11745 SW SUMMER CREST DRIVE I
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INSP PT ON NOTICE
City of Tigard Building DoparlAnpnt `
13125 SW W I Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phons)t 639-4175 Business Phone: 639-4171
Inspection:-_,_
Footing Plbg. UndersA&b M-ech. Rough-in Appr/8dwlk
Found. Plbg. Top Out Gas Line FILIAL:
Post/Beam Struct. Ban. I'm�rar rraming -Bldg.
^ost/,:. :m Hoch. Rain Drain Insulatio•.: -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
21((
,'
Dane Requested: —�/ � y`. Timet AH PH
Address: J ermit t:1 C _
Builder: l _
i
THE FOLIOWIN'j CORRECTIONS ARE REQUIRED:
Inspector s/ � Dates
_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Roinop.
I
INSPECTION NOTICE
City of Tigard 3ullding Departmrmt
P.O. Box 23397 1
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection / -`
Date Requested Zjl -- lime^_ A.M._ P.M.
Address
/. ermit kO
Owner —--- - -- - _ Lot #.
Buil ---
The followinq Building Code deficiencies are required to be corrected:
Presented to
Inspector .. =--• ❑ Disapprmed
Date
CALL FOR REINSPECTION
❑ YES ❑ VO
INSPECTION NOTICE
City cf Tigard Building Department
P.O. Box 2.3397
Tigard. Oregon 97223
Phone: 639-4175
Type of Inspection —
�
Date Requested— Time A.M.��.
Address
i i .? 2--e-2--e--& 7 , e-v C--j Permit # 4•
__ / _
Owner Lot #
Builder ---
The following Building Code deficiencies are requires' to be corrected:
Presented to ___ _ —NApproved
Inspector C _ L,] Disapproved
Date ~
CALL FOR REINSPECTION
0 YEs ❑ NO
INSPECTION NOTICE "
LIP, City of Tigard Building Department
P.O. Box 23397
Tigard, Oregc n 972?3
Phone: 639/4175
Type of Inspection
Date Requested _ ^ ;1111� Time A.M.__rL_ P.M.
Address z 7y-� Permit
Owner _ .._ __ —_ Lot #— _
Builder
The following Building Code deficiencies are required to he corrected:
Presented to — _ Approved
Inspector ` _ /"-� — I Disapproved
Date _ ----
CALL FOR REINSPECTION
❑ YES ❑ No
pR
i
i
k?sgs_cn_0.ri_ O—
City of 71garC Building Department
13125 SW Ball Blvd. Tigard, Oregtn 97223
Inspection Line (Rec-O-Phone): 639-4175 fluaineee Phone: 639-41';1
'nspection:.----- ----- ----- ---
Foot In9 Plbg. Underelab Meeh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
-81 d
P-3Bt/Ream Struc-t. San. Sewer Framing
Post/Ream Mech. Rain Drain Insulation," -plumb.
Plbg Underfloor Water Line Gyp. Rd
Date Requested: ` JJTisDet _ �PH
AdclreeSt #,r
iL,
Builders Z2�-:rn I
TtiE FOLLOWING CORRECTIONS ARL REQUIREDs
Inspector S'r _� Dates,��_�
APPROVED DICAPPROWD APPROVED SUBJECT TO ABOVE
Cul Por Reinep.
i
INSPECTION NOTICE
City of Tigard Building Department < %-
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection /U/�l v�✓�G�—�—�'t[l�—
Date Requested Time_,_�A.M.��P.M.
Address Permit
Owner _-- Lot #
Builder —_---
The following Building Code deficiencies are required to be corrected:
t✓� r
Presented to Approved
Inspector� ❑ Disapproved
Date.
CALL FOR REINSPECTION
D YES O NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested G Time A.M6--,M,
Address ---/—/ 7� Permit
Owner Lot # _
Builder
'The following Building Cade deficiencies are required to be corrected:
/V/Se A-,P7AaPk E f� C.Kim 93
= .ter �tUv
r'resented to l Approved
Inspector ❑ Olapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 n
Type of Inspection _
Date Requested LTi/me A.M._k P.M.
