16742 SW JORDAN WAY I Who
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INSPECTION NOTIJE
City of Tigard Building IDepartmeut
13125 SW Hall Blvd. Tigard. Oregon 97223 '
Inspection Line (Rec-O-Phone): 639-4175 Rusiness Phone. 639-4171
Inspection:_
Footing Plbg. Underelab Hoch. Rou•lh-in Appr/Sdwlk
Found. Pltrg. Top out Gas Line FINAL:
Post/efam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:_ U ` _ Timet pM �,
�-�=�1 � LdPermit #
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: i!
J/ _ Dater
T' _APPROVED bIBAPPwrn APPROVED SUBJECT To ABOVE
Call For Reinep.
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Foo
~ INSPECTION NOTICE
City of Tigard Building Department /t .
13125 SW Ball Blvd. Tigard, Oregon 972:13
Inspection Line (Rec-O-Phone,: 639-4175 Buoineso Phone: 639-4171
Inspection:__
Footing Plbg. Underalab Koch. Rough--in Appr./Sdwlk
Found. Plbg. Top Out Gas Line FINAL: P`
Poet/Beam Struct. San. Sewer Framing
iy
Poet/Beam Mech. Rain Drain Insulation -Plumb.
p
Plbg. :.,derfloor Water Line / Gyp. Bd. -Mech.
Date Req:saeted: Timer 'M •
nddreas:_� )� i.. ze
' G� Permit
tl
Builder:_
THE FOLLOWING CORR:ECrIONS ARE REQUIRED:
R:
i
4'
Inspector: _ Date:—
j _ APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
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F.:
CITYOFTIFARD
COMMUNITY DEVELOPMENT DEPAR i MENT �o noo"
f` 131268WHWIBlvd P.O.Sm 23397,Tqwd,Omgm 9(SW;eaw175
UCC:'11F=AId1 Y
xxxx PERMIT M. C" � r
"y , . . . . . 7 MSI `). ' k i hi
6139 -44171
EI:f
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St t F. ADDRRSf:+. SW JURVAN WY :Rwy 1 1 hI4D...BEUd
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SUBDIVISION. . . . .. BEDFORD GLEN 7~,r1V i NCt a
^a,
BLOCK. . . . . . . . . . a Ln i'. . . . . . . . . . . . . a H
C.:Lf73r OF WC RX. i NEW
rYF�
or US[:— t sr- �
OCCUPANCY 13RP. a R3
UCC:iJPONCY LUAb a 1 19 4+
T 1'�iANT NAME'. . . a ■
Rerniarls«;a PATH i b
uwnc+r-e ._. ..._..w__. ...____..,__ ..._._._..._.._......._._... ,....._._.
BEACON HOME'S INC.
Contractors
AEAC ON HUMES
PO box 1368
BE'AVE:F2TU14 OR 97075
F"hane 410 524 1999
Reg #. . a 71b7&F
Occ,upproy of the above referenced hui1(iing is hereby given, ,and c:^«rt ifie
the c,.)aap11anre with tyre fit&too W C7reyar� "aper�i;�lty 1.c�rJe-1 fi-r" Ch«r group,
oc:t ipmnc'y, sand use e.rndOr which the --iforenced permit wa %.. i raced,.
r' 1 CtF.�. r.tifir'Arl"�r;i•r!T HLIII..0 G; ,,�,,d ,I ! � fClr2
>au.r L,1�1 Nu ter=r t C I Al..
POST IN C0NbP I L1juU* NI.F'a1"E
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INSPECTION NOTICE
City of Tigard Building Department
15125 SW Ball Blvd. Tigard, Oregon 97223�4a
Inspection Line (Rec-O--Phone): 639-4175 Burineaa Phoria: + .'•9-4111
Inspection:
i
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
i
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Boa, M,.-ch. Rain Drain Insulation -Plumb.
Plbg. Unle.Stoor Water Line �yp6d. -Hoch.
Date Requested:- �L Timet -AM PM •
Address:_ rZK--�1� _ Permit I:L'�'?
