15480 SW 79TH AVENUE rA
15480 ad 79th Ave.
it
it
I
W W1 W1 U
�;ITYOFTIFARD 1:1UIL.DING C'EPMIT
GTYOF1n6aRD PERNI T k#. » . „ .. . . : BIJI::190 0367
COMMUNCTY DEVELOPMENT DEPARTMENT, \ Orae00M
3125 SW FWI Blvd. P.O.Boit 23397,Tigard,Onpon 97223(6031 83➢41 75
Dfl•rE: ISSUE:i): IP/12/90
SITE ADDRESS. .-—, 1.5480 SW 79TH 01) VIORCEI_.: 2SI 121,A- 03GOO
SUBDIVISION DURHAM ACRES ZONING: R--4. Fs
LSI...(];*K. . . . ., » . . . ,. x L-OT. » . » . ,, . . . ., . » » :c?
RE.IS5LIE: FI_(]C)I Alil far, _.__.._._...... ._..-• HXTE:F I.CIft WA1_L CONGT"RIJCT'T.I)N''
CI_.ASC UF- WORK. -.DEM FIRST.. . . . : sf N: S: E:: W:
TYPE: (:)f- lJ:.'iE:.. . » :SF" SEC()ND. . » : s,'f f'F:C7 rF (.'T OIZ'F::NIMGa''______..........._. ....
TYPE* OV' CONST. -SN THIRD. . . . a sf Ns S: E : W:
i7C,CUPANCY GRP'. ::11J. TOTAI...-•-._.__.._.; 0 S ROOF CONST: F''TRE. RET?.-
OC:C:UPANCY I._f.)A1): NASiEME::NT. : sf AREA STEP. RATED.-
STC)R. : 1.11-. : ft GORAGE.. . . : sf OCCU GEP.
PSMT?: ME:ZZ'': RECD SF:rEtAC:F:S_ _- --- REOUIRED-.----__w_____.__._.....__.__
Frl_.00R i_.il(11)„ p,f 1.E*F''T: ft RGHT: ft FIR 5PK1_.: SI11OK DET, . :
1)WE:L.L.ING UNITS". FRN'': ft REAR: ft FIR AL_R11i HNDICP ACC:
DE:1)F2MS: 1:ATHSi: I:ITIP SUR1 ACE.: PRO COF'R r,ORK T NG:
VAL.IJE:. 1,» 0
Rema•rPt; : denlra'Iish VXitXY)El ga'r<'ane/st(.)r,.Aq .' bt.0.1d:inq
CENTURY 2J PROPERTIES type amCaunt by date'? reC.,r)t
PO BOX 1408 PAYM $ IS. 715 B(,R 12/12/90
PRM'T $ 15. 00
Tli(1:. 111H (:)k 97O!
I P T NO. i l?f.)--2()762:3
rr- nP T I GARD ... RE-ZEIFT OF FIAYMEI',iT REC'E
(,HECK AMOUNT r 15.75
NAME a CENTURY CASH AMOUNT c).(K)
PIA)PESS f"AY141ENT DATE a 1 12/90
SUBDIvisluN
15460 SW 79TH AVE
PuRPOSE OF F,AYMENT AMOUNT PAID r-lbld"W;E. JF PWIENT Amoum rAxi.,)
..jjT:j7 --0367 15. oc) o. 75
F'ERM OUP90 s I BU I UP PEP
1
DEMOLITION PE.Pflll
AMOUNT PAID .. ... ... .....
KWIWAW
INSPECTION NOTICE
City of Tigard Ruilding Department
P.O. Boa 23397
Tigard, Orey:rn 97223
Phone: 639-4175
I
Type of Inspection
Dater Requested
—1� ___ Time — A.M._—, P.M.
Address 7 _ Permit # '
Ownar_— ,_---------- — Lot #Builder
i'
The following Buildiny Code deficiencies .•,r required to be corrected:
1
I
Presented to _.�– .� pprove.d
Inspector _ ❑ Disapproved
Date
- -- �� -
i
CALL FOR REINSPEMON
❑ YES F-1 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 7.3397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection 's-_ _�—
Date Requested — Time _A.M. P.M.
