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CITY OF TIGARDOCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT DATE I T`SUED: 3 9/99.,- ¢�f+i
1)FTTE I.:,,aUE'I): Q�:s/��i94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171
PARCEL. 2S 1 04CA• 1119200
ITL. ADURE"'iS. . . 13:385 5W 136TH WL.
3USDIVISION. . . . . HIL.LSHIRE ZONING:P_7 PD
BLOCK. . L.OI . . . . . . . . . . . . 909P
t 1JASS OF WORK. :NEW
TYPE OF USE. . . :SF
OCCUPANCY GRP. :R3
►CC'UNANCY LOAD:,=:c:.l
L:.NANT NAME. . . :
PATH I
l_"HARISMA CONSTRU 1 1 t..,.4 INC
i-' 0 BOX 91550
VURTL.ANU OR 972r)10550
_0550
Phone #: 690-•2971
Contractors __ _...__.. . ._..._..._...___...._._.___..._.__._. ._.
RONALD ENGESF 14F.R, JR.
E3885 SW CANYON RC01)
0ORTL.AND OR 972e5
Phone #: 503297--810131
Rc.,q #. . e 56537
Occupancy of the above referenced building is hereby given, and certifies
thv coacp) i.ance with the State Of Oregon Gpc•cialty Codes for the IIr'ot.tp,
uccupa+ncy, artd use under which the rpferenced permit was; issued.
F- I RE r)E PARIMEhiT l.. "Nr N1--f-)1EE:CTC)R
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POST IN CONSPICUOUS PLACE.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: 1`,Q, `
Footing Plbg. Underslab Hech. Rough-in APPr/8dw1k
Found. i'lbq. Top Out Gas Line FIlIALt
Poet/Beam S:ruct. San. Sewer Framing
Past/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lino Gyp. Bd.
Date Requested:_
-A ` \ TL"s `�.AN� PH
Address: O C� t �9Permit 1e�
Bui.l.dera_CAAT/-'f l
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TBE FOLi.01fING CORRECTIONS ARE AEQUIRSU: lock z e; "?
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Inspector: v �--�r �� Dates >
APFROVtD DISAPPROVED APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
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LNSPEcPION NOTICE
City of Tigard Buildiag Department
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspectio Lino (Rec-O-Fhone): 639-4175 Business Phone: 539-4171
Inspections_ Y -�� \ f'� A y . .^.✓��� --
rooting Plbq. Underelab h. Rough-i '� Appr/Sdw1k
Pound. Plbq. 'fop Out Gas Lint rINALt
Pont/Beam Struct. San. Sewer r n]E5/I -Bldj.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Roqueetedt ' — 4 `4. Time) AM PM
Addraee:
Builder: \Z�—,/� -\.` t _ Cjbv:`J'N"Z%I
THE FOILOWING CORRECTIONS ARE REQUIREDt
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Insp.atore Datst
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----"PROVED D1/ISAPPROVED PPROVED SUBJECT TO ABOVE
\'C�Lt., call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Orogon 97223
Inspection Line (Rec-O-Phone)- 639.4175 Business Phone; 639-4171
Inspections
:'noting Plbg. Underslab Mech. Rough-in Appr/gdwlk
Found. Plbg. Top Out Can LinePI(
Post/Beam Struct. San. Sewer Framing -81dg.,1�-
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. ( -Meeh' J
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Date Requeeteds�/ 75 _ I Times /� 1W 1a"r�./ P14
Address: ��3 D� �' -�(J� }( Perwit i ��jT e122 ��(o
Bui.ldors
THE FOLLOWING CORRECTIONS ARV REQUIRED-
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Inspectors Dates.
APPRO"O _ 1Z/ISAPP/ROVED APPROVED SUBJR(T TO ABOVE
� /_ a � _� Ca11 For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 M Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 634-4175 ueinees Phone: 639-4171
Inspection:____ -------
Footing Plbg. Underslab ech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gan Line FINAI.t)
Pogt/Beam Struct. San. Sewer. Framing
Post/Beam Mech. Rain Drain Insulation -Plusub.
