12643 SW 138TH PLACE _L
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CITY OF TIGARD BUILDING INSPECTION NOTICE 1
!r,spection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meth.
Plbg,Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: )-�9 A.M. P.M._ Ent
Address: ! Z-�� 3 3
Tenant: ._, _ Ste: MST:
Con/0 64_16 C9 _ , MEC:
PLM:
C{7 3.`
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:� 7
/
zl�4L>.4_ J-
)APPROVED __DISAPPROVED/CALL FOR REINSP. CF Cr,
CITY OF TIGARD BUILDING INSPECTION NOTICE 1
Inspection Line: 639-4175 Business Phone: 639-4171
Footin7 Rain Drain Nps Cover/Service FINAL.:
J Foundation Water Line N a Ceiling Plumb
Post/Beam Mech, Shear/Sheath Framing ech.)
1
Plbg.Und/Flr/Slab Plbg.Top Out Insulation Elect. t
Post/Beam Struct. Mech, Rough-In Gyp. Bd. Ido.
San. Sewer Gas Line Appr/Sdwik Reins.
Other: 0 _
Date: 44A I'f(e- A.M. _P.M. Entry: �L,E
Address: �2 Lg Gr l% `N'°
Tenant: Ste: - MST:(?J-6 43
F
Con/Own: /'— ! 1 BLIP: _
/ MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
CL
re
vii _� - � .�.Gt1-Y�-�" —•�..���-�----
1
Inspector: — _ Date: - Zq 9
VPPROVED —DISAPPROVED/CALL FOR REINSP. CF CO
CERTIFICATE OF'
CITY OF TIGARD OCCUPANCY
PERMI1 #. . . . . . . : M57'95-043,�
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/24/96
13126 SW Hall Blvd.Tigard,Oregon 97223981 N (503)639-4171
PARGLLs 26104BD-14MVQc0
SITE ADDRESS— c 121643 SW 138TH AVE
SUBD1V1SION. . . . : ROSE MEADOWS ZONINGzR-1
BLOCK. . ,. . . . . . . . . LOT. . . . . . . . . . . . . :020
---------------------------------
CLASS OF WORK. :NEW
TYPE OF' USE: *'!��F '"� 3
OCCUPANCY C-33�4�: bN—
OCCUPANCY LOAD zI
Nemaikss PATH I
JAY MILLER
P C BOX 231459
TIC ARD OR 97281
Phoiic- #: 6847543
JAY MILLER
PO F30): 211,01159
JL16HJtij 01 qj�&j
Phone #n 684- 754:';
[Reg #. . I 3LA0109
this Lrrti -ficate Yr-ikrltr, OCCLIPancy of the above referenced bU11CJ.11)i4 01 put-tion
thet-oof and confirms that the building has been inspected for- compliance with
the State of Or-etion Specialty C:Dde,,K For- the pr-oup, occ,.%pancy, arid 1.13e Under-
which the refer'(-y)LL*d Permit was Assi-ted.
_PE-TOH BUILDING OFFICIAL
POS'r IN CONSPICUOUS PLACE
C-1
41
CITY OF T I GARD PERMITPLUMBING#. PERMIT. . . . . . : MST95-0433L
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 12/12/95
13125 SW Hell Blvd.Tigard,Oregon 97223*8199 (503)632-4171 PARCEL-: 25104BD--RMQN?0
SITU ADDRESS. . . : 1'-'643 SW 1:38TH AVE
SUBDIVISION. . . . : ROSE MEADOWS ZONING: P-7
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .020
CLASS OF WORI-',. . : GARBAGE DISPOSALS. . : 1
TYPE OF USE. . . . :NEW WASHING MACH. . . . . . . : I BACKFLOW PREVNTRS. . : 1
OCCUPANCY 6 RP. . :SF FLOOR DRAINS. . . . . . . . 0 TRAPS. . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . : I CATCH BASINS. . . . . . .. 0
FIXTURES---------------- LAUNDRY TRAYS. . . . . . : 1 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . . I GREASE TRAPS. . . . . . . :0
LAVqTORIE9. . . . . : 3 OTHER FIXTURES. . . . . : 0
TUB/SHOWERS. . . . : 2 SEWER LINE (ft ) . . : L71
WATER GLOSETS. . : 2 WATER LINE (ft ) . . : 100
DISHWASHERS. . . . : I RAIN DRAIN (ft ) . . : 0
Remarks : PATH I
OWNER: -----•----_-_---..__-_.----_._----. -_.---_-__..___-____..FEES____._.__._____.___
