16684 SW JORDAN WAY 1 "��.,, .. -k• �M.w:M'tarn•AM��V+W:IrtR�'11 P'MpMN 'R/7�1Mai�7A+MMM'�IINNMrM4rY�wM�•MP A�M�{.WW'.14Mt}g1�MiN/ ""MMM ►MMf' AiM RI, N�11rw-7—
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT CI RCCUPATC ol"'
J
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 X503)839.4171 CCIJRANG� r
xxx�� PERMIT fle. . . . . . . I M63 9;3-•0i:ZSb 1
b sw- 41'71 DATE: I SSUE'L I �
PARCE L I 2S t 16AD-MBE.D2:3
S1TE AUDRESIL . I 1.66E14 'SW JORDAN WY
OUSD I V T 101\1. . . . I BEDFORD GLEN 7.ON I NG I
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . , . 123
C LASS OF WORK. I NEW
TYPE OF UraE. . . I SF
OCCUPANCY GRP. I R3 �
OCCUPANCY LORD:&;R0 4
I l.'I'JFaNT NAME. I
i
Remarks : PATH I
Owner I
13FACON HOMF'G INC
90-00 5W U.'5TH AVE:
LsE AVER 1 C:1N OR 97005
Pnon•r #: 524-1999
r:ontract or I
BEACON HOMES
9500 SW 12.5TH
BEAVERTON OR 97005
Vlhune #t 524--1999
70782
OcCIApanc.y of the ebuve re`er^enced tmilding is Fereby given, .and cert; r. r ►ei.
t:�-ie compliance with tide Scats Of Oregon Specialty Codes foie the group, P
cwLupancy, slid use under which the referent od permit was iaftued.
IN SPEC:I OR
BUILD N• 5r7 I C I AL_
'OST IN CONSPUX)OUS PLACE
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INSPECTION NOTICC
City of Tigard Building DePart'd'nt �'
13125 SM Hall Blvd. Tigard, Orvgo
n 97223
Inspection. Line (Rec-O-Phone): t39-4175 Rjeineee Photlt 6� �./?71
� 1
Iniapection:
Tooting Plbg. Underelab Hach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out can Line GIn�D
Poet/Beam Struct San. Sewer Framing
Post/Beam Hoch. Rain DraLn Insulation -plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Noah. �
Date Roquentedt-4/_ -q 3___ -Ti.. aN — PN
y ;,` r — t' �_ Permit
,.. Addreeess� c ■
Builder:.
THE FOLLOWING CORRECTIONS ARE U ED: f/Q `!
// ter S%C�!/n �O��t� ��1���,'•G-✓C� a
lnopec --- ----f-3 --- Drte.
i
DIS PPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
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INSPECTION ►'a�i�; ���'li- A
City or Tigard Building Department
13125 ON Bail 81.d. Tigard, Greg— 97223
Inspection Line (Roc-O-Phone): 639-4175 Bvoinee• Phone: 639-4171
'• Inspection:_,__. �F`---- —'—' —
Footing Plbq. Undersla' Mech. Rough-in appr/Sdwlk
1
round. Plbg. Top Out Gas Line lIUALt /
•S���+v
j'
+ " Post/Bohm Strutt. San. Sewer Framing
Post/Beam Mach. Rain Drain Insulation lPlumb• i,
Plbq. Underfloor Nater Line 4,,p. ad. -Much.
_5
[_to 1.equeetedl t"I�" �Q �� -a� J Tiros: /Xl
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7Wdress: 1(O(� `( `.Inn Permit f (3 �
Aztyv- I��'w1C` __
Builder: I
THE FOLLOWING CORRECTIONS ARE REQUIRED:
7
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Inepwc.t Date:_
_APPROVED �— DISAPPROVED APPROVED SUBJECT TO ABOVE
,call for Reinsp.
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J.NSPECTION NOTICE
City of Tigard Building
13125 ell' Ball Blvd. Tigard, (Oreo,or 97Z
Inspection Lina (Rec-O-Phons): 639-4175 Business Phone: 639-4171 ,
Inspection: _
Footing Plbg. Underslab Mach. Paugh--in Appr/Sdwlk
Sound. Plbg. Top Out Gas Lina FINAL•
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underflojr Nater Lias Gyp. Bd. -Koch.
