12832 SW 132ND COURT t o �
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CITY OF TIFA RD I i4\ CFRTIFICATF OF
'\\��TWARD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT . . . . . . . . M 1-33 T 9 0 -0J,
13125 SW Hall Blvd, P.O.9w 23397,rood,Orogw 97223 jSWJ 6094175
SITE ArjDRES�", 11*21A7,a SW 132ND AVE PARCEL:
SUBDIVISION. . . . 3 70NINOt R-4. 5
BLOCK. . . . . . . . . . c LOT. . . . . . . . . . . . .
CLASS OF WORK. rNEW
TYIJ(-. OF UC F. . . t
OCCUPANCY t'37RP. c R3
0CC(.lr--'ANCY LOAD: 1 16 4
l'ENAN'T NAML.
RACHFL & WILLIAM BASK IN
1001*30 SW WALN(il
TIGARD OR 97; :23
Ph011e #-
C"ontractore
BET'TER P!JIL'T HOW'S
1488, NE rilli-E IW
HILLSBORO OR 97123
Fah uriL, #: 640-1913
O(:ckAP^nvY Of thV mbovP refer-procud bail-dirIg is tlf�t--eby given, and certifies
the compllanoe with ttie State Of Oregon Specialty Co(JE3. % for- thq gr,oj_jp,
OCLUP^TtCY, and use under which the referenced periit we-is
T i R E- DE 1=lA--
I LD INC INISPiTCTOR
POST IN CONSPICUOUS PLACE;
4
INSPECTION
City of Tlgi"'d Building Deimartment j
13125 OR gall. Blvd. Tigard, Oregon 97223
Inspection Line (Ree-o-Phone): 639-4175 Business Phone: 639 171
'Inspection._
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line 11NAL:
Fort/Beam Stn:ct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain !nsulation -rlumb.
Plbg. Underfloor Water Lina Gyp. Bd. -Meeh.
Date Requested: �` Time. 1-1--t-AN PM
Address: _——
Builder: ., (�(
�Ul ( \ -►r" (�/]� ( Vl/\
THE FOLLOWING (Y`RRSCAE.^IONS AREQUTABDi�
r' S
-- --
Wv
i
Inspectors ��`_— ---- L� Data:
APPROVED `-_ DI4AYPROVED AppROV[D SUBJECTTO ABOVE
—__Call For Relnop.
IN"PECTION NOTICE �,.
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 972L3
Inspsct.ion Line (Rec-O-Phrne): 639-4175 Business Phon 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulat on ( -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mecn.
n _
Date Requested: ��� ] _Time: /1 MM _ / PM
Address /vi 11 ���� ��4 n �✓ Permit fs
Builder•- Lti--/ �� _
THS !*OLL.OWING CORRECTIONS ARE REQUIRED:
Inepectors_ — - Dater
APPROVED DISAPPROVED APPROVED Sl1RJ6cT To ARM
_ Call For Reinnp.
JNSPSCTION NOP,ILE
City of Tigard rhoildixg Depart-meni
13125 BW Hail Blvd. Tigard, Oregoa 97223
Inspection Line (Rec-O-Phone 639-4175 Business Phone: 639-4171
Inspections —
Footing Plbg. U der;elab Mach. Rough-in / AppriSdwlk
Found. Plbg. Top Out Gas Lino l FINAL:
Poat/Beam Struct San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor water
Line/ Gyp. Bd. -Mach.
Date Requested: v_ ��—L/ � ! / Times f�_AM _ PPH
Address. � s7i �� f �j� n Ct Permit
Builder:
THE FOLU)WING CORRECTIONS ARE REQUIRM
Inapatrtor: � �1_ ''FC; W Date: L I --
1 1C,.AFPROVID DJSAPPROVSD - APPR('VRD SUBJECT TO Aw"
`^�� _Call For Relnep.