Plbg. Underfloor Water Line (� Gyp. Bd. -Meohl r
Date Requested- /7 �^ 1 Timet AM _,_PM
Address:___L_ ,� I�IL /Permit #t `� QV3
Builder: L�' LO - ZSG
THE FOLLOWING CORRECTIONS ARE REQUIREDs
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Inspectors `,- �- L. ��_ Dates
`__APPROVED 1/ DISAPPROVED APPROVED SU&MCT TO ABOVE
For Reinap.
NSPECTION NOTICF. \N
Cit? of Tigard Building Department C
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out fins Line FINAL-
Post/Beam Struat. San. Sewer Framing -Bldg. '
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Lida �j Gyp. Rd. -Mach.
Date Requesteds 1� ^A 1 Timej PM
Address: 3 ��J`+. Permit #i� j O
Builder:
THE FOMOWING CORRECTIONS ARE REQUIREDs
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Inspectors - `- _,4-Y r
APPROVRD —Ae-1618APPROVIM APPROVED BUwxCT TO Ago"
1 ` Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd_ Tigard, Or®yos 97223
Inspection Line (Rec-O-Phone): 639-4175 Businenn Phone: 639-4171
Inspection:__ _
Footing Plbg. Underalab Mach. RougL-in AppC/8dw1k
Found. Plbg. Top Out Gas Line ��lI1fALi
Poet/Ream Struct. San. Sewer Framing -$1//.d4'��)
Post/Beam Mech. Rain Drain Insulation -plu
Plbg. Underfloor Water LLLine C� Gyp. Bd. -Koch.
Data Requested: J K1 I _^ Time: AM PH
Address: J� Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:_ ./� nate! �— y
APPRMD DISAPPROVED APPROVED SUBJECT TD ABOVE
`/Call For Rainnp.
NI SPED ION NOTICE
City or Tigard Building Department __-
13125 aw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phono: 639-4171
Inspection:_
Footing Plbg. Underslab Mech Rough-in Appr/Bdwlk
Found. Plbg. Top Out Gas Line �/IR11L
Post/Beam Struct. San. Sewer Framing -Bldg. l
Poet/Ream Mech. Rain Drain Insulation -Plumb./
Plbg. Underfloor Water Line Gyp. Rd.
Date Requested: J dr _Timer PM
Address: 1 ✓W Permit is
Builders (��4 U- ZS ZS"
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector / w _ Dstot__
APPROVED DTSAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
i
j(rtPECTION NOTICE
City or Tlysrd Building Department
13125 SO HAii Blvd. Tigard, Oregon 9:223
Inspection Line, (Rec-o-Phone): 639.4175 Business Phone: 639-4171
Inepecti.ont_
Footing Plbg. Underelab - h. Rough-id Appr/Sdwlk
Found. Plbg. Top Out Gas Lino FINAL:
i
Post/Beam Struct. San. sewer -Bldg.
Post/Beam Mach. Rain Drain tr.;1` t1,n : -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: `2� /Z 1 '-�� Tiolaf L� AM PN
Addreas: 1�7)D ���� Permit f 7,5L�O ` H
9uildert
TRE POLLCAIING CORRECTIONS ARE REQUIRM
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Inspector DatoI 1 I
__APPROVED "Is"PRROM APPROVED SUBJECT TO ABOVE
V! C.(� ✓ Call /or Mimp.
INSPECTION NOTICE
city or Tigard Building Department -
13225 BA Bell Blvd. Tigard, Oregon 97223
inspection Line (Roc-O-Phone)s 639-4175 Business Phones 639- 4171
inspections ��-� - `- -!__L
Footing Plug. Underslab Meoh. Rough-in Appr/sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Past/Bowe attuct. San. Sewer aminq� -Bldg.
Post/Beam Mech. Rein Drain <:!ns
ulatio� -Plumb.
L_
Plbg. Underfloor Nater Line
C_ Gyp. Rd. -Meeh.
