15632 SW 82ND AVENUE h nAFIII
LS532 Sid 82nJ nve.
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Cah;''TY OF jl��RD CERTIFICATE OF
C1iYOFTISARD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT OREGON P E'R M I T 0 1 MILT`
"i
13 125 SW HWI Blvd. P.O.Box MOregon97,TOW,Or9722a(503j 93"
! 1!76 DATE 15SUEL)t 03/21`/91
SITE ADDRESS. . . : 15632 SW 30'ND AVE PARCEL 2SI12CC-11700
-;USD 1:V I S I ON. . . . : LANGTREE ESTATES ZONING- R---IP
13L.00K. . . . . . . . . . t LOT. . . . . . . . . . . . . :49
CLASG 017 WORK. :NEW
!'YDE OF USE. . . tSF
OCCUPANCY GIRP. tR3
OCCUPANCY LOAD:220 4
1"ENANT NAME. . .
Owner ------
TIT(IN PROPERTIES
VID BOX 6635
OLOHA OR 97007
Phone #1 6456477
'ilTAN PROPERTIES
PO Box 6035
tILOHA OR 97007
Phovir 6456477
13 e U #. "3015518
[)ccupanc,y of the above referenced building is hert4)y give", mild certifies
the compliance with the State Of Oregon !3-pecialty Codes for the grokip,
occupancy, and use under which the referenced permit was ilosued.
iDVCT R
FIRE DEPAR'rMENT LLL 1) 4f-., 1 NG�J��CT
C I AL
POST IN CONSPICUOUL, PLAU.J."
x Kra!
INSPECTION,NOTICE
City of Tigard Buildiaq Depart-meat
13125 SR Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Ree-O-Phone)s b39-4175 Business Phone: 639-4171
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line •INALs
Post/Beam Struct. San. Sewer Framing -Bldg. 1
post/Beam Hach. Rain Drain Insulation -
Plbg. Underfloor water Line Gyp. Bd. -Hisch• J
Data Requested:
Addrees: h C Permit
Builders —
t
THE FOLLOWING OOPIUWTIONS ARE REQUIRED:
I
Inspeccats:
tor s __w—__�
APPROVED DISAPPROVED APPROVED SUBJECT To
Call. For Relnnp.
wam'M
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0--Phone): 639-4175 Business Phone: 639-4171
Inspection:
i
Footing Plby. Underelab Mach. Rough-in Appr/Sdwlk
Pejund. Plbg. Top Out Gas Line FIMAL:
Post/Beam Struct. San. Sewer Framing Bldg. 1
Poet/Beam Mach. Rain Drain Insulation -Plumb
Plbg. Underfloor Water Line Gyp. Bd. -Msah.
7
Date Requested:` c caX�� Times ,{AM lPM
Address: `.2�+ c/ ~� f�i P/Lalt f s �L/ -,OAS,?
Builder:
THE FOLLOWING CORRECTIONS ARE REQOIREDf
Inspector _ — --- Date:
APPROVED DIS PPNO APPROVED SUBJECT TO ABOVE
---Cal I For Neinap.
MwMwltv
INSPEc"PION NOTICE
City of Tigard Building DepartIl nt.
13125 SW Ball B vd. Tigard. Orogon 97223
Inspection Line (Rec-O-Pho )s 639-4175 Business Phone: 639-4171
Inspections 20:: �
Footing Plbg. nderalab Xech. Rough-in Apps/edwlk
Found. Plbq. Top Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insu'_ation -Plumb.
P1bq. Underfloor water Line Gyp. Bd. -Moch.
_ I
Dates Roquestod: � �—_ Time: — AM PM
Addresa: �7 Gam ,n Permit Ot
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r
In i
Inapactort Dates
APPROVED o21AfT1YDVlD ✓APPROVED SUBJECT TO PROVE
Call for Reins".
IN'_PSC.- IQN NOTICE
City of Tigard Building Departoentf
13125 Bw Ball Bled. Tigard Oregon 97223 (
Inspection Line (Rec-O-Phone): 639-4175 Business Phonei 6 9-4171
Inspection:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Strict. San. Sewer Framing t-Bldq.
Poet/Beam Mach. Rain Drain InsulationP.1bg. Underfloor Water Line Gyp. ed. h.
Date Requestedt / '�S:52zTimesAN PH
Address:_ S + ���� h Permit tt
Builder: .6e
THE FOIJ,OWING CORRECTIONS ARE REQUIREI):
LZ %..7
Insiwctors! _ _--- Dates "Z7
APPROVED IBAPPROVBO _— APPROVED auBJECf To ABOVE
.- Call For ReinsP.
