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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 839.4175
Type of Inspection _— T
Date Requested Time A.M. LL_P.M.
Address _ � — Permit # ���
Owner _ _ Lot # —_
Builder
The following Building ode deficiencies are required to be corrected:
I
Presented to _ proveui
Inspector. [_� Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
I
I
I
INSPECTION NOTICE
V Sty of Tigard building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Impection -4-_ r
Date Requested c� lG _ Time A.M��/� P.M.
Address ��c�?7(�� -��L _ P[Aft(1`�►yf� #�����_ C?
Owner_. _ _ ---- _— l'6t �
Builder
The following Building Code 494ioncies are required to be corrected:
Vc�N I-' 1e4 7V0 l4 C N 1-10 G11s
(�`te /-Pl- ,5 T ('AS'
" kZLc i L k�VI Ji^74 Lt .�D O Sc= c�v d/7 IiG Tit a- _
Presented to pproved
Inspector _._ � Disapproved
Date 3'z-sic
CALL FOR REINSPECTION
0 YES [l NO
INSPECTION NOTICE
City of Tigard Building Department %
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested00O _
9 — -- . Time —
/^� -- �) A.M.Address '0
-- —_._ Permit #-�9-�3�Z
Owner
-- _
Lot #
Builder � __-_-------�---_— �The following Building Code deficiencies are required to be corrected:
--------------- `
----------------
- - ---- I
............
-____..
Presented to .� -----"
'Approved
Inspector , � —�
---— --- Disapproved
Date
CALL FOR REINSPECTION
0 YES C.J NO
.. .w aW
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CITY OF TIGARD
NOTICE OF DECISION
VARIANCE VAR 90-0002
DORSEY - APPLICANT
APPLICATION: A request for spproval of a variance to allow a 3.8 foot setback
where 4 feet is normally required. ZONE: R-7 (PD) (Residential, 7 units/acre,
Planned Development) . LOCATION: 12470 SW North Dakota (WCTM 1S1 34CB tax lot
6.300) .
DECISION: Notice is hereby given that the Planning Directors designee for the
City of. Tigard has APPROVED the above described application. The findings and
conclusions on which the decision is based are noted below.
A. FINDING OF FACT
1. Background
The property was annexed to the City and rezoned from Washington
County RU-4 to the City R-5 single family residential zone in 1980
(Zone Change ZC 17 .80) . During the amendment of the City's
Comprehensive Plan and zoning Ordinance, the property was rezoned
R-7 (PD) .
Anton Park subdivision and planner' development was approved by the
Planning Commission in November, 1984. The proposal was approved
with 4 foot side yard setbacks where 5 foot setbacks are normally
required. All other Petbacks are consistent with the R-7 zoning
district.
2. Site Information and Proposal Description
A single family house is currently under construction on the
subject parcel, a 5000 square foot lot in the Anton Park
subdivision. The applicant requests a 3.B foot side v;ird setback
where a 4 foot setback is required. The applicant ratites that an
error was made when the foundation for the houne. was installed
resulting in an encroachment upon the setback of 2.4 inches.
3. Agency and NPO Comments
The Engineering and Building Divisions have reviewed the proposal
and have no objections to it. No other comments have been
received.
B. ANALYSIS AND CONCLUSION
Section 18.134.050 contains the criteria for granting a variance. They
are as follows:
NOTICE: OF DECISION - DORSEY - VAR 90-0002 PAGE 1
a a s a a a aw a se
I. The proposed var.•iance will not be materially detrimental to
the purposes of this title, be in conflict with the policies
of the comprehensive plan, to any other applicable policies
and standards, and to other properties in the same zoning
district or vicinity;
2. There are special circumstances that exist which are peculiar
to the lot size or shape, topography or other Circumstances
over which the applicant has no control, and which are not
applicable to other properties in the same zoning district or
vicinity;
3. The use proposed will be the same as permitted under this
title and City standardu will be ma!ntained to the greatest
extent possible while permitting home economic use of the
.land.
4. Existing physical and natural systems, such an but riot limited
to traffic, drainage, dramatic land forms, or parks will not
be adversely affected any more than would occur if the
development were located as specified in the title; and
5. The hardship is not self-imposed and the variance requested is
the minimum which •rould alleviate the hardship.