Da2 L
Ditto Requestods ✓ , _ -1 a L� Time; AM _1 _PM
Address s J ��o -7�j�'�- rs C�4
c6�
Permit fs _�
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED: i L -
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Inspector: . �k- 1 Date: 2- y --
__APPROVED _DISAPPROVED APPROVED SUBJECT -0 ABOV=
call For Reinsp.
INSPBCTION
Citi of Tigard Build, 9 Depertaent
13125 811 Bwll Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4174 Business Phone: G39-4171
Inspecti,.nt
�iootinq_ Plbg. Underelab Mech. Rough-in Appr/Sdwlk
pound. Plbg. Top Out Gas Lane FINALS
Post/Beam Stract. San. Sewer Framing --Bldg.
Post/"am Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
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Date Reques
stted: O�� 7 v ` Time: AN
Address: //[;;11 � ,,��',yG� � \ `� Permit is1gt/JT q71
,THE
Builders l_N�`�-4 -A` I eC 1/Y��/L� G10 a -2--I 1
I THEE��FOLLOWING CORRECTIONS ARIP REQUITRED:
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Inspector:_ Date+
--_^APPROVtD DISAPPROVED 1 APPROVED SUBJECT To ABOV=
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Departmient
13125 6W Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4111
Inspections_
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Tap Cu!> Gas Line FINAL:
poet/Beam Struct. San. Bawer Framing -Bldg.
post/Beam Hach_ Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line z Gyp. ed. -Hoch.
Date Requesteds Time: AM p1I
Address I ( -J US- Permit
Bulldwci _ C
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Jnepoctor:� i Datet
APPROVED DISAPPROVED _APPROVED SUBJECT TO AROVE
�J Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 811 hall Blvd. Tiqu-d, Oregon 97223 _ _ --
Inspection Line (Rec-o-Phone)s 639-4175 Business Phoro-': 639-4171
Inspections-_ ► \ > 7�P c ,�-- j1 `
Footing Plbg. Underelab �Aech. Rough-ini X Appr/Sdalk
Found. Plbg. Top Out Gas Line �( FLNAL:
Poet/Beam Struct. San. Sewer �iemin X, -Bldg.
Poet/Ream Hoc' . Rain Draininsulation
Plbg. Underfloor Nater Line Gyp. Bd. --Koch.
Date Requeeteds ( V `� Time: `+_�AM PN
c' ? Permit
Addreua 21 1 _� -� h ...� � .]b �` �
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors / �-"`� Date: 36
APPROVED vo, DISAPPROVED APPROVED SUBJECT To ABOVR
7 \ L/ Call For Reinep.
CITY OF TIGARD ►.�r�s1r I s. . . . . . . : M,,)7.,
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PARCEL.c ; : 104CA 17,9;
?DIM. . . • FI:,:t..1 al 1'I ?F'. . .. 7'.01!.(14(.". c:r....7 Lfr,
{.•... „ r �' 1.._iJ 1 a . . ., .. . . . 01)2'
.,�, IrtiJ{Z�'•.. r :14E..-. ` 1/r'14:�t�W1J(�« E�(I�r.�.)1 'tJ:�ri'.��. }ry� ^^�� ``'' �ry -1 Pel 1 y�^� �
Wi-l"�ING f ALI'l. Y . Y Y Y r i 1 LJ�YCKE"LOW I•'{lEVN 1 RS. M -.0
OR;:. Y : r FLUOR DRAINS
il3tiai .. . . . . . . . : WI IER HE:ATElRS. . . . . . : 1 f"ATC1 L�(1:nI{VJ. . . _ . . . .�J
L.141JI DRY :17 I fif'•i j R' DRAIN ;. .
