14955 SW 92ND AVENUE 'y
--14955 SW 92ND AVENUE -
OF
„y
INSPECTION NOTICE
City of Tigard 0?wilding Department
F O Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Ir,spr;cti,3n
----------
Date Requested 'T G Time A.M.r• P.M.
Address Per it # —_
Owner _ Lot # 01
BuilderThe following Buil g ode defieieneiej are required to be corrected
r-tJAZI 1WJCLJ +
_ .� -- --
Ur f
?resented to &pplowd
I
Inspector FJ Dbapproved
Date _ ��" O
CALL FOR REINSPECTION
@)YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —_ v
Date Requested Time A.M. P.M.
Address 1-��5 h Permit
Owner __ Lot #E _
Builder -"�" - A '+-r �'�✓
The following•Buil nj de defici cies are required to be corrected:
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Inspector I [] Disapproved
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CALL RFINSPECTtON
! AVF8 ❑ NO '
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CITYOFTIFAIM, CERTIFICATE: OF
OCCtJPANC:Y
C"OFTWID PERMIT 1l. . . . . . . .. MST90"0061
COMMUNMY MRIEL.OPMENT DEPART49M MOON
13125 SW HmH BWd P.O.Bane 2M97 Oetki,Oregon 97223(6W)639-4175 DATE I S S U IE:D a 09/17/90
SIFE ADDRESS. . . a 14955 SW 92ND AVEPARC'E:l..a 2SJ.11AC --W436H
SUBDIVISION. . . . & L..AUNALYNDA PARK ZONTNOa R-4.5
PLOCK. . . . . . . . . . a LOT. . .
CLASS OF WORK. :NEW
TYPE OF' USE. . . a SF
OCCUPANCY QRP. aR3
OCCUPANCY L..OAD a
TF-NANT NAME.:— . a
Rem arkm a
Owneri
DFNNIS SWAFFORD
Phone! Na
(::contractor:
OWNER/CON T ROCTOR
Phone Ha
Peep 14— m a OWNf~R
Occupancy of the above relferanc.ed building J % heRyeby given, avid certifies
the1• COMPIiane:e with the State Of O-oagon :;peci.alty Cvdem for the group,
Or_re.epancy, and use under which the retereenced pe-rmit was issued.
FIRE DEPARTMENT DU.II.DING INSPECTgR
PUIL.DING RFFICW
POST IN (.:ON9PT(JJ0Ua F'I.AcE
IYir WIwo wIvr w
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection �j �-
Date Requested / -�� Time A.M. P.M.
Address �-.� h _ Permit # -
Owner -------._ Lot
Builder _-
The following BuiI4,Z Code deficiencies are required to be corrected:
Presented to
Inspector Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
(i/ a1
INSPECTION NOTICE l
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection --
Date Requestedmoi �Q�1li Time A.M. P.M.
Address /`/�/T ____ /� h Permit # tGS1—
Owner __ _ Lot # :3
Builder CIL,
The following Building (code deficiencies are required to be corrected:
— ----L —
1
Presented topproved
Inspector �-� _ _ Disapproved
Dated
CALL FOR RLI P/"CTION
YFEa O
� i>t � ■I[ R1r s mr �' ■�
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection _ P M
Date Requested
— Time A.M.
Permit
Address
Lot #
Owner —
Builder
The following Bu Code deficiencies are required to be correct d:
u_ V
V,
.. 2
-
�
pproved
Presented to
[ D sapproved
Inspector
Date —
CALL EQR REINSPECTION
�] Et ❑ NO
APPLICATION — STREET IMPROVEMENT/EXCAVATION COPY TO;
(WHITE)-FILE
ORDINANCE NO. 74-14 (YELLOW)-INSP.
(INSTRUCTIONSON SEPARATE SHEET) (PINK)-OTHER AGENCY t `- 1
(BLUE)-APPLICANT
APPROVED APPLICATION NO.: 11R
NOT APPROVED ❑ CITY OF IIGARD, OREGON FEE AMT. S ��•`�`'�
PENDING FEE. PMT. ❑ CITY Y HALL. RECEIPT NO.:
PENDING SECURITY ❑ PUBL IC WORKS DEPA R TMEN T BY J`-•'�_ DATE OLIJ, /-'= Oa
PENDING AGENCY 'OK" ❑ Application and Progv-ss Rccord -
MAINTENANCE BOND M__
PENDING INFORMATION (:1 FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE.
PERMIT NO.: DATE ISSUED: --- -__ �_ . - �.__ BY. -------
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL_ _ L 1 _1 .'(. '..1• '�' ( 1T�;u11���
—_ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT l.'F_tJt�l� In�F1F G '• I ice ,: � , C
ADD . 1C���
NAME f
T
' tRE53 --"._—.._.—.-------- - - -- -- CITY TY HON
i �
CONTRACTOR -- �LIc c;E j 1_ L)1�•, `\',
NAME ADDRESS CITY - PHONE
PLANS BY
NAME ADDRESS CITY _ - - PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): S
DOLLARS
FOR ORFICE USE: "MIN.
(2) EXCAVATION DATA: 0.04 X S_ —=s ' 0
STREET DESCRIPTION PROGRESS &_INSPECTION STATUS
NAME SURFACE CUT CUTCUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM Q QUANTITY
STREET
-OPENED
INSPEC-
-� R TION
E
Q
ESTIMATED STREET OPENING DATE: / / E
/ i / ( T — -----
ESTIMATED STREET CLOSING DATE: - � g
D
__ --- --
(3) SECURITY NO. ___ SECURITY AMT: S J _L1 0. STREETi:LOSED
SURETY CO : FINAL -
rRTIFIFD CHECK CASHH O noND t INSPEC. ,
__-- - _.�-f-STY z --. _.--�
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS / CONDITIONS
FEATURES, EXCAVATION LOCATION AND EXTENT. T
"-r-4
—
) I 1 I
ri 1 ,
I I I
- —
URB
t_ r �
(5) NOTE THE CITY OF TIGARD DOES NOT. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WA3HINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL. PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK. AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE '� DATE / /
Or r WWMW-
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection txv
Date Requested `7'—`7" �f Time.,ZA.M. P.M.
