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C11YOFTIVARDCERT11"ICATE OF
CF, OF TWA OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT oftem P Rm I r r*. . . . . • , a MST's a.. 0059
13126 BW HWI Bbd. P.O Baa 23187.Tipmd.Orpon 1172254(600)838�1�6
PARC EL t
SITE ADDRU''GS. . . s SW JORDAN WY
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Ur,+U I V I G-ION. „ . . a BEDFORD GLEN ZON I N0 a
CaLOCA.. . . . . . . . . . e LOT.. . . . . . . . . . . . . 13
CLASS~(7F�WORFt. tNEW.m._--__...._.._.,..,_..__..._.......�.... _.....,._,....w.�._,.�_._..._.__._........_.._..._....,w.�._._...__.._..........____.._..._.... �.
T YVIE Cif- USE. . . s 8F
OCCUPANCY ORP. a R;3
UCCUPANC,'Y LOAD a 1 18 4
I ENAN 1' NAME. . . t
N
Remairkat PATH I �
Owners
BEACON HOMES
PC) EOX 1368
BF'AVE:RTON OR 97075
F gone iha 524-4999
Contractors --• ..__�.._ ��__,._._._..,_.___ ..._.._.__._..__._._
BEACON HOMES
NIC) BOX 1368
BE:AVERTON OR 9727 ;
C4ione tie 5P41999
Reg #. . t 70792
Urcupe+nc^y of the ah.ouvp referenced bk0ldi.ny is herer:)y given, alai certifies
the compliance with the Gt.A%@ IIF Oregon riraec:ialty Codes For 4-he group,
or.CupAnl':.y, enci L1se uncier which the t• eferenc.ed permit; w.R% isml.le�-d.
FIRE. PEPARl-Mh h�!'i Il n I IUr I IJs I'F 4:x
BUTL.nINu EWrA.. .�
POST IN C ONrif'I f_;SJr:1UF3 Vk-AC E
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INSPECllON NOTICE
' City of Tigard Building Department
13125 SW hall Blvd. Tigard, Oregon 9722!''
Inspection Line (Rec-o-Phone): 639-4175 BucineaB Phan2: 639-4171
Inspection:
w
Footing Plbg. Underilab Mech. Pnugh-in Appr/Sdwlk.
Found. Plbg. Top Out Gas Line
FINP.Ls
1 " n"
Poet/Beam Strutt. SLn. Sewer Framing ' gidq,
Post/Beam Mech. Rain Drain Ineulatlan
Plbg. Underfloor Water Line Gyp. ed.
Mach. ~
Date RequAsteds ,z-
Time: AM PM
Address:_ rmii- #: G �.
-t
Builders
TR;i FOLL.OWING CORRECTIONS ARE REQUIRED:
r
--- ------ - _ -----.'' - r
Inspector:
APPROVED
_____ DISAPPROVED - � APPROVED 6UBJECT TO ABOVE t
C�
_--Call For Reinnp. �.
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---------------
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INSPECTION NOTICE
city of Tigard Building DepartMen
13125 SW Bell Blvd. T+gard, Oregon 9722- -
Irepection Line (Rec-n-Phone;: 6.19-4175 Dusineee Phone: 639-4171 S'
Inspection: — _ --- - -
" o 0 rig 1
aiC�i sooting Plbg. Underelab Mech. Rough-in Appr/ddalk
AFound. Plbg. Top Out Gas Llne ( PINAL< }
Poet/Ream Struct. San. Sewer Frdming -Bldg.
5 ' A
Poet/Beam Mech. Rain Drain Insulation
Plbg. Under`loor Water Line Gyp. Bd. -Mech.
F
Date Re/quested: 'U - I -� �` —_Time: - AM PM
Add, /&.i 1 JIF'� J["Y�1�C In I VGti � Permit #:�7 ( S
Builder: ---
THE FOLIOWINki CORRECTIONS ARE REQUIRED:
A7
Inspector: �- Datei
[APPROVED _ DISAPPROVED -_ APPROVED SUBJECT TO ABOVE
Call For Reinep.
