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CERTIFICATE OF'
OCCUPACITY OF TIGARD PERMIT #... . . . . sYMST93- 00;36
COMMUNITY DEVELOPMENT DEPAWHENT DATE I S SU(E-D: 07,128195e
13126 8W Hall Blvd.Tigard,Oregon 617223.6199 (603)630.4171
1- -IRCCL.: C S 104AC--:177300
S 11T: i41;DRLSG. . . . i L:.6 0SW 110 0,111`46 1-11 A. 0
SUBDIVISION. . . . : MORNING HIL.L. #F9 ZONING:
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . 1216
CLASS O1=- WORK. a IUCwW
TYV- OF' LffX. . . %SF
OCCUPANCY GRP. R3
OC;GCIPONCY LOAD.224 4 #
TENANT NAME—
Rem-Arrk s: PATH I
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Owners _.... . __._ _-_-__ ..._._.... _._.. _....._-_____.__.___..___ �
JAY MILLER
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Phone f#�
Contract or's
1 CON'rRACTOR NOT 014 FILE I
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F'harle #1
Reg *. . e
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y' This Certificate certifies that the above referenced building Or portion
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thereof has been inspected for compliance with the Tigard Building C'odo
`.ar t:lie group and division of ac�cupaancy and _Ise for which the above ti
-frar-•enued permit was i. gsmed, and oc:cupank-y is h(sreby
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+� 1JILC'INF, INS't1F"CTOR F.Uil'. INCA O F 1C.IAL
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F'OS'T IN CONSPICUOUS PLACE
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CITY OF TIGARG BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 41
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Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplacew'"
Post/Beam Struct. Plbg. Top Out Elec, Rough-in
Post/Beam Mech, San. Sewer Gas Line
Plhg. Underfloor Rain Drain Framing
Alarm Water Line Insulation ech
Underflr, Insul, Shear Wall Gyp, Bd. "liect.
Date Requested T/
�Time: AM PM
Address:
builder.___ /r//��C" Permit #MS rp 3 �_T�
THE' FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:
DISAPPROVED APPROVED SUBJECT TO ABOVE
Cal' I-or Reinsp.
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INSPECPIOp NOTICE ,
City of Tigard Building Depa:went
13125 SN Bs11 Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Vhone)s 639-4175 Buu,.ne®s Phonet 639-4171
t
'spectiont_
Footing Plbg. Vadsrslab Hoch. Rough-in r/Sdwl
Found. Plbg. Top out Gas Line FINAL: '
Poet/Beam Struct. San. Sewer Framing -Bldg.
i
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Uncerfl —,r Water ine Oyp. Bd. -Hoch.
Date Requested:
Timet 11:9 PN
Address L ermit
Builder:_
THE FOLLO ttNO CORRECTIONS ARR REQUIRED:
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Inspectors/. �} 7f f� !'.1 r„r.•• /4--c? '' ti
3 _ Avrttovt!D DISAPPROVED _V APPROVED SUWRCT TO AEDVE
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Call For Reinrp.
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INSPECTION NOTICE
city of Tigard Building Department
13125 SW Ball Blvd- Tigard, Oregon 97223 �
Inspection Line (Rec-O-Phone): 639-4175 Business Phone:
639-4171
y ction: _ —__- ----- -----
1 In pe __� -----
�^
Footing
Plbg. Undnrelab Hoch. Rough-in Appr/Sdwlk
FINAL:
Found. Plbg- Top Out Gas Line '
-Bldg.
r�
San. Sewer Framing g' n
Poet/Beam Struct. - �
3 Rain Drain Insulation -Plumb-
Poet/Beam Hoch- -
Plbg. Underfloor water Line �yp• Bd. -Hoch,,'
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Date Aequeared: — Timec
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7` eeiit r:
Addres8:� --7�/�"t� C✓
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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----------.........
---
p� —
—
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Inspsctors
APPROVED __- DISAPPROVED
APPROVFD SUB.JEGT TO ABOVE
p _call For Reinsp.