f�INWk . . . . . . . . . , . 1 C.REAbE 1"1`(AL. 11�. . . . . . . ;ky
1, _ . (3?";-IE R F"I XTbIa 17G. . . . . .0,
SE=WL11 LINE (ft) . . . . :;(.l
fl'11:tZ L.if\:I:::. i=t ) . . . . : 1I',0
IN 1)RAIN ;f't;) . Y . . :0
:E14 E71;• M!� Ui4 r• I_'t: uN I1;.: '1`TC" $ 1520[t. 00 ,JH I!Zi/04/9Zi
F•' ' :13174 91;� � )_iF,F *r s 478. 00 JH, 10/1114/93
t t:o,iy,K ir. F 91e'-i97a li( 6 r Li1Z1. 87111+ Jhi 10/04/ 3L;
t.� t r, ,. .. _.. MPRT 'r• 71`:1. 010 J11 10Q.,4..`�).
MIA' $ 11. L5 JH 10/04/96
M': 1='C: s 42 0 4/9
a J!•i 1 k:r,
2500 BASELINE/ PO BOX 487 PPPT U 151. 00 J14 10/04/93
CORNELIUS, _ OR Fy�a1'C s 7. 711 JI 1.4`'7"1��14/`i:
97113 T10T 640-2525
1 3 5 6 51 -._.__. 3 4-2 0 7PE,
;,'-.0 UlI °U' af%C.CT 10 NEI
i i r t to i. -..i e ci the r e g
1 + errs' z:ort ,�zlnvd in the Ti;jzrd Mt_(nicipal Frsotifa+.ind in p Raindrr;in Ittst�
t„ade, ;2tzt, . ,,f Ovc. r::rt:z. Tt: Carl vnc; �t1, l Pt)"tiBc_+ m �i't.• uct Wattet' Line Iii 1)
All Wov'k W-111 be done Gast/Beam Mechan ApPn../Sciw1k lnsp
i]1:•11 ,1 t t:4-' S'1I��.�"' ul I:�r:}I"C'�w$'�:1 i..,!i'f.t" t•:. '1'i'1 1.'i i-`1 m f 1"1 n d s l r.b int::p • rr1 E.`C F7.?,!1 i 1..::^\I `' T
t e>,iW:`f1 v if wurf', is, not 5tairt ud F''LM/Under�fIuor f lumta Final
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t_1 ty .. _i. .t�. 1Jir ;.� fanal.
WC.—.. w., ,r, tH( �nyt; . Plumb Top Oi.tt L-'rani.ars Ccan# t
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JERRY L. GUNTHER, SR. Gyp Bo `d I n sHt
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CITY OF T! A 1�'tA`~1-F'LFt PE RM �--.
G RD RLQ PN1 z #. . . . . . . w inf"T9.3,
COMMUNITY DEVELOPMENTDEPIARTMENT DATE ISSUED: 112
111125
111125 SW Hall Blvd.Tigard,Oregon 27223.8199 (503)630.4171
A`3 ?F 13Si. . . :3 &'Z S 3biii
!CONING: R-!.7 1'='1)
BIL_DING •_._._.._._...._ _ _ .___..._..______ ._..__...____� _.._..._
.,: .I 3sl'f-::: l)W(.'."_L_1 N'G UN I TSi: 1 DAWLMENT. . . . . . . . :0 sf
—CiSS Cti WOl�R:. :NEW DEDRM5:4 Eir)T'hiS 3 GARAGE. . . . . . . . . . .484 s',f
FLOOR ARP.I)S _..:...._._._._... REUlJ I RE'D X31:TDACKS _..,.._.._.,
-'E: OF C'UNST. : N FIRST. » . . : 115 ► sf' LEFT. . :5 f'L RIGHT. : 10 •Ft
lJI"'fi)1,l{ `• fiprl. :R3 SECOND. : 1;: lw sf T-PONT. rL20 fit 3EARZ. . :72' ft
FiI' .5. . . . . „ . THIRD. . . . :0 sf
y1IT. . . . . . . . ::'i ft TOIF)L .._....._..__.,._:i iE+:. sf
4000 L.OAD. . . , :4k` psf V(aLUE. . . . . �: 1171410 PARKING GPPF ES. . : '
... ._...._...._.__.._.......,w...,_._........_........_._....__..�_.....,.._._....._..-._.._ PLUMBING __.,.. . ._....