Date Requested:_,_ Time: AM PM
Add.ress: ( �_�U+ �caY L Q V� �_�l Permit #t l �� •
Builder: -
I
THE FOLLOWING CORRECTIONS ARE REQUIREDs
T--
Zf C-42
i
Inepectnr:_____ Date:
____-APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
__Call For itainep..
. . .wsuOf�RWpfli6�x�er►w,:aur.+.......,. ...wvwwwgppY�d�
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ANN
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INSPECTION NOTICE
City of Tigard Building Department I
7.3125 BN Bull Blasi. Tigard, Oregon 97223
Innpection Line (Rec-G Elhone)s 639-4175 Business Phora: 633-4171
Inspection:__ JJ_ —
j.
Footing Plbg. Underelab Mech, Rough-:n App;.Isdwlk
Found. Plbg. Top Out Gas Li-:� FINAL:
Poet/Beam struct. San. Sewer Framing -Bldg.
1
Poet/Beam Hoch, Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
t--/� 7 ..7�T Timet AH PH
Date Requested:— ! L — 3 —
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Addroses_ �1A C -�e'&A- gO Permit fit,
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Bu l lde►
THS FOLLOWllIG OORRECTIC'•NS 4RE REQUIRED:
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Inspectors __ ___.__ Date /001
,,:;/,.P-
T.PPROVED nL..APPROVED APPROVED SUBJECT To ABOVE.
All For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 811 Ball Blvd. Tiga^d, Oregon SS 123 1
Inepecti,sn Line (Rec-O-Phone)t 639-41.75 Busines- Phonei 639-4171
Inspections --
F,
tooting Plbg. Und•.elab Mech. Rough-in Appr/Sdwlk k,
Found. Plbg. Top Out Gas Line FINALS
(A.
Post/Seam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lina Gyp. Rd. -Mech.
Data Requestod t_ I 2z'
r 1 AM PN •
Addressee �{�( k"ti G\�•{/� l.[� _ Permit rt' 13
;under: 14
THE FOLLOWING CORRECTIONS ARS REQUIRRD:
Ap
jv
Inspectors � -
_ Dates--1�� .
__`APPROVRD _ DIS PROVED APPROVED 9UBJECI TO ABOVE
r Call For Reinep.
xw W q q "wP'..rap)Aw Ap � +�a�:•rc yr ,�t" lM s m r ?`gA +wn M 4
N J4,
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INSTE "ZON NOT:CB
City of TigarrO wilding Departsent
13125 Bw Hall Pitd, Ticard, Oregon 97223
Inspection Line (FDc-O-Fhrae)c 679-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Unders.ab Nech. Rough-in Appr/sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing --8:dg. n
Poet/Beam Hoch. Rain Drain Insulatl.on -Plumb.
Plby. Underfloor Nater Line -Hoch.
r 1 �
Date Requestoll �C 1 7� Ti se: AN
/, + /ti/1 _
Addresse �(p���/ V
���r (jC��_V� 1. ,I'
BuildertJGll^a ��.rCS -'/T 45
TRE FOLLOWING OORRECfIONS ARE REQUIRSDI
1/ - / / I ply
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1 1r 7 ter)
ac9
10,
C.-_,C� �� ` C)C
Inspactors_. Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
( _Call For Reinsp.
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'':kMIfMIM�Yw.w."Nr'%.(1V�.'F',''�M4trM4'•nl •
city or Tigard Building Department (/ �
33125 811 Ball Blvd. Tigard, ':723`'
Oregnn 9
Inapecriun Line (Roc-O-Phcre)s 639-4175 Business Phone: 6.19-4171
-------------
Inspection: (" " Il"c
Footing Plbg. UnderslabMech. Rou h-in, A
9 ppc/Sdwlk
found. Plbg. Top Out Gas Line fINALs
Post/Beam Struct. San. Sewer ��lE4�W1 -Bldg
Post/Beam Much. Ral.n train Insulation -Plumb.
Ilbg. Underrloor WaterLine Gyp. W. -Mech.