Address _ �! �_'� -)I6rmit
Owner_- _._ _—_ _ Lot #
Builder _--
The following Building Code deficiencies are required to be corrected:
Presented to _---------____..............—.-----_..._---.-, `Ft Approved
Inspector Disrpproved
Date --
CALL FOR REINSPECTION
❑ YEI ❑ NO
INSPECTION NOTICE Al
City of Tigard Building Department
P.O. Box 23397
Tigard, Orego,) 97223
Phone: 639-4175
Type of Inspection
Date Requested_ C Time_�A.M. —.P.M.
Address �.. J --7 Perm t
Owner__ _ Lot # —
Builder
The following Building Code deficiencies are required to be corrected:
Ar
i
i
- - - ,c-.
dc
Presented to -- T Approved
In%pector ` _ — U Disapproved
Date
CALL FOR REINSPECTION
YES ❑ NO
r
1
ZITY OF 11BARD -- RECEIPT OF PAYMENT RECEIPT NO. :90-'42,04658
CHECK AMOUNT e 1535.00
NAME BROOKS, WALTER CASH AM01-INT - 0.00
AODRESS PAYMENT DATE 09/17 90
SLJaD 14'I 53 1 ON
TIGARD, OR 97223-
PURPOSE OF PAYMENT AMOUNT PA 10 plippoL,.' OF F'AYML-*'NT AMOUNT PATD
00 NSPECT It. 00
SEWER USA
15480 SW 79TH AVF,
TMAL AMOUPiT PAID 1 5-3 5.oO
AL
■MRUNMErm
SE.WER C,OHNECT I ON
CITY OF T'GA RD r I E.'�1111.1. it. SWR90-0362
COMMUNITY DEVELOPMENT DEPARTMENT ogle" Fl R 111. f:1 E R 111.T 0., 5 W R 9 0-03 G 2
13125 SW Holl Blvd, P.o.Box 23397,I jq&M,CWvgDn 91223(5W)M-4175 DATE ISi3t.JED.- 09,,'17/90
SITE' ODDRES�,:,-- .-. 1`5'480 SSW 79TH AV I:)ARCE*L-. 291.12CA 03600
SUBDIVISION- - DURFIAN ACRES ZONING:
DLOCK.. . .. . . . . . . . I L 0 T.. 2 2
TENANT NA111:—
USA NO. . . F*JXTURE UNITS.. . .
C I A S S QF' W 0 R K., „ „ -NEW DWELLING
'T*Yl::,F.:. (7F:' USE.. . . . " :SF NO.. T7F BUILDINGS:
TNE)TOLL T*YI-'E.. ,. .. .. -.BUSWR 1111.)ERV SIJRf---()C[--.
R P In zi-r I-f.s-
......................--- F EES
W A LT E,R LA R 0 0 K 5 tyle -nit)t.kilt by date -recr)t
f.i R MT 1.500. (40
1.
NSP 1, 3'-5., 00
V,W01 fi 1535. 60 3144 09/17/90
1-:.. 1 F.E.- ROBINSON CONSTRIff"'TON
,1:320 SW HUNZIKER ST. SUI IE 300
11GORD OR 972213 .......
1*11-ic)rie #.- 639-8021 $ 1x::35.00 T0TAI.
q W. E,314
R E Q UT RE.D INSVIECTIONS
chis Applicant agrees to comply with all the rules and regulations e w e-r I rti>p e c t i o n
of the.Unified Sewage Agency. The permit eipires 128 days from
the date issued. The total amount paid will be forfeited if the
permit expir-s. The Agency does not guarantee the accuracy of the
side sever tateralF. If the sever is not located at the measurement
.,iven, the installer shali prospect 3 feet in al) directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sever" Permit and the Agency will install
a lateral.
t e
i,t i
S S U P d 14 y
Ca 11 f o-r i ri s pe(7 t i o 11 639--41'7`i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Loh 23397
Tigard, Oregon 9722.3
Phone: 639-4175
Type of Inzpect or /�_t��3Q-� �t'.