�n
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IartxM�
7 INSPECTION NOTICE
City of Tigard Building Department-
13125 SW Ball Blvd. Tigard, Oregon 97223 C `1r
Inspection Line (Rec-O-Phone): 639-4175 Businens Phone. 31�3'!i._,_. `
Inspection: r
Footing P-9. Underelab Hoch. Rough-in Appr/.;dwlk
Found. °lbg. Top Out `tae Li-ne > FII'AL:
P.:gr;9eam Struct. Vin. Sewer Framing -B'.dg.
Po"L/Beam Hoch. Rain Drain Insulatior -Plumb.
Pibg. Underfloor Water Line Gyp. Bd. -Hoch. ,
Dots Requested I_
AN PH
Address:_
iltJti.
Builder.
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: -- --- —------ - -- Date,
_APPROVED DISAPPROV6U APPROVED SUBJECT TO ABOVE
!____Call For Reinsp.
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!
LFSPECTION NOTICE �) R
City of Ti,lard Building Department �
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Ph.3na): 639-4175 Business Phone: 639-4171
Inspection:
r -
- Footing Plbg. Underelab Meeh. Rough-in Appr/Sdwlk
} Found. Plbo. Top out Gas Line FINAL:
Pout/Beam Struct. Sen. Sower Framing -Bldg.
/Beam Mech. Rain Drain Insulation -plum.
Plbg, Underfloor Water Line -Mech.
ate Re ested s Time: AM Py
Addre a: �^ r
�' Permit L�J�
Builder:_��e
THE FOLLOWING CORRECTIONS ARE REQUIRED:
.G
Inspector:_
�APprO%Ef1 --- DISAPPROVED APPRO'/P.'D SUBJECT TO ABOVE -
_`Call For Reinap.
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NSPECTION NOTI_rE '���
City of Tigard Building Department 2�
13125 SII Hall Blvd. Tigard, Oregon 972:e-
Inspection
72
Inspection Line (Rec-O-•Phone): 639-4175 Business Phone: 639-4171
s'
Inspect!-
on:,__
S
), Footirg Plbg. Underelab Mech. Rough-i. Appr/Sdwlk o
i
Found. Plbg. Top Out Gas Line FINAL:
r• .,
Pont/Bear Struct, San. Sewer. Framing -Bldg.
Poet/Beam Mech. Rain Drain / loculation .-Plumb.
Plbg. Underfloor Water Line V t7yp. Bd. -Mech.
Date ker,sted:__ ^�Z _......Timws PN
d8zaeis Permit is _-1G
Builder: ,, 1
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
it
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Inspector
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APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For P.elnsp.
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IN^:&.PION NOTICE
City of Tigard Vul lding Department �•
131.25 Sit Ball Blvd. Tigard, Oregon 97223
rnsp-7tiun Line (Roc-O-Phone): 639-4175 Business Phone: 639-4171
Inspectiors
Footing Plbg. Underslab Meci:. Rough-in Appr/Sdwl)
Found. Plbg. Top Out Cas Line FINAL: 4
Poet/Bear.: Struct. San. Sewer Framing -Bldg. I
?oat/Berm Mach. Rain Drain Insuletion -Plumb.
Plhg. Underflaor Water Line Gyp. Bd. -Meeh.
Date Requested: ( -�� Time: AM PM
Permit
Builder: '
THE FOLLOWING CORRK%-ZTONS ARE REQUIRED:
— —
r.
Inspector ---- _---— Date: I
2-APPROVEV DISAPPROVED APPROVED SUBJECT :n ^„:OVR
Cali. For Reinsp.
ti
3 INSPECTION NOTICE
City of Tigard Building Papar.te ,Ic
n 13125 861 Ball Blvd. Tigard, Orrrmr. 9:
4 Inspection Line (Roc-O-Phone): 639-4175 P•:aineee Phone! 639-4171 a
!