Late Requesteds_ � Lr J ��.Tl1Mt AM PM •
lkidrese: / ' swe W paruit tt� -yz35
B%Alder= A �'�fn�`'r1�'`,'4�- 5 ���- 3y� ■
THE fOLLOWI14o coRRUCTIONS 1R� 1lEQITI1t1DDf
VFW'
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Inspector: - Dates
" APFT10VIfD -` DISAPPROVED APPRO"O suaddCT To ABC+VE '
' -
_ Cal] For Reinsp.
tt�
taraTM >trua;:�u�a.�su��w�,z1h �"i± ,• ,
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INSPECTION NMQj /� 7
City or Tigard Building pspartmmt
V125 B11 Ball Blvd_ Tigard, Oregon 972231 I
Inspection. Line (Rec-O-Phone)e 639-4175 Business Phone: 630-417.
Inspections_
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing _ -Bldg.
Post/Beam Mach. x:l.n Drain Ineulrtion ' -Plumb.
Plbq. Underfloor K!ter Line Gyp. Bd. -Mech.
Date Requested: / 7L� _Time:
Addreees ,�i' LL Permit is
Huildec:-1_
■
THE FOLLOWING CORRECTIONS ARE REQUIRED:
A"1.xvlocz
Inepectoxs_ Data:
APPROVED DISAP OVEO APPRCVRD SUBJRL-r Tf1 ABOVE
__Call For Reinsp.
'Sk
4 i:2
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w vsu t h.' :..r ...,., qr. "+¢., ,x,y•...,.;. J .y,"p^rF' A+a''- root _ -._ tYGYM7YfdQ'K!My'
1�, 1 J C 1^• y� 7 J D�:•b � 4 y� �•�4 { i
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INSPECTION NOTICE �
:ity of Tigard BuiSding Department
13125 SW Ball Blvd. Tigard, Oregon 97223
r S
Inspection Line (Ron-•G-Phone): 639-4175 Business Phone: 639-4171
Inspections '� r� '
Tooting Plbg. Underslab -Mah. Rough-Ln ppr/sdwlk
Found. e
Pl.bq. Top Out Oma n FINAL: •It.,,.
Post/Beam struct. San. Sewer Ftasinq -Bldg.
Poet/Beam mech. Rai,s Drain Insulation -Plumb. fJ.
Plbq. Undo,-floor Nates. Lies Gyp. Bd. -Meeh.
Date Requested:—., b_� - - T � AN PM k �',, •
Address: JI ormit !:
Builder: R
THE FOLLOWING CORRECTIONS ARE REQfIIRED:
Inspector:
APPP.OVED DISAPPROVED APPROVED SUBJECT TO AFfOVE
Call For ;einep.
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�;Ifi•' ,,. _ _maw rvw•.• �sM r -,
¢gEtRION NOTICE
City of Tigard Building Department
i, 13125 IM Ball Blvd. Tigard, Oregon 472
y4 Inspection Line (Rec-O-Phone): 639-4175 Business P
r• ,
Inspections _ --
Footing Plbg. Underslab hexa. Rough-in Appr/'iwlk
Found. Plbg. Top Out .•i Line FINAL:
y ' lost/beam etruet. San. Hewer Framing -Bldg.
,
�r:fa
Post/Beam Mach. Itain Drain Insulation -Plumb.
Mg. Underfloor Water L!-. Gyp. Rd. -Meeh. , "y y.k• !
Date IteQlleltedt� _Time: AM FI! x
PAdreass �. Permit #:1�.3—D
,j
M 9vLlders
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TLS .FOIJ.ONINO OORRiCTIONB ARIL 1t8QUIRED:
hJur
MET
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Inspector _ D:ttee
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S?hQk � y.
__APPROVED DISAPPROVED APPROVEI, SUBJECT TO ABOVE
�A9 t
�__Csll For Reinsp.
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at'4,2f
had
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INSPECTION NOTICE
City of Tigard Building Departeem".
131.25 8w Hall Blvd. Tigard, Oregon 97223 1
Inspection Line (Rec-O-P'one)s 639-4175 Business Phone: 639-4171 y
Inspoctions
Footing Plbg. Dndersl.ab Meeh. Rough-in Nppr/Sdwlk
Found, Plbg. Top Out Gas Li:se FINAL:
Post/Beam 8tru4. Ben. Sewer Framing -Bldg.
AOstjseass —cTllli Rain Drain Insulation -Plumb.
Plbg. Cnderfloor Nater Line Gyp. Rd. -Hoch.
