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CIT`( OF TIGARD BUILDING, INSPECTION NOTICE
Inspection Lne (Roc-O-Phone): 639-4175 Business Phone: 639-4171
7
In,,nection:_ 0"t( �') +2.-L /U i — �—
Fooling Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Meci . San. Sewer Gas line -Bldg.
Plbg Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mcch.
Underflr. rnsul. Shear Wall Gyp. Bd. -Elect.
Date Requested: e"(,— Time: AM —_PM
Address:_LLtJ t�J r �N jJVZ
Builder: S Z ti S /_,[ _ 6,
OC:�U
Permit d: I(�
THE FOLLOWING CORRECT ^NS ARE REQUIRED:
Inspector: Date: �0
APPROVED —DISAPPROVED —_APPROVED SUBJECT TO ABOVE
r-7 —Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE ,
Ins`actio,i a (Rec-O-Phone): 39 41 5 Cnsiness Phone: 639`-4.17'1 ,,�
Inspection: 11<.. oL� _ �T��-,^ �.-1/` �./�►A—a
Footing
Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec Rough-in FINAL:
Post/Beam Mech. San Sewer Gas Line -Bldg.
Plbg. U,iderfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. S�he� Wall Gyp. Bd. -Elect.
Date Requested: `/ �j C C1 Time: AM _�PM
Address:��`l
Builder: Pern it #:�1T' l� GCS Z
THE FOLLOWING CORRECTIONS ARE ' _ 'IRED:
Spector: Date: 3 0 IA
{ROVED —DISAPPROVED —APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Irspection Line (Rec-O-Phone): 6394175 Business Phone: 639-4171
Inspection:
Footing S:,op. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg, Top Out Elec. Rough-in FINAL-
Post/Bec.m Mech. San. Sewer Gas Line
Plbg. Underfloor Ra; drain Framing IU
Alarm W r Insulation �ee
Underilr. Insul. Shear v....; Gyp. Bd. Ere 1,
Date Requested: Z- Time: AM PM
Address:_ 2-. C, 1, �2
Builder: Permit
THE FCORRECTIONS ARE REQUIRED: /`' j O 2-7,
,el
Inspector:_ -- Da_te. Zen Z. j
APPROVED DISAPPROVED r' APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF
TI GA R D CERTIFICATE OF OCCUPANCY
DEVELlPMENT SERVICES LIATE SSUT - MST95 00310
ISSUED• 9/20/96
13125 SW Hain ` H., Tigard, OR 97223 (503)639-4171 PARCEL: 2S104BA-07700
ZONING: R-12
JURISDICTION: TIG
SITE ADDRESS: 13920 SW LIDEN DR
SUEDIVISION: CASTLE HILL#2
BLOCK: LOT: 112
CLASS GF WORK: NEW --
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: PATH I
Owner:
DON MC' .ISSETTE
Phone:
Contractor:
TRI-COUNTY TFMP CONI ROL
13651 SE AMf3LLR RD
CLACKAMAS, OR 97015
Phone: 65a-3115
Reg#:
This Certificate issued 2/28/96 grants occupancy of the above referenced building or portion
thereof and confirms that the building has been inspected for compliance with the State of
Oregon Spe ialty Codes for the group, occupancy, and use undgf which the referenced permit
was issued.
BUILD114G .PE TOR v - BUIL I G OFFICIAL -_._—
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION D!VISION MST �34 L)
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
_ _Date Requested_ _—AM PM —_ BLD
Location_`. i '�'672,0 L t A6/ Suite MEC
Contact Person Ph PLM
Contractor V UPh (� S -� SWR —_
ILDr I� -- Tenant/Owner __ ELC
atntng Wall ELR
Footing Access: FPS
Foundation f� �G ' 1 ----�-- -
Ftg Drain K `" �G� � ' SGN ----- --
Crawl Drain Inspection Notes
Slab SIT _ -
Post&Beam
Ext Sheath/Shear - -- - -----
Int Sheath/Shear
Framing - __.-_ ___.- -
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler ----- - --- -- -
Fire Alarm
Susp'd Ceiling — - ----.�----------- -- ---
Roof
M15 - - ---- - ------------ -----. --- -
F1na ' -
PASS PART FAIL -- -- -- -
PLUMBING
Post&Beam - --------_ - ---.._. -----_----- ---
Under Slab ------------- -------- -
Top Out
Water Service ----- - ----
Sanitary Sewer
Rain Drains ---- _ --. -- --- - --.- - -- — -- . __
Final
PASS PART FAIL `--. --. ------ -
MECHANICAL.
Post&Beam - ---- -- ----- --- --- ---
Rough In
Gas Line - -
Smo!.e Damper -- -_
Final
PASS PART FAIL _ _
ELECTRICAL --
Service -
Rough In
UG/Slab - -- --
I_ow Voltage
Fire Alarm -- -- - --
Final
PASS PART FAILSITE _ _—
Backfill/Grading - — -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection. Pay at City Hall, 1317.5 SVS/Hall Blvd
Catch BasinUnable to inspect-no a�;ress
Fire Supply Line [ J F lease cal;for reinspection RE: _ -. _ I � p
ADA
Approach/Sidewalk nate Inspector - Ext
Other
Final
PASS PART FAIT. DO NOT REMOVE this insper_tion record from the job site.
MASTER RFRMiT
�,I TY' OF T DATE I ISSUED: .