Inspection:
Footing Pll.�. derelab Meech. Rough in Appr/Sdwlk
Found. ��
Plbq. Top Out Gas Line
F11ML: x.
i t
Poet/Beam struct. San. Bower Fravinq -Bldg.
Poet/Blom Mech. Rain Drcin Insulation -Plumb.
Plbq. Underfloor >;..:.
6iater Line Gyp. Bd. -Meeh.
Date Requested:
Timet AM PM
Aaarese:
Permit #2
Builders
THE FOLLOWING m%RECTIONS ARE REQUIRED:
Inepector:
Date:
APPROVED DISAPPROVED
APPROVED SUBJECT TO ABOVE
_`Call For Reinsp.
ry
INSPECTIOI NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inapection Line (Rec-O-Phone: 639-405 Buainess Phone: F39-4171
Inspection:
Pooling Plhj. Underalab ech.-Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Li:s FINAL: ? II
Poet/Beam Struct. San. Sewer Framing -Bldg.
r 1—
Poet/Beam Hach. Rain Drain Insulation -Plumb.
Plbg. Underfl-)or Water Line Gyp. Bd. -Hoch.
/Dpi $ig� ets is--- � Time: AM _PH
Addrese
�•'C�
Permit
Bulldecs
THE FOLLOWING CORRECTIONS ARE RE-�UIRM
Lam.i '- - {.
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Inspectore_ 'o[e Date: ��d
APPROVED _L DISSAAPPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 972'.3
Inspection Line (Rec-O-Phone): 639-4175 Business P:ione: 639-4171
Inspection:
1
Footing Plbg. Under_slab Mech. Rough-in Appr/Sdwlk ,
Found. C Plbg. Top Out Gas Line FINAL:
Pont/@eam ;t.ruct. San. Sewer Frami -Bldg.
Poet/Beam Mech. Rain Drain Inoul:,_i n -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech. ! ,
Date Regi:esteds_k- Tima: AH __PM
�
/& 7Gy _ //�J�� /�-
Address: .Permit 1 C ,
Builder:
S� 1
■
THE FOLLOWING CORRECTIONS ALE REQUIREDt
Inspector:_ �''/ — Date: I _/ -/ 1�
—_I'PPROVED A- DISAP ROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
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LSPECTION NOTICE /
/ � City of Tigard Building Depai-twent -
13Lv/e l'/1 "(A13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line rRec-O-•Phone): 639-41'FS Business i 9
r�
Inspection:_— _-_, -- —
I.
Footing Plbg. Underelab Mech. Rough-in Appr/Suwlk 4a,
Found. Plbg. 'ol. Out Gas Line FINAL:
e
t/Ceam 9truct. San. Sewer Framing -Bldg.
�osk/Beam Mech. Rain Drain Insulation -Plumb.
Plby. Underfloor Water Line Gyp. Bd. -Mech.
/ -z`
Dat: Requested: —Tim6: J AM
/Addr(ab: - /. Permit
Builder:---
THE FOIIOWIN(. CORRECTIONS ARE RRQVI&EA: `i
0
IM
I
Inspectors1/ --- '� Datg:._. _.� ^1 _`''_
• APPROVED DISAPPROVED APPROVED SUBJRCT TO ABOVE
Call For Relnsp.
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�r •S, INSPECTION NOTICE '
C'-ty of Tigard Building Department
13115 SN Ball Blvd. Tigard, Oregon 97223
Inspectior. Line (Pec-O-Phone): 639-4175 Business Phone: 639-4171
` Inspections
Foutin
9 Plbg. Underelab
Mech. Rough-in Appr/Sdwlk '
Found. elbg. Top Out Gas Line
---- FINAL:
C6:t/Beam Struct. San. Sewer Framing -Bldg.
/most/Beam Hoch. __"N -Qin Drain
Insulation _ply,
Plbg. Underfloor. Water Line Gyp. Bd. -Hoch.
