10620 SW COOK LANE-1 «.na.i»n�umpu,YYfIN,r.«...,...«wr..,,n.M.M.,,.,N.uw.r, °WIy.�..wY.� ,.+«,...,.,,...r�...„.awv,+.M..�r•wwnwowrrww
10620 SW COOK LANE
CITYOF TIGARDELECIrN'ICALPERMIT
PERMIT#: i_LC1999-00484
DEVELOPMENT SERVICES DATE ISSUED: 8/5/99
13125 SW Hall Blvd..Ticiard. OR 97223 (503) 633-4171 PARCEL: 2S 103DA 0.5800
31TE ADDRESS: 10620 SW COOK LN
SUBDIVISION: FANTASY HILI. ZONING: R-3.5
BLOCK: LOT : 012 JURISDICTION: TIG
Proiect Description: Service or feeder less than 200 amps
RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCEL'_ NEOUS_
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:V
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER _ BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION: i
I
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amu: EA ADD'L BRNCH CIRC: IN PL-ANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: v >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only SVC/FDR>=225 AMPS_ CLASS AREA/SPEC OCC:
Owner: Contractor:
RESLER, MIKE & BARB OWNER
10620 SW COOK LANE
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES _ e Required Inspections
Type By� Date Amount Receipt _
Elect', Service
PRMT BON 8!5/99 $64.25 99-317434 _ Elect'I Final
5PCT BON 8/51.,9 $4.50 99-317434
Total i $68.75 ORIGINAL
This Permit is issued subject to the reguta;ir ns contained in the Tigard Municipal Code. State of OR. Specialty Cortes and all other apps 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 d w, l<is
su-+)ended for more than 180 days ATTENTION Oregon law requires you to follow rules Fdopted by the Oregon Utility Notification Center. Those
rules are±set forth in OAR 952-001-00 i 0 ip rough OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC at(503)
245-1987. -�
Permit Signature: lam_- Issued By:
t � ,
_OWNER INSTALLATION ONLY
The ins'allation is being made on pro"pe I own which is not intended for sate, lease, or rent.
U,,NNER'S SIGNATURE: ,�-s- �,, ,� ___� —�_ DAT6:�S, �••' `� r f
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _.`_ _-_ __` — DATE:_..
LICENSE NO: ._� -------- -------..- - -- ----- --
Call 639-4175 by 7:00pm for an inspection the next business day
a:
ceTY OF TIGARU Electrical Permit Application Plan Che
13125 SW HALL BLVD. Recd By _
TIGARD OR 97223 Date Recd —
Phone(503)639-4171, x304 Date to P.E.
Inspection (503)639-4175Date to DST
Print of Type Permit#
Fax (503) 598-1960 Incomplete or illegible will not be accepted Called
1. Job Address: v 4. Complete Fee Schedule Below:
Name I
a e of Development_�' � r _ Number of Inspections per permit allowed
Name(or name of business)_ _ _ Service included: Items Cost Sum
C
Address �n6�jZ ) _�_ (.,� 4a. Residential-per unit �—
City/State/Zip__��yyra__�)) �jl ZZ a, ---- 1000 sq ft ,)r less --- $ 11775 n
Each additional 500 sq.ft.or —' --
Commercial ❑ Residential YSJ Limitedportion thereof _ $ 2625
Energy $ 60.00
Each Manurd Home or Modular
2a. Contractor installatiort Unly: Dwelling Service or Feeder $ 72.75
(Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders
Information for COT data base). Installation,alteration,or relocation
Elech ical Contractor _ 200 amps or lesa _ $ 64.25 �y 5~ 2
Addi ess A v 201 amps to 400 amps $ 85.50 2
City _State Zip 401 amps to 600 amps _ $ 128.50 _ 2
-- 601 amps to 1000 amps $ 192.50 2
Phone No. _ _ Over 1000 amps or volts $ 36375 2
Job No. - _ Reconnect only $ 5350 2
Elec. Cont. Lice. No. _ Exp.Dale 4c.Temporary Services,r Feeders
OR State ^CB Reg. No. __—Exp Date Installation,alteration or relocation
COT Busir Qss Tax or Metro No Exp.Date_ 200 amps or less $ 53.50 _
— 201 amps to 400,mps $ 8025
Signature of Supr. Elec'n 401 amps to 000 amps _ $ 10700 —
— -- Over 600 amps to 1000 volts, —^ -
License No. Ex)Date see°b"above.
