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13680 SW HILLSHIRE DRIVE
Page No. 1 CASE HISTORY ?OR CASE NO.: MST94 0340
J ' '.TH CONST.
13,1JU SW HILLCHIRE DR
04/01/99
Action Description Req/ Schd/ E:.d/ Action Notes Disp By Update Upd
Code Sent Done Done Dare By
MSTA007 Application received / / / / 09/01/94 PASS JF 09/01/94 BLT
MSTA010 Plan check deposit paid / / / ! 09/01/94 PASS JF 09/07/94 BLT
MSTA020 Plan check by 09/07/94 / / 09/07/94 PASS RT 09/07/94 SLT
MSTA030 Check for prcl. restrict. / / 09/07/94 09/07/94 PASS JLG 09/07/94 BLT
MSTA092 (F) Issue combination permit / / / / 09/22/94 JF 09/22/94 JF
MSTA097 Issue plumbing signature form / / / / )9/22/94 JF 09/22/94 JF
MSTA705 Foct/found Insp / / / / 10/20/94 PENDINO- ENGINEER SOIL APPROVAL; SEISMIC PASS RB 10/20/94 RB
RESTRAINT; GROUNDING ROD PAINTED.
MSTA705 Foot/found Insp ; / / / 10/27/94 pendina- seismic restraints; PASS RB 1C/28/94 RD
ventilation; rebar req mts as per
seismic hold-down.
MSTA710 Poet/Beam Structural / ! / / 02/28/95 SEE FRAMING THIS DATE FAT', RB 03/01!95 RB
MSTA710 Poet/Beam Structural / / / / 03/10/95 see report .AIL RB 03/14/95 RB
MSTA710 Puat/Beam Structural / / / / 03/14/95 see at Tina! FAIL RB 03/14/95 RB E
MSTA710 Poet/Beam Structural / / / / 05/26/95 SEE BUILDING FINAL THIS DATE FAIL RB 05/26/95 RB
MSTA711 Post/Beam Mechanical / / / / 02/28/95 SEF. FRAMING THIS DATE FAIL RB 0':!0:/95 RB
MSTA711 Poet/Beam Mechanical / / / / 03/10/95 see report F!.'L RB 03/14/95 RB
MSTA711 Post/Beam Mechanical / / / / 03/14/95 see at final FAIL. RB '3/14/95 RB
;•:6TA711 Post/Peam Mechanical / / / / 05/26/95 SEE BUILDING FI!,AL THIS DATE FMi- RB 05/26/95 r.B
MSTA713 Crawl Drain / / / / 11/08/94 not in yet FAIL MS il/r.•194 MRS
MSTA717 FLM/Underfloor / / / / 02/02/95 PASS MS 02/03/95 MRS
MSTA720 Mechanical Insp / / / / 02/22/95 SEE FRAMING THIS DATE FAIL RB 03 '01./95 RB
MSTA720 Mechanical Inap / / / / 03/03!55 SEE REPORT FAIL RB 03/03/95 RB
MSTA720 Mechanical Insp / / / / 03/09/95 see report FAIL RB 03/14!95 RB
MSTA720 Mechanical Insp / / / / 03/14/95 PASS RB 03/14/95 RB
MSTA722 Plu.;.n Top Out / / / 02/02/95 PASS MS 02/03/95 MRS
MSTA725 Framing Insp / / / / 02/28/95 SEE REPORT FAIL RB 03/01/95 RB
MSTA726 Framing <REINSPa / / / / 03/C3/95 SEE REPORT S 15 RB 03/03/95 RB
$15.00 CHARGED
MSTA720; Framing �REINSP, / / / / 03/09/95 see report FAIL RB 03/14/95 RB
Page No. 2 CASE HISTORY FOR CASE NO.: MST94-0340
J T ROTH CONST.
13680 SW HILLSHIRE DR
04/01/99
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTA726 Framing <REINSP> / / / / 03/14/95 PASS RB 03/14/95 RB
MSTA735 Gas Line Insp / / / / V/03/95 PASS RB 03/03/95 RB
MSTA740 Insulation Insp / / / / 03/14/95 pending- insulate basement level rim to PASS RB 03/14/95 RB
under-floor; insulat, window/door jams.
MSTA745 Gyp Board Insp / / / / 03/20/95 p+.ndinq• missed nailing; 7yp stair PASS r3 03/20/95 RB
st:ing,:r at basement; finish drywall at
besement; protect structural members rt
of furnace; poet/beam contingent at
fical.