10/09/9505T95-031
0/09/955^0310
COMMUNITY DEVELOPMENT DEPP.RTMENT PARCEL: 'S 104BW-0'7/00
13125 SW Hall Blvd.Tigard,Oregon H7223.61go (503)639-4171
SITE ADDRE:. •. .. 1=: i71 SW LIDEN DR
SUBDIVISION. . . . : CASTLE HILL #i2 ZONING: R--12 PD
BLOCK. . . . . . . . . . .I LOT. . . . . . . . . . . . . : 11
BUILDING
REISSUE:MST95--•0135 DWELLING 1JN:'TS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :NEW PEDRMS:4 BATHS:3 GARAGE. . . . . . . . . . :660 sf
TYRE OF USE. . . :SF FLOOR AREAS-- ------- REQUIRED SETBACKS--------- -
TYPE
ETBACKS--------.-_ .TYPE OF CONST. :5N FIRST. . . . : 1200 s f LEFT. . :5 ft R I GHT. :5 ft
OCCUPANCY GrRP. :R3 SE.COND. . . :2716 sf FRONT. :20 ft REAR. . : .15 ft
STORIES. . . . . . . :2 FINBSMEN'r:0 sf REC�UIRED--- -_______.._•___.._____
HEIGHT. . . . . . . . :30 ft iU'AL-- ----:2616 sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf WALUE. . . . . f : 1992:87 PARKING SPACES. . : 1
Remarks : PATH I
------------------------------ _______ PLUMBING ___--__._--_.,._______-----_______._.--__--
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PRI=VIVTRS. . : 1
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASIttiS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :0
WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1
MECHANICAL. _...._____._____....___.._____..._----._._____ ...._._.._ FEES
UNIT HTRS. . :0 type amol.:.it by date r-ecpt
.'GAS/ / / VENTS . . . . . :0 SWM $ 180. 00 B 10/09/95 95-27141E
I1AX INPU'r:0 BTU VENT FANS. . :4 SWM 1 100 00 S 10/09/95 95-27141E
FURN ( 100K . . :0 HOODS. . . . . . : i BPRT $ 682 *[A S 10/09/95 95-2'71416
FURN 1 :71110K . , : 1 WOODSTOVES. :0 DPLC $ 5 ' 60 BON 011/15/95 ')5-21,9.37 1,
FLOOR FURN. . . . :0 CLO DRYERS. : i B5PC $ ,. 15 B 10/09/95 95-271416
GAO I1_/C•,MP ( 3HP:0 OTHEF c1N I TS: 1 PARK $ '10. 00 B 10/09/95 ')5--27141.6
GAS OUTLETS: 1 MPRT 5. 10 B 10/09/95 95-271416
Owr1r ;-• _.___.._._—.---..______.---._.___---__._.__._..__._—MPEG 11 " 10/09/95 95-271416
DON MORISSETTE M5PC f 10/09/95 95-2:71416
5000 r,W MEADOWS RD 3BTH 10/09/95 95-271416
SUITE 151 P5PC 1 ' , B 10/09/95 95-2'71416
LAKE OSWEGO OR 970:35 CROS '112 S 10/09/95 95--271416
Phone #1: 620-7538 ERPC $ 21. 3121 B 10/09/95 95-•271416
Contr•ar_tor: _._____..__..___ __-____—____.______—_ERp�C g 20. BO P 10/09/97- 95-2714It,
DON MORISSETTE HOMES SPLC 50. 00 R 10/09/9 95-1.,,71416
000 SW MEADOWS RD
SUITE. 151
LAKE OSWEGO OR 07035
Phone #1: 620-7538
Reg #). . : 3553
$ 1997. 50 TOTAL
This permit is issued subject to the regulations contained in the --- ---- REQUIRED INSPECTIONS ---- -
Tigard Municipal Code, State of Ore. Spe7rha
other Footing Insp Plomb Top O1.1t
aopiica ie laws. All Mork will be doneproved FoLtndat ion Insp Froming Insp
plans. This permit will e►cpire if wa in ;CA Post/Beam Strl.Tct Fi•(^eplace Insp
days of issuance, or if Mork is sus ndedays. Post/Beam Mechan Gas Line Insp
Crawl Drain Ins1_TlAtion Insp
___ .._. ._._ P1m/l.lndslab Insp Gyp Board Insp
PLM/Underfloor Rain drain Insp
I SS'..1Fd By : _ �._._ Y`e: U1 -•---• -_ ____.__ Mechanical Insp Water Line fnsp
Call for inspection 639-4175
9FIIIIIIER
PE RM I T
FIE P11 I T #. . . . . . . . 5WR95360
OF TIGARD DPT-E ISSUED: --010/1*D1-)/1)--j
COMMUNITY DEVELOPME.iT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)039.4171 PARCEL: 2SI04BA--07700
'31TE ADDRESS. . . DEI: � D P
SUBDIVISION. . . . . CASTLE HILL #2 ZONING: R-12 PD
1,ALOCV. . . . . . . . . . LOT. . . . . . . . . . . . . : 112
TENON T NAME. . . . .
USA IVO. . . . . . . . . . , FI XTURF. UN I T-q.
CLAS'S OF WORK. . . :NEW DWEI`LlNG UNITS. : 1
TYPE OF USF:. . . . . :SF NO. OF 'BUILDINGS: I
INSTALL TYPE. . . . :BUSWR I 1111PERV SURFACC. S f
Remarks : PATH I
Owrier. FEES
DON MORISSETTi-I type amol.tnt by cJat P t• pt
5000 SW ; 'EADOWS RD PIRMT $ 2,00. 00 10/09/95 95 -..'11416
SUITE 151 1 NSP $ 313. 00 B 10/09/95 ')5--,:7i416
LAKE OSWEGO OR 97035
Phone #: 620-7538
Contractor-
CONTRACTOP NOT ON FILE
C-1235. 00 TOTAL
Req
REQUIRED INSPECTIONS
This Applicant agrees to comply with 311 the rules and regulations Sewet InFippr-tion
of the Unif-ed Sewage Agency. The permit expires 160 days from
the date issued. The total amount paid will be forfeited if the
.permit expires. The Agency does not guarantee the ace""
side sewer laterals. If the sewer ,
is not to at
given, the installer shall pr9so . in al irection fr-
the stance given. If not so located the ins Her shall puroase
a "lap and Side Sewer" Permit and Agency 11 insta —elateral.
