16712 SW JORDAN WAY w
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DEPARTMENT OF LAND USE&TRANSPORTATION
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• 111I.* SHINGTON LAND DEVELOPMENT SERVICES DIVISION
' 155 NC'RTH FIRST,HILLSBORO,OR 97124
A Cr l%N7Y, INSPECTION REQUESTS: 503/640-3561/693-4415 .
-. aa""1 PHONE: 503/648-8761
OREGON Page 1 of 1
'E Date 03/25/93 I
hit Time 13 : 56
Permit Type Residential Electrical Permit Permit # 05038749
Permit Status APPROVED Applied 03/25/9:3
Situs Address T1 Issued 03/25/93
Permit 'Title SFR - ELEC/E3LJHGLPR PLARM Completed
Permit Descr , 16712 SW JORDAN WA To Expire 09/21/93
Project 'Title SFR - E3LEC/8URGLAR ALARM Project # P0029958
Project Descr , 16'/12 SW JORDAN WA * FROSION
_ ! Parcel Number 2S1'TI - Land Use District
j Valuation 0
j Legal Descr .
Owner INSPECTION - 'TIGARD Constructiotl OTH �
Applicant Name PHILLIPS ELECTRONICS Classification. 900
Applicant Addr. : 1110 NW FLANDERS Occupancy R3
pORTLAW), ON 97'LU9 Validated by : KF
Applicant Phone : 227-05'7] Inspector Area
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Cc N'TRAC'TOR : PHILLIPS ELECTRONICS Lic . C 26-213C 227-0571
Fee description Units Fee/Unit Ext fee Data
---------------------------------
Limited Eritegy/Alter./Extension 1 40 . 00 40 , 00
Subtotal Electrical Fees : U 40 . 00
State Surcharge of 5% 0 2 , 00
l'ota 1 Electrical Eees : 47 00 t
*** Fees Required *** *** Fees Collected & Credits
-------------------------
-
Receipt No . Date Payment `
03/25/93 42 . 00
TOTAL THIS DATE ******yA* 42 . 00
Fees : 42 . 00
Ad 'ustinents : J;'74
7 . 00 'Total Credits : , QU IcrGjy,
'1 otal :'ees : 42 . 00 'Total Payments : 42 . 00
Balance Due : . 00
NOTICE: This permit becomes null and Vold II the work or construction for which it is Issued Is not commenced within 180 days. Once conntructlon has stared,
the pe;mit becomes null and void If construction Is Interrupted for a period of 180 days. 1 certify that the lolormatlon presented by the appllcnnt and
his ag-ni or agents In support of this permit Is true and correct to the best of our knowledge. t acknowledge that the Building Department's reliance
upon false end misleading Information may Invalidate this permit. All proviel^ns of applicable laws and ordinances goveming the construction and use
of this bullding or stricture will be compiled with whether nr not specified on the plans or noted on the plans correction sheets. 1 acknowledge that
the granting of a p•armq does not grant authority to access private property or to use easements. 1 further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections of various times during the process of const;,ellen end the building
inspection staff verifying compliance with the varlot-a codes. Up*or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I further ar',nowiedgo that a Ilan may be pit :ed on the title of the properly upon which the permit is Issued
specifying:het the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requiremenia.