Date Requested:_ Time: AM ,PN
AddreessJ/1 1 L I � � C- Permit is_
Builder: k:�C
I
Tl'it POLLOWINO OORRECTIONS AREOIRED: }
REQ
,try,nx�9y�G
xr 41i
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nr 1p L1 e
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MALI r+.
lY t i t
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1. ,r�t 71 - a
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Inspector: Date:
APPROVED r nISAPP;tOVED APPROVED SUBJECT To ABOVE t
Call For Reinsp.
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INSPECTION NOTICk fM1
Citi. of Tigard Building Department ;
13125 SW Ball Blvd. Tigard. Oregon 972
inspection Line (Rec-u-Phone): 639-4175 Business Ph nes 639-4171
r
Inspection,
Tooting Plbg. Underslab Mech. Rough--in Appr./Sdwlk
!bund. Plbg. Tap Out Gas Line FINAL:
Post/Beam Struct. plan. Sewer Framing -Lldg.
Past/Beam Mech. Rain Drain Insulation _Plumb.
t
Mg. Underfloor Water Line Gyp. Bd. -hech.
`Date Requested:
Time: AM P!1
/ / --
Address:
Permit
. N
Builder:�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
row
1
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1'n-9pector:
APPROVED
_ ` DISAPPROVED APPROVeD SUBJECT TO AFiOVC
_ gall For Reinsp.
I
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I
M01-
ITirni NQTICE
City of Tigard Building Departstepf
13125 BR Ball Blvd. Tigard, Oregw 97223 A
nspsction Lina (Rec-O-Phono)t 639-4175 Bu.inau Phones 639-4171
8
K' t
Inapections
Footing Plbg. Underslak Mach. Rough-in Appr/8dwlk
Found. Plbg. Top Out gas Line
,. ,. . - lINALt 1
Poet/Beam Btruct. Ban. Swwar Framing -Bldg.
Post/
Beam Mech. C Plain Drain Insulation -Plumb. cia:
Plbg. Underfloor `` tar Line gyp. Rd. -Mach.
Date Requesteds __ / 3 c) ■
_ T, 1���.�� PM
Addreent
Permit ts
Builder
�l>
■
THE FOLLOWING ODRRECTIONa ARE REQUIREDt
Inspecto s
� s� Dater
APPROVED DISAPPROVED APPROVED BUDJEllT TO ABOVE
/ -
Call For Reinsp.
r
F7'
INSPECTION NOTICE s
City of Tigard Buildisq Department
13135 811 Ball Blvd.. Tieiard, Oregon 97223 j
Inspection Line (Rec-O-Phone)e 1139-4175 Business Pho : - 171
t
Inspections
f
Footing Plbg. Underelab FSech. Rough-in Appr/sdwlk
I,."Ta11W. Plbg. Top Out Cms Line /INALs
lost/seas struct. Ban. sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation --Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Meeh.
■
Date Requesteds
Addreu: < <'� L Permit 1. 1��_�'Z 3:S
l
Builder: / •
r
TUB POLLONING OORRECTIONs ARE REQUIREDs
71
f �
lee
� 4 7
Inspectors 4 Date: 7
y' APPROVED DIsAPPROVEr1 APPROVED SUBJECT T1 ABOVjr
Cr.11 For Reinsp.
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TIGARD
r
CITY CSF �,�, , E II,� L
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COMMUNITY DEVELOPMENT DEPARTMENT
13126 8W.Hall Blvd. Tigard,Oregon 07223.8100 (603)83"171 i.,�., f':
i-
)ATL 3.5a 3UFDw O'r/i'1/9 3
i a;ui itr._', a. , , 1G+r^^,,�4 SW <''0Rlr•f4N �J'r i-'iii?( I•l.. .`u11G,,FIJ.)-
iF.ic+lllVi51LIN. . . . BE'.OFURD G EFv ZONI G.
