12165 SW MERESTONE COURT 12165 SW MERE-TONE COURT
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Ac"dres: Permit No.
Permit charge p �o
Otrnar Connection fee (r,�1
Paid by y_[" -/Typo of building ;2e� Date connected
Sory i.ce rate
In3psction Fee _ —
Contractor Paid by --- - date
Size of connection Assessment _ Paid T
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ADDRESS /� S �JL(� '/1 LQ�La� sZ�L_;a,�/L�' _ PERMIT N 0.
PERMIT 7HARGE none
OWNER �( � ������ _ COWCT?ON FEF (� G D. ���•
PAID BY
TYPE OF BUILDING 'Z.e. 'e�a � DATE CONNECTED ^
SERVICE RATE �`�� J �.. INSPECTION FEE
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CONTRACTOR PAID BY D A T E .�
`-IZE OF CONNECTION ASSESSMENT FAIL)
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BUILDING DEPARTMENT TIGARD i
11,1"t)
PLUMBING PERMIT 1� •
� � ...__..... holder of a valid plumbing contractors license is hereby
authorized to cause plumbing4A�ork as herein noted to be installed in accordance with the plumbing code of
TigarJ. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
d far all contractors and subcontractors.
n 9- L/--7 Ff
Owner._��- Address_
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT (office Use Only)
Single Family- 1 bath-each I __ 25_00_
Duplex--Each 1.bath unit 25.00
!+ Additional bathrooms-Stich __ �� _ ._ 10.00 -
1 Mobile Home Space-each -
INDIVIDUAL FIXTURE FEES ----
1 to 50 Fixtures it 1 building-each 33,00
u' 51 to 100 Fixture, t building,-each �— _._.2.80
101 to 200 Fixtures e 1 building—each _ _ _ 200 --
" . 231 o,more Fixtures in 1 buildin each _ 1.50
MISCELLANEOUS _
a10 00
a auildin Sewer--1st 50 -
Sawar-each additional 100 ft. _ _ �_. ____10.00 _�-_-
';,' Water Service to building8.00 --
(a' Private Water Syitems--_each_100 ft .._ 10,00
i+ J PERMIT For Plumbing Inspection Phone 639-4171
h State Plumbing Contractor By
TOTAL _v-�= _— RECEIPT NO. Issued By
F
��j , t+
BUILDING PERMIT APPLICATION 11TY TIGARD DATE _—. 639-6355 s
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED 13UILDERPHONF'
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE 4
LOT NO.-----
OWNER
O. —OWNER 6-ri (;011a4'. JOB ADDRESS 12165 Sri McXG3 111 Gt. HOME ADDRESS r
-- - ARCHITECT
ENGINEER
BUILDER B8t114'LJNEADDRESS r_ ___� �DESIGNER_
STRUCTURE — W I Jr.E"AODEL _ ❑ADDITION Or-y
,
REPAIR - ❑RENEWAL [IF IRE DAMAGE rr--yy ❑UEMO-1I_ITION
��ID'�RESIDEN-E ❑COMM ❑EDUCATIONAL ❑GOV'T ❑FFLIGIOUSLIPATIO ❑CARPORT-T ❑GARAGE ❑STOP.AGELJSLAB r_IFENCE
❑BOND C1 MOV.NG 000NDITIONAL USE ❑DESIGN REVIEW DCOUNCIL APPROVED -E]SIGNS
��" 1pAdi
OCCUP_ANCY_1—LAND USE ZONE R•7 —BLDG.TYPE jp _FIRE ZONE-3 PLAN CHECK BY HEAT_— -
canst. single tamily filling w/attached gnrage 3 beedrocat 2 Lw tri
garage 516
OOC .1LQA�_.._ FLOOI3.L9ND _J L�F1T.___'Z� NO.5tQ131E5...1�_�B A lobl ND._H2ELQ?9C$._.__3.YA.L _'4. j.� 7•
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BUILDING DEPARTMENT SET BACKS (RUNT 20 REAR l�1 LEFT SIDE 5()+ RIGHT SIDE 7 ,.r
Permit 166.00
THIS PERMIT IS ISSUED SUBJECI TO THE RE 3UL.A'TIONS CONTAIWED IN THE BUILDING CODE, ZONING
Plan Check MOO REGULATIONS AND ALL APPLICABLE comS AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCOVDANCE NITH THE PLANS AND SPECIFICA'IONS AND IN COMPLIANCE WITH
Sub-total 249.00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS, CONTPACTOrI AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State tax 6•64 LISEY .SEVAATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Trltal 255,64 PIK '#14100.
AP ANT ON AGENT
Approved Receipt No.
-oveL - — PHtmE
AD SS -
. .... ..,r.n..., 1+:..:auto..-.u'l:w».'.AY..•a...k,.. ..u'.Jwv..d.+)•.: n.:....t...aw.wi':v+M..t�.�+WA�''+'.•...• "•_,... .,..'...L'aJ�..yw...A,..+.,4YMWlw':iAwi..id.W4AaYMI•�MIiNYI11Ww'wY4ASduw.ii nM�Ai.i4"�4�Y
DATE INSP. TYPE INSPECI ION REMARKS PLUMBING DATE
FCo n t,
Contractor
Permit No. :2 /5
76 LZe,
Fixture
ry
Ae L�—
Final
AEATING
Contractor
Permit
Gas or Oil
Rol h-m
Final
SEWER
DRIVEWAY
Final
,;trrrn Drairme
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
SEWER PERMITUf _ �l 13897
Unified Sewerage Agency
of Washington County CITY OF__ Tigard DATE 2-10-78 ___.
