14072 SW FANNO CREEK DRIVE ADDRESS:
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IKSPECI NMICE
Cit? Of Tigard Building Department
13125 Aw Ball Blvd. Tigard, Oregon 972231
Inspec-tion Line (Roc-O-Phuna): 639-4175 Business Phones:,/ _ 171
Inspections._
Footing Plbg. Underelab Hach. Rough-An Appr/Sdwlk
Found. Plbg. Top Out Can Line FIK
Post/Roam Struct. San. Sewer Framing
PostlSeam Hoch. Rain Draiok Insulation _plums,
Plbq. Underfloor / ►later Line Gyp. Rd. Mwch.
Gate Requesteds_ !OW _Time= AH —_ PH
AddreesrS(� ;1
��L�All. Permit
Builders
TRE FOLLOWING UGRRECTIOKS ARE P.EQUIR&Ds
l V
Inepector�_
APPROVED DISAPPROVEII APPROVRD SURJECT TO ABOVE
--- Call For Reinap.
'CITY OF TI ''ARD CfmRO CIPANC Ur
Gf�UACY
COMMUNITY DEVELOPMENT DPI?AR T PERMIT #. . . . . . . t MST94-9056
13125 SW Hell Blvd."rigud.Oregon 97223.8109 (9 36- 171 DATE I$SUED t 06/13/94
PARCEL t r 91 12 PS 14900
.i l I ADDRESS. . . t 14012 8W FANNO CREEK DR
SUBUIVI$ICN. . . . t COLONY CREEK NO. 6 YONINQtR-7
ULULK. . . - . . . . . . I LOT* * . * . . . . . . soavle7
_ ___-..._.._--.__-____._,_._w__.__._...--..._...___--.____... ........."
GLASS OF WORK. t NEW
TYPE OF USE. . . t BF
OCCUPANCY URP. t R3
OCCUPANCY LOAD t 222 4
TENANT NAME. . . I
�vmarkst PATH I
JAY MILLER
!' a Box 23291
f 16ARD OR 97
;."hone #t 684-"71543
C;'ontractort _.__-______._.-_-.____-.__.__,__,__
JAY MILLER
DO qtly P.*3 q 1
T I nARD OR 97881
!'hnne Mt h84--7.543
:Ing 1i. . I 30101;
lir'-#4pAnr•v r1f *her above referenced bkgilding its hereby given, Arid certifiefr
l:he compliance, with the State Of Oregon Specialty Cotlps for the: group,
OC•rtlrancy, and Lisa under which the refe.rtenceed permit was ivsuec1.
�ZtBU LIN[3 SPE CTUF7
POST IN CONSPICUOUS PLACE
I
INSPECTION �,(Y�CS
city of Tigard Building Department
13125 an Ball Blvd. Tigard, oregon 97223
Inspection Line (Roc:-O-Phone)z 639-4175 Business Phone: 039-4171
Inspection:_ __ — ----
Foot/ng Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Can Line (_FINAL:
Post/Beam Struct. Jan. Sower Framing (,_-Bldg.
Post/Beam Mech Rain Drain Insulation -Plumb
Plbq. Underfloor Water Line Gyp. Bd. (�`h•
Date Requested`t /J` 1 L/ Timet —AM PM
Address: vf� Per/mit O z9L_��� ,
11
Builder: 1X-C
THE FOLl"hING cORRECTIONS ARE REQUIREDt
2-1 l �.
Inspectors Dst_ez
APPROVED DISAPPR VED APrROVEJ SUBJECT Tz' ABOVE
Call For Ruinrp.
INSPECTION NOTICE
City of Tigard Btailding tlepartamet
13122 SW Ball Blve. Tigard, r-.Alton 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueiness Phone: 639-4171
Inspection:— --�-•- --�_�`—
Rooting Plbg. Underelab Hoch. Rough-in / Appr/Sdwlk
Pound. Plbg. Top Out Can Line ` FINALe
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -plumb.
Plbg. Underfloor Water Line �} 4vp. Bd. -Hoch.