The proposed variance is not detrimental to the Code, Comprehensive
Plan, or other properties in the vicinity. Tlie 3.8 foot side yard
setback requested exceeds the minimum 3 foot setback required by the
Uniform Building Code by 0.8 feet.. The special circumstances in this
case are, as the applicant states, that the foundation contractor
inadvertently installed the foundation for the dwelling (currently under
construction) within the side yard setback resulting in an encroachment
of 2.4 inches. No other properties in the subdivision are affected by
the encroachment. There will be no change in the use of the property.
Physical and natural systems will not be adversely ,affected.. Althou.7h
the hardship could be considered self-imposed staff contends that to
alternative solution, such as requiring the applicant to move the
structure 2.4 inches in order to comply with the conditions of approval
of the original subdivision application, would be a hardship and that a
more appropriate solution is to approve the variance requested. The
applicant requests the minimum variance which would alleviate the
situation, therefore, the request for a variance is granted.
C. DECISION
The Director's designee approves Variance VAR 90-0002.
D. PROCEDURE
1. Notice: Notice was posted at City Hall and mailed to:
NOTICE OF DECISION - DORSEY - VAR 90-0002 PAGE 2
XX- The applicant and owners
XX_ Owners of record within the required distance
XX_ The affected Neighborhood Planning Organization
XX Affected government agencies
2. Final Decision: THE DECISION SHALL BE FINAL ON 2/6/90 UNLESS AN
APPEAL IS FILED.
3. Appeal: Any party to the decision may appeal this decision in
accordance with Section 18.32.290(A) and Section 18.32.370 of the
Community Development Code which provides that a written appeal
must be filed with the City Recorder within 10 days after notice ie
given and sent. Appeal fee schedule and forms are available at
Tigard City Hall, 13125 SW Hall Blvd. , Tigard, Oregon.
The deadline for filing of an appeal is 3:30 p.m. 2/6/90
4. Questions: If you have questions, please call City of Tigard
Planning Department, City of Tigard City Hall, 1.3125 SW Hall
Blvd. , Tigard, Oregon.
l
PREP RED BY: Viola R. Goodwin — DATE
Devel mant Review Planner
APPROVED BY: Keith S. Liden DATE
Senior Planner
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SM SMC L�1 l_l �J [] n 3 0
EARD S.W. ANTON DR. /
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NOTICE OF DECISION - DORSEY - VAR 90-0002 PAGE 3
INSPECTION NOTICE
City of Tigard Building Department /
P.O. Box 23397
Tigard, Oregon 97223 6�
Phone: 639-4175
Type of Inspections --
Date Requested-,-_ .�L C U Time_ A.M. 4_P.M.
Address �.1 `� �L� dl�". Permit
Owner ._ _ ---- Lot #
Builder
The following Building Code deficiencies are required to be corrected:
FY-
Presented to v
[] proved
Inspector Ji Disapproved
Date 2
CALL FOR REINSPECTION
El YES 0 No
INSPECTION NOTICE
City of Tigard Building Department Y\
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection
Date Requested ' _ CT Time A.M. P.M.
Address �Z y�l�_ �/ _ LVy�' Permit # LZ_�
Owner _ Lot
Builder
The following Building C de deficiencies are required to be corrected:
Presented to � _ �pproved
Inspector _ _ ❑ Disapproved
Date A
CALL FOR REINSPECTION
1 YES El NO
aor wr sr %er
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard. Oregon 97223
Phone: 639.4175
Type of Inspection ./L �-
Date Requested — Time M. P.M.
Address .
pe
Owner — -- _-- -- V Lot #
Builder
The following Building Code deficien:ies are required to be corrected:
1
- i
Presented to _ _ - �'�J Approved
Inspector � Disapproved
Date — p d
CALL FOR REINSPEC71ON
C� YES ❑ NO
INSPECTION NOTICE
City of 'figard Building Department
P.O. Box 23397
Tigard, Oregon 97223 r`
Phone. 839-4175
Type of Inspection
Date Req//nested J qime_.._.. A.M. P.M.
Address Permit # c�
Owns Lot #�_
Builder
The following Building Code �eficiencies are required to be corrected:
Presented to _ — _—__—_- Approved -
lnspertor J ❑ Disapproved
Date
CALL FOR REINSPECTION
C] VES ❑ NO
ser s� s� ssss W wAs ss
i
i
INSPECTION NUTICf= �
City of Tigard Building Department
P.O Box 23397 C� -
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested me P.M.
