16540 SW MONACO LANE-1 165W M HMO= r4M
i
�I _
INSPSrrIOh,v;TICS
City of Tigard Building Dopartment
13125 6N Hall Blvd. Tigard, Oregon 97223 � �, �
Inspect Lon Line (Rec-,O-Phone): 639--4175 Sun iness Phoney 639-4171 ,
Inapectlon:
Footing Plbg. Underslab Hoch. Rough-in Appr/,,dwlk
Found. Plbg. Toll Out (Sas Line FINALS
post/team Btruct. San. Sewer Framing Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Undarfloor Water Line Gyp. Bd. -Mech.
Date Requested:. _ �Gv �.� _TLMI AM PN
r ./�GL�
Addronn:� �[�� it #s�,— �
f,�',
Bu i 1 se r CIS--�- ��- -------
I
THE FOLIAYWTHG cORRECCIONS ARE R°IJUIRIDi
�_-InnEM<-P nr• �' Date
APPROVED DISAPPROVED APPROVED BIIBJECT To ABOVE
,CaAl For Reinsp.
INSPE710M_NOT cE
city or Tigard Building Departwont
13125 BW Hall Bled. Tigard, Orsgon 97223 1
Inspection line (Rec-o-Phone): 639-4175 Business Phones 639-4171
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwl'c
Foun.- Plbq. Top Out Gas Line FINALi
Poet/Bram Struct. San. Sewer Framcng -91dg.
Post/Beam Mech. Rain Drain Insulatic- -Plumb.
Plbq. Underfloor Water LLjineGyp. Bd. -Koch.
Date Requeutadr ��— ` ��Ti/��sLvs� �_AM PA
Address s �5 _ �Yld_tt� PMrfmit11p°r 1)
Builder '?/ C /C-_� � --THE FOLLOWING COrMCTIONS ARE REQUIRED:
Inspector,— ' �w Dato: ����
APPROVED nTSAPPROVED Z-PROVED SU0.7RcT To ABOVE
call For Reinsp.
INS.ECTIO)1 NOTIC.
City of Tigard Building Departeent
13125 SA Bill Blvd. Tigard. Oregon 9/223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41. 1
anapection:
Rooting Plbg. Underalab Hach. Rough :n Appr/Sdwlk
Pound. Plbg. Top Out Gas Lina FINALr
Poet/Beam Struct, San. Sewer •rasing -Bldg.
_ q.
Poet/Neem Meeh., Rain Drain Insulation -Plu b.
Plbg. Underfloor Nater Line a,'p. ed�,p. ad.
. -Neth.
Date Requeatedi� �j n� ��� --Time: AN r1PM
Address: LJ /b//SII/�iL' l/I Lam, P 7
; (/
nullder.
i_L L-1
TTITY PP(111�.UF 1NG ("ORRRCTION3 ARE RRQUIREDr
_ .i1,6-7
r v
Ynapactorr �{ Datar ��`�
APPAO{►=p DISAPPROVtD��PP>Z�M-SUBJECT To ABOVE
Call For Reinsp.
r
jhS'ECT�jO J_NO'd'ICB
Ci.tp of Tigard Building Departnert
1.3125 Sit Hall Blvd. Tigard, Oregon 9;223 )
;nspection Line (Rec-0-Phone): 639-4175 Business Phones 639-4171
Inape.tlon:
Footing Plbg. Underslab Mech. Rough-in Appc/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
..__...�,
Pont/Bean Struct. San. Sewer �Framin$I � -Bldg.
Post:/Ream Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
Dote Requested: Z- _ r _ - Times Z--A11 PM
Addrees: I��—L.d LVl O N A (�IJ _ Permit f s C1 Ca 3_719
Rui
THE FOLLOW?NG CORRECTIONS ARE REQUIRED:
��.-SCL�'c-!G� b'�,t� A77•-/-� /1��' ��151"� 1 C c�1:2
I napector t I&
D/
APPROWD DISAPPROVED G.---XpPROVFD st113aECT To ABOVE
---Call for Rednep.
