Permit CITY OF T SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
At'ivdi/ PERMIT # ° SWR95 -0573
� � . _.. 13125 SW Hall Blvd., T i g a r d , OR 9 7 2 2 3 ( 5 0 3 ) 639 -4171 DATE ISSUED:: 01 / 30 / 97 •
l�p PARCEL: 2S103BD— HG018.
SITE ADDRESS•, „ •,e AVE °
SUBDI`'iSI.ON' °• s . 1UNTER'_S..GLEN +• , ,, r ZONING: •R -4° 5 PD
BLOCK..........: LOT ° ° ° ° ° ° ° ° ° ° ° °° s016
TENANT NAME :LEGEND HOMES
USA NO FIXTURE UNITS...: 0
CLASS OF WORK.—.:NEW • DWELLING UNITS..: 1
TYPE OF USE ° ° ° ° ° :SF ,NO. OF BUILDINGS: 1
INSTALL TYPE ° ° °.sBUSWR IMPERV SURFACE: 0 sf
Remarks: Path.
Owner: FEES - - --
LEGEND HOMES type amount by date recpt
6900 SW HAINES •. PRMT $, 2200.00 DRA 01/30/97 97- 289727
INSP $ 35.00 DRA 01/30/97 97- 289727
TIGARD OR 97223
Phone #s 620 -8080 -
Contractor: -- -- ---
CONTRACTOR NOT ON—FILE.—
Phone #s $ 2235.00 TOTAL
Reg #° ° .
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••frae
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 is :not 'located , at- f•the:Aeasuregent
given, the installer ,:hall prospect, 3 .feet. ,in.all•directians from, . -, .
the distance given.- If not. so .locatedothe,- installer, •shalkpurchase : .
a "Taprand;:Side Sewer <Permitr the:Agency widlai� ahl,a lateral.. • ,• . . . , •
Permittee igeatures /�L/ /” „�,� s! . , •. ,.- - •
Issued By ' . ! i v .+ �. —
Ca.l 1,,, for i.nspect•i„on . - 539 -4175
Plan Check # (F r iC°°'
;ITY OF TIGARD Residential Building Permit Application : ecd By'
3125 SW HALL BLVD. New Construction Additions or Alterations Date Rec'd /E3
'IGARD, OR 97223 Single Family Detached or Attached -kt) Date to P.E. 12 (,
503) 639 -4171 Date to DST
a Permit # 1$15 - 0556l1
Print or Type - Called / -7 -q7 OLI . I "573
Incomplete or illegible applications will not be accepted a „ ,,,._a, ,tom ,,,,,p
V �' _.ro soa .._
Name of Subdivision Lot # Name
•
Job HUNTER'S GLEN 16 LEGEND HOMES
Address S ite A ress Architect Mailing Address
127 SW 116th Avenue 6900 SW Haines St. •
Name City /State Zip Phone
LEGEND HOMES Tigard, OR 97223 620 -8080
Owner Mailing Address Name
FROELICH
6900 S W Haines St.
Engineer Mailing Address
City /State Zip Phone g Hampton St.
Tigard, OR 9 6 9 6 9 S W Ham 223 620 -8080 P
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 9.7223 620 -8080
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of 060563 6/ 19 / 9 7 Project <
Current I /� X7 COT Busines Metro # Exp_ Dace Valuation 4.) J _ ���.
Licenses 1 GG�� 0&3 3 6�� / NEW CONSTRUCTION ONLY:
Name /`�I3 in '
Mechanical S U N G L O W INC. J l Sq.Ft. House S q. F G ame:
Sub- Mailing Address Se p? : /.7
Contractor 2428 S E 105th Corner Lot . . Yes No Flag Lot J Yes No
City/State Zip Phone (check one) L. c (check one) Dz.--
P o r t l a n d , O R 97216 2 5 3 - 7 7 8 9 Restricted N,,40151-' . Audio /Stereo n y ty Burglar
Oregon Const. Cort. Board Lic.# Exp. Date Energy / System riw Alarm
Attach Copy of ; 48131 Hi-fi /2.7j, ..5/3 / Installation p Garage Door HVAC
Current COT Business Tax or Metro • E'xp. 'Date ,/,,- Opener Systems
Licenses 1,27 /4 ._�ff *% =��`,
Name (check all that Other:
Plumbing J WOLCOTT PLUMBING apply)
Sub- '••ailing Address Will the electrical subcontractor wire for all Yes No
Contractor P O Box 2007 restricted energy installation
City/State Zip Phone Has the Subdivision Plat recorded? N/A X No
Gresham, OR 97030 667 -9891 , �
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST#j Solar Compliance
Attach Copy of 23047 10 / 19 / 9 7 9/,0 — I (p <_ (Calculation Attached)
Current I 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 / 9 6 State laws.
Name Signae of O yrner /Ag t Date
Electrical GARNER ELECTRIC �/ /Y(I G� /1;96/, h
Con t Perso Nam P ne
SUb_ Mailing Address / e dO ;NCY
Contractor 21785 SW TV Highway Ft O Flt, SE ONLY:
City /State Zip Phone Plat # Map/TL #:
Aloha, OR 97006 591 -1320 t / G� �/ �
Oregon Const. Cons and Lic.# Exp. Date �
bs- 7 ' 1 r Co -51 3�
S� '— ! 1 i� f '
•
Attach Copy of 7. l( -9- - r f / , //9 9 Setbacks ' Zone: Solar:
Current Electrical Lic. # E Da
Licenses 34 -305C ` � 1(' / ✓� �j—L. /, -M) COT Business Tax or Metro � b�a �� Engineering Approval: Plan g Approval: TIF: —
sts�rnstapp.doc ��/C� /7 -0 ,� (
a. (2 3/-16
Permit # Account Description Amount Amt. Pd, Bal. Due
co
/ s/ (,_Qs4. MST. Permit (BUILD) 573. / 571
Plumb. Permit (PLUMB) a .2;, " , ,
Mech. Permit (MECH) , C J c% ca.,
ELC /ELR Permit (ELPRMT) Aso. ` , n, t''
State Tax (TAX) S cl , - S / 5 f C.1
Bldg: - „z se-G.' /
Plumb: if, L s 7
Mech: . L / /
ELC /ELR: / 2.3 V /
Plan Check
MST: $o f 5 / 4- (BUPPLN) /OD, " C� 7 .F o
Plumb: (PLMPLN)
Mech: ��C (MECPLN) //- z" i //. t'
CDC Review c Q (LANDUS) /`/D- � 6 / , /- "'
c 5 ca R.O.0523 Sewer Connection (SWUSA) p 2 4 ,2 vu — .22 6 v
Sewer Inspection (SWINSP) Sr 3i
Parks Dev Charge (PKSDC) /o sv' i /orb
Residential TIF (TIF -R) /57i / 5 41
Mass Transit TIF (TIF -MT) /2-v l / z-/
Water Quality (WQUAL)
Water Quantity (WQUANT) / a v .7 / G v
Erosion Control Permit (ERPRMT) 6 y 4 %- "V
v
Erosion Planck/USA (ERPLAN) G9 �27
Erosion Planck/COT (EROSN) Pv
Fire Life Safety (FLS)
TOTALS: 6y7Ft5U C, y P ( 0
ildsts\mstapp.doc
Rev. 7/96