If+/ ■� Aw R 1! t t � !�
LNSPECfIMI.NoTfICE
City of Tigard Building Department
13125 SH Ball Bl,d. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bu&ineoe Phone: 639-4171
Inepecticn:
Footing Plbg. Underelab Mech. Rouqh-in Appr/Sdwlk
Found. Plbg. Top out Gas Line FINAL:
Post/beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain insulation .Plumb,
Plbg. Underfloor Nater Line Gyp. Bd. -Nech.
Date Requested:_ q1 _Time: AN PH
Addresel
Builders THE FOLLOWING CORRECTIONS ARE REQUIRED:
C.•L �i_l_�-.i.�--v�- ..7f" tet`f�,�_� �`�_ —_
t
i
1 -
In<tpeotore_ Dates
APPNOVtD _ _ DIBAPPRGVFD APPROVED SUBJECT To ABOVE
✓Call For Reinsp.
INSPECT?ON NOTICE ��` n
city of Tigard Building DepaemerAt.
13125 Be Ball Pani_ Tigard, Oregon 97223
Inspection Line (Rec Phons):,. 639-4175 Businene Phone: 639-4171
Inspections
Footing q. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Post/Beau Struct. San. Sewer Framing -Bldg.
Post/Beam Koch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Oyp. Bd. -Nech.
Date Requsetede _ / -CI / Time: AM PN
Addromos L-* 32- Z 32 11 LitPe it 1 t >c Ua
Builder i � �L�/ Lz-L-�//� )cis 7
THE FOLLOVINO CORRECTIONS ARE REQUIRM
r
L•pectora-_ � � � Date:_ J' ' r� � `!
APPROVED DISAPPROVED APPROVED RUBJECP To ABOVE
Call For Reinmp.
s
i-•
APPLICATION - STREET IMPROVEMENVEXCAVATION �� IiYY TO:
ORDINANCE NO. 74-14 `�� "( / : (WH' - FILE
(YE -OW) •INSP.
(INSTRUCTIONS 011 SEPARATE SHEET) (PINK)-OTHER AGF' :Y�A
(BLUE)-APPLICANT
APPROVED APPLICATION NO,:44 ��
NOT APPROVED p CITY OF TIGARD, OREGON FEC AMT. S 7.00 _
PENDING FEE. PMT. ❑ CI I Y HALL RECEIPTI 9!_ 2Iy)`r;'c
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY -- '' DATE_
PENDING AGENCY ''OK" 0 \pplicarinn and Progress Record
PENDING INFORMATION (J MAINTEN�.NCE BOND �M
FOR STREET IMPROVEMENT/EXCAVATION
AS REQUIRED ➢l
ANNUAL
PENDING VARIANCE ❑ E'<PIRATION DATE: yOne year
PERMIT NO DATE. ISSUED BY ,
I<
(1 ) APPLICATION IS HEREBY fv,ADE TO EXCAVATE FOR AND INSTALL _ DRIVEWAY APPROACH
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY RECUIREMENTS.
APPLICANT eettQr Built Hemi:3 1488 N. St.ie Dr, Millsboro, OR 97124 # 644-1913
—NAME ADD:19;9 —._ _--� ---CITY ---...PHONE
CONTRACTOR----(-MME)(-SAMA_ _ _ day # 781-7631
NAMES ADOR 55 CITU PHON[
PLANS BY Per atta.:had_City/County :3trndaro DetNil _
MAIN! ODA[ CITY rH0'14
ESTIMATED IMPROVEMENT TOTAL VALVA f ION ( COST): $ _ $ 175.00_
DOLLARS
(2) EXCAVATION DATA: FOR OFF,CE USE, MIN
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAMC SURFACE CU'E CUT CUT MATERIAL INSTALLED
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY ITEM DATE REMARKS/TYPE BY
132rmi Avenue (S" At LaChed) STREET
OPENED
INSPEC- —
R TION
U
ESTIMATED STREET OPENING DATE: �_ / E
5
ESTIMATED STREET CLOSING DATE. / / T
(3) SECURITY NO. . 175.40 STREET --
_ SECURITY AMT: E CLOSED
SURETY CO.: ____-__ ---
--- _ FINAL
=EpT1 F!ED CHECK CASH a BOND INSPEC.