Address LG;-). Permit #
Owner -
---�--- _ Lot
Builder
The following wilding Code deficiencies are required to be corrected:
IZIL r oe
__.
Presented to
❑ Approved
Inspector '��-
Disapproved
Date
CALL FOR REINSPECTIOA,
IOES L7 No
i
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
r
� E
Type of Inspection ._• -,'-.)•
Date Requested- t Til a-
z
_
y26 s�� �!� �
Address / /� �/� _. it #Q_LaL
Owner �U�l 44W ice_ Lot #
Builder
The following Building Code deficiencies are r aired to be corrected:
r
i
Presented to C_� Approved
Inspectorisa' Droved
Date PP
CALL FOR REINSPECTION
i
YES ❑ NO
I
I
I
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 _
Tigard, Oregon 97223 -
Phone: 639-4175 A
01
Type of Inspection T
Date Requested ___l1�2- Time -_ A.M. P.M.
Addiass Permit
Owner Lot #
BuilderThe following Building Codeeficiencies are required to be consoled:
z
7 _
Presented to — ��/� Approved ,I
Inspector r`-f� c __ _— [__� Disapproved
Date —
CALL POR Rh;INSPF,C'TION
Fj VPS ( 1 NO
INSPECTION NOTICE
City of Tigard Building DepartrrLent
P.O. Box 23397
Tigard, Oregon 97223
Phone: 6394175
Type of Inspection
Data Requested h / _ Time _ A.M._ P.M.
Address ____ L _ Permit
Owner Lot #
Builder,
The following Building Cog deficiencies are required to be corrected:
Presented to _-T___._—__— Approved
Inspector / "-� __ vDisapproved
Date
CALL. FOR REINSPECTION
YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested_—__. ._ _..1_ _ Time
i _.` A.M._ —P.M.
Address _ -- - �f �4�5 _¢._ l'Permit
Owner _ _ Lot #
Builder T_
The following Building ;kdeficiencies are required to be corrected:
cj_oe ;OC) f 'gnzj!!'7Presented to
A
Inspector / Disapproved
Date
CALL FOR REINSPE 710N
YES REIN;;
NNo
*ss sssa wv s# sssr s sssr sINI=
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
y 1
Type of Inspection7 �' �2 ��—
Date Requested Ti g-A '/i.M. P.M.
Address _.. .. _._._ .��� � Permit #_� �_ -Vv L
Owner /`'�- I/7, �7 - ---- -- Lot
Builder
The following Building Ciz, deficiencies are required to be correcUd:
406
`I
Presented to Approved
Inspector 1.C ..•�--�j— __ � � Disapproved
Date
CALL FOR REINSPECTION
F-1 YES ❑ NO
INSPECTION NOTICE
v City of Tigard Building Department
V
� P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested_ /��:-. � Tim( A.M. P.M.
Address _ �. �' ¢ �, Permit
Owner _ _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ _._ '�Approved
Inspector '✓ _ _ ❑ Disapproved
Date --
CALL FOR REINSPECTION
(. 1 YES f s NO
C17YOFTIOARD SEWER PERMIT
t'ERMJT h10. : SE892344
c tm
COMMUNITY DEVELOPMENT DEPARTMENT TE ISSUED: 11/ 6/89
13125 S W.Nall Blvd..P.O.Bow 23397,Tigard,Oregon 97223.(503)639-4175 P I M.PMT.N0. 892228
JOE+ ADDRESS: 12470 SW NORTH DAKOTA ST LISA NUMBER: 39113
TAX MAP/LOT 1S1 34CP 6300 SUB: ANTON PARK l_T:25 BK:
LAND USE: R7PD
LOT SIZE:
SECTION: 34 TWP: Is RNG: 1w
WORK CLASS: NEW
USE TYPE: SINGLE FAMILY
The applicant agrees to comply with all rules and regulations of the Unified
Sewprage Agpncy. The permit expires 120 days from the date issued. The total
amount paid will be forfeited if eche permit expires. The AiTency does not guar-
antee the accuracy of the location of the side sewer laterals. If the sewer, is
not located at the measurement given, the installer shall :rrospect 3 feet in
All. directions from t'he distance qiven. If not so located. the installer shall
purchase a "'tap and ' ide Sewer" permit: avid the Agency will install a lateral,
INSTALL. TYPE: BUILDING SEWER IMPERVIOUS AREA:
FIXTURE UNITS: TENANT IMPROVEMENT:
DWELLING UNITS: t
NO. OF BLDGS. : i
FEES:
W DORSEY JACK PERMIT $35.88
N 16231 S.OAK TREE TERRACE CONNECTION CHARGE $1,2250.00
TIGARD OR 9704; I LINE 'TAP INSTALL.