JAY
-------------------FEES-
JAY MILLER TIF $ 1390. 00 B 12/12/95 95-273802
P 0 BOX 231459 SWM $ 180. 00 F 12/12/95 95--273802
Swil 10171. 00 B 12/ 12/95 95-27380c-`
TIGARD OR 9728,1 ELCF $ 160. 00 B 12/11-='/95 95-273802
Phone #: 684-7543 ELC5 $ 8. 00 B 12/12/95 95-27380
ELPP 1, 40. 00 B 12/12/95 95-273802
Plumbing Contractor-------------------- ELR5 $ 2:1. 1*60 S 12/12/93 95-273802
BV,RT $ 465. 50 B 12/12/95 95-273812121
Name : (c"/', BFILC 11, 302. 58 J*1-1 11/06/95 95-272572
A d d r e s s : r-g? B5PC $ 23. 2'8 B 12/12/95 95-27380L
City= State.. . PARK * 500. 00 R 12112/95 93-27380L
Zia:_._.._ 70
mpR-i $ 40. 50 b 12/12/95 95-273802
Req Oe Addit ional fee --1 o t S h 0 VJ n here. . . . . . . . .
REOUIHED INSPECTIONS
This permit is issued subject to the reg-
UlgtiOnS COTItAined in the Tigard Municipal Footing Insp Fireplace Insp
Code, State of Ore. Spetiialty Codes -ind all Found,.;tion Insp Gas Line Insp
other applicable laws. All work will be done Post/Berm Struct Insulation Insp
in accoi-dancp with approved plans. This Post/Seam Mechan Gvp Board Insp
permit will expire if work is not started Crawl Drain Rain drain Insp
within 180 days of issuance, or if work is PI-.M/lJndev,f loor Water Line Insn
suspended for more thp.n 180 days. Mechanical Insp Water Service In
Plumb Top Out Appr/Sdw1k Insp
u- Electrical Servi Eleutrical Final
Elertrical Rough Mechanical Final
Ln Framing Insp Plumb Final
>- Lov Voltape Building Final
Authorized Plumbin Contractor Signature
Call for inspection - 6314- 41.75
Contractor Notes :
uj
Community development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. n
Tigard. OR 97223 Permit #
-D,-" Issued
Phone (503) 639-4171
CITY OF TI�ARD FAX (503) 684-7297
TDD No. (5031 584-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_It6�$�I r L G _ Number of Inspections per permit allowed
Address 6 2,GG- J,, 9V 4 3 'Cr _ Service included Items C,.L(ea) Surn
City/State/Zip_ /r�cc t� 22 4a. Residential -per unit
1000 sq. R.or less $i 10 o0
Name (or flame of business) Each addltloial 500 sq ft.or $25.00
portion the•eof
Commercial ❑ Residential ❑
Limited Ener(y $25.00
Each Menufc Home or Modular
Dwelling St rvice or Feeder $68.00
2a. Contractor installation only:
4b. Service: or Feeders
Installation,alteistion,or relocation
Electrical Contractor_ _ 200 amps or less $60 00 2
Address _ _____ 201 amps to 4(Damps --" $8000 2
40t amps to 607 amps $12000
City State__ Zip__ _ _ 601 amps to 10,10 amps $180 00 2
Phone No. I over 1000 amps or volts -- $34000 2
Job NO. Reconnect only $5000 2
contractor's license NO.__ 4c. Temporary Services or Feeders
Contractor's Board Reg. NO, Installation,alteration,or relocation
Signature of Supr. Elec'n 200 amps or less
License No. Phone No. 201 amps to 400 amps $5000
-. --- 401 amps to 600 amps $7500
Over 600 amps to 1000 volts $10000 —-
2b. For owner installations: see"b"above,
Print Owner's Named cp f A� Branch Circuits
.N (.14 New,alteration or extension per pane
Address 6/S' S ✓ Cwt�. a)The fee for branch chcuits with
Cit State-0g.-zip�7 purchase of service or feeder lee.
yEach branch circuli _ $500
Phone No. e* �- b)The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee.
