16658 SW JORDAN WAY �r.«•'.�AIIM^MR�" I�YIrY, :� RbIMNIMIM�MSr�tl@#N�"4'M�VNIO!'ct'7thf'*nti7r*�a
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i 13115 811 W1 Blvd. Tigs td, Orwgon 97
inspection Line (Rec-9-Phone)s 639-4175 Business Phones 639-4171
inspections_
Footing ? Underslab Meoh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out aas Line
BINALt
Post/Beam strut. Ban. Sewer Framing -Bldg,
insulation -plumb.
Past/Beam Hoch. Rain Drain `
Plbq. Underfloor Nater Line gyp. Bd. -Koch.
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Data Requeateds ///I
Addrosst /d� i �4 1�,��sr —� 'Permit 1s -
Builders (/
TRE FOLLONINO CORRECTIONS ARE REQUIRRDs
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Imprctors __ Dates
\ APPROVED __ DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13128 8W Hall Blvd.Tipard,OroUon 97223.8109 (503)809-417
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JUN-11-'93 FR i ).0' 15 I D:C I T1' OF K I I JG C I T'� FAX NO:5039-3T71 14612 P01 --- x
Post-it'brand fax transmaaalmem�a 7671 Mor pepee ► o,
1%KI�TG �'ITYCo.CHLA C,)-r 114ar-d-t' iromQ�i s�rCJ. nl
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!b'iUU SW 116th Avenue.iClrtg Clty,Orton 971 Phony; Dep=• �d \i+ ne N "-
_._-
COMMUNITY L FaxN Fac r ,
APPLICATION FOR (a% .3�/ 377 /
(Instractioas on i �. �, I
DATE `l3
1. NF1riE OF APPLICANT: t d) (7,KRA rPhone No. ���- �✓�� 2
ADDRESS: 1 !o $ S w A!f
ADDRESS OF PROPOSED IkffT 01lg2•!F]`FI' SA A_,
2. TYPE OF CHANGE, IMPROV 0-1ENT OR CONSTRUCTION FOR WHICH PERMIT IS REVJES=. -
DESCRIBE BRIEFLY - ATTAQt TWO CPPTES OF PLANS OR DRAWINGS OF
PROPO:ID PROJECT: 3 -L.0 f-1 �J?_A►4 r- A L& ah 1 U I 7'J aN ri 7R
--- ee
3. NAME AND ADDRFSS OF CONTRACTOR �1�<✓L//-1 L Z II-EA7�j r �T � All
9�2 8 S Li) G Ard S PHONE NO.�,a o-564, LIC MSE D70.
d. NEIGHBOERS WHO MAY BE AFFE= BY THIS PROJECT WILL BE NOTIP.L ? $Y -,RE CITY. i
S. APPLICANT OR HER/HIS REPRE.S'MMTIVE; MIDST BE pRESENT AT THE PLANNING CaftISSION
MEETING NEXT HEM ON
RErRESENTATIVES PIAN _PHr,eqE NO.
(The iicq City Planuinq Conlission Till consider anly thas,! applicat�., received at lust five (S) days
pri.or to a aeeting,�, h
' SIGNATURE
APFt ICATION RECEIVID
APPLICABLE FEE RECEIVED $_ r .5 �° TdT*AL_� ,o)• _
PLANNING COMISSION DECISION: ApprovedDeed
CONDITIONS -p K e-` '
�A nnu'� �A _Il A
/BP licati,l is it _tilid far s man nnly
Signature Date_
BOSB: re oaebuil ers La requires tl:;t .ii`persans Tha contract nr cork n tbei.r residence be
egistered Titd the Builders Board Thich wens the coattactur is bonded and insured an the job site.
For your protection, be certain your cankractor is registered by cillinq City Ball Ph: 639-1082. l
DOTE: A permit must also be obtained f- om the City of Tigard Depart_n=t of
Cemamity Developne"nt Yes. _ No
CITY OFrIGARD INSPE;G'riw.REPORT
The above listed project has been inspected and .approved TDenied
Date Cents
c>mn —
Signature__,. _
(&c i.Qd.ing i n,Apmc#nit pPon.AQ "-tf n_ ort¢ ( Y I copy to king ri-,ty)
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p j,1+SPECTION NOT_I_g9 � N
+ cl.t2 0! Tlyard Building Depaztsnent
�125 fill Ball Blvd. Tigard, Oregon 4%123
Inspectio9-�JYsa .(R -O-Pho S)s 639 4175 Bunineas Pho : ',639.44171
7,
Inspections � .- ! ��.__ i % .
