11445 SW 107TH PLACE i
ADDRESS:
445 S-W I o
,
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CITY OF TIGARD CERTIFICATE OF C
OCCUPANCY
PERMIT #. . . . . •• . : MST93-954,
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 11/1h/95
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)830-4171
PARCEL_.: 1 S 134DD-02100
SITE (ADDRLs:a. . . : 11445 ,w 10?TH 1='L
SURD I V I b I UN. . . . : ALEX ESTATES Z ON I NG: R--•4. '5
BLOCl:. . . . . . . . . . . LO1.. . . . . . . . . . . . . ..
CLASS OF WORE:. :NEW
TYPE OF USE. . . :SFE'
OCCUPANCY GRP. "SPF R3
OCCUPANCY LOAD: 1
R e m a r I(c, r 1-,OT1-1 1:
Owner: --------------------------------._--
ROGER/DIAN HEATH
12215 SW 128TH AVE
T IGARD (DR 97223
Phone #: 590-4000
Cuntractore
LYNN TOAUS
2123 L:AMELOT
COURT
PORTLAND OR 9.7225
Phone #: 297-0829
Reg #. . : 00000
this L'ertificate grants occupancy of the above referenced building or portion
thereof ,and confirms that the huilding has been inspect for compliance with
the State of Oreqon Specialty Codes for the group, occ�_Ipan and use under
which the refer ed permit was issued.
11UILDING INSPECTOR BUIL_DIN ' 'F= IL:.I til
POST IN CONSPICUOUS PLACE
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CITY OF TIGARD BUILDING INSPECTION NOTICE �U}
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:`
Footing Susp. Ceiling Sprink. Hough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct, Plbg. Top Out Elec. Rough-in INAL
Post/beam Mech. San. Sewer Gas LineBld
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul Shear Wall Gyp. Bd. -Elect.
Date Requested: ��" t ZQ _41 Tim(3:--AM PM
Address: 0z
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Builder:�y?�n )41�jfCL-PA ��.� Permit tt: 1� 7,N 2,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Insp tor: Date: L Itj
( PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-C-Phone): 639-4175 Business Phone: 639-4171
Inspection: r
Footing Susp. Ceiling Sprink. Rough in A pr/Sd Ike
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. P!bg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Rrquested: t (Z Time:-AM PM
Address: ,-
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: I
p �. f i fS Date; O -
APPROVED DISAPPROVED /'APPROVED SUBJECT TO ABOVE
--Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE 1
Inspectior Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:^
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbq. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line
Plbg. Underfloor Rain Drain Framing mm
�Plu -'bb..
Alarm Water Line Insulation <pdgch.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �'/�' 5� Time:__KA M PM
Address
Builder•/,�`-t�-t' Permit #: �
THE F(�LLtOW116 iteTIONS ARE REQUIRED:
v
Inspector. Dater'
7.
APPROVED DISAPPROVED "!—�OVFD SUBJECT TO ABOVE
_Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection �— --------... __
Footing P16g. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line Al.:IN
Post/Beam Struct. San. Sewer Framing
Poet/Beam Mech. Rain Drain Insulation
Plbg. Underfloor Water. Line Gyp. Bd. M h )
Date Requested:_„ / Time: _!_AM _�PM
Address.. T S 10 7 (�/,`¢��Qp� 4--1 t t.-_��t ' S�y Z--
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED: r
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( ✓ � ..CLQ -P '�4 *'-X
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Inspector: _._ Date:
APPROVED ��DISAPPROVED __ APPRJVRD SUBJECT TO ABOVE
L�Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Departmn_nt
13125 SW Hall Blvd. Tigard, Orogon 17223
Inspection Line (Rec-3-Phone: 639-4175 Business Phone: 639-4171
Inspection.
Footing Plbg. Underal.ab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out (LLne } FINAL-
Post/Beam Struct. San. Sewer g -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Meeh.