I?t-,M i t t e P Si iiat i.tr-e C
S Is t r e cl D y
Call for inspection 639-4175
Residential Building Permit Application
City & Tigard
13125 SW Hall Blvd. A
Tigard, OP. 97223
(503) 539-4171
Jobsite Address: _ %
1 1 Office Use Only
Subdivision:( -�� > �( } I�� Lot # 1 ( =
2-2 j � V Planck/Rec # )
Valuation: L1_ ,,1)
Corner Lot? Y Permit #�/ `7� 16
Q
rN) Reissue of y,i �S `6Flag Lot? Y
Map 7L # U� 1�'<VA -Ca-4
Owner: lt�� �'I nle l S -, I N� Apprr`vals Required
Address ) 5W M � t�l� �I� i ( Planning
Engineering .
Phone: (OOther � ,. �•� ' ') '�' (c '{�7";J
Contractor: ��'d"'1_e I �'�Y_,�y� Items Required
Address _ _— Subcontractors
------- — Truss Details
Phone: —_ Other
Contractor's License # J �J �l f'• _
(attach copy of currant Oregon license)
Contact Name u Phone. r�/L __�__�_� �J 3�
Subcontractors: Arch itecUFngineer:
Plumbing: 11J(;a Address G�'j 5N "Ok Y`>
Mechanical �_�—CCU—NT •L4 :mInAp.
(attach copy of current (.,P Contractor's License)
phone: M�� _ �•�J"' 3C� --
JOB DESCRIPTION.-
Applicant
ESCRIPTION:Applicant Signature & Phone number
Received by (1,' U� �_ --- Date Received: �1_
N�WORMCOMOEW E SAPP
Permit# Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) ��3 �3,
Plumb. Permit (PLUMB) 2 c-o 2 >,,v,
Mech. Pe.-rriit (MECH) U �' �l �'r�-0
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
v
Bld ') r f .>v �'�c�
9'
Plumb:
Mech: i
,-�a,R4y'-0360 Sewer Connection (SWUSA) y
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) 6,1)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (i]F-Il
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WQUAL) �_ �—
Water Quantity (WQUANT) / c 0
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT)
Erosion Plsnrk'USA (EPPLAN) c _ _ 20
Erosion Planck/COT (EROSN) +y
CL
TOTALS: ,?
Ilk
5000 S.W.Meadows Rd.,Ste.161
Lake Oswego,OR 97096
Phone:(609)620-7538
FAX-(509)620-7486
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TRAFFIC IMP,4CT FEE
CREDIT VOUCHE.:?
r%f / In accordarce with the Traf,`ic Impact Fes +'
. lr,•;,;, Ordinance, Matrix Development Corporation
r, • is entitled 10"t �Yo°--'in Traffic Impact Fee Credits that ca
-131 oft Hill lied to TIF ch
on lot(s) 63 he Castle N n be e charges
No. 2 Oeveicpment The use of TIF cr=dits
are subject to the rules and limilViOns of the TIF Ordinance.
This voucher must be rases;ad WnRNING:
p at the tine of issuance of the Building Permit, or if deferral
was granted issuance of an Oc"rpancy Permit.
MATRIX DEVELOPMENT CORPORA TION
title and interest in and to that l-'N heresy_signs all its right,
cer am Traffic Impact Fae Credit to be granted
upon the /ssuarce of a build;nq permit for Lot
CAS TLE HILL NO. 2 su;;division,
Washinslon County, Orecon, to th 9 order of.,
T his assiCnmE171 l ra`;C l! r +
19 Frac• Fee Credit is r„ade and given thi:`
day of �`�
AAA TR IX LEVEL OPMENT CORPORA TION
an Oregon Corporation
Title-or-Pcsition I
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INSTATLAME
Model DV34
Direct Vent Gas Fireplace
ION
Leadership in the design and manufacture of gas fireplaces INSTA
shows in every aspect of the lnsta-Flame fireplace. A Slim Line Design
The Insta-Flame DV34 Gas Fireplace has been designed to
Easy Installation in what used t0
provide builders,renovators,and homeownees with the be thought of as 'impossible
ultimate in economy,attractive looks,and ease-of-use. space' is now possible with the
Requiring only a minimum of space for installation,and Insta-Flame DV34. ops'
approved for bedroom installations,this fireplace can be Only 14" deep and because it
vents from the rear,easy instal- d'
located almost anywhere...ground leve!or above. lation is now possible in most
household room or wall loca-
tion3 with the Insta•Flame CORNER
DV3Q. � INSTALLATION
STANDARD FEATURES
AI)irectVent Gas Fireplecewhichgives you Efficient, I I / 1CROSS CANTILEVER
Comfortable Heat,and No Chimney! _. J CORNER
Insta•Flame's Direct vent balanced flue technology —�"'�rr
means this fireplace takes all of its combustion air from � FLAT ON WALL
outside and eliminates the heat loss which usually r�� CORNER
occurs with a conventional chimney. — I '
The Insta•Flame DV34 fireplace design also provides
the best of radiant and convection heat. FLAT ON WALL
Convenient Control
All Inst-Flame Direct Vent gas fireplaces come com-
plete with a convenient wall switch for that instant /__ __
'flick of a switch'to tum your fire on.
