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_13866 SW ALPINE VIEW _
C!TY OF TIGARD MECHANICAL PERMIT
PERMIT#: MEC2003-00390
DEVELOPMENT SERVICES DATE ISSUED: 7/9/03
53125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S109BA-06000
SITE ADDRESS: 13866 SW ALPINE VIEW ZONING: R-7
SUBDIVISION: HILLSHIRE SUMMIT NO. 2 LOT:0146 JURISDICTION: TIG i
BOCK: -----
-- FLOOR FURN: EVAN COOLERS:
CLASS OF WORK: ALT UNIT HEATERS: VE14T FANS:
TYPE OF USE: SF VENT SYSTEMS:
VENTS W/O APPL: HOODS:
OCCUPANCY GRP: BOILERS/COMPRESSORS
STORIES: DOMES. INCIN:
FUEL.TYPES
0 3 HP:
3 - 15 HP: COMML. INGlN:
l PC, 15 -30 HP: REPAIR UNITS:
MAX INPUT: BTU
30 - 50 HP: WOODSTOVES:
I IRE 'ikMPERS?: 50 + HP: CLO DRYERS:
GA`,, , RESSURE: AIR HANDLING UNITS OTHER UNITS:
FURN < 100K BTU: 1 <= 10000 cfm: GAS OUTLETS:
FURN =100K BTU:
> 10000 Cf I'm
Remarks: Itcl,larr a s furnucr ��ith likr kind LDescription FEESOWnP.r:1. Date Amount
YAP, KIM ONN + JANE TOSHIKO 719103 $7250
13866 SW ALPINE VIEW I11 1'ermit 1 $5.80
TIGARD, OR 97224 J WState'I u\ 7/9103
Total $78.30 _
Phone: 503-524-0559 --
Contractor: _ ------
OREGON COMFORT HEATING INC
HUGHES, RON REQUIRED INSPECTIONS
PO BOX 355
EAGLE CREEK, OR 97022 Gas Line Insp
Phone: h55-0221 Finallnspecticr:
' 2933 tax 00042519
Reg#:
of Ore. Specialty Codes
This permit is issued subject to the regulations 00 This accorthe dance with approved plard Municipal eas. State
permit will expire if work is
and all other applicable laws. All work will be done
not started within 180 days of issuance, or if work i sspendedd for ore tCentan7laose rules are set forth f ii(, I t 952 001 OG
requires you to follow ales adopted in the OregonUtility
Permittee Signature:
Y ----
Issued By: i —
Call (506) 639-4175 by 7:00 P.M. for inspections needed the next business day
07/08/2003 1x:54 5036502933 F11:H PAGE 02
Mechanical Permit Application
Date received: Permit no A& 2n.;-�� ?��p
CIty of Tigard Fmject/app),no.: Expire date:
City ofTlgerd Address: 13125 SW Hall Blvd,Tigard,017 97223 Date issued: By: Receipt no.
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permitno.:
Ti Pr.OF PFRMIT
❑1 &2 family dwelling or accessory 2Jrnmmere.aYindustrial J Multi-family ❑Tenant improvement
❑Nc%v construction fd Addition/alteration/replacement J Other.
Job address: tiSU� ti1 � Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no,: value of all mechanical materials,equipment,labor,overhead,
-- — --------_ -
Tax map/tax lot/account no.. profit.Value$ i
Wt: Block: Sul)division: *See checklist for important application information and
Proicet name: jurisdiction's fee schedule for residential permit fee.
City/county.