Date Requested Time a.M. P.M.
Address -_TSy � 7l'y`` _ Permit #C"J
I
Owner-_._-- _— Lot #
Builder
The follovving Building Code deficiencies are required to he corrected:
_ x
Presented to � � -_. —.— - -- •-
- Approved
Inspector r
_ Ll Disapproved
Date
CALL FOR REINSPECTION
❑ YEIt 0 NO
CITY OF TIGARD MEGHANIGAL PERMIT Receipt # /a 6,U 71:7
13125 SW HALL BLVD. Permit #
P. O. BOX 23397 Description
T I GARD, OR 97223 Table SA Mechanical Code — CITY PRICE AMT
(503)639-4175 1) Permit Fee 0 -0- 10.00
Name of Development
2) Supplemental Permit 3.00
Job AddressFurnace to 100,000 BTU
Address
�'��� S'all �� I 1) incl.ducts&vents 6.00
- -
Tax Lot Map No. 2) Furnace 100,000 BTU +
incl,ducts 8 vents 7.50
Lot Block Subdivision — —
Name(or name of business) 3) Floor Furnace G.00
L �jZOO 1 incl.vera
Mailing Address hlwne 4) Suspended heater,wall heater 6.00
Owner ,S s,/G, S Lv• �Z� �3 c�-j?Z or floor mounted heater
cl!pale 7 Zip 5) Vent not incl.in 3.00
appliance permit
Name! name of business) 6) Repair of heating,ref rig., 6.00
cooling,absorption unit _
Mailing Address Phone -,) Boiler or comp to 3 HP 6.00
Occupant absorp.unit to 100,000 BTU
City/State Zip 8) Bailer or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
Na 9) Boiler or comp 15-30 HP 15.00
A; y r - absorp.unit th-1 million
ai�ut ling Address Phone 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor City/State Zip 11 Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No, City Bus.Tax No 12) Air handling unit to 4.50
10,000 CFM
Air handling unit
1 hereby acknowledge that I have read this application that the information given is 13) 10,000 CFM + 7.50
correcl,that I am the owner or authorized agent of the owner,that pla,is submitted are in
compliance weh State laws,that I am registered with the State Builders'Board,that the 14) Non portable 4.50
number given is correct.(If exempt from Stale.egist(ation please give reason below). evaporate Cooler
15) Vent fan connected 3.00
to a single duct
1 G 4.50 Ventilation system not
/_ 1 ) included in appliance permit _
11411 17) Hood served by — 4.50
mechanical exhaust
Sighature(owner cw a Date 18) Domestic type 7.50
Describe work ❑ addition ❑ alteration tj repair ❑ incinerator _to be done _ residential ❑, non-residential ❑ 19) Commercial or industrial 30.00
Existing use of type incinerator
buildinq or property 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc. 7z
building or property 21) Cas piping otie to four outlets 2.00
Type offuel-- oil 1[1 natural gas ❑ LPG ❑ electric D
22) More than 4-per outlet
OTiCE SUB-TOTAL •�`-�'
THIS PERMIT BECOMES NULL ANC VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 5%SURCHARGE `
DAYS, OR IF CONST9UCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL
Special Conditions
If
Date issued by < —
114ECHANICAL0
1PERMITO
xxxx PERMIT #. . . . . . . . MEC90-0001
639-4171 PRIM. PER11IT #. : 14EC90-0001
DATE. ISSUED: 01/02/90