PHONE (503) 656-6450
OTHER
rA0N DORSEY JACK
DORSEY HOMES
16231S.OAK TREE TERRACE
C oreqon city or 97845
T PHONE (583) 656-6458
REGISTRATION NO. 47558 TOTAL.: $1,285.815
r— RECEIPT NO. 105-941
7
This permit is issued subject to the regulations contained in title 14 _ ___._,--_---_--_-----.
of the TMC State of Oregon Specialty Codes, zoning regulations
and all other applicable codes and ordinances, and it is hereby RIEQUIRED INSPECTIONS
atlraed that the work will be done in accordance with the plans and ROUGH-IN
specifications and In compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive
covvnanis Contractor and subcontractors shall have current city
business tax perm4s. This permit will expire and become null and
void it work is not started within 180 days.or If work is suspended or
ahandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved.
Pei m Signature
Issued By __ _ tfF44F f=Tlflhl ,T> -4f 7$ _.._
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
.. w w aw .� a>•
CITYOFTI GARD 'MECHANICAL ME
PERMIT NO. : E8f392392343
cm&fWAltc
COMMUNITY DEVELOPMENT DEPARTMENT TE ISSUED: 11/ 6/89
— 13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223.(503)639-4175 �— P IM.PMT.N0. 892228
JOB ADDRESS: 12470 SW NORTH DAKOTA ST
TAX MAP/LOT 161 34CP 6300 SUB: ANTON PARK L.T:25 BK:
LAND USE: R7PD
LOT SIZE:
ITEM: N0: Wit
WORK CLASS: NEW FURNACE 000K 1 AIR HANDL.R (10
USE TYPE: SINGLE FAMILY FURNACE 100K+ AIR HANDLR 18K
CONST.TYPE: VN FLOOR FURNACE EVAP.COOLER
OCCUP.GRP. : R3 HEATER VENT FAN 3
VENT VENT.SYSTEM
PLR/COMP QHP HOOD 1
HO.STORIES: 1 PLR/COMP 3•-151-117.' INCINERATOR(DOM
DWELL.UNITS: 1 BLR/COMP 15-30HP INCTNFRA'TOR(COM
FUEL TYPE GAS BLR/COMP 30-50HP REPAIR UNITS
MAX. INPUT PLR/COMP 50+HP OTHER 2
F IRF" DMPRS'? GAS PIPING OUTLETS f
HIGH PRESS?
1 nw GFi ,S? --- ---- ----- —
REMARKS:
need contractor number
O FETES:
At DORSEY JACK PERMIT $10.00
E 11231 S.OAK TREE TERRACE PLAN REVIEW $10. 13
R TIGARD OR 97045 FIXTURES $30.50
PHONE (503) 656-6450 ;TATE TAX $"1.03
- - -- --- - --- - — _ OTHER
C
O
N
T BELL HEA! IHG INC.
