16718 SW JORDAN WAY ,'�y,. . .uwr-.�'.vd.��u�W►• VWMMM'��MMh"�M'.A►r�1,y,•�'�p WN+w�47{M'�,MMtiM•WM'"`g1�IMyy�M y� �p� f1�MNNM�#PMf'°�
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INSPECTION ICE
C.l.t7 or Tigard Building Depacevt
13125 BW Ball Olid. Tigard, Oregon '7223
Inspection Line (Rec-O-,Phone): 639-4175 Busineas Pnune: 639-4171
Inspection:_
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Uut Gas Lane FI
Post/Beam Struct. San. Sewer Framirg -Bidg.
Post/Beam Hoch. Rain Drain Insula,,lonum~b�
Plbg. Underfl or Water Line Gyp. Rd. -Hoch.
Date Requested- I z"5-1 y 1 Time3 _ AN PH q
Address: , L �- Kermit
Bi-alder: i �.� _Ly7.1
THE FOILOWING CORRECTIONS ARE REQUIRED:
t
InspecDate:.. -
APPROVED _-- DISAPgROtBD _- APPROVED SUBJECT TO AEG"
Call Fcr Reinsp.
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CITY CSF TIGARD
CERTIFItRT'C: C7F
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13126 IV!Hall Blvd.Tigard,3raaon 67223.8199 (603)6?Q,4171 PERMIT *. . . . . . . c MST93•-o*,V4..:, '
639--417.1 DATE ISSUEDa 12/30/93
f-'faRCELa 2S1 LGAD--BEDI4
.SITE ADDRESS. — ii 16718 SW JORDAN WY
SUBDIVI ION. . .. . a BEDFORD GLEN ZONING:
BLOC14. . . . . . . . . . a L_QT.. . . . . . . . . . . . . 214
CLASS OF WOt;;N,. aNEWµ_._.__.._._._,_..__•_.__..__..._..___.____._______.____.,._..__._,_...__._.___.__...._____,_w.....
j TYPE OF U Ste'-••.. . . #8F
OCCUPPI\I!'Y GRP. S P3 �
e
OCGUPi4NCY LOAD21113 4
TENANT NAME. . . a r
Remarks - PATH I
Owners
BEACON HOMES
9500 Sw IZIST'H FIVE
Flk::FlllERTON OR 97005
Phone #a 55,4-1999
Contract( � a ___.. ..____.__. ......__._. .____.•._..__.__... •_.
HEAT. m 1-jum1r.S
9300 SW 125TH
41
` SEAVERI ON OP 97005
Phone #u "rc'4- 199'
1 Rey M. . a '70782
Or_rupancy- of t1R , above ref`Prenced bulldir•Irg is hereby gavel,, and c!nrtiiief-
the rnalplti.anc,. with the `]tante Of Or-Pyran r`.;peCial"y Codes fnv' the Wr`oup,
occmparlvyM Pod use truce( which the t-efer•enc mu?d C armit wab
__....._...._ . .,� ._. _....__..
1 F=IRE DEPARTMENT B j-NG—II NSP lR
BUT 14,01 C t11
PUS1' JN CONSP I CUC'US P-1_F•IC E
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E or NdCIc�.
arse CTI
City of Tigan°. Building �92j_
IL3125 SII Fall :lvd. Tigard. Ore
Inspection Line (Rec-O-Phcvu)t 639-4175 Business Phone: -4171
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINA
�L:`
Bld l
Post/Beaty 8truct. Ban. Sewer Framing � 1
Poet/Beam Mach, Rain Drain Insulation Pitx[nbnb/
Plbg. Underfloor Nater Line (;yp. Bd. -Hoch. '
Date Requestedt. �`�' Times AM _
)Permit I
Addr-
Bui—art—..
THE FOLT.ONINO CORRECTIONS ARE REQUIRM
---- t
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6hWIr„ r I r .
qtl ( PI{ IlppSiµ{�.
