11241 SW SUMMER LAKE DRIVE - 11241 SW SUMMERLAKE DRIVE -
■ r
CERTIFICATE OF
OCCUPANC:Y
CIT Y. 0r,-w TIGA RD CITYOFTim RD PERMIT M. . . . . . . a 1-UP892530
C Or MUNfTY UEVELUPMENT DE:ViAATMtW ORNM PRIM. PERMIT 0. 1 892330
1'1126 SW Fish Blw!. P.O.Bax 23397,'Tigard,Oregon 97223 (503)839-.175 � DATE I S S UE D a 95/23/99
SITE ADDRE:SS. . . s 1.1241 SW 5UMI0,r.:.h1.0=u'' ::C< PARCELs IS133AD-158911
SIJBDIVISION. . . . I SUMNE:RLAKE 7.ONINGi R•-7
SLOCK. . . . . . . . . . s LOT. . . . . . . . . . 13�
------------
CLASS W.' WORK. sNE'W
TYPE OF USE. . . ISF
OCCUPANCY ORP. IR3
OCCUPANCY LOADI
TENANT NAME. . . s
Remarks)
DON MORISSETTE
PO PDX 19524
PORTLAND OR 0064910- 0000
Ph vnrw He X100-gHPJ 0000
Contractors _....... .__.._....._._.. ---..w__.....__.._----
PON MORISSETTE BLDE.RS, INC.
P 0 BOX 19524
PORTLAND OR WE 19
i IPI-ione Ox 503-620-- 71.538
Reg M. . s 35533
Or_°c'upanr..y of the elbovp referenced bi.ci lding is hereby given, and c vrti f f es
the c omplianr.e with the State Of Oregon Specialty Codes for the grraccp,
OCCUI)A c-y, and c.iso under which t:hv refPrenced permit was issued.
FIRS. DEPARIMENI J� -DINA INCE
BUILh OFFIL'TAI.
POST IN CONSPICUOUS PLACE
■ W W
INSPECTION NOTICE
City of Tigard Building Department i
P.O. Box 233,97
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested v-' Z 3 Time A.M.______— P.M.
P.dress �:.l Z' y ->« `1ti i cam" Permit # _—
Owner ,_ Lot #
Builder — — — ----- —"��_.
Tue following ?nUding Code deficiencies are required to be corrected:
Prn,,entert to ----- --- ��Approved
-- -
Inspector Disapproved
�1 Z
Date — 3 ------.
CALL FOR REINSPECTION
� NO
I YES L
INSPECTION NOTICE /fes f
City of Tiyard Building Department �/ y
P.O. Box 23391
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection _ �_ �✓ _�
Date Requested V
q Time__;� A.M.---P.M.
Address .._��s!�� ' _ Permi+
Owner Lot "
Builder
The following Building Code deficiencies are required to be corrected:
v
v
Presented to y� Approved
Il'ipector I Disapproved
Date —
CALL FOR RRINS.PWTION
YES O NO
INSPECTION NOTICE
ity of Tigard Building Department
P.O. Box 23397
Tighrd, Oregon 97223
Phone: 639-4175
Type of Inspection L�-)
Dave Requested Time KP.M.
Address
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
5-
Presented to _ 'Approved
Inspector U Disapproved
C-7
Date - e I/
CALL FOR REINSPECTION
DYES 0 140
A
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
77 -Type of of Inspection —_'61
Date Requested Time--"X A.M. P.M.
�_--
Address , Cd. .c'Permit #_
Lot --
Builder —
The following Building Code deficiencies are required to be corrected:
Presented to Approved
nspector U Disapproved
Date
CALL FOR REINSPECTION
0 YES ❑ NO
INSPECT!ON Nr fiC
City of Tigard Building Departme,t .'
P O Box 23397
Tigard, Oregon 97223
Phone. 639-4175 t f
Type of Inspection � �'" ..�•
Date Requested'' Time. A.M. —__P.M.