Addr,Pss 117j! �� �/�/l_%� �� 11�L.1 7. Permit
Owner -, .- �L Lot #
Builder
Th( following Building Code deficiencies are required to be corrected:
---------------------
—
l��--l'�y11�1.Z �'iFtt_ M31��s �-T't3 Sut���J�"f" ��gt,✓1 ��
ALD (ACA n,r— --ro ExL ST-i nA
� C71 .----
>J
(2 rZsa wt-. SvncC oqc c 02 5 -7a L_ViHa Ai
e W721
6--A-: >�di e.- Cit P NEX S
JL)At
Presented tc l
_. _ --Approved-----
Inspector EJDisapproved
�r
Date —
CALL FOR REINSPECTION
❑ YES ❑ NO
COARD
CrIYOFTIGARD p E*R
RYOFTI111 T #
COMMUNITY DEVELOPMENT DEPARTMENT OREGON Fr
R1.11..F.R1.11. 1::,E R 1`1 IT' 14 » 11 S T 9 0
13125 S W I W Wvd 11 0 Box 233W, 1 igarTi,(hopon 97273 JW3)P9.4175 1)0 TL ISSUL.D.- 96
(':')J TA%' ADDRESS. . . » PARCEL: IS134CD--05�.';00
:11.745 SW SUMMER CREST DR
SUDD I V I SI ON. BURLWOOD NO. 3 ZON I NO R-4. 5
It L 0 C'K. . . . . . . . . . 2 L OT. . . . . .. .. .. . .. .. .. .. I.:;
....... BUILDING .............
REISSUEN 0 DWELLING UNITSc BASEMENT. . . . . . . . :352 Sf
CLASS) OF' WORK. ;ADD B F.:D R 11 S-.0 HAT'H13 GARAGE. . . . . . . 0 ti f
TYPIE Of:* USE. - . -.SF FLOOR ARIKOS- REOUIRED
I,yl,I::: OF, CONS ' .. .."5iN F*1:R ST. . 0 1 sf L E F*r.. . @ ft R 3: 0 ft
C')C1C,UPANC,Y GRP. -.R3 SECOND. S f F*R 0 NT. »0 ft REAR— JA ft
G TO R I E13.. . . . . . . »0
T H 1:R D.. . 0 R 1-.'.Q U I R E D
IAEI GHT . . 9 12 -f t TOTAL.....................::0 S11OKE DETECTORS. 1-0
F.L.00R L001). . . . 1.40 1:)Sf VALUE. - 1.4*/84 PORK 1:NO SPACE'S. . »
Renia-rl.f.S::
........................ ............ PLUMBING
SINKS. . FLOOR DRAINS. . . . al. BA11, F"1._OW PREVNTRS. . aO
IOVOTORTE'S. .. . 30 W01ER HEAUKRE). . . 9 'CRAGS. . . . . . . .. . . . . . . . . . . . . . a
TUB/SHOWERS..... -.0 1 AUNDRY 'T'RAYS. . . :0 o.),rci-i BAsiNs. . . . . . . ...o
W 0 TE P C,L 0 SET G., . !:0 SEWER LINE' (ft) . :0 0 GREASE TRAPS. . . .
DISHWASHER'S. . . . » I Wf4T[-::R LINE':. (ft) .- -00 OTHl-._-.R FIX'T'URES. . . . . tO
(3 A R B A(3 E DT S P. RAIN DRAIN (ft) . .0
W A S 1-4 1:N G M f)[,J-1- I SF' R0111 DROINS.
...___......__1.............__.._....._.. M E.C,H A N I C A L ........ FEES ..............................