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INSPECTION NOTICF
City of Tigard Building Department dr` S� ,
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13125 Sq Ball. Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Rusinees Phone: 635-4171
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Inspection:—_—
------
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
pound. Plbg. Top Out
Gan Line
FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
�—
Poet/Beam Mech. Rain Drain /I 4`
neulatl3n -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requeuted:��
Time: A, _AM P!1
Addreee: ,; , / r
Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED: 75
2 // n r�
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Inspector:_ �-
Datel
APPROVED _-- DISAPPROV$Jl y� APPRGvzn SU&MCT TO
1190Vr
_lCnli For Reinsp.
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INSPECTION NOTICE
City Of Tigard Building Department.
13125 BW hall Blvd. Tigard, Oreg,>n 97223
Inspection Line (Roc-O,r.Phone): 639-4175 Dueinees Phone: 639-4171
Inspection:-
Footing
]�pq-
nspection:_Footingpq, Underslab
L'IMech. Rough-in Appr/Sdwlk
Found.
Plbg. Top Out Gas Line
FINAL:
Post/Beam Struct. San. Sewer
Framing -Bldg.
Poet/B, ..n Mech. Rain Dra'_n
Ineulatlon -plumb.
Plbg. Underfloor Water Lina Gyp. Bd.
-Mech.
Date Requeeted __1
'�*�'7 "
F Address: .)� _Tim PM
Builder:_
} THE FOLLOWING CORRECTIONS ARE REQUIRED:
"PttOVSb DISAPPROVED
- APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department-
13125 Sit Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Bueinejo Phone: 639-4171
Inspection:_._ - — —--
Footing Plbg. Underelabech. Rough- Appr/Sdwlk
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i Found. Plbg. Top Out ifs FINAL:
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PostjBeam Struct. San. Sewer Framing ..Bldg.
Poet/Bead Mach. Rain Drain Insulation -Plumb.
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Plbq. Underfloor Water Line Gyp. Bd. -Rech.
Date Requested: Times
fr —
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� it r:
Address. -/� /.
Builders - —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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T'.b-,tor: � �- _ Dates,__.
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APPROVED DISAPPROVED APPROVED SUBJECT 1O ABOVE
'
Call For Reinsp.
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INSPECTION NOTICE
City or Tigard Building Departaent
C sj s'' 73125 SW Hall Blvd. Tigard, Oregon 97223
AINN" rel t, ,tl Inspection Line (Rec-O-Phone): 639-4175 Businens Phone: 639-4171
�"9RC,'-"W3� �
�xqa ',;����,����Ml:q�'•y I � d j� Inspection: --
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-r � looting Plbg. Ondarelab Meeh. Rough-in A r Sdwlk
tyalgr, yrPP /
bund. t1 Ons Line FINAL:
Port/Beam Struct. San. Sewer Frvnin -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Dnderfloor Nater Lina Gyp. Rd. -Mech.
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Date Requested:—
�77 1 Times /
Address: /1 - l ,F- C4rmit f: � —zQ 3e,
at
Builders
THR FOLLOWING :ORRECTIONS ARE REQUIRED:
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Inspector: Date I
—APPROVED �- DISAPrRoVED APPROVED SUB.FECT To ARM
_ —call For Retnnp. `
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW .ill Blvd. Tigard, Oregon 97223
' Inspection Line (Rec-O-Phone): 639-4175 Businens Phone: 639-4171
Inspection: ■
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwl.k '
s
Fourd. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. an. S Framing -Bldg,
POLt/Beam Mech. Ra Ln Drain ) Insulation -Plumb.
Plbg. bnder.floor Water Line Gyp. Bd. -Mech.
r
Date Requested• �*
ime: AM _ PM
Address:]./ 1 Permit 4:� Ct '
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
F.
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.APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
') v^ Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec--O-Phone): 639-41'5 Busineas Phone: 639-4171
Inspection:
Footing Plbq. Undersldb Mech. Hough-in - +
9 Appr/Sdwlk
Found. Plbg. Top Out Gas Line
_._.__.__. PINAI,:
ost/Beam Stru San. Sewer Framing
-Bldg.
�Poat/Beam Mech Rain Drain Insulation t
-- -Plumb.