CI7Y®F tf ARD BUILDING 1,ER11IT ✓
M
WYOFTWARD BUP19003" 0
COMMUNITY DEVELOPMENT DEPARTMENT 00i
13125 SW HWI Blvd. P.O.Box 23397,Tigard,Oregon 97223(503)6394175
DATE IG3UED,. 01/09/91
SW VI( H1,11,j LH V'ARCEL.-
GUBDIVISION. . . . .- KING (.-.Il'Y ZONING:
(tLOC;K.. . . . . . . . . . LO'T . . .
F*LOOR F-XT1".RIOR WALL CONSTRUCUON
','LASS OF WORK. -.W..W FIRST . . . . cI50 Sf N So F i: W
IYF'E OF' USE.,'
.. .. . :SF' SI: C ON D I . . t Sf 1:'R0,rEcj,
i YF'E OF (.,Otsjs*r. cz:;N THIRD. . . . z (>f N: So E WN
H"'CUPIAN("y GRP,. �.R3 T'01,0 L 5 0 ,f ROOF' (,(JW93T- F I R E RET?
f.)(`(.',L1P'ANCY LOAD: bASEMEN'T. Sf AREA SEP'. RATED.
`;'TOR.. -. i. H*r. -. ft GORACIE.. . . sii f O(XU SEP. RPI'71L':D-.
HSMT?.- 11 E,Z 7?- REW) R r::.*Q U I R E D
- LOOR I OAD. . . . ...40 r.1 f LEF T ft RGHT3 ft FTR SPIKL.- S M 0 11, 1)E'T
DWELI IHG UNI76: FRNI c ft REAR, f F`IR ALRM: HNDICP1 ACC:
Otn'.DRMS t I BATHS. IPIF' SUF!FOU FJRO CORR,.
)ALUE. 4000
e ni,
1.)e(i -room i11 o ri 1-i z, I r
............ FEES
(-iE.E PENNOCK t,Y r.)e A m ct 11-t by d<-Ater -reept
16540 SW 11ONOCO I..+1 R M 1, $ 44. 50
PLCK $ 2 S. 93
"TNG CUT' OR 5 PCT` 1, 2. 23
'hone No 639-0426 PAYM $ '75. 6S r.,LL 01/09/91
DFPEK HART*
1330 SW 7141
(.',ONPY OR 97013 ......
F11ollp #." 75. 66 T(3Tfj1.,
c 3309*/
RE OUII;ED INSPEC,'TIONS
This permit is issued sub'iect to the rejulations contained in the F'r a m i riq .1.1.)S P
Tiqard Municipal Code, State of Ore. Specialty Codes and all other 111SUIatiol", LlSp ...........
applicable laws. All work will be done in accordance with Gyp Boa-rd Disp ...................
approved plans. This permit will expire if work is not started
within 190 days
ys of issuance. or if work is suspended for riio*e
thin 180 days, —-----
1 s.t t (J by-
for 639 41.75
jr,,, or TIGARD RECEIPT ur' r-"AYME.N'T RECEIPT NO. 208444
AMOUNT e.,)6
14AME PENNOCK. DEE CASH AMOUNT 00
ADDRESS 16540 SW MONACO LN PAY'MENT WE- /09
GUBD A 1)1 S I ON
1,-:ING (.;ITY, OR ('T7.2,24
PURPOSE OF PAYMENT AMC)UNT PAID PURPOSE OF PAYMENT AMCLINr PAIrl
F-011U)ING PEPM 6UPW -0170 /44.RU Sr. BUILD PER
AN uwcK, rF- 9::,.
TOTAL AMOUN'T PAID
I M-51 . fX 1 f i.1 e --n u o 1 1 n d
P 1-U M B 114 G 1:1 E R III I I'
CITYOFT167ARD 1�� VIERMT. T* 111-11190 02 2 1.1
CITYOF TWARD
COMMUNITY DEVELOPMENT DEPARTMENT ORMCM DATE ISSUED: 12/20/90
13125 SW Hall Blvd. P.O.Box 23397,Tigard,Oregon 97223 (503)639-4175
bi I ft AVOKL51;). . . I tSZ040 bW MOINIntti LN-- PFIRCELs r._, AD
SUBDIVISION. . . . .' KING CITY ZONING:
BLOCK. . . . . . . . . . .. LUT'. . . . . . . . . . . . .