SI1 41<S. `. . . . . . . : 1 FLOOR L)RAINU. . . . r O DAL;1'N -_LUW FIRE VN 1 F.1.:3. . :4?
LAVATORIES. . . . . :" WOTER HEATERS. . . : 1 TRAPS. , . . . . . . . . . . .��
_F U1.3,'i)HLjw1Z.Rs. . . . : L_t,UNDRY TRPYS. . . :0 CAI(,F I Drah 1 N5. . . . . . . :4n
6IC, ''ER CL DSCTJ. . :3 SEWER LING (ft ) . :0 GRE:ASC I RAFTS. . . . . . . :0
1.I SHWAGi if~42. . . . . 1 W(I T*E R LINE �(f t ) . : 100 O TRIER F"I X TURES. . . . . .0
(----ngB(4GE !)ISP. . . : 1 RPIN DRAIN (ft ) . :0
MECHANIWAL _... ..._. FEES
L' TYPE1 .; l.;411.. HTP5. . :0 type: amoulit b 'JatP r V,
VENTS . . . . . :0 TIF >i 15210. 00 11.1 10/04/9
iX II'SPI:! :0 VTU V):I'�lT' F7PNa. ,. ;:/+ BP1?T ^ 478. 01ILI J1-1 10/x'14r''.)3
RN { I00 . . ..0 }IUGlFJIj. . . . . . - 1 SPLC 310. 70 .1L H 08/25/93, 9u -'4,i!EGI
J1 I 10/0 4 9
i.i., . . . c 0 Cl._O DRYERS. : i SsDG $ 280. 0a, .JH 10 04/93,
0Y!IEIi LJNITr; I 1-In iR f 15210. 0e. j1.1 t0,'04/'?3
G"IR OUTL..l'•_'-r::i: 1 Mf PIT 10 45. 00 .TI-i 10/04/93 ....
AFt ' CC1hlSTkUL'l'ICSIV IN(, M ;PC: E. E r J
rJ 0 c.IPP'T a, I x°3. 00 .JH 1.14/04/93
F15F'C $ -7. 7'5 JH 10/04/93
({t7i'.rf �uE?'�: i+IC31 S�iwTllfiPi� .JR.
f_1433'2i SW l.i1TJY0N 14101-)1)
honer: #: 503...p-97--Ala:?,t
LI) t 33,33- G (]1"AL.
> I i sS u%C s urJer_t to the rec tationr contained it the .. ._•.____. ►3&CSU I F2L'n INSPECTIONS
,,„o .isnios«a: i:ode, Itate of (ire. Specialty Codes and all other Foot/fol_nci Fnssp Fireplace Irisp
11�dbFt ea07, rc-P p411 be rchE ith app••oved Feast/Ream Stl—uc t Gas L_inc� Insp
I4-lr lh1 s persit a:i: exGire :f work 01, star w• 168 Post/1 eckm Me!ctian Insulaxtiorl Insp
w ys Of'f9stia^_E, t work is luspelld u for e h days. F'lmlur.dsl b !nap C3yF� i naat,d fnsF,
PLM'LJnderflcjor� Rain df•_ in n r p
M p r 'I e Sl i(::.A 1. 111 s p gni a t e}' L-1.1)0 111 5 p
Iumb Tat .l U u t �)x,Fa►"/SbwlK Trt,p
r ram i.11[1 1 s Mt�k,h %r,ic,71 Vir&I
.-ix 1 f;:,l zrl ap�ct xon - b3`1-- 4 17�
r
P E R 111 T'
CITY OF TIGARD PERM1,11 #. . . . . . . SWR9
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 1-0/04/93
I3125 SW Hall Blvd.Tigard,Orogon 97223*8199 (503)639-4171 PPUCEL- sic I04CA-0929-10
0 D W:.'JS, 13 3 a 5 33 W I
ZONINGi R-? F-1 D
. . . . . .. . . LOT. . . . . . . . . . . . . .*01' "
fm"NANT
LISA 140. . . . . . . . . . FIXTURE UNITS. . .