Data Reguested: _ AJ✓�-G�K '1
/(//'' Time
hddresa
Permit f: "%
Builders— 4
THE FOLLOWING CORRECa'IONS ARE REQUIRED: r
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Inspector:
Date:
APPROVED pISAPPROVED APPROVED SUBJF.Ci TO ABOVE
L Call Fir Rel.nsp.
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NT SPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Oregon,Ti ardOr 97223 `
Tigard, 'y
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection•_
Footing ltc. Underalab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. rop Out G s Idne FINAL:
Poet/Beam Struct. San. Sewer Framing -bldg.
t '
Port/Beam Hoch. Rain Drain Insulation -Plumb
0 1
Plbg. Underfloor /Watelr7 Line Gyp. Bd. -Mech.
Date Re."eer-ed• ll� d-5 .Z� Time: PM _
Agdress•- i u~� GL4
Builder: �� —
r
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Bey
.�JF
I
Inspector: Date:-
APPROVED DI,APPROVED __ APPROVED SUBJECT TO ABOVE t
-_Cal_ For Reinsp.
0
a.
a
INSPECTION NOTICE
City of Tigard Building Department
13225 S# Ball Blvd. Tigard, Oregon 97223
r,
Inspection Lint (Rec--P—Phone): 639-4175 Bueinaes phone: 639-4171
Inspection:''
Footing Plbq. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. 4an. Sower��, Framing -Bldg.
Post/Beam Mach. ain Drain Insulation -Plumb. J
Plbg. Underfloor Water Line Gyp. Bd. -Mach. ;'...�
Date Requested:_ — Time="j AM PH
�
� Addre e: r,'L-(/j/� Permit
1
Builder: � I
THE FOLLOWING CORRECTIONS ARE REQUIRED:
J
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Inspeaty _ Date:
APPROVED D73APPROVED APPROVEd SUBJECT TO ABOVE
Call For Reinsp. ,
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NI srMQVON NOTICE +
City of Tigard Fvilding Departommt
13125 811 Ball Blvd. Tigard, oragon 97223
Inspcation Line (Rec-O-Phone)s 639-4175 Business Phones 639-4171
Inspections
Footing Plbg. Underslab Hach. Rough-in Appr/3dwlk s
Y
ound. Plbg. Top Out Gas Line FINl.Ls
Post/Bo= Struct. San. Sewer Framing -Bldg.
Post/Beam 'a ch. Rain Drain Ineulatlan -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: _ Z• 7imes _AH PH '
t
1►d�rose :r] i Permit ] ro;
x� Yi ■
Builders /
ME FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors-----2,7, Dates
' !- --
APPR0163D DISAPPROVEL APPROVED SUBJECT TO ABOVE
Call For Reinep.
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CITYOFTI(FARD
�
COMMUNITY DEVELOPMENT DEP/►WMENT 0"0" MASTER PERMIT13126 sw Hellati23307,d. P.O.sac z ,TOW,or.gon sMV(60)6394176 � PERM I'1" #. . . . . . .
639-••4171 LATE ISSUED: 05/15/92
/2.7(0`1
SITE ADDRESS. . . : 1 '* SW JORDAN W r PARCEL. _'G 1. ].6AD HED3
3UHDIVISION. . . . : BEDFORD GLEN ZONING:
BLOCK. . . . . . . . . . :._OT. . . . . . . . . . . . . :3 1�
__...___.__.___.__...._..._.._.._._________,____._ BUILDING •_ ..__.-------------------------------
REISSUE:
_____________.________--_.—__.RE:.ISSUE:: DWELT_I NG UN I T5 1 BASEMENT. . . . . . . . :0 s_F
CLASS OF WORK. :NEW HEDRMS:2 HATHS:2 GARAGE. . . . . . . . . . :555 sf
TYPE OF USiE. . . :SF FLOOR AREAS-----____._._ REQUIRED SETBACKS--- -___._._.__..