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Ing pectora _
_/_� Dater
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�11PPRJVND —^ DISAPPROVED APPROVED SDMM"r TO ABOVE
Call For Reinsp.
All,
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IN¢PBCTION NOTICE
city of Tigard Builc'taq Department
13125 Sw Hall Blvd. Tigard, Oregon 9722
Inspection Line (Rec-O-Pbone)z 639-4175 Brininess Ph a: 639-4171
Inspaction: A �n _
Footing Plbg. Underslab xL-11.-uXh-in� rppr/Sdwlk
Found. Plbg. Top Out r Lf_�e_) FINAL.
C--
Post/Beau Struct. San. Sewer <�nra.i -Bldg.
Poet/Beam ►tech. Rain Drain 12rulakii n j -Plumb.
Plbg. Underflxor Fater Line on. ad. -Hoch. �
. IDate Auqueatad7 c7r_ 'Z / 1 J _ -__PM
Address: I: 'JOJJ� 01-t-I Permit. 14 ! ![ fk,
Builders ' CC - .
TAE FOLLOWING CORRE^.TIONS ARS REQUIRED:
f
Inspector;—_._ _ —.---- ----_._--.-._--- Date
_ .`APPROVED - - DIS\PP.kCVED - �' }i OVgD FSU,3JI,,CT To ASOVE
r Nn. .r(.
i
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.;.��a!'�:.'�,�CM*a�',ip7�wp ....,,;,.R ,-,,,..,,._ .,.,.......,... ,...�,..«.rwa.-ti>.✓.w..��.v,:�.......•s.d.ir✓�a.y,.,,,,r,;;,....,+. i ,��`.
1"P&C1'I0Ii NOTICE
City of Tigard Building Deparfawt
13125 BN Ba3.1 Ulyd. Tigard Oregon 9M.3
Inspection Line (Rec-6-Phone)r 639-4175 Business Phones 639-4171
lnspectiont
Footing plop. Undera+lab Mect. Rough-.in Appr/Sdwlk
Found. hlbg Top Out On..; Line FINAL:
e
Post/Beam Struct. San. Bawer Framing -Bldg.
Post-/Beam Nrch. Rain Drain Insulation -Plural .
Plbg. Underfloor Nater Ung Gyp. Bd. ' I Mech. ,
Data Requeateds �� T Times AN PN
q
1Wdnsss ���� WGI� Parl�it ft ! -OL��1 r +
x
Builder s `-3 SIC I
TM FOLLONINa CORRECTIONS ARE REQC?RED:
I
i
Inspectors __ Dates
AFPAOVRO DISAPPROVED _ APPROVED SUBJacr TO ARO'JE
Call For Reinsp.
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INSPECTION NOTICE t, gab
city or Tigard Building Mgwxtment �§�(
13125 811 Hall Bled. Tigard, vragon 97226 `
Inspection 1,ine (Rec-O-Phone)t 639-4175 Bnainess Prione: 639-4171
Inspection:
Footing P_b,. Underela) Mach. Pp-in Rough-Ln h A r sdwlk
/
round. Plbq. Top Out (`pas Lin g/ffrl FINAL: litI' r,gaF
2d
Post/Beam Strucc. Jan. Sr sr r1ramLng G/C -Bldg.
4oet/BFsam Much. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Nech.
fJrta Requested: I l "/'5 Time: AM r11
V1
Perms! It 4�3G
_ ���
BukIder: a C�'� / - 1�1-i 52 ( 1ei /
TRE 1'OLLO1'ING COMMONS AR1C REQUIRED: I d174
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inspector -_— -- Date:�� L 9 `/
1
DISAPPROVED 7`--
APPROVED �A I OVXD SUBJECT To AVWX
Call For Rainey.
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DEC-21-'93 TUE 12:9C, I T1:C I TY OF K I rIG C I Tl' FAX N0:503 63c '771 0199 P09 .