Phone No -_ 4d.Branch Circuits
- -- — New.alteration or extension per panel
I he fee for branch circuits
2b. For owner installations,: with purchase of service or
M� \ feeder fee.
Print Owner's Name L1iSXs�t.�_"t� g Lr Each branch circuit $ 535 2
Address_ j��—��Z b)The fee for branch circuits
r without purchase of service
City _1 _ _ State �i_Zip `�z�3 i or feeder fee.
Phone No 543 6,311 . 69 t3 7First branch circuit $ 37.50
Each additional branch circuit __ $ 5.35
The installation Is being made on property I own which is riot 4e.Misrelloneous
intended for sale, lease or rent (Service or Teener nut Included)
Each pump or Irrigation circle _ $ 4275
Owner's Signature `! Each sign or outline lighting $ 42 75 ---
�— Signal c!rcult(s)or a limited energy
3. Plan Review section (if required):* panel,alteration or extension $ 6000 _-
Minor Labels(10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f.Each additional Inspection over
4 or more residential units in one structure the allowable In any of the above
Service and feeder 225 amps o;more Per inspection $ 50.00
_
System over 600 voteFur hour $ 5000
s nominal In Plant $ 59 00
Classified area or structure containing special occupancy as - --
described in N.E.C.Chapter 5 5. Fees:
5a.E nter total of above fees
Submit 2 sets of plans with appl!cation where any of the above apply. 1 I(%Surcharge(.05 X total fees) $
Not required'or temporary construction services Subtotal $
5h.Enter 25%of lime iia for
NOTICE Plan Review if required(Sec.3) 1
PERMITS BECOME VOID IF WORK OR CONSTRUCTI:IN AJTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONS IK'UrTlnt.' rt
WORK IS SUSPENDED OR ABANDONED FOR A PE.tIOD OF 180 DAYS ❑ Trust Account#
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due t( �5'
i\dstslform0elcctr!c.doc
�'�� ®� �'���® --ELECTRICAL PERMIT
PERMIT#: ELC1999-00,190
DEVELOPMENT SERVICES DATE ISSUED: 8/9/99
13125 SW Hall Blvd.,7iciard. OR 972.23 (503)639-4171 PARCEL: 2,S103DA-05800
SITE ADDRESS: 10620 SW COOK LN
SUBDIVISION: FANTASY HILL ZONING: R-3.5
BLOCK: LO'i : 0;2 JURISDICTION: TIG
Proiect Description: First branch and two adc'itional branch circuits
RESIDENTIAL UNIT TEMP S_RVC/FEEDERS _ —� MISCELLANEOUS
1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION:—
EACH ADD'L 500SF: 201 - 400 artm: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FUR: 601+amps - 1000 volts: MINOR LABEL (10)-
SERVICE/FEEDER _ BRANCH CIRCUITS _. ADD'L INSPECTIONS
0 - 200 amp: WISER"ICE OR FEEDER: _ PER INSPECTION:
201 - 400 amp: 1st 0,/r.)SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
10004• amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect ani! SVC/F'`R>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor.