TYPIE OF CONST. :5N FIRST. . . . : 1E00 sf LEFT. . :S ft RIGHT. :5 Ft
OCCUPANCY GRP. :R3 SECO61D. . . r 0 5f FRONT. -20 f t REAR. . :`h ft X
STORIES. . . . . . . : 1 THIRD. . . . .0 s f RE OU I RED------______---.___-__-
HE I GHT. . . . . . . . : 18 ft TOTAL---------: 1600 S f SMOKE DETECTORS. :Y a
FLOOR LOAD. . . . :40 psf VALUE'. . . . . $ : 83590 PARKING; SPACES. . :0
RemarkQ z POTIA I
-------------------------------------- PLUMBING ••______________________---______.__._._.__..
!SINKS. . . . . . . . . . : J. FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :
LAVATORIES. . . . . 73 WATER HE:ATF..RS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERa. . . . :3 1_AUNDRY TRAYS. . . :O CATCH BASINS. . . . . . .
WATER CLOSETS. . :2 SEWER LINE (ft ) . :0 GREASE: TRAVIS. . . - .0
DIS;HWASHERS. . . . : 1. WATER LINE: (ft ) . : 100 OTHER F•IXTURES. . . . . :0
GARBAGE DISP. . . - I RAIN DRAIN (ft ) . :0 �
WASHING MACH. . . : 1 SF rZA I IU DR'1 I NS. . : 1
----------------- MECIAAN I CAI_ _._ .____.____.__. ------------------ FEES ----------------
FUEL
_—_____—____...FUE.I_ TYRES---------.—•-- UNIT HTRS. . :0 type amount by cd:ite r:scpt �
/GAS/ / / VENTS . . . . . r0 BP RT f 365. 00 JLH 05/15/92 —
14AX INPLIT:O BTIJ VENT FANS. . -3 PPLE It 250. 25 JL1-1 04/07/92 222"7.1 n
1=URN f 100K . . : I HOODS. . . . . . : 1 BSPC 19. 25 JLH 05/15/92 —
FURN ) =100K . . :0 WOODSTOVES. :0 MPRT 1 36. 00 JLH 05/ 15/92 -
FLUOR FURN. . . .. i O CLO DRYERS. : 1 MPLC t 9. 00 JLH 05/15/92 M
BOIL/CMF' ( "31!'1 / ,OTHER UNITS:O M`PC 4, 1. 80 JL.H 05/1.5/92
GAS OUTI_.ETS: 1 F4=IRT $ 132. 50 JLH 05/15/92
(Jwnpr i fs �..___. ___ __._._.___._..-- P5PC $ G. 63 JLH 05/15/92
BEACUN HOMES / MISC $ ;35. 00 JLH 05/15/92 -
GO BOX 1368
8EAVERTON OR 9707`::
Phone #: 5.2..'4-19')'
Contractor: -..—
BEACON HOMES
FSU BOX 1368
i
BEAVF_RTON OR 97075
Rhone #: 524--1999
IReg #. . : 7�0762 _. ._...._.._.._._____--_—_..._______..---__--_.—_.. .
T 1.3/5. 43 T0TAL
This perait is issued subject to the regulations contained in the ---- -- REQUIRED INSPECTION,
1 Tigard Municipal Code. State of Ore. Specialty Codes and all other F=oot/found Insp Fire_11ace Insp
applicable laws. All work will be aane in accordance with aearoved Prost/Beam Strur_t Gas Lire 1'nsp
plans. This oersit will expiry if work is not started within ids@ Post/Beam Mechan 1nscilaatiovi Insp
days of issuance, or if work is susoendpd for eov,e an 190 days. P 1 m/ands I ab Insp Oy p Hoard T n s p
OLM/Underfloor Rein drain Insp
rmittt+e iai�lnartrure, ���1�,�'�' L Mechanical Insp Water Line Insp
F I utmb Ton but Appr/Sdwlk Inst{
ed By; Fr•amirq Insp Mar.hari:ir,aI Finan
1 _
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Fro- :itis. .7prf, l roi " 631�-4175
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PERMIT #x . . . . . .