__ ._..____.. ._._._.......... _._._.._.� ..__._._. ...._. __ BUILDING i'``
I AE J ss(_Z► UWI-LL I NIJ UN i F3AGLMENT.. . . . . . . . a 4,3(-i b f
.LAafi OF WORK. ;NEW BEDRMU.Z t*17H'i: 3 UPF44UL. . . . . . . . . . ...!j
I
YPE OF USS. . . :JF Fi.._UOr
! 'YP= UFCOWS'?`. N L.EFT. . : I i ft RIGH1 . / ft �
I C,. JPi•11NrY URP, R.';: UECONi:tr . . 8696 s f F-14INT. -20 ft (tLON. . .; i? f
(ORI:S. . . . . . . t,i�, THIRD. . . . 30 sf REC,?UIRE=A-�, _._.._._ ..___... .. _...._...... �
0EtS:HT. . . . . '.0 i`t 'VOTAL : 137 sf oirlUi'.L:' DL-VECTORS. ;Y
LOOP LOAD. . . . . 40 r:)s f• VALUE. . . . . f : I 1 54 i,.'
PARKING SPACES. . : 1
I
PLUMBING _.._.__.._.._..._.____.. .._,..._ .... _. __.. _....
■
4404 i URI ES. . . . . s 4 WA I r-H HEPTE«R5. . . 1 TRAF15. . . . . . . . . . . . . . ..0
"iflii:aHCIWI 11;:a. . . .• Lr�Uf�Ff)RY TFill'r'�3. , , i C�'1Tf:'.ii Bf-dSIM,. . . . .
)ATEP CLOSET). . :3, SEWER LINE= (ft ) . :+Z+ GrZb:A:,E TRANf=. . . . . . . :0
j uI aFIWt1 FlEFrwi. . . r WwVRR LINE (ft . . : i.00 UTHER V= IX'T'UNE14. . . . . .0
*44RbA5L DIST'. . . : I RAIN DRAIN (ft :0
MLLJ44NICAL FEES
Ut.1.._ tF-t:a... ...... ... . .... . . _ UN . bl tiyn Iiii�b . e
S -Anrc)..ani: L,y cJatc r••c.c:F>>,
CiFl:i! J' / VEN'1"a . . . :QI APRT # 460 50 JH 05J::- .t i 9:3 _
4)X 1041'UTjO BI VENT FAN:,. ,. :�+ IIF'I_t� F LIE. 33 •3L+1 93
URN ( 100K . . ;0 HOODS. . . . , . : 1 SSPC t 24. 0:3 JH 05/21/ri:;
;JR1, i::. 1+1+0K , , WULr1 S TOVLi, :0 MISL 1; i'`i. 00 JH 0'1%i.1 ; g:
LQ0R F'URId. :i1+ GLG URYE;R:�. : ( MPR1 f 45. 00 01.1 05/".1 J9
lr1(.�I I__I a.+,Ylf•' {
3M.: "0 O T r E'fi 61,411 D.. 1 5 3 V-1
GAS Ou LEI S. FrI,iC' 3
i E �"� 1 G , ,. 'S
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IWilr'r^C __... ..._..._..._._...___._ .....,.._..__...._ .. _._._ ... .... �:IF'!1 IY:rte 4i�/ ....
i; 4 J I••1 �'I
iC>� JH !c`'i /rami
�(cACON HOMES INC, F'aF'l'; +• "i. 7Z; TF•i 4t151i_1/�„�,
'.i."500 :;W 1251+1 AVS:,
BEAV1•RTON OR 97003
I.^
l�t::(aC:tJIJ FIClP1L�E3
PO DU)(
ti�►�e #x 5,214-- 1'199
fi
107, 11 10 P L.
permit is issued sub;eet to the regulations contained iv, rme RE14UxRED INSI-'L.i.,
gard Municipal Coot, Wtatt of Ure, Specialty Codes ane all otner f"o 1Jt/f°aa.rtrd I ns Fr Fireplace I n v p
pl icable laws. All work wt ll be done in eccordanct hr+.'' approved Post/C-aeam 5t r uvt Gas L.+ e '.n;p
ians. This permit will er.pir•e if v;,.,•k 16 not ti tar i60 f-1e15ti
MIX
08i13i92 14:27 '0503 Roo 7297 CIWOF"IG D _ Q001/501 $
OF
71GA"D"
13125 SW Hall d. PLNCK/RECT Y —�sCITY POBmva9� PERMITM ' �
COMMUNITY DEVI;LOY'M6NT nLPARTMENT 71ped,On{on97w _
(SW)63M171 DATE ISSUED
JOB ADDRESS: C �SW .TL`'r CI k) '
" CU�� �( �J
_ TAX MAP/LOT .xs//��D- 6�
SUB: 6) LOT: _ LAND USE:
VALUATION: a
�1WNER SPECIAL NOTES
FAME: 'G1C 1r►2c SV1C� REISSUE OF:
I ADDRESS: 9v� �)V/ �'� (�1 LAST REISSUE:
l Fra ver }�yt o�� _7C)6
FLOOD PLAIN/
PHONE: ����Ct� �( SENSITIVE LAND:
CONTRACTOR A�QBS REQU I REQ
NAME: 1�,f
`,.
