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Page No. 1 CASE HISTORY FOR. CASE NO.: LST97-0227
ROSE MANOR HOMES
12071 SW 96TH PL
06/05,'98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Cc-de Sent Dome Done Date By
MSTA005 Application received / / / / 05/29/97 PASS JA 06/13/97 BT2
MSTA00B Permit .treated / / / / 06/13/97 PASS RT 06/13/97 BT2
MSTA010 Check for prcl. restrict. / / / / 06/10/97 PASS BON 06/17/97 JD
MSTA012 Plans routed to Plans Examiner / / / / 06/10/97 PASS BON 06/17/97 JD
MSTA.026 Plans approved by Pln Examiner / / / / 06/13/97 PASS RT 06/13/97 BT2
MSTA030 Reviewed plans routed to DSTS / / / / 06/16/97 PASS RT 06/17/97 JD
MSTA032 DST Post-Review Completed / / / / OC/17/97 PASS JSD 06/17/97 JD
MSTA055 Hold Release / / / / 03/25/98 Per Ken S. tie saw framing documentation, JT 03/25/98 JT
but did not retain for the file. okay to
remove hold.
MSrA092 (F) Issue combination permit / / / / 07/16/97 PPSS DRA 07/16/97 DRA
MSTA095 Inoue plumbing signature form / / / / 09/10/97 RECD SW 09/11/97 8•W
MSTA097 Josue electric signature form / / / / 08/15/97 RECD SW 06/15/97 S*W
MSTA700 Erosion Contol / / / / / / 06/13/97 BT2
MSTA705 Footing Insp / / / / / / 06/13/97 BT2
MSTA706 Foundation Insp / / / / 07/24/97 PASS KS 00/26/97 J-H
MSTA710 Poet/Beam Structural / / / / 08/06/97 APP XS 08/06/97 KBS
MSTA711 Poot/Beam Mechanical / / / / 08/06/97 APP 98 08/06/97 KBS
M9TA713 Crawl Drain / / 07/28/97 FAIL 08/27/97 J•H
MSTA717 PLM/Underfloor / / / / 07/31/97
Xvr, MS 08/17,'97 J•H
MSTA720 Mechanical Insp / / / / 11/07/97 1. Couneat exhaust. fano. FAIL KB 11/09/97 J•H
2, Wall around teat duct at upper level.
3. Add stud at upper level at
rectangular duct.
4. Soffits not built at: garage.
5. Protect exposed gas piping under
stairs.
6. Adjust harigers at gas piping at crawl
apace for full nupport of piping.
MSTA725 Framing Insp / / / / 11/20/97 no plans an sit-* FAIL KS 11/20/97 J•H
Ci
F—
tn
5-. MST'A725 Framing Insp / / / / 12/01/97 1. Secure fireplace as indicated at PASS K9 12/09/97 J�H
H prior inspection.
2. Insulate void at heat duct garage
ceiling.
LO 3. Protect exposed gan piping orated
�1
� under stairs.
MSTA735 Gan Line Insp / / / / 11/07/97 30 psi PASS K9 11/09/97 J•H
MSTA740 Insulation Insp / / / / 12/09/9'7 See framing thir. date. PASS KS 12/09/97 J•H
Page No. 2 CASE HISTORY FOR CASE NO.: MST97-022.3
ROSE MANOR HOMES
12071 SW 96TH PL
06/05/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Dare By
MSTA755 Rain drain Insp / / / / 07/28/97 1. Backwater valve too high, also can't FAIL RAS 09/27/97 J-H
connect ABS F PVC.
2. No tracer wire on storm drain, or
newer.
3. No test on nower.
4. PVC sleeve under footing needo to be
SCHEDULE 40 if going Lo be tined an
drain.
MSTA760 Water Line Insp / / / / 09/26/97 I-resoure reducing valve at meter. PASS WA 08/28/97 J•H
MSTA765 Appr/Sdwlk lnop / / / / / / PVT N/A 05/14/98 JT
MSTA797 Plumb Final / / / / 05/01/98 previous final corrections by to are PASS OS 05/01/98 GES
approved
NOTE; PLUMBING TOPOUT WAS NEVER
INSPECTED FOR TEST THRU ROOF. SP.NITAPY
SEWER WAS
MSTA960 (F) Inoue Cert. of Occupancy / / / / 05/14/99 06/05/99 JT
MSTP050 Hold for / / / / 11/23/97 Hold inepecticros until engineering is HOLD KS 03/25/99 J•H
submitted from TJI prnvider (this job,
this address) for angle cut TJI joist
and hole size.