F'UEL UNIT HT RG,. -0 type a.ni a t.t ii t by cl A t e -r-: c�p t
/C.,A CS VENTS , . . - .00 1.4 P R T 1; :110. 50
MAX INPUT'n/ 141U VE141 FANS. . -.0 131 SLC $ 71. (33
F:'(.)RN < 100K IAOODS. . . .. . . P3 E15PC $ 5. 513
TURN ) ::---J.00K WC.)0D1-.;T0VES. -.- MPIRT $ 2.9. 5 0
1-:1.0 C)R F'URN. . . . 0 U.0 DRYERS. :P MPU, $ 7. 38
B 0 1:L/C.,MP < :31.1 F', 0 OTHER UNiTsco 115P(*, $ 1. 48
GAS) CJUTLETSs0 P P R T 1, 25. 00
Owilert 1--,5 P C'. 4, 1. 25
R r)L.P 1-4 A I LI ST ON PPYIA $ 252. 4'/ JLH 06/22/90
1J, ?41,`1 13W DR
YH.'iONI) OR 97223
1:1ic)vie #-. 503 (.,84 1089
(.:circ t•ra c� :o-r,» ........... .............
0 W N L'R C)H TR f)C:TO R
1 ,11(11-le #*.
Req #. . -. OWHL.N
$ 25 2. 4'/ TO I AI_
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS)
Tigard Municipal Lode, State of Ore. Specialty Codes and all other F'oot/foi.tiid Iiisp Irist.t1i.-ttiorl Inssp
applicable laws. All worl, will be done in accordance with approved Posit/r', --iani St-rt,iet Gyp Bc)a-rt( II-Isp
plans. This permit will expire if VCTk is not started within 180 Post/Bean lleehAvi RAiv cl-rai)i Iiisp
days of issuance, or if work is suspended for more than 180 days. (-`rawi D-rairi Mechanic: a'l Final
P1 M/Uvide-rf loc)r PJAMb F:Aria l
1:1 e v III j.t t 0 e S 113 11 a t U ..... . ... llecl-lailic,81 111sp ]FILtildi.iiq
Plt.imb Tc)p Ot.tt E-r c)s 1.a ii (:,c)ri t-r a 1.
5 U 0"I B Y t ...... .......................... F-r a III i.1.111 3'1-1 S p P I t.t ni b F.J.vi a 3.
(,a1:1. f o-r i1-1s F) ct i oil 639-4:17'5
Permit No:
Add;ess:
Issued by:-, Date:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statemeni before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not 3ubmit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
1. 1 own, reside in, or will reside in,"
completed structure.
2. A. = My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. C 7 I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors reg!stered with the
Construction Contractors Board. If I change my mind and do hire a general
contractor, I will contact with a contractor who iu registered with the
Construction Contractors Board and I will immediately' notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property OwneFs about Construction Responsibilities on the
reverse side of this form.
-
gnat
04W2P e r N—tA$p-II scant n I
ate
CONSTRUCTION CONTRAGT,0,.-,-,) BOARD
0244J 1/90
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMA..ON NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction
Responsibilities was developed by the Construction Contractors Board in
accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial improvement
to an existing structure, you can prevent many problems by being aware of the following responsibirities
and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractor,, Board to do labor in constructing
or assisting in the construction or improvement of a residential structure, you will, in most instances,
be ruled to be an "employer" and the people you hire will be "employees As the employer, you must
comply with the following:
Oregu_n's Withholdlgg Tax Law. As an employer, you must withhold income taxes from employee wages
at e time employe-es are paid. You will be liable for the lay payments ever if you don't actually withhold
the tax from your er i icvees. For more information, call the Oregon Department of Revenue at 378-.3390,
U 7em�loyment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
pLJrposes on t to wages oT-aTemployees. For more information, call the Oregon Employment Division DHR
at 378.3224.
Workers' Compensation Insurance. As an employer, you are subject to the Oregon Workers' Compensa-
tion Law, and must obtain workers compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may be subject to penalties acrd will be liable for all claim costs if one of
your employees Is injured on the job. For more informatien, calf the Workers' Compensation Division OIF
.at 373.7434.