INSPS ,_ON NgTI(IF
City of Tigard Buildfmg Dopar-t: nt
13125 Sw Hall Blvd. Tigard, Oregon 97223
Inspection Line iRec-h--Phone): 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. Ran. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Pl.bg. ': ,derfloor /Water Lina Gyp• Bd• -Mach.
Date Reyuesteds__ /1 Times AN __PH
Addraest z f �� -� h Permit #_ _ '✓
Builders
THS FOLLOWING CORRE(;''IONS ARF. REQUIRED: !
Z- A717 Af
Inepeatore L _,--.-_-- -- Dat., Z L.
APPROVED UISAPPROVED APPROVED SUBJECT TO ABM
Call For Rainnp.
juw
INSPECTION jpIlgE
City of Tigard Building Department
13125 SW Hall Blvd_ Tigard, Oregon 47223
nspection Line (Rec-O-Phone): 639-4175 Bunin.08 Phone: 639-4171
Inspect ion:
_ — --
Footing P1bg. Underslab Mech. Rough-in Appr/Sdwl,
Found. Plbg. Top Out Cee Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -plumb.
Plba. Underfloor Water Line Gyp. Bd. Mech.
Date Requested:_ L2'�p I / — Time: PM
n �1_ _G_,z�5 Z
Address:^� -_/.��� Permit
Builders-
THE
uilder:_, -THE FOLLOWING CORRECTIONS ARE REQUIRED:co
/
/� Y ! L C
Z V N
ti
Inspector: ----
AppROVU _V DISAPPROVED APPROVED SUBJR(-r TO ABOVE
✓'Ce11 For Reinep.
! ! ! ! !julleff ! ! IA/
IMSPV99110N NOTICE
City of Tigard Building Department
13125 SW Hall Bled. Tigard, Oregon 97223
Inspection Line (Roc-U-Phone): 639-4175 Business Phone 39-4171
Inspection:— --- --
Footing Plbg. Urderslab Mach. Rough-in Ap,r/Sdwlk
Found. Plbg. Top Out: Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Wath Line Gyp. Bd. -Mach.
Date Requested: / - 5� �l Time: _AM PM
7
Address:_ . __-- Permit f: S
Builder: ---
THE FOI.IAY/ING CORRECTIONS ARE REQUIRED:
Inspector: -- --_ -- _ Date:�✓/` �
<1PPROV"D DISAPPROVED — — APPRO%ltD SUBJECT TO ABOVE
Call For Reinsp.
INSTION NOTIC_F._
City of Tigard Building DepartBalasent
13125 8T l Bled. Tigard, Oregon 97223
Inspection Line (Roc-O-Phone): 639-4175 BuninPECegg
Phones 39-4171
Inspection: _.A _ -----
Footing Plbg. Underalab Mech. Rough-1n Appr/Sdwlk
Found. Plbg.. Top Out Gas Line FINAL:
Post./Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain 0,eulatlon -Plumb.
Plbg. Underfloor Hater Line Gyp. Rd. -Mech.
11M
Date Requested: Times PH
G 1 ^
Addrens:'_ �`�� Lit Permit
Builders �� —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inapector:__ --- ���- --- -- Dates_
APPROVED DISAPPROVED �^ APPROVED SUBJECT TO ABOVE
Call For Reinap.
r
INSPECTION NOTICE
City of Tigard Building Department
,��'
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspec`.ion Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection•,
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Li FINAL:
Poet/Beam Struct. San. Sewer raming -Bldg.
Poet/Beam Mech. Rain Drain / Insulatioi -Plumb.
Plbq. Underfloor Water 7Lino Gyp. Bd. -Cech. X
Date Requested: / Time: _ AM / PM
Address:_ 1� ~ _A Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
,0-
Cc T2711c / v//t z
i n iaFw"I or:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinnp.
INSPECTION NOTICE
City of Tigard Building Department
F.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175 /001P
Type of Inspection G�m4- -- —
Date Requested %-0 Time .A.M. P.M.