Footing Nech; tdugll- n f' Apr/Sdws k
Round. r P1 ?ap Out Sao Line FINAL&
Post/Beam Struct. San. Sewer ?raminq -0144•
Post/Beam Mech. Rain Drain Insulation
P1Dg. Underfloor Nater Line Gyp. Bd. Msch.
Date Requested: ` ____TLm02
Addresss�/� Permit
Builders
- � 00
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
Inspector: Dates
\ APPROVED DISAPPROVED APPROVED SUBJECT TO ADM
Call For Reinsp.
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�`�` .. MWIdNX1MA�MIIWMefN9M0iM� ,. .. tb r .
CERTIFICATE' OF
CITY OF TIGARD OCCUPANCY
COMMUNITY DEVELOPMENT Of P qPERMIT M. . . . . . . c MST93 01:" +
13125 8W HaN Blvd.Tlatatd,Oregon 97291oll / c 2) 0 f71 is>F1TE I Ss'iLl1~D c Qf6/4Jw/93
'3IT'E AGDI:ESS. . . : 16658 SW JORDAt,! WY PARCEL: 2S,116PO -8E029 �
'':;USD I V I S I ON. . . . : FIE:UF'ORD GLEN
SL.f]CK. . . . . . . . . . .
__.._._._.__,_ „_.._......I�_QTN29__..__..._...._...�___.,..._...__..._._....._._._......__.___._.._...,.._.�. I
CLASS OF WORK. a NE:W
1 YPE nF- USE. . . c SF-
OCCUPONCY GRP. c R:3
OCCUPANCY LOAD t 1 15 4
Tf":NHNT NAME'. . . c
Remaar-kas PATH I GUNST'RUC.TION
C)wn car"t _ .. . .. _..__ _ __._.. _..... ......_.,._ .»,_._.,._.._....•___....M__
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BEACON HOMES
Ca O BOX 1368
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BEAVERTON OR 9707
Phone *c 524•-1999
Contralr..to-c
BEACON HOMES
(+O 8UX 1:68
BE1.4iIERTON OR 17075
Phone #- 524- 1991) t
Roy 1 70782
Occupancy of the above refpr,enc_ed bUi .lding is hereby given, rind r.er,tifies
the compliance with -the State Of Oregon Specialty Cade5 foo- the qv poll a,
c1cumpancy; and ut;? kinder-- which the i-ef•'Prenced per•�mit: wass i %st.iee.
EIRE Jf'F'ARTMENT I)_.11 I I ST� :L TOR
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POST 11',l CONSPICUOUS PL.ACF,
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INSPECTION NOT CE
city of Tigard Building Department
1.7125 811 Ball Blvd. Tigard, Oregon 97:2214
Inspection Line (Roc-O-Phones 639-4175 Businens Phor/6.Mk-4171
Inspections _
Footing Plug. Underslab Hoch. Rough-in rppr/Sdwlk f
Iound. Plbcj. Top Out Gas Line FINALS
I
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Nech. Rain Drain Insulation -Plumb.
� r
Plbg. Underfloor Nater Line `Qyp. �J -Hoch.
Date Requesteds Times AN PH f
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Address Permit #t _d D 17_7 �s
Builaere— ,�- .� �f��
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THE FOLLOWING CORRECTIONS ARE REQUtRSDt A�
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Inspectors_ DateC
``/APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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INSPECTION NO'.ICE
City of Tigard Build;Mg Departarent
13125 SH Ball Blvd. Ivigard, Oreg,3a 97223
Inspection Line (Pec-O-Phone): 639-4175 ausineas Phone: 639-4171 r ) i " 4
Inspection'-- - -- - — t
Footing Plbg. Underclab Mech. Rough-in Appr/Sdwlk <
.' ,
Foand. Plbg. Top Out _Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing �y� -Aldg.
Poet/Beam Mech. Rain Drain [ Insulation ' -Plumb. ` y
Plbg. UndrerfloorWnt r Lin Gyp. dd. -Mech.