Date Requested//:',� > ✓/w6 / / {T-'imet AH PM
Address: / U ( � 64nn2 arcl� a' Parini f:.9q-��
Builder: (� / //����CJ
THE FO
In
CORRECTIONS ARE REQUIRED:
— — i
i
f nappct or:
APPROVED -- DISAPPROVED --- AP1+lUfll�b Af1hJ m to hem
___ Call For Reinsp.
INSPECTION NOTICE 7
City of Tigard Building Delmirtamant.
1312S 8% Ball Blvd. Tigard, Oregon 97223
Inupeatton Line (Rec--O-Phone)s 639-4175 Business Phone: 639-4171
Inspections
looting Plbq. Underslab Mach. Rough-in Appr/Sdvll:
Found. Plbg. Top Out Gas Line FINAL;
Post/Ream Struct. San. Sewer Framing -Bldg.
Post/Bean Mech. Rein Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meth.
Date Requested:�, V ,)&7 n' Time: _ PRAM _PM
y� 7� ��irny C�te�', L// Permit !r
Addredss �_-- -
Builders j (/EIS --- --
TBE FO NG CORRECTIONS AAE REQUIRED:
Inspect : - -- _------- nate:-%F +�
___APP OVED UISAPPRgVED APPROVED SUBJECT TO ABOVE
V/1-11 For Reinnp.
city o: !1 S E O NOPIC'N C: /
1.7125 9ard Bulldloq Depdnt
SR Be,.
Inspection Line (Rec-o_pho lvd. 7,iq�� Buo "9`01' 9 ,223
s7 Phone: 639•_g171
Inspectiont
Footing
Found. — -------
Plbg• Undereleb
Mech. Rough-in
Appr/Bdalk
P1� Top Out Gas Line
Post/Beam stnlct, FINALr
San. Sewer
Poet Framing
/Beam Mech. -Bldg.
Rein Drain
Insulation
Plbg, Underfloor -plumb•
Nater Llne
Date Re GYP. Bd.
Qtteate�t__ /l v C (2eC ,ti.
Address:��� Timet
Ru i lder: J�� �. Permit a: /
TRE FOLLOWING CORRECTIONSQ
- /
RE REQUIRED,
-
nePector:
----__-
—"-----�'_--._----__ �•�-f—
_ "PROVED
D I SAppRO,,� Date:
APPROVED SUBJECT TO ABOVE
.__Call For Rei nap.
.�$ LCT ON NOTICE
CitF of Tigard Bu.1141M Depaztueat
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)c 639-1175 Business Phon 39-4171
Inspection:
.r
Pooting P1
bq. tlnderelab
4h �PPr/Sdwlk
Found.
—_�/ Y
Plbg• Top Out Can Line
lINAL:
Post/Beam Struct. ttan. Bower homing _Bldg.
Post/Beam Mach. Rain Drain
Insulation -plumb.
Plb9. Underfloor Nater Line Gyp. Rd.
(� -Hoch.
Date Requested: 7 /9- y - �/
Tim. : A!1 _PM
Addrase sQ 4 �p
Permit /:���
Builder
TBE lOLLOpINO WRRECTIONS ARE REQUIRED: I
---- -----------
Inspector: ' n / -
__ ------------ Dotes y/r
PROVln DI3APPRnVED F --
APPROVED SU
BJErT TO A
--_Call Fir Reinsp.
INSPECTION NOTICE
City of Tigard Bulldlmg Department
13125 am Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec•-O-Phones 639-4175 Business Phon 6Y).-4171
Inspections__Footing Plbg.Plbg. Underslab !tech. Rou h-�% Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
s am Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line
C� Gyp. Bd. -Hoch.
l_iJ_L�
Date Requestede -Time: _�-- TAH _ PH
Addreas:_ ��� /Li(_l) r11 .141_ 1L
e_rmit #1
Builder.: _ X��V
THE FOLLOWING CORRECTIONS ARE REQUIRED:
s,.ector: Date:
"-APPROVED DIRAPPROVRD APPROVED VUBJEI-r TO ABOVE
_ Call For peinep.
INSPE�ia��N NOTICE
City of Tigan Hulldl.-q Department
13125 SW Hall Blvd. Tigard, C-myon 972
lnspectien Line (Rec-o-]none): 539-4175 Busineso On63'��-4171
Inspection:----
Footing Plbg. Cnderslab Mach. Rough-in Appr/Sdwlk
Pound. `Plbq. ?Op -Cut_, Gas Line FI;+AL:
Poet/Ream Strutt. Safi. Satyr Framing -Bldg.