First branch circuit $1500 _
not intended for sale, lea/s�e or rent. Each additional branch circult $500
Owner's SignatureL L � - 4e. Miscellaneous
(Service or feed(- not included)
Each pump or Irrlgatlor,at-le $4000 7
3. Plan Review section (if required): Each sign or outline lighting $40 n0
Signal clrcult(s)or a limited energy
Please check appropriate Item and enter fee in section 513 panel,alteration or extension $4o no
_4 or more residential units in one structure Minor Labels(10) $100 00
Service and feeder 225 amps or more
.� 4f. Each additional inspection over
System over 800 volts nominal
Ce Classified area or structure containing special occupancy the allowable In any of the above
H ------- Pnr inspection $15 00
LA as described in N.E.C. Chapter 5 r,ef hour $55 00
y In Plant $55 r 0
Submit 2 sell- :i pians with application where any of the above
-_u opply. root required for temporary construction services. 5. Fees:
5a. Enter total of above fees $
NOTICE — -
5°/ Surcharge (05 X total fees) $ _
t'-f Subfofal
J PERMITS BECOME VOID IF WORK OR CONSTRUCTION $ -
5b. Enter 25%of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Plan Review if required (Sec ii
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR $
Subtotal
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS °
COMMENCED F] Trust Account #
pm pp
Balance nue S
I --
mo�j-F R L' PM T I-
r-r Rrl z r . . . . . . . MST95----0432
CITY OF TIGARDDATI_ ISSlc'
/12/95
l /12/95
• COMMUNITY DEVELOPMENT DEPARTMENT IDARCEL: 12SI04B)DRte 01_0
T113124-_1W;NA"S%Kd..Tigard,Oregon 97223*8199 (503)83P-4171
SUBDIVISION. . . . . i<U&L Ni- ADOWS ZONING: R-7
III---Ocl',. . . . . . . . . . : L-01.. . . . . . . . . 01 L71
Remarks: PATH I
------------------------------------------------------------------- BUILDING ------------`------------------- IP,-
REISSUE: STORIES....... : 1 FLOOR AREAS----------- BASEMENT...: k sf REQUIRED SETBACKS—- REQUIRED-------------
CLASS OF WORK..NEW HEIGHT.......•: 17 FIRST....: 1632 sf GARAGE.....: 450 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FI-OOR LOAD.... 40 SECOND...: 0 sf FRONT.........: 20 PARKING SPACES: 1
TYPE OF CONST.:5N DWELLING UNITS: I FINBSKENT: 0 sf RIGHT....,..••: 5
OCCUPANCY GRP.:R3
L BDRM: 3 BATH: 2 TOTAL------: 0 sf YALUE..t: 112847 REAR..........: 26
----------------------------------------------------------------- PLUMBING ----------------------------------------------------------
SINKS......... I WATER CLOSETS.: C'.' WASHING MACH..: I LAUNDRY TRAYS.: 'a PAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 3 DISHWASHERS...: I I'LOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BAST'&.: 0
TUB/SHOWERS...: 2 GARBAGE DISP..: I WATER HEATERS.: I WATER LINE ft: 100 BCKFLW PREVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
- -------------------------------------------------------- MECHANICAL ----------—--—-----------------------------_---------------
FUEL TYPES----------- FURN ( INK I BOIL/CMP ( 3HP: 0 VENT FANS.....: 3 CLOTHES DRYERS: I
/GAS/ / / FURN )='1001( 0 UNIT HEATERS—: 0 HOODS......... : I OTi.IFF UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: @ WOODSTOVES.... 0 GAS OUTLETS....- I
---------------------------------------------------------------- ELECTRICAL ------------------------------------------------------------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1000 SF OR LESS: 1 0 - 200 ago..: 0 0 - 200 am.: 0 W/SVC OR FDR..: 0 PUW/IRRIGATION: 0 PER INSPECTION: @
EA ADVIL 500SF.: 2 201 - 400 amo..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER. HOUR......: 0
LIMITED ENERGY., 0 401 - 600 asp..: 0 401 -- 600 amo..- 0 FA ADDL BR CIF: 0 SIGNAL/PANEL...: 0 IN PLANT......:
MANE HM/SVC/FDR: 0 601 - 1000 air.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
ION+ amp/volt.: 0 ------------------------------------ PLAN REVIEW SECTION --------------------------------
Reconnect
------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=2L'S A.: 600 V NOMINAL: CtS AREA/SPC OCC:
---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ---------------------------
A. V RESIDENTIAL---------------------------- B. COMMERCIAL------------------------------------------------------------------------------
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM--: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: DTH: y BOILER.......... HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER— : CLOCK..........: INSTRUMENTATION: MEDICAL.......... OTHR:
HVAC..........: DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS: 0
Owner: -----------------------------------Contractor: ---------------------•-------- TOTAL FEES:i 3734.37
JAY MILLER JAY MILLER
P 0 BOX 231459 PO BOX 230459
TIGARD OR 97281 TIGARD OR 97281
Phone 4: 684-7543 Phone #: 684-7541
Rea #..: 300109
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Coats and all other
applicable laws. All work wfil be done in accordance with approved olans. This permit will expire if work is not started withir IPP
CL
days of issuance, or if work is suspended for more than 180 days.
