11600 SW 91ST AVENUE i
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CITY OF TIGARD �
f;M OF WCA RD
COMMUNrTY DEVElOPMENT DEPARTMFXT oaEoan
13125 SW Hall Blvd. P.O.Box 23397,TigwJ,Oregon 97223 (503)SW A 175 BUILDING PERMIT
-'ERM,[T V
DATE ISSUEDi Q16/11/92
Si I 1"h q 1)T.)R E
Qt SW 9 1
57 AV
SUbD I V I G I ON. . . . CHAREAEN ZONING: R-4. 5
. . . . . . . . . . . LOT. . . . . . . . . . . . .
RE I"-',SUE FLOOR EXIERIOP AALL C-ONSTRUC1 .101
CLASS OF WORK. :NEW FIRST. . . . . sf N: S: E: W.
I YPE OF Ul:)L. . . :Ar-6 S E C 0 N D. . . : sf PfROTE(_-T OPENINGS?---
TYPE OF CONS'[. '5N THIRD. . . . . sf N: S.- E: W:
OCCUPPNCY GRP. :R3 TOTAL - ----: lb S-f ROOF- CONST: F I P 1"-' RE'T?
OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOR. : HT. :8 ft GARAGE. . . : 128 Sf OC GU !.-.)EP. RATED.,
BSMT?: MEZZ"). REOD SETBACKS---- REOUI
FLOOR LOAD. . . . : PS I- L V_'Fr-Fj f t RGHT: f is FIR SPKL- f:MOR, PET.
DWELLIN6 UNITS: FRNt :26 ft REAR:60 ft FIR ALRM: HNDICP AM
BEORM6: LIAT14S IMP 5URFACE: PRO CARO: Pw')RKING:
VALUE. $: 1222
Remarks : CARPORT-- IL`6 SO FT DETACHED
----------------- FEES
11. VELL t Y f"C! i�mol.knt by date r'ec!pt
11600 SW 91ST AVE PRMT $ 25. 00 JLH 1216/121/92 228296
PL C K t 16. 25 JLH 06/ 10/92
TIGARD OR 97.--_'P4 5PCT $ 1. 25 JLH 06/10/9,D 228,2C)6
Phone #1 639-13190
U0T)tv'RC2tQ1-! - --------____--_-..._____-.__-__
OWNER
I-vie 4: $ 4.' !7JO TOTAL
'eg #. . : 00000
RFOUIRED INSF ELTIONS
This versit is issued cu'l'iect to the relyflations rortained in the F�-ant/fmm
tcl Insp ...........
iyard Municipi.1 Code. State of Ore. *cialty Codes and all other F-i,amiriq Insp
applicable lay. All work will be done in accordance with Final Inspection
approved plans. Th•.s pfroit will expire if work is not started
within 180 drys of issuance, or it voork is 9uspendid for Bore
06n 160 days.
v.
i t t ee
111 T5'5'..teLj 0Y .
(A-Al. L f,:j) insnectiun 639--4175
1 lllb SW hall BNd.
PLNCK/RECT #
_
%4---"I-TY OF T�_O�►.R D 1O[lox 23397 PERMIT # upp I CLL22 --
COMMUNITY DEVELOPMENT DEPARTMENT lig.:-d,Oregon 97123
(,103)639-4171 DATE ISSUED
�J� !/� TAX MAP/LOTL
JOB ADDRESS: _/��Q� • ��� -- — — —
SUR: 'I G' - LOT: LAND USE:
VALUATION:
OWNER /) SPECIAL NOTES
NAME: _ �-'� � �.�_ REISSUE OF: _
ADDRESS: ��Gt� �� (XJ� `7��'� . LAST REISSUE:
FLOOD PLAIN/
PHONE: % " l SENSITIVE LAND:
CONTRACTOR n APPROVALS REQUIRED �
NAME: PLANNING:
ADDRESS: ENGINEERING:
FIRE WIT: —
PHONE: OTHER:
CONTR. BOARD #: _-- ,�-- `XP DATE: —
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: _-__— BUS TAX:
ARCH/-NGINEER CALCULATIONS:
NAME: -- -___.__ TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLP13. USE: - A),r—Fr,'T ----
COMMENTS:
:,PPLICANT SIGNATURE
Received By: �,,/� Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
j . d/1L. 10-432 00 Building Permit Fees -
10-431 00 Plumbing Permit Fees -- -
10-431 01 Mechanical Permit Fees — —
10-230 01 State Building Tax (5%) 2-
= - —
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee k-1
Building
Plumbing
Mechanical
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
25-448-03 office TIF fees -
25-448-01 Residential Traffic Fees — --
25--448-05 Mass Transi'. TIF Fees -
52-449 00 Parks System ;)ev Charge (PDC) _
3I-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
;L
24-445-01 Water Quality (Fee in lieu oft _
24-445-02 Water Quantity (Fee in lieu of)
J
G]
-
TOTAL
'
i
nm/3587P.Wl'i
w '
CITY Or T t,GARD _. REf.k.rPT OF PnYIhE'NT RFCFIAT 1\10.