1 Mg. Underfloor Water Line Gyp. Bd. -Rech.
i
Date Requested:
7 Timo: AM - ( PM
Address.�tP /1 Z2�Q�!�j���_ ��Z��i/J it f:
Builder: �Jc�='� {IJ S.-�Sm
THE FOLLOWING CORRECTION3 ARE RELUIRED:
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Dates
y� 3
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APPROVED DISApPP.OVBOw
APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE ->
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inupection Line (Rec-O-Phone): 639-4175 Rusinens Phone: 639-4171
j
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk f
Found. Plbg. Top Out Gan Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
P( ldg. Ondetfloor. ) water Line Gyp. Bd. -Mech.
Date R^equeatads_�f _ Time: �A14 � FM
Address:_ � / _2:12 is
3-OLS
Builder:
THE FOLIOWING CORRECTIONS ARE REQUIRED:
i
IfsepHrtOttDate: V'.-
.NPPROVRD DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rei.nsp.
s
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INSPECTION NOTICE
City of Tigard Building Department ff
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phuue: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Foust. Plbg. Top Out Gas Line FINAL:
Poet/Ream Struct. `San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Ad. -Mech.
Date Rnquested: ��� Time: P4
Builder:__.� ��- --
! THE FOIJAMING CORRECTIONS ARE REQUIRED:
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-�=�' /it. �.���•-.' C...� ,�-G-'t-GILD � � �f
--- -- -----
Inspector: - Oat:e:_�V=�
--.---APPROVED DISAPPROVED - -_ APPROVED SUBJECT TO ABOVE
r Call For Reinnp.
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NSPECTION NOTICE
City of Tigard Building Department I¢
13125 STi Ball Blvd. Tigard, Oregon 97223
Inapection Line (Rec-O-Phone): 639-4175 Bucineas Phone: 639-•4171
Inspection: ----
rooting� Plbg. Underalab Hach. Rough-irr Appr/Sdwlk `
ound. Plbg. Top Out Gas Line
FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Ream Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: ,,-�) / � �� Timet
Addreaa: ; siv'lt
it #1 DA3�
Builders J v
THE FOLLOWING ODRRECTIONs ARE rgQUIREDt
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Inepaotort
Rr Datet
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rainsp.
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C17YOFTIFARD
GTY RD I LL.,i IA 1 Nl, i E.f�ll I T
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COMMUNITY DEVELOPMENT DEPARTMENT 0210M F I::f<hI I ti. . . . . . . ;
19126 8W FWI Blvd. P.O.Boos 23367:TIPM,OrW 2M23(600)6344176
1 VE ADDRESS. . . : 12679 SW MORNING HILL DR PARCEL: 2S 104AC--•Iv]H2 16 �
SUBDIVISION. — : MORNING HILL #9 7.ONINGI
CLASS OF WORK. . :NEW GHRBAGE DISPOSALS. . -1
M1 1YPE OF USE.. . . . :GF WASHING MACH. . . . . . . : 1 BACKFLOW GREVN'T'RS. . 00
OCCUPANCY GRE+. . IR3 FLOOR DRAINS. . . . ,. . . :0 IRAPG. . . . . . . . . . . . . . .0
STOHIEa. . . . . . . . IE WATER HEAL"ERS„ . . . . . : 1 CATCH BASINS.x . . . . . . 10