Data Requested: 7 Timet _AM PM
Address: J Permit #: `7 �� /
Builder: G � _
THE FOLLOWING CORRECTIONS ARE RRQUIRED:
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Inspectors_ ��,!`�- ---- _ ___ ---- Date:_
_�APPAOVED i DISAPPROVRD APPROVYt D 9UR,711CT To ABOVE
Call
For Reinsp.
INSPECTION NOTICE.
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Re`c--O-Phone)s 639-4175 ( Business Phon.:: 639-4171
Inspection:_ r IISuQY' _�
Footing Pi . Qnderalab Hoch. Rough-in Appr/Sdwlk
Found. -_-VAb2.Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. ltd. -Hoch.
Date Requested:: 7 ZZ VI Ti4�s G PM
Addreea: I I y A
T CJS- I L� " 1 1 Permit #:�� 13"15-1-/
Builder: /. �i -2
THE FOLLOWING OORREC:TIONS ARE REQUIREDs
i
Inspectors_ --_-__--- _ Date:
11
yAPPUC'mtr DIS►.PPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd_ Tigard, Ormlon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineas Phone: 639-4171
Inspection:`__
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Pl.bg. Top Out Gap Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Di-ain Insulation -Plumb.
i
Plbg. Underfloor Water `Line (� Gyp. 9d. % -Hoch.
Dat,§ Requested:.__ l 9 ( Time: AM PM
Address: �-- '_ Permit I
Builder:
- 9591
THE FOLLOWING CORr.ECTIONS ARE REQUTRED:
7
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Inspector: ~�— Dater
V APPROVRD nISAPPROVED APPROVED SURiarT TO ABOVE
V&
Cell For Reinsp.
INSPECTION NOTICE I ��
City of. Tigard Building repartinent l
13125 Sit Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Ree-O-Phone): 6.39`-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Undorslab Hech. Rough-in Appr/Sdwlk
Found. Plbg. Top Cut Gas Line FINAL:
0000,Poet/Ream St:ruct. San. Sewer (y framing -Bldg.
Poet/Beam Mech. Rain Drain In elation �• -Plumb.
Plbg. Underfloor Water Line (/ Gyp. Bd. -Hoch.
Date Requested:_ if !� 1 --Timet —L—Ax
AM (� L/ PH
Address: I J `--� Permit #a W
't H q3 /�I
Builder•
THE FOLLOWING OORRECTIOt7S ARE RFQDTRFD:
ct-
1A A3-
Inspectors ` Date• ✓ `- t`t
—,.APPROVED DISAPPROVP.D ._� APPROVED SUBJECT TO ABOVE
f ---
Call For Relnep.
INSPECTION NOTICE �
City of Tigard Building Department
13125 JW Hall Blvd. Tigard. Oregon 97223
Inspection Line (Ree-O-Phone)= 639-4175 Business Pho..j: 639-4171
Inspection•_
Footing Plbg. Under.alab Mach. Rough-in Appr/Sdw1k
Found. Plbg. Tog Out Can Line FINALS
Poet/Beam Struct. Sart. fewer ( Framing -Bldg.
Post/Beam Mach. Rain Train Insulation -Plumb.
Plbq. Underfloor Watsr Line Gyp. Bd.
Data Requdeted: �� ��� I11 _ T1.m•t ,l�l`/C1.:� A.Mf 1 pN
Address: � ) C I l I I ��+ �` Permit #it" 13 `I 5L2
Builder: 1�. It 4
T4Z FOLLOWING OORRECTIONS ARE REQUIRED:
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611) Ze e
Insper" !-:
1 �.
it"n^'.^_'" _ L DISAPPROVED APPROVED SUBJECT 10 ABOVE
Call For Reinsp.
INSPECTION NOTICE.
City of Tigard Building Department
13125 '811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (F.ec-O-.Phone)t 639-4175 Business Phone: 639-4171
Inspections —
Footing Plbg. Uuderelab Mecn. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
lost/seen struct. San. Sewer Framing -Bldg.
Post/Bead Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Lino Gyp. Bd. -Mech.