MSTB723 Electrical Service / / / / 11/.1.9/97 PASS HRP 11/19/97 J+H
MST13724 Electrical Raugh-in / / / / 11/19/97 Check box projection. PASS BRP 11./19/97 J-H
MSTB729 Plumbing Top Out / / / / 11/17/97 Nater okay, no toot on waste. FAIL GS 11/17/97 J•H
MSTB729 Plumbing Top Out / / / / 11/19/97 Tent waste through roof. FAIL GS 11/19/97 J+H
MSTB730 Framing Insp / / / / 11/21/97 1. Provide detail from TJI provider, PASS KS 11/23/97 J•H
detail needs to show hole size and
tangled cut of joist above garage.
2. Strap platen at glulam At entry.
3. Add support under post supporting
Junder pont beam at living room. OK to
insulate and call for reframing and
GO
insulation inspe^tion at the same time.
LL)
J
MSTB750 Shear Nall Insp / / / / 10/22/97 PASS KS 10/23/97 J•H
M-ITB795 Firewall Inap / / / / 09/05/97 1. Interior side of separation wall at PASS KS 09/14/97 J•H
lower level.
MST13755 Firewali Insp / / / / 08:09/97 M-1- separation wall not built at th.iot DIS KS 09/08/97 KBS
time
Page No. 3 CASE HISTORY FOR CASE NO.: MST97-0223
ROSE MAFOR HOMES
12071 3W 16TH PL
06/05/18
Action Description Req/ Schd/ End/ Action Notes Dinp By Update Upd
code Sent Done Dome Date By
---- --- -------- ---
ia5TB760 Gyp Board Insp / / / / if 13/97 Approved as noted: PASO KS 10/03/97 J•H
1. Interior side of separaticm, wall at
upper level (protect gypsum from water
drainage).
2. Extend wall to outer edge of
structure.
MSTB760 v.*+ Board Tnsp / / / 12/12/97 Gypsum at separation walla need to FAIL TS 12/12/97 J-H
extend through behind partition walls ao
indicated at prior inspection.
MSTB760 Gyp Board Inap / / / / 12/09/:7 I. Seal void above furnace and extend FI,IL KS 12/16/97 J+H
gypsum to mud mill.
2. Gypsum at separation walls need to
extend behind partition wa: t.
3. Nail gypsum at tub edge.
MSTB760 Gyp Board Insp / / / / 12/18/97 PASS KS 12/18/97 J•H
MSTB796 Electrical Final / / / / 03/06/98 Recpt. at right of range not OFCI FAIL. BRP 03/09/98 J•H
protected 210-8(6).
Flex to furnaces not secured, 350-18.
WP cover at front fo; horizontal mount,
110-3(b).
MSTB796 Electrical Final / / / / 03/27/98 corrections ok PASS BRP 03/27/98 J•H
MSTB797 Plumb Final / / / / 03/17/98 Provide documentation of plumbing top FAIL TN 03/29/98 J•H
out and sanitary sewer inspection with
approvals or expose and test. Seal
front hose bibb at sidirg; secure and
seal rear hose bibb at aiding. Extend
sanitary newer cleanout above grade and
terminate with approved fitting with
threaded plug; provide approved clean
out fitting/plug storm newer.
Clean out thread at kitchen sink to have
approved tape or lubricant with plug
J
Catightened. Secure vertical piping/water
heater safety valve drain.
Repair leaka/wash basin - 2nd floor.
J
Seal shower valve flange at wall.
Install clothes washer box wall flange.
Complete all itema above before
requesting reinspection; additional
corrections may be noted.
Page No. 4 CASE HISTORY FOR CASs: 'AST97-0223
ROSE MANOR .iOMES
12071 SW 16TH FL
06/05/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date T"
MSTB797 Plumb Final / / / / 03/24/98 1. Contact Building Division% regarding FAIL TN 0;/26/98 J+H
hold.
2. See report 031798. Provide
documentation of plumbing topout and
sanitary sewer inspectiins or expose and
test.