Foot/Ream Mach. Rain Drain ]naulation -Plumb.
Plbq. Underfloor Nater Line Gyp. Bd. -Meth.
Data Rnqueatedt t,
Adr'reee:_j (f�17- b-�0m' �I ay D : _ Permit is P'15��5
Builder•
TNS FOLLOWING CORRBCPIONS ARR REQUIPRD:
i
fnnpector _ - - --�`= Dates
APFROVPD - DISAPPROVED APPROVRD SUBJECT TO ABOVE
-_-Call For Reinsp.
INs-MU QNTTI-cE
City of Tigard Building Departmen+
13122 Sw Ball Blvd. Tigard, orogon 97223
Inspection Line (Roc-O-Phone): 639-4175 Rusineon Phone: 639-4171
Inspection!�— - - -- --- -�..�
Footing Plbg. Underslab Mach. Rough-in Appr/S1wlk
Found. Plbg. Top Out Can Line FINAL:
Post/Beam Strut. San. Sewer Framing -Bldg.
Coat/seam Nea. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Rd. -Neoh.
Date Requestedt L f TiM. �1�1t/ /- !N
Addreses t �U ` P.it I.. I w
Builder:
Tnz FOLLOWING CORREL'TION4 ARE REQUIRED:
Inspector: _ _^ Date: 3- 9-�_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
-___—Call For Reinsp..
�1)_B��.ON NOTICB
City of Tigard Building Depart:aent
1. 25 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone):: 639-4175usineos Phone: 639-4171
Inspection z----------------- l( ` --- --
rooting Plbg. Underelab oh
Mail.. Rough-in Appr/Sdwlk
round. Plbg. Top Out Gas Lino FINAL:
post/"am Struct. San. Sewer Framing -Bldg.
Pout/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line OYp• Rd. h'
(� PM
Data Requentedt ,� `_Time: LRM
_ G
Addreeet 1 1 �� -77- / ± Permit #1 C
Buildert'
'CHIC rol.IOgINo CORRECTIOms ARE REQUIRED:
Inepector:__ / _-T Data. .s !!
APPROVED DISAPPROVED APPROVED SUBJw'P To ABOVE
Call For Reinup.
INACTION NOTICE
City or Tigard Building Depsrtaeat
1.3125 BE Bali Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection=
Footing Plbg. Onderslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top out Gas Line FINAL=
Post/Ream Struct. San. Sewer Framing -Bldg.
Post/Ream Hoch. (Ain Dral ' Insulation -Plumb.
Plbg. Underfloor [( Ne,,� ater LiM Gyp. Ed. -Hoch.
- —
Z 7 Gy
Date Requested:
Address e � � '�_ �. � Cv�Q K L-Y Fet7it #
Builder=
THE FOLLOWING CORRECTIONS ARE RMQOIREDt
{I
Inspector: !�
�. PPROVED DISAPPROVED APPROVED SLYR71RCf To ABOVE
___Call For Neinsp.
INSPECTION NOTICE
City of Tigard Buildtmg Departasnt
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 0171
Inspection:_. ----- �. ..� ----- -- ----
looting Plbg. Underelab Koch. Rough-in Appr/Sdwlk
r-
Plbg. Top Out Cas Lina FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor slater Line Gyp. Bd. -Mach.
Date Requsste. i Z 2 1( Y�/ j Timm �]
Addree-:: kHt) 1I t-&0(/ - C_k'(C 4� Permit #t (qq--[(6(
Builders
TNM FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: ' - ---�---__.-,-- Data-__—<_
--'APPROVED DISAPPROVED APPROVED SURJErT TO AROVE
Call For Reinap.
IN¢PECTION NOTICE
City of Tigard Building Department
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phones 639-4175 Business Phones 639-4171
Inspections________ I
` gyp Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
(ftund,1 Plbg. Top Out Gas Line FINALS
-.
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech-
''77 i
Date Requnsteds)� 4` 2/17 <� _1'�IMt ,v]/ {A�Ml�C_�` PM
Addres■s��/ ( Z L! v1V1D G CLK Permit tt /`LI P51J
Bul lder i'_ 'I_- \, . Gy
THE FOLLONING CORRECTIONS ARE REQUIREDs
Inapectors_ _^ __ Dates
7;PPROVED DISAPPROVRD i.,IPROVED SUMINCf TO ABOVR
Call For Rei.nsp.
