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i Arecords\microflm\targets\building.doc
INSPECTION NOTICE
City of Tigard Building Department V
1312S BE Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection: Ct✓ C,G-v\ ll�/` ^�� '�1l �y _��
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
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Found. Plbg. Top Out Gas Line FINALS
Poet/Beam struct. San. Bower Framing -Bldg.
Pont/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Rater Line) Gyp. Bd. -Mach.
Date Requeeted: �{�J� /' _Tiros: _--.—_AM PM
Address: /� 0Q 0 �-�+ Xu RGI V/ 44rmit f: J-
Builder:
TI{E FOLLOWING CORRECTIONS ARE REQUIRED:
Inspectors v Date:
AAjPPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
2.v Call For. Reinsp.
jNSP_F_Cf�ON NOTICE
City of Tigard Building Department
13125 BR1 Hall Blvd. Tifvard, Oregon 97223
Inapection no (Rec-O-Phone): 639-4175 ._Busir•ss Phones 639-4171
Inspectior,r_1j�_ -
-T�' 1
Footing Plbg. Underslab Mech. Rough-in / Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Nater/ Line Gyp. ad. -Koch.
Date Requested,_ / Timet _AM PM
Address: L iC[1' ltipe�rmit ie
Ruilder:_____T_ "k,
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THE FOLLOWING CORRECTIONS ARE REQUIRED,
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Inspectors
ROVED DISAPPROVRD I'— APPROVED SUBJECT To ABOVE
r� Call For Reinsp.
CITY CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 3W Hall Blvd.Tigard,Oregon 07223.8199 (503)6311-4171
i
1312SSW Iiau BJIY& PLNCK/RECT N
CITY OF TIGARD PERMIT N 12,601
COMMUNITY DEVELOPMENT DEPARTMENT T'pnd,Orcgon97M —�-
(S03)63941" DATE ISSUED
`JOB ADDRESS: /�e�., Su)�,,�iJ V.vsey&g PL. �}'�.d�Y C.1:1,� TAX MAP/LOT I/UCC -4 7�v U
SUB: /i 1,__ _�,C_�, LOT: _ LAND USE: _
VALUATION:
OWNER SPECIAL NOTES
NAME: _ JAc�[ PnLA�/ 1 / REISSUE OF:
ADDRESS: %dooe, S(,D aEewl V, TLAST REISSUE:
FLOOD PLAIN/
PHONE: ���3- 6�1� /9e'� _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: {Ze v- PLANNING: _
ADDRESS: _ ENGINEERING:
FIRE DEPT:
PHONE: _ OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECI{: BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS: JAI'SWIA; f2,OW 424s2 inALV- til:
L It;) wl C .0 C o N )g L L- S KC TZ_'-N
A CANTS URE
Received By: i _ Date Received: _
PERMIT # ACCT # DESCRIPTION AMOUNF AMOUNT PD. BAL. DUE
/1Ofs -v Wo 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee • Z>� G•Zf
Building
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection _
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
257448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC) _
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445--01 Water, Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL L .j� /(o2 i� �G�•:?�
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APPROVrD FO"'
713_.-
CITY OF TIGARD — RECEIPT OF PAYMF-,N'*r RECEIPT NO. :93-242659
CHECK AMOUNT 0. 00
NAME : POLAN13, JACK CASH AMOUNT 26. 25
ADDRF,'.'SS : 16000 SW OU17EN VICTORIA PL PAYMENT DATE 07/28/93
SIM I V TS ION
KING CITY, OR 972-24—
.LIRPOSE OF PAYMFNT AMOUN"r PAID PURPOSE OF PAYMENT AMOUNT VIA ID
u I L,D I N G P,F R m 25. 00 ST. BLIII.r) PFR
OTAL AMOUNT PAID 216. 25
U'LlY OF Tl(".iARD RFC F.Tr--r OF PAYMFNT R I No. :93-242234
CHECK AMOUNT s Ia. 00
AME 2 POLANS), JACK CASH AMOUNT e 16. c.5
DDRESS : 16000 SW QUEEN VICTORIA PL. VlAYMENT DATE 07/13/93
KING CITY, FIR SUBDIVISION
97224—
URPOSE OF PAYMENT AMOUNT PA I D PURPOSE OF PAYMFN f AMOUNT r,c)I i.)
Ti c.,K FE 16. 25
OTAL AMOUNT PAID — — — —> 16. .'