6902 SW TAYLORS FERRY ROAD i AvLoRS ROYAD
ADDRESS.
Ta- a v-.s Fil C LA
° ..
I:\records\microtlm\tartjetsuiuilding.doc
1
l
CITY OF T'IGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
CERTIFICATE of
OCCUPANCY
PERM I T ? I MST'Al-0 1 '7
DATE I SSULD i It , 10!96
PARCEL: ISIE'5DA--09900
.;I TF PI)DRESS. . . r 06902 SW TOYLORS FERRY PT)
SUBDIVIGIOM. . . I. , ZONING&R-4. 5
BLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . .
CLASS OF WORK. tNEW
TYPE OF USE. . . I Gr-
TYPE OF CONSTRi5N
UUMPANCY GRP. : R3
LOAD I I
Remarkst PATH I
i-EN
OW)06 SW TAYLORS FERRY FZD
MIMI) OR ")7223
Phone Its 452-0969
C'()'n t r a c t o r z
STONE CAMLE &JILDERE;
PO BOX 230594
TIOARD OR 97281
Phore Ms 503-4532-2*554
P91.4 #. 10;pbea
This Certificate qv,ants accupanc:y of the ;aboyv referonc-pd b,Ailding portion
tjjgr-,gof an(I confirmt, that the building har, 1 Nen inspected for complianco, with
t.,�p ;tat* of ov.,pU(p) Sperialty Crudes fai thegv'ou ocVuPjRncY, anci u-Ae kinder
ro
which the referpi--,ed ppvware weisimed.
S.U ...L-DIN G IN ';VEG.� .TOR id-IL iING OF -it4L
FOST IN r,0NRr'1rUOUC, P1-A('r--
■ I \
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Dra'n Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.N'
Post/Beam Mach. Shear/Sheath Framing -Mech.
OW
Plbg.Und/Flr,'Slab Plbg.Top Out Insulation -Ele N`
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San. Sewer Gas Line ^npr/Sdwl!c Reins,
Other:
Date: 1 S� �A.�M.� ,�PM,•�1__ Entry:
Address. �a ���.. --
Page No. 1 CASF 111'3TORy VOR CASE NO.: MST96-0174
LEN F DALTON
06902 SW TAYL.ORS FERRY RD )
08/25/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTA005 Application received / / / / 03/15/96 PASS JH 04/12/96 BT2
PASS RT 04/12/96 BT2
MSTA008 Permit Created / / / / 04/12/96
MSTA010 Check for prcl. restrict. / / / / 04/05/96 PASS JH 04/12/96 BT2
MSTA012 1•lans routed co Plans Examiner / / / / 04/05/96 ;'ASS JH 04/12/96 BT2
MSTA026 Planq approved by Plans Exmr / / 04/12/96 PASS RT 04/12/46 BT2
MSTA030 Reviewed plans routed to DSTS / / 04/12/96 PA:7S RT 04/12/96 BT2
MSTA080 (F) Ready to issue / i l i 05/20/96 JMH 05/20/96 J*H
M9TA092 (F) Issue combination permit / / / / 05/28/96 PAID JMH 05/28/96 J•H
MST1097 Issue plumbing signature form / / / / 05/28/96 PAIL' JMH 05/28/96 J•H
MSTAL98 Issue electric signature form / / / / 05/28/96 'PAIL JMH 05/28/96 J*H
MSTA765 Footing Inep / / / / 06/11/96 PASS TLP 06/12/96 TLP
MSTA704 Foundation Insp / / / / 06/14/96 N-1 -iot ready) DIS KS 06/17/96 KBS
MSTA706 Foundation Inep 06/17/96 / / 06/17/96 #-1- install anchor bolts as shown- size A/N KS 07/25/96 BT2
/spacig
1-2 install remainder of holdowns
/reinforcing Pach aid,
I
of holdowns
0-3- isolated piers supporting tji fl
system size riot as
shown contractor will pour a
continuous ftg
MSTA710 Poet/Beam Structural / / / / 07/02/96 no mach or plm in APP GS 07/02/96 GES