Address`Jr _7� Permit
Owner _ Lot #T
Builder
The following Building Code deficiencies are required to be corrected:
Presented to �pproved
Inspector --Ll1t'
❑ Disapproved
Date
CALL FOR REINSPECTION
0YE8 ❑ NO
A �
INSPECTION NO-ICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 6394175
r
Type of Inspection ff —
Date Requested ___�T Time A.M. P.M.
fsermit #�
Address -__ 2 '
Lot
Owner
# �_
BuilderThe following Building Code deticiencies are required to be corrected:
---Ltd i?`t? ."� •L7 KI fJ �. C =�r----TD �!.)/�iii�.cI
11 J;e
cif
.lam-.�- -i l` i/�/S� t� �f•�
ppruved
Presented to ._..-
Inspector
(� Disapproved
Date
CALL FOR RLINS'PECTION
❑ YES C NO
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phoi 639-4175
Type of Inspet.tion � ----
Date Requested— Time A.M. P.M.
Address y� �� Permit #
Owner Lot
Buiider 47k�-� �r The following Building Code deficiencies ere required to be corrected:
Presented torrlImved
Inspector -- _ u Disapproved
Date
CALL FOR REINSPECTION
YEs CJ No
INSPECTION NOTICE
City of Tigard Building DepartmF nt
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —
Date Requested- '--�- Time M.
Address �.�rX(� � Permit 02��
Owner_- —
Builder
The following Building Code deficiencies are required to be corrected:
Presented to / ___._ _- --- _--- -- Approved
Inspect-,r l 1 `?L, 1! �tll] - -------- - Disa -oved
Datrr If ---
CALL FOR REINSPECTION
(� YEI ® NO
INSPECTION NOTICE
City of Tigard [wilding Department
P.O. Box 23397
Tigard, Oregon 97223 r`
Phone: 6394175
Type of Inspection �� v — —ea-
Date Requested _ .S -- Time A.M. P.M.
Address L�l �0'0'�' '
�� ;C� Permit # La3U
J
Owner _ _. _ __ Lot #
- '
BuilderThe following Building Code deficiencies are required to be corrected:
-Af.' +✓�
PrAsented to --_ _ Ft� Approved
Inspector ` = __ _.�-- �_� Disapproved
Date
CALL FOR REINSPECTION
0 YES 0 NO
INSPECTION NOTICE
Citv of Tigard Building Department
P.U. Box 23397 a—
Tigard, Oregon 97223 C �
Phone: 639-4175
Type of Inspection — ----_- 2, /
Date Requested _ . _ — Time�`— A.M._ P.M.
Addresses�lL _ Permit # Jpr
Owner __- _ _. Lot #
Builder
The following Building Code deficiencies are required to be corrected:
a
i
?resented to
� _ � Approved
Inspector /
r] Disapproved
Date
CALL FOR REINSPECTION
O YES El NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
7
Type of Inspection
Time.�—A.M. P.M.
Date Requested_ Q
Address
Owner
Lot # __
._
Builder n
The following Building Code deficiencies are required to be corrected:
Presented to _ AA1P'
Proved
Inspector �_ isapproved
Date ::�:L ---+�—�—
CALL FOR REINSPECTION
0 YE8 ❑ NO
ss
INSPECTION NOTICE
City of Tigard Building Department N
P.0 Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection _.—
Date Requested Time. //A.M. P.M.
Address __��_ � _ �--P`rmit
Owner Lot #--- -._---_
Builds( r�� I/I�t 0e-1The following Builriing Code deficiencies are required to be corrected:
Presented to . -- Approved
Inspector [_] Disapproved
Date 4e
CALL FOR REINSPECTION
[] YES L_1 NO
MECHANICAL.
CIIYOFTIFARD L PERM l:T
CITX7FT
COMMUNfTY DEVF� RD PERMIT N. . . . . . . : MEC89257O,�PMENT DEPARTMENT � ortaooN
13125 SWHWIBlvd. r.O.Box z3s7,nqws,Oregon 97n,tWie }�6 / PRIM. PERMIT #. ."#. ." 89253O
---- ----------_ ___-- - - - DA1 E ISSUED: O2/22/90
SITE ADDRE:i:; 11.241. SW SUMMERL.AKE DR PARCEL.. 1 S 1.3,3AD.•..1.513OO
SUBDIVISION. . . . : SUMMERLAKE y ] ZONING: R--7
BLOCKa 1_07 . . . . . . . . . . . . . :39
.............._..__.._........._.._....____.._............._....._......._...._....