(4) PLOT PLAN: INCICATE SITE PERTINENT PH 'SICAL SPF^IAL P tOVIS10NS /CONDITIONS:
FEATURES; EXCAVATION LOCATION AND !KT<NT. 1 . ) Nocify Cite Inspector (1639-4171
1 I I I 24 hrsprior to starting work.
1 I I work area •— 1 $ 2.) All work snail conform to City
1 (12832 SW 132tu3 A e. —
Standar("js 6 specifications.
CURB - ` `. _ _ _ _ _ _ _ _ ._ _ - - -3.) Traffic controls shall be
attached eraillarOVided for by the contractor.
ds � - —
4.1 Excavator must Coldly with
.<�"s l - - - - - _ _ - -• _ _ _ _ - ORS 757.541-.571
1 1 1 1
I I 1 I
(� NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHrRE
RIGHT OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
APPS ICANTS SIGNATUF. DATE
t /1,
INSPECTION NOTICE '�--
City of Tigard Building Department
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk.
Found. Plbq. Top Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Framinq -91dg.
Post/Beam Mech. Rain Drain Insulation --Plumb.
Plbg. Underfloor Water Lino Gyp. Ud. -Mach.
c (` AM Ph i
.../ -�� Timet
Date Requested: __
Address:
• / II �_/ P31-sit
Bu l)alar s
THE FOLLOWIN3 CORRECTIONS ARE REQUIRED:
Inepselocf / 4L 4 —— Dates�� /
APPROVEb DISAPPROVED —� APPROVED SUBJECT TO ABOVIC
--Call For Rainsp.
IIIlow—EWA W_W_1v_LW_M
INSPECTION #OZ1gE
City of Tigard Building Depart..ent
13125 :4d !Lill Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O--Phone)s 639-4175 Business Phone: 639-4171
.nepection:_,_
Foot i.nq Plbg. Underelab Mecl . Rough-in Appy/Sdwl
Found. Plbg. Top Out Qar Li FINAL:
J
Pont./Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. ',(air. Drain Insulation -Plumb.
Plbq. Undarfloor Water Line Gyp. Bd. -Mech.
Date Requeetedc L � 1� Timl. AN PM
Addresa: f�3� Pe7r�miit�#f��� L1c��GI
TBE FOLLOWING OORRr:RTIONS An REQUIRED:
Inrpsctor:
APPROVRD DISAPPROVED �`� AUBQVED SUBJECT TO ABOVE
__Call For Reiasp.
f
:
INSPECT?ON NOTICE �1
City of Tigard Building Department
13125 BN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec•-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection:___ - � -----
r
Footing Mg. Vndterslab Mech. Rough-in Appr/Sdwlk'
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
t
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. U::derfl.00r , Water Line Gyp. Bd. -Mech.
DAte Requested:_ IL�jL(� ��jb (� Time: , _—AM /PM
Address: 1 22125Z� �� L�� I J� a Permit 1: k"),
Builder:__THE FOLLOWING COP.RECTIONS ARE RRQUIRED:
r
I
r
i
InaNttctor:-- Dates !&Z q a
Aq.�PROVZU DI6APPROVtD APPROVRb SUBJECT TO 1►9D1►R
Call For Reinap.
i
INSPECTION NOTICE
city of Tigard Buil14sng Department
13125 SW Sall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Onderslab Mech. Rough-in Appr/Sdwlk
Found. _A(-Plbg. Top Out Gas i ie FINAL:
Fast/Beam Struct. San. Sewer Framing -uldg.
Poet/Ream Mech. Rain Drain Inaulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -./Hoch.