. �
KINC'r CI'TTY
m��aeana 16.300 S.W. 116th Avenue.King City,Oregon 97224 Phone:6394082
COMMUNITi' DFVELOPMENT
APPLICATION FOR SUILDI;NG PERMIT
(Instructions on reverse)
DATE l l l �9 3
1. NAME OF APP14'CANT: k )n k t"i4�.c� Phone No. .7,2 y
ADDRESS=L�Y�lL / r•'g r '�11 0'_ F !R �
ADDRESS OF PROPUSED UVFC1VD1ENT /& 1/S_ YL1 CLu.I !:� U)r74
2. TYPE OF CHANGE✓, IMPROVEMENT OR CONSTRUCTION FOR WHICH PEPMIT IS REQUESTED. �
DESCRIBE BRIEFLY — ATTACH: TWO COPIES OF PLANS OR DRAWINGS GF
PROPOSED PROJECT• _. .Ltd IdC2,4 C
h
1
3. 'lAtE AND ADDRESS OF CONTRACTOR i3eco C
\1',�3 rrm El CZ j, iY)t1� PHONE NO. LICENSE NO. > > L/.<-/`.rt`/
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJEC.r WILL BE NOTIFIIID BY THE CITY.
5. APPLI OR HER/ S R.EPRESFl ATIVE MU� BE FRES AT THE P ING SSION
MEETIN�6 1'M ON
AEPRF,6ENTATIVES/VWi _ NO.
Ohe Kinq City ;lanninq Csei's— sig on will con4ider only those applications rec vec at least live (S) days
prior to a meeting.)
IGNATURE
I
APPLIrATION P:cLZEIVED BY TE
APPL,iQU3LE FEE RECEIVED S rJZ 6(l) qrfrAL
PLANNING 'MISSION DECISION: Approved Denied
ODNUITZO!48 a-k� ec -kms C _ +1 n4- Tr si Gtr . L' �/y�� cz►) i�7 ` ec /n/2
Approve applica 'ons are valid for sir rontbs cnly
rp
�- .5i gnat tirr, Date_� �
10TP.; Or Baneh Ides Lay requires that all persons who contract for"V rk on their reeidew be
registered with the Builders Board which means the contractor is hooded and insured on the job site,
For yiur protection, be certain your contractor is registered by calling City Ball Ph; 619-4082,
NOTE: A permit moist also be obtained cm the City of Tigard Departnwit of
Crnvrnmit:y Development Yes — _ No
CST! OF TIGARD INSPECTION REPORT
The above listed project has been inspected and Approved DeniPci-,—_ —_
Date
Signature_
(B►k,t'd ing inApeet-a , pbw-,W- 4,e tmn. ono. (1) copy .to Kine C(Ag)
CD 2.81
N CT ON NOTICE /
City of Tigard Building DOPartae'nt -�
.3y25 Bw ',Ball Blvd. Tigard, Oregon 97223
Laspaction Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr%Glwlk ,
found..
Plbg. Top Out (,.■ Line FINAL:
�
Struat.! San. Sewer
��'���� framing -Bldg.
n48eam Ifeoh, ?j/ Rain Drain Insulatlon -Plumb.
Plbg. Underfloor Water Line
j
Li�n -Mach.
Date Requeeted: ___1e Gyp. Bd. �(
' D l ---7� TdAnt Ah L--PM S
,�_ (�/_�"�.�• (��,—/�------
hddress: I�1 ( 0 '3afeayx " -"` Permit #t
Builder: At --
V" t�y�� �`7
N
THE FOLLOWING O0RRECTI0Nb wRE REQUIRED:
i
c_ c
Date: .—
Inspectors
APPROVED DiBt.PPROVEIIAPPROVED BUBJECT TO ABOVE
v) Call For Reinsp.
,..,,.,...«..n..n..,.+ww..�+w...»e.a«cw.r..wrw................,.. ........