APPLICANT'S SIGNATURE —
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WASHINGTON COUNTY RESTRICTED
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Department of Land lice & Transportation
Electrical Irapection Section ■
155 North First Avenue,#350-12 ELECTRICAL ENERGY
Hillsboro, Oregon 97124 APPLICATION
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Information: (603)1340470 Fax: (603)693-4412 �
PLEASE PRINT - 7aPlease complete • • • Project No. __ Permit No,) -
Label No. _ Date
1. Location of installatl n Issued By _ Office _
Address , ZZ,2 ALJ � Gv -
riry_�!_ci�� __ — zip Code 972_ 4. Type of work:
Thomas Map Book: Page Section RESIDENTIAL Restricted Energy Fee $40.00
(for all systems)
DirectionsF �� �_d' �
b _�_ � Check type of work in •olved: i
Commercial ❑ esidential [ Audio and_�Siertw Syst ma"
Tenant NamR gTer algin"
(if commercial) _ Telephone Systems*
GarThis permit becomes null and void if the work authorized by the Fire Alarm
Door Opener' i
permit Is not commenced within 160 days from date of Issuance Fire A
of such permit or If the work authorized!s suspended or abandoned Heating,Ventilation aril Air Condiioning Systems
at any time after work Is commenced for a pal Pod of i80 days. Vacuum Systems*
Electrical Permits are non-refundable and nontransferable. Other
2. contractor appli ation: _
Electrical Contractor = y_ COMMERCIAL Fee for each system ;40.00
(see OAR 918-280-260)
Address iO
Date — Job umber _ Check type of work involved:
Property Owner �2t _
Contractor's License No. __ C Boller Controls
Contractor's Board Reg. No. _—` Clock Systems
Phone No.,. 7 t i'71 Data Telecommunications.nstalletlans
Fire Alarm Installation
3. Owner application: HVAC
instrumento:!^n
Intercom and Paging_-yslam
Print Owner's Name Phone No. -
Landscape Irripatlnn Control"
Address Medical
Nurse Calls
--"fie-- Zip — Outdoor Landscape Lighting"
This permit Is Issued under OAR 918-320-370. Tho applicant agrees Protective Signaling
to make only restricted energy Installations(100 volt amps or less) other_
under this osrmlt and to do His following:
1. Only use alectrlcal licensed persons to do installations where
required. (Certain residential and other transactions aro exempt Number of Systems
from licensing. These have Asterisks('). .ill others need Iicsns-
Ing
2. Cel for en Inspection when All the Installations under this permit "No licenses are required. Licenses are required for all other installations.
are reedy for Inspection.
3. Purchase sr pante permits for all Installations that are not ready Jam" Fees
tor Inspection when the Inspector Is out to Inspect under this
portnit. Enter fees $ ;K10- D
4. Assume responsibility for assuming that all cot roctions required _ 1
by the Inspector are done,and 5% Surcharys (.05 X total abovei $
5. AAsums responsibility for calfft.g for a final Inspection when Ali of
the corrections en completed.
The person signing this permit must be the applicant or a person rOtc9i $
authorized to bind the applk"nt ,[
Signature �e !i 7 C�� Space below reserved for validation.
Authority H other than applicant
For Inspections call
640-3561 Or 693-4415
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24-hour recorder,one working dey in advance of need f;
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CITYOFTIFARD CERTIFICATE OF
�
OCCUPANCY
CCMMUNRY DEVELOPMENT DP,RTAE�T IE7b1I r #NftS
13125 SW NOR Blvd.P.o Bm 23391,TOM,OMW 07 iS,{60�1� W1�6
t f fL AI)L+11E•ta,i,. . . a l SW JO RX VIN WY f�flf3t� 1.K 2S 1 1hAD
�A1E'I)I V I i:,f ON. . „ . n 11EIN ORD GLEN 70141 NA r
BLUI:K. . . . . . . . . . a LUT. . . . . . . . ..__ e..16__._. ... ,_..._.. ...._ ... .. ... ... ... .. ..._........____ _...,___
C LAGS OF WORK, o NEW
rYPE:. OF USE. . . r 9F
OCCUPANCY ICRP. a R3
OCCUPANCY LUAO e 221 4
TENANT' NAME::. . . a
Remarki dw WD wiDen Path I KING CITY �
Ownera
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17080 SW 131
T I GARD OR 97224
Phon" #s 684-9711
Contractors
K. D. LEE BUILDERS
10915 SW NAI,.L BLVD
Tl Of'RD OR 97223
Phone ## 639--a723
Reg #. . r 13471
I?c:C:'Uj.-)Arley of tho above reef ererac:ed building as hereby given, and c ort i t i j#e
"le c;�tml�l. i ar�ce with the F:itrat;O Of C1r•e40n SPQc ialty C41(1011 for^ the gramp,
oc^cicipanc:y, ,anti urse uncler• wtiit.q) the refer-enced per-mit was ises.ted.
F I f tE: L►1 F'�AR rMEN71111.1).f IyC+
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POST IN CON.'!PIt UOI.Wi PLACE
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` INSPECTION NOTICE ,
city of. Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
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Inspection Line (Rac-O-Phone): 639-4175 Business Phone: 639-4171
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Inspection:
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Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk ,
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Found. Plbg. Top Out Gas line FINAL:
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Post/Beam Strutt. San. Se-ar Framing -Bldg. r
Poet/Ream tech. Rain Dxcin Insulation -Plumb.