Address _— L A,cL
���, � Permit *.ie)
Owner —, _ Lot #
Builder
The following Builds g-Code deficiencies are required d to 5e corrected:
i
1
Presented to �J � Approved r
Inspector — [ Disapproved
Date
CALL FOR REINSPECTION
❑ YEs; 0 No
ff r FW
CITYOFTIOARD cnYOFn�Aifl
COMMUNITY DEVELOPMENT DEPARTMENT oa>coee
13125 SW Ndl RkKL P.O.BOK 2]39(7.rpud.ONOW 97223(5(13)63s4 175
CITY OF TIGARD - BUILDING PERMIT
PERMIT . . . . . . . : MST90-0061
PRIM. PEPMIT J. . . MET90-0061
DATE ISSUED: 03/06/90
ITE ADDRESS. . . : 14955 SW 92ND AVE PARCEL: 2S111AC-04300
JBDIVISION. . .. : LAUNALYNDA PARK ZONING: R-4.5
LOCK.. . . .. .. . . . LOT. . .. . . . . . . . . . :11
---------------------------------------------------------------------------------
&ISSUE: FLOOR AREAS---------- EXTERIOR WALL CONSTRUCTION-
LASS OF WORK. :NEW FIRST. . .. :1536 of N: S: E: W:
TYPE OF USE. . . :SF SECOND. . . : of PROTECT OPENINGS?----------
fPE OF CONST. :5N THIRD. . . . : of N: S: E: W:
'.CUPANCY GRP. :R3 TOTAL-------:1536 of ROOF CONST: FIRE. RET?:
::CUPANCY LOAD: BASEMENT. : of AREA SEP.- RATED:
rOR. :l HT. :18 ft GARAGE. . . :470 s OCCU SEP. RATED:
iMT?: MEZZ?:0 REQD SETBACKS--------- REQUIRED-------------------
"R LOAD. . . . :40 psf LEFT:15 ft RGHT:5 ft FIR SPKL: SMOK DET. . :Y
BELLING UNITS:1 FRNT:20 ft REAR:15 ft FIR ALRM: HNDICP ACC:
3DRMS:3 BATHS:2 IMP SURFACE: PRO CORR: PARKING:
imarks:
oner: ----•-------------------------------- ---------------- FEES --•------------
4NNIS SWAFFGRD type amount by date recpt
1351 SW INVERURIE ST PAYM $ 100.00 JLH 02/14/90 107348
PRMT $ 352.00
1KE OSWEGO OG 97034 PLCK $ 228.80
lone #: 625-5562 5PCT $ 17.60
STDG $ 600.00
3ntractor- ----------------------------- SSDC $ 250.00
OWNER/CONTRACTOR +' PARK $ 250.00
PAYM $ 1598.40 JLH 03/06/90
------------------------------------
none !: $ 1698.40 TOTAL
?g #. . : OWNER
------- REQUIRED INSPECTIONS -------
nio permit in issued subject to the regulations contained in the Foot/found Insp Water
igard Municipal Code, State of Ore. Specialty Codes and all other_ Post/Beam Inep Appr/
pplicabl.e laws. All work will be done in accordance with Plm/undslab Inop Final
pproved plans. This permit will expire if work is not started Mechanical Inep
Ithin 180 days of issuance, or if work 1.9 suspended for more Plm top-out Inep
nan 180 days. Framing Inep
Fireplace Insp
Gas Line Insp TT_`
Insulation Inep _
ermittee Signature: _- �^ - Gyp Board Inup
Sewer Inep
sued By: _ -_ Rain drain Insp
Call for inspection - 639-4175
CITYOFTIFARD LN WER
CIiYOFT16A
COMMUNITY DEVELOPMENT DEPARTMENT oe";Orco ECTION
13125 SW Hall Shed.P.O.Boot 23397,Tgiud.0,+9*ANP&3 t5M16394175 RMI T
--bag-4171--- - -- -aGWR90 0068 _ --
PRIM. PERMIT i . : MST90-0061
DATLO. ISSUED: 03/06/90
;ITE ADDRESS. . . : 14955 SW 92ND AVE PARCEL: 2S111.AC-04300
;UBDIVISION. . . : LAUNALYNDA PARK ZONING: R-4.5
IIAXK. . . . . . . . . . . LOT. . . . . . . . . . . . . :11
------------------------------------•------
.'ENANT NAME. . . . . .
ISA NO. . . .. . . . . . :40475 FIXTURE UNITS. . . :
!LASS OF WORK. . . :NEW DWELLING UNITS. . :1
'YPE OF USE. . . . . :SF NO. OF BUILDINGS:1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . : :of
remarks:
timer: ------------------------------------- --------------•--------•- ----------- ----- FEES
TENNIS SWAFFORD type amr,unt by date recpt
6351 SW INVERURIE ST PRMT $ 1250.00
INSP $ 35.00
JAKE OSWEGO OG 97034 PAYM $ 1285.00 JA 03/06/90
'hone #: 625-5562
:ontractor: -------------------------------
OWNER/CONTRACTOR
------- ----------------
� -------------
'hone #:
$ 1285.00 TOTAL
teg M. . : OWNER
------- REQUIRED INSPECTIONS
'his Applicant agrees to comply with all the rules and regulations Sewer Inspecti-
)f the Unified Sewage Agency. The permit expires 1.20 days from _
.he date issued. The total amount paid will be forfeited if the
rermit expires. The Agency does not guarantee the accuracy of the _ r
ride newer laterals. If the sewer is not located at the measurement -
liven, the installer shall prospect 3 feet in all directions from
:he distance given. If not so located, the installer shall purchase —
r "Tap and Side Sewer" Permit and the Agency will install a lateral. �-
'ermittee Signature: --
slued By: -
Call for inspection - 639-4175
CITYOF TIFARD CRYOF IC
AL
COMMUNITY DEVELOPMENT DEPARTMENT 02t*ON P IT
13125 SN HaltBMi P.O.Bar 23397.TWd.Ore"IPM(503)639-4175 ... ; MEC90-0039
- PRIM. —PERMIT-fie MST90-0061 ---__--_------
DATE ISSUED: 03/06/90
ITE ADDRESS. . . : 14955 SW 92ND AVE PARCEL: 2S111.AC-04300
;UBDIVISION. . . . : LAUNALYNDA PARK ZONING: R-4.5
;LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :11
---------------------------------------------------------------------------------
'LASS OF WORK. . :NEW FLOOR FURN. . . . : EVAP COOLERS:
'YPE OF USE. . . . :SF UNIT HEATERS. . : VENT PANS. . . :3
1CCUPANCY GRP. . :R3 VENTS W/O APPL: VENT SYSTEMS:
:TORICS. . . . . . . . :1 BOILERS/COMPRESSORS HOODS. . . . . . . :1
'UEL TYPES------------ 0-3 HP. . . . : DOMES. INCIN:
/GAS/ / / AHh. . -. C.OMML. INCIN:
iAX INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
'IRE DAMPERS?. . : 30-50 HP. . . . : WOODSTOVES. . :
.AS PRESSURE. . . :L 50+ HP. . . . : CLO DRYERS. . :
10. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. :1
'URN < 100K BTU:1 <= 10000 cfm: GAS OUTLETS. :l
'URN >=100K BTU: > 10000 cfm:
remarks:
)wner: ----------------------------------•- ----------------- FEES -----•---------
,ENNIS SWAFFORD type amount by date recpt
6351 SW INVERURIE ST PRMT $ 36.00
PLCK $ 9.00
.AKE OSWEGO OG 97034 5PCT $ .1.80
'hone /: 625-5562 PAYM $ 46.80 JLH 03/06/90
'ontractor: -------------------------
'ACIFIC HEATING & AIR COND
647 SW HUBER ST
'ORTI.AND OR 9721.9 --•-------------------•--------•--------
hone #: 5032444623 $ 46.80 TOTAL
teg /. . : 2221
------- REQUIRED INSPECTIONS -------
'his permit is issued subject to the regulations contained in the Gas Line Insp
'igard Municipal. Code, State of Ore. Specialty Codes and all other Mechanical. insp
applicable laws. All work will be done in accordance with Final Inspectiol
1pproved plans. 'Phis permit will expire if work is not started _
:ithin 180 days of issuance, or if work is suspended for more _ y
.han 180 days.