INSPECTION NOTICE
City of Tigard Building DepEinesq;
13125 SW Ball Blvd. Tigard, OrJ
Inspection L,.ne (Rec-o-Phone): 639-4175 BuP i X99-4171
Inspection:
Footing •
Plbg. Underelab Mach. Rough-in Appc/Sdwlk
Round. Plbg. Top Out Cas Line FT
NAL.
Post/Beam Stract. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb,
Plbg. Underfloor Nater Line Gyp. Bd. _Hech.
Date Requested: �1V AM _ .PH
Address: L1 1 ( b 1c'%tA�a(/\ c0a, Permit f s t; '..�)/1(
Builder! Q C `�,r"lQ e, L e Q , 11 by_, 1 H
T.'► FOLLOWING CORRECTIONS ARK REQUIRED: [
I
l
T.nepector:
APPROVED v L_ DISAPPRQ1►K1) APPROVED SUBJECT TO ABOVE
v/
Call For Reinep.
..r+aww�s,..Awa,......,...,..........:w..,.,..�..emwe..w»nwnw,.r=:,;.:,,s......_e.ur.....r.a.,,....,.,,.
�t�
IMUTION NCTICF;
City of Tigard Building D.spartaant
1312S OW Ball Blv'3. Tigard, Uregor 97223
Inspection Line (Rec-O-Phone,I)s 639-4175 Eiusinesa Phone: 639-4171
Inspections—M
Footing Plbg. Underalab Hoch.. Rough-in Appr/Sdwlk
Found. Plbg. Top )ut Gas Line FINAL:
Post/Ream Struct, San. r
Framing -81c�g.
Post/Ream Hoch. Rai=0:7rain-) Insulation -Plumb.
Pl.bg. Underfloor Nates Line Gyp. ed. -Mach.
I '
Date k ested s rl� 1 �-/l 5 TLoe s L , AN PM
�� // t,� 7
Address:_
�s
l /I ���G� u �'� Permit ( �
Builders
THE FO:.LOWING OORRECTIONS ARE REQUIREDs
t„
Inspectors /1� ---- ^-- — ------- Data.-_% i } p
--- t-
G� APPROVED DISAPPROVED APPROVED SUMTECT TO ABOVE
Call For Reinap.
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."'r""°'e'+'y�r�.""e+"aPrJMwr•:i..'�'WGM.,,,,,.
INSP 01120 NOTICE
I
City of Tigard Bulldog Department /
• ti ,
13125 Sof Bell Bled. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Ph.)nat 639-4171
Inspections
looting Plbg. Underalab Meeh. Rough- in Appr/Sdwlk
ou11d__) Plbg. Top Out Gas Line FINALS
it/Veam Struct. Ban. Sewer Framing -Bldg.
cost/Beam Mach. Rain Drain Insulation -Plimb.
Plbg. �onderlloor Water Lino Gyp. Bd. f -Mech.
Date Requesteds J (' `� Times ` (n!A!1 YM •
1 1
Address: � �J�(�.�5 0.[. Permit #t l//��`nC:;1 e13 �j
n`PkI
Builders— �/. O( - ( h, ? tt�',. ■
TBE FOLLOWING CORRErTIONS ARE RE()UIREDs
trk^71J...
1
1
Datat'' �'
:�JA;PROVED DISAPPROV70 APPROVED SUB.TSCT TO hao
—Cali. For Rai.nsp.
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT TE"� S 09/30/""
11125 SW Hall Blvd.Tigard,Oispnn 97223.8199 X503)839-4171 DAA`'
.w s 1 t� 71.LA :3 W )I',"DAN W'! �
J�:�17k4'IaIUN . . e BELIF=ORD GLEN ZONING .
1 :..:;. . . . . . , 1.0?. . . ,. . . . . . . . . . . 14
1 5SLUE; JWLL..1..I NO UN w 7 i: 1 Df-ISC,IhEN l'. . . . . . . . .0
ASIS 0 WORK. :NEW }31~.IJP1416:3 11:R f t-ri:r GARAGE. . . . . . . . . . : 430
f•: AR A<;._...__ !a`[;OUIRED .ETBOC'.F(;,_...._____.