CLASS OF WORK. . tNEW GARBAGL Drsposw..f.i. . - MOPILE HOME SPACES.
TYPE or USE. . . . :SF WASHING MACH. . . . . . . 41 PACKFI OW PREVNTPS. . 1
OCCUPANCY GRP. . 1R3 FLUOR DRAINS. . . . . . . : TRAPS. . . . . . . . . . . . . .
S'i OR I ES. .. . . . . . . 21 WATEk HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . .'
LAUNDRY TRAYS. . . . . . .. 9F RAIN DRAINS. . . . . s
SINKS. . . . . . . . . . : Ur'I'NALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . .
LAVATORIES. . . . . a P FIXTURES. . . . . .'
TUB/SHOWERS. . . . a .',~k LINE (ft) . . . .
WATER CL0SETS- 8 WATER LINE (ft) . . . .
DISHWACE,HERS. . . . ! RAIN DRAIN (ft) . . . .
Remarksi alt. 4arawe into bed room in half
OWNER:
PEE PENNOCK PRMT $ 215. 00
1-6540 SW MONACO LN 5PCT $ 1.25
PAYM $ 26.25
KING CITY OR
Phone #v 639-0426
V"1.u m h i n g C o n t r A r t(.-)r
I,Iiii me
Ad d-r e S S
State a
Z i p I Phone#Fc-
Reg
REQUIRED INSPECTIONS
ThiiE permit is issued subject to the req .
illations contained in the rigard MUI-O.C.A.PAl ran-Out InSp
Code, State of Ore. Specialty Codes and all Final Inspection
other applicable laws. All work will be done .........
in accordance with approve(. plans. This
permit wIll expire if work is not %harted
within 180 days ni Issuance, or if work is
suspended for more than 180 days.
Ok.ithorized Plumbing Contractor Signature
Call for inspection 639-417-5
Contractor NateaA
commuNiTY DEVELOPMENT
-ITY OF' '11GARD RECEIPT OF PAYMENTRECEIr-I'T NO� 207827
CI-4Er.l:' AMOUNT 246. 25
NAME tlUDFRN F,LLJMF-.(ING (,'(3 ChISH AllOLJNl i).(R)
ADDRESS G Po Yox 273,07 PAYMENT DAll, 1 47, 17,1 X90
TIGARD. OR 97227, SUBD I V I S I ON
165540 BW MONACO LN
PURPOSE OF PAYMENT AMC UNI PAID (=URPME OF PAYMENT AMOUNT PAID
--lIMPTNU FIERM FILM9i)-.0-227. 00 ST. WILD PER
AMOUNT PAID
C11Y OF TI ARD
CffYOF TWARD,
4z
COMMUNITY DEVELOPMENT DEPARTMENT OREGON
13125 SW Hell Blvd. P.O.Box 23397,Tiprd,Orepn 97223(5W)6394175
PER Irl T F;1_.1.,1 9
639-4171 DATE ISSUED: 12/20/90
S1 TE: ADDRI.-ESS. :16540 '.-,W MONACO LN P()RCEI-,- 2S116A1)---
SUBDIVISION. . . . KING (,ITY Z ON T NG
PLOCIK. L 01 .
CLASS OF WORK. . tNEW M 0 Y4 11 E I-1011E.-
i Yi)E Or, USE. . . . z sp, WASHING FIACKF LOW PREVNTRS,
0[X(.)Pn111C`Y GRP,. -R,3 F1.00N DROING''. TRO FS. . . . . .. . . . . . . . .
SIT 0 R I K-S. . I. . . . . . ; I WATER HEA7'ERS. . J. C(111'C',H P A S I N S. ., . � . . .. -
F 3:XT 1i R -6-••___........». LOUNDRY TRAYS. .. . . SF RAIN DRAINS),,
!'.)INKS. . . . . . . . . . . U[6 N A L S. . . . . . . . . . . . . GREASE rRAPS.
I AVOTORIF":'i. . . OTHER FIXI'URES,. , - „ - 1.
7'UPP3HOWERS. . SEWER 1-1 NF* (f-0 . . . . -
W01'ER LA-OSETS. WATER I-INE (ft) . . . . ..