RIDUIRED INSPECTIOW, -----------------—--------—----
Footing Insp PLM/Underfloor Framing Inso Gyp Board Insp Electrical Final
ti Foundation Tait Mechanical Insp Low Voltage Rain drain Insp Mechanical Final
Post/Brag Strut. Plumb Too Out Fireplace Inso Water Line Insp Plumb Final
7 Post/spas Mechan Electrical Stryi Gas Line Insp Water Service In Building Final
(_3 Crawl Drain Electrical Rauq� i Insulation Inso ADorlSdwlk Insp Erosion Control
per-in it t ee Ij i qnat t.it-e I-,riAeci By : L__
C.%I I for- 1 n s�)ert ion — 639-.-4175
PERMIT
CITY OF TIGARD DATEIISSUED:. 12/12/199)-0491
COMMUNITY DEVEpLOpPo�1MENT DEP-(Ar�pRTMENT PARCEL: 2S104BD—RM020
SIT—
31(�f�DRESS.d.•Tipud,l G�4:?7 T811�E31N �VI�71
SUBDIVISION. . . . : ROSE MEADOWS 7.OW'NG: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :020
------------------------------------------------------------ --------------------------
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASS OF WORK. . . :NEW DWELL.I NG UNITS. . : 1
TYFIE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYF'E. . . . :BUSWR IMP,ERV SURFACE: 0 sf
Remarks-.- F'ATH I
Owner-: ------------------------------------------------------ FEES
JAY MILLER type amol.tnt by date v^ecpt
P 0 BOX 231459 PRMT 4 2200. 00 B 12/12/95 95-273602
INSF, $ 35. 00 B 12/1.2/95 95--273802
TIGARD OR 97::81
Phone #: 684-7543
Contractor:
CONTRACTOR IUOI' ON Fli_E
1=Bone #: $ 2235. 00 TOTAL
Ren #. . .
------- REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer- Inspection
of the IMified Sewage Agency. The permit expires 180 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 and the g c4 will install a lateral.
I u r-m i t i-
CA11 for inspection - 639--4175
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Residential Quildiing Permit Application
City of Tigard
13125 SW Nall Blvd.
Tigard, OR 97223
(503) 639-4171
JobsiteAddress:
tn� r Office Use Only
Subdivision: l,�•t I-,CCtC�OII-� Lot# �'Zt _
.• ��, � Contact Date 1Z/ 1 I / 1� Initials
Valuation: Result
New Construction Only: (Squ.-.re rootage) Planck/Rec # - �-7
Permit # n 13 9•S-o y32
House: 6 6A A L Garage: _ 45, ' — Reissue of t
MapB� TL# �SIU�-1131 - (�r''Ic' Zy
Corner Lot? Y CN) Flag Lot? Y N Zone
Plat #
Owner:
Approvals Required
Address: .C'I X-
C Planning Setbacks _ Solar ._
S ��' Engineering
Ph,;ne ( •� ) 0�._1S-43 Other
Contractor: ^)a�4 LV &LI IL I _ Items Required
Subcontractors _
Address � I71.L Q_S CLL1C L'`e_. _ Truss Details
Other
' Notes
Phon.%' (_.�_
✓f20"l d�- GQ � <�to
Contractor's License # 75 I'0 02ct Y
( ttach copy of current Oregon license) " C(Aati,r` .ua 605
Contact Name:
Contact Phone: (C,41-�
Subcontractors: TQ ' 12 7//c /Arch itect/Enginccr: I� II �' C 1.t J/1�
Plumbing: f xCIn �h`� � �1G}1�1 Address: PE"
Mechanical:
` (attach copy of current OR C(*tractor's License)
Phone:
JOB DESCRIPTION: MU-)
% . b`7;0
Appl ent Signature t App!icant Phone number i ti
Received by. _ __ Date Received:
Permit Account Description Amount Amt. Pd. Bal. Due �.