MSTA755 Rain drain Insp / / / 11/08/94 uk around house PART MS 11/09/94 MRS
underfloor needs to he back-filled perf
pipe to be added
MSTA765 Appr/Sdwlk Inep / / / / 05/09/95 1. Replace form for lip of approach. PEND LT 05;22/95 NL
2. Keep drain line in wing 2" from top
of curb when pouring.
3. Add rock to end of sidwalk on uphill
side.
4. Be prepared to protect finish.
MSTA765 Appr/Sd1ilk Inep ! / / / 06/01/95 PASS LT 06/20/95 JS
MSTA770 Misr. Inspection / / / / 03/03/95 SHEAR SEE REPORT FAIL RB 03/03/95 RB
MSTA'170 Misc. Inspection / / / / 03/09/95 shear see report FAIL RB 03/14/95 RB
MSTA770 Misc. Inspection / / / / 03/10/95 shear see report FAIL RB 03/14/95 RB
MSTA770 Misc. Inspection / / / / 03/1x;95 shear PASS RB 03/14/94 RB
MSTA795 Mechanical Final / / / / 05/26/95 SEE BUILDIN3 FINAL THIS DATE FAIL RB 05/26/95 RB
MSTA795 Mechanical Final / / / / 06/01/95 N-1 corrections not complete DIS KS 06/02,95 KBS
MSTA795 Mechanical Final / / / / 06/06/95 APR KS 06/06/95 KBS
MSTA795 Mechanical Final / / / / 06/02/95 APP KS 06/06/95 KBS
MSTA797 Plumb Final / / / / 05/19/95 PASS MS 05/22/95 MRS
Page No. 3 CASE HISTOGY FOR CASE NO.: MST94-0340
J T ROTH CONST.
1.3680 OW HILLSITYRE OR
04/01/99
Action Descriptinn Req/ Scnd/ End/ Action Notes Dien By Update Upd
Code Sent Done Cone Date By
MSTA799 Building Final ; ! / / 05/26/95 ELECTRICAL FINAL; USA FINAL,; FIRE STOP FAIL RB 05/26/95 RB
THRU PENETRATIONS AT FURNACE; BALISTERS
MISSING AT MAIN STAIRS, SPA DECK SHALL
RECEIVE GUARDRAIL; POLITIVE CONNECTION
REQ'D AT POSTING OF DECK- OR- 45 DEGREE
BRACING; HANDRAIL REQ'D AT STAIRS AT
DErK; NOTE- FAILED PREVIOUS INSPECTIONS,
INCLUDING POSSIBLE NJ WATER LINE
INSPECTION; INSULATION MISSINn
UNDER FLOOR; SUPPORT FLEX DUCT 4'
INTERVALS UNDER-FLOOR; DRYER VENT TOO
LONG- RE-ROUT." OR UP-Si2E DUCT TO 5";
INSULATION FEL., OUT OF WALL CAVITIES
UNDER FLOOR- RE-SUPPORT; UNDER-FLOOR
ACCESS DOOR PROVIDE LA.P7DING AND/OR
STAIRS OR SECURE DOOR; ATTIC ACCESS
SEALED- UNK. IF INSULATION WAS
INSTALLED; FINISH GRADE 6"-10' SLOPE
AND 6" TO WOOD-TO-EARTH CONTACT.
MST4799 Building Final / / / / 06/01/x5 k-1- correction■ not complete DIS KS 06/02/95 KSS
m rA799 Building Final / / / / 06/02/95 APP KS 06/06/95 KBS
MSTA960 (F) Issue Cert. of Cccupancy / / / / 06./02/95 JF 03/05/96 RB
MSTA960 (F) Issue Cert. of Occupancy / / / / 06/02/95 JF 03/05/96 JF
CERTIFICAI E Of
CITY OF TIGARDOCCUPnNCY
PERMIT ##. . . . . . . : MST94--OZ-,,4,;,
COMMUNITY DEVELOPMENT DEPARTMENT
. r DATE 151,31UED: 06/02/95
1131125 SW Hall Blvd.Tigard,Oregon 97223e8199 (503)639.4171
SITE ADDRESS. . . 13680 SW HILLSHIRE EPR
�';UBDJ V 1,ION. . . . : HILLSHIRE F'FjTAT15) 7.ONING:R-7 P0
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :024
CLASS OF WORN,. :NEW
TYPE' OF USEE. . . :';F
OCCUPANCY GRP. :5N
OCCUPONCY LOAI)zc'
Remat-k%: PATH I
I -T RUTH CON'ST.