There is even a millivolt gas control to ensure you have
uninterrupted use at all times,even in the event of a ------ SPECIFICATIONS
power outage.
—A ___.,y F M T
The
Each lsea Flamegaf fiirrepllacemustpassquahtyInspec-
t
nspec•
tion standards which may well be the most stringent in ��'.�)
the industry...al) art of the Insta•Flame assurance ,I / c
F is
qualirv,safety,and performance. —
Enhance Your Roo-n p. — 1 FRONT VIEWRO
r• t .. —y phµ.
The Inset-Flame DV34 is an exceptional fireplace which will enhance your .-.r�
environment even when it's not in use. _
Easy to see and enjoy behind a large,high temperature,neo-ceramic window,the j RION _TvtEW LEFT VIEWLIJ;511
Insta•FlamC DV34 gas fireplace also features five attractively arranged logs with I Model Fuel InputeTUput
that rough-hewn hark texture look of real oak. a H Dv74RN Nawral Gas 20 w0A full five(5)year Warranty is also provided for on the combustion chamber. —P.-- Dv34RP Propane 18000 �
4 4 ll REAR VIEW
''Mth aPtronal Ian system
Optional Features FONT VIEW RIGHT VIE L _ V EW REAR VIEW-
6
EWe Hand Held Cordless Rvmore Control Kit•RC-1 A 36"915mm F 14'1350mm L 16 IS t6'430mm P 19 n t6'500mm
e Variable Speed 160 CFNI Blower System-FK-36 8 36 t 4'920mm t3 24 t 4'1615mm M 15 3.4'/400mm 0 1 1;2'36mm dia
e Decorative Trim Kit,Available in the following finishes: C 14 t 4.870mm H 25"635mm N 10 qiF'275mm gas knockout
AS Antique Brass CH Chrome D 20 F 16'/515mm I 81,2'/215mm 0 a II t6'1220mm R 7 8'123mm dia
E 32'8"835mm J 6 5,+6'160mnt Electrical knockout
PB Polished Brass PC Polished CopperK 3,j grmr
in the IMer"l Of constant Product improvements we reserve the right to change Wc4¢a /
frons he Inst notice Patents pending h this product Beforenq'solos A this as Regulations
/ ETA YOUR AUTHORIZED DEALER
reed the Installation tnrhutlrone and check all local awlMng^,Odes ora G85 Requlatron4 ( C I
Cerblled and Approved by the Canadian Gas Asmahon Also PTL Approved
0 CANADIAI`i FIREPLACE DOROTHY TESTER SALES
XWTUFACI'UIING INC. (503) 697.7081
SGC^-A Orden Drive,Mississauga,Ontario,Canada L5T 1J7
C.FI'%1 F3A.1416)670.4676 Tel:(416)6748600
The Leader in Gas Fireplace T'ech,noiogy
US Paient No.4.E76,240 U.S Patec4 No.4636.241 PRINTED IN CANADA
Community DevelopmEnt ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 P lanck/Rec. #
Permit # 6 `7
Phone (503) 639-4171 Date Issued iC•- ;lo - y5
CITY OF TIGAitD FAX (503) 684-7297 Issued by
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development (I J�
C �— t Number of Inspections per permit allowed —
/� l I
Addtes:= ���7r�� �W L U1�1. Service Included. Items Cost(ea) Sum
City/State/Zip ,`� i)P, �1 7:T�7_ 4a. Residential• per unit 4
J +� 1000 Pq it Of $11000 ,�D
( ) I \'/�/� I�- Each.idditional 500 sq 11 or
Name or name of business , t,( portion lherertl $2500 /� 1
Commercial ❑ Residential I Limned Energy x2500 _rn2
Each Manuld Hoe or Modular
Dwelling Service or f nodtif $66 00
2a. Contractor installation only:
4b.Services or Feeders
Installation,alteration or relocation 2
Electrical C ntractor tv
Oe C 200 amps or lase $6000 2
Address_ —�. ? _ 201 amps to 400 amps 0 00
/��)�� 401 amps to 600 amps $12000 2
2
(:fly !�3�iw V— tt n State %1/S Lip—��"�H 601 amps;o 1000 amps $I BU 00 2
/ 2
Phone No. Ga'7���[�. Reconnect only
or volts E50 OU
Contractor's License No._ .,24� 2 9�J _ _
Contractor's Hoard Reg. No. 4/_ 4c. Temporary Services or Feeders
Installation,alte(ation,or relocation 2
Signature of Supr. E �_ 200 amps or lase $5000 2
License No. _ Phor9 No.��jZ20amps to 400 amps $05 00 2
4011 amps l0 6U0 amps $10000
Ovor 600 ampe to 1000 volts
2b. For owner installat►-7ns: a"•b•ntxrve
4d. Branch Circuits
Print Owner's Name----.__— _ Now alteralion or extension per panel
Address s)The fee to,branch circuits with
City-- Stale Zip purchase of servire or feeder lee. 2
.—---- -- Each l7ranrh circuit $500
Phone, No b)The lee for branch circuits lvithouf
The installation is being made on property I own which is purchase of service or feeder lee. 2
First branch circuit _ $35 00 2
not intended for sale, lease Or rent. Each additional branch circuit $500
Owner's Signature__.-- _ ___ __ 4e. Miscellaneous
(Service or feeder nr±t included) 2
3. Plan Review secillon (it required). Fa&pump or Irrigation circle $4000 _ 2
Each sign or outline lighting $4000
Signal cimuil(s)or a limited energy 2
Please check appropriate item and enter fee in section 5B panal alteration or extension $4000
4 of more residential units in one structure Mirror Lahals(lo) $10000
t _ _Service and feeder 225 amps or more
—System over 600 volts nominal 41. Each additional inspection over