Descn on an446cation of work on premises:
Frr(r�.) 7'Mal
Est,date of comple-tion/insp o,—'O'
n: HVA10ewription tpy. Res.onl Res.only
Tenant improvement or change of use: an
Airhandlin unit ______ __ (�P14f
Is existing space heated or cogditionrAd7[!'Yes ❑No r con oning ire plan ren re ) _
Is existing space insulated?9 Yes 0 No Altcration of existing HVAC system
gel Boiler/cornpremor.%
Business name: StAtc boiler permit no.:
HP Tons BTU,'H
Addles , / Nire/smo a a�rsl�uct Amo c detectors
City: State: ZIP: q� 2 Aeatpump atcplanrcquittiri) - -- -
Phonic: f�^5- Fax: (o�- E-mail: Install/replacefurnace/burner,J�0T /ice
,L,, Including ductwork/vnnt liner W.'es No Iq
CCB no,: f4A Insts /replac re ocateheaters-Auspendod,
City/mctro lic._no.: 1• wall.or floor mounted
Name( lease print): Vent fora liance otherthan furnace
Rearijersumi
Absorption units BTU/H
Name• _�fps__
ChillcrA-__ HP
Addresn: Com essors HP
- Envirotammital rxhaulrt and vcnttliltton:
City: state: ZIP: Ap lianervent
Phone: Fax. E-mail: Dryercxbaust
Hooft Type It 111res. to en azmat
hood Fre Auppresnion system
Name; , fAZI Exhaust(an with single duct(bath fans)
Mailing address: Tf�g�y exhausts stet.a�artfmm aeon or AC
Cit Lel p p ng an n(up to 4 outleL-)
City: I Yta - - State, ZII':�� Type: _LPG NG Oil
Phone:-' `Q- -d55 Fax:
I''tttatl: uel i m rack additional over 4 outlets
M WIN INProcess p p ng(!tchemn:ic.Tcquircd)
Name: Numtxr of ootids
-- —..- Gt er 1 Irl cep-p lkr0 erreq ipu ine�u' —--
Address: _ _ Dccorativcfitc Ince__
City-
State! ZIP: --- nscrt-type --- -^ -
Phone: _ Fax, E-mail: Woodstove/pel et stove -
Applicant's signature _ Date: '7 Ut et-
Name (Print):
Nol ell)utiedl�cu,(Qr�1 tr em errant cards,plea"rill imixd,com for maic idwritlrn. permit fee.....................S
U Vila �/M9ltCrCard Notim This permit application Minimum fee................$
1 / expires if a permit is not obtained Plan review(at _ %) S
t+cpires within ISO days after it has been
tone a da accepted as complete.r en e r c State surcharge(896)....S
$ TOTAL .......................S
Creohol cr s NR Amount WWt)J617{6+tIprCOM1
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST _
BUP
Received Date Requested_—_—__`�-3 ._- AM_ PM BUP
Location ---— 3 E&(e aLtj rcQ_l�-t ,j ---Suite— MEC
Contact PersonPh( _) �,SS- Off-01 PLM —
Contractor _ Ph( ) SWR
BUILDING Tenant/Owner ELC
Footing H !-
Foundation ELC
Ftg Drain Access:
Crawl Drain ELR -------- ----
Slab Inspection Note,-,: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear -- --- - --
Framing --- t- -- -- - -- --
Insulation
Drywall NailingFirewall
Fire
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: -
Final -
PASS PART FAIL
_PLUMBING
Post 6 Beam
Under Slab
Rough-Ind
Water Service
Sanitary Sewer
Rain Drains --
Catch Basin i Manhole
Storm Drain --
Shower Pan
Other. - -- - ----- ---- - --
Final
PASS PART FALL_ - -" -
MECHANICAL
Post& Beam
Rough-In - - -— -
Gas Line
Smoke Dampers -------- - -• -, --
,PART FAIL ---�-�-t1 `_ � ►' r Lam' ?)�� �, �7-- -
ELECTRICAL
Service ---- - - -1
Rough-In
UGiSlab - - - -
Low Voltage
Fire Alarm
Final EJ Reinspection fee of$.-. ___-____ _
PASS PART FAIL _ required before next inspection. Pay at CityHall, 13125 SW Hall Blvd.
SITE _ [] Please call for reinspection RE: --_ -_ LJ Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewaik Date c :, -=- InspertQ 'J- '-cam^ _ EA
Other:
Final DO NOT REMOVE this Inspection record from the Joh site.
PASS PART FAIT.
1 �.
I
PLUM
CITY' OF TIGARD PERMIT"#. . . . .
