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12912 SW VILLAGE PARK LANE t f e1 A 1 12912 SW VILLAGE PARI; LANE _ Vnsrrurrion InsTw6on& Relared Tcstx G-wlson Testing, Inc. P.O. Box 23614 AMENDED REPORT 5-17-91 Tigard, Oregon 97223 Phone(503) 6643460 !08 N0. C,p_'859 FAX(503)664.0954 REPORT OF IN-PLACE SOIL DENSITY TESTS N.e}• 13, 1001 OR-AK CURPI:'RATION _ — -------- VILLAGE @ SL�f'R LfT PARK NO. 3, 4, 5 .:c,i Descripi,on MC)PrU FRC:C. 3/4"-0 Rock/* SiltyRoc,1„ZI r1w k',Cx. Ory Density 122.5/*107.4lbs. cu. (t. Optimum Moisttre 12.SL�1Z.�e 4tethrsd of Test_1iT[1 i.:LR 1440 _ I't.o 10••0\ACI DENSI'rT • t or rfr — T E S T L O C A T I O '4 _- t`tv' "r' onru�t i.ts.1cu. rr.i 't 11. Y0. CSW►.(r10. -13 1 Lot 190 Ruilding pad and footings SC 4.7 123.6 118.1 96.4 —_ 2 0 tl 11 6.2 133.1 125.3 100+ 3 .2128.3 120.0 98.7 4* 22.3 122.2 99.9 93.0 5* u n n 123.7 122.8 ---?9.3 92.5 Remorks cc: Leonard A Fidel, :'E �C & M Construction Pride Services - St amn B ~�-- K. Mrall:tj Tested By: CAR LSON tW ING INC. ��t4� ('onstruction Inspection$Rebtc4 Tests Carlson Testing, Inc. PO.Box 23814 Tigard,Oregon 97223 Phone(503)684-3460 FAX 684-0954 IOC NO., REPORT OF IN-PLACE SOIL DENSITY TESTS Client Project Sol Descr plion — Max. Dry Density lbs./cu. ft. Optimum Moisture_ ' o Method of Testi+� 07 ?� lr- -- ri[io iN-MI.SCE DENSITY oar[ or r[sr T E S T LOCATION [t[v. ur r Moisrvsc rus.icu rr.r /1. N0. t DRY COw►ACTION T[17 N0. WILT Remorks i CARLSON TESTING INC I w w INSPECTION NOTICE � City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 972.23 Phone. 6394175 Type of Inspection Date Requested �� .Q�re Time_& A.M._ P.M. Addressrl /�- ��i /�L�_ _9rmi#Q� Owner Lot #_ Builder -- TAe fullowi.ig Building Cole deficiencies are required to be corrected: f I Presented to — AA proved Inspector F1 Disapproved Date CALL FOR REINSPECTION ❑ YEs ❑ NO III E-C-,I-I A N I C L I-'I-E,R Il 11* CITY OFTIFARD # W(W T7WARD PRIVI. PER1111, 44. N E.,C 9 0 WE 0 COMMUNITY DEVELOPMENT DEPAR7oMENT ORIGON DATE .'N)SLjLD-. @8/06,/90 13125 SW Hall BW. P.O.Box 23397,Tigard,Oregon 0&3(15W)111169.4175 11, P 1)R E";".i 1.2 21 SW VIARK LIq IGI-3,3DD-412000 EWDDJV:L1;;IC)N. ZON 1,NG B1 OCK. . . . . . . . .. . ... I-O'T. . . . . . . . . C,'LOSS OF' WORK. ADD F'LOOR. F•'URN c EVOP COOLER13 OF:' USE. . . . zSF UNIT HEn TERS. . VEN*T F'ANS. . . . O(1(111JPANC,'Y URP. . IR3 VEN*r!i W/O ()("'PL.- V1_.'111, !-)y'31,E III S (3*1*01RIES. . . . . . . . c 14 C)I L 17 N S/C 0 M P R E S E')0 R 6 HOODS. FJJEL 0.1-3 HF'. DOMES. 1NCIIA: /WOD/ 3-45 HP. (',OMIIL. INCIN-. I MOX INC LIT'.- EITLJ I R I r­ "A I R U N, I S F-1 R E D A 111:E.R S?. 30--.':;H HP. WOOD13TOVES. . : :L GWS PRE'S13UREE. . 504- W1='. . CLO DRYS WL . 1,10. OF: ......- AIR Hf-)NDLINU UNITS OTHER UNITS. FURN < 100K YI'Un <:= 10000 c-,f Int GW3 I::'LJRIq ) "J.00K VW.- > 10000 R e III a-r k i5 FIEES ,]A('-'K D0I-I.-- )HI.PlIKE'V31-111 type a.niOUI-It b-y (1,ate e -r e c,I: 1-291.2 SW VII.A.-W311 P(4RK LANE P A y III $ 15. 