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Permit MASTER PERMIT . PERMIT #:. ..... :1 DATE ISSUED: 03/12/96 COMMUNITY DEVELOPMENT DEPARTMENT 131'25 SW;Hall Blvd. Tigard, Dragon 9723•8199 (503)639-4171 PARCEL: 25115BC-17300 SITE ADDRESS.,-..: 16682 SW QUEEN ANNE AVE . . . SUBDIVISION....: ZONING: pocv....;.. .. : . : LDT 'ReparRs: ON3 SUN RE01 160 SO FEET = FFISEUE: STORIES . 1 FLOOR AFEAS---------- BASEFINT,,.: 0 sf REGU1RED SETBACgS---- REOUIRED- CLASS CF 01%42. KIEV . 21 FIRST . 160 sf GRIM . C 5f, LOFT ' . 5 SNORE DETECTRS: - ' TYPE 07 ' FLO LORD . 43 SECCX0...: 0, sf FRENT.,.......: 0 - CARXIND SPACES:- -0 ' ' , TYPE, OF ELNST.:5N DWELLING UNITS: 1 FINBSNENT: 0 sf 'RIM—. .... : 5, OCEPATCY GRA.:R3 BOE4:',0 BATH: 0 TOTAL--; 160 sf VALUE..$: 10346 - REAR—, ..... : 15 , --- TILMIllS ....... ---------7----------------- 0 MTER METE.: @ WASHIRS MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS .- 0 LAVATORIES . 0 DI9AWASHERS...: 0, FLOOR DRAINS,.; 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 - TUB/SHWERS...: 0 GMASE DISP.:1 8 - WATER HEATERS.: 0 WATER LINE ft: 0 DCHFLU PREVNTR:' 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 --------------- FUEL TYPES----- FURN ( MR .. 0 BDIL/C1P i 1HP: 0 VENT FANS . 0 CLOTHES DRYERS: 0 • . ''.- FURN ..: 8' UlIT HEATERS..: 0 ' HOWS ....: 0 OTHER UN1TS..,:, 0 . N.AX I. 0 BTU FLOOR FURNACES: 0 VENTS. - • 0 'VOODSTOVES.....: 0 GAS'OUTLETS...; 0 ------------ — ' ---'- — LECTRIGIL --------L—'---------- --- . '-RESIDEITIAL UNIT-- . ---SERVIOE/FEEDER---- --Tr P SRVC/FEEDERS-- --BRANCH CIRCUITS-- "----01SCELLANEOUS---- -7ADD'L INS;ECTIONS- IM SF OR LESS: Cl 0 - 208 anp..: 0 0 - EU app..: 0 U[SVC OR FDR..: 0 IIRRIGATION: 0 PER INSPECTION: 0 EA ADM ailSF.: 0 201 - 4:21 anp.._: C 201 - 400 app.„: 0. 1st U/0 SVC1FDR: 0 _ STOW LIN LI:.0 _ PER HOUR _. 9 - LIMITED MO.: 0 401- GM app..: 0 431 1 602 anp..: 0 EA ADDL BR CIR: 0 SIONAL/PANEL.,.: 0 ' IN PLANT kANF 0 601 - =app.: 0 601+acps-1020 v: 0 MIERLABEL -0: 8 pia+ app/volt.: 0 - -------------- ------------ PLAN REVIEU SEETION,----:-----------=-----7----------- - . . RELunitect only.: 0 /.4 RES UNITS..: SVC/FDR/.225 A,: )-40 V NOMINAL: , U.S AREA/SPE OCC: -- ELECTRICAL - RESTRICTED ENERGY ------------±----,--------- . A. SF RESIDENTIAL-----7--------------------- B. EDNXERCIAL . - — - - - - — - - - - - — - - - - - - - — - — - - - - — - - — - - - - • ' , . AUDIO & STEREO.: VADJUN SYSTEN,„; . AUDIO & STEREO.: ' FIRE ALAIA1 • INTERCO/PAGING: OUTDOOR UDR LT: . EVRGLAR POE.: 0TH; :: , BOILER : HVAC. .„.: LANDSCAPE/IRRIG: PROTECTIVE STK: • EWE NENER.,1 'CLOCK • ' INSTRUgENTATION: MEDICAL ' ETHR: KVAC ...... -.....: • . DATA/TELE COM,: NURSE CALLS • TOTN_ A SYSTEMS: 0 . . , . Merl ---- ---7--- — -- —7-- - --Contractori ------------ TOTAL FEES:I 147.05 ' , • . ROBERT UINDEc4ER COOPER MOUNTAIN DONSTRUCTIONO ' 16682 SH ZED; ANNE WALTER PROT III . . , = . , 3315 SW'MYSSEN RD . , . . : OS CITY OR 97224' ALOHATR 970/6 - - Phone A: 629-2057 Phone A: 224-9E20 ' , . . Reg A..i 5,5167 . . . . , , • . This wait is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other . . appliphle iEV6. All work will be done in accordance with, approved plane. This perait will expire if work is not started within 180. days of issuance, or if Work is suspended for core than dais, . -------------------------- REQUIRED INSPECTIONS- Foot ng Insp Insulation Imp Foundation Insp Gyp Board 'lisp ' . . • . , Post/Beaa Struct Rain drain Insp . .' • . . . , Crawl Drain ' Building Final . . . Franing Imp Erosion Control - _ . . Perinittee Signature: Isued By: _ ' - -Call - for inspec . tion - 639-41T5 - . , • . . . . , . . , . . . . • . . . , . . . • . , . . _ , . _ . . . • _ _ _ ece z -2( Residential Building Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639 -4171 Jobsite Address: /(f( G2C/71 N Subdivision: X/^/G ec Lot # Office Use Only 1' ,/ PlancklRec #'• 7- 5 4'K' Valuation: /U 3 N ( Permit # Corner Lot? Y 5 / � �1 ou m r( Flag Lot? Y Reissue of Map &. TL# 261 15tx.^ . - 17 Owner: Approvals Required Address: /(o e0,(16-- Ava2s— Planning /Cv Ci C-1 Engineering Phone: Other Contractor: kJ/9 - 07Z.— Efiedelot aoo /4 00 Items Required Address: is u/. ?»✓1S" / wiz 7ids7 Subcontractors Truss Details Phone: c 2 ( ' Other Contractor's License # � (attach copy of current Oregon license) Contact Name & Phone: , v� Subcontractors: Architect/Engineer: Plumbing: ///4- Address: nt3efik Mechanical: A// ' (attach copy of current OR Contractor's License) Phone: JOB DESCRIPTION: 50 H 42)D/7764 Applicant Signature & Phone number Received by: c � , e.l Date Received: .2 - O - 94 6 . Gur i.-- — t vex eD( L - 1 —/ tp Permit # Account Description Amount Amt. Pd. Bal. Due iir V9'00`/ 1 Bldg. Permit (BUILD) 06 86.5 " Plumb. Permit (PLUMB) Mech. Permit (MECH) State Tax (TAX) 43.1 «' 33 Bldg: Plumb: Mech: Plan Check (PLANCK) ,j 6. 2 3 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 -I) Institutional TIF (TIF -IS) Office TIF (TIF -O) Water Quality (WQUAL) Water Quantity (WQUANT) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN)' TOTALS: /Y 7 u6