1 Time: AM f'
Date Requesteds, � — PM ,
Addrens: 1
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Builder: i
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THE FOLLI.`WIhG CORREC'T'IONS ARE REQUIRED:
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---- 74e —�
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Inspector: - —�_ _- Date:_ _
-APPROVED _Y DIS PRnVED APPROVED SUBJECT TO ABOVE
cell For Reinsp.
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INSPECTION NOTICE fi 1
a City of Tigard Building Department
13125 9W Hall Blvd. Tigard, Oregon 97223
Inspection L a&J( -O-Phone): 639-4175 B—i ness Phone: 639- 71
Inspection:
Footing Plbg. Underslab ec=Ro-g�-- Appr/Sdwlk .
Pound. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer raminq -Bldg. I
{
7 Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor J410
r Line Gyp. Nd. -Mech.
r,
Date Requested: -Time: --AM _ PM
Address: =C-L��-- Peniit #:
Builders�� Z _
■
THE FOLLOWING CORREC,IONS ARE REQUIRED:
L �
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Inspector: _ — Date: / l
APPROVED IfiAPP VED APPROVED SUBJECT TO ABO
-Call For Reine.p.
Is �_�
INSPECTION NOTICE
City of Tigard Building Department =
' 1312° S' BeYl Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 -
Inspection•— —
:' Foot)ng P'bg. Underslab Nech. Rough-in Appr/Sdwll. ,
Fou-id.
g. Top Out -i:ae Line FINALS
f.i 1 hr
Past/Beam atruct. San. Sewer Framing -Bldg.
Post-/Beam Mech. Rain Drain Insulation -Plumb.
P:bg. Undarflcor Water. Lirye / C,p. Bd. -"ech. ,
Date Requested: —��I 1 � —Time:
AM
Addreae: `J Permit #t
Buil.der:
-
1
THE FOLLOWING CORRECTIONS ARF. REQUl""J:
i
Inspector: "
APPROVED -Y pISAFPAOVEDAlwak i� APPROVED SUBJECT TO ABOVE
y Cell For Reinsp.
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INSPECTION NOTICE
,.ity of Tigard Building Department
1:125 SW Ball Blvd. Tigard, Oregon 97223
inspection Linr iRec-O-Phons): 639-4175 Business Phone: 639-4171
,. Inspection:
Froting Plbg. Underslab Mech. iugh-in Appr/Sdwlk
Found. -�. Top Out Cas .ine FINAL:
Post/Beam S,:ruct. an. Sewer Framing -Bldg.
,:,..
Poet/Beam Mock.. Rain Drain Insulation
Plbg. Underfloor Water. Line Gyp. Bd. -dech.
Date Requested: --Time: AM _-_PH
Addreee: 47
� -4�� Permit f:
Builder: >
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
+' APPROVED DISAPPROVED J APPROVED SUBJECT TO ABOVE
ll Call Fcr Reinep.
VON{
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INSPECTION NOTICE
City of Tigard -Tullding Departzbent `�
13125 SM Hall Blvd. Tigard, orew"n 97223 r
InspP^tion Line (Rec-O-Phone): 6i9-4175 Business Phore: 639-4171
j Inspecticn:____--- — --.- ,
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
(\/Post/Beam Struct San. Sewer Framing -Bldg.
('Post/Beam Mech. Rain Drain Insula`-'on -Plumb.
Plbg. Underfloor Nater Line Gyp. Bl. -Meeh.
Date Requested:_ —TimE'a _�6r _,_PM
/J
Address:'�� -- (� L Permit �: G7 � `D�•�
THE FOLLOIIING CORRECTIONS ARE REQUIRED:
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9 Inspector Date: ----
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap. � � �-,�
INSPECTION NOTICE j
City of Tigard Building Department {
13125 S.: Ball Blvd. Tigard, Oregon 97223 1
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 m
i
Inspection:��— ---�
Footing Plbg. UnderelabHoch. Rough-in Appr/sdwlk
i
Found. Plbg. Top Out Gas Line FIN":
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Match. Rsin Drain Insulation -Plumb. S
P` . Underfloor 1�j Water Line Gyp. Bd. -h.�ch.
'! Date equ_Requested:. Tim:/^� J —_ Tune: / AM PM
Address: /i� 7/ I TL� Permit 1: C73 6),2 k �.
Builder,
THE FOLLOWING CORRECTIONS ARR REQUIRED:
1W F
ONW
_. ------- --- ---------- -- --- -Y----
nate:-.3- f--
--APPROVED -- DISAPPROVED APPROVED SUBJECT TO ABOVE
--Call For Reinsp.
