8256 SW MATTHEW PARK STREET �rwwm•+.+ie-...rwrcvr • v*^•�...^ ,wp w••�s...•+r+.ri.+�w�r!"m,a.w�+�e'^,^ +w�►-^..�-wwwM.... „+�..��4'4'�M
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INBFECTION NOTICE !" mM111
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Cit? of Tigard Building Department
S
13125 BW Ball Blvd. T.lgard• Oregon 97223
Inspection Line (Rec-O-Phone)1 r 639-4175 Business Phone: 639-4171
_
Inspection: ✓ �i� � a-� M
Tooting Plbg. Underslab Msoh. Rough-in Appr/Sdwlk Y
Found. �`- . ..
Plbg Top out Gas Line FrNAL:
Post/Beam Struat. San. Sewer Framing -Bldg.
f
Post/Beam Hoch. Rain Drain Insulatlor: -plumb.
Plbg. Underfloor Water Line gyp. Rd. M•3ch.
Date Requested:,-/ 1- `7_-- Time: .�AM _ PM
Address: 1�� , ' hermit rt
i
Builder: < C
TME FOLLOWING CORRECTIONS ARE REQUIRED:
/ 1
Inspector: l.-
Date:
APPROVED _ DISAPPROVED APPRCMRD SUBJECT TO ABOVE
r Call For Reinsp.
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%WOF TIGARD�iT�
COMMUNITY DEVELOPMENT DEPARTMENT
'13125 SW Hall Blvd.Tigard,Oregon 97223+8199 (503)639-4171
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City of Tigard MECHANICAL PERMIT Planck/Rec. # �•
4
13125 sw Hall Blvd. APPLICATION Permit #
Pd Box 23397
Tigard, OR 97223
(503) 639-4171
.rw «oPm«wDescription
Table 3A Mechanical Code QTY PRICE AMT
Jobb S? /A1 ��p/ i�a) �a„� �L� 1) Ponnit Fee 0- 0- 10.00
Address rM
2) Supplement,-!Porinil 3.00
—«m»• »• urnace c, I 77=
44 1) incl. ducts v vents 6.00
.V «.
Furnace 100,0( +
{ Owner k ,-574, - X,(- ,it. 2) incl. ducts 8 vents 7.50
—75-6775—mance
3) incl. vent 6.00
•m• « •• �•
Suspended a seater,we)r eaten r—
c ,•�, r 4) or floor mounted heater 6.00
•v «• Tin-.m
Occupant 15) applir,nce permit 3.00
w air of leating,re ng.
d 6) cooling,absorption unit 6.00 i
■^• of er or comp, heat pump,au con .
iLB
p�'�' 7) to 3 HP absorp unit to 100K BTU / 6.00 -C '
»• oder or comp, eat pump,air con .
S5.' Sl ?ro2'?.e- �.l f` 8) 3-15 lip absorp unit to 500K BTU 11.00
Contractor of ar or comp,heat pump,air con .
9) 15-30 HP absorp unit.5.1 mil BTU 15.00 1
r• •• ••
Boiler or comp,heat pump,air con .
10) 30-50 HP absorp unit 1-1.75 mil BTU 22.50
hereby ac cw go that I have rea t riTf s applicabon,t sat Tie__ of er or camp,heat pump,air cond.