MSTB797 Plumb Final / / / / 05/04AS Crawl drain,_�o teat through roof. PART 08 05/05/98 J+H
correctr6ne per TN of 033498 are
approved.
MSTB798 Mechanical Final / / / / 03/24/98 Approved as noted: Support gas piping at PASS RS 03/26/98 J+tl
horizontal section adjacent to water
heater. Also support b-vent at
horizontal section.
MSTB799 Building Final / / / / 05/04/98 Plumbing 6 Bldg final: FAIL 08 05/05/98 J•H
1. Permenantly secure garage, house
step.
2. Remove dirt from foundatica% vents.
3. Mechanical protection for water
heater.
4. Remove underfloor debris.
S. Expone crawl drain backwater valve.
Note: PRevious corrections dated 032498
by TN are approved. Plumbing top out
was never inspected for toot thru roof.
MSTB"99 Building Final / / / / C 05/14/38 Previous correct-tons approved per 08. PASS TLP 05/10/98 J*H
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CITE' OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . . n MSTS7-•0223
DATE ISSUED: 05/t4/98
PARCEL-: 2 S 102PA-03600
JI TE ADDREE.6. . . : 1207 1 7W 96 TH PL
SUBDIVISION. . . . : DUBLIN PORK ZONING o
SLOCvK.. . . . . . . . . . o LOT. . . . . . . . . . . . . r1?106 JURISDICTION:TTG
CLASS OF WORK. :NEW
TYPE OF USE. . . tSFA
TYPE 13F C;ON`;TR: 5N
OCCUPANCY GRP. ,R3
OCCUPANCY LOAD-2
13 e m at-,k is s PATH 1 112 WPl.EX(TOldWOUGE)
Owner t
ROSE MANCIR HOMES
GST NW CONST
106c2*0 SW LUCAS
TUALAT I N OR 97062
Phone #o 452-81::3
Contractor :
ROLES MANOR HOMES INC
1 OC 20 SW LUCAS DR
TUALATIN OR 97W_
Phono M: 452--81J3
Rey k. . : 1096E 8
This Certificate 9k-ants occUpanc:y of the AbOVU f'efet-e11CFd bUilding nr' portion
thereof and confir^mv that the building has been ins-per.ted for compliance with
the State of Orerlon Specialty Cndeq for th, Aroup, occupancy, and use under
lNh irh t 6_"rof,rrenred erm it was i s 4'_ted.
E GILDING INSPECTORCTI N SUPER419OR
J
POST m CCINC,rIGIJOUS PLACE`.
I ) I
J
L�
1
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: �� e A.M. _ P.M. MST: 2-
2-
Location: 0_7 L / (e /�-�l G��_ BUT:
Tenant: Suite: Bldg: NMC:
Contractor: Phone: • PLM: _— —
Owner: Phone: ELC:
F.LR:
SIT:
BUILDING — BLDG co ) — PLUMBING MECHANICAL ELECTRICAL SITE
Site un Post/Bcam Post/Beam Cover/Service Sewer/Storm
Footing Roof lJndF1/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas bine Rough-In UG Sprinkler
Foundation Insulation Sewer l kxxl/I)uct Reconnect Vault
Bstnt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain VC IK;Slab
Shear/Sheath FirjLSPkjL1,,M111 Crawl/Found Dr I feat Pump Low Volt
rots Approved Approved Approved Apptoved
Appr/Sdwlk .t Approved Not Aptvoved Not Approved Not Approved '.Jot Approved
FINAL FINAL FINAL A1NAL
n_
V)
J
G]
11'
O Call for reins on O Reinspection fee of S let fired/before next inspection O Unable to inspect
Inspector—_ -- Date. J Page of _
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-How Inspection Line: 6394175 Business Phone: 6394171
Date Requested: —7 /'• y_ 7 A.M. P.M. MST:
Location: B1fP:
Tenant: _ Suite: / Bide MEC:
Cont:actor: Phouc: � Ct! I p PLM:
Chimer: Phone. ELC:
EI.R:
SIT: _
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Lure
Slab Framing To 0 t Gas bine Rough-In UG Sprinkler
Foundation Insulation ewer Iiood/Duct Reconnect Vault
Rsint Damp Drywall n Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found ih I lcat Pump low Volt _
Approved Approved Approved Approved
Appr/Sdwlk Not Approved NottAA Lroved Not Approved Not Approved Not Approved
FINALFINAL FINAL FINAL
a
t--
c�,
C1 Call for reinspection O Reinspecticn fee of S /required before next inspection O IJnable to inspect
Inspector:�/� _� Date:�7 C�`�' Page_/of .�
�tt.
