild1n7 Depart—L
13125 BM 6x11 B1R1_ Tigard, C_'cpoo 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phones 639-4171
Inspection% --- -
plbg. Underelab Mach. Rough-in
Appr/Sdwlk
Tooting
Plbg. Top Out
Gas Line FINAL%
Found.
Post/Seem St.ruct. San. Sewer
Framing -Bldg•
Rain Draln
insulation _tlumb.�
Poat/'9eam Mach. _
Plbg. Underfloor Water Line
Gyp. ed. -Neth.
_?--6 / Time' -----AM pM
Date Regt%eetedt� ( - �-
It
Address%_
Builders
---
THE FOLLOWING WRREGTIONS ARE REQUIRED:
---------------
Inspector:__ �--- -
APPROVED DISAPPROVED APPROVED SUB.tECP TO ABOVE
Call For Reinnp.
kNSPECPION NOXI..,
City Of Tigard Buildln:3 �Partaent
13125 an gall Blvd, Tigard, Oregon 97223 �.,/
Inspection Line (Rec-o_phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing
Plbg. Underalab Mach. Rough-in A r sdllk
Found. � /
Plbg. Top Out Can Line
Post/Beam Struct,
San. Seger Framing FINALt
-Bldg.
Poet/Ream Nech. Rain Drain
Insulation -Plumb,
Plbg, Underfloor Water Lina
Cyg. Bd. -Mach.
Date Requested:_ L l
-Times _-AM ^ �
Address: 1 �/J
-� Permit
Builder:_
�1
THE MLLOWINO CD]tpl MONS ARE REQUIRED: _
y
r)
v
�'K- .•� I/ ��
h Cv rfp
1"7 �►n��fit --11
r- ��
--------
Inepac*., rt -
�"
_ Date'
-2r7
APPROVED DISAP�"DAPPR'OVRD SUBJF.rp ,n AP
OVF r
Call For Reinsp,
INSP_.._TION NOTICE
City of Tigard Building Departs, of
13125 SW Ball Blvd. Tigard, Oregon 9/'23
Inspection Line (Rec-O-Phone: 639-4175 Business Phonp: 639-4171
Inspection:
1 .
Tooting Plbg. Underslab %ech. Rough-in Appr/Sdwlk '
Found. Plbg. Top Out Gen Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg. \
Post/Dea.m Hoch. Rain Drain Insulation -Ply.
Plbg. Underfloor Nater Line -Hoch.
Gyp. Bd. �
-
9 Date Aequestadt �/ 7 e-� Time: AH PH
Wmit i:__D /M.-�
Builder:
TBV. FOLLOWING CORRECTIONS ARE REQUIRED:
�i c!A.d Al, ��✓ S M JFA 55- Q R 'A r /,4 Ir- 'TtI
-AV/i../7"'S _/✓c.:EI> -T-U p�'�'v 2 O.•v T-'�L.g'
fYi G'Ij L-,e _�l��.s.�L —ra -�,o.�rt�•s
A �----
S--fn's
Inspectors �' p
— _ Date:--,,
APPROVED DISAPPROVED APPROVEb SUBJECT TO ABOVE
__Call For Reinsp.
INSpgC - NOTICS
Ci1Y or Tigard Bulldiarl Daparta nt
13126 SW Rall HIId. Tigard,
Inapectlon Line Rec Oregon '97223
( Phone): 639-4175 BuBiress Phone: 639-4171
Inspection:
Footing �.i_ _. _----•
Pibg, Underslab HF-,h. Rough-in
Found. Appr/Sdwlk I
Plbg. Top Out Gas Line
am Struct. � _ _
Poet Be FINAL:
/ --�
San. Sewer G-c-
FreminL) -Bldg.
Poet/Beam Hoch
Rain brain
Insulate -Plumb
Plbg. U.,der_loor pater Lina
DGYP. Bd.
qu9ated: _ -Mach.