information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
of the owner,that plans submitted are in compliance with State Air handling unit to
laws,that I am registered wi'' ,the Construction Contractor's Board, 12) 10,000 CFM ;.50
that the number given is correct. (If exempt from State registration, — ir handling unit i
please give reason below.) 13) 10,000 CTM+ 7.50
-ITon porta e
�-,I 57••-� y y�f'�f�� 14) evaporate cooler 4.50
Vent fin connects
15) to„ single duct 3.00
-Vantilation system not
,. `� , > �•�. y 16) included in appliance permit 4.50
• -- •rHood sory y
17) mechanical exhaust 4.50
Describe work new 0 addition alteration 0 repair 0 Commercialor industrial
to be done residential Q non-residential Q 18) type incinerator 30.00
Existing use o i Other i.e.,woodstove,water
building or property 19) heater,solar,clothes dryers.,etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
Type of fuel-oil Q natural gas Q LPG Q electric
More than 4-per outlet
NOTICE
ric Q ;
Minimum Fee$25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION —`
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR —.6%SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR '—
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED —
TOTAL
Special Conditions ”"
Date issued �- by
WMEWPOAT
r•Ida«nbv
-77
1
4
1
77,
' 4
OF T I GARD — RECEIPT OF PAYMENT RECEIPT NCI. 193-241219
3-241x.:19
NAME s BELL HEAT I IVU CHECK AMOUNT 26* 25
ADDRESS ° 15550 SE:' PIAllA AVE CASH AMOUNT 0. 00
P='AYME'NT DATE t 06/11/93
CL.ACKAMA(,w, OFR X3'701; — SUBDIVISION
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''URPOSE:; OF PAYMENT AMOUNT PAID PURPOSE OF PAYMPNT AMOUNT PAID
+IECHANICAL. PE __. _. _—S
._ _.._w—TI
_
c"�• Q�0 c;T. STJ I L D r P—FF? 5
1. 25
1
SW MAT'THE'W PARK ST
TOTAL AMCII.JI\IT F )T I)
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9
CIIYOFTIFARD
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COMMUNITY DEVELOPMENT DEPARTMENT e
19126 BW FWI BW P.O.Bac 23M.T1pWx Or"m W=(609)63er-4176
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EWE OP
0C.C.; )PANLY
rtuxx PERMIT #. . . . . . . a M13T92-225'/
63)---4171
DATE ISSUEDt Oi?/03/93
91 TE AUDRF ,PS. . . a 08856 SW MATTHEW PARR `!'I PARCT:':L a ?G l a c2BC—_ 11Af;+0v1
6LISD I V 1 S I LAN. . . .. a MATTHEW PARK 7 ON J NC;i
BLOCK. . « . . . . . . . z Lu'T. . . . . . . . . . . . . an Y
GLASS OF W0HK. a NF",W
TYt:'C: OP USF:« « . bSl"•
OCCUPANCY Gf7P. a R3
'C CUPONCY LOAD a 1 19 a
I ENANT• NAME:. . .. e
F Romarks a PA'M 1
Ownert _•�.M__ ____�.. _..». _�_. _.__.r _�..._..... .»
,TAY MILLER
F:xU BOX 2 3i•?91
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E•hnne 0: 6A4-754:
L;urrtreer..tor.s -,��.•»........_......»..-.w...__......_..•._...»._,_._..,..•..».._,_..._
JAY 011L.1..F:.R
110 BOX 2 3ia:`.31
T C HARD OR 9.7281
Phone Mt 684-754.3
Reg M. . a :.30109
Oc c:•upiant.-y of the &[iave reef terhetnc.erd hui ldi rip it, hereby given, Anci c:ei^t i f i es
cho compliances with the fjtQtr 04f (Jr'epon Spe(AsIty (:label% for theyr•ump,
rnrc:upalnc:y, and use under which the reefer"tent' eci permit was i osk.jocl.
DEPARTMEr NT BU T NO,
Ell1 L►IIV(3 01--f"IC IAI.
POST IN C:C)Nf•WIGAJOUS PLACE
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INSPECTION NOTICEow
City of Tigard Building Departuent
13125 SW Ball Blvd_ Tigard, Oregon . 22
Tnapection Line (Rec-O-Phone): 639-4175 Huuiness Phone: 639-4171
Inspection•
Footing Plbg. Underslab Mech. Rough-in AppriSdwlk
Found. Plbg. Tor Out Gas Line FINAL:
Poet/Beam Strutt. San. Sewer Framing Rldg.v�
Poet/Beam Hoch. Rain Drain Insulation C -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch. )
7 �C
Date Requested: Time a _AM PH
Address: `d, , CtZ2Zrk, ermit
Builder:.-., •'
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector --- �- bate:
`_—APPROVED DISAPPROVED APPROVED SURjrc*r To A90VE
Call For Relnap.