CITY OF TIGARD MASTER F'ER11 IT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : MST97---022_,
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED. 07/16/97
PARCEL: 2S 102DA--0_`,600
SITE ADDRESS. . . : 1 ='071. SW ` 6—TI-I F'L
SUBDIVISION. . . . :DUDLIN F'ARI< ZONIN(:.T:
DL.00K. . . . . . . . . . I-OT. . . . . . . . . . . . . :C-, JURISDICTION: TIG
Remarks: PATH I 1/2�t1PtEX• -�"�
---------------------------------------------------------------- BUILDING ----------•---------- -
REISSUE: STORIES....... : 2 FLOOR AREAS--------- BASEMENT...: 0 sf REQUIRED SETBACKS—- REQUIRED-------------
CLASS OF WORK. :NEW HEIGHT......... 22 FIRST....: 704 sf GARAGE.....: 440 sf LEFT..........: 0 SMOKE DETECTRS: Y
TYPE OF USE... FLOOR LOAD....: 40 SECOND...: 782 sf FRONT.........; 20 PARKING SPACES: 2
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT• 0 st RIGHT.........: 10
OCCUPANC- 41P.:R3 BDRM: 3 BATH: 3 TOTAL----- 1486 sf VALUE..$: 107192 REAR..........: 21
--------------------------------------------------------------- P111MBING -----------------------------------------------------------------
SINKS.........: l WATER CLOSETS.: 3 WASHING MACH..: I LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 100 TRAPS.........: 0
LAVATORIES....: 5 DISHWASHERS...: I FLOUR DRAINS..: 6 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0
TUB/SHOWERS...: 2 GARBAGE DISP-: I WATER HEATERS.: 1 WATER LINE ft: 100 BCKFLW PREVNTP: 1 GREASE TRHPS..: 0
OTHER FIXTURES: 0
--------------------------------------------------------------- MECHANICAL ------------------------------------------------ ---------------
FUEL TYPES----------- FURN ( 100K ..: 1 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: i
GAS FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1
MAX INP.: 0 BTII FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS—., I
------------------------ ------ - ---- ELECTRICAL
---------------------------------------------
--RESIDENTIAL UNIT---- ---SERVICE/FEED R--- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADDIL INSPECTIONS--
1000 SF OR LESS: 1 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IP.RIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 2 201 - 400 amp..: 0 2"1 - 400 asp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: N PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - :,00 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 TN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 asp.: 0 601+asps-1000 v: 0 MINOR LABEL -10: 0
1000+ asp/volt.: 0 ------------------------------ ---- PLAN REVIEW SECTION -------------------------------------
ReconneL only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
------------------------------- ---- _-- --- - ELECTRICAL - RESTRICTED ENERGY ----------------------------------------------------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------------------------------------------------------
AUDIO 8 STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM.....: INTFRC^M/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: DTH: :: X BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION= MEDICAL........: OTHR:
HVAC........... DATA/TELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0
Owner: - --- - -------------------------Contractor: ------- --------- —_--- TOTPI FEES:$ 4438.51
ROSC MANOR HOMES ROSE MANOR HOMES INC This permit is subject to the regulations contai-ed in the
GSI NW CONST 10620 SW LUCAS DR Tigard Municipal Code, State of nre. Specialty Codeb and all
106,0 SW LUCAS TUALATIN OR 97062 other applicable laws. All work will be done in accordance
TUALATIN OR 97062 with approved plans. This permit will expire if work is
Phone N: 452-8133 Phone 1: 452-8133 not started within 180 days of issuance, or if the work is
N Reg 1..: 109868 suspended for more than 180 days. ATTENTION: Oregon law
---------------------------------------------------------- requires you to follow rules adopted by the Oregon Utility
i Notification Center. Those rules are set forth in OAR 952-001-00'7 through 9AR 952-001-0080. Y:u may obtain copies of these rules or
direct questions to OUNC by calling (503)246-1987.