1 Puilder_—rL`�� -r!
N
THE FOLLOWING COPRECTIONS ARE REQUIRED:
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7nspecto-: Date:_Z
APMOVED DrSAPPROVED APPROVED SUBJECT TO ABOVE
i call For Reinep.
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INSPECTION NOTICE
i City of Tigard Bui.ldlig Deparf-.ent
13125 SW Hall Blvd. "i.gard, Oregon 97223
Inspection Line (Rec-O-Phone): 6:9-4175 Business Phone: 63� 7 '
Inspection:_ ,-------
Footing Plbg. Underelab Mech. Rough-In Appr/Sdwlk
Found. Plbg. Top Out GasLineFINAL:
Poet/Beam Struct. San. Sewer FD6tQLh — -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
(
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requeated: I Time: -_AM PM ay r
��AdQraas: j � .J ACL\ l�L� Permit t:_
ai➢u f
Build
or,
L.1
THE FOLLOWING CORRECTIONS Al v '-QUIRED. —
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tr
' g• � � ,� �'Fr' fir I r+�':t
6
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Ins ctor
D
pe ate
— APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
C:ill For Reinsp. h F r.. 4r
ar t
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i'ii4 Fri �RC Ti F+ A� �.
771
INSPECTION NOTICE,
City of Tigard Building Department
13125 SW Ball Blvd. Tlgard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-41.75 Business Phones-
Inspect ion z
hones.Inspection: -------
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
i
Found. %P)bg. Top out Cas Line FINAL=
Poet/Beam Struct. San. Sewer Framing -Bldg.
1(;
Post/seam Mech. Rain Drain Insulation -P) 1mh.
Plbg. Underfloor Water I'.ne Gyp. Bd. --Moth.
im
_-11�_/�J 1 eT`� 2C�
Date Requested: T
Permit
Builder:
s
THE FOLLOWING CORRECTIONS ARE REQUIRED:
n
Inspector:r
_-I APPROVED DISAPPROVED APPROVED SURJECf TO ABOVE t
Call For Reinep.
.1,
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 9722
Inspection Line (Rec--O-Phone): 639-4175 Business Phon . 639-
Inspection: _
Footing Plbg. Underslab ech. Rough-in� Appr/Sdwlk
Found. Plbg. Top Out Gae Line FINAL:
Peet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requested:-���
Times AM PN ,
y �1� / /" / -- / -7
Address• 7 �/��7--]� Permit #:�'� G�/ k
Builder:
THE FOLLOWING ".PRRECTIONS ARE REQUIRED: 1
i17 ..--. ..
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Inspector:_ - e
i
_ APPPOVEU DI3APPAOVED APPROVED SUBJECT TO ABOVE
-_Call For Reinep.
1
INSPECTION NOTICE
City of Tigard Building Departs:ent A,
13125 SW Hall Blvd. Tigard, Oregon 97223 l✓J��
Inspection. Line (Rec-O-Phone): 639-4175 Business Phone: 639-41.71 j
I
Iinspection:_ — f- --__----
j Footirq Plbg. Underslab Mech. Rough-in Appr/Sdwlk I
s
Found. Plbg. Top Out Gas Line FINAL:
` Pcst/Beam 8trn San. Sewer Framing -Bldg. d
;4o13t/Pearn Noor' Rain Drain Insulation -Plumb.
N
S g. Underfloor ) Water Lino Gyp. Ud. -Nech. Y
Date Requested: ([/ �� �`7 Z.--- Times _ AM PM
/add i (' Wit' _ Peet t:
S
Builder:.
a
THE FOLLOWING CORRECTIONS ARE REQUIRED: U
y
I
d
A
Inspector: __——� Date: C) ~C �
[ APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
(S -_____Call For Reinsp.
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I INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregan 97223
Inspection Line- (Rec-O-Phone): 639-4175 9ueineee Phone: 639-4171
Inspection:
Footing Plbg. Unduralab Mech. Rough-in A
4 ppr/Sdwlk I
Found. Plbq. Top Out Gan Line rINAL:
_ m_ .
Poet/BeaSlruct- San. Sewer Framing -', ld '
1. g.
I+Qat/B®am Mech, Rain Drain Ineul.ation -Plumb..