RESLER, MIKE & UARB RED'S ELECTRIC CO INC
10620 SW GOOK LANE 2002 SE CLINTON ST
TIGARD, OR 97223 PORTLAND, CR 97202
Phone: Phone: 233-6467
Reg#: SrJP 20595
LIC 000044
ELE 26-152C
-- FEES
_ �Requi -d Inspections _
Type By Date Amount Receipt Flert'I Service
FRMT BON 8/9/99 $48 20 99-317496 Elect'l Final
SPCT BON 3/9/99 $3.37 99-317496 t G
}Total $51.57 !`, R I INA
phis Permit is issued subject f.o the regulations contained in the Tigard Municipal Code,State C OR Specialty Codes and all other applicable laws
All work will be done in acoordsnce with approved plans This permit will expire if work is not started within 180 days of issuance.r,r if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregor Utility Notification Center Thu,-'e
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rule, -,,erect questions to O0C a,(303)
246-1987 / 1
permit Signature: t Issued By: Gey t
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: — �__ ��__ —_ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: i't l,-4 1
;kArn,
`^--.------ DATE:--
III
ATE_!- "
LICENSE NO- ---- ---- -- — —
Call 6394178 by 7.00pm for an inspection the next business day
L
AH/C3/1999 08:27 2331281 REDS ELECTRIC CO F'111AE kit
Community Developmont ELECTRICAL PERMIT A77PLICATION
13125 SW Hall Bivd.
Tiqard, OR 97223 Planck/Rec. #
Permit #
Phone (5031 639-4171 Date Issued `) '
Am FAX (503) 684-7297 --- -- - _
ISSUr'� by
CITY OF TIGAIRD rDD No. (503) 684.2772 __-
� j( Inspection (503) 635-4175
1. Job Address: ^ - - --�� 4. Complete Fee ,Schedule Below:
Narne of Development_ Number of Inspectiona per permit allowed -•-• -
Address__.l_ >r"-EC- _Lo%jy t SarvicN included Ilnmr, cost(sa) Sum
City/State/Zip___ Ia. Re;dper enlial- punit
,nm
m 1, or 66A :1,�un
Ew _ttonel 5no ari 11 or
Name (or name of business)-lie T �VVtI ponanthereal WSW
Cnmmorclal o RAniclontlal® Umai4 Erwvv - << r.,
Each Menul'd Nnmu nr MMutar
pwelf�p 3etil•�nr Fe*3er ___ fP� NI
2a. ContrsCtor Installation only: 4b.Services or Feodere
� (t� Irsl00al ion.eht rabcn.or relaaLnn ---
Electrical Contractor � 2tw scala or lase flet oe
AddrASS �,Qp_, ],�_,SyG , 101 amps to uro umpe yo m
`�f,s, a01 em to Mo em
City. C^;�.rA.eC {- ;:�lati?..Q�_ zip-79� noI amp"1.IWO amp% Vo ot ..--- --
Phone No01
__� . IWO amps� „ana $3.0 00 —__ r
_ 7
Contractor's License No-2.L—a a!'2�� Re rineA orlly $5000 "
Contractor's Board Reg. No..— &-e &V 11f 4c.Temporary Sorvlcee or Feaderie
naurNshon,aharet o or relayhon. 2
Signature of Supr. Elec � f / - 200 ample or tees syn oo �- 2
License No.�Q S9 5_a Ph<�*0. v 201 ar„Ve h ally W„Pa
401 am2e 10 0n0—pa $100 00
cher 000 amp*I. 1000 rolls -----
2b. For owner Installations: moo•b•fttmo
Jd. Braneh Circuits
Print Owner'; Narne'�_ Newa4eraakn o,erherwon Per r.enet
Address a)The lee for Nanch esrcuns MOM
City State lip purchase o<r.rke e.lr.e.r Are. 2
-- — -- Fad,b,a—h nrrua t:5 00
Phnne No. h)The lee ler heamh rrrnim wlthrwt -- �` ,�,
The installation is being made or property I own Whir.n is purdu.e,ler earrica a ft d Aw o- 2
not Intended for sale, lease or rent Ford trach oro"I _- W 2
rerh wtdllinnal hrsnrh rerun SF m
Owner's r;ignah,re 40. Miscellaneous
(Servirs or loader not included) 2