Address S _.. Permit
Owner __.. __, _ _� Lot #
BuilderThe following Building Go de deficiencies are required to he corrected:
Presented to P-Approved
Inspector 1 Disapproved
Date 1 L
CALL kR REINSPECTION
1-1 YES ❑ NO
ffO w w w w of i
INSPECTION NOTICE
City of Tigard Building Depart3ment
13125 Sit Ball Blvd. Tigard, Oregon 97223 w•-�
Inspection Line (Rec-O--Phone)s 639-4175 Business Phone: 6P9-4171
Inspection:__ ��
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struet. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: 7- ^Time: Aq PM
Address:_ t �lJ 7 Z. `->� Pwl(/9lit #t
Bu i]der.: 2 ye�
TI4E FOLLOWING ODRRECTIOMS ARE RSauIRED:
Date:
DISAPPROVED APP"ovin SUBJECT To AROVF
I_Call For Relnep.
INSPECTION_NOTIC_E
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:`_ — —
Footing Plbg. Underslab Mech. Rough-in l Appr/Sdwlk
Found. Plbg Top Out 1 Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Gyp. Ed. -Koch.
1
Date Recpiesteds �� -�� �L�1%,/ -_- TPM
Permit fs �_
Address:
r
Builders
THE FOLI.ONIKo CORRECTIONS ARE REQUIRED:
�
e.z Ae'
1579- 1-2
Inspectors Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
I
Eff FOR
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 )v
Type of Inspection
Date Requested 1,�2 -e A.M.--P.M.
Address Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
en'6c'
Presented to Approved
Inspector FJ Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 4V
Type of Inspectioit,���'.e-m+ � -
Date Requested �G -�L� me A.M. P.M.
Address /157L 31 �� r Permit #�d-Z-�S 7-
Owner _ ___ Lot # _
Builder kQ1✓ - — — --The following Building Code deficiencies are required to be corrected:
Presented to _- - -- 1�,�] Approved
Inspector _. __ �Ld\Disapproved
Date
CALL FOR REINSPECTION
O res 0 NO
s �
INSPECTION NOTICE Via;
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested �� �C G Time—�t�_ A.M. P.M.
Address 13� ��� H Permit
Owner ��-- __� Lot #!_.
Builder
The following Buildi Code deficiencies are required to be corrected:
Presented !o _..___ A+-1 Approved
Inspector _ ____ I Disapproved
Date !�
CALL FOR REINSPECTION
C� YES ❑ NO
INSPECTION NOTICE �^
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Ti IICC�AII:---P.M.
Address __� /_. Permit
Owner _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to L iJApproved
Inspector __ Disapproved
Date
CALL FOR REINSPECTION
C_� YE8 ❑ NO
'TYOFTIFARE) MASTER F."ERM11"
1
WYOFTWA F'ER M I T E» " » " " " " .. 11,15T 9 0 0 2 5 7
COMMUNITY DEVELOPMENT DEPARTMENT r"i0miGom F.IRIM. PERMIT*
13126 SW Hell Blvd. P.O.Box 23397,Tolud,Orr m 91�9 DATE ISSUED., 1.0/04/90
GIJE ADDRESS. . . : 15632 SW 82ND AVE PARCEL: 2SI12C:C.-11700
SUBDIVISION. . . . .. LANGTREF1. ZONING.-
1.4 L 0 CK. . . w . . . . . . Q LOT.. . . . . .. . . . . . . . :49
BUILDING
REISSUE:MST90-0.130 DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. .-NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :388 s-F
T'YPE OF USE. . . :SF FLOOR AREAS------- REQUIRED SETBACKS-
FYPE OF CONST. :5N I*--I R S T. . . . ...862 sf LEFT'. . :5 ft R I GH'T. -5 f.,A.,
OCCUPANCY GRP. :R3 SECOND. . . :698 sf FRONT". .-20 ft REAR. . -.32 ft
ST'ORIES.. . -.2 THIRD. . . . .-O 15f REQUIRED----
HEIGHT. . . :20 f t TOTAL-----.-1580 S f SMOKE DETECTORS. ;Y
FLOOR LOAD. ._ :40 psf VALUE. . . . . $: 73344 PARKING SPACES.. . :0
k
PLUMBING
SINKS. . . . .. . . . . . .. I FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . .-O
LAVATORIES. ., .. . . :4 WATER HE . . I TRAVIS. . . . . . . . . . . . . . ..0
TUB/SHOWERS. . . . ,.,P LAUNDRY I*RAYS. . . 0 CATCH BASINS. . . . . . .. ::0
WATER CLOSETS. . ;3 SEWER LINE (ft) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : I WAI'ER LINE (ft) . : 1.00 OTHER FTXTURES. . . .. . .-L,)
GARBAGE DISP— si RAIN DRAIN (•Ft) . :0
WASHING MACH. . . s1 SF RAIN DRAINS. . : 1.
MECHANICAL -------- FEES
UNT'r H'TRS. 0 type a In a i.t n t by date reept
/(3AS// VENTS . . . . . :0 PAYM $ 40. 00 JLH 07/24/90 203044
MAX INPUTPO BTU VEN*T FANS. . :4 PAYM $ 250. 00 JL.H
FURN ( 100K HOODS. . . . . . : i BFIRT $ :355. 00
[`URN )=100K WOODSTOVES. :O BPLC $ 40. 014
FL 0 0 R FU R N. . . . ..0 CLO DRYERS. c I B5PC $ 17. 75
DC)T1_/CMP ( 3HP:0 OTHER UNusto BPLC $ ill-5. 00
GAS OUTLETS: J. STDC $ 600. 00
Owner: SSDC $ 250. 110
! I. I AN PROPER'T I ES PARK $ 250. 00
PO BOX 6835 MPRT $ 39. 00
MPLC $ 9. 75
AL.0HA OR 97007 M bi P C 1; 1. 95
) II ane #-. 6456477 PPRT $ 140. 00
C_'(:)ntrac,tor- P 5 P C 4, 7. 00
T11'AN PRUPF."R,rms PAYM 91 J.435. 45 JLH 10/04/90
1:10 BOX C,835
ALOHA OR 97007
$ 172'5. 45
this persit is issued subject to the regulations contained in the ---- RF OUTRED INSPECTIONS
Tigard Municipal Code, btate of Ore. Specialty Codes and all other Foot/fOLInd Insp Mechanical Insp
applicable laws. All work will be done in accordance vith .approved Wtr Procifirip Bsni Pltmb Top Out
plans. This oeroit will eypire if worP, is not started within 180 Post/Beam Strutt Framing Insp
days of issuance, or if work is is ed or,7roIll days. Post/Be,-Am flechan
Fireplace
ireplace Ins
Crawl. Drain Gas Line Insp
Pprmittee Signati.trP� --- lni/undslab Insp InSt.11atiryJI)
PLM/Underfloor
Gyp Board Insp
T�.-,S ti e d B Y .............. Ftng Drain Fisnilt Rain drain Insp
Call for imipection 639--4175
CITY OF TIGARP RLCEIPT" OF F'AYMENT RECEIPT' NO. ;9(-).-2054'78
CHECP AMOUNT : 1435. 45
NAME s FITCiN PROPER7*IES CASH AMOUNT'
ADDRESS PAYMFN'T DATE 1 1(.')/4)4/9()
SUBDIVISION
ALOHA. OR 97007--- 156:7,2 SW 132ND AVE.
P(JRPOSE Of- PAYMENT 0MOUNT rATD PURPOSE Or- PAYMENT AMOUNT PAID
WILDING PERM :"55.0(l PLUMBING PERM t 40.00
MECHANICAL P 19.00 ST. BUILD PER 2 6.7()
PLAN CHECK FE 24. '7'5 STREET SDC 600.00
PARKS SDC 2ts(). t:)()
TOTAL AMOUNT PAID 14 41',
® SEWER CONNECTION
CITYOFTIGARD PIE RMI T r
CITYOFTWARD PERMIT T 0. . . . . . . . SWR90 0107
COMMUNITY DEVELOPMENT DEPARTMENT 0"GON PRIM. PERMIT Ef. : 11ST90- 0099
13126 SW Hrl Blvd. P.J.Box 23397,Tipud.Ompon�21?,{ 3)}a1 7e DATE ISSUED: 06/28/90
1:;ITE ADDRESS. . . 15632 SW 82ND (TVI::: PARCEL.: R!:1)112C:C 11700
SUBDIVISION. . . . : LAIAGTRE:E ZONING:
DI UCK. . . . . . . . . . .. LOT'., ,. . .. .. . . .. ,. ,. . r.49
TENANT NAME.. . » » » :
USA NCI. . . . . . . ,. .. » :41687 FIXTURE UNITS. . » :
C:I ASS OF WORK. — ;NEW DWELLING UNIT S» . : .(.
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
I NSTALL TYP'E.:. . » . :BUSWR I M DERV SURFACE.