1c_540 SW 68TH
I IGARD OR 97224
Plicirle 0: 639—a639
f . POTH CONSTRUC110N INC
1p-":1340 r3W 687H PARKWAY
OR 97223
31700
This Ceir,tificate Pr-ants occupancy of the aboy,.? referenced buildim) or portion
lhev,-Ftof and conFir�ms that the I,-3uilding has been inspectod for, complt�%mce with
le State of Oregon clreclplty Codec for the ,groupp a n c y mnd use %mdet-
1-iich the referenced permit was ir4 �14ed.
JILL-ING INSPECTOR SWUM OFFICIAL
poc,'r IN CONSPICUOUS, Pi ACE
CITY OF TIGARD BUILDIIJG INSPECTION NOTICE_
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 339 4171
Inspection:
Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in _
Post/Beam Mech. San. Sewer Gas Line
PIbg. Underfloor Rain Drain Framing -Plumb.
Alarm Wa;ar Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: � - 12'— �1.�� Time: AM 'PM
Address:
Builder. c) o—T-14 Permit p:.�Ix;;!:9Y—
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Insspecttoor.: Date:
d -/APPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 6:39-4171 —
BUP
Date R(--q-.jested AM PM -__ BLD -
Location�D � , % L� ��� � _ Suite MEC
Contact Person — Ph PLM
Contractor 1�'1.i/i_ �,� ^_ Ph ��I�J` %7�Jf SWR
BUILDING Tenant/Owner ELC _
Retaining Wa.l ELR _
Footing --�-- -
Foundation Ac NOT REQUESTED le�` Ff' FPS ----
' Ftg Drain FOUND DURING RESEARCH SGN
Crawl Drain Irl`
Slob110 INSPECTIOINSPECTION(S) FOUND IN FILE _ SIT
_
Post Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing �—
Insulation
Drywall Nailing
Firewall ------- -- --------- �. --------�---
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling '_"_ /�,• —_�— —�—
Roof
Final ---- _----- -
PASS PART FAIL
PLUMBI14G
Post& Beam
Under Slab
Top Out - -- —_--
Water Service
Sanitary Sewer — - --- - --------�—i----
R• grains
IsIlof
S PART FAIL
. iiANICAL
Post& Peam — ------
Hough In
Gas Line -- ----- — --- -... __.. --- ------
Smoke Dampers
Final ---- ---- ----- --
PASS PART FAiL
ELE17TRICAL - --- --- --
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL -- ------------�__-�.-- —_,—_-_.
SITE
Backfill/Grading —_�—_—
1 Sanitary Sewer
Storm Drain I J Reinspection fee of$ _required be!ore next inspection Pay at City Hall, 13125 SW Mall Blvd
Catch Ba!in J J F,lease call for reinspecfon RF —�— ( J unable to inspect- no access
Fire Supply Line —
ADA
Approach/Sidewalk
Other Date _ Inspector _ Z'�o�/ _i _ Ext >1
Final i
PASS PART FAILj DO NOT REMOVE this inspection record from the job site.
C`P'ITY TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT PLUMBING PERMIT
13125 5W Hell Brv,i.Tipnrd,Oregon 97223.8199 (503)839-4171 PERMIT #. . . . . . . : PLM95-0299
G'79 4171 DATE ISSUED: 10/11/95
PARCEL-: 2S 104CD-02400
SITE ADDRESS. . . : 13680 SW HILI_SH1RE DR
SIJBDJVISION. . . . : RILLSHIRE ESTATES ZONING: R-7 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :02-4
CLASS OF WORK. . :ALT GARBAGE: DISPOSALS. . : MOBILE HOME SPACES. :
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . : I
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . : TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . : CATCH BASINS. . . . . . . :
FIXTURED--------------- LAJNDRY -TRAYS. . . . . . : SF RAIN DRAINS. . . . . :
SINKS. . . . . . . . . . URINALS. ,, . . . . . . . . . . . GREASE TRAPS. . . . . . . .
LAVATORIES. . . . . . OTHER FIXTURES. . . . . :
TUB/SHOWERS. . . . SEWER LINE (ft) . . . . :
WATER CLOSETS— : WATER LINE (ft) . . . . :
DISHWASHERS. . . . : RAIN DRAIN (ft) . . . . :
Remarks : Onp residential backflow Prevention device.