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1
j INSPECTION NOTICE
y City of Tigard [Milding Deparfwent r
! 113125 Sit Ball Blvd- Tigard, Oregon 97223
Innpectlon Line (Rec-0-Phone): 639-41.7!� b+.afneae Phones 639-4171
I j
f'
Inspection: -- -- ,
r k8; 1
Footing Plby. Underelab Hoch. Rough-in Appr/Sdwlk
y d Pound. Plbg. Top Out Can Lino FINALS
Poet/Beam 9truct. n. Sewer Framing -Bldg.
Poet/Beam Hoch.
1 ) Insulation -Plumb.
Plbg. Underfloor �7ater LineGyp. ed. -Hoch.
_ U �
Date Requp ted: _Tinos/ AN _—PN
Permit i:�%.
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Builder:
THE FOLLOWING CORRECTIONS -M REQUIRED: S
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Inspector: Date:
----------.— Data:l.----/—
APPROVED DISAPPR)VED APPROVED SUBJECT TO ABOVE.
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_—Cell For Reinap.
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INSPECTION N ICZ
City Of Tigard Building pep&z't358nt
1.1125 BW Ball Cly d. Tigard. Jregon 97223
i
Line Rec-O-Phoneys 639-4175 Bueinass Phone: 639-4171
inspection C,
Inspections—
Plbg. Underrlab Mach. Rough-in
Appr/Sdwlk
jy (�}o/otin �
- nae Line FINAL=
l�ia��� nnnddd Plby. Top Out :
I
5Framing -Bldg.
Post/Beam Strut. San. Sewer
Post/Beam Mach. Rain Drain
Inaulation -plumb.
-Mach.
Plbg. Underfloor Water Line Gyp. Bd.
- �/ Time: AH —PM
J
Date Requesteds _S—
Address:
Builders— G C� —
TBE FOLLOWING CORRECTIONS ARE REQUIRED: —�
Dates — �
Inspector: _
APPROVED DISAPPROVED APPROVED SUBJECT TO AIIOVE
Call For Reinsp.
�Ln: L
r
INSPECTION NOTICE ".
City of Tigard Building Depertoent
13125 SN Ball Blvd. Tigard, Oregon 97 i
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41/1
Inspection: --—
Footing Pl:g. Underel.ab Mech. Rough-in Appr/Sdwlk 4
FINAL:
Ir Found. Plbg. Top Out Gas Line
Poet/@eam 5truct. San. Sewer Framing -Bldg.
s
post/Beam Mech. Rain Drain
Insulation -Plumb-
Plbg. Underfloor Water Lina Gyp. Bd. -Mech.
Date Requested:
�J Time: AM PM 1
Address:— J �12 _,,� rmit
Builder.:
i
THE FOLLOWINO CORRECTIONS ARE REQUIRED:
r
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—
Inspector: Dater — [
—�_.�- — --
APPROVED DISAPPROVED `J APPROVED SUBJECT TO ABOVR
Call For Reinep.