Classified area in- structure containing special occupancy the allowable in any of the above
115fas described In N E C Chapter 5 Per Par hour hour lio i $35 00
__ $5S00
In Plant $55 00
submit 2 sets of plans with opplicatioa where any of the above
apply. Not required for temporary conotruction services. S. Fees:
NOTICE So. Enter total of alho Paas $
5%Surcharge(05 X total fees) $
I1 RMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ _
Al ITHORIZED IS NOT COMMENDED WITHIN 180 DAYS,OR IF 5b. Enter 25%of lino A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
OMMENCED ❑ Trust Account M $
Balance Due $ f jZ
enrcrtowdxNMxc fern Rr
V1,
CITY OF TIGARD _
ELECTRICAL PERMIT
RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR95-0223
13126 SW Hall Blvd.Tigard,Oregon 07223.8100 (603)630-4171 DATE_ ISSUED: 11/ _7/95
PARCEL: J'G 104SA-117700
1. I E ADDRESS. . . : 13920 SW ,_.I DEN D f-<
,UBDIVISION. . . . s CASTLE HILL #2 ZONING:R-12 PD
BLOCK. . . . . . . . . . . L01.. . . . . . . . . . . . . : 112
Prr,.ject Description : All encompassing residential restricted energy pet-mit
A. RESIDENTIAL--------- B. COMMERCIAL_________________________—._.________—_._
AUDIO & STEREO. . . :X AUDIO & STEREO. . a INTF_RCOM A PAGING. . :
BURGLAR ALARM, . . . ax BOILER. . . . . . . . . . : LANDSCAPE/IRRIGAT. . -
GARAGE OPENER, . . . aX CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . aX DATA/TELE COMM. . : NURSE CALLS. . . . . . . . :
VACUUM SYSTEM. . . . :X FIRE_ ALARM. . . . . . : OUTDOOR LANDSC LITE.:
OTHER;ALL a : HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL.. . :
INSTRUMENTATION. : OTHER_ - .11
TOTAL # OF SYETEMSs 0
Applicant : -.-_-___..____ ._.____.____.._._-__-__..__....... ._ _ _._ _.__ _._.____ FEES
MICHAEL C.ARMIENCKE type amot.lnt by date recpt
461 NE STH AVE PRl+IT $ 40. 01b TSD 11/27/95 95-2732'30
5PCT $ 2. 00 JSD 11/27/95 95-273230
HTLLSBORO OR 97124
Phone #s
i INTRACTOR NOT ON FILE t 42. 00 TOTAL
------- REQUIRED INSPECTIONS
Ceiling Cover Elect' I Service
i 'Iione #: Wall Cover- Elect' 1 Final
Req it. . :
This permit is 1ssUed subiect to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t ee Si gnat i.1r—
applicab'.e laws. N11 work will be done in accordance with
approved plans. This oermit will expire 1f work is not started
within 10 days of issuance, or if work is suspended for more
than 180 days. lis Led By
INSTALLATION ONLY--_
The installation is, being made on property I own which is not intended fn,,
sale, lease, or^ rent.
OWNER' S SI UNA fURL-.: DATE:
INSTALLATION ON1_Y--•---._.____-_-____. _
1 UNATURE OF SUPR. ELEC' N s DATE::
I CEN SE NO:
Call l for inspection - 639-4175
—v
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. //
Tigard, OR 97223 PEKMIT # -ln- ___1_
Phone(503)639-4171
FAX(503) 684-7297 DATE ISSUED —
TDD No. (503) 684-2772
CITY OF TIGARD Inspection (503) 639-4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. '.'.'OF OF WORK
D2
Address RESIDENTIAL—Restricted Energy Fee . . . . . .
T/CzItzp Dl2 c, ] (FOR A11 SYSTEMS)
cam— State { Zip Check Type of Work Involved:
ry
PEP't.7.;ARE NON-TRANsrtRABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
ci NOT STARTED W11 HIN IRO DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS ❑ 13urglarAlarm
❑ Garage Door Opener'
2. CONTRACTOR APPLICATION ❑ Healing,Ventilation and Air Conditit mg Svst
Contractor _ I yhr ❑ Vacuum Systems"
❑ Other
Address -
I bur COMMERCIAL—Fee for each system . . . . . . . . . �4Q,QQ
- (SFF OAR 918-260-260)
Property Owner -;.heck Type of Work Inyolve 1;
Contractor's Board Rel;. No ❑ Audio and Stereo Systems
❑ 13niler Controls
Phone# _- - __- ❑ Clock Systems
❑ Data Telerommunit-ation Installations
3. OWNER APPLICATION ❑ Fire Alarm Installation
fr4rc-h Ad Lrrt tvc -_ &.I t, 4H31 ❑ HVAC
Print Owner's Name Phone No ❑ Instrumentation
t0 ❑ Inforcom and Paging Systems
Addr ss
❑ I andscape Irrigation Control'
city State p ❑ Medical
❑
This Ixnnit Is Issued under()AR 918-320.370 This applicant agrees to make only Nurse Calls
restricted energy installations(11x)volt amps nr less)under this permit and to do the ❑ Outdoor Landscape I ighling.
following:
Prolective Signaling;
1. Only use electrical licensed persons to do installations where required.(Certain
residential and other transactions are exempt from licensing.These have ❑ Other
asterisksM.All others need licensing).
2. Call for an inspection when all of the Installations tinder this permit are ready
(or Inspection at 503.6394175. 1-3 Number of Systems
3. Purchase separate permits for all Installations that are not ready for inspection
when the inspector Is out to under this permit. •No licenses are required. licenses are required for all other installations.