Owner : -------- -- -------_._____-_.--.---.--_.._________.----____-- FEES - ---- -____
DAN BULL type aimour.t by date rer_-pt
13680 SW HI1_LSHI RE DR PRMT $ 25. 00 CJ5 10/11/9L5 95--:-'71536
5PCT t 1. 25 CJS 10/11/95 95-271536
riGARD OR 97223
Phone #:
Contractor: ---_____.---------__-___----_--___-.
DENNIS' 7 DEES
7355 GE JOHNSON CREEK BLVD
PORTLAND OR 97206-9329 - ---_ ----_-- ------ ------__.________.
Phone #: 777--7777 Z 26. 25 TOTAL
Reg #. . 5009
- ------ REGU;RED INSPEC:T100S
This permit is issued subject to the regulations contained in the RP/Backflow Pr -v
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applrcabl- laws. All work will be done in accordance with
approved plani. This permit will expire :f work is not started
within 14 nays of issuance, or if work is suspended for more
than IAA days.
Permittee Signature: ��Q...-.____.__.__________
ISSlled By: I1P,f ?�
Call for inspection 639-4175
City Of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # ��-
Tigard, OR 97223
(503) 639.4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Now Single Fwni!X Residences Ong
❑ 1 BATH HOUSE$140.00 ❑ 2 BATrI HOUSE$195.00
Job -)oo 5 W M l i(S h l i- (�at or ❑ 3 BATH HOU:E$n5.00
Address Fee Includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and !,,onn sewer. See fees below.
FIXTURES QTY PPICE :IUfC
JuI Sink 9.00
"'r'e A Wm ^"" Lavatory 9.00
0%%(ner �) L� V I S rc Or Tub or Tub/Shawer Comb. 6,00
C&PSMr Shower Only 9.r0
(� Water Closet
g,00
tet"'"' `"""'r Dishwasher 9.00
Occupant ( .J Garbage Disposal 9.00
Me"AW" PMM Washing Machine 9,00
Floor Drain 9.00
Water Heater 9.00
_ Laundry Room Tray 9.00
Urinal 9,00
Other Fbctures (Specify) 9.00
Phow IF
Contractor 9.00_
r ��i1 Ur7 r� l��Ut Y 9.00
Moab" vs
7110(G' Sewer 1st 100' -- 30.00
a ret To"` Sewer-ea. AddtL 100' 25.00
Water Service tat 100' ` 30.00
1 hereby acknowledge that I have read this applleatlon, that the Water Service ea. Addit 200' 25.00
Information giWh is correct, that I am the owner or authorized agent of
the owner, that pians submitted are in cornplionc-i with State laws, that Storm b Rain Drain 1st 100' 30.u0
I am registered with the Construction Contractor's Soard, that the Storm& Rain Drain Addit 100' 25.00
number given Is correct (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
{- E �J (� r Device or AnrJ-Pollution Device 9.00
a••• + •o•Mr Dw Any Trap or Waste Not
Connected to a Fixivre 9.00
Describe work rsw Q addition U afteratlon repair Q Catch Basin _ 9.00
to be done residertial (Q non-residential Q Insp. of Ex Plumbing '- 40.00Rv
Existing use of Specially Requested inspections 40.00/hr_
building or property _ Rain Drain, single family dwel!Ing 30-70
Residential backflow prevention y
devices I 15.00 >
Froposed usry of
building or property
-�- - '(EKcept residential hackflow
L - -_^_ prevention devices)
NOTICE •Mlnlmunr Fee $25.00 SUBTOTAL J
PERMITS BECOME VOID IF WORK OR CONSTRUCTION _ r_
AUTHO(tIZED IS NOT COMMENCED WT''HIN 180 DAYS, OR IF 511. SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED --- -
FOR A PERIOD OF 180 DAYS AT ANY I ME AFTER WORK IS
COMMENCED. PLAN REVIEW 25116 OF SUBTOTAL
L_- TOTAL
Special Cond+!:,,ns ---
Da,e issued _ by_ _..
CIT' OAF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hell Blvd,Tigard,Oregon 97223.8199 (503)839.4171
r-'ERMIT #. . . . . . . . M5T94--0-340
639-4171 DATE. ISSUED: 09/22/,14
PARCEL: cS104LD--0 400
S I TE ADDRES;:a. . . 13680 SW H I LL.;H I RE DR
SURD I V I S I ON. . . . : 1-11 L-LSH I RE ESTATES ZONING: R-7 F11)
BLOCK. . . . . . . . . . LOI... . . . . . . .. . . . . . .0124
BUILDINfa
PE I SSUE::: DWELL I NG UNI N3: I BASEMENT. . . . . . . . :0 s f
,_,LASS OF WORK. :NEW BE:DRMS BATHS e:3 GARAGE. . . . . . . . . . :680 ss f
I YPL-- OF USE. . . :SF FLOORARkAS- ---___._-_-_-. REQUIRED SETBACKS-___..-______.