OF WOR!". NEW DWEL.L I NG UN I TS.
TYPE OF: U9E. :SF NO. OF BUILDINGS: I
1 NISTALL T YP#E.
FEEG
CONCT17UC"lJ, J Ajw type amount by date ),C-Cpl-
BOY 915,50
V--'RMT 2200. 00 JH 10/04/9
I NISP $ J14 10/04/53
LAN -) rr 'D72".)1 -.0350
690-2971
"ONTROC-70H NOT 0111 FVJ],'
#;
1 N:;;I L i UN'L)
-,...cart ag-ees to cot'ply wth all the rules and regijW:ins Sewer, 1nspe,.-:;, icm
v UnifJj St-wage Agercy, T,-,e persit expires IN days fro
1c ate ss-.ec. The total atovt paid wil! LE fo:�fe;tE, ,,, the
;trt;r expires. :he lwgervy Gm not guarantee the acc.:racy of the
1,ide il Nor iaterak. If the sewer it not located it the avasurivent
given kh+ ifistalle-r shall prvspect .1 fee! 1, '"irrctlons frog
thi dWaloo giver, T, r3t so locate i!i purchase
ift? Seger" Pervit a"g'tivt Ag ftral.
31
Ca I I f o ir.r,pect i wi zi f 7f`j
L51�
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i"
CITY13175 SW1131113ML PLNCK/RECT #OF TIGARD PERMIT # m3r'15 '42
COMMEINMDENEE.OE'MENTDEE'ARTMENT liprQOrcgon9n23
(503)639-+171 DATE ISSUED
JOB ADDRESS: I S __. S-L-J t3�i� -- we,I-<- TAX MAP/LOT _
SUB: -4UlsLOT: — X91 LAND USE:
VALUATION: qiqno�ro
OWNER SPECIAL NOTES
NAME: (�C-a��s - oNq to REISSUE OF: -_
ADDRESS: _9 15*So _ _ LAST REISSUE:
ot4.(c,h�7 ,,, 5-2,Z9j_ _ FLOOD PLAIN/
PHONE: e503) GNU- "7,2-L_—_ SENSITIVE LAND:
F;%-be Ai hyo- Y(.yy
CONTRACTOR APPROVALS REQUIRED
NAME: _--- _ 5r�«_j_C_ I_ &46dwy �- _ — PLANNING: --
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: ( -0 3 4.1A 7 / _ OThER:
CONTR. BOARD #: S/_ 53-7 �G�' EXP LSz1Z�
9,�.?5
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ �� lls Lo� �/�.,{;h _ LIST/SUBCONTRACTORS:
MECO; . 1 BUS TAX: —
ARCH ENGINEER \' CALCULATIONS:
NAME: //1, yrttis��_J 1�s��«, ,��cs�• _ TRUSS DETAILS: .----_-._-- _—
ADDRESS: _ /S/S 6) �� ,¢,,�, — OTHER:
Q.c 6.h 9Z,�/0 — --
CL
PHONE: � —_T_��
l
PROPOSED BLDG. USE: --
COMMENIS:
w
AP L C T SIGNATUR l
Received By: —---- — ----__ _ Date Received: �12 5— �7�--
PERMI' # ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
/77)t 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 1 �'
Mechanical
10-433 00 Plans ChecR .cc ��� y'` / `'2'S0
Building 3/0, /U /
Plumbing
i
Mechanical
10-230 OG Fire
30402 00 Sewer Connection _,:2.2 LJ
30-444 00 Sewer Inspection _. jf 7
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees _
25-448-06 Institutional TIF Fees _
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees 14/y
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC) 'L) __,� Ste✓
31-450 00 Storm Drainage Syst Oev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
i-i
24-445-02 Water Quantity (Fee in lieu of)
r
c TOTAL
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