Date Re
Addrasq: _Time: AM PM
- .0
.�.__--_'` }a Permit � ( ,,.�
Builder= 2c- 3 0
�0- �— - 5(X _
THE FOLLOWING CORRECTIONS ARE
REQUIRED:
--
9-4
c —
Inepactor: -- /
Date:_APPROVED DISAPPROVED --
APPROVED SUR
•TECT TO ABOVE
Call For Reinsp•
INSPECTION NOT'-CF
City of Tigard BuildLn9 DePartOgnt223
13125 SW Sail Blvd_ Tigard, Oregon
Inspection Line (Ree-O-Phor+e): 639-4175 Business Phone: 6394171
Inspection+. - --
Footing p1bq. Underslr.b Mec
h, Rough-ia APPr/Sdwlk
Plbg. Top Out
r� Can Lin* FIMhLi
Fo-snd.
San. Sower
Framing -H'-dg•
poet/Beam Struct.
`Plumb'
Rain Drain
Insulation
Poat/Beaus Mach.
plbg. Underfloor slater Line
Gyp. Hd. -Mech.
PH
Time+ A14
Date Requestedsy
' permit
Addrena:
Builder:_ -
THIS FOLLOWING CORRECTIONS ARE REQUIRED.
Innpectorc__ ..-.— -- r---'
PAPPPOVED DISAPPROVED APPROJFD SUBJECT TO ABOVE
__---
Call For Reinnp.
INSPEC{'.LON NOTICE .1 ' 7 V
City of Tigard buildinDeps-t�aent
137.25 811 Hall Blvd. Tigard, Ore,p,i 97223
ln,,pac.tion Line 00c-O-Phone): 639-4175 Businese Phana, 639-4171
Inspection:
Footing
Plbg. Underslab Mech. P.ough-in APPr/Sdwlk
Found. —
C, Plbg. Top Out G&B Line FINAL=
Poet/team Struct. San. Sewer
Framing -Bldg.
poet/Beam Mach. Rain Drain
Insulation -Plumb.
Plbg. Underfloor Water Line
GYP. ed. -Meeh.
Date Requeetedt— :j - ,�, Cr y
Time: —PM
Address:—J' --
C'i�l Permit.
Builder-
T" FOLLI. 'INO CORRECT1oNS AR.R REQUIRED,
Tnqp�c-t or:
� hate
APPROVR_n DISAPPROVED
---- APPROVED SUBJECT TO ABOVE
----Call For Reinup.
INSPECTION Nc_ICF
City of Tigard Building Dopartaent
13125 SW Bail Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 634-4175 5usinesn Phrne: 639-4171
Inspections
Focting Plbg. Undernlab Mech. Rough-in Appr/sdwlk
Found. Plbq. Top Out Gas Lino FINAL:
stPo /Beam ,struet..' San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain In.ulation -ply_
Plbg. Underfloor Water Line Gyp, Bd. -Mech.
Date Requestad:__ - '1< L_ Times AN
Address sZ t
E�_�1_—.- c.� « , Permit 1 �' z r�
Builder: '
THE FOLLOWING CORRECTIONS ARE RRQUIREDs
(AA i i i.J -i L L-L-
Inspeatort
::::2!jj
APPROVED DISAPPROVED
APPROVED SUBJECT To ABOVE
Call For Reinsp.
INSPECTION NOTICE �/ / ( 6—
city of Tigard Building Departassat
13125 811 Ball Blvd. Tigaru. Orecw•:. 97223
Inspection ..ine (Rec-O-Phone: 639-4175 Business Phones 639-4171
Inspections _
Footing Plbg. Underel.ab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer \ Framing -Bldg.
i
Post/Beam Hoch. in Drain Insulation -Plumb.
Plbg. Underfloor star Line Gyp. Bd. -Hoch.
1�D
Date Requested: _c�� TunasAH PN
Address:._ ` << _ lti.J Permit #:,
Builders �,��
TBE FOLUMING CORRECTIONS ARF REQUIRED:
I
Inspectors —_ D�•_ws�'�- L C — �'L
Y,_APPROVED DISAPPROVED __ APPROVED SUBJECT TO ABOVE
Call For Rainsp.