SITE RDDRESS. . . : 15480 SW 79TH AVE PARCEL: 1S111XX-99999
SUBDIVISION. . . . : ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
------•-------------------------------------------------------------------------
CLASS OF WORK. . :ALT FLOOR FURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . :
OCCUPANCY GRP. . :R3 VNTS W/O ADPL: VENT SYSTEMS:
STORIES. . . . . . . . : BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL TYPES--•------- -- 0-3 HP. . . . : DOMES. INCIN:
:/OTH/ / / 3-15 HP. . . . : COMML. INCIN:
MAX INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS7. . :N 30-50 HP. . . . : WOODSTOVES. . :l
GAS PRESSURE. . . : 50+ HP. . . . : CLO DRYERS. . :
NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. :
FURN < 100K BTU: <= 10000 cfm: GAS OUTLETS. :
FURN >=100K BTU: > 10000 cfm:
Remarks: applying for a permit for a pellet stove already installed needs
inspection
Owner: -------------------------------------- ---------------- FEES --------------
WALTER BROOKS type amount by date recpt
15540 SW 79TH AVE PRMT $ 14.50 / / I We J
�
5PCT $ 0.-/3 /
TIGARD OR 97224 PRMT $ 0.00
Phone #: PAYM $ 15.23 DEW 01/02;90 4590
Contractor: -----------------------------
CONTRACTOR NOT ON FILE
------------------------------------
Phone $ 15.23 TOTAL
Req N. . ,
------- REQUIRED INSPECTIOVS -------
This permit .is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and ali other v _
applicable laws. All work will be done in accordance with
approved plans. Phis permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. -�
Permittee Signature:L/ /' �
Issued By
Call for inspection - 639-4175
CITY OF T'GA BUIA-DING PEWMI: T
RD h�!k NO. : B1A3V11.8H,`3
cnyOFYMVM
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.,RO.Box 23397.Tigard.Oregon 97223,(503)6394175 DATE ISSUED: 91 1A./09
JOB ADDF*fE-SS : 1.5AC-10 SW 79'TH
TAX MAP/1 OT 25:1. 1.2 SUB: L.T . Bl< :
LAND USE:
LOT SIZE : VALUATION: 111 21620 SETBACKS
FRONT : REAP :
WORK ASS : ADDITION DWELL.UNITS : LEFT: R 1('A-IT :
USE TYPE : GAWAGE N0. 181EDROOMS : EXT .WALL CONST :
CONST . TYP[".: VN NO. BATHS : N: S: E: W:
OCCUP.C;WP . PROT .OPENINCS:
OCCUP .LOAD N: S: W :
TOTAL AREA:
NO . STOPIES : I IST : ROOF GUNST: FIRE PET"?
HUI G HT : IR 21ND: AREA SEPAP7 RWY :---D:
HASEMENT7 3PD: OCCUP SEPAR7 RATED:
MEZZANINI:::7 BASiEW1
FLOOR LOAD: GAPAGir.: : 1-10 FIRE 5PPKL W? ALARM'{
FLOW(GPM) DETECT7
II-jr- 'L -T-Ypr11-111,1111",P Anf�Vt;4,7
PI AN Cl,4F-':CK BY. r I t
REMARKS :
(1wne?r- tLi c1c) a7.1 wc)i•k . Acacia t—i r1n t a PKISSUE OF' N(J.
dp.tial::htad LAST REISSUE
FEEI.5 :
O W br-aoks watl (. & Jc1i:111 PERMIT $38.50
N I.b.1!1-10 mw 79th PLAN REVIEW $25 . 03
E
R It.J.ca iiL I,d al., 9IRP-41 FIRE DEPT
PHONE 450,1) 639-3228 STATE TAX I 1>3
OTHER
C OEVELOPMENI U-IAW(.*,ES :
0 SDC(STORM)
N
T S Dt.;4 STREET
R
A
C PREPAID < 11111615 .
T
0
R TOTAL . 0 0
This permit Is issued subject to the regulations contained In Title 140 NO.