4. Assume responsibility for assuring that all corrections required by the inspector
are dnne,and
;. Assume responsibility for calling for a final inspection when all of the 5. FEES
corrections are completed.
The person signing for this permit must be the applicant or a person a. Enter Fees $
authorized to bin he applicant.
i I). 5`,'/a Surcharge(05 x total above) $__` _
Ignalure TOTAL $ f L✓/
Authority if other than applicant
FNERGAP.CHP
I
Lam.
ELECTRICAL
RMIPERMIT OF TIGARD ET ##: E50600
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 12/05/95
13125 3W Hall Blvd.Tlgard,Orogon 07223.6100 (503)630-4171
PARCEL: 25104BA•-0770121
.I. : ._ IU)DR::;JS. . . . 1:3-92Q1 5W LIDEN DR
SUBDIVISION. . . . : CASTLE HILL #2 ZONING: R-12 FAD
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 112'
Project Description : Residential :3, 500 sq ft.
--------------
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS----- -----MISCELLANEOUS-----
1000 SF OR LESS. . . . I 1 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 1,
EACH ADD'L 500SF. . . : 5 L-01 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . 1 0 SIGNAL/PANEL. . . . . . . : 17,
MANF. HM/ SVC/FAR. . : 0 601+amps-.1000 volts. t 0 MINOR LABEL (10) . . . : 0
-------- ERVICE/FEEDER---- ---.--BRANCH CIRCUITS------ ---ADDVI_ INSPECTIONS-.-__
0 .200 atmp. . . . . . a 0 W/SE.RVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
=.01 - 40121 amp. . . . . . a 0 1st W/O 5RVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 1(1
401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
(301 1000 amp. . . . . : 0 __.__-__.-___---_- -PL_AN REVIEW
10120+ amp/volt. . . . . : 0 )-4 RES UNITS. . . . . . . . : ) 600 VOLT' NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPFG OCC. :
Owner; --- - - ------ _.__.----- ._______________._.________.__._________ FEES
BEAR ELECTRIC type amoi.cnt by date reept
P10 BOX 369 PRMT $ 235. 00 CJS 12/05/95 95-273520
5PCT $ 1. 1. 75 C.,TS 12/05/95 95-27:35.20
DONALD OR 97020
Phone #: 5033-678-1355
Contractor:
HEAR EI-E(--,TRIC f 246. 75 TOTAL
P10 BOX 309
-- - -- - REQUIRED :".SPECT I ONS - --
DONALD OR 97020 Ceiling Cover Elect' l Service
Phone #: Wall Cover E"lect' 't Final
Ren #.
This permit is issued subject to the regulations contained in the
T ioard Municipal Code, State of Ore. Specialty Codes and all other Per1d i t t ec Ri gnalt ure
applicable laws. All Mork 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 L..!>��/rS_. . __,_.__.,-,-._,.___ _.___.___.._..____•_._.-_
than 180 days. I s s e_i a d By
INSTALLATION
The instatlletion is being made on property T own which is not intended for
sale, lease, or rent.
OWNE=R75 SIGNATURE:
__----._-CONTRACTOR INSTALLATION C)hli..Y-___.__.___._____.----•-_-
GNATURE OF SUPR. ELEC' N: _O.,h_..._.a. .. . .....-....._.. DATE;
((:.'ENSE« NO:
Call for inspection - 639--4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # r r 06cc,
Phone (503) 639-4171 Date Issued / a - .ti-
FAX (503) 684-7297 Issued b,
CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_ .43 TGE Number of Inspections per permit allowed
Address / 3 5 20 S W L1,P L� ®jfL-- Service included. s Cost(ea) Sum
y/6 y, rl Z 2�_ 4a. Residential-per unit °
City/Statin/Zip�� s20 OR . Z a,do
loon pa n or less 1_ silo 00 /l ,
Each additional aq If or
Name (or name of business) Da NMoll rT "ki portion thereof
s2500
Gommercial❑ Residential Limited Energy 12500 2
Each Manul'd Home or Modular
Dwelling Ssrvion or Feeder 0800
2a. Contractor Installation only: 4b.Services or Feeders
Installation,alterntiai or iwlorelion 2
Electrical ContractorBEdfI- E�Ec-r/(,l c" tw[=z 200 amps or less $6000 2
Address r.U, dOX �$9 _ 201 amps l0 400 em pe $6000
401 amps to 600 amps $12000
2
City— po/UA--0 State a e- Zip q7Q�- 601 amps to 1000 amps $16000 2
Phone No. _,7A ��1;c Ovor 1000 amps or volts $34000 2
Reconnect only $50 00
Contractor's License No.