I.1 : MST96-0168
COMMUNITY DEVELOPMENT DEPARTMEN) DATE ISSUED: 04/11/96
13125 SW Hall Blvd.Tigard,Oragon 97223.8199 (503)839.4171
PARCEL: 2S109BA-HS246
311'L "UDR bG. . . : 13866 SW ALPINE VIEW
SUBDIVISION. . . . : HILLSHIRE SUMMIT #2 ZONING: R-7 t'1)
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :046
CLASS OF WORK. . :MST94--0454. GARBAGE DISPOSALS. . : 1
TYPE OF USE. . . . :NEW WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . : 1
OCCIA.-JANCY GRP. . :S3 FLOOR DRAINS. . . . . . . . 0 'TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . :2 WATER HEATERri. . . . . . : 1 CATCH BASINS. . . . . . . . 0
17'1XTURES - --------- - LAUNDRY TRAYS. . . . . . : 1 SF RAIN DRAINS. . . . . : 1
''1 NKA;. . . . . . . . . . . 2 GREASE TRAPS. . . . . . . :0
LAVATORIES. . . ,. . : S OTHER FIXTURES. . . . . : 0
TUR/SHOWERS. . . . : 4 SEWER LINE (ft ) . . : 0
WATER CLOSETS. . : 3 WATER LINE (ft ) . . : 100
1)1 SHWAS HERS. . . . - 1 RAIN DRAIN (ft ) . . : 0
Remarks : PATH I
OWNER
.-I-IL CONSTRUCTION SWM $ 180. 00 JMH 04/1. 1/96 96-278050
7110 SW FIR LOOT' SWM f 100. 00 JMH 04/11/96 96--278050
ELCF $ L2355. 00 Jlrlh' 04/11/96 96-278050
T I GORD OR 97223 EL :5 $ 11. 75 JMH 04/11/96 96-278050
I'hone #: 6i'24--7714 ELRP $ 40. 00 JMH 04/1. 1/96 96--278050
ELR5 $ 2. 00 JMH 04/11/96 96-278050
F11-umbing Contractor: - - -- ___.________._ BPRT $ 660. 50 JMH 04/ 11/96 96-278050
I \ RPLC $ 50. 00 JH 03/25/96 96-2:77418
Name : B5P'C $ 3.3. 03 JMI1 04/11/96 96 78050
AddreS �11 PARK $ 500. 00 JMH 04/11 /96 96-278050
City:_ :1,( ✓ ',:�tG�te :-�„�r / -- MPPT, $ 45. 00 JMFI 04/11/96 96-x 78050
Zip:_ r _Phane#i:� i 2_3 MPLC $ 11. 25 JMH 04/11/96 96-278050
Reg #:_ 7}�' -, 1_ ._ Additional flees not shown here. . . . . . . . ..
---- -- - REQUIRED INSPECTIONS
This permit; is issued subject to the reg--
ulations contained in the Tigard Municipal Footing Insp Gas Line Insp
I;ade, State of Ore. Specialty Codes and all Foundation Insp Gas Fireplace
other applicable laws. All work will be done Post/Beam Struct Insulation Insp
in accordance with approved plans. This Post/Beam Mechan Gyp Board Insp
permit will expire if work is not started Crawl Drain Rain drain Insp
within 180 days of issuance, or if work is PL.M/Underfloor Water Line Insp
suspended for more than 180 day=_. Mechanical Insp Water Service Irl
Plumb Top Out Appr/Sdwlk Insp
Electrical Servi Electrical Final
Framing Insp Mechanical Find
Low Voltage Plumb Final
x _ Fireplace Insp Building Fina '
Puthorized lumbing Contractor Signature
Call for inspection - 639-4175
Contractor Notes :—
CITY OF TIGARD
OREGON
April 22, 1996
LHL Construction
7110 SW Fir Loop
Tigard, OR 97223
In a routine accounting of application fees received in the last month, we discovered that
the following permits were issued with the wrong amount acc assed for the parks system
development fees:
\,
1.)MST96-0168 13866 SW Alpine Dr. Hillshire Summit #2 Lot 46
The resolution to change Parks SD fee was adopted on 2/20/96, with a start date of
3/21/96. As the above permit were submitted to the City of Tigard on 3/21/96, the
correct Parks SD fee should have been $1050.00 per permit. Your company was issued
this permit with Parks SD fees of $500.00, paid on 4/11/96 with receipt number 96-
2
6
278050.