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Plbg. Underfloor Water Lina Gyp. Bd. -Mech.
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Date Requested: ._�l L)� �.._ _rima: _____AM •----PM
Address Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: �-•----_--_-^ —. Date: _' i
APPROVED -�- DISAPPROVED APPROVE`) SUBJECT TO ABOVE
--call For Reinsp.
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:PECfI0N NOTICE
City of Tigard building Department
131.25 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phony ): 639-4175 Business Phone: 639-4171 I
Inspection:__
Footing Plbg. Underslab, lA� ech. Rough-in \ Rppr/Sdwlk
Found. Plbg. Top Ovt 'tae LLYne FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Nech. Rain Drain Insulation -Plumb.
' Plbg. Underfloor Water Line Gvi. Bd. -Rech.
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Date Requested: -� Time: AN PN
A�dre��: _aa Permit 1:�� "���3 7
Builder:_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors Date:_
_APPROVED DISAPPROVEDAPPROVED SUBJECT TO ABOVE r
____Call For Reinap.
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INSPECTION NOTICE t
City of Tigard Building Department '
13125 Sit Ball Blvd. Tigard, Oregon 972 "6_._' t'
Inspection Line (Rec-O-phone): 639-4175 Bueineuo Phone: 639-4171
Inspection:
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwl.k
Found. Plbg. Top out Cas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
—1 . 6 �
Post/Ream Mech. Ratn grain Insulation -Plumb. /
Plbg, ctnderfloor Wator L'_ne Gyp. Bd. L-Nech. / r
D(er. Time:
�t77Reque�ted: /fes 7 AM / _PM !.
tltddre�e YV Z. Permit
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Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date:
_APPROVED DISAPPB Vgp --_ APPROVED SUBJECT 1Yj ABOVE
Call For Roinsp.
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INSFECTION NOTICE
City of Tigard Building Deparbnent
13125 SW Bali Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone.): 639-4175 Business Ptom�: 639-4171
Inspection:
Footing Plbg. Underalab Mech. Rough-in Appr/sdwlk
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Found. Plbg. Top Out Gas Line FINAL: $,
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Post/Beam Struct. San. Sewer Framing --Bldg.
Poet/Beam Mech. Rain Drain Insulation -•Plumb• t f
Plbg. Underfloor Water Line Gyp. Bd. -Hach.
Date Requesteds - - - 4q5-lrP-1
Address: LG Permit #a
IMEN
THE FOLLOWING CORRECTIONS ARE REQUIRED:
inspectors Dates
Dater
_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE `
City of Tigard Building Department ,
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspectioa Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
— --- —
InepeciIon s
Footing Pl.bg. Underelab Mach. Rough-in Appr/Fdwlk y) '
Found. Plbg. Top Out Gag Line FINALS
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Poet/Beam Struct. San. Sewer Framing -Bldg.
A Pogt/Be-,m Mach. Rain Drain
In -Plumb.
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Ping. Underfloor Water
7Line
Gyp. Bd. -Mach.
Data Re ,eeteds TimerAH PM
)( Addroes• Permit r �oLZ
Builder:
TBR FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector s
w. _�-- -------- Date
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---APPROVE?.) DISAPPROVED APPROVISD SUBJECT TO ABOVE
— _Cell For Roinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SM Ball Blvd. Tigard, Oregon 9.7223
Inspection Line (Rec-O-Phone): 639-4175 Businesc Phone: 639-4171
Inspections
Footing / Plbg. Underslab Mech. Rough- n Appr/Sdwlk.
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Found. Plbg. Top Out Gas Line FINAL:
Poet/Ream Struct. San. Sewer Framinn -Bldg.
Poet/Beam Me,-h. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line G
s h ' yp. Bd. -Mech.
Date Requested:
Time: _AM PM
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Adress:
dPermit is 4"" f//3
Bulld,r: 9L
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THE FOLLOWING o0 IONB ARE RiQVIREDi
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�-Inspector= �� aj� — ------------ Date:vim_ J` d
}� PROVED -� DISAPPROVED APPROVED SUBJECT TO ABOvE
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INSPT FCTION_-NOTICF, i�..