�o- UT CONST. 5N FT RST. , 1 C,21 S f LEFT. . :l ft R I GH7 . :5
'CIJP'iaFJC;v (:ISP. ^F?';3aG-1,C7N1). . . :0 Sf` FRONT. :,.,o ri:
TORIES, . » , . . . s 1 l'HIRD. . . .0 S f,E:C`1UIRF
1 OI t'T. . . . . . . : l i1 f t TCi'Tla1._ ; '1 r::') c t SMUT L T)G'1 ..1.,TCJl�S. :Y
C}UFi LOAD. . . . .40 ps f VAI Uf. . , . . 5 ' D.::.306 Pi-RK I NU ,r.�s[41GEGi . - 1
FSI UMB I NCC
r,l'al'... , . . . . . . , ,. . . . r..l_aUr, DRAINS. . . , .t7� I,c-ai�I:...L_t'W rryF EVNTRG. .
14 fa-riiRi E=;,. . . . . ; WPT17 R F-LATE.40. „ . : 1 I F•tA� . . . . . . . . . . . . . . :0 `u
1Ji1/;'s'1AQWERS3 . „ . t_PUNDRY TRAYs . . c :1 CATCH DA21N2. . . . . . . :0
-"TF
`F', CLOSETS. . : SEWER LINE (f'.. ) . :0 GF?Eo' SE TRAPS. . . . . . , s�
l'iHWA! .1L:1t 3. . . . : 1 Wf il'(.P I...f,I' EE ` Ft ) ,. : 1.00 OTHLP F='I x'r(.JRES. . . . , -.0 J
I:)I:-.;P. . . 1 RAIN DRAIN f`t ) . :0
.....__��_.�,,.,.._. ........, hl[:C.(iANICFIL _.._._..._,. .......,....._.....__.. _._.__,_._._..._.__.._.._ .. FEES
UNIT HTRS. . :� tyhF amount 1-1y date ret:pt.
;n5! VENT." . . . . . v0 DF'RI �. 38E, 00 JH 09/30/93 —
AY. S:MN.1TiO B1,U VEN,f F FN'S. . 13 BPL..0 30 .JLI-I 08/09/93 ':1:3
_JRN t 100F; , » : 1 HOODS. . . . . . .. 1 L35PC 19. 10 JH 01/U,-l/93 —
I
JF I•i ) - 1k.'t f( :0 W(JUDISTOVE04. :0 MPITT r 40. '50 .JH 09/30/9'3' --
-GOR F t..fRN. . , w0 CLO DRYERS. : 1 IYiF"Lc a% !0. 13 JI•i 09/:341/93
L.11vI t'7 O; I M 56- 0'' JII I 0+)/1 3 0
Gn-S L7UTL_r.T1' . 1 F'PRI 1; 1 3e:. 50 ,JH 09/30/93
17154-'(.; ?t. 009/,307"3,_'
f::AC,C.IN HOMES 1y1 T :;[; r 35. 00 .JH 09/30/93 _
�'AVE:RT0l4 OR
i
.;.11410 S w 1 s21-'i-F f
trifle iMr 524 19'3�)
ii0. lRd _... _..._.. ... ._._.__..._.... ._,. .......
.__ �
07(. „ .1 ') TLT)'01_
ki perfit is, 45sied sua.,Fr is the rei�,te;: 5 c.l+ta:red :r• the _ ._ .__. .._ REQUI REED :[N;.->t-,EC:'T 101-,1 , _.._.,.. _
igard Muflicipa! Cade, ;tate cF Ore. Eper.ialti '_ode; and all .Ithmr 1-a:,t/f 0 i..a11d I n s,4:t F" r'e p l aac:e I n E .