lermittee Signature: —
:sued By: ----------- --- —
Call for inspection - 639-4175
PLUMBING PERMIT
PERMIT #. . . . . . . : PLM90-0025
xxxx PRIM. PERMIT t. : MST90-0061
639-4171 DATE ISSUED: 03/06/90
;ITE ADDRESS. . . : 14955 SW 92ND A%''r PARCEL: 2S111AC-04300
:UBDIVISION. . . . : LAUNALYNDA PARR ZONING: R-4.5
iLOCK. ... ... . . . . LOT. .. . . . . . . . . . . :11
-------------------------------------------------------------------------------
:LASS OF WORK. .:NEW GARBAGE DISPOSALS. . :1 MOBILE HOME SPACES. :
'YPE OF USE. . . . :SF WASHING MACH. . . . . . . :1 BACKFLOW PREVNTRS. . :
)CCUPANCY GRP. .:R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . .
;TORIES... .. . .. :1 WATER HEATERS. . . . . . :1 CATCH BASINS. . . . . . . :
'IXTURES--------------- LAUNDRY TRAYS. . . .. . : SF RAIN DRAINS. . . . . :1
;INKS.. . ..... . .:1 URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . .
.AVATORIES. . ... :2 OTHER FIXTURES. . . . . :
:UB/SHOWERS.. . .:2 SEWER LINE (ft) . . . . :
LATER CLOSETS. . :2 WATER LINE (ft) . . . . :100
ilSPWASHERS. . . . :1 RAIN DRAIN (ft) . . . . :000
remarks:
►wne.r: ---------------------------------- ---------------- FEES --------------
)ENNIS SWAFFORD type amount by date recpt
6351 SW INVERURIE ST PRMT $ 117.50
5PCT $ 5.88
.AKE OSWEGO OG 97034 PAYM $ 123.38 JA 03/06/90
'hone #: 625-5562
!ontractor: -----------------------------
IODERN PLUMBING
'O BOX 23307
'IGARD OR 97223 •------------------------------------
'hone 1: 5036393701 $ 123.38 TOTAL
tag #. . : 181
------- REQUIRED INSPECTIONS -------
'his permit is issued subject to the regulations contained in the Water. Line Insp
'igard Municipal. Code, State of Ore. Specialty Codes and all other Rough-in Insp
applicable laws. All work will be done in accordance with Top-out Insp ��—
►pproved plans. This permit will expire if work is not started Rain Drain Insp
+ithin 180 days of issuance, or if work is suspended for more Final Inspection —_—
han 180 days. Final Inspection
'ermittee Signature:
slued by:
Call for inspection - 639-4175
CITY OF TIGARD RECEIPT OF PAYMENT REC NO: 00107596
CHECI,' AMOUN T s 'M').!58
NAME. ANNE AllAKA CASH AMOUNT t .00
ADDRESS: 16351 SW INVERURIE PAYMENT DATE 97-06-90
LAI:E 05WEGO, OR 9705 FLOCK NO/ADDRt
14955 SW 92ND AVE
PURPO'33E OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PA I E,
----------
BUILDING Fspiivr -"a0-0061 ) 00 PLUMBING PERMIT ('+0-00-39 1 50
MECHANICAL PERM M-0025) 736.00 ::,TATE BUILD PERMIT TAX i5%', ."5.413
r':-HIA GHECI FEE 177.HO SEW;' USA 1.4`0,110
SEWER INSPECION '-5.00 STREET SDC 600.00
00
25n.OC STOFII DRAIN SLIC
VARPS Sf-STEM DEVELOPMENT CH
Pmr*i[TS WILL K PFINTED ANO MAILEP TO OWNH ,'CIJNTFAC TOR
FOrvil- AMOUNT FAIL, 58
CITYOFTIFARD ® (v HECK APPLICATION
7C"Of I1G'4RD PLAN CHECKCOMMf1Ni Y DEVEI-OPMENT DEPARTMENT soa,
»>25sw+4eadP.o.e«zxvV.lj.a.o�.Q0, 9e,MOW)eaa41yc PERMIT I
-- DATE ISSUED
JOB ADrvF9S: 5 <
Gt1 n,( TAX MAP/LOT /_ /J A C
SUB: IAT: LAND USE:
IALUAATION: SS T "" SETBACKS ONT: REAR: LEFT: RIGHT:
R •
J HEIGHT: TOTAL AREA:
USE TYPE: _ FLOOR LOAD: '' _ IST:
CONSTR TYPE: -, .r��... HEAT TYPE: �°�'/_i-. 2Np:
OCCUP GROUP: _�� DWELL/UNITS- 3RD:
OCCUP LOAD: NO BEDRONO OMS:—. _ Bim ;
IMPSSURFACE : -�- NO BATHS: �., GARAGE:
APPROVALS REQ'D SPECIAL NOTES ITEMS_RFA UIRED
PLANNING: REISSUE OF: LIST SUBCONTRACTORS:
ENGINEERING: LAST-REISSUE: BUS TAX:
FIFE DEPT.: FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND.: TRUSS DETAILS: �r
PARKING PLAN:
LANDSCAPE PLAN:
PIAN CHECK BY: OTHER:
COHKENTS:`Lri) 21
PERMIT N ACCT y DESCRIPTION AMO NT AMOUNT PD. BAL. DUC
MS's 9G.0#41 10-432 00 Building Permit Fees