73 JLH 011104, 1-'R1711, 9s 14. 50 FIGARD OR 97223 5 P.,C 0. 7;3 1.2675 SW LAE'AVLRD0I1 RD DIEWVERION OR 97005 ............ 1:1 1-1 c)ri e Ili 6---C,4 0 9 1:leq N. . 51469 KI--'.'(1IJIRED INE.J.4ECTIONE) This permit is issued subject to the regulations contained in the F'irit-41 Dispe?c.,tiori Tigard Municipal Code, State of Ore. Specialty Codes and all other .................. applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 diVS of ISSUAIICP, or if work is suspended for more than 180 days. .................................. ............ .................. 'I ri s t.t e(1 13V (3a11 fixr- ir),.Apec,tioi-i 639-4175 'IPT OF PAYMENT RECEIPT NO. ,IT*Y OF' TICARD PECJ�- CHECk AMOUNT J.15. NAME C PLA11111"NSHIF'. iAa r)AL.E' CASH AMOUNT ADDRESS s '125'12 SW VILLAGE PARK LN PA,eMENT DATE V I S 1.ON Piffi-POSE: OF PAYMENT AMOLOTT Po I D rUPPOSE nF PAYMENT AMOI-fll' PA10 T. DUILD F'[:-7R TCST AL 5 I C'TYOFTIFARD CEkOC OF OCCUPACUNANCY CrTllaFilia7lRQ C0MMPERMIT !1. . . . . . . a MST96--0029 L1NrTY DEVELOPMENT DEPART�NT oinowa 13125 SW Hell8W. P.O.Bax23397.Tied,Oregon97W�JWJ%*Atb6 PR M. PERMIT #. x MS'r90-•00e9 SITE: ADDRESS. . . a 1291%- SW VILLAGE PARK LN FARCE I-a 15133DD--2000 SUBDIVISION. . . . a VILLAGE:: Al SUMMERLAKE PARK 2 ZONINOa BLOCK. . . . . . . . . . a L.0'1.. . . . . . . . . . . . . s59 CLASS OF WORK. aFiEW TYPE OF USE— i ff OCCUPANCY WP. aka OCCUPANCY LOADoL29 4 TENANT NAME. . . a Remarks Ownera _..___.._.. _._______,._..________....__.-____- I)ON MORISSETTE ELDERS, INC. P O BOX 19!524 f>ORTL.AND OR 97219 Phone #1 503--244--9314 Contractors DUN MORISSETTE: OLDER£, INC. P O BOX 19524 PORTLAND OR 97219 Phr3ne Na 50:3-620--'7538 Racy 18. , t 35 533 0c.cupanry of the abovereferenced building is hereby given, and Certifies the compliance with the -;tate Of Oregon Specialty Codes for the group, 0c'CupanCy, anti US* Under which the referenced permit was issued. FIRE DEPAk r MErNT B LDINO INSPla:r6-rT UILDIN EICI P081' IN CONSPICUOUS PLACE I NUMMMAR s ■ W_ W INSPECT'ON NOTICE OG City of Tigard Building Department '/ , P.O. Box 23397 , f77 / Tigard, Oregon 97223 •v' Phone: 639-4175 Type of Inspection L. Date Requested_ c� _ Time A.M. /IL .M.J Address Permit Owner _ Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to _ �pproved — Inspector ❑ Disapproved Date CALL FOR REINSPECTION ❑ YEt ❑ NO WW W Xqj INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested �� Time p,M AddressI,�— �i�, � _=�j permit Owner Lot Builder The following Building Code deficiencies are required to be corrected: Presented to ' ` I Approved Inspector C!mpproved Date CALL FOR RF, MVECTION ❑ YES ❑ NO 9 INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection =� — Date Requested e2 �� ��� Tim/����A.M. P.M. Address �_� /•� ���P � O G�sem- Permit Owner_ i_ Lot 1b Builder - ------ i The following Building, Code deficiencies are required to be corrected: Presented to _- ---_--_ --_-_ �'J Approved Inspector Ditepproved Date 9- - ----- - - CALL FOR REINSPECTION 0 YES _J NO INSPECTION NOTICE_ City of Tigard Building Department P.O. Box 23397 Tigard, Orego-, 97223 Phone: 639-4175 Type of Inspection �A'-tt Date Requested__ (L- Time A.M.