Bldg. Permit (BUILD) � •Xv
Plumb. Permit (PLUMB;
Mech. Permit (MECt1) 0• v _ U ,-TJ
Bldg: _25 2V e/5-, 0 �°
Plumb: y
Mech: Z 3
Ed c.
Plan Check (PLANCK) G
Bldg: �30 2 • .5 3'
Plumb: _
Min:
�----
Sewer Connection (SWUSA) � !� ,� 6q)
Sewer Inspection (SWINSP) 3 J, 3
Parks Dev Charge (PKSDC) _�SUy _ U
Residential TIF MF-R) / L1 l q ?v
Mass Transit TIF (T1F-IMIT) _ 12-v
Commercial TIF (TIF-C) _
Industrial TIF (TIF-1)
Institutional TU- (TIF-IS)
Office TIF (TIF-O)
Water Quality (WQUAL) led
Water Quantity (WQUANT)
Fire Life Safety (FLS)
cn
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPL AN) C'7'
Erosion PlancldCOT (EROSN) �
s
TOTALS:
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Ml - Q -
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11
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To: The City of Tigard
As the owner of Lot 22 , permission is herein granted for the 1'6"
overhang on the private ;corns drain easement on the north side of Lot 20
Rose Meadows.
t+
Owner Signature Print Name
STATE OF OREGON, "ORM No.43—ACKNOWLEDGMENT.
Stevens Ness Low Publishing Co. NL
/ 99. Portland,OR 97204 01992
�G
BE IT REMEMBERED, That vn .......day of thls . /�. _
. .......... -. _ ..
before me, the undersi ed, .a Notary Puj)lic in nd`fgr t/Te State of Oregon, personally appeared the within
named.......................�. �.C.C �. ../....... .. /�. ....... J.S ... .................................................................-..
.........................................................................................................................................................................................................
......................................................................................................................................................-----...............................................
known to me to be the identical individual...... described in and who executed the within instrument and
acknowledged to me that........1..2.:�...........................executed the same freely and voluntarily.
IN TESTIMONY WH ERE F,I have hereunto set my hand and affixed
cc: OFFICIAL SEAL m ficial seal the d an
N SUSAN KAYE BOZEMAN y" year last abo ntten.
NOTARY PUBLIC-OREGON
> COMMISSION NO 09847 'c/!LG �-.�.. ... -�C-.�..i. •.'�. .- ._. ..... .. ... LJ
COMMISSION EXPIRES FEB 12,1999
ofary Public! r Bort
My commission expires.........c?.-.� ,;,,1�. ........,--„•••
c�
W
J
To: The City of Tigard
As the owner of Lot 21 , permission is herein granted for the 116"
overhang on the private storm drain easement on the north side of Lot 20
Rose Meadows.
Own Signature// Print Name
STATE OF OREGON, FORM No.27—ACKNOWLEDGMENT.
/ Stevens Ness luw Publishing Co NL
/
CountyOf Portland,OR 97204 6)1992
BE IT REMEMBERED, That on this....GG .....day of �' y-S
.... ...y1f.��...............19........, R
before maw f undersi�,ie , a Nowt rY Public in and for tfje S�at�of Ore$on,/Pers�n Ij a peaj�V the within 1
named...., ..�Z. C..... .s :.f�� y /-C.�.....C/. ./7..LN/!1 ;roL
......................................................................................................................................................................................... .............
..
known to me to be the identiindividual..:-..S
c 1 described in and who executed the within instrument and
a acknowledged to me that- _ . J executed the same freely and voluntarily.
.. ...............