F'1XTURES----_.___---_.__.._.__-_ LAUNDRY fRAYS. . . . . . .. l SF RAIN DRAINS. . . . . . 1 �
SINKS. . . . . . . . . . : 1 GREASE. TRAP"S. . . . . . . :0
Lf-)VATURIES. . . . . .. 4 OTHER FIXTURES. . . . . .(A
TLIB/SHOWERS. . . . : SEWER LINE: (ft) . . . 10 k
WOTER CLOSET'S. . I:ti WA'T'ER LINE (ft) . . . . : 100
DISHWASHERS. . . . 11 RAIN GRAIN (ft) . . . . Ike
Remarks: PATH I
OWNER:
JAY MiL.1_1-k TIF $ 1460. 00 JH 02/16/93 - 1
BPRT $ 4cq. 00 JH 02/16/93 -
BPLL $ 40. 00 JLH 01/19/93 9,:i-235 i 16
BSP''C $ 21. 20 JH 02/16/93 - I
Phone IP: GSDC $ 280. 00 JH 02/16/93 _
F)ARK $ 500. 00 JH 02/16/93 -
F'lumbiriy UOntractor1-__-_..---_r_... . 1*11PRT" $ 43. 50 JH VJ211.6/93
/ / > MP'LC s 10. 88 JH 02/16/93 -
Name . I15RC; $ C:. 10 JH 02111 /93 -
6
Address: _ _._. ._.._.._..._..._...__._....._..__....___.___..._..---__ �'F'RT' $ 15b. 00 JH 02/16/93
C i t y »_ --.- N WATTS CONSTAUGTJONP-15 PC: $ ?. 75 JH 02/16/93
Re g 1) OREGON
----------- RE.UU I RLD 1 NSPEC1 1 UNS -�-
This permit is issued subject to the req--•
{ Ulatioris contained in the Tigard Municipal Foot/found Insp Rain drain Insp
{i I Lode, State of Ore. Specialty Codes and all Frost/Beam Struct Water Line Insp
r nther applicable laws. All work will be done Post/Beam Meehan Appr/Sdwlk Insp
in accordance with approved plans. This F'lm/undslab Insp Mechanical. 1= iI
j permit will expire it work is not started VILM/Underfloor Plumb Fina)
E within IHV clays of iSSI.lance, at', if work is Mechanical Insp Building Final
suspended for more than 180 days. V'lUmb Top Out Erosion Control
Fr^arcing crisp Crawl Drain
Fireplace Insp
Gas Line Insp
Insulation Insp
x -
X Gyp Board ins
P-► Ines lz.ed Plumb r1y Contractor Signature
Call for inspection - 6.39--4175
L;ontrae.,tur Notes :
4
C17YOFTIFARD
My TM
C:OMMUNTTY DEVELOPMENT DEPARTMENTanew MASTER I=LRhtl r
131268WrWIBW P.O.Bak 23387,TOW,Or*W 97?23(603)639.4176 I ERMI F #. . . . . . . 115-1-93-0036
639--4171 DATE ISSUEDi 02/16/93
SITE ADDRESS. . . : 12679 SW MORNING HILL DR PARCEL: 2S104PC-MH;:11E �
SUBDIVISIOIV. . . . : MORNING HILL #9 ZONING:
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :216 , .
-� BUILDiNG
�
.'1L i SSUE :IvIS'F92'-0: 30 DWELLING UNITS: 1 BASEMENT.. . . . . . . . sO >sf ■
CLASS OF WORK. :NEW BEDRIhl5:4 BATHS:3 CIARAGE.. . . . . . . . . . :438 s f I
1
TYPE OF USE.. . . s SF FLOOR AREAS------------ REQUIRED SE:'T'BACI(S----______
FYf='E" OF CONST. :5N FIRST. . . . : 1034 sf LLFT. . 112 ft R &'UHT. : 12 ft
r OCCUPANCY GRP. :R,:3 SECOND. . . :F196 s-F FRONT. :20 ft REAR. . :35 ft w
STUB I E:S. . . . . . . 12 TH I RD. . . . :0 s f REQU I
r HE:T GHI. . . . . . . . :24 ft I O'FAL-.-----: 1930 S f SMOKE: DE:TECTORS. :Y
FLOOR LOAD. . . . 940 ps F VALUE:. . . . . $ : 96664 RARE{I NG SPACES. . : 1
Reinarl<s: PATH I
{ _--------
__.__._ .__.._------.-_.___--_-_---__ PLUMBINLa
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :V1 1.OC:KFLOW PHLVNTP?5. . -0