__ //P.M. Address 01 mit # 1L :�M 4 Owner _ _ �w Lot #_ Builder The following Building Code deficiencies are required to be corrected: Presented to _ _ 4pproved Inspector �/ ❑ Disapproved Date -- CA.'L FOR REINSPECTION El YES O NO INSPECTION NOTICE City of Tigard Building Department P O Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection CP/� Time A L`i` Date Requested ___. A.M. ."- Address !c7 �/� X71.!) la�(�Z —� ¢ Permit Owner_ -y—�___ Lot # _. BuilderThe following Building Code deficiencies are required to be corrected: Presented to _ W Approved Inspector _—AI2(— Disapprcved Date lP— 3 qG --- CALL FOR REINSPE^TION ❑ YES 99 NO W W INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 / Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection i Date Requested - �� Time—A.M.--P.M. Address��c� V hermit # L Owner_ _ Lot Builder .iZl%7 r ✓ ------— �� The following Building Code deficiencies are required to be corrected: f ----------- Presented to _ XApproved Inspector Disapproved Date — CALL FOR REINSPECTION ❑ YES I.--] NO !�► vF1 !EWA INSPECTION NOTICE City of Tigard Building Department 1 ' P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 1 � Type of Inspections f=7ZA. 51 Date Requested 'q-- << Time_ _ A.M.__ P.M. Address l�l i..�T '� LSC_._ Permit #✓?(7 DO O-v—it Lot Builder _ kt-fiC G-1+ S -C The following Building Code deficiencies are required to be corrected: IS v ---?77 2-t ef,� -Ta 214elAA Presented to /0,14pproved Inspector Disapproved Dale CALL FOR REINSPECTION ❑ Yet ❑ NO i INSPECTION NOTICE City of Tigard Building department P.O. Box 23397 Tigard, Oregon 972'.3 Phone 639-4175 Type of Inspection Date Requested�!���_ � Tim A.M. P.M. Address � ermit Owner--- -- — ------� — Lot BuilderThe following Building Code deficiencies are required to be corrected: Presented to —,)&,- Approved Inspector ;%; _ ❑ Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO sa �r iw 6 nor u® as W INSPECTION NOTICE j 1 City of Tigard Buiriing Department Al-;% 0/ P.O. Box 23391 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested L _ � _—_—� Time _ A.M._ P.M. Address �•�C7 �� _ 1� �_ t' ��-1�ermit Owner. _ Lot # Builder. ,1r.2Li�`e2.� _ _ -- The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector r Disapproved Date --- CALL FOR RFINSPF.CTION Cl YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _- - -- --- -- Date Requested— 3 - ��L—.-- Time A.M. _.P.M. Address � �r � �- ��c-'--_____ Permit Owner _-- — —�.