Date Requestedsc �� .�� �� =Ti_me: _ ✓' AH - _j'M
Addresss�s Q 3�� - --- /Permit
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_`�� Date:
APPROVED D.SAPPROVSD _ APPROVRD SUBJECT TO ADOVE
Cell For Reinap.
MIUW_LWUIFKWJ�i�r
INSPECTION_NOTICE
City of Tigard Building Departx..r-et
13125 SW Ball Blvd. Tigard, Oregon 9722b
Inspection '.ine (Rec-O-Phone): 639-4175 Business Phone: 639-417.1
Inspection:
Footing Plbq. Dnderelab Mech. Rough-in Appr/Sdwlk
Found. P1bQ. -op Out Gas Line FINAL:
Poet/Bes,i attuct. -an.-Sewer Framing -Bldg.
Yost/seam Mech. Rain Drain Inrulation -Plumb.
Plbq. Underfloor Nater Line Gyp. Bd. -Mech.
Date Req::esteds < /j ,(li `� ] Time: AM PN
address:___ a � /�P� h Permit fs��^ ).2
/^ C
Bulkier:
THE FOLLOWING CORRECTIONS ARE REQUIREDs
Impactors Date/Z_
/7 �<
ikPPROVRD _>IrsAAPPROVED APPROVED SUBJECT TO ADM
Call For Reinap.
i
I
i
1
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Nall Bled. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4.175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Structs San. Sewer Framing
�"•-_-::_.tea.
Fbst/8680 k4ehr Rain Dcr'n Insulation --Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
Date Requested: /'-[' 4&1 y
T4&14
AM PH
y _ r
Addresa:-_ cJ Z �.� r� Permit #t
i
i
Builder: �i , _ ci ZZ ..
THE FOLLOWING CORRECTIONS ARE USQUIREDt
Inspectors_ � _ nate: /%eW f '
APPNOVlD DISAPPROVED APPROVED SUB,1RCf TO ABOVF
_Cell For Relnsp.
W +
INSPECTION NCEOTI '7 !
f.
City of Tigard Building Mapartec.nt
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-41.75 Businese Phone: 639-4171
Incvectioa: --
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwik
Fouad. Plbg. Top Out Cas Line FINAL:
Post./Beam Struct. Lan. Sewer �' Framing -Bldg.
Post/Beam Moch. ( Rain Drain ) Insulation -Plum' .
Plbg. Underfloor (1lAer W `, Gyp. Bd. -W,ch.
Date Requested: Time: SLI AM PM
Address:�_ Permit 1 t1
Builder:
THE POLL0WIlM CORRECTIONS ARE REQUIRED:
Inspector:J[ .! — —__ —_ Date s
AIPROVFD DISAPPFIOVE11 APPROVED SUBJECT TO ADOVS
Call For Reinep.
INSPECTION NOTICE I 1
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business °none: 6jy-4ill
Inspection:__—
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. P).bg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Dr%i.n Insulation -Pltunb.
Plbg. Underfloor Nater Line Gyp. BP -Hoch.
Date nequeetedt �/^ —�/- �!o — Timet _AMi //_PH
Addreen: �l> h _ Permit rt IiD'QGO
Builder:
THE FOLLOWING '"ORRRECTIONS ARE REQUIRED:
Cd-
Inspector:_ �� Dates/
— --_—
APPROVRD .:ISAPPROVRD APPRONtD SUBJECT TO ABCWE
_--Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223 \
Phone: 639-4175
Type of Inspection t
Date Requested �U f - �G' Time A.M. P.M.
Address .� ?'� ��a _ Permit
Owner __-_ - -- Lot #
' i
The following Building Code deficiencies are required to be corrected:
�' / >✓r /�''77�411EL, div G� �e WA
1 c l lJ�_ A-t — 6 EE
C?A,1C'72,:�.7
Present*d t0 _ __ -Approved
Inspector ____——_ — --- i Disapproved
Date -
CALL FOR REINSPECTION
YES F-1 NO
I
W I'M W W
IWIS VE'R 1,:1 ER ITI I J
C'TYOFTIIFARD WYOF TWARD) ["E-R 113'T It ITI G T 9 0 Or"."