Plbg. Underfloor Water Line Gyp. Bd.
-Mech.
Date Requeetec!: AM
_ Tom=
(
Permit
Builder:_
■
'"TM FOLLOWING CORRECTIONS ARE REQUIRED,
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Dater/� Z.-
__APPROVED DISA�PROVEp APPROVED SUBJECT TO ABOVE
7 ca:l For Reinnp.
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51 INSPECTION NOTICE
City of Tigard Builds g Department
13125 SN Ball Blvd. Tigard, cregon 9'/:123
Inspection Line (Rec-O-Phone)s 639-4175 Bu-;i,ness Fhone: 639-4171
t+
Inspection:
Fo-3ting Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Fouad. Plbg. Top Out Gas Line FINAL:
Poet/En;.+ Struct. ` Sin.�B Framing -Bldg.
Post/Beam Mech. QRe!in�Drain Iww ci,m -Plumb.
y` Plbg. UnderflooraLBr Gyp. Bd. -Mech.
Date Requested: �- � - �' Time: AM PM
7:ddress:f-^, �—�— !.) 'L/ Permit #: t
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Builder:
'Y
THE FOLLOWING CORRECTIONS ARE RkQUIRED:
1
IN
Y _
•f. L.
✓1 �
Ine hector Date:
_APPROVED DISAPEROVED APPROVED SUBJFCT TO AFIOVE
Call For Reinsp.
J#
I149PFCTION NOTICE 1
City of Tigard Ba. Jog Department
{ 13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Puniness Phone: 639-6171
Inspections
1` Footing Plbg. Underalab Meath. Rough-in Appr/Sdwlk
c
ifound. Plbg. Top Out Gas Line FINALS
r Poet/Beam Struct. San. Sewer Framing -Bldg.
A Poet/Beam Hoch. Rain Drain Insulation -Plumb.
f
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
l
�D atQ /Ragusated e_�!�_��� -��. Time:
-r• adresas [l / 7 ��(J L rmit 131��'-���
tT �
Buildars ���
THE FOLLOWING CORRECTIONS ARE REQUIRED: �
p
it
•S' y 36[{
B: v
i' Inspectors u J -------- Date:
L� APPROVib DISAPPROVED APPROVED SUBJECT TO ABOVE ,
Call For Reinsp. 1'
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„< .:, '� ref� i'fM1�t' •• i>L• 5 ti. .,
IWO-
tITYOF TIFARD
1----LUI+1B I NC-i PERMIT
*C00 PERMIT #. . . . . . . a Miaft)2-0187
COMMUNITY DEVELOPMEN".' DEF'AFtTMENT 131268W►SriBlvd.P.o.Bax�,TOW,Or"m9722:(603)=4175DF•1T'FF: ISSUEDa 09/14/92
��
SITE ADDRk:SCi. . . c -�i(,-r-r•�. . S',J JORDAN W'Y PARCEL: 2E11&AC)-BE:p6
G''LbIVIE;IUN. . . . a BEDFORD GLEN 7.UNINJ_-ia
Bt.00K. . . . . . . . . . LOT. . . . . . . . . . . . . 98
CLASI OF WORK. . I NE:W UARSAlaE DISPOSALS— al
TYPE OF USE. . . . aSF= WASHING MOCH. . . . . . . a1 BAC14FLOW PREVNT'RS. . s0
ULCUPkNCY 6RP. . a R3 FLOUR DRAINS. . . . . . . :0 TRAPS. . . . . . .. . . . . . . . ..0
STORIE=S. . . . . . . . a 1 WATER HEATE.RS. . . . . . 11 CATCH BASINS. . . . . . . s0 �
FIXTUREE ---._._.__.•.__._..___,- I_H►. MDRY 'T'RAYS. . . . . . 30 SF RAIN DRAINS. . . . .. 91
SINKS. . . . . . . . . . 11 URLASL TRAPS. . . . . . . :0
C2. OTHER F I X T'URE G. . . . . 90 �
Ob/SHUWERS. . . . a SE WI R LI IVF (ft) . . . . 10
td1+E•E.R C:LU ES. . a2 WPTEF2 ;I„INE: (ft4 . . . . a100 r
V1 SHWAS14 . . . . if ' ` RAIN 'D RN I N (f t) . :. . a 0 '
RemArksc PAili I
OWN_Rv . _.__�....•.._..___......__._. _ _....._.. ___..__..__.. _ __�,....�_.._.__..._.___..._FEES;_____.____...____..____..