MSTA711 Post/Beam Mechanical / / / / 08/22/91 PASS RS 08/23/96 RB
MSTA713 Crawl Drain / / / / 07/02/9( none in DIS OS 07/02/96 GEE
MSTA713 Crawl Drain 07/08/96 / / 07/08/96 PASS MS 07/25/96 BT2
MSTA715 Plm/undslab Inep 06/27/96 / / 06/27/96 me PASS MS 06/27/96 MRS
Bass
MSTA720 Mechanical Inep / / / / 08/22/96 extaust venting disconnected; soffit FAIL. RB 08/23/96 RB
ductwork at basement; plcmbinq
under-floor req'd;
MSTA720 Mechanical Inep / / / / 08/29/96 conference w/ contractor CONF RR 08/30/96 RA
MSTA722 Plumb Top Out / / / / 08/12/96 PASS MS 08/13/96 MRS
MSTA723 Electrical Service / / % / 08/20/96 PASS CVS 09/03/96 MJR
MSTA724 Electrical Rough In / / / / 08!20/96 PASS CVS 09/03/96 MJR
Page No. 2 CASE HISTORY FOR CASE NO.: 14ST96-0174
LEN F DALTON
,u SW TAYLORS F,'MY RD
08/25/98
Action Description Req/ Echd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date B;'
MSTA72t Framing Insp / / / O8/22/S6 Plumbing under floor req'd, extend shear FAIL RB 08/27/96 RB
of rear wall to roofs nail shear wall
-rear of garage; anchor HD's; draft
stop; add straps; add nailers/etude;
vent baffles; shower/tub blocking; temp
glazing; attic access; support stairs;
install post protection- under-floor
location; back water valve at low point.
MST 025 Framing Insp / / / / 08/29/96 conference w/ contractor CONF RB 08/30!96 RB
MS'f472s Framing Invp / / / / 09/04/96 N-1- prior framing inspection DIS KS 09/05/96 KB5
corrections not done at this time
MSTA725 Framing Insp / / / / 09/03/9C N-1- framing corrections not complete 014 KS 09/06/96 KBS
MSTA725 Framing Insp / / / / 09/11/96 N-1- framing corrections not complete at h,'N KS 09/12/96 KBS
this time complete fireblocking at
lower .level soffits and furred walls
N-2 tempered glazir,g adjacent to patio
door
0-3 secure protective collar at B vent
attic
CK TO INSULATE CALL FOR
FRAM/INSULATION
MSTA726 Shear Wall Insp / / / i 08/22/96 see framing this date FAIL RB 08/2'1/96 RB
MSTA726 Shear Wall Inap / / / / 08/29/96 conference w. contractor CONF RB 08/30/96 RB
MSTA726 Shear all Insp / / / / 09/04/96 N-1-nsii all shar panels an per DIS KS 09/05/96 KBS
schedule.
N-2- MSTA strap missing at rear of
structure
MSTA726 Shear Wall Insp / / / / 09/11/96 APP KS 09/11/96 KBS
MSTA735 Gas Line Insp / / / / 08/22/96 PARS RB 08/27/96 RB
MSTA740 Insulation Insp / / / / 09/13/96 APP KS 09/13/96 KBS
MSTA745 Gyp Board Insp / / / / 09/16/96 issues w/in dwelling; garage PART RB 09/16/96 RB
incompleted at separation wall.
pending. failed.
MSTA745 Gyp Board Insp / / / / Oa/19/96 APP KS 09/19/96 KBS
M.STA755 Rain drain Insp / / / / 07/03/96 around house only PAS, MS 07/08/96 3
Page No. 3 CASE HISTORY FOR CASE Nn - MST96 0174
LEN F DALTON
06902 SW TAYLORS FERRY RD
OB/25/98
Actior Description Req/
Schd/ End/ Action Notes Disp By Update Upd
Code
Sent none Done Date By
MSTA7E0 Water line Insp / / / /
09/20/96 PASS MS 09/23/56 MR.'