U S. ;nternal Revenue Service: As an employr3r, you must withhold federal income tax from employees'
wages.You wlll be liable for the tax payment even if you didn't actually withhold the tax. For more informa-
tion, call the Internal Revenue Service a1 221.3%0.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Cum.�p,ll�.iance. As the permit holder for this project, you are responsible for resolving any failure
tbl et coda requirements that may be broupht to your attention through inspections.
Liability and Property Dama a Insurance: Contact yor►r insurance apent to see If you have adequate
insurance coverage for accArit4 and omissions suCh as falling toots, paint oaerspray, water damage
from pipe punctures, fire, or work that must be redone.
Time to Supervise Employees. Make sure you have sufficient time to ,supervise your elilployees.
Ex ertlsw Make sure you have the expertise to act as your own general contractor, to coordinate
tie work-of rough-in and finish trades, and to notify building officials at the appropriate times so
they can perform the required inspections.
If you have additional questions, write to- Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 50:3-378-4621
0244J 10124189
OF TISAr;b -,-- FCCC.IPT' OF PAYPIE11T RECEIPT NO. 90-201959
"!f 2. 4 7
CHECP,,� AMOUNT
ALL:L SON. RALPH D CASH AMOUNT
AOCIPE'55 j [745 '-3W ISUMMERCRE.ST ORIVE PAYMENT �ITE, Ob/'72i 9 Q
Sur-K)I v I s I fil"I
cir�, 9' 7AGD, 551'11,.
FLIP 'OSE OF PAYMENT AMOUNT FAID OF PAYMENT AMOUNT PAID
Pp.--Pr')
I 11"). 150 f,t.litirimc, r'Er,'M 75. i.)t.)
MECHANICAL PE 29. "'.T. EUILD FISP'
IPLAN CHECKFE' t
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TOTFA- f4MOUNT [4*1tt)
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M`YYM�M�M�MYi�I�:�^•Yw�w� t^�*� IMVMWN. +..a�.Wn•I�r
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PIAN ( MM... AIPPLICATION
P.o.o.9oR 2s� PLAN CIiDCk � -7� `-
Uveal°rev°^°'z"
OMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED
3C SS D
J(n3IU)DI2I' �I171,• �`�, � �- LAND usm
SON'---z- �-'�-� Sp}7C.LAL_�s0►rF
oWNKZ RETS OF: --
1 kq •
r1AN[}:• _ 7 -� r , , ,Vr r�' T >_ — IIJOCI PLAIN/SENSX —
A1D(7�2T5S:
F ,7E JAND:
PIANNUG:
ING:
/_
NAME: �/) nom, r !� FIRS DEP-r
A OR SS: - OTHER: _ - --
BUUDERS [JOAM 1^ -- EKP 1111E Bm I=:
CAT
AVENGIIT _ TF4= DE %nS: -----—
NAME: -____.l----- - OUIER:
P1iONE:
AM3= AMO Nr PD. BAL. DUE
1 1'i7dilT ACCT DE'SCIRLVnCN u, s��
]0-432 00 Building Permit Fees
15. v v
10-431 00 Plumbing Permit Fees
_ 10-431 01 Mechanical
10-230 01 State Building Tax (5%)
Building
Plumbing 1,L)
_
Meas
10-433 00 Plans Cher k Fee-
Building
eeBuiLdi.rg _
Plumbing
Medi _
_ 30-202 00 Sewer Oanxs C'-oci --
30--444 00 Sewer InsPec.'ticn Qtan '- (SDC)
51-448 00 Street SYstem D'--v
52-449 00 Parks System Dr_v 0h1a� �) ( �)
31--450 00 StOrm DtainaW `yst Dev