- Lot _--- Builder ---------- The following Building Code deficiencies are required to be corrected: WI AX" ----- ._ _ Presented to Approved I Inspector __ u Disapproved Date -- CALL POR REINSPECTION ❑ YES n NO INSPECTION NOTICE City of Tigard Building Department ✓� P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested –. �___. . Time-- A.M. — P.M. Address Owner– Lot Builder1 = ---The following Building Code deficiencies are required to be corrected: +� _ d Presented to _ _ Approved Inspector Disapproved +C-= - pp Date 5 CALL FOR REINSPECTION YES I J NO INSPECTION NOTICE / City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone. 639-4175 Type of Inspection Date Requested. a 7� _ Time 11�— A.M. - P.M. Address ASZ9—#& _ ()[1- ,e, )"AA-Z/- Permit #�Q Owner---r ` ---- -- lot # �� -6'er2 Builder Z; -'L. The following Building Code deficiencies are required to be corrected: Presented to AppruveA Inspector ] D approved Date 7 _ CALL FOR REINSPECTION ❑ YES ❑ NO i INSPECTION NOTICE / City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested __ _ __TI-me- _ A.M.— P.M. ov— Address _ LLl1 16U U�� Permit #_Lot Owner --�-- 0-jilder The following Building Code deficiencies are required to be corrected: Presented to Approved —_ -- -_""" Inspector - - Disapproved Date _�(� _ - CALL FOR REINSPECTION ❑ YES ❑ NO CITYOFTIFARDWER�bMA„& COMMUNITY DEVELOPMENT DEPARTMENT OaECON Co qECTION 19125 SW Hall Bhd P.O. 23397.TqW.OnpwK11 W2(509)63"175P� P RMI T fi32-4121 - -�.h T- ter. r+ Swago-003 3 ------— PRIM. PERMIT #. : MST90-0029 DATE ISSUED: 03/12/90 SITE ADDRESS. . . : 12912 SW VILLAGE PARK LN PARCEL: 1S133DD-2000 SUBDIVISION. . . . : VILLAGE AT SUMMERLAKE PARK 2 ZONING: BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :59 --------------------------------------------------------------------------------- TENANT NAME. . . . . : USA NO. . . . . . . . . . :40604 FIXTURE UNITS. . . : CLASS OF WORK. . . :NEW DWELLING UNITS. . :1 TYPE OF USE. . . . . :SF NO. OF BUILDINGS:1 INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . : :sf Remarks: Owner: ----------------------------------- ---------------- FEES -------------- DON MORISSETTE BLDERS, INC. type amount by date recpt P 0 BOX 19524 PRMT $ 1250.00 INSP $ 35.00 PORTLAND OR 97219 PAYM $ 1285.00 TLH 03/12/90 Phone #: 503-244-9314 Contractor: ----------------------------- CONTRACTOR NOT ON FILE --------------------------------------- Phone : $ 1285.00 TOTAL Reg . . . -------- REQUIRED INSPECTIONS •------- This Applicant agrees to comply with all the rules and regulal.ions Sewer Inspection —_ of the Unified Sewage Agency. The permit expires 120 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer 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 a�nd� the Agency will install a lateral. _— Permittee Signatures Issued By: Call- for inspection - 639-4175 CITYOFTIFARD CmroF PERMIT COMMUNITY DEVELOPMENT DEPARTMENT YC M M . . . . . : MST90-0029 :3125.SW"W1Blvd. P.O.BOX 23397.Tgafd.Or V=AM Y3(503)639-4175 RIM. IT #. : MST90--0029 -4 .44A01-- �,�.