NSP CT ION -M-9UCE
City of Tigard Building Department
131254 BW Hall Blvd. Tigard, vregon 97223
Inspection Line (ltoc-O--Phone)s 639-4175 Business Phone: 639-4171
Inspection:,
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -141dg.
Post/Beam mech. Rain Drain Insulation -Plumb.
Wager Line Gyp. Bd. -Koch.
Data Reqvestad:
-51 Timet !1N PM
Addresss1X i:�, � ���,� �Q ��"_ Permit f:
Builders_
THE FOLLONING CORRECTIONS ARE REQUIRED:
i
Inspectors _ Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
IISP&CTIUN NOTICE I•
City of Tigard BuildlAg Departaeak
13125 ON Ball Blvd. Tigard, oregon 97223 v1
Inspection Line (Rec-o--Phone): 639-4175 Business Phone: 639-4171
Inspection:
footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer framing -Bldg.
post/Beam Mer_h. Rain Dra'n Insulation -Plumb.
Plbg. Underfloor. Nater Line Gyp. ad. -Nec
Date Requested:
Address-_� �ll`/ Es
Builder:_� 1 THE FOLLOWING OORRECTIONS ARE�REQUIRED:
Inspector: �_ nate:
APPROVED DISAPPROVED J�;PROVED SUBJECT TO ABOVE.
Call For Reinsp.
CITYOFTIGARD
MAS"CEk PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT �oa61oM i6m ''ERMI 1 #. . . . . . . . MST91. -ytirh
131168W H11 B1 d P.O.Ba 133W/,T%Wd,Or"m O717J 600 A3Y 4176
' -il 1 71 DATE T,',+I IF=')a 04/1.7-/01
SITE ADDRESS. . . : 12999 SW FALCON ON RISE. DR PARCEL: I':,133DI)- 16 1 V,0
SUDDI-VISION. . . . : VILLAGE: AT SUMMER LAKE PARK 5 ZONING: R--4. 5
FLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 197
BUILDING
RF,I' SUE:MS T90-0353 DWELLING UN 1 TSa: 1 BASEMENT. . . . . . . . .kt' S f
CLASS OF WORK. :NEW REDRMS:4 PATHS:3 GARAGE. . . . . . . . . . :528 sf
TYPE: OF USEr. . . :SF FL C]OR AREAS..__-____.__ _ REOU T RED
( Yi-'E OF CONST. :5N FT RST. . . . : 1283 s f LEFT. . .- 10 ft RIGHT. .-6 f t
DE'CUPANCY GRP. :R3 SECOND. . . : I'ZI45 s f F RONT. .'20 ft REAR. . :25 ft
STORIES. . . . . . . :2 THIRD. . . . :0 sf RE.DUIRFD---___.___..._________
HEI3HT.. . . . . . . . :20 ft TOTAL-- --- S2f3 f SMOKE. DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE=. . . . . $ . 1 16 59 2> PARKING SPACES— :0
Remarks :
PLUMBING
SINKS. . . , . . . . . . 11 r Ll'C' 2 DRAINS. . . . :0 SACKF'LOW PIPEVNT05. . :0
L.AVATORIE_S. . . . . 13 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :N CATCH L•1ASING. . . . . . . :0
WATE=R CLOSETS. . .-3 SEWER CINE (ft ) . :O GREASE TRAPS. . . . . . . .0
DISHWASHUP 5. . . . : 1 WATER LINE (ft ) . : T.00 OTHEP FTxTURES'. . . . . :O
GARBAGE DISF'. . . : 1 RAIN DRAIN (ft ) . :N
WASHING MACH. . . : 1 Sr-- RAIN DRAINS. . : t
MECHANICAL -- F'EE'S
FUEL TYF'h .___--__.__.__.-- UNIT HTRS. . :0 type .amount ba {fate r^ecpt
/CCAS/ / / VENTS . . . . . a @ Pv__1vM $ 40. 00 JLH 03/26/91 21 1::12
MAX INPUT-0 PTU VENT E=ANS. . BE_+T $ 475. 50 /
F-URN ( 1O0K . . :0 HOODS. . . . . . : 1 FPLC $ 40. 00
F URN ) =100K . . : 1 WOODSTOVES. :0 '35PC $ c'3. 7t3
F=LOOR FURN. . . . :0 CLO DRYERS. : 1 BPL.0 $ 30. 00
POIL/CMP ( 1AP:0 OTHER UNITS:0 !-)SDC $ ,37'.j. 00 /
GAS OUTLETS: 1 PARK $ 250. 00
Owner.: -_...____________.__.___._.______.______.__ MPRT 1 :37. 50
DON MORISSETTE BLUERS, INC. MPLC $ 9. 38 t /
P 0 BOX 19524 M5PC $ 1. 88
PNRT $ 122. 50
PORT'I_AND OR 972'19 P5PC $ 6. 6.
