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11077 SW 81ST AVENUE-1 w�+1�t/Aw 1Aww.w:Mb'or w.Yr�WYWwr1FYMwt� �,.,._..,:...wo,Wwe�ypryMyy N V F 00 N• y C m I f 11077 SW 81ST AVENUE _ CITY OF TIGARD EXPENDITURE REQUEST This form is a multi-use form. Appropriate receipts and documentation :oust be attached to this form. Approved request due Wednesday 10:00 AM to A/P for checks by Friday. _ __ DATE: July 28, 1992 VENDOR NO. : PAYABLE TO: Nj DJO I�A MARNUVICH__ REQUESTED BY: BRAD ROAST 11077 SW 81ST TIGARD OR 97223 - - MISCELLANEOUS EXPENDITURES: -- Date Description, Invoice No. , etc. Account No. Amount ^� REFUND OF RECEIPT NO. 91-218912. PRGJECT HAS BEEN CANCELLED. (THE pLAN CHECK FEE HAS BEEN KEPT) -r--- BUILDING PERMIT 10-43200 $193.00 _ MECHANICAL PERMIT 10-43101 26.50 PLUMBING PERMIT - 10-43100 $_ 45.00 _ ST. BUILDING PERMIT _— 10-43001 $ 13.00 TOTAL _ _ $277_50 - Mileage $0. 28 - APPROPRIATION BALANCE: .50 AS OF: 7/1L92 SIGNA`T'URE: =_� -- (Up TO $25.00) Section Manager — -- Purch. Agent ($25.01-2 ,500.00) Division Manager -- ($2,500.01-7 ,500.00) Dept. Head — ($7 ,500.01-15 ,000.00) City Administrator — ($15 ,000.01-? ) L-ocal Contract Review Board C11YOF TIGARD ,� 011F TWA COMMUNrrY DEVELOPMENT DEPARTMENT o"em MASTER PERMIT 13126 SW FWI Blvd. P-0.BCx 23397,TpW,Oregon 972 (603)839-4176 PL'.RI+IIT #. . . . . . . : MST91--0167 6:s9 -4171. DATE ISSUED: '31TE A0DRESS. . . : 11.07'7 SW 81ST AV UBDIVISION. . . . : HERB & PEG13YI S PLACE PARCEL: 19136CB--•O7300 [LOCK. . . . . . . . . . . LOT.. , , . , ZONING: R-4- 5 F<EISSUF: BUILDING _______________.__._.._-•- __ DWELL-ING UNITS: 1 BASE.MENT. . . . . . . . j_F_`.__. i�LASS OF WORK. ADD BEDRMS;O BATHS: TYPE OF USE. . . :SF FLOOR AREAS --- ---- _ GARAGE. . . . . . . . . , :11 s f T'YP'E OF CONST. :SN REOU I RFD SETBACKS-- -.._._.....__-- F I RST. . . . :64`1 s f LEFT. . :Ib OCCUIDANCY GRP'. :R;:3 SFC'OND. . , ;I� ft RICHT. :0 ft STORIES. . . . . . . : 1 sf F'RONT. :0 ft RF1aR. . :k) ft THIRD. . . , -.0 5f REClU I HEIGHI... . . . . . . . : 15 ft TOTAL-• -.---:645 - F=LOOR LOAD. . . . : �f Slhpi�:f_ DETECTORS. : 40 ps f VALUE. , , , . 29670 PARK ING SF'ACE:S. . :0 Remaaddition --- - -r'jf famiIY r^oom r^emodeding batl;r^ooms SINKS. . . . . . . . , eO -__-_____ - P'LIJ BIND L(aVATGRIES. . . . . :2 FLOOR DRAINS. . . :0 BACKFLOW PREVNTRE. . .O WATER HEATERS— :0 TRAP'S. . . . . . . . . . . . . .TUB/SHOWERS. . . . :2 TY TRAYS, . , 0 :0 WA"rER CLOSETS. . ,2 SEWER LINE ( _ CATCH BASINS. . . . . . , :0 DISHWASHERS. . , , :0 WATER IN f t ) :• GREASE TRAPS. . . . . . . :0 ) , .0 OTHER FIXTURES. . . . . :O GAFiLIAGI" U I SP'. . , :I/, RAIN D A I i f ) . :0 WASHING MACH. . . :o c,F Ria I W I ? ----------------- A NS. . c 0 MECHAN I AL - FUEL TYPES---- lJ IT HTR FEES --____._.____•__ /GAS/ / / °0 type amount by date -eapt VE TS BP'RT t 19;,%. 00 JLH 10/,.3/91 - P MAX INP'UT:O BTU VFN - FANS , FURN < 1O0K . . :0 BP'L_C $ lc'-�, 45 JLH 10/23/91 - HOOD!$. . . FURN B5P'C $ 9. 65 JLH 10/23/91 > =1 OOK , :0 WOODS'T O S - FLUOR FURN. . . . :0 MF RT 26- 50 JLH1012;;/9 1 CLO DRYER-J. : 0 MPI_.0 f 5. 50 JLH 10/23/91 - BOIL/CMP' ( 3HP .0 O1I-11=R UNI T5- o M,�PL t 1. 10 Jl_I-i 1141/23/91 - GA5 OUTLE"tS:O P'PP,T $ 45. 00 JLH 10/2,3/91 - _.__..--- .. PP'C $ r�'. c5 JI-1-1 10/6 ;/91 NFDJO MARKANOVICH - GLOBAL. PLUMBING 11077 SW 81ST T I GARD OR 117223-IhOOO if-'hone #: 5113-6;x'0-•8971 :ont 'actor: GLOBWL. P'LUMRING 1 107 7 SW 815T 1 1 UARD OR 97223 0hone #: 503-624 -8971 Rer #. . . 