Cr
IN TESTIMONY WHER OF,I have hereunto set my hand and affixed
✓) OFFICIAL.SEAL fficial seal the de and year last written.
SUSAN KAYE BOZEMAN
NOTAFIV PUBLIC .4
COMMISSION NO 03""7 L (�[ 6C.�L
-� My COMMISSION KXPInES FRM 12,Ing i •• •••-••••••--••••
Y COmmission expire. �'
/otary Publ c fo OreBon�
J
JAY MILLER
BUILDER, INC.
P.O. BOX 23291,TIGARD,OR 97223 (503)884-7543
Nov. 29, 1995
To: The City of Tigard
As the owner of Lots 19, 20, 24, and 25 in Rose Meadows, permission
is herein granted for the 1' G" overhang on the private storm drain
easement on the north side of Lot 20 Rose Meadows.
13 A. �-
Own ttxi-e J Print ame
FCMM Ne.24—ACKNOWIFDGMEN1—COIRORAiiON. covrnic Nr ion %T[v1N9 Ncee LAW PUILISN,NO CO.,IOPTLA14=on 91204
STATE OF OREGON,
County of... .�//.. ....... On i e�---this ..day of.. .......>% ... ........... ...........
beforeme appeared..................J. ..... w ................................... ..... .---..........and
both to me personally known,who being
a duly sworn.did say that he/efrr; the said...._. ..... .... .. ../...�1-L.�j .......... _ ........
is the . . . _-. - President.and he/she,the said.................................................. ........//........... ,....... . ....
N is the __. .. ._. ........_ _.Secretary..........................................of - .. ......�. C..�1�sf�.. t ...... ..,
> the within named Corporation, and that the seal, if any, affixe to said instrument is the corporate seal of said
I—
r
Corporation, and that the said instrument was executed on behah of Directors,and........................... .._ ....................................and..` of said Corporation b......----..................................................authority
Boar
of its d
acknowledge said instrument to be the free act and deed of said Corr.-ration.
W IN TESTIMONY WH REOF, I have hereunto set my hand and affixed
_j my offi ia,seal the dayor r last aboitten.
OFFICIAL SEAL. L _ ./..
.... c....... .... .........
...
SUSAN KAYE BOZEMAN mY `
.. :" / of r Pu c fo Oregon..
NOTARY PUBLIC-OREGON -miss � ••
COMMISSION NO 0.,19647 s . �. r .................
MY COMMISSION EXPIRES FEB 12,1999
I�'15}y5,0�l3L
To: The City of Tigard
As the owner of Lot 23 , permission is herein granted for the 1'6"
overhang on the private storm drain. easement on the north side of Lot 20
Rose Meadows.
Ow r Sigena4ure Print Dlame
DATED thisa
IDpday of, L)jyLMgE& , 1995
Notary Public For Oregon
My Commission Expires 05-14-99
OFFICIAL SEAL
JW SCAPPLE
NOTARY PUBU"REGON
COMMISSI('%Iq NO.
MAY64
Wcommew
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. C1TY CSF TIGARD F'LECTR.TCAI.- PERMIT —
COMMUNITY DEVELOPMENT DEPARTMENT RESTRICTED ENERGYPERMIT #: EL-R95-024913125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639-4171
DATE ISSUED:
PARCEL: 2S 104BD—RMrl20
51TE ADDRESS. . . : 12643 SW 1. 8TH AVE
SUBDIVISION. . . . : ROSE: MEADOWS ZONING: R-7
BL-OCR. . . . . . . . . . . I_O'i . . . . . . . . . . . . . *020
F'r-ci jer_t Description:
A. RESIDENTIAL--- ._..-...__
AUDIO & STEREO. . . : X AUDIO 9. STEREII. . INTERCOM f. PArTNC;. . :
BURGLAR AL.APM. . . . : X BOIL_ER. . . . . . . . . . LANDSCAPE/ IRRIGAT. . :
GARAGE OPENER. . . . :X CLOCK. . . . . . . . . . .. MFDI CAL. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . : X DATA/TELL: COMM. . . N1 IRSF CAL.LS. . . . . . . . ..
VACUUM SYSTEM. . . . : X FIRE ALARM. . . . . . OUTDOOR LANDSC LITE:
OTHER: : : HVAC;. . . . . . . . . . . PRC7TrCTivE SIGNAL.. .