Phone #: 503-620-7538 TIF $ 1350. 00
L; PAYM $ 2692. 17 JI_H 164/1.21/91.
DON P'ORISSE:TTE BUILDERS, INC.
15555- SW RANGY RD.
#201
LAKE= OSWEGO OR 97035
Phonl3 #: 61`710-7538
Reg #. . : 35533 --------------
$ 2732. 17 TOTAL
This pereit is issued subiect to the regulations contained in the - ------ RE:.UUIRELP INbPEC"rIONS --
Tioard Municipal Code. State of Ore. specialty Cooes and ail other Foot/found Insp Fireplar_e Insp
applicable laws. All work will be done in accordance with ameved POSt/Seam Strur-t. G.As L-lne Inst,
plans, This pereit will expire if work is not started N' 180 Post/Pegm Meehan Insulation ITISD
days of issuance, or if work is susp nded for are th 1Q0 day Plm/undslab Insp Gyp Board Tnsp
PLM/Under^floor^ Rain drain Insp
Permittee 'aign�ati_n'e. kit- _ h'.e+chaniczal Insp Water Lint, Insp
Plumb Top Out Appr/Sdwlk Insp
lsso.led By : _--_ -__ _ _.. Fr-aming Insp Mechanical Final
Call fa -
CITY OF TIGA RD SEWER CONNECTIUN
PERMIT
CbMMUNITY DEVELOPMENT DEPARTMENT PERMI r #. . . . . . . . SWA91-0.1063
13125 BW HO WA P.O.Ow 23107.TWwtL OPW 97 (5W)030-417S
Ail—4i , 4 i��Li�AiPu
SITE ADDRESS. . . : 12999 SW FALCON RISE DR PARCEL : 1SI33DD-16100
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE PARIS 5 ZONING.o R--4. 5
BLC)CK. . . . . . . . . . 2 LOT. . * . . . . . . . . . . .. 197
FENANT NAME. . . . . :
USA NU. . . . . . . . . . :4 3&2'1 FIXTURE' UNITS. . .
CLASS OF WORT!.. . . DWELLING UNITS . : 1
T-YPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . .BUSWR TMPEPV St)RVPCV--.
Remarkst
Owners --------------------------------------- ----------------- FEES
DON MORISSETTE BLDERS, INC. type amoLtnt by date rept
0 BOX 1137-]'4. PRMT 1500. 00
I NSF '33. 00
T1001-..AND 09 972'19 PPYM $ 15135. 0171 JLH OAi Q)t
Piunp #- 503-6LIA-7538
Contractor:
CONTRACTOR NOT ON FILE
Phone 1':7,35. 00 'TOTAL
Reg #— :
REQUIRED INSPECTIONS
7hig Aoplieant agrees to comply with all the rules and reaujitions Sewer Inspect iun
�f the Linified Sewage Agency. The Dermit eyvires 128 days from
the date issued. The t.1tal amount paid will be forfeited if the
permit expires. The Aaercy does not guarantee the accuracy of the
�idr sewer laterals. If the sewer is not located at the measurement
given, the installer shall grosoect 3 feet it all directions from
t�p distance given. If not so located, the installer shall Durchr'!