Date Requested: Ihh-1 1 Timet AM
Address!;
Address:: ( y C' T ( ftmLt #t
Builder, �. -E--el9 -61
THE FOLLO1IING CORRECTIONS ARE REQUIPMD:
i
I nspector t _._._-__
natal 73
G APPROVED UiSAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinnp.
INSPECTION NOTICE
City of Tigard Building Department
13125 :40 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Business Phone: 039-4171
Inspection:
rooting Plbg. Underslab n A4 Appr/Sdwlk
round. Plbg. Top Out (-Qat Line f11L�
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mh> Rain Drain Insulatior, -Plumb.
Plbg. Underfloor Nater Line Gyp. ad. -Mach.
l
Date Requestuds 1 `j J Time: AM PN
H 41455 I r-1111- 045111 3 LP
Addreses Permit f:
Builders
THE POI.I.OWTNG OORRECTIONS ARE REQUIRED:
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Inspector: �1j� nate: ZZ-
"PROVED
Z-APPROVED ` DIS"PROVxn APPROVWD SUBJECT TO AB(ri/E
Call For Reinsp.
INSPECTION NOfICL �/
Cit? of Tigard Building Department
13125 Bel Hall Blvd. Tigard, Oregon 97223
Inspection Lina (Rec-O-Phone): 639-`4175 Business Phones 639-4171
Inspection:
Rooting Pibg. Unde!relab Hoch. Rough-in Appr/Sdwlk
Found. Elbg. Top Chit Gas Line FINAL:
Post/Beam Struct. San. Sewer Frami^g -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plhg. Underrloor Water Line Gyp. Rd. -Hoch.
Date Requested((:'' I (`I 7 3 _"Time: AM _ PH
Address:_ U' lqc� 1(/.� 1 Permit r: ftv
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Builders_
THE FOLLOWING coRRtC ono ARE REQUIRED:
i
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Cil
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Inspector:_,,_ Date# Z,
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'� _APPROM DrBAPPRovzo APPROV= SDt,1f@r TO AgM
/
-—Call—Call For Relnap.
INSPE TjgN WCrr10E
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 Mach. Rough-in Appr/Sdwlk
Pound. Plbg. Top out Oas Line FINAL:
Poet/Beam Struct. San. Sewell Framing -Bldg.
Post/Beam Nech. i�Aa n Drain Insulation -Plumb.
Plbg. Underfloor Meter Line) Gyp. Bd. -Hoch.
Date Requested:_ 11 - (� - 1 J Time: AM I41-0 PH
Add:-onasI�qy I' �'`. Permit ISIAN
Builders- (1✓�� Imo_ l7\ i 7�<� 1-7 10
THF. FcU-OWING CORRECTIONS ARE REQUIRED:
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Inspeotore Date
APPROVED _— DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Roinsp.
INSPECTION NOTICE
City of Tigard Building Departmett
13125 .811 Hall Blvd. Tigard, Oregon 97223
Inspaction Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Linspectiont—
rooting Plbg. Un erelab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beanl#rstre6. Sart. sewer Framing -Bldg.
Post/Beam Hach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Gyp. Rd. -Hoch.
i , q
Date Requested: - Jp� Times _ AM PH
S 1D� /--�. Pim
Address, x:33-
Builder.:
THE FOLLOWING C)DRRECTICHS ARE REQUIREDs
L
3s
Inspectors i ------ — -_ -- Dates��r
"PROM DISAPPRCSVED APPROVED SU9.IECP TO ABOVE
__Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspection:
.Footing r Plbg. Undorslab Hoch. Rough-in Appr/Sdwlk
Pounds. Plbg. Top Out Gas Line FINAL:
Post/Beam Btruct. Ran. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Hoch.
Date Roquostod: I I - l3 Time: /AN
hddress: I 1�(y I \ • Permit t kw5lt7
Builder:
THE FOLLOWING CORRECTIONS AAE REQUTARDI: �
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Inspecto�rs _._` �� �---•—r-} Datas��
� APPROVED/�__ DISAPPROVED tl�APPROVED SUBJECT TO ABOVE
Call For Reinsp.