CLASS OF WORK. . I NEW FLOUR TURN. . . . : E.VAP COOLERS;:
TYPE OF USE. . . . :SF UNIT HEATERS. . .' VENT FANS. . . : 2
OCCUPANCY GRP. . e R3 VENTS W/O APDL.: VENT SYSTEMS a
STORIEi. . . . . . . . . :l BOILERS/C:OMPRE"BSORS HOODS. . . . . . . : 1
f'UF:I.. TYPES _..._.........._.._._.._..___._. 0-3 HP. . .. . DOMES. INCIN:
:GAS 3--15 HP. . ,. ., ;, COMP1... INC:IN:
MAX INPUT: 141 U 1 30 HP. . ,. ,. ;; REPAIR U11ITS:
F'I RE:: DAMPERS7. . : 30 50 HF'. . ., . WUODSTOVES. . :
GAS PRESSURE. 50+• HP. „ r CLO DRYERS. . :
NO. OF UNITS -_.._._._.__._.... AIR HANL'L.:ING UNIT'S OTHER UNITS„ e 2
F'URN < 100K k:+Tl.l: 1. <:::: :10000 r_i m: GAS OUTLETS. : 1.
TURN >-1O0K BTU: > 10000 cfm:
Remarks:
DUN MORISSiETTE type anIOUI-It by date •rec:pt:
PO BOX 19524 PRMT $ .10. 00 MAN
PI._CK $ 9. 38 MAN / !
PORTLAND OR 00000-.•0000 5PCT $ 1. 88 MAN
Phone N: 000...000-•0000 F'RMT $ 27. 50 MAN
PAYM $ 48. 7G .TI._H 04/2O/90
Cantractorc
I P.:A_L_ HEATING INC
1.5550 SE PIAZZA AVE::
i CI_.ACKMASi OR 97O15 _..................._.__.__._.__...._..__..____..__..__.._..__..___._.. ...
C,Fic:111e ##: $ 48. 76 TOTAL.
I;;e g 0. . . 4 47
......_._.._._.._-.. ' _.._..__...._.......
Ihis pewit is issued subject to the rejulations contained in the REC�UIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other _
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is not started
within 180 days of issu,nce, or if work is suspended for more
._.._...__ �. __._. _.___.____.. .____. __..___.
than 1AN days. .._
Permittee Sig natu'r•e9
I si s t.x e d B y tt
C.411 far irIsper•timi - 639--4175
■
SEWER CONNECTIC)N
CITYOFTIFARD APERM I T
QqY0F TWO PERMIT b. . . . . . . . SWR892511
COMMUNITY DEVELOPMENT DEPARYMENT 0016011
13126 SW Heil Blvd. P.O.Box 23397,Tigard,Oregon 97223 4176 PRIM. PERM11 892530
GJ 1 'LaroLIED: 92 9 W
SITE'. ADDRESS. . . 1 11.241 SW G1J111ME;'RLAKE DR PARCEL.-
L.- IS1330D 1.5800
SUBDIVI ;ION. . . . : SUMMERLAKE ZONING: R--7
BLOCCK. . . . . . . . . . .I LOT. . . . . . . . . . . . . .39
TENANT NAME'.* *
USO NCI. . . . . : : : *;40466 FIXTURE UNITS. . .
CLASS OF WO« K. . NEW D W E L L 1'.NUNITS. . .
TYPE OF USE. . . . . SF NO. OF BUILDINGS: 1.
INS144.1. TYPE BUSWR IMPERV SURFACE:. . : -sf
Rema-rks
DO11 MORISSETTE type anloLtilt by date r e
1--'O BOX 1.9524 PRM $ 35. 00 MAN
F RMT $ 1250. 00 ITION
I"ORTLAND OR 00000 0000 PAYM $ 1.285. 00 JI...H 04/20/90
Phone #,-, 000--000-0000
Caritractar.-
DON MORISSETTE PLDE-RS, INC.