A 15550SE PIAllA AVE
C CLACKAMAS OR 91015
T
O PHONE (503) 243--1184
R REGISTRATION NO. 441 TOTAL-: $52.66
This permit Is issued subject to the regulations contained in RECEIPT NO.Title 14
of the TMC, State of Oregon Specialty Codes,zoning regulationsand all other applicable codes and ordinances, and it is hereby F'EOUIRFD INSPECTIONS
agreed that the work will be done in accordance with the plans and GAS LINE
!tpecihcations and in compliance with all applicable codes and POST R BEAM
r;rdinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city R6JGH-IN
husiness tax permits. This permit will expire and become null and FINAL
yr id of work Is not started within 180 days.or it work is suspended or
ehandoned for a period of 180 days any time after work has
co-nmenced. It shall be the responsibility of the parmittee to assure
all required inspections are requested and approved
Pet III itte gnalure �
Issued By --- -- Fftt--4;*R-1NSPE6!ONF-£>39-4175
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
----_ --------'--- PLUMBING PERMITITY /
CITY OF TIGA RDc '��PERMIT N0. : �'L8'3234? f
COMMUNITY DEVELOPMENT DEPARTMENT
E ISSUED: 11/ 6/89
1:112S S W Hall Blvd. P 0 Boa 23397.Tigard,Oregon 97223,1503)639-4175
JOB ADDRESS: 12470 SW NORTH DAKOTA ST
TAX MAP/LOT 1S1 34CB 6300 SUP: ANTON PARK LT:25 BK:
I..AND USE: R7PD
LOT SIZE:
ITEM: NO: NO:
WORK. CLASS: NEW WATER CLOSET P TRAP
USE TYPE: SINGLE FAMILY URINAL. BKFLOW PRVNTR
CONST.TYPE: VN LAVORATORY 2 TRAP PRIMER
OCC"UP.GRP. . R3 TUR SHOWER 2 GREASE TRAPS
DISHWASHER 1
GARBAGE DISPOSAL 1
NO.STORIES: 1. W05HING MACHINE 1
DWE•LL.UNITS: 1 LAUNDRY TRAY BLDG.DRAIN (DTA
FLOOR DRAIN
SINK 1 SEWER (FT)
WATER HEATER 1 STORM/RAIN (F1 1
OTHER
REMARKS:
need contractor number
FEES-
0W DORSEY JACK PERMIT $117.50
N 16231 S.OAK TREE 'TERRACE
R TIGARD OR 97045 FIXTURES
PHONE (583) 656-6458 STATE TAY, $5.88
OTHER
C
U HORN ROBLRT L
N
t R L HORN
R
A pobox1038
C oregoll city or 97045
T
v PHONE (503) 631-2:385
R REGISTRATION N0. 49771 TOTALi $123.38
This permit Is Issued subject to the regulations contained in Title 14 RECEIPT NO.
of the TMC. State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances. and it is hereby REQUIRED INSPECTIONS
agrPed that the work will be done in accordance with the plans and PL.B.UNDERSLAB
specifications and In compliance with all applicable codes and POST & BEAM
ordinances The Issuance of this permit does not waive restrictive WATER LINE
covenants Contractor and subcontractors shall have current city
business tax permits.This permit will expire and become null and PL B.TOPOUT
void if work is not started within 180 days,or if work is suspended or RAIN DRAINS
Abandoned for a period of 180 days any time atter work has FINAL
commenced It shall be the responsibility of the permittee to assure
Fill required inspections are requested and approved
Permit Signature
Issued By ^—� i()fi 1hlCaL'k(eT I11h1 &A'4 41/a
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY
OF T167A BUILDING VERMIT j
T�ERMTT NO. : F+U89r�.22[� 1 /
cirYOFTI �w b/
COMMUNITY DEVELOPMENT DEPARTMENT °a11°°"
TE T S SUE D: It/ 6/ ,7
13125 5 W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)939.4175
JOE+ ADDRESS: 12470 SW NORTH DAKOTA ST
TAX, MAP/LOT ISI 34CN 6300 SUN: ANTON MARK LT:25 BKs
I.-AND USE: R7PD
1_01 SIZE: VALUATION: f '73,986 SETBACKS
FRONT: 20 REAR: 4
WORK CLASS: NEW DWF'I.I .UN 11"; 1 LEFT: 4 RIGHT: 2i
USE TYPE% SINGLE FAMILY NO.NFDROOMS: 3 EXT.WALL CONST:
CUNST.TYPE: VN NO.NATHS: 2 N: S: E: W.
OCCUP.GRP. : R3 PROT.OPENINGS:
OCCUP.LOAD N: S: E% W.-
TOTAL
:TOTAL AREA: 1573
NO.STORIES: 1 1ST: 1573 ROOF CONST: C FIRE RE1?
HEIGHT: 18 PND: AREA SEPAR? RATED:
BASEMENT! 3RD: OCCUP.SEPAR? RATED:
MEZZANINE? BASEM'T
FLOOR LOAD: 40 GARAGE: 440 FIRE SPRKL.R? ALARM?