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INSPECTION NOTICE �1
City of Tigard Building Department
13325 Rp Bail Blued. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone),639-4175 Business Phone: 639-4171
Insper_tion•_ — '"��. ■
Footing Plbg. Uslab Mach. Rough-in Appr/Sdwl.k v
Found. Plbg. Trip Out Gas Line FINAL: �
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation --Plumb.
Plbg. Underfloor Water Line Gyp. 9d. --Mach.
Date Requested: j _ _ _ Times AM oM
Addresn:
— 1 Permit
Hull der:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:_�GTNl4 /llYDate: '73
APPROVRDvc
DIffiAPPROVSD APPROVED 9U9JECT TO ABOVE
Call For Reinep.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SM Ball B 1
lvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Uue'neae Phone: 639-4171
Inspection:__ _ i ■
Footing Plbg. Underslab Mech. Rough-in �4ppr/Sdwlk�� I '
FINAL: /
Found. Flbg. Top Out Gas Line FINAL: !
: �
Poet/Beam Struct. S&:. Sewer Framing --Bldg.
Poet/Beam Mech.
Rain Drain Insulation _plums.
Plbq. Underfloor Water Line Uyp. Bd. -Mech.
Data Requested•- Ti
• mes � _PM
Addrees -�
arrait #:
Builder:_--
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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_7....�_ Dstet y� l
APPROVED DISAPPROVED __z�PPROVRD RtWNcT To ABOY6
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Call For Reinep.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 972�rr A
Inspection Line (Rec-O-Phone): 639-4175 Bus.inesn Pho : 639-41'71
Inspection:,
Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Can Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drair Insulatian -Plumb.
Plbg. Underfloor Water Line Gyp, ed. -Hach.
Date Requested: - Y Time: _,_AM __—PH
Q�S1P
Addresn: -�//��7 �((�[.L,L f`Y/iwJ" �/�-- Pormit 1 t I
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
Dates
APPROVED DISAPPROVED APPROVP.D SUBJECT TO ABOVE
�i -
Call For Reinap.
Tell IMIM
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INSPECTION NOTICE
City of Tigard Bui.ldincDepartmen
13125 RK Ball Blvd. Tigard, Oregon 97 �
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_ ——_
Footing Plbg. Undere).ab Nech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line f Gyp. Bd. -Mech. _ I
Date Requested:,_ ` ^2- —Time: - AM PH
Address: 7jZ7lii' �cV �� 1�YPermit 1:
: 1
Bu.il.dersJ .
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector _ ____-___��__ Date:_y
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APPROVED DISAPPROVED — - APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Degartiisient
13125 SW Hall Blvd. Tigard, Oregon 97223
inspection Line (Rec-0-Phone): 639-4175 Dusineas Phone. 539-4171
Inspection:_ _ -_ \ ---
Footing Plbg. Underalab Mach. (tough_i�sl Appr/Sdwlk '
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. Sass. Sewer /Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
I Date Requested: 1-2-
-1
t-1 e,Z_,1 Times O� AM
Address: Permit
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors, _ Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
j __Call For Reinnp.
I
INSPECTION NOTICE
City of Tigard Building Department /
13125 SW Hall, Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 539-4171
1
Inspect ion s
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found.
�T -t
Gas Line FINAL: M
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Macho Rain Drain Insulation -Plumb.
Plbg. Underfloor Wat. Line Gyp. Ed. -Hach.
G
Uate Requestede I _Time: AM YM
Address: z�(� Permit
_ --
Bui-lder:_ __,----- —.
TIUi FOLLOWING CORRECTIONS ARE REQUIRED:
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L Inspector: _ _ Date: G i
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APPROVED DISAPPROVED APPRC"ED SURJFCT TO ABOVE
s Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball BlvA. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 634-4175 Business Phone: 639-4171 'f
Inspection:T_
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Found, Plbg. Top Out /Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bl.dg.
i
t
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Mech.
°
Date Requested: 7� Time% PM
Addr9eas rZl Z S 1�Vim �Y�u) n�1^ Pen.lit
Builder: EA-1 (A -'l t •�(la/i �P`7� .. (I ��t�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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r e
�gal
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Inspector: Dele:`� '
--� ---- F-�—__.._.__�
y APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE _
Call For Reinap.