TYU�i H W A S 14 E Rfl. . . . s RAIN DRAIN
RePI,AYJS!: Alt- ilit(:) bed -raonl J.il fiaj.-r
W ri v'r ....... FEES
OF FIF.111NOC11r, type a M(.1 k.t)I t ljy date -r e pt;
:'`i4(!7 9W' 25. 00
MONACO LN PRMT
5 $ 1. 25
K CITY OR PAYM $ 2(:.. PIZ,
0: 639-46426
C'.tax.•t:r a c t c)Y'
;11)1)t:-,RN 1:1 UMBING
IJO DOX 23307
TJCJ1ARl) OR 9*7223
'hctxte 11; 639-3701 $ PC.— 25 TOVX-
RF:-QUTRED INSPEXTTON4,;
This permit is issued subect to the regulations contained in the cl p 0 U t 11-1 S F)
Tigard Municipal Code, State rif Ore. Specialty Codes and all other Filial
applicable laws. All tork will be dope in accordance with
,iDvroyed plans. This permit will Pxpirp if work is rot started
within 160 days of issuance, or if work is suspended for more
4 a n 188 dayn,
.......... ..........
0e., ttev
T, S U EA d Fty
........................ . ..... .......
.1 f a'r i 1-1 r.P e c t I a 639-41, 75
y
CITY OF TIGARD Box 3397 P!_NCK/RECT #
�Box L7�97
C( M1iMIJNI'IY 1)EYFLOPMENT 1)EPARTMEWF �7iRard,Oregon 972D PERMIT #
(503)63%4171 DATE ISSUED
JOB ADDRESS: 1 b 5`t C1 MONRCO LN TAX MAP/LOT
SUB: icy C1,6 LOT: LAND USE:
oF
VALUATION: DDD
OWNER SPECIAL NOTES
NAME: c.- — �� N N0� �. REISSUE OF: _
ADDRESS: \ 5 `� U ��� "�1.1J r„ - � .-- LAST REISSUE: --__-- --__—
FLOOD PLAIN/
PHONE: 1 32—Dg SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
-);AME- PLANNING:
ADDRESS: _ C. ENGINEERING:
FIRE DEPT:
PHONE: '1-L;l, - 4 `1 `t OTHER:
CONTR. BOARD #: 310 �,'"� EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ IST/SUBCONTRACTORS:
MECII: _ _ BUS TAX:
ARCHZENGINEER CALCULATIONS:
NAME: —. TRUSS DETAILS:
ADDRESS: _ _ OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE----------'----
Received
IGNATURE — __Received By: ____ Date Received:
PERMIT # ACCT P DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
c v3 c 10-43? 00 Building Permit Fees 4q. ,t1
v Z Z.3 10-431 00 Plumbing Permit Fees 1;4t,00
10-431 01 Mechanical Permit Fees
/ 10-230 01 State Building Tax (5%) 340 5 —
Building 5
Plumbing
Mechanical
10-433 00 Plans Check Fee ti -'
Building a 3
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
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
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL IVY, r l_
nm/3587P.WP1
INSPRCTIo- OM-1
�t l✓�I y City of Tigard Building Department
13125 IM Ball Bled. Tsgard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Buoinese Phone: 639-4171
Inspection:
Footing Plbg. Underelab Mech. RougZn Appr/sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Ream Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requestedt_ /2 -II--e'1li Tlmet �`AM PM
Address• _- - (L' L�G i, /L//L,�CL.t Permit #t
Builder:
THE FOLLOWING ODRRECTIONF APR REQUIRED:
Tnspector Date:
APPROVF.p - DISAPPROVBU APPROVRI7 SIIBJE(.'4' TO ABOVE i
Call
For Roinnp.
i
jM$PECTION NOTI� �`({
Cityof Tiqu-d Building Department {I yy
13125 SW Hall Bled. Tigard, ormlon 97223
Inspection Line (Rec-.O-Phons): 639-41.75 Business Phone: 639-4171 ?1
Inspection:
Footing Pltg. Underslab Mach. Rough-in Appr/Sda k
Found. Plbq Top Out Gas Line FINAL:
Pont/Beam Struct. San. Sower Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: --Time: , AN 7 PM
Addrese: �!�?�__--,�!�11i1�.Ll�L.� P6rmitt#a ✓
1
Buildar:
THE FOUAyAINGy OORRECTIONS ARE REQUIRED:
a
i
Inspector:-•ter? .--�_ nate.