F:eIII aY'E'.5 C
1.1 w ri e r: _.........._._.._..__.._......._..._...___._._. ._.._._.._._.._...__.._.___..._._..._..... ._.._.._.._..._. _.._____._..._.__ FEES
TITAN PROPERTIES type Amcnunt 13y data ro; l)i
PRMT $ 1250. 00
INSP $ 35. 00 /
P A y M $ 1285.00 .JLIA 06/x.28/90
I!1-iL)ne 11:
c.ON11,OCIOR NOT (JN E :I:L..f:
i 'l l r rlt: fir $ 1.285. 00 TOTAL_
_.__....._..._-- REQUIRED INSPECTIONS
this Applicant agrees to comply with all the rules and regulations S ewee-r Irlsppc•tiori
of the Unified Sewage Agency. The pewit expires 128 days from
the date issued. The total amount paid will he forfeited if the
nermit 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. ti._ installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
P e?r m.I.is t rr t S:i i.Ia n a is t.t ea: _.._ ._...___ .._ .........__...._._._....._....... __..___..._. _ ...____....__.._.___....._._..._.._.._..
.1.ssl.te?d Eby=
Call for inslpeetion - 639--4175
CITY OF T167A RD crtv Im CATION
cATW PLAN CHECK APPEI
COMMUNITY DEVELOPMENT DEPARTMENT O1M00" PLAN CIIECK N :3
13125 S w Hall Blvd.,P.O Box 23397,Tigard,Oregon 972Z3,(503)6394175 PERMIT i! 471 `f 4 D-0 p 1.�—
I DATE ISSUED
XJOB pt
RESS: 5g J a - _�: ''rr� _ TAX MAP/IOT
SUB: XLU I : _�-f- LAND USE _
VALUATION: 7
C►WNf.R _ _ SPECIAL NOTES -� a r�,
NAME: ( t� S A - REISSUE OF: �'T -/D- OV67_
ADDR1 SS LAST REISSUE: _
__•_ ��__1__-_____ FLOOD PLAIN/
SENSI11VL LAND: _
1110 E:
--`T APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME:
�. ' ENGINEERING:
_�- -----
ADDRESS: _ EIRE DEPT _
OTHER:
PHONE.: ITEMS REQUIRED
BUILDERS BOARD #: �- _. EXP DATE: ` .X-Z1'G LIST/SUBCONTRACTORS:
BUS TAX: _
ARCH/ENGINEER CALCULAI-IONS:
NAME : _ � TRUSS DETAILS:
ADDRESS: -�— OTHER: _ —
PHONE:
cOMME N TS:
SUBCONI RACTORS: PLUMB: / 1 l _„- MECH:
PERMIT # ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
IG- 432 00 Building Permit Fees
_ 10-431 00 Plumbing Permit Fees -+ j 7,
10- 431 01 Mechanical Permit Fees ?7. 3UEi
10-230 01 State Building Tax (5%)
Building zi—14-J-—
Plumbing
Mech
10 -433 00 Plans Check Fee
i
Building --41
_
P 1 umb i rig _-_
Mech j'., 31 _.
30--202 00 Sever Connection
3a-444 00 Sewer Inspection
51-448 00 Street System Dev Charge 0DC)
52 449 00 Parks System Dev Charge (oDC) 5�
31-450 00 Storm Drainage Syst: Dev Chig (SSDC)
10-230 06 fire
1 1uTAI_
l� R f C: N �_
APPRAN SIGNA111RE
Received By: _ ,1 Date Received:
cn/3587P/18P /
11i t i MR WX W1 aw RR
CITY OF TIGA R®
c►►!ornow PLAN CHECK APPLICATION
COMMUNITY .EVELOPMENT DEPARTMENT o PLAN CHECK N _ 2 — -5
13125 S.W.Hall Blvd-P U Box 29397,Tigard,Oiegm 97229,(W31,639-4175 .. PE RMIT N [?1 sl`- 9rl— o2 S 7
�9v V DATE ISSUED
,)(JOB �t RESS: _ �J `^' ��"� TAX MAP/LOT S
SUB: --)(LOT. _ _ _ LAND USE
/VALUATION:
OWNER 1 1 SPECIAL NOTES
REISSUE OF:
NAME:
ADDRESS: _ L _ LAST REISSUE:
-6n-7 _ FLOOD PLAIN/
� �_.�
PHONE —���-- —. ..—
SENSIIIVE LAND:
APPROVALS REQUIRED_