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INSPECTION NOTICEt
City of Tigard Building Department
13125 SR Ball Blvd. Tigard, Oregon 972
Inspection Lina (Rec-O•-Phone)t 639-4175 Business 39-4171
'i
Inspections
s
Footing Plbg. Onderslab Mach. Rough-in Appr/Sdwlk
Sk
Found. Plbg. Top Out Gas Line FINALt
et/Beam Struc San. Sewer Framing -Bldg.
ost/Beam Mac Rain Drain Insulation -Plumb.
i Plbg. under ]oar Water Lin Gyp. Bd. -Mach.
Date Requested i I_'-9z' Time
_
/� n t AN PM
Address: •k-,2,-5_,1,, / — � �
Permit 1:
-
Builder-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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y Inspec -, Date:
PPROVED _-- DISAPPROVED -_-_ APPROVED SUBJRCT TO ABOVE
Cell For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 ON Ball Blvd. Tigard, Oregon 97223 5
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41.11 �r `a
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Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk ti U,"8i ,+�l�yt"'a 'r YS
Found. Plbg. Top Out Cas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. ` aln Drain Insulation -Plumb. 4
Plbg. Underfloor_ Gyp. Bd. -Hoch.
Date Requested:/ ' Timex AH G-' PH
Addrese: � ,/_'" Permit 7, /
Builders_��
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: �/l�' i— Dates 1 J= �
APPROVED DISAPPROVED �— APPROVED SUBJECT TO ABOVE
i
Call For Reinep.
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i INSPECTION NOTICE
,.u' ; City of Tigard Building Lepartsient
13125 BW Ball Rlvd. Tigard, Oregon 97223 }
Inspection Line (Rec-O-Phone): 639-4175 Business Phon 639-4171
S
F' ° Inspection: �r
i, Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk '
r.N..
ound. Plbg. Top Out Gas Line FINALS s+.•
g
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Ineulatlon -Plumb.
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1•
Y v°
i Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
'
} �}� Date Requested: J �. Time: / / AN PM
Address:_
Builders
I
R THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspe
ictor: _ �"
_ Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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Call For Roinep.
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CITYOFTIFARD
WYO R
COMMUNITY DEVELOPMENT DEPARTMENT oe!aooer
13128 BW Heil Blvd.P.O.Box 23,997,TOW,OnVon 9n23(503)8394178 MASTER PE=RMIT
-�.
639-417.1 DATE: ISSUED: 11/10/92
SITE ADDRESS. . . : 8256 SW MATTHEW PARK ST PARCEL: 2S112BC•-:0600
SUBDIVISION. . . . : NAT iHEW F''ARK ZONING: 4
BLOCK. . . . . . . . . . . L_O-r.. . . . . . . . . . . . . .S
BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . .0 sf 4.
CLASS OF WORK. :NEW BEDRMS:2: BATHS:2 GARAGE. . . . . . . . . . :480 sf
TYPE OF USE. . . :SF FLOOR ARF'AS----------- REQUIRED SETBACKS----------
TYPEOF CONST. :5N FIRST. . . . : 1504 sf LEFT. . :8 ft RIGHT. .-6 ft
OCCUPANCY GRP. :R3 SECOND. . . :0 sf FRONT. :20 ft REAR. . :51 ft
STORIES. . . . . . . : 1 TH I RD. . . . :0 s f REG)U I RED---__�________.--•--.-_--
HE I GH T. . . . . . . . : 19 f t TOTWL_--- ---: 1504 s f SMOKE DETE.CTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 77824 PARKING SPACES. . - 1
Remarks: PAFH I
PLUMBING -•-----
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :ill BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :3 WAFER HE:AT'E=RS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . :0
WATER CLOSETS— :2 SE=WER LLNE (ft ) . -0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 11:LINE (ft ) . : 100 OTHER FIXTURES
GARBAGE DISP. . . : i RAIN DRAIN (ft ) . :0 "
WASHING MACH. . . : 1 SF [RAIN DRAINS. . : 1
MECHANICAL ---------------- ---------------- FEES
FUEL T'YF='E5- - - - - UNIT HTRS. . :0 type amount by dat a recpt
/GAS/ / / VENTS . . . . . :0 TIF $ 1460. 00 JH 11/10/92 X
MAX INPUT:O BTU VENT F'AIVS. . :3 BPR1 $ --;'67. 00 JH 1 .1/10/92: X
FURN ( 100K . . : 1 HOODS. . . . . . : 1 BF'LC $ 250. 00 JLH 11 /03/92 233363
A
TURN ) -100K . . :0 WOODSTOVES. :0 B`;F'C $ 18. :35 JH 11/10/92 X
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 2'80. 00 JH 11/10/92 X
BOIL/CMP ( :3HP:0 OTHER UNIT'S: 1 PARK $ 500. 00 JH 11/10/92 X 9,
GAS OU TL.ETS: 1 MPRT $ 40. 50 JH 11/10/92 X
Owner: ---_______._.___...._______.__._.__.__..._._______. MPLC $ 10. 13 1'1-1 11/10/92 X
JAY MILLER M5F,C $ 2. 03 JH 11 /10/92 X
PO BOX 23291 PF'RT $ 147. 50 JH 11/10/92:' X I
P5F'C $ 7. 38 JFr 1 1/10/92 X
TIGARD OR
Phone #: 684-7543
Contractor: ---•---_------------------.-___.---
JAY MILLER
PO BOX 23291
TIGARD OR 972:81
Phone #: 684--7543
Reg #. . : 30109 -------------------------------------------
$ ;3082. 89 TOTAL
This permit is issued subject to the regulations contained in the ------- RE UUIRED INSPECTIONS - - ---
Tigard hunicipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
i
applicable lrqs. All work will be done in accordance with approved Post/Beam Stri.tct Gas Line Insp
plans. This permit will expire if work is not started within 180 Post/Beam IYlerhtan Insttlation Insp
days of issuance, or if work is suspended for more than 180 days. Plm/undslab Insp Gyp Hoard Insp
dL�� PLM/Underfloor Rain drain Insp
Permittee Si ynat .tre : filer-hanir_al Insp Water Line Insp
/ Plumb Top Out Appr/Sdwlk Insp
Issi_ted By: f< !� _ Framing Insp Mechanical Final
Call fo., i nspert i on - 639-4175 ---���
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CITY CSF TIGA RD SEWER CONNECTION
PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : swR920345 „
tat268WHall 6tid Ro.e«Mr,rpm,a. ° � 1+ � _ DATE ISSUED: 11/10/92
SITE. ADDRESS. . . : 8256 SW MATTHEW PARK STPARCEL: 2S112BC-10600
SUBDIVISION. . . . : MATTHEW PARK ZONING:
BLOCK. . . . . . . . . . . . . ;
LOT. . . . . . . . . . . s5
4
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNIT'S. . . s 3
CLASS OF WORK. . . :NEW DWELL I NU UNIT'S. . : 1
TYPE OF USE. . . . . :SF NO. OF BU I LD I NGS: 1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . :
Remarrkss PATH I
Owner: -- ------------------------------- ---------____- FEES
JAY MILL ah type amolant by date- _ recpt M1Y
PO BOX 23291 PRMT $ 2100. 00 JH 11/10/92 X
I NSP $ 35. 00 JH 1 1/10/92 X