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CITYOFTIFARD
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COMMUNITY DEVELOPMENT DEPARTMENT osnoas MASTER fIcRI�II T ,
i 1ai2sSWHWIBlvd.P.O.Boec23397,T13W,OnOon erm(M)M4176 PERMIT #. . . . . . . : hIST93-006 a ,
i
639--•411.1 DATE ISSUED: 03/01/93 h,
SITE ADDRESS. . . : .kE*�E+�'" SW JUi�DAN WY ►�AHCEL s 251 16AD—BE:D49
SUBDIVISION. . , . : BEDFORD GLEN �'pj5 �'� �� ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .29
—
BUILDING
HE:I SSUE:IdST9e-00@2
DWELLING UNITS-. J. BASEMENT. . . . . . . . s0 s-f
CLASS OF' WORK. :NEW BEDRIVIS:3 BATHS.r: UARAGE. . . . . . . . . :556 s f "
TYPE OF USE. . . :SF FLOOR AREAS—— REQUIRED SETBACKS—
'TYPE OF CONST. :51\1 F I R'J'T. . . . s1894 s f 1_EF T. . 5 f t R I CFS r. c5 ft �
OCCUFIAI14CY GRP. :R;3 SECOND. . . s@ s f F'ON'T. s 20 ft REAR. . t 15 ft
STORIES. . . . . . . : 1 •TH'L RD. . . . :0 s f REOU T HED-- -----_—~-- -----— _
HEIGHT. . . . . . . . . 15 ft TOTAL----- --: 1894 sf SMOKE DETECTORS. :Y �
FLOOR LOAD. . . . t 40 ps f VALUE. . . . . 'b : 9.71.32 PAHKING SPACES. . : 1
Remarks : FIATH 1 CONS'(RUCTION
i"'LUIhB I hJG _
SINKS. . ,-. . . . . . . : 1— FLOOR DRAINS. . . . :0 BACKFLOW FIREVNTR':3, . : e)
LAVATORIES. . . . . s3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WArFR CLOSEI"S. . :_' SEWER t_INE. ('Ft) . 90 GREASE TRAPS. . . . . . . :0
DISHWFISHE-RS. . . . : !. WATER LINE (ft ) . : 100 O rHER FIXTURES. . . . . .0
GARBAGE D l'SF,. . . : l RAIN DRAIN (ft) . '0
WASHING MACH. . . : L SF RAIN DRAINS. . : 1
ly11J.HAN I CAL ----- FEES ------ --
FUEL 'TYFIE'S-- - ....__.. _._........_.... UNIT HTRS. . :O type amol.int by date rec:pt
/bAS/ / i VENTS . . . . . :0 TIF $ 0. 00 PILL 03/01/93 — r
MAX I INPUT s O BTU VENT FANS. . g3 BFIR1 i 42i. 0A FILL 03/01/93 —
F•URN ( 100K . . : I HOODS. . . . . . ti BPLC b 40. 00 JLH 02/03/93 93-236298
F"URN >mLOOK . . :O 'W10ODSTuVES. :0 B5PC '1, 21. 35 PLL 03/01/93 —
FLOOR FURN. . . . s@ CLO DRYERS. s 1 BPLG `4 15. 00 FILL 03/01/93 —
B01L/C1v1PI ( 3HP:0 O•rHER UNITS: i hIPR r fi 40. 50 PLL 03/01/93
GAS OUTLETS: 1 MPLC 6 10. 13 FILL @3/01/93 —
Owners ---••--._____._.___._.._._____.___._.._____.I►15F'C 1$ 2. 03 PLL 0.3/01/93 —
DEACON HOMES-- PPRT $ 132. 50 PLL 03/01/91 �
P 0 BOX 1366 P5PC $ 6. 63 FILL 03/01/93 �
111SL 41 3b. 00 FILL 03/0 1/93 -
BEAVERTON OR 97075
Phone #t 524-•1999
Contractor: ----_—___._—_—___—__-.._..__..----__—__
BEACON H01,IES
PO BOX 1368
a
BEAVERimi OR 97075
{'hong fi: 524--1999 1
_70782
130. i4 TOTAL
This perut is issued subject to the reu�ilations contained in the ------- REQUIRED INSPIFI TION>=► — ---
Tigard Municipal Lode, State of tire. Specialty Lodes and all other Foot/found Insp FirepInc.e Insp
applicable laws. Ail wor'l, will be none in accordance with approved Post/beam Struct Gas Line Insp
plans. This pereit will empire if work is n t start d within 180 Posh letam IheGhan Insulation Insp
clays of issuance, or if work is suspended dot• han Ai days. F'lm/undslab Insp Gyp Board Insp
PLI'I/Underfloor Rain drain Insp
Pe)•nrILtc�L� I_iIgT1Otti-ire ° Mechanical 1113p Water Line Insp
Plr_tmb Tap Or_tt Appr•/Sdwlk Insp
Issr_ted 1::•y : -� Framin:4 Insp Mechanical Final
L- La.11 1c)— irrsuer_t .iun
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13125 SW Il,u Blvd. PI.NCK/RECT
CITY OF TIGARD PO[lox 23397 PERMIT a
COMNIUNITY DLVELOPMEN'f DEPARTMENT Tigard,Oregon 97223
(503)639-417' DATE ISSUED
JOB BORES TAX MAP/LOT 2 S t Y �°419— BE D o2�J_
SUB: LOT: — LAND USE:
VALUATION:
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SPECIAL NOS
NAME: �� • REISSUE OF: e
DRESS: LAST REISSUE: 1
V FLOOD PLAIN/ •
PHONE: • SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ __ PLANNING:
F.DDRESS: _ ENGINEERING:
FIRE DEPT: _
PHONE: OTHER: _� 1
CONTR. BOARD #: o EXP DATE: 00
It ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: m111%4 LIST/SUBCONTRACTORS:
MECH; CQBUS TAX:
ARCH/ENGINEER • CALCULATIONS:
NAME: TRUSS OLiAlLS: —
ADDRESS:
W ' OIHER: —_
ruffillmorm- f 7
PHONE:
E PROPOSED B�11. USfs AAO
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COMMENTS: __•_.lr�
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APPLICANT SIGNATURE
Received By: _ Date Received:
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PERMIT -# ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAt. DUE
2 a v / Z7. oU !