M-FILE( ON NOTICE
City of Tigard Building Department
13125 811 Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rea-o-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Undorslab IMoh. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Lino FINALS
(_Post/86M struat. San. sewer Framing -Bldg.
Post/80M Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line z Gyp. Bd. -Meeh.
Data Requestede! ►� 2-3 "1'3 Time: r AN (�_PH
Addrasot �� i J �(-.! f4` �I-- _ _j7� �, PermitfiplV\G��` �(3�
Builders_ ycyyr 5-1 O^ / r, )
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:__ Dates
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APPROVLD DIS PROVLD APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD
MATER PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT -. . . . . . . : MST93954L
13125$W Hall Blvd,Tigard,Oregon 97223.8144 (tn3)'632-4171 D(�TE ISSUED: 10/25/93
PARCEL: I S 134')D-021 00
SITE ADUR:.S,3. . . : 1144t• SW 10'01+1
SUBDIVISION. . . . ; ALEX ESTATES ZONING: R-4. 5
BLOCK. . . . . . . . . . , LOT. . . . . _ _ _ . :3
BUILDING ___.._......____.._.._______...... _.
RE I ASUE: DWELLING UNITS: 1 BASEMEN•T.. . . . . . . . .0 sf
GLAGS OF WORK. :NEW DEDRMG:3 PATI-IS:3 GARAGE. . . . . . . . . . :911 sf
TYPE~ OF USE. . . :SF` FLOOR AREAS---------- REQUIRED SETBACKS
--_._...TYP OF CONST. :SN FIRST. . . . : 860 sf LEFT. . :5 ft RI.GHT. :S ft
OCCUPANCY CRF'. : R3 SECOND. . . 04 sf r=RONT. :20 ft REAR- 17 ft
`:;TORIES. . . . . . . : 1 THIRD. . . . :0 sf REQUIRED-___--_..--_..-_..-_.__.-__.. .-.
I-1C I GHI.. . . . . . . . : 13 ft TOTAL-----_ :2860 sf SMOKE" DETECTORS. 1 Y
"LOOK LOAD. . . . :40 psf VALUE:. . . . . $ : 1. 47958 PIARKINS SPACES. . : 1
Remarks : PATH I
......______..-_... ............_.___.-._._...-____— -__--.-__.-_ PLUMBING ....__—_.___—___..-_---.-.
S I INIK a. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 bACKi`I_.OW P)3 E VNTRS. . :0
LAVATORIES. . . . . :4 WATER HEATERS 1 TRAPS. . . . . . . . . . . . . . ..0
TUS/SHOWERS. . . . : LAUNDRY TRAYS. . . : 1 CATCH 130SINi . . . . . . . :0
'.MATER CLOSET S. . :.3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 1.00 OTHER FIXTURES. . . . . ;0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :0
WF'i SH I NU MACH. . . : 1. SF R111 N DRA I NS. . : 1
MCCHANICAI _._._.---. __......_ �_._____.._. - r-:LES
FUEL TYPES----------- UNIT HTRG. . :O type amount by date rec^pt
/GAS/ / / VENTS . . . . . :W TIF $ 1520. 00 JH 10/25/93 X
MOX INrz'L)T :171 LTU VENT FAI\1S. :. .4 BPRT $ 553. 00 JI I IQ1/2'S/9:_" X
F'URN ( 100K . . :Q) HOODS. . . . . .. : 1 BPLCS $ 559. 45 JF•I IIA/25/93 X
FURN > =1210K . . : 1 WOOD`.STOVES.. :O l:15PC I L7. 65 JH 10/23/93 X
FLOOR F'URN. . . . :0 CLO DRYERS. : 1 SSDC $ L80. 00 JH J.0/25/93 X
DOLL/CMF' ( 3HP;0 OTHER UNIT•:S71 PARE! 1; 500. 1110 JH 10/25/93 X
Owner:
GAS OUTLETS: 1 MPRT• $ 45. 00 JH 10/L5/93 X
Owner : -.....-__.._ MI"LU $ 11. 23 ..TH 10/25/93 X
ROGER/DIAN HEATH M5PC 1 2. LS JF) 10/25/93 X
1.x:01.5 ;SW 128TH AVE PPRT $ 155. 00 JH 1@/25/93 X
P5PC S 7. 75 JE-I 10/25/93 X
7 HARD OR 0,702-3
^hone 0: 590--40018
cantvactary
JWNER
v:
none 0:
Reg
-J t :346 1. 35 TOTAL.