t17YOFTIFARD
COMMUNITY DEVELOPMENT DEPARTMEW owaal
ratassrvwlewa P.o.eo.x�o�,7t�d,onpon erm(t�r)�-+r>6 +- L)AT E=: ISSUED:
`
.,ITE A[}DRE�5. , . : _.rte' `3 JOIaL�AIV lJl' P�=aRCEL. 'S 1 16AD -ISE D:"s
l.CiNIhIG,:
BLOCK. . . .. . - r-. . NE 1iFCiRD. GLEN
to-At;r OF WORK. . .NEW GARBAGE DISPOSALS. . : 1
1'YVIE OF USE. . . . -SF WASHING MAC;H. . . . . . . It BACKFLOW PRE'VNTRS. . .0
OCCUPANCY 9PP. . i R3 F1.11OR DRA I Nei. . . . . . . so TRAPS. . . . . . . . . . . . . . :0
STDR I E r. . . . . . . . : 1 WATER HEATE-R5. . . . . . : 1 CATCH BpS I Nc�, . . . , . ,
F"IXTi.JRt..' _... ._..__. ._._.__.._._..-. LAUNDRY IPAYS. . . . . . :0 3F RAIN DRAINS. . . . . : ]. �
E�JIVF6�i. , . . . . . ,. . . : I GREASE TRAPS. x . , , . . :0
LAVATORIES. . . . . . 3 OTHER FIXTURES. . . . . 10
TUS/SHOWE.RS. - . - : SEWER LINE (ft) . . . . 10
WATER CLOSETS. WATER LINE (ft) . . . . 4100 �
PI];HWAyHERS. . . . : 1 RAIN DRAIN (ft ) . . . . 60 .
4 .
Remarks. PATH 1
OWN[---"RI
BEACON HOMES BPRT $ 385. 00 JLH 05/15/92 --
PC; BOX 1368 BPI._C $ 2'50. `,5 JIJI 04/07/92 2 '5719
B!-)PC $ 19. ,�5 J•I.H 065/15/92 -
BEAVERTON OR 97075 MPR T ¢ 36. 00 .JL.I-( 051 /15/92
f ht�ne Ms 524-•1999 MPLC 9. Oro JLH 05/15/9iR
M5F'C i. 80 .TL..I-f 05/15/152 y
Plumbing Contractor: ---_,_.._.._-__._____._ PPRT -' 32. 50 JLH 0551't5/92' -
' P`PIC 9 6. 63 JL H W°11`1/9:'
Nam e e ,. ..(.L.�_._
M1 13C35. �113i .JLH �T 3/1.5/9 -
City 1.�.�115tateo
F :_ l. Cft' _Phone#I.1v_ .
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_._._.-_-• RE EUI RE:D ' hisInin
E:CT I ON3
This; permit is issued Subject to the reg-- � t
<rlAtions containerl in the 'Tigard hlunicipAl. Foot /found Insp drmin Insp
Code, "State of Ore. Specialty Codes and all Post /Beam Struct Water, Line Insp
other' appl"i"cable lawv,.A4 All Work 'wi,ll ban done Post/Bkam' Meuhan (1ppr/Sdwlk Insp
in accordance with approved pl,an%. This Plm/undslab Insp Mechanical Final
permit will expiv�e i1' work is not started PLM/Under-fIaor VIlumb Final.
within 100 dans of issuance, or if work is Mechanical Insp Duilding Final
suspevrcied for• mol-P than 180 days. Plumb Top Out erosion Control
F'r•aming Tnsp Cr,awi Drain
Fireplave Insp
f Gas Line Insp
Insulation Ing _
I ns • p ----
1'_5:.,. Gyp Board Insp
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Authorized Plumbing Contractor Signatmre
I Call for inspection - 639 -4175
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Cent.ract•or Not es e._
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SANITARY,*
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umor ,agency ;.