1-', 0 BOX 19524
PORTLAND OR 97219
Pliarie 0- 503--244---931.4 $ 128`,.00 TO 14)1..
135533
REOUIRED INSPECTIONS
This Applicant agrees to comply with ail the rules and regulations ...................................................................- -.-..............
of the Unified Sewage Agency. The permit Pxpires 120 days from .......... .....................
the date issued. the total amount paid will be forfeited if the .. ................
�.)Prmit expires. The Agency does not guarantee the iccurary of the
Side sewer laterals. If the Sewer is not located at ��p 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 he Agency will install a lateral.
P P-r,m J.t t e e G i q 11 a t U'1'0 ................
1-3 S U ed R y
C a i I f c)-r irispect:ic)vi 639-4175
� +� w■► � Iw � � felr elf eee �
CITYOFTIFARD BUILDING F!ERMI'T
GIIY0F1WARD I.'ERMIT #. . . . . . . : BUF'Ci`2530
COMMUNITY DEVELOPMENT DEPARTMENT ONGWOr PRIM. PERMIT N. : 6' 2530
13126 SW lull Blvd. P.O.Box 23307,Tipud,Oregon 97223(6 j+��.7 D A'T E ISSUED: C2/22/90
11241 SW S3LIMMERLAKE DR P'ARCE:L I I S 133AD_..1."Z!� 00
SUBDIVISION. . ., .. SUMME:RI_AKE. ZONING: R--'7
1:tLOCK. . . . . . . . . . 7 LOT'. . . . . . . . . . . . . I.39
.............. ..
REISSUE.-BUP FLOOR APF'A6..__..__.__.„.._._.._._ EXTERIOR WALL CONS'T'RUC'T'ION--
CLASS OF' WORK. .-NEW F-IRS'T'. . . ,. -. 1 78") Sf N: S: E: W«
'T'YP'E OF USE:. . . ISF SECOND— . % $f PROTECT OPENINGS'?-
'T'YF'E: OF CONS3'T'. :5N 1441RD. Sf NI S: E: W-
OCCUPANCY GRP'. IR;3 I'D I'AL ., Sf ROOF` CONST:C FIRE RE:T''
OCCUPANCY LOAD: BASE::ME'N1'. : Sf AREA SEI-'. RATEDa
S'T'OP:. : 1 HT. : 1.8 It GARAGE. . . It 400 sf OC:CU SEP. RAPED:
14 13MTMEZZ'): RE:. D SETBACKS-._.-.......___.-._. IRE CILIIF�ED __._.._..._._._.._._.._...._...._....... .__ _
F'L..DOR LOAD. . . . : 40 ps f LEFT e 5 ft FIGHT: 5 f t FIR S PKI_I SMOK DET. . :Y
DWELLING UNITS', I FRNT:20 ft- IREAR:25 ft FIR ALRM: 11NDICP 0C;C.
HF:DRMS1 3 E40IHS» 3 IMF' SURFACE. PIRO CORP: PARKING:
VALUE. $: f3c':3;311
RemarF+.s:
(awripra ..._._....._._.._......__._....._..._._....._..______..__._._......_.�_ ..__ _._._ __...._......_..__....__..__...... F-E::E S
UClll MORISSE:TI'E type ameaa.(nt by date recpt
1.1) 1:.4OX 19524 PRM'T $ 382. 00 MAN
PL..CI; $ 248. 30 MAN
PORTLAND OR 00000 0000 5PCT $ 1.`:7. 10 MAN
Phc)rie H I 000 ..000. 0000 PAYM $ :100. 00 MAN
SSDC $ 250. 00 MAN
C:rarit•ractor I -_._......_..__w.__._..___....__....__......___....._.._,....._.._._...._....._ STDC $ 600. 00 MAN
DON MORISSE'TTE BL..DE:RS, :INC. P'DCF $ 250. 00 MAN
1`! O BOX 19524 4 PAYM $ 1.649. 40 JLH 04/F-0/90
POR'T'LAND OR 9721:3
P'hicarie N: 503-244-9;31.4 $ 1749. 40 TOTAL
35533
REQUIRED INSPECTIUNS
This permit is issued subject to the regulations contained in the
tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. Ali work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 188 days.