10-230 06 Fire
S z -
AP'{*I CW SI
Date Rpoeived:
Tieoeived By:
of/3587P.FAPF
1)1 /T:;ROSTQti Lt�lyTROL IbLFORMATION
GENFRAL CO ACTOR NAME&ADDRESS: CASEFILE NO.:------
.4 M/se A PERMIT NO.:
T Lei) d o APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME&ADDRESS:
OWNER NAME AND ADDRESS:
TELEPHONE NUMBERS:
t;'PL.ICANT: PROPERTY DESCRIPTION:
G�R. STREET ADDRESS AND CROSS STREETA CATED
GENERAL.CONTRACRA: - - --
EXCAVATION CONTRACTOR: --- —
SiT FnOB: to S'v
LEGAL.DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.:
COii TACT PERSON,TITLE,TELEPHONE: 1/4 SECTION
_ SITE SIZE,ACRES; _
DISTURBED/WORK AREA,ACRES:
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE)
(N, oTli:POLMTS MAY BE RFQUTRrD) CATCH-BASIN, DLTCH PIPE CRE;-K
r _
(CIRCLE ONE) PRIVATE PROPERTY
PUBLIC RIGHT OF WAY
CiS10N/SEDIMENTATTON COMM SOMEAS
d;
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SFD!? -41'ATION FACILITIES STABILIZE EXPOSED SURFACE
STABILFZED CONSTRUCTION ENTRANCE: REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PR ACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCTION SEQUENCE OTHER _
O'T'HER_
PLAPl FOR EROSION CONTROL I'REPARED AND SIJBMTITED IN ACCORDANCE WTTH TECHNICAL GUIDANCE HANDBOOK-.
EROSION CONTROL PLAN DRAWING,AS REQUIRED.HAS PLA'!CONSTRUC nON NOTES COMPLETE.INCLUDING EMERGENCY
PHONE NUMBER. SCHEDULFISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE.
OWNER SIGNATURE APPLICANT SIGNATURE.
o • • • • • • • • • • • • • • • • o • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
CIFFICIAL USE ONLY
RECEIPT DATE ACCEPTED
I-FF NUMBER RECEIVED BY
tw
� PLAN CHECP. APPLICATION
CITYOFTIGARD CITYOFTWARD PLAN CHECK 1
COMMUNfTY DEVEI-OPMENT DEPARTMENT OREGON PERMIT I -- -
131ZSW14M8Mt P.O.9=2X4T.Pp dCjWW
_. DATE ISSUED
JOB ADr4F.SS: TAX HAPAOT _
SUB: - LOT: LAND USE:
VALUATION: SETBACKS: FRONT:+ REAR: LEFT: RIGHT:����
{TORR CLASS: HEIGHT: </ TOTAL AREA: .3-5 Z.
USE TYPE: FLOOR LOAD: _ -C IST: ,
HEACONSTR TYPE: T TYPE: k y 2ND:
—
OCCUP GROUP: 4OCCUP GROUP: - 11 DWELIJUNITS: / - 3RD:
OCCUP LOAD: _ NO BEDROOMS:--��s BASEMENT:
NO STORIES: _�� NC BATHS: �_ GARAGE: —,-
IMP SURFACE:
APPROVALS RRQ'D SPECIAL NOTES ITEMS IRBD
PLANNING: REISSUE OF: LIST SUBCONTRACTORS:
ENGINEERING: LAST.REISSUB: BUS TAA: _
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS: _
OT1F,R; SEN LND.: _ TRUSS DETAILS: _
-- - -"
PARKING PLAN:
LANDSCAPE PLAN:
PLAN CHECK BY: OTH1M:
COMMENTS �--.
PERMIT # ACCT 0 DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
U(V 31 10-432 00 Building Permit Fees Jje,,,SV '5V
10-431 00 Plumbing Permit Fees --
_ 10-431 01 Mechanical Permit Fees
i� y
10-230 01 State Building Tax (5%) r
Building —
Plumbing ; 1
Mech __
10--433 00 Plans Check fee
Building
Plumbing
Mech
30-207 00 Sewer Connection _ _ --
- - - 30-444 00 Sewer Irnspect:ion _f
51-448 00 SLreet Systen Dev Charge (StIC)