PRUNED DISAPPROVED APPROVED S11BJRVT T11 ArV.WE
Call For Relnep.
CI1YoF TIGARD
IWMRD P E R 111.1 T 0. . . .. . . . . 1,1k:C90 0287
Ca i
COMMUNITY DEVELOPMENT DEPARTMENT ORM)N
13 125 SW tW Blvd, P.O.Box 23397,TM,Oinagon 97= 76
DATE'
16540 SW MONACO LN PARIC,'EL:
2SI16AD-04400
kl ! 101 e
Aooin
•j ZONING:
LOT. . . . . . . . . . . . . ..
...........
W('.)RK. . :ADD FLOOR FURN. EVAP COOLERS v
E UNIT HEATERS. . a VENT FANS. . . z
(,'Y G R Fl. . R 3 VENTS W/O APPLs VENT SYSTEMS:
BOILE.-RS/COMPRESSORS HOODS. . .. .. . . . .-
b- 0-3 HP DOMES. INCIN:
:3••-15
3--15 jjr:" COMML. INCIN.-
L41 U 15-30 HF'. ., REPAIR UNITS II
30--'50 HP. . . WDODSTOVE S. . .'
50+ IAP. . . . I CLO DRYERS. . :
1•,l T ........ A.T.R H A N 1)1 ING UNITS OTHER UNI.TS. -.
10011 P'TU.- <W 10000 cfnie GAS OUTLETS. :
10 0 V BTU. 10000 cfmg
FEES
t Y' I-) 'AnInt.111t Ijy date
(:'IA 140HAU) LN PAYM $ 16. 80 JLH 12/10/90
P R M 7' 1, 16. 00
I f '-' (JR 1-37224 5PCT $ O. 80
970 t 3 .......
$ 16. 8O TOTAL
REOU*1 RED E(.',I'.IONS
1-- opreit is issued subject to the 'regulations contained in the Firial liisr)ectiolli
v,l! !"' -i mai Code, State of Ore. Specialty Codes and all other
1,1,;1 C a H i labs. A): work will be done in accordance with
vilro,10 dans, This permit will expire if vork is not started
lthi-) 18F drys of issuance, or if work is suspended for more ......
'11 i8e jars.
...............
j.
a t cc r e
...............
Call. fa-r ires pect.icall 639-4175
-
-ITY OF TIGARD W.ICEIPT or PAYMENT RECEIPT NO. a 90-2075c)9
C'
,.,HED,'. AMOUNT a 36.80
("ENNnu'. DEE (.3 ASH AMOUNT 0.00
PAYMENT DATE 12/10/9'")
SUBDIVISION
16540 SW MONACO L.N
OISE OF PAYMENT' AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
ME.r,'
AN I CAL PE )28'7 J 6. ST. BUILD PER
f,-J.l.ANEOLJS -,(),
J,
FE--,L --- NOTSLREADING TEST I�T)R KINCI CITY
WNDITIONER
1011- AM(YJN'T PAID 36. 80
CITY OF TIGARD
I'1 ,� ll�rl (31NG PERMIT ��� (J� 02Z� 13125 SW HALL BLVD.
P. O. BOX 23397
Applicants must hoki Oregon Registration to conduct a plumbing TIGARD, OR 97223
business ur must be Property owner/operator not hiring outside help.
NameP Deve nt (503)639-4175
- I t- IV160i ,yup' L�f/ ) Plumbing Permit No. . _
Address Description
l��5 q/) lnmr l ORS 014-21-610 DUAN. PRICE AMT.
