Permit CITY O TIGARD SEWER CONNECTION
A, DEVELOPMENT SERVICES PERMIT
��I14 1 PERMIT #.......: SWR96 -0502
L ' �.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1 O / 31 / 96
PARCEL: 2S 103BD —H6024
SITE ADDRESS...: 125 SW 116TH AVE
SUBD I VISION. HUNTER'S GLEN' ZONING ° R -4. 5 PD;.
BLOCK........... LOT .............o024 •
TENANT NAME. ....:LEGEND HOMES
USA NO..... .... , ' ... ., • FIXTURE., UNITS..... 0
CLASS OF WORK...: NEW DWELLING UNITS.. a 1
TYPE OF • USE... . o SF . ' . NO. OF., BUILDINGS: 1
INSTALL TYPE °BUSWR IMPERV SURFACE: 0 sf
Remarks: , Path', 1
Owners __ . FEES..
• LEGEND HOMES type amount by date recpt
6900 SW HAI_ NES ST• . , PRMT-$ 2200.00 JMH 10/31/96.. 96- 285978
INSP $ 35.00 JMH 10/31/96 96- 285978
TIGARD OR 97223
Phone #„ 620 -8080
Contractor:
CONTRACTOR NOTION •'FILE.
Phone #d $ 2235.00 TOTAL
Reg it..
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 guarantee the accuracy of the
side sewer laterals. If the sewer .is4not•located the measurement' '
given the 'installer' shall 'prospect3 feet in•allFdirect:'iens:,froe •
the .d istance.. If'. not'. so' located;'' the: 'installer purchase • •
a., "Tap. and Side.•Sewer' 'Pereit' and theAgency;•wi '.ins .11.,a lat: • . • ,. . , •
Permittee Signature ° , / /,� • . ° - .
Call for inspection- 639 -4175
Plan Check # < - 5
:ITY OF TIGARD Residential Building Permit Application Rec'dBy Mi• .
3125 SW HALL BLVD. New Construction Additions or Alterations Date Recd io =. -9,
!GARD, OR 97223 Single Family Detached or Attached Date to P.E. 10-2 -`1- (.P
503) 639 -4171 Date to DST %O - Z1-9
Print or Type Permit # 5 - DECO 51006 -
Incomplete or illegible applications will not be accepted Called OS�L
Name of Subdivision Lot # Name ,
Job LEGEND HOMES •
HUNTER'S GLEN 24 Architect Mailing Address
Address lst•,'re 116th Avenue 6900 SW Haines St.
Name City /State Zip Phone
LEGEND HOMES Tigard, OR 97223 620 -8080
Owner Mailing Address Name
FROELICH
6900 SW Haines St.
City /State
zip Phone En Mailing Address
Tigard, OR 97223 620 -8080 6969 SW Hampton St.
City /State Zip ` Phone
Name Tigard, OR 97223 624 -7005
General LEGEND HOMES Describe work nev addition 0 alteration 0 repair 0
Contractor Mailing Address to be done:
6900 S W Haines St. - Additional Description of Work:
City/State Zip Phone
Tigard, OR 97223 620 -8080
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of 060563 6/ 19 / 9 7 ' Project 2.Y
Current COT Business Tax or Metro # Exp. Date Valuation $ / ' 7 /
Licenses 43 der 96-2,40,33 61/97 NEW CONSTRUCTION ONLY: x
Name
Mechanical SUNGLOW INC. Sq.Ft. House, Sq.Ft.Garage: /�
Sub- Mailing Address y
Contractor , 2428 S E 105th Corner Lot . Yes No Flag Lot Yes No
City/State Zip Phone (check one) $ (check one) '∎
I Portland, OR 97216 253 -7789 Restricted 7 Audio /Stereo Burglar
Oregon Const. Coat. Board Lic.# Exp. Date Energy System X Alarm
Attach Copy of i 48131 S
Currentx COT Business Tax or Metr9 # Exp. Installation Garage Door HVAC
Licenses 1-1-171276 ('7 egt - t 7 / / i 2 / 3�� Opener Systems
Name (check all that Other:
Plumbing ; WOLCOTT PLUMBING apply)
Sub- '.!ailing Address Will the electrical subcontractor wire for all Yes No
Contractor P O Box 2007 restricted energy installations?
City/State Zip Phone Has the Subdivision Plat recorded? N/A es No
Gresham, OR 97030 667 -9891
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach Copy of 9 36 A 7 10/19/97 (Calculation Attached)
Current Plumbing Lic. # Exo. Date I hereby acknowledge that I have read this application, that the
Licenses 2 6 - 2 0 8 P B ' 8/31/97 information given is correct, that I am the owner or authorized agent of
COT Business Tax or Metro # Exp. Date the owner. and that plans submitted are in compliance with Oregon
96 -4281. 12/96 State laws.
Name Signat of Ow a Agen,� Date
Electrical GARNER ELECTRIC
/'il / �iT - i,,.5 � --
Contac *on N=
'-
Sub- Mailing Address " - /� / ' Phone
Contractor 21785 SW TV Highwa FOR OFF=ICE USE O'LY:
City/State Zip Phone Plat # Map/TL #: •
Aloha, OR 97006 591 -1320
Oregon Const. Cont. Board Lic.# Ex to I(O i D f "t /,�� � �)z�
V
Attach Copy of 74896 O /� Setbacks FY r Zone: Solar. /
Current Electrical Lic. # ate p \ \r7 A. �/ p
Licenses 34-305C
t / c�sr, viitt Mtr (i R 5 T •� l/ ,
COT Business Tax or Metro # Exp. Da e E gineerin Ap ova': Planning Approval: TIF:
, / o
sts\mstapp.doc - / J hl�f t 1d Pf � kin
Permit # Account Description Amount Amt. Pd, Bal. Due
m MST. Permit (BUILD) 42,. S4.) 6 ,2 o •s ,/
'Plumb. Permit (PLUMB) 09,2S--,c4 c).5.6`)
, .- Mech. Permit (MECH) z/ C, vo 1...f .. Di ./
ELC /ELR Permit (ELPRMT) 0 (2 , o0 ./
State Tax (TAX) S,Ci. Zr 58 .2-Y
Bldg: (3 /, o3
Plumb: / I • L f /
Mech: ?
ELC /ELR: /317r/
Plan Check /
MST: ( BUPPLN) 4/03. A5O' . /5,3 ..33
Plumb: (PLMPLN)
Mech: . (MECPLN) // , Z) //, Z r
CDC Review (LANDUS) i/o . 2 /0 ,
6c442.0.05 - 6/ Sewer Connection (SWUSA) 0 .1,2 c'v c,2-a0
Sewer Inspection (SWINSP) 3 j 3,7
Parks Dev Charge (PKSDC) /p 5 / o5 -0
Residential TIF (TIF -R) 15 70 /5 70 V
Mass Transit TIF (TIF -MT) / 2. / 2 -0
Water Quality (WQUAL)
Water Quantity (WQUANT) /0 0 (0 `/
Erosion Control Permit (ERPRMT) 6 c/c w 6 4.
Erosion Planck/USA (ERPLAN) "/1 _fii__
Erosion Planck/COT (EROSN) kt1' (p ,I) r/
Fire Life Safety (FLS) ------ 1 ■
TOTALS: 6Y58 6 c2 0 / lv‘o�, Cffo
is \dsts\mstapp.doc (� Q
Rev. 7/96 (/ i(