City of TigarBuilding De l
W. 13125 SM Hall Blvd. Tigan Oregon 73
Inspection Line Rec O- ego
( Phone): 639-4175 Business Phone: 639-4171
Inapoc%Lon:_
Footing Plbg. Underslab `
Mech. Rough-in Appr/Sdwlk
Found,
Pl'19. Top Out Gas Line FINAL:
Poet/Boam Struct.
San. Sewer Framing -Bld
9•
Poet/Beam Mech. Ral.n Drain
Insulation -Plumb.
Plhg. Underfloor Water LineG ,
yp• Br.. -Mech.
Date Requaeted:
Address: AM PM—��(�"� � f i
permit ♦ '� - l//•'3
Builder:_ ,7 1 4
THE "OLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: _'��
/ `APPROVED — DISAPPROVED -------�
APPROVED SUBJECT TO ABOVE
__Call For Reinep.
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INSPECTION NOTICF. r F
City of Tigard Building Department.
p 13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Businees Phone: 62 -41,1.
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Inspection: _— ----- `' r
j Footing Plbg. Underelab rmsch. Rough-in Appr/Sdwlk
Found. Ylbg. Top Cut Cas Line� FINAL:
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' Poet/Beam Struct. San. Sewer Framing -Bldg.
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Poet/Beam Mech. Rain Drain Insulatton -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Mech.
Date Fequeeted: fTime: AK PM
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Address: / / P rmit
Builder:_
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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tospector:�� /' - Date: 1 t(
� APPROVED DISAYPROVBD APPROVED SUBJECT TO ABOVE .I.
___Call For Rei.nsp.
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N� SPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line 'Rec--O-Phone): 639-4175 Business Phone: 639-4171
Inspection•
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
'lost/Beam Hoch. `. Rain Drain Insulation -Plumb.
1 -
Plbg. Underfloor Hater Line Gyp. Bd. -Hoch.
D e Ra estedt �J 7 —- Time: AH PH
Address:/ f, i2 t� Permit Is ✓ /'� i +
Bvi.lder:
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Ins ctor: Date:
APPROVED DISAPPROVED L APPROVED SUBJECT TO ABOVE
Cali For Reincn.
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INSPECTION NOTICE t
City of Tigard Building Departsient
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)• 639-4175 Buoiness Phone: 639-4171 A
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q Inspection:._ - —�
r.' Footing Plbg. Under.slab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out ,.is Line FINAL: r �:;
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Poet/Ream Struct. an. Sewer Framing -Bleg. {
z Post Beam Rech. '
/ �Zgin Drain_ Insulation -plumb.
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Plbg. Underfloor ("'. a�Line`', Gyp. ed. -Mech.
Date Requested: �c�ri °7 --------Time: AM �_PH
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Address:- 71
�� Permit i
Builder:—_A1��/�`�—"'�- 7 2Y
�..,, THE FOLLOiIING CORRECTIONS ARE REQUIRED: :
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Inspecto -- — —� Date:
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{ APPROVED - - pISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE S
City of Tigard Building Department
13125 SW Bail. Blvd Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Business Phone: 639-4171
Inspection: t
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
i r �
I t,Plbq. Underfloor \ Water Line Gyp. ed. -Mach.
Date Requosbia-- -�"��1 `7 a- Time.: _ AM PM
Addrese:� 0—t' rl -//, (:�— Permit /: C� `[�13
% 1 � ell
Builder:�� �� i �• (�• �� .l �
TISK FOLLOWING T ONS ARE REQUIRED:
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Inspector✓ —_ Date: -27 ?J
APPROVED DISAPPROVEDAPPROVED SUBJECT TO ABOVE ; I
Cali For Reinap.
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INSPECTION NOTICE
City of Tigard Bailding Department
13125 811 Ba11 Bled. Tigard, Oregon 97223
Inepoction Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwl.k
Found. Plbg. Top Out rae Line FINAL:
Port/Beam Struct. San. Sewer Framing -Bldg.
Y
Post/Bean Meeh. Rain Drain Insulntlon -Plumb.
Plbg. Underfloor Water Line Gyp, Bd. -Mach.