/1),e( s 00 ? 10-431 00 Plumbing Permit Fees f J J, Sv
Pl.fA ^ e4'3S 10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5X) dam$
Building
Plumbing '-'r ✓
Mer_h _ _^ �U ✓
10-433 00 Plans Check Fee 's, �G 1✓U
Building
Plumbing
Mech , o i ✓
30-202 00 Sewer Connection /2 SO
30--444 00 Sewer Inspection
51-440 00 Street System Dew Charge (SOC)
52-449 00 Parks System Dew Charge (PDC)
31--450 OO Storm Drainage Cyst Dew Chrg (ssw,) ._-
10-230 09 TRFD _
10-230 06 Washington County fire M1 (95X)
10-2.20 00 Amart/Wedgewood -—�-
RIC H
APPLICANT SIGNATURE
Received By: Date Rrceived: �U
cn/3587P/19P
I
CITY OF TIGARD • RECEIPT OF Pi'YP1EN1 Rt C NO: 001077,4'
;,HECP AMOUNT : J56.47
I
tJAME: DENNIS F-WAFFORU CASH AMOUNT t .CIO i
M1)rjRFSSv 16351 'W INVE'RURIE ' T PAYMENT DATE : 0L••14-90
LAVE OSWEGO. OR 97074. BL00C ' NO�ADDR:
14955 SW ''?NCS
PURPOIK OF PAYMENT AMOU14T PAID PURPOSE: OF PAYMENT AMOUNT PAID
t'LiaNl CHECK+FEE-4`1O-.'.OR�..____ _.__.._.1 JiJ.4_
l
BALANCE OF PLAN PEVIE14 FOR 1795 'SCJ FT HI)USE
TO i AL. AMOUNT F'N I D - - 1.456.4`
CITY OF TIGARD RECEIPT OF PAYMENT PEC WO: 00107-4B
CHECK AMOUNT I oo'.Z
NAME: DENNIS SWAFFORD CASH AMOUNT CIO
ADDPESS; FAYMENT DATE s 0'., 14-qO
LAKE OSWEGO, OR 970 3 4 BLOCK NO,'ADDF,'t
1AI955 SW 52NO
PURPOSE OF F'AY'MENT AMOUNT PAID PURPOSE CIF' PAYMEW AMOUNT PA I D
PLAN CHED:' FEE (T--2:6 R 100.(10
FFITAI. AMOUNT PAID
CITYOF TIFARD
CrTYOF7WAND PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT °"°°" PLAN CHECK #
13125 S.W Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223,(503)639-4175 PF RMIT #
DATE ISSUED —
JOB ADDRESS✓% `�� �>,s� �- ' ' TAX MAP/LOT ^
L
G / u d
-�
SUB: ZaiA 3 I\IT-,,d L — LOT: _ �� LAND USC:
— AALUAI'ION:
OWNER SPECIAL NOTES
NAME: ``1L_1-411 5 SW A�V06 10 REISSUE OF:
ADDRESS: _ 1! �r,l �,Q Sr1'Jt-Qk3V 1� _��T LAST REISSUE: —`-
--�� FI_000 PLAIN/
_ SENS] ifVE LAND:
PHONE: 01C.✓-1T —
A_PPRO_VAL.S REQUIRED_
CONTRACTOR PLANNING:
NAME: �t't��-AF 1Z1 _ ENGINE..ERING: - - —
ADDRESS: _ FIRE DEPT
OTHER:
PHONE: __— ITEMS REQUIRED
BUILDERS BOARD #: EXP DATE: _ LIST/SUBCONTRACTORS:
BUS TAX: _
ARCH/ENGINEER CALCULAEIONS:
NAME.: _ C,)YJ y AV�L-hj TRUSS DETAILS:
ADDRESS: _ �� pf? 0 - OTHER:
PHONE: `-
COMMENTS:
SUBCONTRACTORS: PLUMB: • D o Ell 0 MECH: ►�4 1� 1 k A t � ►•�L, �L z, � /
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10_.-432 00 Building Permit Fees -39.2
.2i/_3 10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) 17.E Q'7 3F
Building /9./0
Plumbing _
Mech
10-433 00 Plans Check Fee
Building
Plumbing
Mech
Cl:2 (i) 30-202 00 Sewer Connection
30--444 00 Sewer Inspection
51-448 00 Street System Dev Charge (SDC) "
52-449 00 Parks System Dev Charge (PDC) .7
31-450 00 Storm Drainage Syst Dev Chrg (SSDC) ) S ✓
10-230 06 Eire _
TOTAL I
APPLICANT SIGNATURE
Received By: Date Received:
- r
cn/3587P/18P
i • � t R � �
44
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BRACING WOOD TRUSSES: TRUSS PLATE INSTITUTE
COMMENTARY AND RECOMMENDATIONS ` M nofrio Drive,Suite 200
Madison,
n,WI 53719
n.I TRUSS PLATE INSTITUTE,INC.,1978
TM design of wood Irus In.-id—with 111 dw1II while
NowarM cth 101 woad bust an,tlsaMnad aha"t—b 1,NI this 1.T—r•,errlhere wa Inlllally alragbl udlwln in aw—Vi
e al sell q IM TIMI wavibn and bluing al.real d Ilan ml7.
rrh.11 aid unllorm In deep propwlM
at Ihlt c kal IVPs of cenapWllon Ibe.—,of IM,NII,
wplllun'it essumpgna slmw Iu11111M d IpxbM 11'ands., 7 Tluw ars PWM nru[wnl conl{gnM1a,I—.I-Nit vl N.
INTRODUCTION the—sup.mrw mar nwlt i�.-11;—PI In..—Inn.,which N IV—,Tl.—,—
pewnl 41wN mwsmMl and PNN4110 shroI—
hltl II•wlntanflll low of lima Ind mrr*IN1.Ind Much al Mn11 awns I:,M dallpl ensil,
result In u 1MI ul III.