Please remit the balance of$550.00 immediately to bring this case current. A HOLD h is
been placed on the case and building inspections will not be permitted until the balarce
due has been remitted.
Please contact me directly if you have any questions regarding the above.
Sincerely,
Jill Idrich
Customer Service Supervisor
Development Services
13125 SW Hall Blvd., Tigard, OR 972.23 (503) 639-4171 TDD (503) 684-2772
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
BUCKAROO ELECTRIC
16780 S UNION MILDS RD
MULINO OR 97042
Electrical Signature Form
Permit # . . . . : MST96-0168
Date Issued. : 04/11./96
Parcel . . . . . . : 2S109BA-HS246
Site Address : 13866 SW ALPINE VIEW .
Subdivision. : HILLSHIRE SUMMIT #2
Block . . . . . . . . Loc : 046
Zoning. . . . . . : R-7 PD
Remarks :
PATH I
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, tl-e signature of the supervising electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
WIdI�R : ELECTRICAL C'-'-)NTRACTUR :
LHL CONSTRUCTION BUCKAROO XLECTRIC
7110 SW FIR LOOP 16780 S UNION MILLS RD
TIGARD OR 97223 MULINO OR 97042
624-7714 Phone # : FAX-829-3853
Reg # . . : 89524
X 4 - ,.r,� �
Signature of Supervising Electrician
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. #1310
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
CERTIFICATE OF
OCCUPANCY
PLRMIT #. . . . . . . : M6196 OIL-0
DATE ISSUED: 10/23/96
PARCEL 29109BA-HS2'4(,
;ITE. ADDRESS. . . 1 13866 SW ALPINE VIEW
AJBD I V I S I ON. . . . i HIL-LSHIPF SUMMIT #2 2 ON 1146 c P 7 PID
1ALOCk. . . . . . . . . . I I-OT. . .. . . . . . . . . . . s046
"LASS OF WORK. NEW
IYPE OF USE. . . aSF--*
TYPE OF CONSTR:`JN
')CCUPANCY GRP. i R3
,..)CCUPAN(.,,' LOAD:2
i4emarkst PATH I
Owners
LHL CONSTRUCTION
711o sw fR LOOP,
I'TOAPD OR 97223
I-,hone #1 0524-7714
IMI.. CONSTRUCTION INC
7110 5W FIR LOOP
rlor*[) OR 97223
Phone #: 6,P4-7714
Reg #. . . 53769
This Cert illicate u.1y'ants OCCUPlan- , of the above t-toferenced builditig or Pov tiOn
thereof and confirms that the ilding has been inspected for comPliance with
the State of Oregon Specialty Cocips for the gro p, occLtpancy, ancj' ijfte uncier
-ihich the referenced permit was iss,.Aed.