cc ----------------------------------------------------------- REQUIRED INSPECTIONS -----------------------------------------------------------
Erosion Contol Post/Beam Mechan Electrical Servi Gas Line Insp Water Line Insp Building Final
_J Grading InsNecti Crawl Drain Electrical Rough Gas Fireplace Appr/Sdwllr Insp
Footing Insp PLM/Underfloor Framing Insp Insulation Insp Electrical Final
Foundation Insp Mechanical Insp Shear WAII Insp Gyp Board Insp Mechanical Final
Past/Beal Str ',,,,Plumb Top Out Low Voltage Rain drain Insp Plumb i al
Iss1-led - y : f�4 r'ermittee Signature:_ _
4-.4..+.+A-+4 +++41+i..+..++41-4-t•+•+-+-+.+ 1 I-�1-�+-y-4-+-i++9-•1-4��t-F-��-�-�1--1-•i-i-+-�-4-4 +�4-4+-...I 1 ++ i + 11-1_.1 1. r +.-1..4 #_ I-+4 .1 1
Ca 11 63 --4175 by 00 p. m. for an inspection needed the next b1-Isiness day
CITY OF TIGA,RD
DEVELOPMENT SERVICES SEWER CONNECTION
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT
PERMIT #. . . . . . . : SWR37--021E,
DATE ISSUED: 07/IE/97
PARCEL-: 2S102BA-03,600
5TTF_ ADDRESS. . . : 1'7'071 SW 96TH PIL
-UBDIVISION. . . . :DUBLIN PARK ZONING:
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :6 JURISDICTION: TIG
TENCiNT NAME. . . . . :
USA NC . . . . . . . . . . : FIXTUr�E UNITS. . . 0
r-Lc)SS OF WORII. . . .NEW DWELLING UNITS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: I
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE': ta S f'
Remarks : PATH 1 1/2 DUPLEX
Owner,: FEES
ROSE MANOR HOMES type amcii-Int by date rec.,pt
GSI NW CONST PRMT $ 2200. 00 Tn1 07/IG/'77 97-297227
10G'L20 SW LUCAS INSP $ 35. 00 TAT 07/16/97 9- -2971-227
TUAL-nTIN OR 97062
Phone #-.
Contractor,. --------------------------------
OWNER
—
-----------------------------------------
Flhone #: $ 2235. 00 TOTAL
[Reg #.
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agen,-y. The permit expires 180 days frus
the date issued, The total amount paid will be forfeited if the
permit expires. The Age-icy 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 iiistaller shall purchase
a "Tap and Side Sevier" Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-0101-0080, You may obtain copies of
these rules or direct questions to DUN' by calling 15031246-1987.
Tossed b Permittee Signat,.n-e :__
1 +++++-4--F+++++++++++++++++++++++++++•F+++++++++++++++++++++++++++++++++.4-F++++++-Fr
Call 639-4175 by 6:00 p. m. f cir- an inspection needed the next business day
. ..........................4.4-+++4......4.++-#+++•++++++++++++++++++++++.1•+•' ++4-4.+++++
5i19l9 r 12:11VesldentFai
84 7297 CITY OF TIGARD
Y glen Check f$
C iYOFTIGARD Rifliding Permit Application RoctlBy
13125 SW HALT_BLVD. New Construction Additions or Alterations Date Rete Sc
TIGARD,OR 9727..3 Single f=amily Detached or Attached (Duplex) Date tnRIE
-
V 503•-639-4171 Data to UST- -
F 503484-7297 Fem,it o MP-4 __U 23
Print or Type
Incomplete or illegible applications will not be accepted
Name of Project Name
Job & //;�. 4�✓/! I-JA-5-e" —
Architect Lfaaing Address
Address site adore p?1 5 P.1 q�I'. - — ri-