MSTA765 Appr/Sdwlk Itisp / / / / / / COMMERCIAL DRIVEWAY FXISTINC N/A PI 11/21/96 JT
MSTA770 Misc. Inspection 07/03/96 / / 0'1/03/96 #-1- insulate perimeter of slab A/N KS 07/03/95 KBS
,ondition space
MSTA790 Electrical Final / / / / 11/05/96 PASS HW 11/06/96 MJR
MSTA795 Mechanical Final / / / / 11/18/96
PASS RR 11/18/96 RB
MSTA797 Plumb Final / / / / 11/05/00 PASS MS 11/18/96 RB
MSTA199 Building Final / / / / 11/01./96 0-1- canceled by request N/R M.S 11/13/96 KBS
MSTA799 Building Final / / / / 11 /96 PASS RB 11/18/96 RB
11/21/9 JT
MSTA960 (F) Isoue Cert. of occupancy / / / / 11,
MSTA970 Case Finaled
/ / / / 111 PASS RB 11/18/96 RB
MSTB708 Erosion Control / / / / 11/15/96 PASS USA 11/18/96 RB
j,
MASTER FIERMIT
CITY CSF TIGARD IDERMIT #. . . . . . . : MST960174
DATE ISSUED: 05/28/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard,Oregon 97223.8199 (503)632-4171 F.",ARCEL: 1S125DA-09900
SITE ADDRESS. . . : 121%+902 SW TAYLORS FERRY RD
SUBDIVISION. . . . : ZONING: R-4. 5
I.Al.-OCK. . . . . . . . . . LOI.. . . . . . . . . . . .
Remarks: PATH I
------------------------------------------------- -------------- BUILDING --------------------------------------------------------------
REISSUE: STb:IES....... I FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:NEW HEIGHT........: 21 FIRST....: 13% sf GARAGE.....: 484 sf LEFT..........: A SMOKE DETECTRS: Y
TYPE OF USE... :SF FLOOR LDAI).... 40 SECOND...: 776 sf FRONT.........: 25 PARKING SPACES: I
TYPE OF CONST.:SN DWELLING UNITS: I FINBXNT: 0 sf RIGHT.........: 23
OCCUPA14('Y 6RP.:R3 BDRM: 3 BATH: 1; TOTAL------: 2W. if VALUE—$- 142898 REAR,.........: 17
--------------------------------------------------------------- PLUMBING •----------------------------------------------------------- -
SINKS
--------------------------------------------------------------
SINKS......... I WATER CLOSETS.: 3 WASHING MACH..: I LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 4 DISHWASHERS—: I FLOOR DRAINS..: 0 SEWLR LINE ft: @ SF RAIN DRAINS: I CATCH BASINS.. : 0
TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS.: I WATER LINE ft: IN BCKFLW PREVNTRi I GREASE TRAPS..: 0
OTHER FIXTURES: 0
-----------------------------------------------—------------ MECHANICAL -----------------------------------------------------------
FUEL
---------------------------------------------
FUEL TYPES---------- FURN ( 100K I BOIL/CMP i 3HP: 0 VENT 4 CLOTHES DRYERS: I
/GAS/ / / FURN )=INK I VAIT HEATERS..: 0 HOIODC I OTHER UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOO1191%, @ LAG OUTLETS...- I
--------------------------------------------------------------- ELECTRICAL -------------------------------------------------------------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDEF(cj--- ---BRANCH CIRCUITS--- ----MISCELLPNEOUS---- --ADD'L INSPECTIONS--
1000
NSPECTIONS—1000 SF OR LESS: I @ - 200 alp..: 0 0 - M alp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADWL 5005F.: 4 201 - 400 amp..: 0 20! - 400 amp..: 0 1st W/O SVC/FDR: @ SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 alp..: 0 401 - 600 alp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
W HM/SVC/FDR: 0 601 - ON, amp.: 0 6014amps-1000 v: 0 MINOR LnBEL -10: 9
ION+ amp/volt,: 0 ------------------------------------ P1
.-A:J REVIEW SECTION -----------------------------------
Awonnect only.: 0 )=4 RES UNITS.. SVC/FDR)=225 A.: ) 600 V NOMINAL: U AREA/SK OCL:
--------------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ----------------------------------------- ----
A. SIF REW7NIIAL--------------------------- B. COMME RC I AL-—---------------------------------------------------------------------—----
AUDIO & STEREO.: VACUUM Syb'EM..: AUDIO & STEREO.: FIRE ALARM—_: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM_- 0TH: X BOILE........... HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
I 'qC........... DATA/TELE COMM. ; NURSE CALLS....: TOTAL 0 SYSTEMS: 0
Owner: ---------------------------------Contractor: ----------------------------- TOTAL FEES:$ 4085.04
LEN DALTON STOW CASTLE BUILDERS
06906 SW TAYLORS FERRY RD PO BOX 230394
TIGARD OR 97223 TIGARD OR 97281
Phone 0: 452-0969 Phone 0: 503-452-2554
Reg #..: 102608
This permit is issued suLject to thr regulations contairpd in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approv?d plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than IN days.