FLOW(GPM) DFTFCT? YES
L�--------kIEAI- IXC% GAS--------- unro_ArmscS ---
PLAN CHECK BY: r1t
RF-MARKS:
reissue of 891500 REISSUE OF NO. 891500
LAST REISSUE
0 FEES:
W DORSEY JACK PERMIT $355.00
F 1.6231 S OAK TREE TERROCF; PLAN REVIEW $40.80
R TIGARD OR 970451 FIRE DEPT
PHONE (503) 656-6450 STATE TAX $17. 75
-- - ---- — -------_— OTHER
C DEVELOPMENT CHARGES:
N DORSEY JACK. SDC(STORM) $250.00
N
T DORSEY HOMES SDC(STREET) $600.00
R
16231S.OAK TREE TERRACE PDC(N1 f?50.00
C nregon city or 97045 PREPAID < $40.00)
T
0 PHONE. (503) 656-6450
fa NEGISTRATION NO. 47550 TOTAL.: $1,472.75
T hi, ermit is issued subject to the regulations contained in Title 14 RECEIPT NO.
of 1,,e TMC. State of Oregon Specialty Codes. Zoning regulations
and all other applicable codes and ordinances, and it is hereby REOUIRED INSPECTIONS
ngreed that the work will be done in accordance with the plans and FOOTING SFWLP
specifications and in compliance with all applicable nodes and FOUNDATION WAL.I RAIN DRAINS
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city POST 8 BEAM WATER LINE.
hus ness tax permits. this permit will expire and become null and PLB.UNDERSLAN CITY APPRCH/SW
void if work is not started within 180 days,or if work is suspended or SLAB FINAL
ahandoned for a period of 180 days any time after work has PLB.TOPOUT
commenced It shall be the responsibility of the permittee to assure FRAMING
Fill rwgwred inspections are requested and approved
FIREPLACE
GAS LINE
INSULATION
GYP. BOARD
Pnrrmttee Slg jute
ISsied t:1y :�-/
" T'F r -FUR-THM-FL,1 1 X3'3-41 1Z)
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
%oITY of TIGARD
urrso PLAN CH[:(.K APPLICA'fI0
COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK
13125 S.W.Hall 6W..P.O.Box 2=?,T4pwdOn?gM9nM,(sod)0.994175 PERMIT # 4
// nG/-Cl /� DATE ISSULC
/ V/ _
,JOB ADDRESS: /1,7� _�GC ^V` !/ '� TAX VAP/LOT
SUB: 6'I.. ~t" L� L07 _?S LAND U::f-:
�i�a !"
VALUATION:
OWNER SPECIAL NOTES
NAME _ REISSUE OF: �'�?
ADDRESS: LAST REISSUE:
FL000 PLAIN/ �-
�__ SENSTI IVE LAND:
PI(ONE: -
_�__ APPROVALS REQUIRED
CONTRACTOR // PLANNING:
NAME _ C^IE S E r / ol+l S L c , ENGINEERING:
ADDRESS: /G Y.7/ -2 2a Z c c 7;,-t V IRE DEPT
-u o,• C)"e 9>c y r- _ OTHER:
PHONE: _ G S'G Cj�_1'o _ ITEMS REQUIRED
BUILDERS BOARD M: EXP DATE: �- /? �._> LIST/SUBCONTRACTORS: —
BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME : _ TRUSS DETAILS:`~ _
ADDRESS: OTHER: -�
PHONE: - --
COMMENTS:
SUBCONTRACTORS: PLUMB: MECH:—' L lu" J y-4;"
PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. DAL. DUE
r 10--432 00 Buildir ; Permit Fees ass .
_ 10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees ✓ D ��, �_ lfe,.�7�
10-230 01 State Building Tax (5%)
Building /7. 7
Plumbing
Mech a-o3
10-433 00 Plans Check Feel
Building f/c
Plumbing
Mech
30-202 00 Sewer Connection U ,z.5 U
30--444 00 Sewer Inspection _� . ? 1
51-448 00 Street System Dev Charge (SDC) AC- C-0
52--449 00 Parks System Dev Charge (PDC) -2.5-c; SZ,
31-450 00 Storm Drainage Syst Dev Chrg (SSDC) .2 S u S�
10-230 06 Fire
TOTAL
REC # f
APPLICANT SIGNATURE
Received By: _ _, Date Received: _
cn/3587P/18P -