rh:s permit is issued subject to the reguletiors contained in the - - - -- REUU:IRE:D INSPECTIONS) - -- --- -
Tigard Municipal Code, State of Ore. Specialty Codes and all vhe Fo it/fol.tnd Insp Fireplace Insp
applicable laws. All Korb will be done in accordance with approved Post/beam 5t ruct Gas Lin ; Insp
pians. Tris permit will 1xpire if work is not started within 180 Post'seam Meehan I n s U l at i:n I n s;r,
days o` issuance, or if work is suspended for sore than IG0 days. PIm/undslab Insp Gyp Board Insp
PLM/Underfloor Rain brain Insp
m•i. F. t:p v :T i.g n a t u r e r -_---_ _ Mechanical Insp Water Line Insp
00 Plumb Top Out Appr/Sdwlk Insp
1m5ued lay , _.y ._.._ Framing Insp Mechanical Final
Call for inspection - 639-4175
,�W�n CONNECTION SF TIGARD PERMIT'
COMMUNITY-DEVELOPMENT DEPARTMENT PERMIT #. . , . . . . : SWR93-04E.Ei
13125 SW Hall Blvd.Tigard,Oregon 97223.81(10 (503)e34./171 DATE I St:�UED:
PARCEL.- 19134DD--02100
3177E A1)DRESS. . . : 114-. r 5W 10711.1 P'L
sUSD I V I S I ON. . . . : FLEX ESTATES ZONING: R•--4. 5
LcLOCK. . . . . . . . . . LO'1 . . . . . . . . . . . . . :3
ENANT' NOME. . . . .
JS NCI. . . . . . . . . . FIXTURE UN I Tt,. . . .
'.'LOSS OF WOI'21-*,. . . :NEW DWELL.I NG UN T 1`S. . : 1
Y1-!E OF USE. . . . . :SF NO. OF BU I L.D 1 NCS: 1
IN`.iTALI__ 1-Yf'E:. . . . :LAU:3WR 3'IYIPERV SUI?FACE. . : : Sf
emarks : PATH I
FEEU
'ROGER AND DlANNE: HEATH type amvl_cnt, by date r-ec�pt
0215 SW 128TH ()VE; PRMT v :?2:00. 00 JH 10/25/93 X
INSP $ 35. OC: Ili 10/C-215/93 X
"IGARD OR 97223
hone #: 590A000
r_ret ract or,
AINTRACI'OR NOT ON FILE
hone 1t: 1: 2235. 00 TOTAL
-- -- REQUIRED INSPECTTONFr - - - - -
nis Applicant agree: to compiy with all the rules and regulations Sewer Inspect ion
f the Unified Sewage Agency. The permit expires 19e days frac
the date issued. The tota', amount paid will 5e forfeited if the
aermit expires. The Agencj does not guarantee the accuracy of the
ide sewer late��a?s. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from _
ane d?stance given. If not so located, the installer shall purchase
i. "Tap and Side Sewer" Permit and t Agency will install a lateral.
e.,r-mittee L3:.gnat�_rre 1 1At..