---------------------------------------.---------- -- REQUIRED INSPECTIONS ------------ -------------------------------------------...
Footing [nip PLM/Underfloor Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Erosion Control
Foundation Insp Mechanical Insp Low Voltage Gyp Board Insp Electrical Final
Post/Beals Struct Plumb Top Out Fireplace Insp Rain drain Insp Mechanical rinal
Post/Beam Mechan Electrical Servi. Gas Line Insp Water Line Insp Plumb Final
Crawl Drain Framing Insp Gas Fireplace Nater Service In Building Final
1oel-m4ttee Signatt-tv-es Issited B y
Call for inspection - 639--4175
SEWER CONNECTION
CITY OF TIGARD PERMIT #PERMIT. . . . . . . : SWR9' 69
COMMUNITY DEVELOPMENT DEPARTMENT DATE 'r,:,--:1JED:
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PARCEL: IS12'51)A-09900
SITE ADDRESS. . . li 06902 SW 'TAYLORS FERRY RD
SUBDIVISION. . . . : ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . ..
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . IZI
CLASS OF WORK. . . :NEW DWELLING UNITS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: I
INSTALL ryi-,,E. . . . :BUSWR IMPERV SURFACE: 14) s f
Remar-ks ., PATH I
Owner: FEES
LEN DALTON type amount by date r,ecpt
06906 SW TAYLORS FERRY RD PRMT $ 2200. 00 .TMH 05/28/96 96-279846
INSP $ :3 . 00 j 11 H 0.:,/28/9E• 96-27984h
TIGARD OR 972623
Phone #s 452-0969
Contr,actor,:
CONTRACTOR NOT CN FILE
Phone 2x:':.35. 00 TOTAL
Reg #. RLIPUIREI) I NSPECT I ONS -------
This Applicant agrees to comply with all the rules and regulations Sewer- Inspection
of the unified Sewage Agency. The permit expires IN dzys from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not yu.-antee the accuracy of the
side sewrr laterals. if the sewer is not located at the measurement
given, the installe-f shall prospect 3 feet in all directions from
the distance given If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
Per in i t t e S i gnat 1.Av'e
d B y : C-441111-
11 for inspection 639-4J75
Residential Bu_ildina Permit Amlication
City of Tigard
13123 SW Hall Byrd.
Tigard, OR 97223
(.503) 639-4171
Jobsite Address: SIA ji-4(o 's _Fvclr
Subdivision: Lot # Office Use Only
w Planck/Rec #
Valuation: //
Corner Lot? Y rN � Permit #�'�`��f"iE• C' �
Reissue of
Flag
Lot? � � N _
Map & TL # 71
Owner: r'( AT
`_-�qq,��,I� Approvals Required
Address Y?1513�_S�1 T0.jL�_T� Planning
Engineering
Z" r�
I'honQ: l •' o-+�-+ — Other c�-,.�P��.7 '7 T- c•- c-
, �
':ontractor: _ ���C I� �v
_� tLD��S— Items Reguired�
(ter
Address. Z Subcontractors
Truss Details
Phone � D'3 5 Z " — 1 Other Nrvr< t� 1�,,.�, 'J,• �,_S � f .r
77
Contractors license # ���� �
r`
8 - —
(rattta_a0 copy of current Oregon liceaFe) /
Contact Name & Phone:
df;Y L,.l.(
Subcontractors: Architect/Engineer: Pb�aY ' Omar
Plumbing dress -lit �. �4 Sc 210
'��
Mechanical: s.1
(attach copy of currant OR Contractor's License)
Phone
JOB DES(-'Z!PTION
Applicant Si natuT6& Phone number
Received by: ^ T �_ Date Received. —_�
Permit# Account Desc,iP^'0n Amount Amt. Pd. Sal. Due.
13ldg. Permit (BUILD) ,..` Sy'�%• ti U
Plumb. Permit (PLUMES) ' Z
.rte
Mech. Permit (MECH)
Chit {Tlkit)
Bldg:
Plumb: '
Mech:
F
Plan Check (PLANCK) �• ' _ f''' A3Bldg . v
Jf�V
Plumb: �Qiti. ; �"(�}�t.? 1�`� .1 :i•... LJ
. . •.. y • , '� �
.4 I Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential 'riF (TIF-R)
Mass Transit TIF (TIF-MT) • ' ��+ ��
T
f
CommercWI TIF (TIF-C) � .' , f ` �•
w
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
office TIF (TIF-0)
r t Water Quality (WQUAL) _
a t
Water(Quantity (WOUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion PkAnck/USA (ERPLAN)
Erosion Planckl(OT (EROSN) _� •�� '
TOTALS: �,� �
Box,B. continued Box R:
2. Measure change in elevation from front property line to finished floor elevation. If
the lot slopes up from the front lot line to the foundation, the figure is positive. If
the lot slopes down from the front lot line to the foundation,, the figure is negative.
3. Measure distance from finishes floor elevation to the affected peak/eave. _. ft
4. If the roof line runs North-South, deduct three feet. If the roof line ruts East-West, __._ �''° ft
deduct nothing.
S. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. O it
6. Total figure for box FS: ft
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the � �' ft
affected peak/eave.
-:' (9
2. Measure the distance from the foundation to the affected peak or eave. + C ' ft
3. Total figure for ,:)x C: _ ft
It is most useful to draw a vertical line to represent the appropriate figure found in box"A"and a horizontal line to represent the
appropriate figure found in box 'V.The intersection of the vertical and horizontal lines determines the value found in box"D". The value
in box "D"should be compared to the value in box"8"; if the value in box "B"is less than or equal to the value found in box "D", then
the building is in .ompliance with the solar balance code If you have any questions, please contact us at 639-4171, x304 or at the
Community Development Counter
MAXIMUM PERMITTED SHADE POINT HEIGHT (In Fent)
Distance to I North-south lot dimension(in feet)
shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from northern
feet)lot line On
70 40 40 ` 40 41 44 43 44
65 38 38 138 39 40 41 42 43
60 36 36 ' 36 37 38 39 40 41 42
55 34 34 ; 34 35 36 37 38 39 40 41
50 32 32 32 33 34 35 36 37 38 39 40
45 30 30 30 31 32 33 34 35 36 37 38 3q
40 28 28 28 29 30 31 32 33 34 35 36 37 38
35 26 26 26 27 28 29 30 31 32 31 1 3s S6--
30 24 24 24 25 26 27 28 29 30 31 32 33 34
25 22 22 22 23 24 25 26 27 28 29 30 31 32
20 20 20 20 21 22 23 24 15 tri 27 28 29 30
15 18 18 18 19 20 21 22 23 24 15 26 27 28
10 16 16 16 17 18 19 20 21 22 23 24 25 26
5 14 14 14 15 16 17 18 19 20 21 22 23 24
Box D. Maximum allowed shade point height: �. �� feet 1
h:ldocslnancy�.ventura\solar.chp
Revised 2/26196
Solar Balance Point Standard Worksheet
d
Address
Box A calculations: North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
1
I�11NiE � lOT LINF
N North-South
Dimension for Lot:
Measure the distance from the midpoint of the North lot line to the South lot lire along i
the described line. 7/ 5
1
l
NCtJM1I-SOtr4i C'M£NSION�
Box B calculations: Shade point height for your residence, Box B:
1. Determine whether measurements will be based on the peak or eave of your \Vhizh describes
structure. The orientation of the ridge is also important. ,ou• residence?
la: If the roof line runs North-South, measurements will (circle one)
be based on the peak of the roof. o o u o �«
NCDTi'"r 1 A 1 i' I�
1 b: If the roof line runs East-West and the roof pitch is
less than 5/12, measurements will be based on the
eave.
'1 tDf POINT EAS£
Y --.
1r-: if the roof line runs East-West and the roof pitch is
5 12 or steeper, measurements will be based on the b .r." :
peak.
',ran a.f11 up.F
CITY OF TIGARD
May 25, 1.995
OREGON
Mr . Len F . Dalton
11720 SW 92nd Avenue
Tigard, OR 97223
Subject : Application :.o Building Permit @ 6906 SW Taylors Ferry
Road -- Parcel 2 of MLP 1993-002.
This .is to advise you that your application for a building permit
has not been accepted by the City due to the lack of information
relating to the conditions of approval for the City MLP 91-0010
approved November 11, 1.991 . Attached is copy of the City' s letter
dated January 30, 1992 from the Permit Coordinator asking that you
addres.-, these conditions . No reply was found in the file and our
computer files do not show any record of these items being
completed.
Your prompt attention to this matter would be appreciated. Please
contact Jill Aldrich, Customer Services Manager, at 639-4171 or at
her voice mail at: 639-6556, Ext . 322, for further instructions .
Sincerely,
ichael J. erson
DeveloZ:ment view Engineer
C: Jill A' -rich
Diane Jelderks, Engineering
ATT :
MA\DSTOOI.Iti
3125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (503) 684-2772
_J
Residenti LIAR-u—fldiRg Permit Application
City of Tigard
13125 SW Hall Blvd.
�Lr7 2 a iv(' IQ rto Lvov %r-IIA f
T:-ard, OR 97223 1�d��� C „�,� l�h
(503) 639-4179 tog
Jobsite Arldress: R I �
ry Office Use Only
Subdivision: Lot
3 l Planck/Rec #
Valuation: �`� �
Permit # 171 5 ) ~u� � �ln`7)
Corner Lot? Y (N,1
.� Reissue of
Flag Lot? N
Map & TL #
-y5PVT
Owner: l-�fJt-"(L� Apps^v?is a ul
Address. ��'�� SW -�p�J� LRf��/ Planning
71LaA�U IZ �"12 _ Engineering 010L
�n Other a y � L' LVI
J E �EW11'�t,,l
Contractor: ONE - wit- .`� Items Re u*_ed
Address: PLSC'X 'L3GJq"� S contra tors
Tr ss Dets —_
Phone - 04 _ L' '( _—_ Cath r
Contractor's License
(attach copy of current O , on lic nse) y/
Contact Name & Phone:
Subcontractors: *rchitecVEn neer: -
C"-
Plumbing: �
�r; t\ �\-� J1t
Mechanical: --
(attach copy of current 0 Contractor's Lic nse) -i
Phone: --
JOR DESCRIPTION: tv`" £r\ 1.��� �IP1(c�l,e
1
Applicant Sigmture & Phone number
7
Received by: Date Received. `__ --- --
Permit# Account Description Amount Amt. Pd. Bal. Due.
1?71V4, - 0, rW Bldg. Permit '(Bulm)
Plumb. Permit (PLUMB) c;2?i-,
Mech. Permit (MECH)
State Tax (TAX) /• i�
Bldg: b L
Plumb:
Mech: '
Plan Check (PLANCK)
Bldg: j� 3
1 �
Plumb: �. 1
Mach:
w
Sewer Connection (SWUSA) ,ZGv
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)- �� u \ ..Som ✓
Residential TIF (TIF-R) U �
Mass Transit TIF (TIF-MM
Commerdlal TIF (Tll�q
Industrial TIF (TIR4)
Institutional TIF (TIF 4S)
OfP.:e TIF (TIF-0)
Water Quality (WOUAL)
Water Quantity (WOUANT) _L' ` _ A")
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
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TOTALS: - 1.� �)z 2 f
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