1-YPE. ri CONST. :5N FIRST. . . . : 1:34c sf LEFT. . :8 ft RIGHT. : 10 ft
OCC:UFANCY GRP. :R3 SECOND. . . : 1210 15f FRONT. :20 ft REAR. . :613 f
STuR L ES. . . . . . . :2 F1 N8SMENT:'7 75 s f RE QU 1 RED___---._.-__----.-.____..-_.
HE I GHT. . . . . . . . :28 ft i OTAL-_.-..._.-..-._:332 7 s f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 r.f VALUE. . . . . $ : 226168 PARKING SPACES. . : 1
Remain-(s. PATH I
PLUMBING
SINKS. . . . . . . . . : 1 FLOOR DRAINS. . . . :O BACKFLOW PREVNTRS. . : 1
LAVATORIES. . . . . :5 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUFA/SHOWERS). . . . : 3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WHILR CL_OSETS. . - 3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1. WATER LINE (ft ) . : 100 OTHER FIXTURES). . . . . ..0
13ARBAGE DISP. . . : l RAIN DRAIN (ft ) . iO
WASHING MACH. . . : 1 GF HP1N DRAINS. . : 1
MECHANICAL _ -_.__._________.___,_-----______ __. ____..__- FEES
FUEL. TYPES-------------- -- UNIT HTRS. . :0 type aamk,,_Int by date r-ecpt
/GAS/ / / VENTS . . . . . :0 TIF' $ 1550. 00 ,JF 09/2x/94
MAX INPUT:0 BTU VENT FANS. . :4 B P R T $ 750. 50 JF= 09 '2.2/94 -
F'URN ( LOOK . . !0 HOODS. . . . . . : 1 BPLC $ 487. B3 JF 09/22/94
FURN ) -=10OK . . : 1 WOODSTOVES. :0 B5F'C $ 37. 53 JF 09/22/44 -
FLOOR F=URN. . . . cO CLU DRYE":RS. : i SSDC $ 280. 00 JF' 09/:=2/94 -
F1(JIL/GMP ( .3HP:0 OTHER UNITS. 1 1-DARK $ 5001. 1110 JF 09/22/94• -
GAS OUTL_ETS: I MPRT $ 45. 010 JF 09/2:2/94
lwner: ____..._... _ --- -_..__-----__.... ...._ .-.__..-_..._._.._ _.._.....MFLC $ 11. 25 _F 09/22/')4
'T" ROTH CONST. M5PC $ ._. 25 JF 09/22/94
C-40 SW 66TH -: BTI-I $ 225. 00 JF 120/22:/94 -
P5PC, $ 11. 2.; JF 09/22/94 -
i:-ARD OR 9722:4 EROG $ 88. 00 JF 09/22/94 -
hune #: 639-26-2(1 ERPC $ 28. 60 JF -
unt r-ar_,t ur : - - --- _.. .. . __._ ....._ __ _..___.._..__.._._ -ERPC $ 28. 60 JF 09/22/94
. r. ROTH CONSTRUC1 i.iN INC
2540 SW 68TH PARKWAY, SUI`FES B
IGARD OR 97223
-lone #: 639 x:639
<ey #. . 31700
$ 4045. 81. TOTAL
-his pewit i� rss,.ed subject `.o the regulatiuns contained in the --- ---- REQUIRED INSPECTIONS --- -- -
:pard Municipal rode, State of Ore. Specialty Codes and all other Foot/found Insp Fr-aming Insp
--,licable laws. All work will be done 1n accordance with approved Post/beam Str.+ct Fireplace InsT;
ans. This oerert will expire if work 1s not started within 180 Post/beam Mer_ha3n Gas Line Insp
rays of issuance, or if work is mpenaed for Bore than 181 days. Crawl Ot) a i n I n s u 1 at i -)n Insp
�!""� � )p/ F'lm/�_rndsliab ?•,spu Gyp Board Ins;
e*-m:i.ttvv ;'-;1 gnatut,e : 7 axo- GC-�--• F L._M/Unrlpr-fl c:nr- Rain dr-ai,i TTrsp
Mechanical Insp Water Line Insp
Pyr F•Il umb 1"op Out Appy/Sdarl.k I mc;p
Cal l -or- insper ion t+ .r
CITY OF TIGARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERM T
13125 SW Hall Blvd,Tigard,Oregon 07223.8199 (503)830.4171 PERMIT #. . . . . . . : SWR94-0_�Ob
DATE ISSUED: i1WEE/94
f
PARCEL: 2S 104CD--0c_40lZ, s
ITE ADDRES!3- 'SW HILL51i1RL DR
,UBDIVISION. . . . : HIl_L.SHIRF ES;TATFS ZONING: p--7 FID
CLUCK. . . . . . . . . . . LUT. . . . . . . . . . . . :024
! ENANT NAME-- . :
JSA ia(.1. . . . . . . . . .. . FIXTURE UNITS. . . .