s .ccri
By :
N Call for, inspection 639 -4175
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C,I I Y OF I I 0444 RF:C f::I P I' I1F' PAYMF:.N 1' UP:C::F..A f'T NO. s
1:14EI;K 011I:1I..IN T' s 5446. :3`.1
I1F A T I1, RUGER & f.)I{INNS CASH AMOUN'C' s 0. 00
PAYMFNI I)AIF s 10/c-'5/93
t0.12'15) 9M U28TH AVE '-AJB 0 J1)1SlCIN s
T I BART) CIR 9 7PP3—
ifZPOSU. OF PAYMF-:N'T AMOUNT PATI) F'URF'U8j—. CII: PAYMFFNT MIA IN1 PAID
1.l_PINS PF'f7M 5.3. 00 PIA M A I NG PERM RM 195. 00
C CAN I C:Al. PE' 45. 00 H7'. BUILD PFR :37. tib
ON C:f IFC:K FF I El.0. '711r Hf. WF'R ll,'-A PPOO. 00
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WF-.R TNE'PE CIA :3`5. Oki F�Af1K4; SDC `�V�N. 00
11IRM I/RAIN (BrA, f71110. 00 IM44 It; 1.1 V!i 1410. 011)
� �'i': T RANG I I TI I I' F.F-b 110. 00
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;1'93--9542 — 114451 SW 10/ f I l PI_f 1,E
EX FH?AIF S I OT 3
i 1►1 AL AMt II IN I PAIR 44b. 35
III y t"f" 'I I"Alif) F4F:(',k I P T OF PAYME N1 FOAA ll'i NII. 4.'4d490;-'
1A hwl. 00
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Residential Building Permit Application 1 1
City of Tigard
13125 SW Hall Blvd. '
Tigard, OR 97223
(503) 639-4171
Jobsite Address: 6-J /0 7 f?Lr9 �_
/ Office Use Onf
Subdivision: !: �S� �_; Lot #
Plandc/Nec
Valuation:
Permit # 2r
Owner: '/ c' 4 //►1��� 7� /� 'r _
- Reissue of
Address:
Approvals Required .
Phone: a OG
Planning -
Phone:
lanning ,
iwrtgineering
Contractor. E- Othor
Address:
items R wired
Subcontractors
Phone:
ss Details4.
Ir
Contractor's License# 4 / ( f { Yl `:
(attach copy of current Ortigo4 license)
Subcontractors:
Plumbing:
Mechanical:
(attach copy of current OR Contractor's License)
Address: �cO7 i S
K,Li K�
Phone:
COMMENTS:
)Cop
lica ignat re & Phone number
Received by. �' __ _ ,_ Da;r Riceived: /dIA-1 /�3
Permit # Account Description Amount Amt. Pd. Bal. Due
M< ��- Z Bldg. Permit (BUILD) .SS3, vU
Plumb. Permit (PLUMB) ASS
Mech. Permit (MECH) A ) �r✓ •��
State Tax (TAX) Z�i� ,44
Bldg: .,,226 s /..
Plumb: 7• )�
i
Mech: 1'Z
Plan Check (PLANCK) 7U• U
Bldg:
Plumb:
Mech: A
i1 Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) 3 s
Parks Dev Charge (PKSDC) Sy U SoU
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) / v _ Z
Commercial TIF (TIF-C)
_ Industrial TIF (TIF-1)
fY
v Institutional TIF (TIF-IS)
~ Office TIF (TIF-0)
J
Water Quality (WQUAL)
�1)
Water Quantity (WQUANT)
Fire District (FIRE)
TOTALS: 3�J ..Z // $ `• )
Permit No:/.�'k.
Address:
Issued by
46-All
%
Date: 46-All
�1 ✓% _—FOR OFFICE USE ONLY—
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are 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 ORS 701.010(7), need not submit this statement. This statement wirl be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 313:
1 . I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.L I My general contractor
Contractor registration number
I will instruct my general contractor that all subcontractors who work og the strur,-
ture must be registered with the Constructicn Contractors Board.
OR
3. B. z--_-_I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, i will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above Information Is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
LL reverse side of this form.
rgnatu of Permit Applicant Gate
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT