11403 SW 90TH AVENUE-1 i
L11IJ3 5W 9Uth AVENUE
CITYOFTIGARD 1A
OF TWA PD
COMMUNITY DEVELOPMENT DEPARTMENT CM ORI
13125 SN'NYII Blvd. P.O-Box 23397,Tigard,Oregrin 97223 (603)839 4175
`r.1 E`.ICJ IN.
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LC{C)R LOAD. . .Jt:Remarks : PA-1-k-! 1?�
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CITY OF TIGA RD
OF T16ARD
COMMUNITY DEVELOPMENT DEPARTMENT �rcdOREGON /I
13126 SW►WI Bhn1. P.O.Box 23397,Tigard,Oregon 972,:3 (603)8,"I 7S
� :s ADVI1Cd@t agrees to :empiy with all the ruler and egjIetiary 4,er t lir ,��w( t i r
-f the Unified Sewage Agency, T"e hermit pkci-ps IAA days frog
the date issued. The total aaaant t.aia 0111l he tcTfe►ted of the
nt�,eit eypires, The Pgency does riot g+..tarantee the accuracy rf the
�icie sewer laterals. If the sewer 1s not Iocated at the meas,remen�
given, the installer shall oroscect I feet in ail r.re;:-tion` from
the distance given. IF rot so located, the inst hail purchase
"Tan and Side Sewee" Permit and the ry l• .tali a latRr•al,
A ,
131 u 25 SW II, Blvd PLNCK/RECT � � ��� 3�
CITY O1' 1 ItJt- RD roBox 13397 PERMIT #
TiVKA oresm 97713
COMMUNITY D[;VisC.OI'MGNT DEPARTMENT
(So,)63"171 DATE ISSUED —.
3
JOB ADDRESS: __ � Tb ` TAX MAP/LOT !S
SUB: 'l/l�.4c�i�IP LLQ LOT: > rN ' ,•' LAND USE:
VALUAT I ON:
OWNER SPECIAL NOTES
I� I REISSUE OF:
NAME: ^„ .�!{ -
LAST REISSUE:
FLOOD PLAIN/
SHONE: v � �_ SENSITIVE LAND: _
CONTRACTOR APPROVALS RE UO IRED
J
PLANNING: -
NAME: � -- —
ADDRESS: ����%�' i ` ENGINEERING:
FIRE DEPT: —
PHONE: ----- 4OTHER:
CONTR. BOARD #: �r EXP DATE: _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: Lek � ` "'�' LIST/SUBCONTRACTORS:
MECH: � ^� 'C =� � rZ1 BUS TAX:
RCH ENG%NEER CALCULATIONS:
NAME: `� � r7 fair'{' ` TRUSS DETAILS: — --
ADDRESS: _ OTHER:
PROPOSED BLDG. USE: 'err'► C �' ''' '_-T -r`—`-e-
COMMENTS: '11 14
__ *IN
APPLIj ARE
Received By:
Date Received:, ---
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Perir.it Fees `r•S� — ''�' ''
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical ?ermit Fees -� .�— �
10-230 01 State Building Tax (5%)
Building Zc'
P1 umbi ng
Mecharical
r
10-433 00 Plans Check Fee
Bui ldivg & - }~
Plumbing
Mechanical
1
10-230 06 Fire —
,5a' 42-021k-30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-C4 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
r
25-448-01 Residential Traffic Fees 12
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC) w _ ��•'
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 "Z,3
nm/3587i'.W1'F
TIGARDCITY OF
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171
INSPECTION NOTIcz
City of Tigard Building Department
13125 SK Ball Blvd. Tigard, Oregon 97223
IneFection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: !
Footing Plbg. Underslab Mech. Rough- n Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL-
Post/Beam Struct. San. Sewer Framing =-Eldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Nech. 1
Date Reques/tedt_ -� _Time: AM /PM
Address:_1 �� [,/ Permit it��
Builder:
THE FOLLOWING CORRECTIONC ARE REQUIRED:
Inspector:__ "� nates
APPRUVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE
Call For Rrinsp.