____....__.____.._._ __..._ ..._.._. _.....__._.._.._.._.._.._..__._
I'ii mi 1,f;r•.>ea �,i.gnatci•re,«
1.ss s,a.i e d B y: ._..... ._.
Call for ia•aspeetic7ai 63941.75
■r w Ir
CITYOFTIGARD PLUMBING PERMIT
C17YOF11 rIT�RD F'Imf;MIT N. . . . . . . : PLMS92569
COMMUNrTY DEVELOPMENT DEPARTMENT oReooN 1='RIM. F'ERMI'T N. : 892530
13125SWFWIBlvd. P.U.Box 233D7,rb..d.or °r oa�frs ►jie DAIS ISSUED: 02/22/90
SITE ADDRESS. . . : 11241 SW SUMME:RI_AKEF. DR PARCEL: 1S133AD.-:15800
SUBDIVISION. . ., .. : SUMME:R1_AKE ZONING: R--7
BLOCK. . . . . . . . .. . . LO'T.. . . . . . . . . . .. . . ::39
CLASS OF' WORK. . sNEW GARBAGE DISPOSAL_':;,. . ; :I. MOBILE HOME SF,ACES. :
TYF:'E OF USE. . . . :SF WASHING MACH. . . . . „ „ 1 BACYFLOW r-'REVNTRS. . :
OCC:UF'ANCY ORF'. . IR;3 FLOOR DRAINS. . . .. . . % TRAi'5. . . . . . . . . . . . . . .
STORIES. . . . . . . . : 1 WATER HEATERS. . .. . . . : 1 CATCH BASINS. . . . . . . :
FIXTURES----- LAUNDRY TRAYS. . . . . . : SF" RAIN DRAINS. . . . . :
SINKS. . . . . . . . . . . 1 URINALS. . . . . . . . . . .. .. .„ GRE-ASE TRAPS. . . . . . . .
LAVATORIES. . . . . s 2 OTHER FIXTURES. . . . . :
'IUB/SHOWERS. . . . : 2 SEWER LINE: (ft)
WATER CLOSETS. . s 2 WA'TE'R LINE:. (ft) . . . , : 1
1)1SHWASHE:RS. . . . : 1 RAIN DRAIN (ft) . . — I
Owner: -_..____.__..___w_._,.._._.__...__.-._.__._._._..___...._.._._. __._.._.._.__..___.____._._....__.... rF:ES
DON MORISSE:TTE type amount by (1<:.Ate recpt
PO BOX 1.9524 PRMT $ 117. 50 MAN / /
SPCT $ 5. 88 MAN / /
PORTLAND OR O0000 0O0E, F'.'AYM $ 1r:3. :38 J1 O4/i?O/`0
Planne #-. 000-000-0000
Contraetcir:
SHOE MAKER' S PLUMBING
F, O BOX 250
ESTACADAOR 97023 __..__.__.___....._._....____._.__..___..._.._....._.__..____._._.___._._._.
PFiane tt: :5O3-6 3O-7728 123. 38 TOTAL
Reg W. . '561:315
_._._....__..__ REQUIRED INSPECTIONS .......................
This permit is issued subject to the regulations contained in the
Tiqard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
Approved plans. This permit will expire if work is not started _.____ ....__._ .._.___._.�..._...
within 189 days of issuance, or if work is suspended for more
than 180 days.