�..m_,s9 D: - SITE ADDRESS. . . : 1.2912 SW VILLAGE PARK LN PARCEL: 1S133DD-2000 SUBDIVISION. . . . : VILLAGE AT SUMMERLAKE PARK 2 ZONING: BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :59 ---- BUILDING --------------------------•----------- REISSUE: DWELLING UNITS:1 BASEMENT. . . . . . . . :0 sf CLASS OF WORK. :NEW BEDRMS:4 BATHS:3 GARAGE. . . . . . . . . . :451 sf TYPE OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS----------- TYPE OF CONST. :5N FIRST. . . . :1149 of LEFT. . :8 ft RIGHT. :6 ft OCCUPANCY GRP. :R3 SECOND. . . :1219 sf FRONZ. :20 ft REAR. . :34 ft STORIES. . . . . . . ..0 THIRD. . . . ..0 sf REQUIRED------------------- HEIGHT. . . . . . . . :20 ft TOTAL------:2368 sf SMOKE DETECTORS. :Y FLOOR LOAD. . . . :40 psf PARKING SPACES. . :O Remarks: - PLUMBING ------------------------ SINKS. . . . . . . . . . :1 FLOOR DRAINS. . . . :0 BACKFLOW PRF.VNTRS. . :O LAVATORIES. . . . . :3 WATER HEATERS. . . :100 TRAPS. . . . . . . . . . . . . . :0 TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0 WATER CLOSETS. . :3 SEWER LINE (ft) . :O GREASE TRAPS. . . . . . . :0 DISHWASHERS. . . . :1 WATER LINE (ft) . :100 OTHER FIXTURES. . . . . :0 GARBAGE DISP. . . :1 RAIN DRAIN (ft) . :0 WASHING MACH. . . :1 SF RAIN DRAINS. . :1 ---------•------- MECHANICAL -------------- ---------------- FEES ------ ------- FUEL TYPES----------- UNIT HTRS. . :O type amount by date recpt /GAS/ / / VENTS . . . . . :0 PAYM $ 100.00 JLH 01/17/90 106917 MAX INPUT:O BTU VENT FANS. . :3 PRMT $ 453.00 FtIRN < 100K . . :0 HOODS. . . . . . :1 PLCK $ 294.45 FURN >=100K . . :1 WOODSTOVES. :O 5PCT $ 22. 65 FLOOR FURN. . . . :0 CLO DRYERS. :.l STDC $ 600.00 ROIL/CMP < 3HP:0 OTHER UVITS:O SSDC $ 250.00 GAS OUTLETS:1 PARK $ 250.00 Owner: ----------------- ------------------- MISC $ 15.00 DON MORISSETTE BLDERS, INC. PRMT $ 37.50 P O BOX 19524 PLCK $ 9.38 5PCT $ 1.88 PORTLAND OR 97219 PRMT $ 132.50 Phone 1Y: 503-244-9314 5PCT $ 6.63 Contractor: ------------------------------ PAYM $ 1972.99 JI.H 03/12/90 DON MORISSETTE BLDERS, INC. P 0 BOX 1952.4 PORTLAND OR 97219 Phone ►: 503-244-9314 RegV . : 35533 ------------------------------------ $ 2072.99 TOTAL This permit is issued subject to the regulations contained in the ------- REQUIRED INSPEC Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Inep Gas L applicable laws. All work will be done in accordance with approved Post/Beam Insp Insul plans. This permit will expire if work is not started within 180 Plm/undslab Inep Gyp B days of issuance, or if work is suspended for more than 180 days. PLM/Underfloor Rain 1 PLM/Underfloor Water Line Insp Permittee Signature: k 1, 11"Lj& (' ai ) Mechanical Insp Appr/Sdwlk Insp Framing Insp Final Inspection Issued By: Fireplace Insp CITY OF TIGARD RECEIPT Or-' PAYMENT RK NOi 00107737 CHE0 AMOUNT : -'>257 9? DON MOR ISSE TTE CASH AMOUNT : oo D R E PAqMENT DATE a 05- 1.2 90 POPTLANE1, OR' 9721? BLOCK NO/ADDP& 1.291Z SW VILLAGE PARI;- L PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PWYMENT AMOUNT PAID ---- ------------ BUILDING PERMIT 00-004-9) 453.00 PLUMBING PERMIT 1'-, .50 MECHANICAL PERMIT 37.30 STATE BUILD PERMIT TAX (45%) -31. 