DEACON HUPIE S INC;. IPPR f $ 349. 00 .:hi 09/14/92
BPLC $ 226. 65 JLH 08/26/92
135PIC: $ 17. 45 JH 09/14/92
PPRT $ 117. 50 JH 09/14/92
Phone: #; p5E'*1C $ 5. 8PJ JH 09/14/90 -
MF'RT $ 40. 50 JIi 09/14/9E' -
I Nlumt:ing Govitr4ctor. _.____......,...._._.__... _..... MPLC: $ 10. 13 JH 09/14/92
JJ M5PC: t 2. 03 JH 09/14/92 -
i
Name.- P��vb- at-ln MISC $ 35. 00 JH 09/14/92 . .
Ndcire 4% a 0
Gitya /�+►�/�tc _._ tit te3D�
Phone#: Gb.?
Reg
i
RLGaUlkE.0 INSPEI.'TICINS
rhia permit is issued subject to the reg-
ulations contained in the Tigard hla.aniCipAl I7oot/focIt)d insl) Rain Thain In`-h'
Cori r., 9taatar of,, Uv*6 Special :y +rAes and all Port/Beam 1..-)truct, Watgr Lime Insp
other applicable laws. All work will be done Post/Spam kec:haan Appr/Sdwlk Insp
in acaar•daana-e with approved Mans. This Plm/undslah Ingp Mechanical Finzl
wermit will expire if work is not !-taarted F''L.11/Underfloor Plumb Final
within; 1.80 days of issmance, ar if work is Mechanical ,'nxp Building Final
suspFride i for more than 180 daayl,;;. Plumb Top 01.1 ErL sion Contro I
F i,aming Insp f'rahl Drain
h ir,eplare Insp
Gas Line Insp _r
I n s u l vAt i o n Insp
6-4Gyp Board Insp
HU'thorized Plumbing Contractor Signeatr.are
Call for inspection - 633-4175
Lontractor PJotesa
s1
. CirlOFTIFARDhAST
F.R PERMIT cJrMM0
I COMMUNITY DEVELOPMENT DEPARTMENT oRmooM PERMIT #. . . . . . . : 1�I5T9c'-�18?
�126 SW Fill Blvd. P.O.Box 23397,Tipud,Oregon 97223(SM 8344176
i ----- -T . yS,Hpn• 09/14/92
SITE ADDRESS. . . -. �42491--SW JORDAN WY PARCEL: 2S 1 16AD-bED8
SUBDIVISION. . . . : BEDFORD (al_EN ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
BUILDING
REISSUE: DWELLING UNITS;: 1 BASEMENT. . . . . . . . .0 s f
CLASS OF WORK. :NEW BE:DRMS:3 BATHS:2 GARAGE. . . . . . . . . . :414 s f
IYPL ,t- UsL. . . :SF• FLOOR AREAS----- FREUUIRED S;E ('BACKS-----•-_----
TVf='E OF CONST. :51N: FIRST. . . . : 1391 cf LEFT. . :5 ft ;iIGFHT. :5 ft
OCCUPANCY GRP. :R.ti SECOND. . . :0 f FRONT. :20 ft REAR. . :20 f•t
STORIES. . . . . . . : 1 THIRD. .0 sfHEIGHT. . . . . . . . : 19 ft FO"FAL-__.._..__...-: :1391 s f SAOKE� �EIF T y
FLO(:JF: LOAD. . . . :4111 ps'F VAL_UE. . . . . Y : .' !. ':��1 I`-'i-TF21�:I�;h C-if-' �
Remarks: PATH I
PLUMBING - -______.______•----______.___-_----•-_--_--
SINKS. . . . . . . . . . : 1 FLOOR DFf-TINS. . . . :0 BACKFLOW PREVNTRS. . :0
LAVATORIES. , . . . :2 WATER HLAI ERS. . . : J rr,rlF'S. . . . . . . . . . . . . . :0
TIJB/SHOWERS. . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER Cl ;j-.iETS. . :2 SLWE::R LINE (ft ) . :0 GREASE TRNF'S. . . . . . . .0
DISHWASHERS. . . . : 1 WATER LINE= (ft ) . : J.00 OTHER FIXTURES. . . . . :0
GARBAGE DlEP. . . : 1 RAIN DRAIN (ft ) . :0
WASHING MRCH. . . : 1. 5FF. RAIN DRAINS. . : 1
MECHANICAL - - _____.____. _..______..____________._..__... FEES