3. Flan Review v*ction (it required): Each sang or irrvallon Corse 940 on 2
Eerh elon w aaN,a lighling pso no
Retinal cimuil(a)or s Ili,fled energy 2
PlaaaM check appropriate ilem and enter ice in sec!lon SB, penal a9.,■llon or ad.naioo r:/0 00
_ 4 or mole residential units In one slnicture Mr,Mr Leteak 1.10) - - $l0a D0
Service and feeder 225 amps r.more
System over foo volts nomiral 41. Each additional in-goaction over
Classified area nr strurtura remaining special ocauparry the allowable in any of the above
a,:clAscribad In N E C chapter 5 *r im pw;,inn -� iib no —
'ar
Submit 2 sets of lana with In Plar't
p application where any of the above
apply. Not required for temporary mnalruclio^ services
5. Fees:
NOTICE. so. En or'nPAI of ahrve 19es s
,large ( 05 X total feet)
PERMITS BECOME VUIU IF WORK OR CONTRUCTION sUbm 'r s __
AUTHOF417CO IS NOT rOMMENCED WITHIN Igo DAYS, OR IF I Sb- Enter 25%of line A for
CONSTRUCTION OR WORK is SUSPENDED OR ABANDONED FOR I Plan Review it requirod(Sec 3) s
l btota $
A PERIOD OF 1B0 DAYS A7 ANY TIME AFTER WONT( IS Su -�.—,
c;OMMENCED Trust Account 0 S
f3al9nce DUO
varyy r.r.1"P. w I I
lj
i
Permit #: 99 CO,�P/ -7 --
4F �
Address:
IN. r ZI Issued by: L1f'17Ji�'t�3fh Date:
1$'15q
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, DRS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to .sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Ucensed
argil '`pct and engi•teer applicants, exempt from registration under ORS 701.010(7),
nee iot submit .his statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
® 1. I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is i
(Name) Contractor regis. #
I will instruct my genera:contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, : will contract with a contractor who is
registered with the CCB ind will, immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I ha%a read and do understand the Informalioll
Notice to Property Owners about Copstwction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
CITY OF TIGAR® MASTER PERMIT
PERMDEVELOPMENT SERVICES DATES UIED: M3999 �9-00217
13125 SW Hall Blvd. Tigard, OR 97223 5 rr
SITE ADDRESS: 10620 SW COOK LN' ( 06� NAL PARCEL: 2S103DA-05800
SUBDIVISION: FANTASY HILL ZONING: R-3.5
BLOCK: LOT:012 JURISDICTION: TIC
REMARK: Single-family addition
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 14 FIRST: 288 of BASEMENT: of LEFT. SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: of FRONT: PARKING SPACES;
TYPE OF CONST: 5N DWELLING UNITS: rINSSMENT: at P.r IT: 11
OCCUPANCY ORP: RVALUE: $20,05 .323 BDRM: BATH: 1 TOTAL: of REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS, 1 GARBAr-::DISP: WATER HEATERS: %VATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
_ MEr.HANICAI
OTHER FIXTURES:
FUEL TYPES FURN�100K: BOIL/CMP.OHP: VENT FANS: 1 CLOTHES DRYER:
FURN>•100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: /
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS AOD'L INSPECTIONS
1000 SF OR LESS- 0 200 amp: 0 200 amp: WISVC OR FDR: PUMP/IRRIGATION: PER INSPE,:TION:
EA ADO'L 800SF: 201 400 amp. 201 - 400 amp: tat W/O SVC/Fr is SIGN/OUT LIN LT: PEP HOUR.