I NSTRUME:N rAT I ON. : OTHER. . : . .
TOTAL_ # OF SYSTEMS. 171
Applicant :
ROBERT HOLT TAUS type amo�_int by date t-ec,pt
:.615 SW CANYON LN #2 PRMT $ 40. 00 B 12:/29/95 9':,— '744,i,.
5PCT $ 2. 00 B 12/29/95 95-274443
PORTLAND OR 9'722`;
L'hone #: 297--2474
Cont Tact or-:
OWNER k 40 . 00 TnTAI..
-- -----
REQUIRED INSPECTIONS
Ceilinq Cover Flert' 7 See-vice
Plhone #: Wall Coven Elect' 1 f=inal
Rey 0. . : (AV.10 X00 Z,
This oertit is issued subiect to the regulations contained in the `t
Tioard Municipal Code. State r.,f Ore. Scecialty Codes and all other Perm i t e+e Si[_matt ure
acolicable laws. All work will be done in accordance with
acoroved plans. This nernit will eymoe if work is not started M A
within 180 days of issuance, or if work is suspended fol' tore
than 180 days. Iss1_ied By
INSTALLAT ON
The installation is being made on prop r I own which is not intended for
s%A1e, l ease. or rens;t
OWNf=Vit' S SIGNATURE: `�L.�ti�_�L DATE: f Z—2 _g
.. _.__—___-----------------•-CONTRACTOR INSTALL-ATION nNl_Y—-----------------------------_.
LL
F..
r LS I GNATURE OF EUPR. ELErC' N: DATE:
f-
J '-I CEM SE NO:
w
Gall for inspection — 639--4175
J
COMMUnity Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. �� Q
Tigard,OR 97223 PERMIT it
Phone(503)639-4171
FAX(503) 684-7297 DATF ISSUED__ Z�
TDD No. (503)684-2772 p f� '
CITY OF TIGARD Inspection (503) 639-4175 ISSUED BY (VU_A•'� 4&V 4--'
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION
4. TYPE OF WORK
Address RESIDENTIAL—Restricted Energy Fee . . . . . . . . . $40.00
�t (! l l �- (FOR ALL SYSTEMS)
City State Zip Check Type of Work Involved:
PERMITS ARE NON-TPJ NSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. Burglar Alarm
2. CONTRACTOR APPLICATION ® Garage Door Opener'
Heating,Ventilation and Air Conditioning System'
Vacuum Systems'
❑ Olt er
Addret�s - -
Date COMMERCIAL—Fee for each system . . . . . . . . $40.00
(51`E ()AR ":is-260-260)
Property Owner _
- C!esk Type of Work Involved;
Contractor's Board Reg.No. ❑ Audio and Stereo Systems
❑ Boiler Controls
Phone# - -- ._` _- ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
f/ )
El Fire Alarm Installation
0�Ly-4A 14a ! �._ �� )-q - 7V- ❑ HVAC
Print Owner's Nat nle- hone No ❑ Instrumentation
Ad ess Y '� -- ElA 61 Intercom and Paging Systems
❑ Landscape Irrigation Control'
City State Zip ❑ Medical
This permit Is issued under OAR 918-320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy installations 1100 volt amps or lessl under this permit and to do the ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required.(Certain ❑ Protective Signaling
residential and other transactions are exempt from licensing.These have ❑ Other
asterisks(*).All others need licensing).
0_ 2. Call for an inspection when all of the installations under this permit are ready
for Inspection at 503-639.4175. 13 Numher of Systems
►� 1 Purchase separate permits for all installations that are not ready for inspection
v,hen the inspector Is out to Inspect under this permit.
•No licensrs are required. licenses are required for all other installations.
F_. 4 Assume responsibility for assuring that all corrections required by the inspector
are done,and
S. Assume resp>,msibility for calling for a final Inspection when all of the 5. FEES
corrections are completed.
I Ire person signing fnr this permit must be the applicant or a person a. Enter Fees $ V•Viq
authorized to hind the applicant. 7
h. 90 Surcharge (.05 x total above) $ UV
5i)~ ,!tore L
TOTAL $ 4 2 00
Authority if other tHr,applicant
ENERGAP.CHP