7 till bn we PInnM pmrmine
s1 lt Id dsblron of P.41
In n o nNlon of IM""an,YIHy ole Iwop l"braced rml (M Trues Plate Im1nu11"Oulpl 51,en1uuM1 for Light Meul orcwnthnanly
1Mam,IM alrprMl IKY of 1nowNdgl ul how,rvlu,h,aha wheal Io Pon ConM1:1M Wood TrhMw"we wumrMnW for IM design of Thth1 II conflnully of e1gld rnemMrl al pole Iw dththmlM
x,Nll darWtl bung.s,d ln'ha lmthest nl pubic YlslY IM Trues IMIYldual weotl lruww*rWlural Comporlmle only lien of momMllfrswn
Platy IMlllule,Inc.,m cpnulNlron Mlh 1N Cbmppwnl MMulwlunthe
C Md membramP.Me-4—ken IM d.Met—of I—rearm LIIth II Wlcing.I1 may be neunM br design In awl Mr111rw b.compawbn ni—bene w.4.....1,--nimd m sb co,c urY
rlwrdulom Nrglh of IMrllnuel Iruw mNMw1.II.wrl ul IM wood Iruw detlp tilde d Inlsrval'.
olds II IM only W-N IMI MII b IbNdlld on IM Iruw design
gubstenhal conerminYd nudV end dellbwallH anis bV IM TPI bung, LININ brulry 11 to be eubpllul In IN sl,Nwcllld and B 5wNImpHM dead d IIx load,u,rMlrallY,wird lewd w
THnnkal AdmNry L—mmu Ipmpnlry•membnhlp of the&let nlbd at IM Isogon NHIMd on be buss chop weMryl by IM pPl.rbrm.1 10 IM pons of 11a top choro.wd oust—aud
elrumunel"new.nl rnMhbr Platy menulHtumlP sawlpns,rpra build or wKtbn—lades TM building designee,d mals—mull loads ane aPphM*a—I
esu.—of IM weals,[cemmher,ll Y,and hideparxNnl roneull.N —I—IMI IM fisscllld 41x11 bluing rl pe1N1Y IMI111M and Ins,
wylnwl hm been derO1M to this elfwl Cenultatror,with IM TPI this blaclng rI wllleNnlly anchor.d mtle—by dlagpnet feeclry M t In fai Ib pn la,uel tu—N pwrlued by IM WIN Wwgow,
Cain hwan
bald Nl MMuladu,w,CYIIMII NI Imhd In brlrglig palllul dmnl Ile moMmMl the building dawpth MII N,IIY ublcNnl Wti w r41
Mb4 aha Nu—Wc4 Nml Into a shallow f—Instillation of a g.,to IM Plane el Inn Irutl in MM arwy Iruw ms N,b
IM 1MYpw Iunm—nak 1 ler an-uta Mnd11ry end Mullan 511ec,el design ImW—m win as..no W-N.pool bung, the fgblgn awlrNd In.h In d.,,
poc —II old I,,-Mull of the eonsububM II Is planned to aa_bncrrg,dwpMNms.shear walla,or utl w lo)Ir naw althnmfl 1 71,1 building dwlpin Ilml IM row dsegnwl will NNIIy
ItWYIUNhw Intl MYrN upM mew imlHlH rlmmmlmdNlam and IMIr bnmrflvne to IM woad Iruw mull b ronlldnM uflldmf bHlry end rMmcpone,o Ml'ma,M 4ssl kdlry
while 1M rwmmmwdellnne for Wwin,m I.—Minn w wd soushrnushody'1 bulkllinna le dis,enens, He nabr*ll mP as mine ups lin nes, e11hs Mllrl etruclur.
,.h.-IV Nord,II n mel Intended iMt IN,be enMldthM tie oMY thew I.—D4go sal or C o blurry II rKommw41M In IM pane TM IMo,of bluing r1 in apply ulh,lwn Yrplwt.,r4,l MrpN
mHhod III,bluing a—1 eHNm Ninths,souk IMM n 1-4. Idmd by IM lop chane.In IIw plane ImmM by the bollPm cbwIN m ms plane of MI I,-In MM we,Y Iruw rnemlw,In IM—I.-
tions b InlenM w
rp ' lube-,tow a tlandsM that would necwllrlly and fWplyd—lie,In the Iruw web mwrhbin,se needed Ion IN= _insel hId n m design This,MpY mW I M IPWIM as IMes wary
N"failed In Ilw,u1 an thtbnuv,d mglnal design Ip t—N Iw stability of IM anlns mlmtun Truth bluing eml Wn—on detail'
a PaINUM,rpl 0"'wh Mould M aim on the building dw--I I—."pen w Nn of 1M 1TA11 OME Ounry gu�Mlng Ueslgo end Trues Drip IndMldual Iruw
draw MaMnp a'.."ruin ll en nos uuilly II—abuf.,Wt of —N"we rMe1d Id bW111N and
41Ma1 burry II Nu111d w
Thave—nand bucIngwoMbuwwyineollom IN Ins wood OusePwlage.and should b—Vuod by the Widw d —."adIbr awn fru,—tam, TM hundpg noggin turn Nulty
,nd-he a.-.—nI leading luMkal pNpoM1 In IM word Iruw Nulbn-.11 1. how,IM,Is,—,bwlry d to M eMMrM d rNInInul 1e pawn,
IndWby,but mall.dW Ip IM nei of lucomlblllllw 1—swill,b 41tha1 mewmMt sbuM all Iww membri,N bud.Nrd Iv bu1M
pHenld mIY H a pada Ibr IM uN of a cuelifN building dHIpN. TM blldw d*1alIM conouler Is relpoMMls ler pons ward f IM H shown In f I
MIIPw,n mcllon cnrrb—Thal.IM Trues/I.N IM11w11 Ieps1Y IrvN bMdllnp ens fol Most,Iwnpdwy bluing He mull mum that pls l lbl This may M ucorrwllalwd by
dw41m1 mY reeponwbb'y ler Winery wrong Iron IM rs.pplY 1M wood Iruw*a noI 1lhuwrasly dNwP1d durlrg archin Intl'hN 1.A,kherpl lig blltl Md slh IFgxre Ilcll
Ilp,w n.—MIN nsdnmNM4lbn,and Mhematbn pinllined tI"ere mNmwnM In allgommt ban,du'IN.aha a1M-ville11M
Min by Mlklng tlesgnert nr by*Neem ronbaHpl Twnpdan d NUNon Wu."
may to]'— but sol mess"'M 7 Olepnel awing In ins p4M el wad mwMNw Ilyun I ldll
IIRlled 1.the buildlry dsugnw 1 I—ing pIM 1111 r,bnmwdM tall 1 OIW r M N delHminM br IM bulMlry dead—
IbM billing pa sMIId N soh Iluw 11 PI—d In—mon
2 3
rwalYlw•M,wlr��jr,tl
\rneOlrlwml ww. n \\ �.....�......r...-m.,r
._wwme wwM
fyleg Ilan
fwwms T �—r..n
wenw
filpns Ind
----" PIpN 11e1
1 1 l rI•IIw.' o.rrwM -
1 l 1 xr .•.nn wwxw'
11 11 �_s~ie�• w w...