FUEL 'f'YPES-- _._.--._-_._...___ 1JNIT HTR S. . :0 type amoo_tnt by date r ec pt
/GAS/ / / VENTS . . . . . o0 BPRl' $ 349. 00 JH 09i 14/92
MAX. INPUT:O BILI Vr.:-NT FANS. . 93 BPLE $ x_. 6. 85 JLI-H OB/26/92
TURN ( 11R. 1<. . . : i l-IUUDS). . , . . . 21 135PL 4 17. 45 JH 09/14/92
FURN ) -:100F< . . :0 WOODST•OVES. e0 PPR f' $ 117. 512.1 JH IZ19/1 4/92 -
FLOOR FURN. . . . :0 CLO DRYERS. s 1 P5PC 4 5. 88 JH 09/14/92
BOIL/CMF-' OTHER UNITSe1 111-RT `t 40. 50 JF•H 09/14/92 -
GAS OUTLETS s 1 IyIF'LC 4 10. 13 JH 09/14/92 -
ONlner 2. V13 JH 09/14/92: -
bFF.ACUN HOMES SC $ .35. 00 JH 09/14/92 -
j
C;ontr acto
BEACON HOMES /
Pb BOX 1368
BEAVERTON OR 97075
'hone #: 524--1999
Flet' #. . : 7111782
$ 81114. 34 FOTAL
This permit is issued subject to the rego!,tions contained in the - -- - -- REUUI RED JNSPECT ION'S
Tigard Municipal Code, State of pre. 5necialty Codes and all otherFoot/fol..tnd Insp �=ir,eplace Insp
applicable laws. All work will be dole in accordance with approved Post/Beam StV'UCt Gas Line Insp
plans. This permit will expire if work is not stared within 180 Post/Beam Meehan insL�J.ation Jnsp
days of issuance, or if work is suspended f mn t BO days. Plm/i-mdslab Insp Gyp Eioar^d IT--.-,p
f•'1-1vl/Under floor- R.kir1 drain Insp
Permittee Ivies^Iranical Insp W, ter, Line Insp
P1i.rmb Top 01st {-Ippr-,/Sdw.lk Insp
I s s i-red Dy : r ..._. Framing Insp M e r_.hr a n i c:a l Final.
f_.e 1 For inspection - 639-4t75
509 884 7297 CI Y (
i IF TIGARD Z001i001
CITY13WSWHallDiv I. PLNCK/RECT
OF T GAi�.D U397COMMUNITYDEVELOPMENTDEPAATMENT Tp9AOman 97W PERMIT
Iswl��gal't DATE la"11ED
JOB ADDRESS: Sw .Tnr,9an Way TAX MAP/LOT -2S/•/G 4d - ,&4 9
SUB: Bedford Glen LOT: LAND USE; _
VALUATION: / 8'
OWNER SPECIAL N0JES
NAME: icon Hanes, Ina• REISSUE OF:
ADDRESS: P.Q. Box 1368 LAST REISSUE: ■
Beavertc i, Ore. 97075 FLOOD PLAIN/
PHONE: 524-1999 Fax 524-1998 SENSITIVE LAND:
r. S
CONTRACTOR APPROVALS REQUIRED
NAME: Hanes, Inc. PLANNING:
ADDRESS: _ p_ n- Bax 1368 ENGINEERING:
Beaverton, Oregon 97075 FIRE DEPT:
PHONE: 524-1999 OTHER:
CONTR. BOARD M: 70782 EXP DATE: 12-9Z
lUtL-L REQUIRED
SUBC_ O__ NTRACTORS: PLUMB: VA1,le Plumbing LIST/SUBCONTRACTORS:
MECH: - %�,-he.9uality Heating BUS TAX:
A�Clg CALCULATIONS:
NAME: naninl V Smith Oe_sign Associates TRUSS DETAILS•
ADDRESS: P. o. Box 2192P4 OTHER:
Portland on 97225-9284
PHONE: 292-9583
AAW
PROPOSED BLDG. USE: Residential
COMMENTS:
r � •
i
APP CANT SIGNATOR
Received By: �� � .�� Date Received: 9
` l $141iF"�IIi+N/RJUIf`.YINLMV'Or•WNbWA1M\...:1„41.[.N •. ” . 1 '�:ti64�{��Jtl
WN,a rA
3 PERMIT # ACCT DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
�
143J92-D/ 10-432 00 Building Permit Fees
_ 10-431 00 Plumbing Permit Fees 1VUr�. — � `n
10-431 01 Mechanical Permit Fees 4D.S0 _ 0
10-230 01 State Building Tax (5%)
Building /?•Y
. k
Plumbing 51Ar
_
Mechanical a '03.