61Cc, /I I rmo S PLANNING:
ADDRESS: ENGINrERING:
FIRE DE,'T:
PHONE: LI Cl (7 _ OTHER: —
CONTR. BOARD #: 7�. 7(�s 2 EXP DATE:
ITEMS REQUIRED
BCI CONTMCTORS: PLUMB: Camto1, (11on1 1 V C LIST/SUBCONTRACTORS:
MECH: _W) �1�� 61)(1 1(fi-I �i �-?� BUS TAX: _
ARCH/ENGINEER CALCULATIONS:
NAME: A`sSdC. TRUSS DETAILS:
ADDRESS: (?D r`��(.'X I C1 �� OTHER:
PHONE:
PROPOSED BLDG. USE: .C)(Ck tih a
COMMENTS:
APPLICANT SIGNATURE
I Received By: Date Received:
M9gdP.q'IIU4IY:;.,rA3r +SAS@+.�+�'t,
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■
RERMIli' # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
jest 3.p 3 S 10-432 00 Building Permit Fee:; ��•.S U' # r
10-431 00 Plumbing Permit Fees �S S• `;_ �' >; I
10-431 01 Mechanical Permit Fees �J ✓ '� _ _ �1�
10-230 01 State Building Tax (5%)
Building ?� •4
Plumbing `Jv
Mechanical z >
10-433 00 Plans Check Fee 313, S8 - 'SZ
Building
Plumbing
Mechanical
10-230 06 Fire _
30-202 00 Sewer Connection _ --
30-044 00 Sewer Inspection
j 25-448-02 Commercial TIF Fees
2.5-448-04 Industrial TIF Fees _
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448•-01 Residential Traffic Fees _
25-448-05 Nass Transit TIF Fees
52-449 00 Paries System Dev Charge (PDC) _
S
31-450 00 Storm Drainage Syst Dev Chrg
(SSOC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
I
TOTAL
nm/3587P.WPF
13125 s��i�,u 41v& PLNCK/RECT #
CITY OT IG� D _ —
Ti Qrc••o,9nn PERMIT # -- I
COMMUNITY DEVELOPMENT DEPARTMD'T (50
I50')63s"" DATE ISSI!cD
JOB ADDRESS: _ _ TAX MAP/LOT —
SUB: — __ LOT: _ LAND USE:
VALUATION:
_ q
OWNER SPECIAL NOTES
NAME: _ _ _—__—.__,� _— REISSUE OF:
ADDRESS: — —___ — LAST REISSUE:
FLOOD PLAIN/
PHONE: SENSITIVE LANG:
CONTRACTOR APPROVALS REQUIRED
NAME: T_ —_--- -- _—� PLANNING:
ADDRESS: — — ENGINEERING: _
FIRE DEPT:
PHONE: �— -- -- OTHER: ---- —
CONTR. BOARD #: _ EXP DATE: — _—
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: — BUS TAX: _—_—
ARCH/ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PRW)OSED BLDG. USE:
COMMENTS: _
APPLICANT SIGNATURE ,
Received By: _-- Date Received: --- _
... ..•.^„n-ras:nn.v,e.l te...u.nasi:.:uubbl!prr�gwri'.'d1�+aht•XwnaMrn,wvwwsn�+Hr�:*aW+uwysvutY4a#w'tlf�YwlTiAa c.. ,r • ru t=.:.v ,. x. r.:..•:
r,
,
+ 1
d`
y
a
CITY E:1F T 1 GAf2D -- RECE I F'T or. PAYMENT RECEIPT NO. :9.3-2403'76
r CHECK AMOUNT s 823. 11
NAME s RFACON HOME"s CASH AMOUNT : 0. 06
ADDRESS s
PAYMENT DATE 05/21 ,`;3
SUBDIVISION s
NURF'C1SE OF PAYMF N r AMOUNT PAID PURPOSE OF PAYMENT AMOUNT ESA I U
BUILDING PERM 480. 30 F'1_UMAING FERIA 155. 00
ME:_C:HAN I CAL. PE 45. 00 ST. HU I E._U PER 34. 03