38881 This oereit is issued subject to the regulations contained in the __ $ 408. 45 TOTAL- Tigard Muniripai Code. State of Ore. Specialty Codes and all otherFoot/foo - ` REUU I RED 1 NSP'EC T I ONS Foot/fo�_Ind Insp Insulation Insp applicable laws. All work will be done it accordance with approved Post/Beam 5truct G plans. This oerait will expire if work +s nct started within 188 Post iB"m Mec•h2n GypRaiSoav-d Insp rfays of tssuance} or if work is suspaded for mo"e than 188 days. P'lm/unds lab Insp Meehan lcal Final Permittee Signart'.1r . : �1j„ ,� PLM�Under floor c'l�_imb Final d`+G/ __ MNr_hanical Irtyp Buildinq Final Issued By., '� Plumb Top Out Erosion Control Y• _. Framinq Insp Cull for insPPetion - 639-•4175 CvITY OF TIGARD •- RE'CE.IP'T f.)(" PAYMENT RECEIPT NO. : 41—r 16912 CHECK AMOUNT : 4O8. 45 NAME s M:)RKANOVIC:H, NE:DJO CASH AMOUNT s 0. 00 ` ADDRESS s 11077 SW 81ST PAYMENT DATE 10 1 tJBDIVI sIOfd T IGARD, OR 9722-3-- PURPOSE OF PAYMENT AMOUNT PAID PURE-JC'E. OF+PAYMENT' AMOUNT PA I U BUILDING PERM �.._. 193. 00 PLUMBING PERM l U -1/ 3/OU 450. 00 ME:CHAN I CAI_ PE 10- 4j .3)01 26. :50 ST. HU I L.D PER /C — ! 13. 00 FLAN CHECK FE 130. 95 I 7. L' tv ,J/G +l , I TOTOL AMOUNT PAID _._ > 408. 45fi I I: • Cl-(Y OF TICARD RE.cElFST OF pfiVMENT RECET.PT NO. rHEGIA AMOUNT t 408. 43 CASH AMOUN1 NAME : MARKANOV ICH, NEDJO PAYMEN"f DATE ADDRESS : 110*77 5W BIS'T SUBDIVISION 'TIGARD, OR 97223- PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMEN"f AMOUN'T PAID 193. 00 PL-UMSlr4G PERM NL1IL_DING 'ERM 26. 550 ST. BUIL-1) PER 3. 00 MECHANICAL PM. PLAN CHECK FE 130. 95 TOTAL AMOUNI PAID > 408. 45 CIT, Y Or TIGARD »iusw►ia39iwI1a. PINCKjRECT #lklx CnMMNI7l'D�wjIj'oOPMENTDEPARTMMENTTTiga�,Dlregon97M PERMIT # oj�,t5 f-of 7 (503)639-4171 DATE ISSUED JOB ADDRESS: -j/0 )' y J cv �' ! VF TAX MAP/LOT SUB: 11, 6 f�oa,_ ,. ��� LOT: . - LAND USE: VALUATION: OWNER SPECIAL NOTES NAME: � � <Q—�����y -- jV'�7) Ir REISSpr �r ADDRESS: 1/077' c.0/ A�S /�c� _ LAST REISSUE: / � � �� `� �--y 7 1 Z 3 _ FLOOD PLAIN/ PHONE: _ SENSITIVE LAND: CONTRACTOR — — NAME: APPROVALS REQUIRED — ��;. ADDRESS: PLANNING: _ ENGINEERING: FIRE DEPT: PHONE: — - _ CONTR. BOARD #: OTHER: EXP DATE: 3�` — — -- ITEhS REQUIRED SUBCONTRACTORS: PLUMB: —GL n TZA., r'L�-c�uR��C LIST/SUBCONTRACTORS: MECH: _ ____--- BUS TAX: --^— _ ARCH_/ENGINEER NAME: -- CALCULATIONS: _ -- ---. -- — ADDRESS: TRUSS11ETAILS: .= ----- OTHER: PHONE: PROPOSED BLDG. USE: COMMENTS: — -. APPLICANT SIGNATURE _ Received By: c :L'�� Date Received: PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE 10-432 00 Building Permit Fees ,L�[-3, a s, _ 10-431 00 Plumbing Permit Fees 10-431 01 Mechanical Permit. Fees ��, 54 __ W• iz 10-230 01 State Building Tax (5%) i 2, �— Building 1 Plumbing Mechanical 10-433 00 Plars Check Fee / > v ` S _ 130 `>> Building ay Piumbing Mechanical S.5y 10-230 06 Fire 30-202 00 Sewer Connection 30-444 00 Sewer Inspection 25-448-02 Commercial TIF Fees 25-448-04 Industrial TIF Fees 25-448-06 Institutional TIF Fees 2.5-448-03 Office TIF Fees 25-448-01 Residential Traffic Fee: 25-448-05 Mass Transit TIF Fees 52-449 00 Parks System Dev Charge (PDC) _ — 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) 24-445-01 Water Quality (Fee in lieu of) 24-445-02 Water Quantity (Fee in lieu of) TOTAL 2`X. Wim _ U�.-a nm/3587P.WPF �� V