BUILDING INSPECTOR G OFFICIAL
POST IN CONSPICUOUS PLACE
MASJFF� P,ERMIT
F
PI #. . . . . . T9CITY OF TIGARD DATEER1111'ISSUED: . 04/1MS6--01681/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Orogon 97223*8199 (503)839.4171 PARCEL_ 2S109E;A—HS246
'SITE (.4)DRE SS. . . - 13866 SW AL-r-IINE VIEW
"'UBDIVISION. . . . : I-IILLSHIRE SUMMIT #0 ZC)NINCS: R-7 F,D
I-ILOCK. . . . . . . . . . L 01.. . . . .. . . . . 10 1.1
Remarks: PATH I
-------------------------------------------------------------------- BUILDING ----- -----------------------------------------------------------
REISSUE:MST94-0454 STORIES,...... : 2 FLOOR AREAS----------- BASEMENT... : 0 sf REQUIRED SETBACKS---- REQUIRED---------- --
CLASS OF WORK.;NEW HEIGHT........: 28 FIRST....: 1592 sf GARAGE.....: 755 sf LEF7.......... J SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD...,: W SECOND...: 115C, sf FRONT.........: 20 PARKING SPACES: I
TYPE OF CONST.:5N DWELLING UNITS: I FINBSPIENT: 0 sf RIGHT......... : 17
OCCUPANCY GRP.:R35 BDRM: 3 BATH: 3 TOTAL------: 2744 sf VALUE.A: 190338 REAR..........: 49
---------------------------------------------------------------- PLUMBING --------------------- --------------------------------------------
131 WS.......... C', WATER CLOSETS.i 3 WA RING MACH..: I LAUNDRY TRAYS.: I RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 5 DISHWGHERS..., I FLOOP DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS— : 0
TUB/SHOWERS.,.: 4 GARKA DISP.,i I WITER HEATERS.: I WATER LINE ft: 100 BCKFLW PREVNTR: I GREASE TRAPS.,: 0
OTHER FIXTURES: 0
--------------------------------------------------------------- MECHANICAL -------------------------------------------------------------
FUEL TYPES----------- FURN s 100K 0 BOIL/CMP ( 3HPi I VENT FANS.....: 4 CLOTHES DRYERS: I
/GAS/ / / FURN =10* I UNIT HEATERS..: 9 HOODS.........: 1 OTHER UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACES: @ VENTS.........: 0 WOODSTOVES.... 0 GAS OUTLETS...; I
----------------------------------------------------------------- ELECTRICAL ------------------------------------------------------------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS--- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTI AS-
1000 SF OR LESS: I @ 200 amp..: 0 0 - 1300 alp..: 0 W/SVC OR FDR..- 0 PIMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 5@09-.: 5 201 400 amp..: 0 201 - 400 alp..: 0 1st W/o SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR...... : 0
LIMITED ENERGY.: 0 401 - 600 am,o,.; 0 401 - 6N amp..; 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: @
MANE- HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+86ps-I00e y: 0 MINOR LABEL --10: @
1000+ alp/volt.: 0 —---—-------------------- PLAN REVIEW SECTION - -------------------------------
Reconnect rnly.: 0 c4 RES UNITS..: SVC/FDR)=225 A.: 1600 V NOMINAL: CLS AREA/PC OCC:
- ------------------------------------------------� FLECTRICAL - RESTRICTED ENERGY ------------------------------------------ ----
A. 5F REGIDENTIAL--------------------------- B. COMMERCIAL-----------------------------------------------------------
OUDIO A STEREO.: VAC" SYSTEM..: AUDIO I STEREO, FIRE ALARM.....: INTERCOM/P.IGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..- 0TH: X BOILER......... : HYAC_......... LNNDSCAPE/IRRIG: PROTECTIVE SIGNL;
GARAGE OPENER..: CLOCK.......... : INSTRUMENTATION: MEN CAL........: OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL 11 SYSTEMS: 0
Owner: -----------------------------------Contractor: ----------------------------- TOTAL FEES:$ 2212.63
LHL CONSTRUCTION LHL CONSTRUCTION INC
7110 SW FIR LOOP 711@ SW FIR LOCK'
TIGARD OR 97223 TIGARD OR 97223
Phone 0: 624-7714 Phone #: 624-7714
Reg 0..: 53769
'his permit is issued subject to the regulations conta?ned in the Tigard Municipal Code, State of Ore. Specialty Codes and all Other
3PPlicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspenled for more than IN days.