155 N.First Ave.,Suits 270,'Hillsboro,Or.,97124 SURFACE WATER �.
:y 503 648-8621
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CONNECTION -PLRMIT
ISSUE DATE 051592• - -EXPIRATION DATE 111192 PERMI1' 102623 '
r' STRUCTURE ADDRESS 12365 FkOJLC'I' 15'(18
STRUCTURE STREET ' -SW JORDAN WY
LOi' 3 BLOCK
TYPE CONNECTION NEW OFBEDFORD OLEN NO. 1
TYPE INFiTALLATIQf�=` r('1S) PL'G 'SWF,'/ERO CON/ELIC
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TYPE UCCUPANLf- ( 1 ) SINULE FAMILY PARCEL 2S1 16 AD 23700
(ATF: SEC 4716 M11 16395
OWNER PETER KUSYK
ADDRESS PO BOX 1368 TREATMENT PLANT D1114HAM
BEAVERTON OR 97675 JURCRO GIST'
PHONE «524-1999 JukIED
FIXTURE EQUIVALENT DtirLL I NG RESI LILNT I(IL
UNITS SERVILE UNITS 0.0 UNITS 1 SERVICE UNITS I
CONNECTION FELS SURFAL;E WA I EF LILVELUFMENT FLES
WATLR QUALITY 180.00
LESS CRLDIT < 60.00>
WATIER QUANTITY 100 .00
LESS CRLDIT .: 0.00>
EROSION CONTROL
INSPECTION 40.00
PLAN CHECK 26 .0u
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SUBTOTAL 0 .00 SUBTOTAL 286.00
T01At. 286.00
APDL NAME F ETEF I,;LIJ'1 h; PHONE
AFFILLIATION OWNEF..
REMARKS WATYE1*: 4F SAN CONN FEET SLE LET1 ER IIA I E11
*214 HOUR N01ICE OR ER 51UN CONTROL INC-PECT IONS REQUIRED
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Permit Conditions: 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 date of
issuance. The total amount 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 accur cy 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.
6/90 WHITE — USA, BLUE — Accounting, GREEN —Inspection, YELLOW — Customer �
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CITY OF TIC'sAR FtECEIF'1' OF F''AYME:NT F1ErF_Tt�T NO. n4Jr !Fj 4�
;LHF�CK AMOUNT i (:►� •
GASH A14DONT s 0. 00
NAME BEACON i-Il.1M 5 PAYMENT DATE t 05t I5/9
ODDREE+s s �-)UsD I V 19 ION
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PURPOSE OF PAYMENT Ar1OUNI PAIL) PURP(ISE OF PAYMLhIT P11111JNT PAID
i IJYL GINC3 i�EMrtM ?rC-b5. 00 IAC IJMBIN13 PERM 1? • 50 j
01ErC HANICAL. PC 36. 00 ST. 131JILD l*'R 27. 68 �
;-ILAN CHECK FE X3. ::"'3 GEWEP INSPECT 35. 00
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/(Q1p el
c,.6W JORDAN WAY
BEDFORD GL N LOT #3
TOTAL AMOUNT PAID ._ •_ ) bo-'.5. 4:4
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CITY OF T I GARD RECEIPT OF PAYMF NT RF C-F l PT NO. ,9 C.,— '.::'t? J '+
C,1 'ECK PMOLJNT , 12,50. 0.'
NN VI' o BEACON HOMES, TNC Cil€)N AMOUNT s 0. 0(/,
F''WYMLNT DATE':: s 04/07/91.
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PURPOSE OF f(IYMk`sNT 0MOUN"r E'AII3 r='UriE'C'3i3E OF' QYMENT AMOJNT PAID
Pl..ANCK F=EES FOR BEIA)1=f.RD GUEN
rC I AL. AMOUNT PA l t)
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