Contractor's Board Reg. N0. _ 4c.Temporary Services or Feeders
Installation alteralton,or relocation 2
/r 200 amps or less s50 o0
Signature of Supr. Elec' ' 201 amps to 400 amps $1500 2
Phone . 107 - 1355 —'— $10000
License No.�7� 401 amps to 600 amps _ —
clear 600 amps to 1000 volts
2b. For owner Installations: Re@"b"abovA
4d. Branch Circuits
Print Owners Name New,aNaration or erlennion per panel
Address of The fee for branch circuits with
-- purchase of service or Waller M. 2
City State Zip _ Etrch branch circuit $5 00
Phone No. __ h)The fps for branch circuits vvifhouf
purchsse of service or Awder ice. 2
The installation is tieing made on property I own which is First branch circuit $3500 2
not intended for sale, lease or rent. Each additional bran&circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
Each pump or irrigation circle $4000 2
3. Plan Review section (if required): Farh sign or outline lighting $4000
Signal cimunls)or a limited energy 2
Please check appropriate item and enter fee in section 513 panel alteration or"Prision $4000
4 or more residential units in one structure Minor t abals(10) $10000
Service and feeder 225 amps or more 41. Each additional inspection over
System over 600 volts nominal the allowable in any of the above
Classified area or structure containing spW-lal occupancy Per nrpecoon $3500
as described in N E C Chapter 5 ,how,, $55 00
n r n $55 00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5, Fees;
NOTICE 5a. Enter total 01 above flies $
Z3S U°
5`1.Surcharge(05 X total fees) $
Subtotal $ �'7
PERMITS BECOi: VOID IF WORK OR CONSTRUCTION 5h. Enter 25%of line A for
AUTHORIZED IS NVT COMMENCED WITHIN 180 DAYS,OP IF Plan Review if required(Sec 3) $ A
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED Tnlst Account ill $ _ A
Balance Oue LyG•7�
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd,
Tigard, OR 97223 PERMIT#
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED _--
TD) No. (503)684-2772 -- --
CITY OF TICARD Inspection (503)639-4175 ISSUED BY
--
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
-� _�_Sri�.�__r - _ X11 -
Address RESIDENTIAL—Restricted Energy Fee . . . . . . . . . S4
U OR AI I SYS 11 MY
City I 7_ip Check Tyrie of Work Invu1wd: 1A1 C6)'►ia"U
IPERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK
S NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR to and Stereo Syslr nts'
180 DAYS
Bur lar Alarm
2. CONTRACTOR APPLICATION /Garage Door Opener*
L�_1' ing,Ventilation and Air Conditioning System*
Contractor _ _Type_ ETV .duum Systems*
Address Other__
GARY ' S VACUFLO. INC. 775-2042
9015 SE FLAVEL . PTLD. OR 97266 COMMERCIAL—SEEFeefOAR aP111-too -2 D) $40.00
DATE: �/�/_�S .TOB*
OWNER: a1 Check 1 12 Jof Work Involved:
LLE 26728 , JLL 985 , CCB: 69047 ❑ Audio and Stereo Systems*
I'h4uue #
❑ Boiler Controls
--- - - ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ 1 ire Alarm Installation
Print Owner's Name1:3HVAC
Phone No
❑ Instrumentation
Address — ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is issued tinder OAR 91 q-320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy installations(100 volt amps or less)under this permit and to do the
following: ❑ Outdoor Landscape I ighting*
1 Only use electrical licensed persons to do Installations where required.(Certain ❑ Protective. Signaling
residential and other transactions are exempt from licensing.These have 13 Other
asterisks(*) All others need licensing).
2 Call for an inspection when all of the installations under this permit are ready �T
for inspection at 503.639.4175. ❑
1 Purchase separate permits for all installations that are not ready for inspection Number of Systems
when the inspector is out to inspect under this permit.
4 Assume responsihlhty for assuring that all corrections required by the inspector *No licenses are required. Licenses are required for all other Installations
are done,and -
5 Assume responsibility for calling for a final inspection when all of the corrections 5. FEES
are((.mpleted.
I he person signing for this permit must be the applicant or a person
authorized to bind the applicant, a. Enter Fees $— I- p C7
h. 5% Surcharge(.OS x total above) $ � �_
Signature
TOTAL $_ )0
Authori4 If other than applicant —
ENERGAP.CHP
Page No. 1 CASE HISTORY FOR CASE NO.: MST95-0310
DON NORISSBTTEE
13920 SW LIDGTI DR
09/14/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
code- Sent Dome Dome Date By
MSTA007 Application received / / / / 08/15/95 PASS BON 08/23/95 BTA'
MSTA010 Plan check deposit paid / / / / 08/15/95 PASS BON 08/23/95 BLT
MSTA020 Plan check by 09/23/95 / j 08/23/95 PASS RT 09/23/95 BLT
MSTA030 Check fot prcl. restrict. / / 09/23/95 08/20/95 P, 4S SON 08/23/95 HLT
MSTA050 Hold for / / / / 09/14/97 hold c/o for site permit final approval. LIOLA JT 09/14/97 JT
Jeanne t
I looked throvlb the file on this date.
no final enginort ing report.
MSTA090 (F) Ready to issue / / / / 08/28/95 PASS BON 08/28/95 B
MSTA092 (F) Issue rombinat.ion permit / / / / 10/09/95 PASS BON 10/09/95 B
MSTA097 Issue plumbing signature form / / / / 10/09/95 PASS BON 10/09/95 B
MSTA705 Footing Insp / / / / 1,0/11/95 PASS RB 10/11/95 RB
MSTA706 Foundation Insp / / / / 10/11/95 PASS RB 10/11/95 RB
MSTA710 Post/Beam Structural / / / / 10/23/95 BEAMS MISSING DIS na 10/23/95 GES
MSTA710 poet/Beam Structural 12/28/95 / / 12/28/95 PASS RB 12/28/95 PB
MSTA711 Post/Beam Mechanical / / / / 10/23/95 APP G9 10/23/95 GES
ME'TA713 Crawl Drain / / / / 10/23/95 APP GS 10/23%95 GES
MSTA717 PIM/Underfloor / / / / 10/23/95 APP GS 10/23/95 GBS
MSTA720 Mechanical Insp / / / / 12/26/95 enclose drywall behind furnace; eoffit FAIL. RB 12/26/95 RB
ductwork in garage and main water
closet; secure dryer vent and protect
throat; sea] all thru penetrations
within RA flo,,r plenum; Vac tubing must
be rated fo, plenums; fur out for duct
in fwdbedrm at tap of stairs; 3e&1
exhaust vent at maatec bath and extend
to roof jack;
MSTA720 Mechanical Insp 01/03/96 / / 01/03/96 nee framing this date PASS RB 01/03/96 RB
MSTA120 Mechanical Insp 01/06/96 / / 01/06/96 PASS PB 01/08/96 RB
MSTA77.2 Plumb Top Out / / / 11/22/95 PAIS MS 11/22/95 MPS
Page NG. 2 CASE HISTORY FOR CASE NO.: MST95-0310
DON MORISSETTF.