i'LAGS Of"' WOW'— . . :Nt:1. DWELLING UNI TS. . : 1
' YRE OF USE. . . . . : F NO. OF BU I LD I Nf. S: 1
1.NSI ALL TYPE. . . . :BUbWR IMPERV SURFACE. . . : S
�einar^ks : PATH I
wners _._--__.___.___________._______ _---_—_---___-- FEES
.1 T ROT14 CONST. type amount by date rcpt
12540 SW 66TH PRMT $ 2200. 00- JF 09/22/94 —
INSP $ 35. 00 JF 09/22'/94 --
IGARD OR 97224
''hone #: 639-2639
:ONTRAC:TOR NOT ON FILE
$ 2235. 0k• TOTAL,
_.._.__—._—•-••
REQUIRED T.NSPECT I ONti --— —-
!his Applicant agrees tc comply with all the rules and regulations Sewer Inspection �4
of the Unified Sewage Agency. The permit expires 160 days from
!he date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
;ide sewer- laterals. If the sewer is not located at the measurement
gryen, the installer ihall prospect 3 feet in all directions from
.he distance given. If not so located. the installer shall purchase
a "Tap and Side Sewer" permit and the Agency will install ailaater_al. w
er mittee 3ignat uv-
r� :
! sued By : V
Call for- inspection 639-4175
JS =105
Residential Buildingpermit Application a�
"City of Tigard
13125 SW Hall EIvd.
Tigard, OR 97223
(503) 639-4171
Jc,bsite Address:
,,y
Off ce Use GnlY
Subdivision: ��1c�/��'i:f E i� Lot# "
� �-
Valuation: PlancWRec
0 -----
Corner Lot? Y N Permit
y
Flag Lot? Y Reissue of
Map & TL#
Owner. �' 7/ % 7 Dr' v �✓ Avorovals Reaulred
Address: ? , �•1.i �; Planning
_ �t .Engineering
Phone: L� 3/ , �3/ — Other
Contractor: ✓T>>- l -��'% 7' Items Re ua Ired
Address: ����w ��/ �y —_ Subcontractors
Truss Details
Phone: Other
Contractors l_iceii-,e #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Arch itectJEnglneer:
Plumbing: �t"7 �' �/y,. (-"c'�ddress: /}J,; _�G✓ ��
Mechanical:
(attach copy of current OR Contractor's license)
Phone: <- <<
JOS DESCRIPTION: ✓�. _
Applicant Signe ture &. phone number
Rer:,ived by: ,; Date Received:
N VNORD\COMDEVIRESAPP
Permit# Account Description Amount Amt. Pd. Bal. Due
/715f4 a.3 Bldg. Permit (BUILD) U Sy _ 1��•$OJ�\
Plumb Permit (PLUMB) ;2 L -N
Mech. Permit (MECN)
State 'rax (TAX) _S/, o3 ✓ ^ 5 �,V 3 /
Bldg: J;1,S"3
Plumb:
Mech: .2, Z' J
Plan Check (PLANCK) y. �
Bldg: �3
Plumb:
Me^h: //• J
oJ u(. Sewer Connection (SWUSA) �u Z L. o"
Sewer Inspection (SWINSP) 3 3 of
Parks Uev Charge (PKSDC)
Storm Drainage Chg (SDSDC) ..2-4�-V "
P,3sidential TIF (rIF-R) / 13o
Mass Transit TIF (TIF-MT)
Ccmmerruial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Ouality (WOUAL) _
Water Quantity (WQUANT)
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT) _
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: 6•2Fy,S,
------------- 223
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