10-433 00 Plans Check Fee �•3(v� �I �7D /3 ° -
Building 9.26.
Plumbing
Mechanical 13 .
10-230 06 Fire _
30-202 00 Sewer Connection
30-444 00 Sewer Inspection .3-�__ 3 S r
25-448-02 Commercial TIF Fees _
25-448-04 Industrial TIF Fees
25-448-06 institutional TIF Fees
25-448-03 Office TIF Fees _ ——
25-448--01 Residential Traffic Fees
i
25-443-05 Mass Transit TIF Fees _
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg I
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL D . 3 z �U
349 . 00 +
117 . 50 +
40 . 50 +
nm/3587P.WPF 2 5 3 6 +
1 3 0 2 +
35 . 0 +
580 . 38 *
y
F77 !E9INA!Kakh''9�% HMPA4Mp'cM•rii4yer:r,.,..,.-....,.....,v.+,wwwr:wYM49�M(. .vw.w..:nwwrarwN,......w. _.....,... ..._......... .........+w>:.n„
T ~; T) 13125 sw lieu aNd. PLNCK/RECT #
CITY OF T1�..�ARD 1'O[lox?J97 PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT Tigard,Oregon9TM
(503)6394171 DATE ISSIIED
` JOB ADDRESS: TAX MAP/LOT —
SUB: LOT: LAND USE:
VALUATION:
OWN _
SPECIAL NOTES
NAME: REISSUE OF: ____ I
ADDRESS: LAST REISSUE:
FLCOD PLAIN/
PHONE: SENSITIVE LAND:
CONTTOR APPROVALS RE�UIREO
RAC
NAME: _ 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:
PROPOSED BLDG. USE: --
COMMENTS: —
APPLICANT SIGNATURE
Received By: Date Received:
CITY OF T I GARD - RECEIPT OF PAYMENT RECEIPT NO. n`�•"=-��1�"'�
CHECK AMOUNT n SE3�. 38
NAME n BEOGON HOMH 5 CASH AMOUNT
ADDRESS n PAYME=NT DATE. a 09/14/92
I SUBDIVISION a
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PURPOSE OF PAYME=NT AIdOUNT PA 1 D PURPOSE OF PAYMENT AMOUNT PA I 1)
it BUILDING PERM 3,49. ON I'LE1MSIN(3 PERM 117. 50
IIME,C.;HANICAL PE 40. 5V1 G1 . BUILD CER 25. 36 �
ELAN CHECK FE. 1.3. 02 SFWE.R INSPECT 35. N�
L.OT 8 BEDFORD GLEN
r :?
12491 SW JORDAY WAY
r `k TOTAL._ AMOUNT PAID - - - > ,31��• 39
u
x
CITY OF TIGARD - RECEIPT OF PAYMENT RFCE'ICT IVCD.. a98-- t7.09r e;
CHF-.CK AMOUNT 541b. 00
NAME:. r BEACON HOMES, INC CASH AMOUNT n IA. OQ
ADDRESS s CO BOX 1368 r.,AYM(~N'r DATE= a 08/85/9':
Bt..AVE RTnN, OR SUBDIVISION a
)•7075 .