1.3920 SW LIDEN DR
U9/14/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code sent Done Done Date By
------- -- ----------- -------- --------- -----------------—--------------------- ---- --- -------- ---
MSTA725 Framing Insp / / / / 12/26/95 meth issues; master shower blocking; FAIL RB 12/26/95 RB
enclose lid of corner of entry a. bedrm;
family shower blocking; strap plate at
mid stairs; strap Tedi lam at base of
stairs; strap plate at waste at kitchen;
support notched hole in stud adjacent to
waste at kitchen; strap beam at nook-2;
support violated stud at back wall of
garage/utility; strap plate at waste at
back wall of garage/utility; strap
thriple micros in garage-2 at both "min;
strap 2x4-to-2x6 walls in garage-2; stud
missing at back entry in garage
MSTA726 Framirn •REINSP> 01/03/96 / / 01/03/96 complete soffit in gaarge and hathrm; PASS RB 01/03/96 RB
meal all thru penetrationr w/in RA
plenum; vac_ tubing to be removed i.om RA
plenum;
MSTA726 Framing REINSP, 01/06/96 / / 01/06/96 PASS RB 01/08/96 RB
M"TA735 Gan Line Insp / / / / 12719/95 PASS RB 12/20/95 RB
MSTA740 Insulation Inap / / / / 01/06/96 PASS RB 01/08/96 RB
MSTA745 Gyp Board Insp / / / / 01/12/96 APP GS 01/12/96 GES
M.STA755 Rain drain Inap / / / / 10/16/95 PASS MS 10/16/95 MRS
MSTA'760 Water Line Inap / / / / 10/16/95 PASS MS 10/16/95 MRS
MSTA761 Water Service Insp / / / / 02/27/96 APA GS 02/27/96 GES
MSTA765 Appr/Sdwlk Insp 02/23/96 / / 02/13/96 1. Clean up mud inside forme. PEND PI 02/23/96 C•H
2. Felt at cold joint.
3. Be prepared to protect finish.
Mr,TA795 Mechanical Final % / 02/27/96 SHE BLD DIS GS 02/27/96 OES
MSTA795 Mechanical Final 02/29/96 / / 02/28/96 APP GS 02/29/96 GES
MSTA797 Plumb Final / / / ! 02/27/96 SEE BLD FNL DIS GS 02/27/96 GES
MSTA791 Plumb Final 02/29/96 / / 02/29/96 APP GS 02/29/96 GES
MRTA799 Building Final / i / / 02/27/96 COMPLETF WEATHRRSTPIP OF FRENCH DOOR; DIS GS 02/27/96 GES
LANDING OUTSIDE FRNCH DOORS; FINAL
EROSION CONTROL; R.RSUPPORT UNDER FI, DUCT
AR REAR OF HOUSE [ORND CLEAR]
ELR PERMIT NOT C'OMPLET'E AT THIS TIME. '
WILD BE DONE APPROR 60 DAYS AND WILL
CALL FOR FINAL
Page No. 3 CASE HISTORY FOR CASE NO.: MST95-0310
DON 110RISSETTE
13920 :W LIDEN DR
09/14/97
Action Dbecri.ptim Req/ Solid/ find/ Action Note" Di.sp By Update Upd
Code Sent Dome Done Date By
MSTA799 Building Final 02/29/96 / / 02/28/96 APP GS 02/29/96 GES
M43TA970 Cane Finaled / / / / 02/29/96 see sit permit APP GS 02/29/96 GES
MSTB708 Erosion Control / / / / / / 08/23/95 BLT
MSTB750 Shear Wall 1218p 11;09/95 / / 11/09/95 tighten nuts of hd's; h-wall connections PASS RB 11/1.3/95 RB
missed
7 I §
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6
CITY nF TIGARD RE.-".('FIPT OF PAYMENT RECEIPT NO. r y:,•--C`6 9 376
CHECK AMOUNT 350. 00
DON MOR ISSETTE: HOWS, INC GASH AMOUNT y 0. (flo
01)1)P.Fsq r 5000 SW MEADOWS RD. 601 TF.' 1`'11 PAYMEMT DATE" a ON/1`i/''a"•
LAKE OSWE(30, OR SUBDIVISION
97035-
PURPOSE OF PAYMENT AMOUNT PAID PUHPO9F OF PAYMENT AMOUNT PAID
VILAN CHECK FE 250. 00 PLAN CHECK Fr 50. 00
Pt-AN CHECIA FE 50. 00
FjW t.-I DEN A-51 R, 13920 SW L I DEN - 8 --)FR
1 ,3400 RW LIDEN B--43R
Tf)l'Al-. AMOUNT PAID 350. 00
IA it i"I"
o1i It DON 1'411x1 1 F, I I t 114114k!') 0411 I
"'(400 '-.,'W MI-A-10OW; 1;- IA Ill'i'voll 141
IJAKI I:it 14x1 t it) I IR )I liip I It 1, 1 114
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1414-11-111Y VOCIIATY U.,F-F 1 SO, (AIA I WOON I I I 'v Fri! 1 .1 1 y I r f I 00. AL-110
PI 0114 CHECK i ION I fit it I-If.Hm 1. 11 IJ I-'"I. 1/110
IN (AlN I ROL P11.AN L,K 0. 1`30 V HI 1i,z I(IN I f IN I PI,11
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