CHECK AMC UNT 50
N(WE CASH AMOUNT 0. 1710
ADD PES EI 11600 5.;W 910T nV17 PAYME V DATE:
0unr�:csl��r'1
I-I UARD, LIP 9722-3-
► UkPCIS4: OF' PPYML`:Nr (4MOUNT PAID E�liFPOGE: OF PAYMI.NT AMOUNT PAID
AU 1 L..ll I Nl3 CSE:E?r4 25. 00 PI.AN CHEUK FE:
ST. BUILD PEP 1. 25
CARPOPT
TOTAL, AMOUNT PAID _ _ .._ - y 42. 50
INSPELTION NOTICE
City of Tigard B+cilding Department.
13125 SR Sall Blvd. Tigard, uregon 97223
Inspection Line .(ReC-D-Phone)t 619-4175 Bveiness Phone: 639-4171
Inspection:__
;-oti.ng Plbg. Underslab Mach. Rough-in Appr/Sdwlk
pound. Plbq. Top Out Gan Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
nost;Beam 11oc:h. Rain Drain Insulation -Plumb.
Pl.bg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requestehr�— ,Time: AM PM
Address;//d C�L1j c✓ ii" .s T _ Permit i:�� O/
Builder:_
TRE FOLLOWING CORRECTIONS ARE REQUIREDs
G
Inspectors__� _ _ Dates O —3-9
f APPROVED nISAPPROVRD ABPPAYM SUSINCT TO ROM
Call ^or Reinap.
INSPECTION NOTICE
City of Tigard Building Departvent
13125 SW hall Blvd. Tigard, Oregon 97223
Irerection Line •(Ftec-o-Phone: 639-4175 Business Phone: 639-4171
i
Inspect ion: /'7 _—_
ootirtg Plbg. nderslab Mech. Rouah-in Appr/St:wlk
Found. Plbg. Top Out Gan Line FINALS
Post/Beam Struct. San. Sewer Framing •3ldg.
Post/Beam Mech. Rain Drain insulation -Plumb.
Plbg. Underfloor /Water Line Gyp. Bd. -Hech.y
Date Requested: Times _ AN"�"" PM
/ S �/�jj
Address t �� j / I+gTfnk t t
Builder: / �(���
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
F-
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IbNpwtors Dates
y APPSOM Cts"PROM APPRONRD NOB.1=CP TO ABOVS
Call For Reinsp.
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Permit No:
� Sf
Address:
N z Issued by:______ _ Date: // Z
___FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES �I
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who ars not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under URS 701.010(1), i,:,ed not sibmit this statement. This statement will be
filed with the permit.
Fill in the applicable blanks, and initial hexes 1 and 2, and either bo: 3A or 313:
1 . 1 I own, reside in, or will res de in the completed structure.
2. E _ I I understand that I must register as a construction contracto- if the structure is sold
or offered `.or sale before or upon completion.
3. AJ f - 1 F iy general contractor is -
Contractor registration number
I will instruct mYgeneral contractor :hat all ,;ubcontractors who work on the struc-
tore must he registered with the Construction Contractors Board.
OR
3. B. I will be my owr general contractor.
If I hire subcontractors, I will hire only subcontracto -gistered with the Construc-
tion Contractors Eoard. If I change my mind and i general contractor. I will
contract with a contractor who is registered with th fiction Contractors Boaid
and I will immediately notify the office issuing this uooding permit of the name of
the contractor.
1 hereby certify that the above information is correct arid that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities kill the
reverse side of this form
Permit A cant Date
Signature of F er pp
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY r0 ISSUING AGENCY PERMIT FILE
PINK COPY TC, APPLICANT