LIMITED ENERGY: 401 800 amp: 401 800 amp: EA ADDL BR CIR: SIGMAL/PANEL: IN PLANT:
MANU HM/SVCIFDR: 801 - 1000 amp: 801.ampa•1000v: MINOR LABEL-
1000+ampIvou:
Reconnect only:
PLAN REVIEW SECTION
>•4 RES UNITS: SVC/FDR>•228 A.: >800 V NOMINAL: CLS AREA/SPC Or,C:
ELECTRICAL•RESTRICTr D ENERGY
A SF RESIDENTIAL _ B.COMMERCIAL, _
AUDIO 6 STEREO: VACUUM SYSTFM: AUDIO 6 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOr)R LNVSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: FP0TEC1IVE SIGNL:
GARAGE OPENER: `/6 CLOCK: INSTRUMEN-'AT10N: MEDICAL- OTHR:
EXPIRED DATAfTELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 573.52
RES LER,MIKE is BARB 1 / STRIDE CONSTRUCTION CORP This permit is subject to the regulations contained in the
10620 SW COOK LANE 111 9222 SE WO DDSTOCK Tigard Municipal Code,State OR Specialty Codes and
TIGARD,OR 97223 PORTLAND OR 97286 all other applicable laws, All woo rk will be done in
accordance With approved plans. Th;r permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phone: Phone: Oregon law requires you to follow rules arlopted by the
Oregon Utility Notification Center. Those rules are set
Rao R: LIC 01-08095 forth it OAR 952-001-0010 through 952-0M-Q080 You
may obtain copies of these ruler)r direct questions to
OUNC by calling(503.1246-1987
REQUIRED INSPECTIONS
Sewer Inspection Underfloor insulation Plumb Top Out Rain drain Insp Building Final
Footing Insp Crawl Drain/Backwater Electrical Service Electrical Final
Foundatlon Insp Feoting/Foundation Dr; Electrical Rough In Mechanical Final
Post/Beam Structural PLM/Underfloor Framing Insp Plumb Final
Post/Beam Mechanica Mechanical Insp ;nsulation Insp Final Inspection
Issued By : Permittee Signatur _
Call(503)9 4175 by 7:00 p.m.for on Inspection needed the next business day
f -
CITY (-'F: TIGARD Residential Building Permit Application PlancheUc#Rec'
13125 SW MALL BLVD. Additions or Alterations Date Hate e
Date 7 ��
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) nate to P E.
V 503639-4171 Date to DST
F 503-684-7297 Permit
Print or Type called__
Incomplete or illegible applications will not be accepted
Name of Project -- ------- --- - Name ----------^- A'
7
�— Job , e � Architect Mailing Address
address Site Address
e'v L•-t L City/State Zip Phone
Name
Owner Mailing Address
--l-0 Engineer Mailing—Address—
City/,;tate
ddressCity/tate Zip Phonn ll ``,�� -
"(C�Jo
' City/State Zip Phone
General Name 1 /*
Contractor : e. CiO.151 Descrihe work New O Addition O Alteration O Rpralf O
Mailing Address to be done:
Prior to permit 9 z z z �,r ' Additional Description of Work:
issuance,a copyC/- � Phci�
of all licenses or �, � � 72J-9606 � t Ski
a:e required if Oregon Const Cont.Board Exp.Dater PROJECT
expired in COT L.ic.# SVA, UATION $ _ _
database -- - f - --
Mechanical Name _NEW CONSTRUCTION�bNLY:
Sub- �. J�t 1 Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing Address ` -
Prior to permit Indicate the restricted energy installation by the electrical
issuance,a crnv City/State zip Phone subcontractor in the following areas
of all licenses Restricted Audio/Stereo
are required It Oregon Const Cont. Board Eyp.Date Energy S stem Alarms
expired in COT Lic# Installations Vacuum Irrigation
_ database _ System System
Plumbing Name l S r , (check all that Other:
Sub- ------- .- 1 i I y' _PPI )
Contractor Mailing Address Comer Lot YES ''O Flag Lot YES NU
f �� �� chei.k ons_ check one
/9i 4q 7 _ !!�__ _ Has the Subdivision Plat recorded? NIA YES NO
r nor to permi! yf t e is Phone
is.,uance a copy /"-�� � 3 -1-841X -----of au;licem-ps are Oregon Const. Cont Board Exp.Date
required if L c# I heaiby acknowledge that I have read this application,chat the
expired in COT
database Plumbing Lic # Exp Date information given is correct,that I am the owner or authorised agent
of the owner,and that plans submitted are In compliance with
_ Oregon State laws. _
Name Signature of Owner/A it �J� e
Electrical � r�
Ccntact Person Name- � Phone#
Sufi- Mailing Address
Contractor Cit _ �-
y/State Zip Phone
^.ior to permit
issuance,a copy _ FOR OFFICE USE ONLY: _
of all licenses are Oregon Const.Cont Board Exp. Date PIAT#; IMap/1 L#:
required it Lic# T' 1_ -h I /t
expired in CrT _ ' rP —
d.tah'se ElecO.rical Lic #v Exp DatebocknK
Zone; Solar I.