NG
"CITY OF TIGARD PLUM
MIIT# . PERMIT : MST94-9056
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 02/16/94
13126 SW Hall Blvd.Tigard,Oregon 97223*11M 1433)439-4171
PARCEL: 2S1 1 SPP--CC 1 c:7
SITE ADDRESS. . . : 1.4072: SW FANNO CREEK DR
SUBDIVISION. . . . : COLONY CREEK NO. 6 ZONING: R-7
CLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 127
CLASS OF WORK. . :NEW GARBAGE_ DISPOSALS. . r1
TYPE OF USE.. . . . sSF WASHING MACH. . . . . . . 91 BACKFLOW PREVNTRS. . a0
OCCUPANCY GRP. . sR3 FLOOR DRAINS. . . . . . . :0 TRAPS. to
STORIES. . . . . . . . :2 WATER HEATERS. . . . . . : 1 CATCH
FIXTURES------- ------- LAUNDRY TkAY,S. . . . . . : 1 SF RAIN DRAINS. . . . . 31
SINKS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . 10
LAVATORIES. . . . . :4 OTHER FIXTURES. . . . . a0
TUB/SHOWERS. . . . s SEWER LINE (ft ) . . . . 10
WATER CLOSETS. . :3 WATER LINE (ft ) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . . so
Remarks : PATH I
OWNERs ------ ____- -------_--- ----- -------------------FEES----------------
..JAY MILLER TIF t 1520. 00 JH 02/16/94
P U BOX 23291 BPRT f 421. 00 ,JH 02/16/94 -
BPLC $ 273. 65 JLH 022/10/94 94-248/84
TIGARD OR 97 B5PC $ 21. 05 JH 02/16/94 -
Phone #: 684-754:3 SSDC $ 280. 00 JH 02/16/94 -
FIARI-11 $ 500. 00 JH 02/16/94
Plumbing Conti•act _/__�_�._._---__.__.__- MPRT $ 43. 59, JH 02/16/94 -
�. ��L MPL1C $ 10. 08 JH 02/16/94 -
Name:__&n. C. � ����1 ,15F(� � 2:. in JH 02/16/94 -
Address: PPRT $ 147. 50 JH 02/16/94 -
U,ity:_ - State : PSPC $ 7. 38 JH 02/16/94 -
Zips _ Phone#:_-___-- �-
Reg
r
--- - - -- REQUIRED INSPECTIONS ------- r
This permit is issued subject to the reg-
ulations contained in the Tigard Municipal Foot/Found Insp Rain drain Insp
Code, State of Or*. Specialty Codes and all Post/Beam Struct Water Line Insp
other applicable laws. All work will bs done Past/Beare Meehan Appr/Sdwlk Insp
in accordance s-i.th approved plans. This Plm/undslab Insp Mechanical Final
permit will expire if work in not started PLM/Underfloor Plumb Final
withir. 180 days of issuance, or if work is Mechanical Insp Building Final
uspended far more than 180 days. Plumb Top Ouf Erosion Control
Framing Iniip Crawl Drain
Fireplace Insp
Gas Line Insp
_ Insulation Insp _
X (3 +p Board Insp
AL orixed Plumbing cantractor Signature
Call for inspection - 639-4175
Contractor Notess
CITY OF TIGARD
MASTER PERMIT
COMMUNITY DEVELOPMENT D�����1T PERMIT ##. . . . . . . : MST94-9056
191'25 8W Hall Blvd.Tigard,Jrpon 97223.81 f`'(do3) ffl DATE ISSUED: 02/16/94
PARCEL: 2S112BB-CC127
SITE ADDRESS. . . : 14072 SW FANNO CREEK DR
SUBDIVISION. . . . : COLONY CREEK NO. 6 ZON1NGe R-7
3LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 127
-----------------•------------------ BUILDING -------
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . -0 sf
CLASS OF WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :43O Sf
TYPE OF USE. . . :SF FLOOR AREAS— _.________._. REQUIRED SET BACKS------•-----
TYPE OF CONST. i 5N FIRST. . . . e 1023 s f LEFT. . :5 ft RIGHT. e 5 ft
OCCUPANCY GRP. :R3 SECOND. . . -882 sf FRONT. :20 ft REPR. . :37 ft
STORIES. . . . . . . :2 THIRD. . . . z@ sf REQUIRED--------------------
HEIGHT. . . . . . .