LAVATORIES. . . . . :4 WATER HF: ATLRS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWS RS. . . . :3 LAUNDRY TRAY'S. . . : l CATCH BA:y1NS. . . . . . . ..0
WAFER CLOSETS. . :3 SEWER LINE: (ft) . so GREASE TRAPS. . . . . . . c0
DISHWASHE:RS. . . . : i Wi4'1 E:H LINE ( ft) . : IQ)0 OTHER FIXTURES. . . . . :0
GARB(FGE DISP. . . : 1 RAIN DRAIN (ft) . :0
a
WASHING MACH. . . : l SF RAIN DRAINS. . : 1
---------------- MECHANICAL __________._.___._.__..._.___.__ .__-_.____ FEES
FUEL TY'PES______._. _ .._ UNIT HTRS. . :0 type amur_int by date recpt
/GAS/ / / VENT'S . . . . . :0 IIF $ 1460. 00 JH 02/16/93 -
l+OX INPU'T:0 BIU VENT FANS. . :4 BPR F $ 424. 00 JH 02:/16/9;3 -
F'URN ( 100K . . : I HOODS. . . . . . : 1 BPLC $ 40. 00 JLH 01/19/9.3 93-235716
FURN ) =I1Z-Q1K . . :1(.I WOODSTOVES. :0 B5PC $ L1.. 20 JH 1712/16/93 --
FLOOR FURN. . . . :0 CLO DR'YE.RS. c 1 SSDC $ 260. 00 JH 02/16/93 -
BOIL/CMP ( 3HP:0 OTHER UN IS: 1 PARK $ 500. 00 JH 1112/16/93 -
GAS OUTLEIT'S c 1 MPRI $ 43. 50 JH 02/16/93 -
Own eva ---- -_____.__._...___...._______ __. ________..._ IrIF'LC $ 10. 83 JH 02/16/93 -
JAY M I t-LER M5l`''C $ 2. 18 JH 0E:/16/9;3 -
RPRT $ 155. 00 JH 02/16/93
16/93 -
P5PC $ 7. 75 JH 02/16/9.3
Phone
Contractors#:
Contract Or:
JAY MILLER
PO BOX 23291
TlGAHL' OR 972-81
Prione #: 064-754.3
Reg #. . : 30109 ----------------------------------
$
..
$ 2944. 51 TOT"L
This permit is issued subiect to the regulations contained in the ----------- RE UUI RED I NSPF"CTIUNS - —
Tigard Munc.ipai Code, atate of Ove. Specialty Codes and all other Foot/f`ol.ind Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Strutt C,as Line Insp
plans. This permit will expire if worth is not started within 180 Post/Beam Mechan InsUlatiOn inr_Ii
days of issuance, or if work is suspended for more than 180 days. F,lm/k.indslab Insp Gyp Board Insp
PLII/Under,f.loor Rain drain Insp
Permittee Signature: ` C/L�✓ _ Mechanical Insp Water Line Insp
Pl,imb Top O1.it Appr,/Sdwlk Insp
ISSIAed By : .�^ _.___._.._..... _ 1:4--ming Insp hlechanicaI Fina1
Lall for, inspection - 639-4175
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CITYOFTIFARDWYOF AD SLWE R CONNL(; I 10N
COMMUNITY DEVELOPMENT DEPARTMENT P'EF011 F
13126 SW 1 WI Bbd.P.O.Bar 23397,Tipold,O».yon 97223(603)6*4176 . . . . . . .
639--41.71 DATE ISSUED: 0.2/16/93
511"E ADDRESS. . . : 12679 SW MORNING rill-L DR PARCEL: 2S104AC-I1H2Ib
SUBDIVISION. . . . : MORNING HILL ##r) ZONING.
}BLOCK. . . . . . . . . . . LOT- . . . . . . . . . . . " :216
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : f
CLASS OF WORK. . . ::NEW DWELLING UNITS. . : 1
TYPE OF: USE. . . . . :SF NO. OF' BUILDINGS- 1
I NS'T'ALL TYPE. . . . :HUSWR I MPERV SURFG•ICE. . : : s f
Remarks: LATH I
Owner: ____ _ ._.___..___..,_.____.__.___...__ _..________.__._ _____.___ (-EES
JAY MILLER type amor.lnt by date
PRI11- 2100. 00 JH 021/16/93 -
INSP 5. 00 JH 02/16/143
Phone #:
(.0N I RACTOR NOT ON FILE
Phone it- $ El 35. 00 TOTAL
Re_y it.