Job Tax Lot Map.No."�- - —
Address
-- -- FIXTURES
1-01 Bkxk SubdMsbn __---
Sink 7.50
Name a-(tans rest Lavatory - - - -- - 7.50 -^
Tub or Tub/Shower Comb 7.50 --
MSJWV Address -- -- - -
L Shower Only 7.50
Owner City/State �f 7� r > Water Closet - 7.50 --
(� J�1 Dishwasher ! 7.50
Pbone g -
arbage
D IN . --- ---- - _ 7.50 -
Name Washing Machine 7.50
Fuer Drain 7,50
Dung rets Phone----- Water Heater u 7.50
Occupant - - laundry Room Tray 7.50
P city/State -rip --- ----- ---
Urinal 7.50
arnrq Ottmer Fixtures(SPocify) - 7.50
Oeyl,l7.50
/ Phone) LS —_ _ ..-�_ J
7.50
Contractor CHY/Stats 7.50
i q .1 I,. /Z �/7�� MISCELI ANEOUS
City&ro Tax No Sower 1 si 100' 10.00
State s -dl7o -'tate Plurnbers Buslr Flo. +wer�a Adcfit 100'` _ 15.00
(Resufential) Wath Service 1st 100 20.00
I hereby acknowledge that I have read this application.that the information Water Service ea.Addit200r ^- - - 15.00 -
given is coned,that 1 am registered with the State lkrilder's Boeni.and also Storm 6 Rein Drain 1 at.100' - - 30.00
have a State Pkrrnbktg license that the rxxnbers pnron are Conw-t that all - ----
plumbing work will be done in socordance with aWhomble Provisions of Ore- Storm 3 P:.in Drain Addit.100' 15.00
port Revised Statutes Chaplnd ent 447 and 693 aappllCabls Codes aril that Mobil"Morrie Space - -- - 25.00 -no help will be wmkrfed armies!11cmised under ORS 691.(H exempt from --- - --- -----
State registration,please give reason below). Back Flow Prevention
f/t)tWFOWNERS....I hereby certify that I am the owner of it"property do Oevioe or Anti-Polknion Device ---- - 7.50
scribed above.of which location 1 propose to make a pkartbkmg InalaRation for Any Trap or Wasle Not
MY can Or-and It"property Is not bekq Constructed for salt.base ux rem C wined►d to a Fixtt" 7.50
Catch BiuM -- -- 7.50
ktap.M FxW Pkxm>;ng - 40.00 Per Hr. --
___ —.-------__--_. Specialty Requested Inspections _40.00 Per Hr. -
Rain Drain,
Single Ram. Dwlg. 15'00
AUTHOR I D cc��I�TU --- Date ---- -----,-
Describe boor* new n addition❑ afwsffon repair[]
t be done residential rxin-roe tial _
Exisfinp use of MINIMUM PERMIT FEE 25.00
txAkl N or pr"tty- SUB—TOTAL ;2--) V
Ii�u"o1 5% SURCHARGE
txAdwv or poop"- - - ----------- — ---- -- 25% PLAN REVIEW
Tt*fww*b000nwe null and void*work or oonaftmAun istahort:ad Is not Com TOTAL
rninoscf*W*i 1(10 deyw^K c*no*txilon n worms*UVe Kfad or abandoned kv
e 0"ki err 1 qr1 days al any bilis ails•wrtrk 1s on"w"e ow
a>"lCmi_OoNOf "f%
Datn lestrexl - by -- — ----------
CITY®FT167ARD SUILMING Pk-..WMVT'
CITYOFTIOND PEI--4M*.1*.*T NC . IN.111[38169e?
COMMUNITY DEVELOPMENT DEPARTMENT
13125 5 W Hall Blvd..P.O Box 23397,Tigard.Oregon 97223.(603)6394175 I�Arr: 9/26/BE)
-T
P14.1 M PMT 4rT—. ---(7T.!FT197
..)OIR ADDRESS : 165410 SW MW,46CC) LN
VAX MINP/L.OT 251.16AD St.RJ: KI'N(.'., CJ Y t_.1 1:1I<
L.-AND USE :
1.()'T SIZE : 1.)Al-U611'.ON !k "100 5E l'C111C:K!5
WOPIK C1 ASS : 6LTL-74it-'41'1(')N MILLI UNIT'5 : P I G11-11,
LME TYPE : FAMILY NO I:.:X'T' - WAL.1- UJIN151' :
(".11INST - 'T*YPF.; VN NO . [V)]1-41:i :
N: w : E W
(:)(*,C',LJP .GRP. : P3 P11401' C)r)F.--'NJ:N(*..,S :
OMUP .LOAD NW
NO . G113PILS : PE HIL.T-1
NF::-]: ;.?ND: AWI;KA SLPAW? RA*1*I*:A*):
WASEMENT7
MF;2ZAN*.rNP--'? F3ASL*-:M' 't
P'll-001-1 LOAD: GAPAGI�.-.