-
Electrical Supervisor Lic.# - Exp Date ngli ewng Approval: Plann'irl ,Approval: 1 IF;
1
i Wstslformslsfar'daft doc 4/20/99
I`
WASHINGTON COUNTY DLPARTMENT OF HEALTH AND HUMAN SERVICES
i ENVIRONMENTAL HEALTH AND SANITATION
( 155 N. First Avenue
Hillsboro, Oregon 97124
Q (503) 648-872
Tax Map #:
Road Name: ,.1,�
P F RA/1 11'
i New Construetiou .._..._�
Repair( Majo(, Minor 1
Alteration �An On-Site Sewage Disposal Permit is issued to : u�-
for a period of'one ear from the date issued. _v `�—
(This Permit is NO_T transferable)
i All septic systems must be installed as indicated on the approved plot plan. If any changes are
anticipated, a revised plot plan must be submitted to the Washington County Department of
Hea;'h and Human Services fir approval. The plot plan is part of the permit.
Before a drainfie!d can be backfilled, a pre-cover inspection must be made. The inspection will
be made within 7 working dais after it is requested.
�... __
Date Issued: —0 �`� � (, O/L
Envire imental Health Specialist
.r..,+pp.,n„rya......._.-...-___-... ..-.. _. ..:.--E'.,ylrri`CK'.,.�..,�,"'•`T.'�'lnlK"'^'r."�'+*'sM=...,... ...,'T.�T........-^+.ww-...w..�....-... .... —...-..--....._".y.
WASHINGTON 'COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICE
ENVIRONMENTAL HEALTH AND SANITATION
155 N. First Avenue
Hillsboro, Oregon 97124
CR. #: Foyo (503) 648-8722
Tax Map #: �i��— q .� U�i 1 (_,j -�, J
Road Name. _7 ,
PERMIT
New Construction
Itepa�r( Maio ,10inor)
Alteration
An On-Site Sewage Disposal Permit is issued to
for a period of oneyear from the date issued.
(This Permit is NOT transferable)
All septic system] must be installed as indicated on the approved plot plan. If any change:; are
anticipated, a revised plot plan must be submitted to the Washington: County Department of
Health and Human Services for approval. 'rhe pot plan is part of the permit.
Before a drainfield can be backfilled, a pre-cover inspection must be made. The inspection will
be made within 7 workingd.ys after it is requested.
Date Issued: _ G' �` _ � 1_ 1A/L
Environmental Health Specialist
i
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08/24:99 TSU 10:27 FAX 5038994400 WASH CO HHS khoo?.-
RIP DE9 W CULT
LAND USE COMPAI'ISILT_TX STATMCMr
FOR ON—SITE SEWAGE DISPOSAL SYSTEMS
APPLICANT'S NAM! KAILIHG ADDRESS w P"(AIL
1TY S1AlE _ ZIP
TfAAISNIP RAIKE SECTI(M TAX LOT OR ACCT No
R n f 1 �j . C► �>
P A SII rv1SI0"/PwACTLOT BL= LuxtT
T f `
T M
vRaVERT'r IS A LOT ,1 REL'ORD LRFJl71:D BEwRE ALpAAT 1, 7901.
PROPOM LAUD LLS1
STATEtdRNT OF COMPATIEILTTX FROM APPRUPRIATE 1AND USE AUTHORIT'
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PROPERTY'S 2MIM0 D"10w171014
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