FLAN CHECK r-'(-. '73. 58 0. 00
s
it
I—OT P3 BEDFORD GLFN
16684 SW JORDAN
j TOTAL. AMOUNT PAID __ .._ ._ .,..) Fac.3. 1 1
`�FMww .+f"hw[ •....:..'..♦ .Y,.1p.({ ,[ ...tf••,.:tl itA ILPti..Fp. yy
I
,•4nO►NVA k1M M?e. .!aN+ nh. ;'dw•v V ,r:::,•y�,r.. r ,1
un;iced • (1 fl f i
V
sewerage,
SAN ITARY (�
agency 24 SURFACE WATER ��
155 N. First Ave,Suits 270,Hillsboro,Or.,97
503 648-L:'.,31
r. CON14ECTIO14 PERMIT `
ISSUE DATE. 051993 ' �r`"'''"'"''6PIRATIOW��DATE 111:5q� r,ERMI T 1012:'9
r PROJECT' 1939
STRUCTURE ADDRESS 16684111'; _�» r
STRUCTURE STREET SW-.JORDAN'-WAY
LOT 23 BLOCK
TYPE CONMCCTION- NEW - OF BEDFORD GLEN PHASE
t TfiSti inrvi F 't~(liwl�FFOI yn � 11t, �:1' v,r�f�•r} r�:`.: 'r,: •
TYPE INSTALLATION- X19,) PLD CWR/CRO CON/8I1C
j TYPE OCCUPANCY-' ( 1 > ;ANGLE" FAM.1 1 PARCEL. 2S1 16 AD 25700
QTR SEC 4716 MH 1(.:090
C r 1
OWNER DEACON HES ON � i ti' y.�b0 1 of . { ' ' "
ADDRESS 9500 3W 125TH,,r'� '.�i w,l.'� �1, I : , . TREATMENT PLANT 11UPHOM
BEAVERTON ' :`(;r�':u
PHONE 524-1999 vT 1..� r hf1 .':,' <�J�u�t2 "'r'UURISD KING CITY
. rr .Y.r• ».•w•r.r. M� M',r r.r••• r•• wMii- -•r,r.•••.w...M iwr.r r..•.................... ..... .....
I
FIXTURE EQUIVALENT I1WT:I..I..INEi RF"ILIF.:WTTFL.
UNITS SE.RVICC UNITS 0.0 UNITS 1 SERVICE UNITS 1
CONNECTION FEES SURFACE WATER AEVEI..OPMEN'T FEES
SEINER CONNECTION " 2100.uV. WATER QUALITY 100 .00
LESS CREDIT < 100 .00>
WATER QUANTITY 100,00
LESS CREDIT < 0. 00''•
EROSION CONTROL
INSPECTION 40.00
FLAN CHECK 26.00
5 '
SUBTOTAL 2100.00 rSUBTOTAL 166.00
i
T01 AL. 2266 .00
NAME PETER KUYSK PHONE
IAFFILLIATION VP
REMARKS PR0J#1939-BEDF0RD p •N 2--LOT 6 23
*24 HOUR rnTTCE; FO � G�I ONTROL INSPECTIONS RCQIIIRED
rlr. N 4 T Il R rTr.cuirn Ly jLinIjj2nnw _
Perera Conditions: The applicant a ees to comply with all rules and regulations of the Unified Sewerage Agency. When calling
for an inspection. please refer to the Permit Number. The Permit expires one hundred eighty (180) days from the date o1
j Issuance. The toX amount paid (permit fee, connection charge, line tap rep and/or other charge) will be forfeited if the
I permit expires.
I The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer 1s rwt located at the I
measurement given, the installer shall prospect three feet in all directions from the distance given. If not so located, the .
installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agerwy will install a lateral. i
6/90 WHITE — USA, BLUE — Accounting, GREEN —Inspection, YELLOW — Customer
•
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