s 3 v0�63 10-43: 00 Building Permit Fees -
Fees /3 2• �Z .3
10- 43I 00 Plumbing Permit
1 _�. p.jZ
10-431 01 Mechanical Permit Fees 7Z I
10-230 01 State Building Tax (5q)
Building
i Plumbing
a
Mechanical
10-433 00 Plans Check Fee / t`vS / 3_
Building �,14;,
Plumbing
Mechanical -
10-230 06 Fire
_ 30-202 00 Sewer Connection __—
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
i
25-448-04 Industrial TIF Fees _
15-448-06 Institutional TIF Fees _
I
25-448-03 Office TIF Fees
I
I
25-448-01 Residential Traffic Fee-
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
s
TOTAL /j�•/�{ o.
nm/3587P.WPF
_- .._.,.•n�S'�hkWaNMY7�Wlt�N,almaur.rrrerc^'*M+Y!rMMgM�'4n'n}A'�F1W1G:k6, ,Y#1lM oeru.-....:.,. ..:i,.......,.».r.•wr«:,rr.�.�MM�K�:7tr4-MMWwr� ,..
uiuswtlauliwd. PLR�CT # •
CITY OF TICTAIZD PO Mix 27797 -- —
Tigard,Oregon 97113 PERMIT
(�VI
COMMUNITY DELUPMGNT DI;PARTMI:NT (507)679-4171
DATE ISSUED
JOB ADDRESS: _ _ TAX MAP/!OT
SUB: -- LOT. _ LAND USE: —
VALUATION:
OWNER SPECIAL NOTES
NAME: REISSUE OF: _— - I
ADDRESS: LAST REISSUE:
■
FLOOD PLAIN/
PHONE: _ — SENSITIVE LAND: _
i
CONTRACTOR APPROVALS REQUIRED
PLANNING:
NAME:
ADDRESS: __ — ENGINEERING: _
FIRE DEPT: —
PHONE: _ — OTHER:
CONTR. BOARD #: __ EXP DATE:
IT MS REQUIRED j
SUBCONTRACTORS: PLUMB: _ _ _ LIST/SUBCONTRACTORS:
MECH: — BUS TAX:
ARCHANGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESc: — _ OTHER:
PHONE:
BLDG.BLDG. USE: -
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COMMENTS:
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APPLICANT SIGNATURE ~� _
Received By: _ _ Date Received:
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c J TY OF T I UARD RELE I PIT OF PAYMENT FtLGE I PI NO. :17, 75
CHECK AMOUNT a 690. 14
fald E BEACON
CASH AMULIN f t 0. 60
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F f�AY'MErN'r DATE: n 03/01 /93
c►DVRF6IL : FAL► BOX 1368 ', UBDTT V ISIUN 5
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__..__..._ .`4;:7. 00 FrL_UMDINL';�F�E RM _._� ...�..1,3p. 50
BU J L_L7 I trll`3�PE:RM 2--1 e R
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PLAN C AE C:rt FF. 0.154 1;� :�F PE:C:1'
18660 SSW JORDAN WA f'
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unified
sewerage SANITARY D NTH agency SURFACE WATER I '
166 WFlrst Ave„S03ef270.
0�8d2sboro,Or..97124
: I
014 1�•F.r;M I T
Lit', I'C: 1 '2:09? f:XI'TF(A'I'11Ji4 DMI. 06:'673 PE 1N 111 1,0,i':19y
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J"YUE TN!"-1 A1.LATTU14 c19) MAI
SINC;1.•I';1FAIN (A.Y ('ARC,i l.. r1t'sl 1/1 !i(') 26,300
Ll'1'k .iL'C 016 MH 111093 �
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11E.AVU�i TON 91075
F IXTUR,F kOUT VAt ENT Lill( I t. 1141.11 RF715.Cr1E'N11111.