I'ermit.tH(- Si.gnat(.(•re;
I riLl( (�
By-
Ca 11 for ins;peet1on - 639-4175
M
CITY OF 71GARD PECEIFT OF' PAYMENT PEC Nth C01074,38
CHE0 AMOUNT 106.54
NAME. DON MOR ISSE TTE CASH AMOUNT n .00
ADUPESSi PAfMENT DATE t 02-22-90
PORTLAND, OR 97219 BLOCK NO/ADDRs
111241 SW SUMMEPLAVE DR
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
SUILDING PERMIT (8921530) 3>82.00 PLUWAING PERMIT (892569) 117150
MECHANICAL PERM (892570i 37.50 STATE BUILD PERMIT TAX (5%) 2h.E)13
PLAN CHECK FEE 157.68 SEWER USA (892571) 11250.00
SE14ER INSFECION 3'.3.00 STREET SCLC 600.01)
PARRS sysTEM DEVELOPMENT CH 2511.00 GTOPM DRAIN SDC 250.011
PEPTUT WILL PE MAILED TO CONTRACTOR' WHEN PPINTrm
TOTAL AMOUNT PAIL)
•■ w
C11YOFTIOARD �
a �» PLAN CHOCK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ` PLAN CHECK N
I j1n S.W.No Blvd..P.o.mor Z3"?,Tigard,Oregon sTm,(Sttr)639417S PERMIT N -1YT�aT
Dl1TE ISSUED
TAX MAP/LOT -r�L �3 �� foZ
JOB ADDRESS: l Z4 I C - LAND USE:
SUB: LOT'o SP -
- '—
VALUATION: g --
SPECIAL NOTE
MEOWNER ^_. 0111:44- r � W' I?t�;�,� I l,' REISSUE OF: - _ --
r-� .0 1.4 LAST REISSUE:
ADDRESS: FLOOD PLAIN/
2r cxt �j zr � —
__.r^ SENSII IVE LAND:-33
PHONE: _ `" -�) `� �� 5 APPROVALS REQUIRED
PLANNING: _ —_—
CONTRACTOR ENGINEERING:
NAME: _ FIRE DEPT
ADDRESS: — OTHER: -
ITEMS REQUIRED
PHONE: c LIST/SUBCONTRACTORS:
BUILDERS BOARD N: EXP DATE: /L f,'J
-- BUS TAX: _-
ARCH/ENGINEER CALCULATIONS:
NAME: _ - i (1 TRUSS DETAILS:
ADDRESS: __-_-
OTHER:
_ --
--
PHONE: - S
COMMENTS:
SUBCONTRACTORS: PLUMB: ;,
PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. D.UE
10-432 00 Building Permit Fees
- l S 0
S �,y 10-431 00 Plumbing Permit Fees
y 7y 10- 431 01 Mechanical Permit Fees - j
10-230 01 State Building Tax (5%)
Building /,k
Plumbing _ 5
Mech /-
10-4--3
10-4--3 00 Plans Check Feeel�, jv
Building -
Plumbing
5 7 30-202. 00 Sewer Conrirction ` ��5
30-444 00 Sewer Inspection -- '
51-448 00 Street System Dew Charge (SOC)
52-449 00 Parks System Dew Charge (PDC) --
31-450 00 Storm Drainage Syst Dew Chrg (SSOC) S U
10-230 06 Fire
TOTAL
A—pp 41a, NATURE
Received By: Date Received:
cn/3507P/18P
1 �
�tD
APLAN CHECK APPLICATIONITY,0F TI6Ar p
arrorticxa' PLAN CHECK N
COMMI:"NI TY DEVELOPMENT DEPARTMENT �� 1 PERMIT N __ 99 zze;/�-
13125S.W-f4AB1.Q•P.O.Box 23397•T1grd..Oregon 9=1.(503)63"175 G, / DATE ISSUED rI /
ZQ
JOB ADDRESS: `_ v>w ✓ 1 _.� i AX MAP/LOT
- � _ IM (r4 4 I
SUB: V1,1 4_ I"- _ LOT: ---- LAND USE: —
VALUATION: - —
OWNER SPECIAL NOTES P
,� INIUR
NAME- l s ( REISSUE OF:
-- ""---- —