PL AN CHECK BY:
M-MAPKS :
m.0cl wiridow to taingl.w fami :k%
OF No
As,r WEISSUE
0
VV
N loc PEPMT*r $105. 00
E 16540 %W luoiliaLzo 11-1 PLAN PEVIEW
I<il-lg (:.ity Of., P 1 RIH: DE P1,
Pi-1(3Nr.-: (503) 639-04;26 51'A1,E. 'TAX
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T tits permit is Issued subject to the regulations contained in Title 14 WE:UE:TWt NO.
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and It Is herebyPF.A) 1.NsPEUTIONS
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and
ordinances The Issuance of this oermil does not waive restrictive F 1 NAI
covenants Contractor and subcontractors shall have current city
h0sinesS tax permits This permit will expire and hecome null and.
void if work is not started within 180 days.or if work is suspended or
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Pprmillee Signature
Issued By
I At I I UP ION 639-411. 75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIPED ABOVE
t
I
CITY OF KING CITY
15300 S.W. 116th AVENUE 1
KING CI'I Y , OREGON 97224
( 503) 639-4082
I
i
APPLICATION FOR
COMPLIANCE REVIEW BOARD PERMIT i
1 . NAME OF APPL I CANT : YF-N %,..i Q
ADDRESS:_ �1.;> 5 14 M u tJ P'C u
TELEPHONE NO. In 'Sq - C)q-LL
ADDRESS OF PROPOSED IMPROVEMENT
2. TYPE OF CHANGE , IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT
IS REQUESTED. (DESCRIBE BRIEFLY/ATTACH TWO COPIES OF PL-ANS
OR pRAWINGS OF WHAT I5 PROPOSED) : kL _ Z W1iySOW
U-IR1s"i—_390A L -Ilu LsZ 0 vrt
3. NAME AND ADDRESSES OF CONTRACTOR : y \jk&
Woo ��u�t-N C)R'
4 . NAMES AND ADDRESSES OF NEIGHBORS WHO MAY BE AFFECTED BY THIS
CHANGE , IMPROVEMENT OR CONSTRUCTION . ( IT IS THE APPLICANT ' S
RESPONSIBILITY TO NOTIFY EACH NEIGHBOR ) :
SIGNATURE OF APPLICANT
DATE OF APPLICATION
OFFICE USE ONLY :
APPLICATION RECEIVED BY l � DATE � Z 211F --
APPLICABLE FEE RECEIVED $10 .00 OTHER_ TOTAL PAID_/0, O
APPLICATION REVIEW SCHEDULED: DATE:
CnMPLIANCE REVIEW BOARD - DECISION:
APPROVED DATF_��; � ---T"-
DENIED__ _ _ DATE
CONDITIONS:--
Application
ONDITIONS:__Application approved You are urged to hire con-
for six month period only tractors who are recTistered
10187 with the Builders Board
( Information/InstrUCtIons on reverse) I
CITY OF TIGARD MECHANICAL. PERMIT Receipt#
13125 SW ITALL BLVD. Permit#
11', 0.. BOX 23397 Description —
T I G ARD, OR 97223 )- Table 3A Mechanical Code - OTY PRICE AMT
� 1 V c,'
(•X0-3)63.9-4175 �_�, I I � 1) Permit Fee -- �0- v 10.00
-- — Name of Devek4w ers I
` 2) Supplemental Permit 3.00
Job Address 11 Furnace to 100,000 BTU
Address _
incl.ducts&vents 6'00
Tax Lot Map NoFurnace 100,000 3TU +
2) 7'50
incl.ducts&vents
W 9locic Subdivision incl.