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg (SSUC) _
10-230 09 TRFD -
10--230 OG Washington County Fire #1 (95X) _ _ _-
10-220 00 Amart/Wedgewood
Rpt: N
APPLICANT SIGNATURE
Received By: -- - -- Date Received: ---��----.�--_-__
cn/3587P/18P
CITY OF TIGARD
13125 SW ITALL BLVD.
pl ,UM BI NG PERMIT P. O. BOX 23397
AIKnGcants must twtd Oregon Registration to conduct a plumbing T IGARD, OR 97223
twsiness or must tx txopMY ovvnlr/operator rxN hiring outs-id-l.elp. (503)639-4175
Neaw d 0eveloprtwnt Plumbing Permit No. _-_-
/4kkess ------- --- fMscnpbo" (311AN' PRICE AMT.
nf:s 814 21-610
Job Tax I r _
>t
Addreea FIXTURES _ -- - -----
lDt _--- 7.50
Block Subdivision sink _
7.5.3 --
— Lavatory - - -
-- — Frame jot Aeon@ mess - 7.50 l�'
Tub or Tub/Stuwet Comb -
wry ess Showe(ONY -- 7 0 ---
_ --- Wale(Close( 7-50 7 77)
Owner City/State J --Dshwashal. --- 7.50 - --
- ^ Ptnorne Garbage0ispos.al - - -_ 7.50
- 750
_ Washing Madune
-- Name Flax Crain — --7.50
-- 7.50
------phpMJ Water Heater __ --
s — _ 7.50
Laundry Room Tray ---- - - —
Occupant
Other F"rres(SPeoify) - 7.50
--- - erne 7.50
1�aiGig9-)0 V-ss Phone - --- 7.50
- --- 7.50
Contrac.'tor City/State -------
I MISCELLANEOUS
- — --- City Cue.Te w 1 $ewer 1 st l ar
15.00
$ewer ea.Add t.100 _ -----
tato -
(Resdenti:il) WaterServioa 1st Il]D' 20.00_
_ ---_---- Water Servioe ea-Addis�x)r _ 1500
I twxeby acknowledge that 1 have read this app4cffoOn•aw ens Monnation --- ---- 90'00 -
given is corned that 1 am repiclered`vi>h 11M Stale&alders bard'.and also Storm R Rain Crain 1 st.100'
trave a State PluorbkV Nce nse that the mxf"xs'Iwern are s that all c�&Pyn Drain Addrt.100_ - - 15.00
pk,tnbirq wrxk wi!t»6-"in ecoordrunoe with prowcions of Ore- _
codes end that Mobile fforne Space 25.00
gr)n Revised Statutes Ctieptert 447 and 699 ander(n exerrnpl frcxrn --------
yed unless Ilreoeed under F Prevention
State registration.peease 0^w reaxx'.bsk)w)- Qg� oar An( n Device 7.50
I KNytFOWNERS-I hereby certify Ihd I srn the owner of the Property da- —
Inst,Manon Ion Any Trap or Waste Not
e« and above..t vrf+kl+Incision t prvpo�e b maker•pt 'ra 7_50 _
caastrtxled for iiia,bane a rens. Cd>rwcted b•Fxtuo
my own use and�pnrparty b rrsl bekng - -- 7.50 -
Catch 13a.-An
---- -- -
- - 40.00 Per Ht
k+ap.d Exfet.Plumtx�q- ---
---- Specially ReQws'°d InspaaAlau -40.00 Per Hr. _
Rain Dwain, tS.00
---- --- --- -- - ingl.e Fam. Dwlg. _ --- —
AtIT14011117FO fAGNATUPE _
l)eecrdle work new❑ eAdition p afterntion Q rePelt❑ - _ --- -
rxxt roeldentiel
fp be done
residential
MINIMUM PERMIT FEE 25.00
E-,ds q tae o1 SUB-TOTAL
txAk*V Or protwrty— __._-- -- - --5% SURCHARGE f r
I xropoesd u"(A - 25% PLAN REVIEW —
ti0T1t.'£ _ -- - TOTAL ( >
1104 permit be"nes non+and vokt M vwwk Or 00(wouctlon arrttxxtred Is not Dom -
rrAnned wW*j 1 a d.yarx«ww.xtr.~m wrxk{a elw:+ended rx W w%60rwid k>•
•pwlrx]nt 18r1 do"N env flrtw atlwr"vn nk It to r�.�+v w1
tiK.'.L11.rXkfI7fTlUft!t-
by
t IelR H11 Nhl
(joce^1K If
N OF TIGARD MECHANICAL PERMIT P�1� - -----------
T.br.]A,tRncfi�n��.I Co6e QTY Pit1GL AI[T
t Tigard 1) Pcmftt Fcc -0- -4- 10.00
SVIL Map Jtvd. —
3070233 ! ?� 5upp4xnelTW Pemid 3A0
1r OR 97723
r7 i 1) f=4Mra-eio100.000mU .,�..