COMMUNITY DEVELOPMENT DEPARTMENT 0111119M DATE I.E)SUED: 10/16/90
131;5 SW Hall Blvd. P.O.Box 23397,Tigard,Oregon 97223 (503)639-4175 C /
n-
,>(j lj D J.VI 1:';1.0 N. . . . . R-4. 5
L 01
BUILDING ..........---
1A,E 1'.'i S U F'. DWELLING UNI TS: 1. D(I S E-11 E'.N T.. . . . . . . .. :,Ell -q f
C"LW3S Or-- WORK. N E W E4 E D R 11 S-3 DATHS.-2 GAROGIE. . . . . . . . . . :480 f
TYIDE7 OF W:iE. .. . GF FLOOR - REAUTRE"D
Tyr-)[:., Or- CONST. »SN FIRST . : 1477 ref LEFI 31 ft NI 6 H T. » 10 ft
0(*(,'(JF-1r)1qCY GRF'.. »R3 SECOND. .040 f t
f F N 0 N 1'. 2 0 ft I--�F-AR..
10 R I Ef
THIRD. . . .. .0
C, ft T(JT(1 L : 1471 S f SHOKE 1)ii. T iz,c'r o Rs,. Y
1: L..C.)0 F< L 0 P)1.). . . o.40 Psf V(4 L U E. 69594 V,A R K I N G E;F)A C,'ES. 0
C?III i.-A r 1.,.S
...............
N K 1;'s. . . . . . . . . . .. 1. F'L(3 0 R 1)R 0 1 N3. . . . ..0 POCKF1 OW V'REVF;TRS. . 0
I R 0 V'S. .. . . . . . . . . . . . . .0
1. 0 V OTC)R I E'.(3). . . . . .. WATER HEATER5. . . - I
I U P/�.:;1-4 C.)W E R E). . . . .2 LOUNDFY TR(-)YS. . . c 1 (.,.oT c ii F3 0c.)I t,l 0
W(I I L: C,L 0 S ET S. . 2 E-31".WER L.I NE (ft) . :0 G R E0 S E TR A[:'S. . . . . . . .0
T, I '31AW)GHERE'). I WOTER LINE (ft) .. : 1,00 c)Tj-ivF! FTX . . . . . ...
11RD0G1::* L RAI 14 DRAIN (ft) - -0
W(4 1.4 1'.NG MACH. .. . : 1 5 F R P)111 1)R A 3:N G.
.................... 11ECHONICIPlL.
I F:L. T y P 1:.S... UNIT HTRS. . :0 tyle i-A 1110 U I I t by date
VLNTS; . . . . .. 0 P A y 11 $ 100. 00 JIJA 07/31/90
1*N F'L)T'0 P TLJ V F.'111 T F 1-1 N'b F.4 V,R T $ 343. 1 0
111:0,1 < :1.001! I•• J. B V,L Cl $ 222. 95
I k ' OK 'T(WES. 0
J1'1%1 -:1.0 W()0 1)G E15VIC $ 1l. 1.
1 0 0 R F U R N.. C*LO DRYERS. :1. STDC $ 600. 00
P01I MF' < 3 H 0 (X1*1A1;::R UNIT'S .-O 3)8 D C, $ 37:i. 00
GAS OWLETS. I PIARK 4- 250. 00
e-r ITIFIRT $ 36. 00
1-1,C)(JILL & WILLIA11 1`4W.)XIN 111VIL-C $ 9. 00
(44 30 GW W01 1q(J T ST 1,151-1C., $ 1.. 80
F41RT $ 1.:3i
�'J C 0 N N E C 7* 0 N
C17YOFTIFARD 1:1 E R N*11*T'
MYOf7WAPD� P 1-R 11 J-T cS W R 9 0 03:1 7
COMMUNITY DEVELOPMENT DEPARTMENT CREGWDN
13126 SW Hall Blvd, P.O.Box 23397,Tigard,Oregon"."J,"�41175 �11 I/
PPATE113FIJED . 1.0/1F;/30
0DDREG)S— ., -. .12832 SW 1321,11) W)11'.