-------------------HEIGHT. . . . . . . . 1.22 ft TOTAL--------•-: 1905 s f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . ♦ : 95370 PARKING SPACES— : 1
Remarks : PATH I
---.._-------------------------------- PLUMBING ---------------------------------------
SINKS. . . . . . . . . . .. 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :4 WATER HEATERS. . . - 1 TRAPS. . . . . . . . . . . . . . :O
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE ( ft) . :0 GREASE TRAPS. . . . . . . eu
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 1O0 OTHER FIXTURES. . . . . i@
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :O
WASHING MACH. . . : 1 SF RAIN DRAINS. . e 1
------------ MECHANICAL __.___.____.__________.----__ --_____-- FEES
FUEL T`IPES--------- -- - UNIT HTRS. . :0 type amount by date reept
/GAS/ / / VENTS . . . . . :0 TIF $ 1520. 00 iH 02/16/94 -
MAX INPUT:O BTU VENT FONS. . :4 BPRT $ 421. 00 JH 02/16/94 -
FURN ( 1O0K . . - 1 HOODS). . . . . . : 1 BPLC 1 273. 65 JLH 02/10/94 94-248784
TURN ) -TOOK . . :0 WOODSTOVES. :O 85PC $ 21. 05 JH 02/16/94 --
F-LOUR FURN. . . . :0 CI-O DRYERS. : 1 SSDC t 280. 00 JH 02/16/94 -
BOIL/CMP ( 3HP:0 OTHER U19ITS- 1 PARE; f 500. 00 JH 02/16/94 -
GAS OUTLETSel MPRT f 43. 50 JH 02/16/94 -
Owner: --- -----------_--------._______._---._-_Mf='LC f 10. 88 JH 02/16/94 -
JAY MILLER MSPC $ 2. 18 JH 02/16/94 -
F O BOX 23291 PPRT $ 147. 50 JH Oc'/16/94 -
PSPC t 7. 38 JH O2/16/94 -
TIGARD OR 97
Phone 1#e 684-7543
Contractors -•--------------•---•-----------
JAY MILLER
PO BOX 23291
TIGARD OR 97281
Phone Ne 684-7543
Req 4#. . . 30109 _ - --------------------- --------------
$ 3227. 14 TOTAL
This permit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS -- -_----
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/fo�And Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Struct Gays Line Insp
plans. This permit will expiry it :ark is not started within 180 Post/Beam Meehan Insulation Insp
days of issuance, or if work is suspen'edfo� ! n IN days. P1 m/unds lab Insp Gyp B 3ard Insp
PLM/Underfloor Rain drain Insp
F'e�•mittee� Signature : ' � _ WV � Mechanical. Insp Water Lino Insp
/ Plumb Top Out Appr/Sdwlk Insp
is-tod Hy : _ Fr�miy,g Insp Mechanical Final
Call for, inspection - 639-4175
CITY OF TIGARD SEWER CONNECTION
PERMIT
COMMUNITY DEVELOPMENT DFP RTM NT PERMIT #. . . . . . . .. SWR94-0065
13f26 BW Hall Blvd.Tigard,Oregon 97223•e1o4 `b 44 71 DA1 E ISSUED: 0`/16/94
PARCEL: 2BI12BB—CC127
SITE ADDRESS. . . : 14072 SW FANNO CREEK DR
SUBDIVISION. . ,- . 1 COLONY CREEK NO. 6 ZONING: R-7
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .. 127
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . i
CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGSal
INSTALL TYPE. . . . :BUSWR IMPS RV SURFACE. . : :sf
Remarks: PATH 1
Owner: ------------------------------------------------------- FEES -------_______
JAY MILLS , type amount by date recpt
P O BOX 23291 PRMT $ 2200. 00 JH 02/16/94 —
INSP 0 35. 00 JH 02/16/94 —
TIGARD OR 97
Phone #: 684-7543
Contractor: -----------------------------
CONTRACTOR NOT ON FILE
--------------------------------------
Phone #: S 2235. 00 TOTAL
Reg #. . i
-- ----- REQUIRED INSPECTIONS -----This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency.. The permit expires 190 days from
the date issued. The total amount paid will be forfeited if the _
permit erpires. 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 locates;, the installer shall purchase
a "Tap and Side Sewer' permit and the envy will ins 11 a lateral.