I —WlrrvllwrY hwr Yw1 —YM !woes
1 � 1 Irwlwr �r� e
I f ar If
.—o�w.rw lar.ww I. 11
j
RrM nw.rrw•wrI•Ir
C.Y I' �-1ete�rNre..r Mew
—waw I.•.. flpN lltll
Flpn Ins Ilpn 11b1
-- 1T1101 TWO During T,uw lrwbon the bulk*on wadbn tmlrwd
II n�wo —W nw1 dwMnwl hnel'�ng Imunmum 71Mh Ih'tl mxas 1111 w1uhm a pruWpenl Io wan 11.1 Ih1 wad I,—thl MI bwhng Irllam depandt 1st a pact is—on Mw well IM Niel buN N
mal Iurnbw1 b Innellod a1 apponmawlr•a,dap*angle le IM "IV ..",demNM Plane,I-gg,N q IWIN IM uN of ueestln bare bncwl
W—I blue Dupml bulk squad M.11. in Iles MpoII's pile ens multiple pull up pointe,~1 reguxd,11 nwil In pawn)
nl IM wine mM,Mr nguWry 41*a1 bails, dMage during NMing tanfaNre-onniNn141wn we pawn'en In on'
YI'llNtnry mwhM r'Id rue Aral Iruw lap c1gM M b brawl)
the Appwdle bthslo (take drlHh ism IM pound and Morel,arkhwM The Iesmd
Tnn prulry mer b cMI1nVPW or mithmulMl al IM bwldlry h,w.e I.n M nuel M upbrxlel w Via—In figure g,It N M N
desgMr'1 0P1—nMNrer,I n rHwn—dtd IMI mlthmNlenl going II n mil ImleurIl l Ip blue 1M lust I,u4•1 IM and of IM bur14 Adillrmel pound ora..In the nluoessN e—all","We Ili
M1..1—g(1 Ml.d N—IM hdwMlal run o11M diagonal bulk bullWng wturely All o1M,I,00m Na 1•b in IM I.,,hr thus IM hu1ldlhg sue awn rKommwdM
0 ! 6
TM p.und Wates d—WI N I—'M d-11,n hue wdh 111 revel p 1Kammwdad IMI Innllnuos,Withal bluing M ImNIfed M'nIn g ur �y�a.w
mo,N d ronllnueW MINI'baring Olh—.,IN lop ngld el IM meow of IM rdp line w[MIN Ima and a1 lamtlna lY 1 Nal Io ID +s—
hip pow w bled wdewew IM show IM Pu1N11n Mltl Tnll dull INI InINY4 be,—1M ring Ism of 11obw.Iruw d tMIN IIM of
InwMr Ofhl,pull a beneand—1l1a1n On all
cennNllonl o1 1M 141 Iruw*and IM N.e1 for dwble nw,Me*Irus1 1M,Ipclng aiI•�.rh 1-�,�-y,
bw.I Ieb—I a,IM Ila*.of 1N buw wWM'hen b ad1}wl to MIwaN,1a1waN may b IrkrelNtl 1st 17 IMI In If INI DlaPpnaN, I-1n1� 7 w
'ng / �..I..�...^.r
Mrd I.-w cohlbunt on lead eurh H Mnd.of
plrwoed p,Mf xtcalM MwaM IM let.,b,Iry and N1*eppommanly fig dalPw
tluryles Ixd1A' cl,N'prw rarer angles norm the Ir Wyk rpu.M Id IlahhhN In m1 plane el IM lap Fr aw•.�•uI
chordNM Nwes
NOT$ Long NIMw y feeds slay r ,l—snaring .�•��
All willrr el bNlry e1quM b dens N)net II IM aisle dquM MIIY1In 41waI bump ens clew,In10na4 M'lrwn d.""""'
lent lv buses w Iv.1M nem will M nuwM W*NN.rel In
esu Mrawal fI31.1 bluing In IM o41r of IN lop
tlwa fillgMN odes
11 I,rol,w:emrne'dd m Mn sue m IM and nlas NN ran 1M blMlry ne 1 ,
base IN Ib "uw T1cahl Mesa ell ur poutull 111nw1ro
ry 11 Possible IN nllnu 1.Wwn1 Wenn,to,1M should
—d wuld
t sal.,tN4eN M o1uM on she u—IIW el IM lap rhwd N Inas d NII neI MN In _
M Iamnwd N IM IllwrbM d*11N u awl b TM buds wt Ilwn MM \ ��
Ae I,uw M b In p,,,Me brrkth or NKIIen rnnpu'or muff will e r awn during 14dii on—
able., -
a11k1M1 Iwnpw NY Masim'e MM the ouw1 plump.In II 1N Mua11Y ?