Date Rted s
Addr•ee:_ -� L Permit /s�� U�J
Builder:—x'
THE FOLLOWING CORRECTIONS ARE REQUIRED: p,
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Znepecto
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'— — — Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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Call For Reinep
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CI>,TY OF TIC�A RD Cf1Y 7WARD
COMMUNITY DEVELOPMENT DEPARTMENT oftvoM MAS-rE R PET I T
$3125 SWFW19NdP.O.Sm23M,TlWd,o�97 1,603)&V4175z,ERMIT #. . . . . . . :
6.259-4171 DATE ISSUED: O7/14/92
51 SW JORDAN WY PARCEL: 2G116AD-BEDI(-
SUBDIVISION— . : BEDFORD GLEN ZONING:
BLOC;K. . . . . . . . . . .. LOT. . . . . . . . . . . . . : 16 {
BUILDING
RE I SSUE i DWELLING UNITS: 1 BA SEMI;N'T. . . . . . . . ..0 sf,
CI_-4S i OF WORK. :NEW BEDkMS s 3 BATHS:3 GARAGE. . . . . . . . . . :451 sf
'TYNE Cc USE. . . :SF FLOOR AREAS--- -_---_-- - REQUIRED SETBACKS---_-__...._
TYPE OF- CONST. :5N FIRST. . . . : 1019 sf LEFT. . :7 ft RIGHT. :S ft
OCCUPANCY GRP. :P3 SECOND. . . -935 sf FRONT. :24 ft RE')R. . - 16 f:t
STORIES. . . . . . . :2 THIRD. . . . :0 sf REUUIRED---------------------
HEIGHT. . . . . . . . :21
-----____,...______..._..-HE IGHT. . . . . . . . :21 ft T0TAL-------: 1rj54 sf SMOKE DETECTORS. :Y
FLUOR LOAD. . . . :40 psf VALUE. . . . . 0: 98002 PARKING SPACES. . : 1
Remarks: New SFD w/Den Plath 1 11.1NG LI TY
---------------------------------- PLUMBING
SINKS. . . . . . . . ., . : 1 FLOOR DRAINS. . . . :10 BACKFLOW PREVNTRS. . :0
LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . 10
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :
WATER GLUSETS. . s3 SEWER LINE (ft) . sO GREASE TRAPS. . . . . . . sO
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OThiER FIXTURES. . . . . c 0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :O
WASHING MACH. . . : .( SF RAIN DRAINS-:1
------------------ MECHANICAL -_________.____._ ------------------- FEES
FUEL TYPES---_._._. .____.._ UNIT HTRG. . :0 t +' 1
type amount by date re4ru `
/GAS/ / / VENTS . . . . . .0 PPRT t 4.30. 00 JH O7/14/92 -
MAX TNPUT:O BTU VENT FANS. . :4 DPL.0 P-79. 50 .TH 0 9r." -
FURN ( 100K . . : 1 HOODS. . . . . . : 1 BSPC 21. 50 JH 07/14/92 -
FURN )-100K . . ^it WOODSTOVES. :O MDPT $ 39. 00 JH 0'7/14/9P
FLOOR FURN. . . . :0 CLO DRYERS. : 1 MPLC f 9. 75 JH 07/14/92 -
SOIL/CMP ( 3HP.0 OTHER UNITS-.0 MSPC 11; 1. 95 JH 07/14/92 -
GAS OUTLETS:2 PPRT $ 140. 00 JH 07/14/92 -
Owner: _____.._..__ _._..__.._.____._..__._..__._______.......__.._.__ P5PC: s 7. 00 JH 07/14/9c -
K LEE MISC $ 35. O0 JH 07/14/92'
08O SW 131
TICARD OR 97224
"'hone #: 684--9711
Contractor:
KEVIN LEE, KD BUILDERS �
10915 SW HALL BLVD
I
-rIGARD OR 971223 j
0hone #s 5036204100 i
Neq #. . s 1347.1 ------------------------------------
$
$ 963. 70 TOTAL
This oersit is issued sibject to the regulations contained in the ----'--- REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found insp Fireplace Insp I
applicable laws. All work will be done in accordance with approved post/Beam Struct Gas Line Insp
olans. This pereit will expire if work is not started within 190 post/Beam Mechan Insulation lns_c' j
jays of issumice, or if work is suspended for tore than 180 days, Plm/undslab Insp Gyp Board Insp 6
PLM/Underfloor Rain drain Insp
,rmittes !ii(lriat .ir^a: �•__� -C_ Mei^hanic ,,l Tnsp Water, 1-.ine Insp
Plumb Top Out Appr/Sdwlk Insp
By: w"rasminq Insp Mprhanical IL sna,).