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f:ll!'iI� 1::014,'x1':'1'; 1 CC)i4 =.'.100 ,04 iJr11f.IA 1411,;1 1''I'Y 10000
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WA T U1)AIN I I TY 100 , ()0
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permit conditions, The applicant'agrees to comply with all rules and regulations of the Unified Sewerage Agency. when calling
far an inspection, please refer to the permit Number. The permit expires one hundred eighty (180) days from the date of
issuance. The total amount paid (permit fee, connection charge, line tap fee end/or other charge) will be forfeited if tF,e
permit expires.
The agency es.doenot guarantee the accuracy of the location of side sewer laterals. If they sewer 1s not loWQe at the
lnstallernshall,wen. thepqrchasails'TapeandhollPrSide ewepr'tpWE,erinit atetheitYrrantll ichargenandroi thethe Agencytwill Inseall an. ,lateretf not o lotrted, the
6/90 WHIT! — USA, •LtlL — Accounting, GR6¢N —Inspection, YCLLON — Cwtolser
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Y.
,
unified
sewarage SAN ITARYO
1� Poo
155 N. agency SURFACE WATER T
155 N. First Ave.,Suite 270, Hil2lsboi,,�, Or.,97124
503 648-e6
CONNFCTTOM Pr R M IT
i ss!j r- TI A r. 1.2 4 9 2 F X P r 13 o r.T a N D A T E 0 F E k 111 '1 1.03°;94
STRUCTURE oDDRFSS 1 F'O 7. 1(d Q Y- PR OJ F C T *6tI& 1908
G TR 0 C T U FRt.'. `;TR E E T SW JORDAN WAY LOJ 29 111-OCK
TYPE CONN(A],I'l UN - NEW OF BEDFORD 6t-EN PHASE .'4
FYPE INSTALLATION... ( 19) PL.11 13WR/ERO CON/SDC
TYPE OCCUPANCY— ( I ) SING1.1'. FAMILY PARCF.1. ?St 16 AT) 26',M
UTP SLC 4716 MH 'ISOQ1
owm"r,- Etrocr.)N HOME'S
A]-.I1I1-"F5S F.0 BOX 1638 TRFATMENT ri ANI DURHAM
BEAVERTON OR 97075
F,HONE 626--9029 JURT130
F I'X T U R F EQUIVALENT' DWH.A..ING
UN I' rs 9F.'RVTC(.:! I1NTT9 040 UNITS I SERVICE UNITS
CONNECTION FFES SURFACE WATER IIF VF1_O1''M1'J1*1 1-*F*.'FS
SEWER I'll 11 N N F,".Cl I' 10N 2100 , 00 WATER Q 1.)A 1.1 TY 180100
LEO'S CREDIT 1.S0. 00>
WATER QUANTIT'Y 100 .00
L.E'SS CRFPIT < 0. 00::
EROSION CONTRM_
INSPECTION 40tOO
PLAN 26, 00
SUBTOTAL. 1.00 1 00 SUBTOTAL 166.00
TOT 01. 2266 .00
'52
. y-
ADPL. NAME PFTFR K11YISK PHONr.'
AFFILL.IATION VP
REMARKS PROJ# JY39 PEDF'OFM MFN ;1 1. 0 T -, 29
*24 HOUR M0110- t7
rR SION I 1101RIJI_ INSPECTIONS PEOUIRED
R
'Mill UR rq�'
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Permit ccnditions: The applicant agrees to comply with ell rules and regulations of the Unified SewerigP Agency. When calling
for an inspection please refer to the Permit Number. The Permit expires one hundred eighty (180) days from the (late of
Issuance The total amount paid (permit fee, connection charge, line tap fee and/or other charge) will be forfeited If the
permit e(pires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at the
measurprient given, the in'-Aaller shall prospect three feet in all directions from the distance q ven. If not so located, tne
installer she'l purchase a "Tap and Side Sewer" Permit at the current charge an6 the Agency will Install a lateral.
6/90 WHITE - USA, BLUE - Accounting, GREEN -Inspection, YELLOW r:ustoMer