CONTRACTOR PLANNING:
NAME: ENGINEERING:
ADDRESS: FIRE DEPT
OTHER:
PHONE: — ITEMS REQUIRED
BUILDERS BOARD N: EXP DATE: LIST/SUBCONTRACTORS:
BUS TAX:
ARCH/E:NGINEER CALCULATIONS:
TRUSS DETAILS:
ADDRESS: y OTHER: ^—
PHONE
COMMENTS: --------
SUBCONTRACTORS: PLUMB: ir>�.[��� P46• 3 '/� ' 9/ MECN: C �ijl /U 2 pe
PERMIT N ACCTN DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
711 ' �u_v7.5� 1(► 432 00 Building Permit Fees " _
_ 1C, 431 00 Plumbing Permit Fees ✓
10 431 01 Mechanical Permit Fees e
10-230 01 State Building Tax (5%) ✓ 10
Building / 7
Plumyirig -17'.�,c, ✓
Mech �4S „1-� i.y�- _
10-433 00 Plans Cheek Fee ✓ ✓ � � �..:. ) � (O,'� r�A �
Building
Plumbing
Mech �_�"
7 . U/ .7 30-202 00 Sewor Connection ✓ /.L5 ' F
30-444 00 Sewer Inspection
51 -448 00 Street System Dev Charge (SDC) ✓ ,� —4�oc'
52- 449 00 Parks System Dev Charge (PDC.) ✓ 1� '. '
31--450 00 Storm Drainage Syst Dev CF,rg (SSDC)
10--230 06 Fire
TOTAL
R( C N J
APP t 'AN SIGNATURE
Received By: _ _ D;,te Received:
,-n/3507P/18P
/ (mAnINGIFTOSION CON]'1 01, INE010- /1'1'1()fV
GENERAL CONTRACTOR NAME& ADDRESS: CASEFIL.E NO.:
I ..•c PERMIT NO.:
l
g r b 4A t'�o a� --- APPLICANT NAME.AND ADDRESS:
EXCAVA11ONCONT'RACTOR
NAME&ADDRESS: O t
_ OWNER NAME AND ADDRESS:
`'il�yL1E _
TT-IX-.PHONE NUMBERS:
APPLICANT: l(f,-- Cvll`]7 PROPERTY DESCRIPTION:
OWNER; [ fI I C - &'0 / ' STR:1 j A�D SS ND ROSS STRE 'A D s,GENERAL.CONTRAC`10R: �:- L� ';
EXCAVATION CON'TRACT'OR:_f g _ n4 2 U -
STIE/1013:
LEGAL DESCRIPTION:
24 IIWAITER HOURS EMERGENCY 'TAX LOT NO.:
CO ''ACI'PERSON,''TYLE,TEL.EPI ION E: 1/4 SECTION:
Q,1Y SITE SIZE,ACRES:
DISTURBED/WORK AREA,ACRES:
LOCATION& ADDRESS WHERE SPOILS
LEAVINO SITE WILL BE TAKfiN Sill-: RVINQIT DRAINS TO:(CIRCLE ONE)
(NO FE:PtxMrls MAY BE RIiQU1RED) CATCH BASIN DITCH PIPE CREEK
(CIRCLEONE) PRIVAJI PkOPERTY
( uO1,LC RIC,I1TOFW
L-RQi_IQN/SI INIEN•I'AI'loN LON'Fit01, (ESC MUMUM
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DI JRING CONSTRI1(- ION: FOLLOWING CONSTTlucTION:
SED1MUNTATION FACILTI IC•S Sl ABILIZF.EXPOSED SURFACE
STABILIZI.1)CONS•IRIX-FION EN11?ANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMEl1:R R1)NOITCON-114(1. FACILITIES
CLEARING AND GRADING RFS TRI('1 TONS CLEAN AND REMOVE ALL SILT AND DF.RRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCIION SEQUENCE OITIER
OTHER -- _
PLAN FOR EROSION CONTROL.PREPARED ANI)SUBMITIED IN ACCORDANCE WITH'TECIINICAI.GUIDANCE IIANDB(X)K".
EROSION CON'E'ROI.PLAN DRAWING,AS RCQ111RF.D,BAS PIAN CONSTRUCTION N(TTE.S COMPLETE.INCLUDING EMERGENCY
PHONE:NUMBER, SC IlLIJULUPWAGING[-OR INSTALI_A'I ION AND REMOVAL OF EROSION C.'ONT•ROL MEiASORES,ANI)
APPLICABLE.Sl ANDARD N(YTES.
E HAVE RF�AD ANE)WILL COMPLY WITII THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT'ON 1.1IF CONSTRUCTION SITE.
i OWNERTUR1: APPLI AN ,NATURE
0T ICI A!.IISEONLY,
RI?CETT'1' DA11? ACCI VITD
Il !. NUMBER RECEIVED ItY