OWNER : Ed Gause__ PHONE 639-6355
OWNER 'S ADDRESSt
TYPE OF INSTALLATION:
)DCH7 UILDING SEWER [:]BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCYt
XCNEW XHC S I NGLE FAMILY ❑ COMMERC I AL
❑EXIST . (PRIOR TO 7-1-70 ) MULT . RES. INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL_
BE FORFEITED SHOULD EXPIRATION OCCUR .
FEESt
PERMIT FEE E 25„
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION _
ISSUED BY
OTHU.R
TOTAL $ 625.
APPLICANT DATE -
SEWER PERMIT Ml 13897
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ADDRESS OF STRUCTURE 12165 SW Merestone Ct.
TAX MAP--- -- TAX LOT SYSTEM fanno creek
LOT _ G K OF
APPROVED BY DATE ISSUE BY DATE
REMARKS Bldg. 441872 Paid to Lenon Heigl L5; $1 5n nn __
CITY OF TIGARD
ORDINANCE #77-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE: d ESTIMATED SALES PRICE $
APPLICANT NAME TELEPHONE #
.10 8 Ai 3-9 Y^�1�_�" �? }te a .� !�c' c, BLDG. PERMIT #.� �
AMOUNT OF' FEE FOR S. D. C.
DESCRIPTION OF IMPROVEMENT �-
EXEMPTIONS -PER ORDINANCE #77-26
FEE RATES:
A. Singles family dwelling unit under $60,000.--- ---_ 00.01'
R. Single family dwelling unit over $50,00G.--------- $4 -rJT
C. Mobile &.)me Court Space (New Development)------ -- $150. 00
D. Multi-Family Dwellings--per unit---------------------- $240.00
E. Commercial , Industrial & Institutional(Park. Spar.e) $ 50.00 each
F. Single family unit under $40,000. ------•----------- $250. 00
CITY OF TIGARD
ORDINANCE #77-71
t! PARK SYSTEM DEVELOPMENT CHARGE
DATE : �A�_ ESTIMATED SALES PRICE
APPLICANT NAME f✓ TELEPHONE
JOB ADDRESS / S— �jJ�r� , f BLDG. PERMIT #
b O
AMOUNT OF FEE FOR P. D. C. Z,elle
DESCRIPTION OF IMPROVEMENT
EXEMPTIONS - PER ORDINANCE #77-71
FEE RATES :
A. Single family dwelling unit under $40,000- --------------$ 75.00
B. Single faiii:.ly dwelling unit over $40,000------------- . 17
C. Mobile Home Court Space (New Development)--------------$ 5Q;Xp
D. Multi-Family dwellings--per unit-------------------------$ 60.00
CONSTRUCTION IS LOCATED ON S.E . SIDE OF 5.11/. PACIFIC
HIGHWAY . N.W . is Park District #I. S.E . is Park District #I I.
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��UILDING PERMIT APPLICATION COF TIGr ,RD DATE _ _�Q--_..- -_. ts7 = Np
HE LINDE RSIGNID HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
SHOWN AND APPROVED IN THE ACCOMPANYING PLANS A.ND SPECIE ICAT IONS. OWON
OWNER PHE
UP AS �H� LOT NO --
JOB ADE PLSS �—f[D N _II`^�`�" ^_!•'I"E ADDRESS
ARCHITECT
I I ENGINEER
DESIGNERFf
.,NE Q.NEW -..__❑REMODEL ❑ADDITION ❑REPAIR -❑RENEWAL [:]FIRE DAMAGE ❑DEMOS-ITION
'PI NCE �EDUCATIgNAL ❑GOV'T DRELIGIOUSOPATIO ❑CAR PORT ❑GARAGE OSTORAGEOSLAB ❑FENCE
]HAND ❑MOVING ❑CONDITIONAL USE ❑DLSIGN REVIEW []COUNCIL APPROVED ❑SIGNS
uFnNCYr,JLAND USE ZONE_ BLDG TYPE FIRE ZONE PIAN CHECK BY HEAT_. ""
/ /
–77
QAI?_--- -.__ FLQ.Q.H_�4Al2 �-� HESa1iL 'X111_�_..�N4_$LQRIE.$.�._._-AREA- t�NQ
—B UILDING_DE PARTMENT SET BACKS FRONT '"CJ— REAR^ LEFT SIDE �Z f RIGHT SIDE
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
plan CheckREGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
-- -- WORK WILL BE 'DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUh•lotel ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY RUSINESS
late Tex _� LICENSE SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
B y -- --
_ APPLICANT OR-AGE NT
ApprUved 16.E
Receipt No. ----- ----- PHONE------
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