T I GARD OR 97223
Phone #: 664-7543
I
Contractors
CONTRACTOR NOT Ohl FILE
Phone #: ------
$ 2135. 00 TOTAL
Reg
REQUIRED INSPECTIONS -------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage 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 ggarantee 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 located, the installer shall purchase _
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
Permittee Signature :
T s s i_i e d B y
Call for inspection - 639-4175
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CITY MJF TIGARD u�uswN.�oMa. PLNCK/RECT !(<
PO Box U397
COMMUNITY DEVELOPMENT DEPARTMENT rqpm*0MV0 m PERMIT 92 - oz 5'-j
(303)639L4171 DATE ISSUED
JOB ADDRESS: g z 6 5[-t� /�C,�:-�-//t Q c�_ /C• 5 t' TAX MAP/LOT Q2 S I l 13G - 10�O oy
SUB: 6Y1-C huuJ exr'k �
LOT: Jam' - fp LAND USE:
VALUATION:
SPECIAL NOTES
NAME: JU14 fn r ilea' REISSUE OF: _
ADDRESS: ,PD BoX :z 3 7L9 1 LAST REISSUE:
T I•q 0.rd . OK q72-7-3 FLOOD PLAIN,/
PHONE: 1p8cl - 75V5 SENSITIVE LAND: t
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CONTRACTOR �
APPROVALS REQUIRED
NAME: _J-6 LI Vn of a 810 r• _ PLANNING:
ADDRESS: C)- o5ox �L 3 2.9 1ENGINEERING•
a.rCl - 62 q 7zi 2 Z3 FIRE DEPT:
PHONE: lo 8V - 7/6'�3 OTHER: -[F-y(
CONTR. BOARD A: EXP DATE:
ITEMS REQUIRED
�'%Pc. i }
SUBCONTRACTORS: PLUMB: Kin Wu-ft-5LIST/SUBCONTRACTORS:
MECH: BUS TAX:
AITCH/ENGINEER CALCULATIONS:
NAME
TRUSS DETAILS:
ADDRESS: _ OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
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APPLICANT SIGNATURE
Received By:,,-
Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT
AMOUNT PD. BAL. DUE
Y*s 2 2S 7 10-432 00 Building Permit Fees ?;�-
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) Ao
Building H. S� /
Plumbing 1r3
Mechanical 1.v
10-433 00 Plans Check Fee
Building -23Y65 /
Plumbing
Mechanical /0,1.3
10-230 06 Fire
SwR 1-Oiyi 30-20c 00 Sewer Connection
30-444 00 Sewer Inspection
25-445-02 Commercial TIF Fees
kI 25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
:t
25-448-01 Residential Traffic Fees a
25-448-05 Mass Transit TIF Fees -
52-449 00 Parks System Dev Charge (PDC) S L)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) � U _ ,2 6 V
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fr.e in :ieu of) _
TOTAL SAA
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CITY OF T I CARD RECEIPT OF PAYMENT RE.Cr- I P T NO.
NAME: a MILLER, JAY CHUCK AMOUNT s 4956. 44 I �
ADDRESS s CASH AMOUNT a 0, 00
PAYMENT MATE:'
St. BI)TY ISION
I
PURPOSE- OF PAYMr-:1,IT 0MOUNT PAID PURPOSE Ol PAYMENT AMOUNT PAID �
HLIILDINCa P'E:RM
367. 00 PLUMBING PF_'RM___.._. 147. 50
MECHANICAL PF 40. 50 5T. BUILD PER 27. 76
PLAN CHECK FE -1. 32 SEWER USA 2100. 00
SU-WER INSPECT 35. 00 PARKS SDC 500. 00
STORM DRAIN SDC 0-180. 00 RIESIDE:NTIAL TRAFFIC PEES 1350. 00
MAIRS TRANSITTIF FF: -5 110. 00
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8256 SW MOTHEW POP['
MST 9E'--025, � I
TOTAL. AMOUNT PAIL) _) 4'956. 44
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CITY OF TIGARI) RECFIPT OF PAYMENT RECEIPT NO. :9c"'-'33363
CHECK AMOUNT a 250.O0
NAME r Mll.l_ER, JAY CASH AMOUNT O.00
AUURE:ab s PAYMENT DATE a 111(b319r^ Ii
SUB A I V 1310N
P='URP'OSE OF PAYMENT AMOUNT PAIL) PURPOSE= OF PAYMENT AMOUNT FERN)
PLAN f'FIFCK._F _._._"._... _.�-. 4 5O.Q�Q
LOT 3 MATTHEW PARK
"E56 5W Mt1TTHFW PARK 13,
1 mAI. AMOUNT P'A I T,E ) 50,00
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