lrl4iceble laws. All work will be dc-re int.rr;ance r t" apprcved a F,f.; <a'71 '_-it r .ic i r 7 n I_ a I n s Fa
it s; pelrri w'.1.1 expire is wot« s poi xtarled withit 184 f'ay' +Pm Mer_•h-11-1 Lan J'vsp
I5'j nef, or 0 dais. PIM/ Insp Gyp SneAt,d ITIrp
f,L_M/ur:JF;rt=lclar•, R'-1i.t•, ciral3n Irf-�lp
.._.._ _ o'1 F1 r. , a! , cs'i.1. 1 nc.;p W�aee'r Line 1n
1 --imb `Iar1 i fiat For^i ;tit�1.N 1rt<..
,3 I41 afd r' N"y�': �•, d ":xi44-. xW�$x , -��,,,�:.
. K4h1'Mic;!t'+' - vtrk+vlrM1.7NiiYlMwearn<!rFMnmrwnwlan'taM:+•r. ..nm.-
r13125 Sw tfall Blvd. PLNCK/RECT # - � •
` TTY 01A �� ^GARD . KI[k)x o 97223 PERMIT #
COMMUNITY DEVELOPMI�,NT DEPARTMENT �rd.C-ca-inl
DATE ISSUED
JOB ADDRESS: Q Jf�� � w — TAX MAP/LOT
SUB: I��d�+,rd � in LOT: [+ LAND USE: --
VALUATION: —
OWNER SPECIAL NOTES •
NAME: LAU ILA '` REISSUE OF: --
A,DDRESS: ��' LAST REISSUE:
dam-. Ck caOS FLOOD PLAN/
PHONE: — SENSITIVE LAND: _ --
CONTRACTOR APPROVALS REQJRED
NAME: -' -t-F� ✓ �ta`^��-� _ PLANNING: e
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: V52-+ 1� '� '� _ OTHER:
CONTR. BOARD 0: n�l�4= _ EyIV*C: 1
ITEMS RFU
1 v2_- LIST/SUBCONTRACTORS:
SUBCONTRACTORS: PL�UM�: ►/ �� —
� � MF�C.FT: BUS TAX:
CALCULATIONS:
.�� �ER —
NAME: - n''� �' -' '��� - TRlIsS DETAILS:
ADDRESS: iOr., a TG = _ OTHER:
` -'e '—
PHONE: ��`�-- 4421 _
PROPOSED BLDG. USE.: —2'- -J0 *=r- "%�L,4 __ �� �\►-� _ _
COMMENTS:
APPLI NATUK
Received B�-: � _ _ Date Received:
A.
Gam,,,•..............._._., .,.+..vnnn• Com'A,.ic:'l",tf•
PERMIT # ACCT # DESCRIPTION AMOUNT / AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees 3y •�'u
10-431 00 Plumbing Permit Fees /.31.. 31,5r I
10-431 01 Mechanical Permit Fees ,)-v
10-230 01 State Building Tax (5%)
Building / 9• / o
Plumbing
Mechanical o 3
10-433 00 Plans Check Fee / :,2. 5 ',�� •����f
1
Building
Plumbing
Mechanical ?. /
10-230 06 Fire
30-202 Ou Sewer Connection
30-444 00 Sewer, inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
i
25-448-06 Institutional TIF Fees
I —
25-448-03 Office TIF Fees _
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Oev Charge (POC)
31-450 00 S�orm Drainage Syst Dev Chrg
(SSOC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAI1�111�
nm/3587P.WPF
9
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CITY OF1•IC�ARD PAYMENT �
- RE:.C:L:IPT OF PAYMENT RVGFIV"T NO. :93-244(,93
NAME c BEACON HOMES CHECK AMOUNT : 626. 19
nDDRE:SS CASH AMOUNT : 0. 00
PAYMENT DATE" : 09/30/93
SURD I V 17 I ON
1"URPOSE OF PAYMEN-f AMOUNT PAID PURPOSE:: OF PAYMENT
AMOUNT PAID
RUIL.DINr PERM
I+IE:.CE�FINICAL. FPF382. 00 PLUMBING PERM 1321. 50
I 40. �.0 ST. BUILD F'E=R
,PLAN CHECK FE 27. 76
8. 43 SEWER INSPECT 375. 00
(:, 718 SW JORDAN WY, t_O1' 14
Cf"17AI AMOUNT F'AII) 626. 19
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agency
U158 N. First Ave.,Suits 270,Hillsboro,Or.,97124 SURFACE WATER
803 848-882
CONNEf TION I''I::RM3 T
09 '.y'73 I XPTRATCOH DATI.: 0.121174 Is"UR14T.T 104741.