Name(or name of buss ess) Floor Furnace
3) incl.vent 6'00
Maw,y Address — Pncxe - — Suspended heater,wall heater
Owner
�f
4) or floor mounted heater 6.00
city/State Lp Vent not incl.in
5) appliance permit _ 3.00
Name(or name of business) Repair of heating,ref ig., c.y
6) cooling,absorption unit 6.00
MailingAddress--- Phone Boiler or corn ;u 3 HP
Occupant 7) absorp.unit to 100,000 BTU 6'00
c ryistate V ZIP 8) Boiler or comp to 3 HP-15 HP 1100
absorp.unit to 500,000 BTU _
1 I 9) -Boiler or comp 15-301-fP
4 15.00
�\�� a lv� -�-}� absorp.unit 1h-1 million -�—
Mailing Address PIKV 10) Boiler or comp to 30-50 HP 22.50
11 L 1(1 D CZ absorp.unit 1 -1.75 million --
Contractor cnyistals ZIP Boiler or comp to 50 HP
11)3 r_+ absorp.unit 1,750,000 BTU 31"'0
State Registration No City Bus.Tax No ) Air handling unit to
12 10,000 CFM 4.50
16w"by adrrxrwledge that I have read nds application nut the Information given is 13) Air handling unit 7.50
rxnrrr(y,mel I arum the owner 01 authorized agent of rr
the orner,that pons submitted we in 10,000 CFfur +-- -- —
rrxr%*ance wro State laws,that I am registered with the Stale Builders'Gerd,nutthe Non portable
numtm+r givon is conod.(n exempt from stale registration please give reason below) 14) evaporate cooler 4.50
Vent fan connected
5 to a single duct 3.00
- --- -- --- --- — -- Ventilation system not
16) included in appliance permit 4.50
17) Hood served by —
4'�
mechanical exhaust
StgnaOae(owner or agent) Dae Domestic type --— —
18) incinerator 7'50
Describe work— ❑ addition ❑ alteration I I repair ❑ _ incinerator
to be done residential ❑ non-residential Cl 1 Commercial or industrial
--------�----- -- -- 19) tyI�incinerator 30.00
I=xisting use of -- --
building or properly --- --------- —__—_ Other i.e.,wocdstove,water
20) heater,solar,clothes dryers,etc. 4.50
Proposed use of -- _
building or property 21) Gas piping one to four cutlets 2.00
Type of fuel- oil [l natural gas ❑ LPG [I electric O
----- 22) More than 4-per outlet
SUB-TOTAL ,
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -------- —
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 —_ 5%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - ---- -- -
WORK IS COMMENCED, TOTAL
Special Conditions
Date issued�, ..—by — (?
C17YOFT167ARDPLAN CHECK
APPLICATION
COMMUNRY DEVELOPMENT DEPARTMENT CITY RD PLAN CHECK M
13125 SW HMA 8W. p.0.BM 23377.T Wd.0r@gW 97M(SM)$304175 ofteom PERMIT M
DATE ISSUED
JOB ADDRESS: � .'� �� . ��� TAX MAP/LOT
SUB: LOT: LAND USE:
VALUATION: .h"
OWNER
SPErTAL NOTES
NAME: �'�r_. - �
ADDRESS: REISSUE OF
LAST REISSUE: _
— -� — FLOOD PLAIN/
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT
OTHER: _
PHONE:
ITEMSREQUIRED
ARCH/ENGINEER LIST/SUBCONTRACTORS: _
NAME: BUS TAX:
ADDRESS: CALCULATIONS:
TRUSS DETAILS:
PARKING PLAN:
E PLAN:
PHONE: LANDSCAPE _
OTHER:
COMMENTS:
PERMIT N ACCT N DESCRIPTION
10-432 00 Building Permit Fees AMOUNT AMOUNT PD. BAL. DUE
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5X) —
Building —
�' S
Plumbing
Mech _
10-433 00 Plans Check Fee
Building _
Plumbing _
Mech -
30--202 00 - "--
Sewer Connection
30--444 00 Sewer Inspection ----
51-448 00 Street System Dev Charge (SDC) - '-
52•-449 01 Parks I System Dev Charge (POC)
52-449 02 Parks TI System Dev Chane (PDC)
31-450 00 Storm Drainage Syst Dev Chry (SSOC)
10---230 69 TRFD
10-230 06 Washington County Fire M1 (95X)
10-220 00 Amart/Wedgewood -
TOTAL
REC N
APPLTC:ANT SIGNATURE
Received fly : Datr- Received:
ht/35BIP/18P -
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