Nynmw,l aha.n a Nle fwdllxm un111 IM pthmMNn1 bully.Aw11ry, nwNl bNI 'mpw'ant Id ins!u'•I:N Nadbn ca,1l,Klw to
aldlw N1YIMng Nn M xhstal'ed TemwwwY
IN
dquM b roll Nes M In IM p4M ei IM bb rlgrtl Iw liar reel rc Iklor .�
than gag dumMaen IumbN Md squid b es Irr^g N pwlkal ld Iruw TM use el t e1m11M buoy otbaln,l laeomnwrdM 1..11141
Iwldlrry TM IIN nl law,eeeru Prises el 4n(w,Ir—adoNnl pow Ias—hu alwrrllon n tluI[IM In baclry w IN and of ilei IIpN 71b1
h—..
ow n cul nrrm,mwastis unlew ossa Nmpprwuy In plperellM Id 'west x Il,own In Flora JIM ---
ImrMwN Inwll,t-n pl bryw mlmlbul bluing IP les'mwmum IMr-1 el IN wine 1-1—haul d m,M I'll—is pal ler
n1 t--,r MN hasher squad b MINI'N'h Iwo tlolubly 7 *a— pool 11 is alb--,b Iniew 1M ., pthm Mall MNn
le^gf xq ng.ale may b--ball of Inn pima 1 Wwiry 1'
wades Ib Nur al weer mterwulbn Nlh IM WwM mMdM bwlry In 1M pane PI 1M wall m,nbNe Th'.bHlry II uW111 N I.—nus,dad IMI dlspM bwug M MMM of earl•Mab mM.ur
Iwanlry wx I 4Nesl b." II Mn a sou11Nd, II 4
Ile NwmblY el pulp of bow en the ImrM in.ashntu.ally r,pmnwrhdwl1'he'II M o4cw1 a1 M les..lawn Ig Ies1 InN.ra4
unit,whkl
bawd ale IMM1 II
If M Inpl pWcs w—M.IIM .+sw•'Ie•rw►,.,rnln.n•n.•.nn May IN now by'h Iw 1- ,rush ami g Iw1 Innrvais Id I—
aeypwbM IIINMN to IM nM*I oma m*MM ��-r.syr• ur 1 n.r.rl IrrAw 1
y.n
I-,yrelry he— bullas squid b MIn41netl N bluing,, hof Ii.nw.r.l n.n 11 II MI gM1 aneg nelesny I.d dlah,.,Wlbry 1.h inn Ido nu
'Mlel4d Io aMd Int IWerMul pulxl of aril lry bulng N Wilds
fele r ' only Id IM lull 4ry1b of ow hlllldlng b11 n 11 rwaxnlneulwl lNl 1M
apKlng e1 sresiblry n appN,l IMI w of ad11a'Iry WWclry"Nn w IN�.�..., amai bed—MN el dlapnel Mw N MI..awe 7n be,d
awe Iruttll b'oppN II a 1st Mnnwllu Ie,.-.d N IM Nury `t he,Ilwllll ru el IM do*..'ou-4 Flows nl 20stlengbcll
rlml r II.b ueM In blue Now Iruw Mees d-Newsl Irwhng is
Tl-bwnry mud M abplNl m,MN Planes of at.—In Ili / Imwwlkal Fywa Pl41.1 dlusbaNs d40wwl bl.—I.n IM pares o1 IN
wall—le.,Fit—gtb)IIluMes be lelwel--I,M may
.m11Y,Nm Iv marl etIb111Y I.T.than IeslMryl Pa.'7 Mab /I,w+N rt,'w occur Nr.w Muug n ueM wlibwn dial l nMr,
IMmbw pine rc esu Mal pang w MltuW M I.—and 1 hos— wPtg // , •1 I
lewd Irwlingl prM IreeMm,•w M+a 1 1W.—Chard PIM In wan ru MM pnpw aorlrg M MN
rbwd
�w•s wins w. boll—boll— wmuxYY eraexy n o4
.atpmnhen+,an.n nwellsnl rue
I i»11'bNd PM. MPeI MMNNmI 1.the build"w a1Mbn �~.rwN I tixrr ban rrm rnwd cill—,idles..blwug al rig Iss—mal P las,4
ISMgbI N bPalay M e1N/Iww N IIss Np*herd.irIIN IM elealM ale rwwa•w+e to law an—W I e"IN buses swe a rewnwhwu4d lull oNsh w
1M
111MNelM N le"bang beam.they se;bNal 1aw#NOUN 11 N PIMP 11,1 IM bulMlry,nelNd In IN rob of IM bhnm rlwd O1+arW brew,'
7 , A
to
wt'
WWII,
r• m ' f
\ \ `•,m.,.n I � 1 I I __ Ilia..w
_ I � I Aatwlw
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it li I tt w...,•..r...,.......
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! 1 I illpin MN,.
i1F+w 6 P«mINnl I..no mu11 on,""WIIICIxII WppMo.1 rlFhl IMIw lD
its p,I.of IM«7.1.IoM wwr"U.INnlbn In IM ym111un
MauM M PIxw1 M 1M l,uNw In ON en..n,,nfn Neuld b.IM.M o to,11
11 wl Mnlr orll.IxP W.wNto wed owbMlM MY MN 11uM OWWIMdOMmNto lol"
All diNlV;d In MnIM
IIPw 1111 m NOl.l qulDmml lMuM M butts only en IM 1ru11w. On't"t VIM.,
N Ila IIXww
OVV,,Nd lu 1u_.II II MauM MI M drdplad w Mn M1 nmMn Mtly
MMM,Wt..N pINM.t.Pyrwr oliwly./d.W-•[rxemmw,lwl y e11«.• m.w IM Iruw.[x..dqu.N1Y Mw•rM All Iles PxmIMnl brwlnp oat M 1AMIr Ido Inln Ihw IopIc11 nmpe
NO,11w11111y of IM Mtlem e1IXd Dlxpnn MNlnp In tM d.m of IM truYn_I4 MlMgwnly 1nPrM 11 nll.o.PI rr .1 mxxnN w1 molt
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CITY OF TIGARD MECHANICAL PERMIT
Permit b�_
Oce«tptloo - �- �-
T.bla 3A fAechan{eat Code QTY pmcr: AUT
G of Tigard
1312 c S.W.Hall Blvd. 1) PennitFcc — O to—oo
P.O.Box 23397 2) Supplemental Permit 3.00
Tigard.OR 97223 -- —
639-4175
Fumace to 1 oo,00013TU
1) incl-ducts&vents 6.00
2) F-umace 100;000 BTU + 7-50
incl_duds&vents
Name d Developnrerrt 3) Floor F u race 600
irlr:l-vent
Job Aeere= - 4) Suspended heater.wall heater 600
or floor norm-ted boater
Address
LO( p f1a --- Vent not hidL(n 3-00-
TAXlnl BlockSrb6nision
aPP4ar�p��
Name(a name d tx>Qack --- Repair of beating.refrig_ 6.00
cooCrng,absorption twit
ttANnb Aeeross t�M 7) Baler or cone Lo 3 HP 6.00
Ownerabsorp.unit to 100.000 BTU
---— lip 6) "c(or comp to 3 HP-15 I-1P 11.00
absorp.unit to 500.000 BTU -
Boiler or comp 15-30 lip 15.00
Name 9 HT1 urlit.h_1 withal
FRa7.rgAddrers P+one 10) Boller orcomp to30-50lip 22-50