_.__._.__._.. REDUIRED INSPIEC-1IONS .._._.__.__-•.-
This Applicant agrees to comply with all the rules and regulations Sewer~ Inspection _•.. ._•._____�� _
of the Unified Semage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires. 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 direction_ from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral. _•_ ___
P a r•m i t t e e :.,i y i i,,t i i ,.> : �p ► -� ._ __.._.__ __.___ __..__.___F____w._.._. __.._......_...__.__ _ _,_.
Issr.led Ery : _
Call for inspect ion - 639-•4175
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• 1)175 SW Hall Blvd. PLNCK/RECT #
CHT OF TIGARD PERMIT # 171� f .3G'
COMMUNITY DFVELOPMLNT DEPARTMENT Tiprd.Oregon97721
(5006]9-4171 DATE ISSUED
JOB ADDRESS: /z �'7 �' �c) %y)/.prr�r;'�'j -�7�'ll /�r TAX MAP/LOT y Ac
SUB: (W) t0lo i LOT: 1 / LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME: 'C.�-c/ 1771/ 1 J Y g I<1 Y REISSUE OF:
ADDRESS: Po e 3 Z 9 LAST REISSUE:
0 72GS/ FLOOD PLAIN/
PHONE. SENSITIVE LAND: _
I
CONTRACTOR APPROVALS REQUIRED
NAME: _ ,,Ca-r_/ /71,/I y _ PLANNING•
ADDRESS: _ ENGINEERING:
FIRE DEPT:
PHONE: _ _ OTHER:
CONTR. BOARD # EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: JftI Wc2 LIST/'SUBCONTRACTORS:
MECH: 'Cll�I cr BUS TAX: ._
ARCH/ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:,,tLj �.�z� l_ �2-2
COMMENTS:
APPLICANT SIGNATURE y
Received By: -- Date Received �3
tr '
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees q 2 y2 y
10-431 00 Plumbing Permit Fees /5-5,
10-431 01 Mechanical Permit Fees V
y_3. 5L
10-230 01 State Building Tax (5q) �3/./} 3/, 1-3
Building Z/, 2:�i
Plumbing 75
Mechanical
10-433 00 Plans Check Fee 5`Z;�� - /'u.d'y
Building
P1 umbi rg
Mechanical o+ _
10-230 06 Fire
30-202 00 Sewer Connection c,u /a
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 j-5
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) P -y
7.4-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
TOTAL im— So 3q,
nm/3581P.W1'f
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MIT
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CITY OF' 11601140 w 1tEC LIPT OF C-OYMFN1 WC'I.TPT NO. :j� , � •�,t��3rx; v
IW MI: 111 !_I_ER, TAY Mill AMl7UN 1' a 17h� 00 a �'
411"li)idkf;'., x PAYMENT PATE
SU90TVIS1011
4
PURPUSF OF PAYMEN'r AMOUNT I Ufa 1 D I URPOISE UP PAYMENT +4MCILJNT PAID
_. w..._.n __...._,_.._._.. _. _,. _.___.._........_...._..._...- w...._ .., ..
(I I T L D I NG FIE RM 424. 00 PI.IJMA T NC:3 PERM
MC;'RgANILAL. PL +'i;:�. 5)0 ST'. BUTI.1J PFR 13
it
I"`I N CHECK FE 10. I:3A SEWER LISA w 1�I�, 00
{+ I WEF1 INC,rgE,C'T 135.. v`.10 PARKf3 E;DC:: :il v"1. 00 y
f.3,T RM f)PAIN SDC; `60. 0111 wsTD :N'rrNl._ rPi=iFFIC FEES 1350. 00
MV ISS I M448 T T 'TIF FEES
4�
1 II_I. 216 MORNING HILL 9
i ; '679 79 EM MORNING, FIIl.t_. Dk
k
i 0rA4 0MOUNT P"AIn