16 PLAN CHE(.-.i:, Fi:-.E A.18.83 SEWER USA 1,250.00 SEWER 1NSPECION :5.010 STREET SDC 600-00 P,)RVS SYSTEM DEVEI-OPMENT CH250.00 2750.00 NORM DRAIN SDC TOTAL AMOUNT rAll) GRADING/EROSION CONTROL INFORMATION GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.: - , ?,. a PERMIT NO.: ,z I 1 h )t APPS ICANTN AND ANDRE$ : EXCAVATION CONTRACTOR k L. ` .{ L NAME&ADDRESS: Yv_v OWNER NAME AND ADDRESS: TELEPHONE E - APPLICANT 1`.� ,C ,....—_ PROPERTY DESCRIPTION: OWNER: L. STREET ADDRESS AND CROSS STREET/LOCATED GENERAL CONTRACTOR• �• _ - EXCAVATION CONTRAcTO W\L( 2/ -fit 77 � /<i , SITE/JOB: LEGAL DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: _ CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION: _ SITE SIZE,ACRES: DISTURBED/WORK AREA,ACRES: _ LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO: (CIRCLE ONE) (NOTE:PERMITS MAY BE REQUIRED) (CATCH-BASIN DITCH PIPE CREEK _ (CIRCLE ONE) PRWAT'E PROPERTY__ PUBLIC Mdtfr OF WA� EROSIQN/SEDIMENTATION CONFP.OL (ESO MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DI JRING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFF CONTROL FACILITIES CLEARING AND GRADING RESTRIC"I I ONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER OTHER __-- PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK". EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND APPLICABLE STANDARD NOTES. 1 HAVE.READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SF,DIMEN'T ON THE CONSTRUCTION SITE. OWNER SIGNATURE APPLICANT SIGNATURE OFFICIAL USE ONLY RECEIPT DATE ACCEPTED FEE NUMBER RECEIVED BY i PLAN CHECK APPLICATION CITYOF T16;A"' RD .,. j � m PLAN a+Eac a PERrirr n _ � f OMMUNfT DEVELC'PMENT OEPARTt �, DATE ISSUF �st25iw.�uead�pA.ao�unr.��^4�'^srm.(sa�) ` i AX MAP/LOT JOB ADDRESS: l.-�I S'�'� , OT• r. LAND USE: _ Si1B: n' S�.�! - VALUATION: - SPECIAL NOTES OWNER D( n r nQ f�1/ REISSUE S NomMID r; LAST REISSUE: jADDRESS: nn� FLOOD PLAIN/ -- 0 - SENSITIVE LAND: r P}IONS: 2�41�3�4 APPROVALS REQUIREO PLANNING: -- qONTRACTOR ENGINEERING: NAt'lE: - --—- - FIRE DEPT AOORCSS: 0114ER: _- -- _ ITEMS R ElQ_lIR_EO PHONE: LIST/SUBOONTRACTORS: - BUS TAX: ARCH/ENGINEER �f A 1 C, CALCULATIONS: --- - NAME: __- I r -- —f -M TRUSS DETAILS: ADDRESS: PARKING PLAN: _ LIUVQSCAPE PLAN: _— --r-24.�i_ _ OWER, _ -- PIIUNE: 0CMENTS: ACCT q DESCRIPTION AMOUNT AMOUNT PO. BAL. DUE PERMIT N - Y 10.-432 DO Building Permit Fees ` - - 10-431 00 Plumbing Permit Fees 10-431 01 Mechanical Permit fees ,rr,, �• 10--230 01 State Building Tax (5X)/ Building - "✓ Plumbing Mech '� ✓ ''lti I �oo i. �:�J 10-433 00 Plans Check Fee Building _ Plumbing Mech Sewer Connection y/--i----- 30-2oz a� � 30-444 00 Sewer Inspection 51-440 00 Street System Dew Charge (SOC) ✓ --- s 52-449 00 Parks System Dew Charge (POC) - 31--450 00 Storm Drainage Syst Dew Clary (SSUC) 10-230 09 TRFQ y--` 10-230 OG washington Gcwnty Fire !tl (95X) ----.