absorp_unit 1-1.75 mllion _
Contractor � -._._ rp — 111 Boilcr or comp to 50 l fP 31.50
atysorp.unit 1,750,000 BTU — -- — ---
Stale negisYafrxr No. cry aa.Tu NO i 2) Air handling unit to 4'50
10,000 C17M
Air(iand(itlg unit 7-50
1 fxxetry ac re%dge Wal 1 have react Otis appfGaliexf chat tlxr irkxrrution owr,a e 13) 10,000 CFM 4
orxreet_WN 1 am rhe owner or avllxxired agent of the owrrer-that ptaru uRx* ted ue in ---- --- --- --`-..--
c-,n .vith S le taws.chat r am regisse.ed wrW rhe`.,dare ov�rfers'noa.d_War OW 14) Non pOcLlble
rpfart» 4-50
"U"tw given is coned.(11 e.enr(A IrOm State registration plot"give reasnn hetes. evaporate coolof -
----- -1 5) Vent(an connected 3.00
— to a single dud --- - -_-- --- �-
- ---- ----- 16) Ventilation systen i not 4.50
included in appliance permit ----- -- - -
------- --- --- - Hood served try 4.50
17� medlanical oxhaust
V-W-I°M"° -*"C,l_ — luft 16) Domestictype 7.50
Describo work C1 addition Cl alteration O repair (Iincineratorto Iw done —residential O non-residential ❑ 19) Commercial or industrial 30.00
type incinerator - — —!-
Cxisting use of
building or properly_ — 20) Other i e.,woodstove.water / 4.50 l
heater,solar,clothes dryers,etc_
Prolx>sod use of -- -- -- -
txrilding or property -_ _ 21) Gas piping one to(our . Ilcls 2.00 J
I ypo of fuel- of O natural gas ❑ LPG ❑ electric ❑
—_ �- 22) More than 4-per outlet
NOTICE J— SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- / Gv
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 160 _—_ _ 5% SURCHARGE v
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL 9 --
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER / U
TOTAL
WORK IS COMMENCED.
Special Conditions . _ _
w w
1.312 5 SW HALI, BLVD.
PLUMBING P RM IT P. o. BOX 23397
A4vlic:ants must hold Chegon Reglstration to conduct a plumbing T T GARD, OR 97223
txnmrss or must tee property owner/operator not hiring outside help. J 03 1 639-4175
Nanus of 0ev-e60pmenl Plumbing Permit No.
Ackkess Oescnption
ORS 814-21810 OUAN. P1110E AMT-
Job Tax ld Map.No. ^- — --—
Address FIXTURES
Lot - Block - SubdMslon Sink ---- --- 7.50
-_.__ ame�narrw-To sr,ess la4atory ---`_— ?i 7.50 7 �+
Tub or T ubrStxYwCf Comb. 1i ?.SO
llaitrny ass -- Shower Or ily 7.50
water t30set --- Z- 7.50
Owner City/State zip - 7
Dishwasher _ 50 •)
---- MOO Gartmge Disposal - 7.50 7i 11
Washing Madlwne / 7.50 7, S'L
Name 7.50
Floor Oram
I�arfing- rens Pfane WalerHeater -- - _ 7.50 7 r
L...
Latxtdry Room Tray - 7.50
Occupant city/State -- zip Urinal _ 7.50
(fitter Fixtures(Spedty) _ - 7.50
7.50
1Taa &J&Oss -'� Phone _--_-'-._ -- -- 7.50
__ ------ __-------------- --- 7.50
Contractor CftylSYr►te - - ----�- -- zip
MISCELLANEOUS
Gus Tax No. Sewer a st 100' 30.00
_ Sewer-ea.Addri.100' 1500
Male ��13oar��To lele�ers--L�us-Tx.l�o. 20.00(desdenGaQ Water Service 1st 100' 20.00 _---
_ 15.00
Water Service ea.Addil�r -
I lwttehy 6cf0x7+4OdQ r that I have r.tert dus appuc-asom aul a1s ktlormalirx, Storm a Rain(train 1st.t00 30.00yr~is co Tact,stnt at 1 aregistered with ate State tluildefs Board.and also _---
rtave a Stale Pkxnbhp foams"atal 11"mxnherx g^nn are coaw-k that an 15.00
ph mtbinp work vvitl be dune n eworohence with appwcbttle C"abions d Ore Stam a P-Jn Drain Add 1.100'
tyw r devised;>uttutes Clu ws 447 and 693 and afK,Gcable orxies and that Mobile Borne Spaoa -- 25.00 _-_-
(v,11xk)tvlll be rr,tploy d rxde"Rowed txrkr(NTS 693 (a exemPtl f"n hard FlowPravention
'hots registration.phase give reason below). Device or Anb4N son Device 1.50
I i()Mt*0WHCRS-1 hereby certify 01611 am awe 0"Of ate Property rkr -
6r:rtl red above.at wt,kh location 1 Propene to make a I*ATA*,p"da"don lar Any Trap or We$*Not
y mon use and 0,h p noway k not b"kV orxsstruckO for sale.tease a rent - b a Fixture 7•�
m
Catch Basin 7.50
- kap.of Fjdst.Plumbing - - 40.00 Per Hr.
- Specialty Requested InspWb'u 40.00 Per Hr
Aker.of PkrnbktD wtlhln -
- F K7 Didq 15.00 nfAn --
AUTT10Rt7F0 SI(3NATMFIE
- DateNaw Bldg of&M.Addition 28.00Itlln.
1)aim sitrgle talltily --
CktscYitx+vrrxk now(') addition(] attwatlon❑ reprdr(l dA-1 1 1113 15.00 �
t4 be dew residential - non�esldentia� --_- -
Eldstlnp use of SUB-TOTAL u
t) orlxotr)rty ---- ---------� ------ ----
t o•ed u"of - - ` --- 5% SURCHARGE
tx Oftwopetty 25♦ PLAN REVIEW
_W"ICi -- -- -- --- TOTAL _--
T1tls p&rn*baoatlss mAl am,void M work Of oonatnxakxt auaxxuatl Is rxA ucx,i
mean W vM* 190 r"Aw it n r.shtx-tkrt cr work 1a Marmrvled or abandoned
a p6rW M 190 day+M any W.&%W wtrM is oonitrA. 6v1
"01AL 0OW111k)N9