of the TMC. State of Oregon Specialty Codes,zoning regulatir -9
and all other applicable codes and ordinances, and it is hery jy REQUIRED INNPECTIONS
agreed that the work will be done in accordance with the plans and F OUT I NG
specifications and in compliance with all applic3ble codes and FR AMI N11'..',
ordinances The issuance of this permit does not waive restrictive FTNA
covenants Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and
void if work is not started within 180 days,or if work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required Inspections are requested and apOoved
Permittee Signature
I
Issued By 41k-
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED 4BOVE
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dry
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OJ ani t33l�C)��lcltl
Nol 100811 _.-------
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/ PLAN OTECK APPL TION
CITY OF TWA RD CrroF ncAan PLAN CI ECK
PERMIT It `I
COMMUN" DEVELOPMENT DEPARTMENT j OATI: ISSUF_0
vvvxsw_F<.ae�e.�P_o_s�nvvr.Tiy..�oKv� srs.(,syo��lvrs
fAX MAP/L01 _
JOB ADDRESS: OT: ocl LAND USE: _
S!113
_ VALUATION: �Cs��u. _____--- SPECIAL NOTES
OWNER // w C o A-1 J /� $ REISSUE OF:
NAME: L� rLAST REISSUE:
ADDRESS: �Q •�-_Zl - FLOOD PLAIN/
SENSZTIVE LAND:
APPROVALS REQUIRED
PLANNING:
OONTRACTOR / ENGINEERING:
NAME: K�✓�� T /cin� s FIRE DEPT
ADDRESS: , C OTHER:
Zt 1� ef 7Z `� 2 2-
_ ITEt1S REC,►UIREO
LIST/SUBOONTRACTORS:
ESUS TAX:
ARCH/ENGINEER CALCULATIONS-
TRUSS DETAILS:
ADDRESS: - _ PARKING PLAN:
LANDSCAPE PIAN: _..
-- -- OTHER: _ _ --
PI IONS:
COMMENTS:
: ---
PE_RMIT 9 ACCT N OESCRIPTfON AMOUNT AMOUNT PO. BAL. DUE
10-432 00 Building Permit Fees -
1C-431 00 Plumbing Permit Fees - --
_ 10-431 O1 Mechani.cal Permit Fee!. �-- -
~^ 10-730 01 State Building Tax (5X) —
Cuilding
Plumbing
10--433 00 Plans Check`Fee --- -
Cuildiny _--
P1�imli;vxl .---- ----- -
Mech --
3C--7.07 00 Viewer Connection - - - -
- 30--444 00 Sewer Inspection ---.---- -
51-448 00 Street System Dew Charge (SOC) _
52-449 00 Parks System Dew Charge (PDC) -
31--450 00 Drainage Syst Dcw 01n3 (,SO=) -
10-230 09 --
10-730 06 Washington County Iire #1 (95x) --
10-770 00 nmart:/Wedgewu d 7
101 A1_
nPPt ICANT ST RE
Received By: j - __ __ DaUo Received:
-=�-----
cn/35871111 8P
BUILDING PERMIT APPLICATION TIGARD DATE __- _ _ ts r33 4613
1"HE UNDEhSIGNED HEREBYAPPLIES FOR A PERMIT FORTH EWORK HEREIN INDICATED RUILDER PHONE 6110-1543
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNER 141ter Srootca JOB ADDRESS I5/01) " • "t h LOT NO.
ARCHITECT
BUILDER ?:etuieth Old!! ADDRESS Renters ENGINEER
DESIGNER
STRUCTURE _ ❑ NEW _❑ REMODEL QYADDITION ❑ REPAIR ❑ RENEWAL I FIRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE ❑ COMM Ci EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT L] GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY _—LAND USE ZONE BLDG.TYPE _.FIRE 20NE_ PLAN CHECK BY 1 HEAT
[Fill Permit r arproxiiately 150 bu. Yda. of Fill
,Npplicant CleXUad tthi9 request with Planning, Otev?
SEWER PERMIT N
OCC.LOAD FLOOR LOAD HEIGHT - NO.STORIFS AREA NO.BEDROOMS VALUE_
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit •., I THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE COPES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _ �f WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALI APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal i ^ESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax
.40 CENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
_
Total 10.40 - — SDC-
By Jru j
PDC# APPLICANT OR AGENT
_
Approved Receipt No.
ADDRESS -- PHONE
"UUUU UUUU UDOD �
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
—[—Permit No--
Rough in
Fixture
Final HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
Final
DRIVEWAY
Final
Storm Drainage
(Rain[train)Final
Sidewalk
Curb&Street Final
TEMPORARY CERTIFICAT7 OCCUPANCY
Approw".