PURPOSE OF PAYMFNT AMOUNT PA 11) PURPOSE OF DAYME:NT AM(XINT PAID
CLAN CHECK uFE -A-•-64R 250. 00 PLAN ~E:HEC.K FE 8-•6PR 250. OILA
CLAN CHECK FES 8-•63R 4¢1. 00
12491 SW JORDAN WAY, LOT (a
123S123SE SW JOPDnN WAY, LOT 60 % 1-07 RE%I F)SUF
TOTAL AMOUNT POI►) __ .__ _) 5t4L7.1. 00
�grl�gpr"4"'r,�+t;p I, em. :µrYf.p ��45:,ri :.1.' u- �,; ...Wa �^KN!li;'M�'�n.. "rx.a!IrR �. ._..�F � .. .... ^y.,��,a.F:..prat+.•+�'i���'.
° ..::'.v�'t�,' -'l:�M riw' '. h '• r ;^7.'r tNr__' .. 7 •" 'ln.,.. - �; ?�9 .. J
'an.pllp�p/Na,q.'r twr — ,a.rw.nw.riw,r..+Llwy,,,y�wx
RY 0lvv
NTH
1t
�' " R � tfSURFA A`fER
i170; leti r t' ;:Y• t!
.141
.( j.,`J,e'{ ,r�tF� Fac '. S�r _ ;., '��,i•�,>.�p: Im ihAte .0.3 PEFtMI T 103189PRO.�Ec.vYx. a BLOCK`
j?few ,rl l;•� t
TYPE"Qa�l� h'_ NSW ' w ;r OI" BEDFORD GLEN NO .. 1
TYPE INSTALLATIOW'� IYO)"'BLD IWk/CRO CON/SDC
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;TYPE OCCUPANCY'— (I ) 81NOI.E FAMILY PARCEL 281 16 AD 24200
QTR SEC 4716 MH 16394
OWNER'+':, A 1 u r'r_J NC i i, , i.�" '
All T� Z 1 9.1 y� �+� " R i 114 IY PLANT DURHAM
PHONE 1 JURI5D
• FIXTUf;�'•���- n� 'EQUIVA~~ ....•.:__________ _._ .. _ __.. ..,..._._._ ..
LENT DWELLING R :StDEN TIAL
UNITS ' '' 't ''' SERVICE UNITS 0 .0 UNIT: 1 ;.►ERVICE UNITS t
cm ION! ION FEEg SURF ALE WATER DEV L0►'MCNT FLLS
WATL-'R QUALITY 180100
LESS CREDIT C 180 . 00'
WATER QUANfITY 100 .00
.ESS CREDIT < 0.00:
EROSION CONTROL
�rt� r
INSPECTI1. 40.00
PLAN CHE 26 . 00
SlJBf01' ba;.'' ,i 0.00SUBTOTAL ' 166 .00
TOTAL 166 . 00
APPL NAME P tR KUSYK F HOh1E --- ---------
f
AFF,TL0ATIO -","0WNER
REMAR
X24 FOR Pn9ION CONTROL INSPECTIONS ktauIRED i
By mAEtr%rww
P4►�11�" �t , r�+fie eppli ant sprees to comply with all rules and regulatlont 4f the Unified Sewerage Agency. When calling
for „h1pYGt r' pltase' refer o the Permit Number. The Permit expires one'';hundred eighty (180) days from the date of
illukocl. ,'.The pteI amount paid permit fee, connection charge, 11t tap fee 'Ind/or other charge) will be forfeited if the
permit explr4s. =)
The Agency does' not guarantee tha cCurley of the location of side sewer laterals. If the sewer is not located at the
measurement iven, .the installer shall prospect three feet in all direetionl frM the distancepivan. If not to located, the
p
installer shall rchele c"Tap and Side Sews,'' Permit at the current charge and the Agency will install a lateral.
6/90 WHITE — USA, BLUE — Accounting, GREEN —Inspect.on, YELLOW — customer
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