"Tao and Side Sewer" Permit and the Ouency wII4:n;tal ral.
m i.t+ e e S i rl n a t .Ar
s iipd 9y
Call for insrection 6:39-417 ;
r
I
CITY OF T I GgRD RECEIPT OF ;PAYMENT RECEIPT NO. 01-212040
—212040
CHECK AMOUNT 42 `'7. 17
tIMf" 1 MON98ETTE9 DON CAS•31.1 AMOUNT a 0. 00
aUUI�E:EiE3 PAYMENT DA'TL t14/16/91
SULDIJ7SION a
I
PURPOSE OF PAYMENT AMOUNT PAID PURP013E= OF PAYMENT AMOUNT PAID
LBUIL.DIi ( PER . 475. FO PL,I i INO_F�f�RM 1 `2. JO
MECHANICAL PF 37. 50 ST. BUILD PER 32. 29
PIAN CHECK FE. 39. 38 SEWER USA 1500. 00
c,'EWF R INSPECT 351 00 RFS I DEN T I Al_ TRAFFIC FEES 1250. 00
BARK'S SRC, x='10. OST STORM DRAIN SDC 375. 00
MASS TRANSIT T I•F FEES l 00. 00
1 999 i,W FALCON RISE DR
T(►'(AL AMOUNT RAID — —> 4227. t7
jam! 6 3l HA Bled PLNCK,/RECT 1 �� v"z p-
CITY OF T j.G PERMIT i
COMMUNITY DEVELOPMENT DEPARTMENT
(50)5"+1» DATE ISSUED
JOB ADDRESS: l74S\_c��._ �.1L.0 ----- TAX MAP/LOT . 3AW
SUB v,,\L (,,N�a�, arrtno r�r,Y�1`5 LOT: �_L_ (AND USE:
VALUATION:
OWNER SIAL NOTE.
NAME: �� _ SSP ✓e' — REISSUE OF: _
ADDRESS: 1 5� 5. LAST REISSUE:
FLOOD PLAIN/
PHONE: _ 3 SENSITIVE LAND: _
CON C OR I�PP.ROVAI S_MUi?ED
NAME: PLANNING:
ADDRESS: ___ F_NGINEERING:
FIRE DEPT: _
PHONE: OTHER:
CONTR. BOARD 0: EXP DATE:
ITEMS R QUIRED
r
SUB ON_ TRACIO_�� PLUMB: LIST/SUBCONTRACTORS: _
MECH: US TAX:
ARCH/ENGINEER T�'rn�' CALCULATIONS:
NAME: .- -(-KI 1 -p - - TRUaS DETAILS: pi _
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: Sw— _
COMMENTS: C-10 ���
APPL ANT SIG AT
Received By: _� _ Date Received:
PERMIT•/ ACCT DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
�4 10-432 00 Building Permit Fees '� 1 S�v .475.5
10-431 00 Plumbing Pvinit Fees 132,5o
10-431 01 Mechanical Permit Fees 7. '� �
10-230 01 State Building Tax (5%) ' 4.2
Building
Plumbing
Mechanical
� v
10-433 00 Plans Check Fees
Building
Plumbing
Mechanical
10-230 06 Fire
or 30-202 00 Sewer Conn.:ction
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 12 ,y ).-Z 5-v
25-448-05 Mass Transit TIF Fees !vo _1"
52-449 00 Parks System Dev Charge (PDC) /' 250 ,.5-71
31-450 00 Sturm Drainage Syst Deli Chrg
(SSDC)
24-445-01 Water Quality (Fee 4n lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL 41 !Z 1
nm/3587P.WPF
SHOEMAKER'S PLUMBING INC.
350 S.W. ZOBRIST
ESTACADA, OR. 97023 (P.O. BOX 250)
TO: CITY OF TIGARD
13125 S.W. HALL BLVD.
P.O. BOX 23397
TIGARD, OR. 97223
TO WHOM 11�' MAY CONCERN,
SHOEMAKER'S PLUMBIN" INC. GIVES THEIR PERMISSION TO
LET DCN MORISSETTE HGMES INC. SIGN ALL PLUMBING
PERMITS FOR SHOEMAKER'S PLUMBING INC.
SINCERELY,
HAROLD B. SHOEMAKER PRES.
630-7728
TH-E i' OLLOWING
DOCUME -NT
IS OF POOR
ORIGINAL
QUALITY
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