Permit . . ' —�
_
��� OF � BUILDING PERMIT °
� � � PERMIT #.......: DUP':;
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/03/95
13125 SW Hall Blvd. Tigard, Oregon 97223°819e (593):,639,417;1
PARCEL: 2S102BA-00200
SITE ADDRESS...: 12045 SW 95TH AVE
SUBDIVISION....: NO.TIGARDVILLE ADDITION AMEND. ZONING: R-25
BLOCK..........: LOT............~:61
REISSUE: FLOOR AREAS ----- EXTERIOR WALL CONSTRUCTION—
CLASS OF WORK.r'"< � FIRST....: sf N: S: E: W:
- TYPE OF USE...:SF r SECOND...: sf PROTECT OPENINGS? --
TYPE OF CONST.:5N THIRD....: sf N: S: E: W:
OCCUPANCY ERP.:R3 TOTAL------: 0 sf ROOF CONST: FIRE RET?:
OCCUPANCY LOAD: BASEMENT.: sf AREA SEP. RATED:
GTOR.: HT.: ft GARAGE...: sf OCCU SEP, RATED:
BSMT?: MEZZ?: REQD SETBACKS-- REQUIRED ---------
FLOOR LCAD....: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET..:
DWELLING UNITS: FRNT; ft REAR: ft FIR ALRM: HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR PARKING:
VALUE.$: 0
Remarks: Demolition of one building. All debris to be removed. Sewer to be
cappedand inspected.
Owner: ---- ----- — FEES ---------
LANDMARK DEVELOPMENT type amount by date recpt
9990 SW GREENBURG ROAD PRMT $ 25.00 JDA 08/03/95 95-268905
SPOT 1.25 JDA 08/03/95 95-268905
TIGARD OR 97223
Phone #: 620-4427
Contractor. — —
OUT TO BID •
Phone #: $ 26.25 TOTAL
Reg #..
REQUIRED INSPECTIONS -------
This pernit is issued subject to the regulations contained in the Cap sewer line
Tigard Mnnicipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This pertit will expire if work is not started
within 180 days of issuance, or if work is . suspended for ooro
than 18N days,
. + Permittee Signature: '
Issued By: ' — --'
Call for inspection — 639-4175
•
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: 12045 SW 95th Avenue
Subdivision: Lot #
Office Use Only
Contact Date I / Initials
Valuation: Result
New Construction Only: (Square Footage) Planck/Rec #
Permit # e 4 - 0 3? v
House: Garage: Reissue of
Map &TL# la ),ja _oo ).00
Corner Lot? Y N Flag Lot? Y N Zone
Plat #
Owner: Landmark Development Corp.
Approvals Required
Address: 9990 SW Greenburq Road, Ste 101
Planning Setbacks Solar
Tigard OR 97223 Engineering
Phone: ( 503 ) 620.4427 Other
Contractor: to be determined Items Required
Subcontractors
Address: Truss Details
Other
Notes
Phone: ( )
Contractor's License #
(attach copy of current Oregon license)
Contact Name: Merre Wi 1 i a rd
Contact Phone: ( 503 ) 620.4427
Subcontractors: Architect/Engineer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone: (
JOB DESCRIPTION: E M O LT 7,1-p&1 / 11.0 (,L - 5,060 er
Applicant Signature - Applicant Phone num�w�
Received by: Date Received:
ft oginld$tsl,esapp
Permit At Account Description Amount Amt. Pd. l Bal. Due -
Bldg. Permit (BUILD) G -7 �� ,Q. 0 v
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) ` C � -
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -1)
Institutional TIF (TIF -1S)
Office TIF (TIF -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
-
•
CITY OF TIGARD - RECEIPT OF PAYMENT RECEIPT NO. :95-268'
CHECK AMOUNT : 276'25
NAME : LANCMARK DEvELOPMENT CORP CASH AMOUNT : 0.00
ADDRESS : �)90 SW GPEENBURG ROAD PAYMENT DATE ; 06/03/95
SUITE 101 SUBDIVISION :
TIf OR �723-
PURPOSE OF PAYMEN"' AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
____-_-__-__-__'__-
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