--- ------------——---------------------------------- REQUIRED INSPECTIONS --------------—-----------------------------
footing Insp PLM/Underfloor Low Voltage Gyp Board Insp Electrical Final
Foundation Insp Mechanical Insp Fireplace Insp Rain drain Insp Mechanical Final
Post/Bean Struct Plumb Top Out Gas Line Insp Water Line Insp Plumb Final
Pott/Beam Mechan Electrical Servi Gas Fireplace Water Service In Building Final
Crawl Drain Framing Insp Insulation Insp Appr/Sdw1k Insp Erosion Control
M I t t e 'i i g T1 a t 1-i?,e I s s;i-k e d y : >n� -
Call for, inspec=tion — 639-41757
M -,J'7- 0 i f�
' |
PERM IT
CITY OF TIGARD D A T E I S S U* E' I")':* 0-4 1 .1. 17)6
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*6199 (503)639-4171 P,ARCEL.: 29109DA—HSC-.46
_ASS OF WORK. . . :NEW DWELLING UNITS. . : 1
(JWner-: FEES
'7tl@ SW FIR LOOP, PIRMT $ 2200. 00 CJS 04/11/96 96-278750
INSF' $ 35. 00 CJS 04/11/96 96-276750
116ARD OR 97223
Phone #s 624-7714
CONTRACTOR NOT ON FILE
� Ph * $ 223o mm TOTAL
�
-~ '
� REuu^mzu INSPECTIONS ------
|
This Applicant agrees to ^^~"^r with all the '.^.. .— regulations--- ____vInspection
of the Unified Sewage Agency. The permit expires 180 days ft,om
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 the measurement
qiyen, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, th t Her shall purchase —--------
a "Tap and �ide Sewer" Permit and the Age y ill install lateral,
I ss 1-t e d By '),A
V Call fat- inspec.,tion 639—A175
�� _ '
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Cu,Iled
(503) 639-4171 CTS
13565141
Jobsite Address: - , V/E ,,
Subdivision: � ��S�nt� �c.1 '� Lot#
Office Use Only
Valuation:
fav 3� �/ Contact Date / / _Initials
-- Result
New Construction Only: (Square Footage) PlanciJRec
HouseGara e: Permit # _�5 , U illy ' rJ
g --- -- Reissue of (Vl nl7 )5 - C•3 I
Corner Lot?(r Y.__% N Flag Lot? Y N Map & TL #Zone _
Plat #� - �!''• i :
Owner: � t �C�S U-c��� —
Approvals Required
Address: -1 11 Cl^- �L,U -�yZ �'���
Planning Setbacks Solar Q�-AyA 6 N.
Engineering -j; Q,c�
Phone1 1 Other
: (r ��� ) 6 �(—�7 ) 1. --
Contractor: J��1VV� Items Re aired
Subcontractors
Address _._ _-- Truss Details
Other [�-
----
Phone: �----�- _--_ Notes
Contractor's License # —,13! 6 — —
latt c17 copy of current Oregon license)
Cori;act I`Jame � �
Contact Phone.
SubcontractP s: } Architect/Engineer: (pn
1�c.��� ..-- ____�
Plumbing: ,� �M U tiyt>(J �y [, Address:
Mechanical: _ Y2�(J �� T (q `— — —
(attach ojff current OR Contractor's License)
1 +; r ' VU�Inc•l(ZQO Phone ---
J'J8 DESCRIPTION:
ApplicantSigrS to 601� / Applicant Phone number
o.t: l
Received by: 4j Date Received
•+'IoyMGY[[op
Permit;$ Account Description Amount Amt. Pd. Bal. Due
�51� Bldg. Permit (BUILD) 660'x0
Plumb. Permit (PLUMB)
Mech. Permit (MECH) "�! 9)
f,c U?�>
15ie1-Tax M111%) y u -3
Bldg: ���a'c.- z �'c)
Plumb: 11,2- >
Mech: -��
Plan Check (PL',NCK)
c�
Bldg: L)
Plumb:
Mech:
cal �
-3 ft (' U to Sewer Connection (SWUSA) ci
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residentlal TIF (7117-R) a.,
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL) ^�� t)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrf Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) G j� ?e
Erosion Planck]COT (EROSN) .�"f 2r JV
TOTALS: ".7
ISIERRA PACIFIC
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DEVELOPMENT, INC.
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P.O. Box 1754 L 'cE OSWEGO, OR 97(.35 (503)68d, 1175 FAX (503) 684-3176
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'PHIS VOUCHER EN'T'ITLES Lilt, � t fr?A
TO ONE ( 1 ) TIF CREDIT FOR LOT ( IN THEh't mr,-k-y
SUBDIVISION.
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