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+' f CITY OF- TI GARD — RECEIPT OF PAYMENT RECEIPT NO. a 9i?-2P D!:5c c_'
CHE=CK AMOUNT a 71:3. 70
w NAME: a K. D. LEE DU I LDF RS CASH AMOUNT a 0. 00
ADDRESS a PAYMENT DA-TE a 07/14/92
SUBDIVISION a
' PURPOSE; OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
F3U I L 1)I NO PERM
430. 00 PLUMBING PERM 140. 00
MECHANICAL PE 39. 00 ST. BUILD PER 30. 45 I 1
i)LAN CHECK FE 9. 25 SEWER INSPECT
35. 00
1
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I. L-44, 4 9W JORDAN WAY �
1 +
A
1T(Ii. iIMf11-11:!'1 PVI T r)
e
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CITY OF T 1'GA RD RULE I PT OF PAYMENT REC F I PT NO. a 92-2P8950
(..,HEC14 AMOUNT 00
NAME a K. D. LEE BUILDERS CASH AMOUNT 0. 00
ADDRESS a 10915 SW HALL. PVLVD PAYMENT DATE:: a 06/26/9P
TIGARD, OR SUBDIVISION a
PURPOSE OF PAYMF:'NT AMOUNT PA I D ruRF OEGE [117 P;",'ME;IJT AMOUNT V,A I I)
i PLAN CHECK FE E.--53R ..._..._...._.....250. APi ...._..._.�.._...._.....___......._...__..__.._...._.._.. ...,..__...._._...�._.._._,...w,.
is
I
A-P6444 SW JORDAN WAY. LOT 1.E.
:t
SLI) ORD GLEN
4O TAL. AMOUNT PAID __ _ _.1 ?50. 091
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unif led �- -- SAN ITARY• D NTH
sewerag 1,� t I;�'t
agency
0155, �S
N. First AvOr.,97124 U RFACE WATER
CONNELiIUN PERMIT
S5UE DATE 070292 : kPIRATIUN ItAIE 122992 PERMIT 102944
TRUCTURE ADDRESS +26-81 /(!71 Z- PROJECT15',08 .I
TRUCTURE STREET SW JORDAN WAY' r•
LUT 16
YPE -COfri&CTION-• NEW OF BEDFORD GLEN NO. 1 „�
7PE INSTALLATION- ( 19) DLL, SWI';/ERO CON/'SDCr i • r '
.YPE OCCUPANCY-- ( 1 ) SINGLE FAMILY PARCEL 261 16 AD 25000
rs UTR SLC 4716 MH 1-8025 �
WNER K D LIL-1 BUILDERS
DURESS 10915 SW HALL 1:L"D TREATMLN7 PLANT DURHAM
TIGARD UR 10J:,2 s SUitCRG DIST
1HONE 639-2723 JURISII Ii
IXTURE EOUTVALENi DWELLIM6 RESIDENTIAL i
NITS SERVICE UNITS O.0 U H IT 6 1 SERVICE. UNITS 1
i
CONNECTION FEES SURF ACL- WATER LILVELOPMENT Ff"t'5
SEWER CONNECTION 2100.OuWA?'ER gUALITY ISO."
! F= 1 LESS CREDIT < 180.00
WAL11'"R QUANTITY 100.00
LESS CREDIT < 0.00 •
EROSION CUNTROL
INSPECTION 64.00 r
n v PLAN CHECK 41 .60
'4
SUBTOTAL 2100.00 SUBTOTAL 205:60' 1
TOTAL 2305.60 I' - •
PPL NOME YIN LEE PHGi1
I �
i FFILLIATION OWNER n
EMARKS PROD# 1900-BEDMM GLEN-LUT 0 16
24 HOUR NOTICE FOR EROSIUN CONTRUL INSPECTIONS REQUIRED
f art; �f
Tqc;ItErl Ry 'TWIMP1:, JA
{
r• Permit C ndltions: The applicant agrees 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 s date of
1 issuance. The total araunt paid (permit fee, connection charge, line tap fee and/or other charge) will be forfeited if the
permit expires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at the
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 Agency will install a lateral.
' t. I
6/90 WHITE - IISA, BLUE - Accounting, GREEN -Inspection, YELLOW - Customer