.............
H0. . . .43103 i-*ix,rURE UNITS. . .
OF'- WORK. — NEW DWELLINC-) im'r.n. .
'TYPE OF LJSE HO. OF EIIJILDIN(-,C;: J.
ENGT'A I.,L. T Y P,E. . . Ji tj l.,)w 1� 1111`17 R V S U R P0 C F S f
FEES
1:44CHEL & WT.I.-LIPM BW31/,1*1q
type anlot.11-It by date 'r e C,P
1.0030 1:;W W(,1., %lU'T' S7 PRMT $ 1500. 00
'11GORD OR 97223 1NS0 $ 35. 00
1"'A Y 11 $ 1535. 00 J-1 1-4
F�'htarle N»
Cc)rit-raeto-r:
C,01q1'RAC*TOR NCYT Olq j.:jj E*
1:,1-1c„-1e if 1`.;3`:;. 00
1-*;E 0 U I R E D INGPEC-1—IONS
This Applicant agrees to comply with all the rules and regulations Sewer Ivirpertic)ri
of the Unified Sewage Agency. The permit expires
vires 120 days from -—---- ...............
the date issued. The total amount paid will be forfeited it the ...............
permit eivres. The Agency does not guarantee the accuracy of the .......... ............
side sever 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 Age y will nstall a lateral. --------
...........
.......... .............................. ......
Pe-rilli.ttee
I !i t.t e d Iq Y
..............
Ca 11 -f i ils pect J.c)n 639---4:115
1
.l•TY OF TIGARD RECEIP'r OF, PAYMENT RECEIPT NO. ?0-205070
CHECk:' AMOLIN'r '4:9.0'3
NAME FIETTER BUILD WRIES CASH AMOUNT u.CaCC
1 ADDRESS 1480 NE STILE VR PAYMENT DATE 101116/90
SUDD I V 15 1 ON
HILLGPORO. OF, r?"7124-612C) 12032 SW 132ND
y
1"URPOSE OF F"'AYMEN T AtioUta PAID PLJRPOSE OF PAYMENT AMOUNT FIA 11'.)
PERM I
MECHANICAL, PE 7-6.('')0 ST. BUILD PER X5.50
!"LON CHECK FE I*'*�I . 95 SEWER LISA 1500.00
.;EWER INSPECT 35).oo ss'rRFE'l 3DC 600.()Q
FARKS 3DC :''5 0 0 93TORM DRAIN SDC '375. CIO
-IOTAL AMOUNT PAID
-'ITY ` F TIGARD RECEIF7 OF F'AYMENT RECEIPT r4 fir'!
C)
CHF CH' AMOUNT w 100. 00
HAME FETTER UMILT HOMES [:(-ASH AMOUNT
D D F�'E S'S a 1488 NE STILE DR PAYMENT DATE ?
SUBDIVISION
HILL.SDOR0. OP 97124-- 12-8312 Sbi
Ir
-PUP'POSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT Pll10 .
PLAN CHECR: FE 7-66C I C.) (7()
TOTAL AMOUNT PAIL)
■
CITY
OF
T167A
�3�2s sw 23 ova. PIAN a DCIC APPLICATION
RD 4} r.o.Box m 97 PLAN CIiDQC
` / nao�a ck�vnza PEId9IT ,�
COMMUNITY DEVELOPMENT EPARTMENI{,� ���/i/3j 639AI71 PATE ISSUED
,7f9$ ADDRESS: ?