1'IiUCTURF: A11L1RF'IR5 16 ],f3 FRf?�II::C'T 17'30
t 121.11' rl►12r•: :.3 rR[ I:1'
90 JORDAN WAY
. L U'I' 1 4 El 1..1'1 t'K
Y1''I: I:;fl hl h! i:1':Clahl Nf::W Cir" Dr.:D1"ORD PARK
i i-1- INSTALLATION— ( ]9) DI..II f;WR/FRD (11014/0111C,
PoRI';I::I. 31 1.6 ACI 7.4000 t
011, SEC; /1711.+ MM ].11;493
i
11 1RE S'S 91,100 ^M I2r5I H " 1U1 TRFA'l MFNT Pl,AN'f it111;F1(1M
14EAVFRTO N Cl(2'' 7y00'S
I H0ME 52 4 1997 ' Jl. RI!'I KING' CITY
IY"(URF E00IVALENT IIiJL".I.I INC) RF,II'1I'N11AL
1?11 i �i ''il"1211'r Cf; Ilhl)Y1'`3 0 .0 11MT.1'".i i �ih:RVIU. UNIT'S 1
CAMNEC-TICIN I CI.:I; fil.lR AJA:' hln'LI::I: IIr'.VI:L,(11'MI:,N'I' t FE'S
SE-1111:1Zf;[1NM1;f';T'l:tTi`t 2200,00, WAT":I 1.80 , 00
1_F I)5 f:Fc F:I1) T 0 :)U
WATV'R (:11.1nh1 I'1: 1'Y 1.00 ,00
L.E:I;S CRE I'1T1 0 , 00 :.
1 E:ROIT.IM r;(ThlTROL
INSPECTION 40 t OU
FLAN CII'Vl',K 26 00
';Ilr1 iO UIL ',2200 00 :i 1.11: T1:11'AL. 'i46 00
1,01M. 2",•,X11• , 00
fi'l'l 1•I'ili1: 1`["'1 .::'2 I< I'1;:iK I'�'III:INL� /.l✓r ._.
&1-:IL.LIATTON VP
'L M(,.PK'� ULF'N•-1_01 t14
2q H01112 NOUTC1'. 'CI 1 t'tI�FST.I N C;ONTPil11.. INSf'E:C1"CC)NFi REOUIREC1
t1 0 KI A I I 10�' ,- M. ily
Permit Conditions: The applicant agrees to oonpy with all ndes and regulations of the Unified Sewerage Agency. When caping for an inspection, pease
refer to the Permit Number. The Permit worse one hundred eighty(160) days from the date of Issuance. The Agency does not guarantee the accuracy
of the location of side sewer laterals.
7/93 WHITE - USA, BLUE - Accountfng, GREEN -Inspection, YELLOW - Customer
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CITY (IF T I[ ARU RECEIPT OF Pf"4YME,1\11 RECEIPT NO.
CHEM( AMOUNT a X0. 00
HOME BEACONtIOME CASA AMOUNT 0. 010
fai�[�RF4;�3 a PAYMENT DATE s 0A/09/53
GUDDIVISION a
-'URPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT Atl(JUNI PAI D
-'I_r4N CHECK FE 250. 00
i
-Of' 14 BEDFORD GA—FN
To I nl. AMOLIN T PAID — 0,50. 00
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