-- --+`=-� 10-220 00 Amar-t/Wedgewood 1 OVAL arc It 1i. _ _ / APPLICANT SIGNATURE Received By: 1 _ bate Received: CITY OF TIGARD MECHANICAL PERMIT Receipt " Permit # 13125 SW HALL BLVD. P. o. BOX 23397 Description T I GATtD, OR 97223 1 Table 3A Mechanical Code CITY PRICE AMT (503)639-4175 l t) Permit Fee _ -0 -0 10.00 Hama of Devotopn• • 2) Supplemental Permit 3.00 Furnace to 100,000 BTU Job Address 11 6.00 incl.ducts&vents /V1d(ess - --- _ - Tax Map No. 2) Furnace 100,000 BI i 7.50 incl.ducts&vents i int Bloch 9ub*Avion -- - _ Name(or conte of busktw) 3) Floor Fumace 600 I VA4 tC._ 1 A(e l A l�rc tS� incl.vent,- ;�- Suspended heater,wail heater MoNitpAddrafM Ptafn � 4) 6.00 r�wnet _ or floor mounted heater ,lA V �kr( I�f1vL�� �aiW cnyra,ete5) Vent not incl.in 3 00 m 2 zo Cl-7 2-1 _ appliance permit - - Name(or nae of business) 6) Repair of heating,I efr ig, 6.00 - cooling,absorption unit _ Mailing Address Pttorte 7) Boiler or comp to 3 HP 6.00 Occupant absorp.unit to 100,000 BTU - c�yfstate ZIP 9) Boiler or comp to 3 HP-15 HP 11.00 ` absorp.unit,i 500,000 BTU _ �- Name 9) Boiler or comp 15-30 HP 15.00 < j (_I(c I`u{ absorp.unit ria-1 million Mailing Address PIN" 10) BC.iler or romp to 30-50 HP 22.50 jird i, 1'- ,j _ absorp.unit 1-1.75 million ,� ,tX� Contractor city/slate ZIP 11) Boiler or comp to 50 HP 31.50 absorp.unit 1,71,0,(00BTU _ State Registration No City Bus.Tax No 12) Air handling unit to 4.50 10,000 CFM Air handling u0!--- 7.50 I hereby adcnowlodge that I have read atws application at the i iefmation given is 13) 10,000 CFM + — ,.Ted.Mu+t I am ttm owner or auftmired agent of Mie owner.that plans submitted are in ----- - - nrwnf*ance with State laws.Mwi I am registered with the State Brilders'Board,Mrat the 14) Non portable .50 nrxnber given is correct (If exempt from state registration please give reasrxr below). ----evaporate Cooler 15 --- -- J ) Vent fan connected 3.00 ---- --- -— - _ - to a single dud - -_-_--.- ----------- ---- Ventilation system not 4.50 16) included in appliance permit - - - 1 7)--Hood served by 4.50 _ mechanical exhaust DateDomestic type - 7.50 18) Describe work 1-1 addition I-I alteration O repair F1 _incinerator to be done - residential ❑ - non-residential U 1 g) Commercial or industrial 30.00 type incinerator Existing use of Other i.e.,woodstove,water 4.50 building or property __-_--__.___--------- 20) heater,solar,clothes dryers,etc. Proposed use of - ----! building or property_-____ - _-_.--_-_-- -- 21) Gas piping one to four outlets 2.00 Type of fuel- oil C I natural gas I ) LPG ❑ electric I l - ----___ - - --- 22) More than 4-per or.ttlet NOTICE SUR-TOTAL 11115 PERMIT BECOMES NULL AND VOID IF WORK OR GON- -- — --�_ STRIICTION AUTHORIZED IS NOT COMMENCED WITHIN 160 _ —_ 5%SURCHARGE DAN'S, OR IF CONSTRUCTION OP. WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL ARANDONFD FOR A PERIOD OF 180 DAYS Al ANY TIME AFTER -- - TOTAL WOi1K IS COMMFNCFD Special Conditions ---------_.._-- __ _--____-- Date issued_ �— by