TAX rJI P/ur ��I x/yc /3c �
SUB: _ IOP: IJTM USE:
VAIII MON: _
OWNER SPEX'IAL NOTES
NAME: Q / �� S REISSUE OF: —
ADDRESS: �G�C'3C� Sit- �J�,i�.y :1Li iy �'"°t IMT REISSUE: -
--__-- 1U)OD PLAIN/
SENSITIVE LAND:
PHONE:
--- --_ -
--- APPRMALs RDOUIRED
(X�FIl2ACTOR -� j PLANNITJG:
j NAME: ��' f - . -- -
AMVF-- S: 1 '��.� nw FIRE. DEPT
(MIER.
PH10NE: (Z4(LA7/5 ITEKS RDDUIi2ID
BUILDERS BOARD EXP PATE: _ c n LIST/
BUS TAX:
ARM EMTNEER CA10ffIITIONS: --- _
NAME. !/ e - ff. SSc�c/c, /' ��� �c TRUSS DEiAnS:
ADDRESv: Z S l OTHER:
PHONE:
CUb?4 NTS:
RS: PIIIv13: l, 1 a MDCH: ;, . 14 1 z
PF144rr f AOCT f DFSr RIP'I'ION XU I T AMO INT PD. BAL. DUE
10-432 00 Building Permit Fees — — .c
10--431 00 Pltnnbirg Permit Fees ''
10-43.1 Ol Mechanical Permit Fees
10-230 Ul State Building Tax (5%)
Building
Plim►birg C
Mech
10-433 00 Plans Check Fee
Building
Plumbing
mech
--- - 30-202 00 Sewer oDmection ----
30-444 00 Sewer Intspect,icln
51-448 00 Street Stem Dev Charg, Dc) --
52-449 00 Parks System Dev Charge %PW) _
31-450 00 Storm Drainage Sy,,-t acv cl" (.SSDC) J-/-�
10-230 06 Fire
liulAL Y6 Al
RDC f
APP'I�ICANr SIGMIURE '
Ikxx?ived By: - ---- Date Reoeived: 31
ef/3587P.WF'F
T� rw
yJ2ADIN(:/ER0SI0N CON" 1, INFORMATION
GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.:
-x LC.� PERMIT NO:
' 'L , 1�` ' APPLICANT NAME AND ADDRESS:
1 v r-
EXCAVATION CO"'.ACTOR
NAME&ADDRESS:
OWNER NAME AND ADDRESS:
v r
TELEPHONE NUMBERS:
APPLICANT; �-''f�' � ��� � �'- PROPERTY DESCRIPTION:
OWNER STREET ADDRESS AND CROSS STREET/LOCATED
GENERAL CONTRACTOR: (, `{ c- 1 1 ) 5 — --
EXCAVATION CONTR ACTOR:
SITE/1OB;__ _ —
LEGAL DESCRIPTION:
24 HR/AFTER HOURS TAX L JT NO.:
C NTACT PERSON,-IT T..E,'I'F1.L•PHONE: IM SECTION:
t sru SIZE,ACRES:
(l c I`l1 ��
DISTURBED/WORK AREA,ACRES
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAW$TO:(CIRCLE ONE)
(NOTE:PERMITS MAY IIF REQUIRED) CATCH-BASIN 074 PIPE CREEK
(CIRCLE ONE) PRIVATE PItOPERTY
PUBLIC RIGHT OF WAY
EROSION/SIrDDlMENTATIQN CONTRQL (ESCI MEASURES
MINIMUM ESC REQUMEMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUC'1ION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL_ FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCTION SEQUENCE OTHER _
OTI Ilan,Y _
PIAN 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 NECESSAP.Y
TO CONTAIN SFDIMF:NT ON THE CONSTRUCTION SITE.
OWNER SIGNATURE APPG--' T C!c;NAIURE
01-1-ICIAL USE ONLY
RECEIPT DATE
ILt NUMBER RFCEIVFD P
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