DiT CERTIFICATE OCCUPANCY Final
Bt r; 7PT. FINAL
ICE,
Landscaping
2-o-rig Fir.0
I
BIJILDINi- PERMIT APPLICATION TIGA � DATE % 19�
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
CIVJVERJOBADDRESS 16 4t tfQ �G(i
" f 0<� 1 ARCHITECT
� ENGINEER
BUILDERBUILDER ,zt.� ORE�,S,S�L�J•� ► DESIGNER
STRUCTURE ❑ NEW ❑ REMODEL '7 AOUITION 0 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCZ,iPANCY LAND USE ZONE BLDG.TYPE —FIREZONE_^PLAN CHECK BY HEAr---
SEWEURMITO
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES _AREA �NO.BEDROOMS VALUE -
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SICE RIGHT SIDE
Plormit THIS PERMIT IS ISSUED SUBJECT TO TH1 REGULATIONS CONTAINED IN THE BUILDING CODE,ZON!NC
REGULATIONS AND ALL APPLICABLE COt ES AND ORDINANCES, AND ITIS HEREBY AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE%PITH THE PLANS AND SPECIFICATIONS AND IN COtJ!PLIANCE
E— WITH ALL APPLICABLE CODES AND ORUINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIN.
5utrletal _ RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT C17-Y BUSINES;
LICENSE SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
;3tile Tax 0 L
----- SOC -_
Total _ ----- --- ------
PDC# APPLICANT OR AGENT
By
�----� .&eceipt No.
Approved ADDRESS
SDC
PUC -
SEWER CONNECTION S
`IEWLR INSPECTION S
',E-WER SURCHARGE S _
i
PLAN CHECK APPLICATION
C11YOFTIGARD CRYOFTaRD
COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK
13126SWHd%A P.0.9a2x97,T1p 40reg*n arm(603)630.4176 PERMIT 1 l
DATE ISSUED
JOB AI)DQF,SS: TAX MAP/LOT
SUB: LAT: - LAND USE: -
VALUATION: �2 �-e SETBACKS: FRONT: REAR: LEFT: RIGHT:-.,-
WORK CLASS: HEIGHT: �� TOTAL AREA: _
USE TYPE: FLOOR LOAD: 1ST: "
CONSTR TYPE: HEAT TYPE: 2ND:
OCCUP GROUP: DWELL/UNITS: 3RD:
OCCUP LOAD: NO BEDROOMS:�e_ BASEHENI:
NO STORIES: NO BATHS: GARAGE: --
I_M"'c SURFACE:
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: REISSUE OF LIST SUBCONTRACTORS:_
ENGINEERING: LAST REISSUE: BUS TAR:
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN IND.: TRUSS DETAILS:
PARKING PLAN:
7ANDSCAPE PLAN:
PLAN CHECK BY: OTHF-R:
COM ENTS:--j-
_ ACCT I DESCRIPTION AMOUNT
OWNER 10-432 Building Pe=lt Fees S o
NAME: _ _ -431-600 Plumbing Permit Fees >t
ADD S: 10-431-601 Mechanical Permit Fees �
_ 10-230-501 State Building Tax (5x)
10-433 Plans Check Fee
PHONE: 30-443 Sewer Connection f
30-202 '
CONTRACTOR 30-444 Sewer Inspection
NAME: .51-448 Street System Dev. Charite (SDC)
ADDRESS: _ '52-449-510 `
52-449-620 Parks System Dev. Charge (PDC) S
31-450 Storm Drainage Syst Dev Chrg(SSDC) t ��
PHONE: 10-230-505 TRFD (95x) >t
10-435 TRFD (5%) s
ARC9. /ENGINEER_ 10-230-506 Washington. County Fire /1 (95x)
NAME:_ _ 10-435 Washington County Fire 11 (52)
ADDRESS: �r 10-220 Amar.t/Wedgewood
TOTAL
4
PHONE:
PREPAID
REC t
BALANCE DUE
APPLICANT SIGNATURE
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