ADDRESS: U O 2 LAST REISSUE: —
_ FLOOD PLAIN/
SENSITIVE LAND: w ,-
PHONE: 3�
APPROVALS
WNTRACTOR PLANNIN -
NAME: �_NGIN _RING --
RE EPT _
ADDRESS: 0 HER: r _ _—
PHONE: ITE S R IREO
LIST U ACTORS:
AROVENGINEER BUS TA
NAME: ` M "1` I L � CALCULATIONS: _—
TRUSS DETAILS:
ADDRESS: PARKING PLAN: --_
-- - \ LANDSCAPE PLAN:
PHONE: _ OTHER: ---
COMMENTS: ( -1' �'-L Cc'
PERMIT N ACCT N DQE ,AMTON AMOUNT AMOUNT P0. BAL. DUE
10-432 00 BuildiN Permit, ees _ - —
__ 10-431 00 Plumbing it Fees �-
10-431 01 Mechanical Permit Fees —
10-230 01 State Building Tax (5X)
Building
Plumbing
Mech _ -
10-433 00 Plans Check Fee AF �
Building %44:M
11' PCr
Plumbing cl
Mach —
30-202. 00 Sewer Connecti(%n
30--444 00 Sewer Inspection _
51-448 00 Street system Dev Charge (SOC)
52-449 00 Parks Sysl:em Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg (SSOC)
10-230 09 TRIO -
10-230 06 Washington County Fire N1 (95X) l-
10-220 00 Amara/Wodgewood -
RIC N i �` �u �7_ { -r CI
APPI_ICAN1 1(,I1n111RE C c / SU
cc,
Received Hy . 7,�Gt.J _ Date Received: — S'i Q 3 y 1 q
Cn/35BIP/101'
1�
CITYOFTIFARD PLAN CHECK APPLICATION
PLAN CHECK N 3
COMMI INITY DEVELOPMENT DEPARTMENT o.�ooM PERMIT N
19125S.WNNIMod,P.O.Box 23.197,Y19.nkOrtVm97223,(903)&W417S DATE ISSUED
JOB ADDRESS: I ( e.-11 S_G-�. . S V L�.N Q t'a 10(L— i AX MAP/LOT
`.UB: Suj,'p7ywe., L4tQ-1 LOT: ;,� _— LAND USE: 7P-y _
VALUATION:
OWNER /J SPECIAL NOTES
NAME: ��5�� 1Clrs �l1 REISSUE OF: --
ADDRESS: —_ ` > 5 . 2!j LAST REISSUE:
FLOOD PLAIN/
--l--�� _ SENSITIVE LAND:
PHONE: L1 -L --- APPROVALS. REQUIRED
CONTRACTOR -'~ PLANNING: _
NAME: ENGINEERING: —_
ADDRESS: _ ('IRE DEPT
PHONE: IT :-REQUIRED
T/SUBCONTRACTORS:
ARCH/ENGINEER BUS TAX: —NAME: -- --- �� _--_ CALCULATIONS: —
ADDRESS: TRUSS. D11--TAILS:
PARKING PLAN:
LANDSCAPE PLAN:
PHONE: OTHER:
COMMENTS:
PERMIT N ACCT N DESNIPT. N AMOUNT AMOUNI PD. HAL.. D01.
r0 3 l 10-432 00 Building
� L 10-43100 Plumbing Perhv► t Fees
,1JC1L f 7
10-431 ,01 Mechanicol Per 't Fees
10--230 1,11 State Bui ;ding 1 x (5X)
Building '[�, C� �� 3p 3�� 3n
Plumbing -
Mech o�
10, 433 00 Plans Check Fee
B u'l' 4-nq-— 4I .� 15
Plumbing ___
Mech
10- 202 00 Sewer Connection Jry,
30--444 00 Sewer Inspection
51-448 00 Street System Dev Charge (SIC)
52-449 00 Parks System Dev Charge (PD(;) �Sp_ __ V
31-450 00 Storm Drainage Syst Dev Chr•y (SSUC:)
10-230 09 I-RFD
10 230 06 Washington County Iire N1 (95X)
10-220 00 Amar•t:/Wodgewood
TOTAL
RE C N
APPL_. SIGNATl1RE -- -- ---.--____----_ __
L '�
keceived By: %t .l Date Received:
cn/3587P/18P -- -- — - ----