mittee Signatures
Issued B y .
all for inspection — 6.39-4175
D �
LITY OF: 116"HI) RECFiF,r OF-: PAYW NT REcF I v-,'r' NO. 04-249008
CHECK AMCIUNT 5212. 14
AME JAY MILLER CASH AMOUNT 0. 1110
1)D R E S 11.4 PAYMENT DATE a OP/16/94
SUBDIVISION
`IHRPOGP. OF PAYMENT AM0(INr PWD PURPOSE OF PHYMENf (MOUNI 1-16,410
MILDING PERM 421. 00 PLUMBING Plt;klyl 14 7. 50
FC-.'HAr,IJCAE- PF MI-094-9056 43. 51A ST. BUILD PER 310. 61
I-AN CHECK FE :34. 5:a HEWER USA 00
'F-WF7F3 JNSPF-Cl 35. 00 PARKS SDC hoo� 00
MIRM DRAIN NDC 280. 00 RE-SIDENTIAL THAFFIG FEES 1411A. 010
ASS TFLANS II 'tIF FItES 110. 00
SW FANNO CHERK, COLONY C;RV..-.V.K #6, LOT 121
11.11'fll- AMOUNT PAID 9,P I P. .1.4
OTY13lZ$SW HA p� 7-5),0PLNCK/RECT 0 �OF TIGARD PERMIT B
COMMUNITY DEVELOPMENT DEPARTMFIVT 716KAO' a—mu
(XO)M4171 DATE ISSUED
JOB ADDRESS: IVO ?a 5 W rail ?o US- Dr TAX MAP/1-01-
SUB:
AP/LD1 SUB: CQ/o C,t EStat25 (oLOT: is 7 LAND USE:: �-
VALUATION: _5- -3201
dWl�gE SPECIAL NOTES
NAME: TG_ ._mi11.Gr Cl Ir • -T/�c-- • REISSUE OF:
ADDRESS: R3.a91 LAST REISSUE:
"1" and . FLOOD PLAIN/
PHONE: 8 ?5K3 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ % mr'1 L4.,, PLANNING: _
ADDRESS: — ENGINEERING:
FIRE DEPT:
PHONE: OTH-R:
CONTR. BOARD : EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS:, PLUMB: JC2n kkilt"s P1 ln!� LIST/SUBCONTRACTORS:
MECH: P11. {ftG�7'r1c� BUS TAX:
AR�H/ENGINEER CALCULATIONS:
NAME: _ TRUSS DETAILS: _
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
/»SLV�JOSG 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5x) 3oIG
Building aLO-5
Plumbing
Mechanical Z
10-433 00 Plans Check Fee 294-- S
Building
Plumbing
Mechanical /Q& /
10-230 06 Fire _
30-202 00 Sewer Connection
30-444 OG Sewer Inspectior. Sy A
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional Tit Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees "q-
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC) S G _ S O U
31-450 00 Storm Drainage Syst Bev Chrg
(SSqC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of) —
TOTAL .5stiz, 1 U Sl
nm/3587P.WPF
C I I Y IF TI 60RD HFI-CE I PT Or.' P(4 Y Mt,-..N I RE(4-.1 PT No. .94--P-48784
CHI-".IK AMOUNT 250. 00
AMR a MILLER, JAY CAS14 A01HUNT a 0. 00
DDRESS A PAYMENI DATE r 021 10,'14 4
t2
3IJBD I V I S I ON
,IIHPOSV OF PAYMENT AMOUNT PAID PURPOSE'. OF PAYMENI' AMOIJNJ PA 11)
ILAN CHECK FE 250. OIA
407P SW FANNC.) CMU�.K DR
(.1.1. 127 LICILONY URLEK F.91 6
(I I'At. AWKIN T PAID P�-,Jvj. 00