-- C�1SUM Zip Phone
Name
�i`Lert !f>•�Es tial w ^ � .t? Om2� 72
P -- NarDe
Owner Mailing Address -J
CRyf9tate -�— Phone Engineer A.npAcidress
P
--- — /N Zobr `��1 x/33 y _ /v2
Name CStyrStata P;qjot2 17-??/L-�p 15 Y-6 2 f Z
faenerafy� /� ypn f tTe:scrfba,rork Nev.O Addition Alta*wr0 Repair
Contractor Mailing Address — I 'Abe done:
�o S w L e ire D n Addb•el aesci iption of Work: —
CitylSiats Z4► Phone
74 onA-77,j 9262 a- !3) Z- 41
Oregon x
Oregon Orme[Cont.Board Lf" Exp. to
Jct copy L !I e 5
Cu
Current CO'r Business Tax or Marro to F�Dpta ,e PROJFCTc
Licenves _ VALUATION $
Name I
NEW CONSTRUCTION ONLY:
Mechanical _. ___—�� SV• Ft Hou e G Sq- Ft�Garage
1 :-1 ^
Sub- tin rem _ V U
Contractor ,3 7/ 7 s" ,S. .>,p•- 2d comer Lot YES NO F lag ;vt YE�NO
CrtylStata Zip Phone
/old 14 cJa 97o d �oGd 73/L (check one) -- (chock one
Omwn Conal Cant.Board Llr! Exp.Dina Restricted Audio/Steren Burglar
Attach Copy of � 2. I �il Lner7W System Atarm
Currant CCT ushm Tax or Mekn f ryp no" I Iretailltion Curage f)cs zr I Pv'Af;
- Liceaeaa Opener Systems
Nano -----
(check all taut Other
Plumbing c �11x Hct, i c�t t ■-M3-
Sub-
Sub- s ung Address Will the electrical subcontrhrlor wire for all YES NO
Contractor /"(-/u o Bodl" restricted energy instaJlatlons?
----
chy
1 e ap Phom Has the Subdivision Plat recorded? N/A YFS NO
At 97oS-) 6&e-7311 V
--- -- --- ---
Atlaeh Copy of Oregon cCont. Board uc. I� Dale ! Reissue of MS Solar Compliance
Curvet Plambiny Lic Exp.Date (�%aICUl9tlon Atttached)` _
lJcer+srvs /, j I has"acknoWedge that I have reed this eppliratiun,that the
EOr Business Tax or Metro• - information given is comtxi,that I am Hie comer or aufhrx4ed
Oats agerd of the awner,and that plans submitfrxf ere in comphAoce
-- -- ams with Oregan State haws. _
Electric al �N;�,,-s Sign f Ow rf alit Drlt,e
Sub- Wiling Address Contact Person Name Phone A
Contractor / 3 i 1 5,.1 /7e- 6 S��c1-3 �/SZ x/31
city,Ron Zp phone FOR OFFICE USE ONLY:
D U p t if 7 pled : r1 r Msp/TL4:
m Or"gri Const C nt.Bosni Lie, E� Date v�i t� 3 1 UZ t:.- 0,3400
Attar h Copy of 6 0 l -c?7 QSetbacks, 70ne: solar
r Gurneld Flectr l Ur-0 _ EM Date f- k,I icxrwea L r- U' 1-97 Fjtgiriesting Approval: Panning Approval: 11F - --
r. mines Tax at Metro 2 p.Data eL
1'SFAPP-DOC (DS7) 4197
97 May 28 17:56:25 R:',LT\LT5-6DP SATURN(M.R.R.I
4007
BY :
ROSE MANOR HOMES, LTD.
(PH.) 452-8133
CITY OF TIGARD
Z 5to 2 ,6A-0-76-00LOT
PARK
LOT 5 - 12095 S.W. 95TH AVE.
19; ZSio c.BA - o3boo LOT 6 - 12071 S.W. 95TH AVE.
15' PRIVATE �6r 0^
S.D.E \ NO rE:
� \ 165
GRAVEL DRIVEWAY ENTRANCE
�ZRiN Dltfhr�S 3// �S. i
PER EROS/ON CONTROL
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05/28/97 MRR
ALAN MASCORD DESIGN ASSOCIATES.INC O
IS NOT IIABIE FOR THE ACCURACY OF THE
TOPOGRAPHY INFORMATION 11 IS THE SOLE
RESPONSGILITY OF 111E BUADER TO VERIFY
AL1 SITE CONDITIONS.INCLUDING ANY FILL
PLACED ON THE SITE AND INFORM OWNERS
OF ANY POTENTIAL FIELD MODIFICATIONS
ALAn 11AICODD Mfllln AffOCIATEf IM (
1305 N W 18TH AVENUE, PORTI AND, OREGON 97209 (503) 225 9161 S C A L E 1 " 2 0 ' 0 "