end ducts&vMd
t-ucnaoe 1o0.000 mu+ 750
end.duds&vents
E1ooct-unace 6-00
Suspended txat�vcatllacad�esc' GM
job Addm= � octt0ocmouclLodlloaLx -
----=-- Ycx1(clotindin - 3-Q0
Lc1d tR.ptla S7 gyp='t�12i _ -
_ 1,ot tnalc Sr�s.«r ticpairdt>c�firgrl�dcig_ 6.p0
*tow*(orwwe of baa.--c7 G) 000Q,g,atmocPliocl m'a -
(oaffoconmptoWIP Gm
Ural loo.0001TTU _---
ooaexoeooenp(031(V-15tip Moo
Oa7ctocooR+p 1.5301(P 15.00
absocp-ura"1z-1 n'Jrm
(toaeeccxcoaVto30 50I4P 21:;0
10) absorp.unQ1-1-75axWw" — —
coae(or<=m to 501 t 31 SO
amp ural i 750 000 BTU _ ---
ttus_Tan lio 1 AiI tlarld lg tln[i b 4- — I
9�.s.tiagast*fion No. - ' 10.000 ccu ---
/lerttattiQGcg tt(;d 750
13)-10.000c"A 4-
O.t 1.n.r..o.wwor.uf.oe:r.d.pnA d a..o enrK_•.a+t l�"t sbi.:ard ah:n
monpod
�w
riry�rritr Stab 4wL e.rt 1....«p"s+�«.4"'Q`ef.o 91.0 I1+.ldoft[1o+�Q etw r.e 1 4) 1""•� 450
Yom[piers is romsoL(�M«wPrt Mon.,Sub.wgarrabn Pt++ta p"�a reason hw4w+)- l'Ya,IXK�C e70f]IOr — _ _--
-_-- 15) Vcxd tan aor>,v%Ac! 3.00
- -- to a single dud
------ Vcnaatinn system i X01 450
-- - -- 17) 1' .Jdservedtry 4-50
10) Oomesttetylpc 7.50
inrancralor _ ----
aanbe wwk O
addiction O a8ecalion O cepaa O -_ oc industrial
Pe dorm residential ❑ Oon4eside ntial O_--- - 19) 30.00
sting used (htweci.e_woodsiove.wa(ec 450 y' 7
kfngd txopatr —T - — 20) taeatec.solar.dafltesdayrxs•eete _ _- _- -----
Vased use of
k"oc(xoPCKV ---- ---- 211 ;as PipicgonelOtow outlets 2.00 -- -
XN of hero- ON D natural gas f] LPG O electric O - ---
_--- � mote tt>an 4 iw cntlks4
tmnCF — - — SUt3-TOTAL
IS peWtT (W:COMES NULL AND VOJO IF WORK OR CON- 5-/- SURCHARGE tI
RU(.'T10N AU1110RQEo IS NOT OOULARICED WITHIN 180 _ J
YS.CR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REYlE1Af 25'K OF SUt3-TOTAL % D
ANOONM FOR A PETIM OF 180 OAYS AT ANY TIME AFTER TOTAL TA1_ L,-2
)RK IS COMMENCE0.