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CITY OF T16i4 RD VIEPIA—T NO. : SU881990
CITYCIFTWARD
COMMUNITY DEVELOPMENT DEPARTMENT MOM DATE ISSUED: 10/17/0a
13125 S.W Hal!Blvd,P.O.Box 23397,Tigard,Orrgot. M.(503)6394 P
175 RIM, PMT .NO. 881990 '
JOR ADINIE:GS : 11.3585 SW 1.0911-4 AVE:
TAX MAW'/1.0'11* PS1 IODD 1,330-1) SUR: :WMMEPFJE:1-1) FH 14 1-'T : 703 BK :
I-AND USE : W,fpl*)
L O'f !S I Z r4: VAI..i UNT1 ON : $ a I 2'eI3 %i."TIFIACKS
F;'W()N*r : PF:AA:
WORK CL.ASG ' ADDITION DWI:A-L .UNITS : I LEFT: PIGH'T' :
USE TYPE: : 1'.a.NGI F F*AMXL.Y NO. Ull-:UPOOM5 . E'.X*T'.WAI L CONST :
CONST TYPE : VN NO . EIA T'H G N: S : F.: W
C)CrLJP . (..;Pr) : P3 PPOT .0PE:N1NG5 :
OCCUP .I OAD N li : Ei W
T 11111 Al.. APEA: 204
NO.ST0141EG : 1. IST : 20141 WOOF CONST: C FXPE PEI"?
HF:1:G'1-41' : 1.6 2ND: ARE'A +.PAP? RATFO:
SASFEME:14*11*7 3PD : OMMIP . liE'FAI-17 RATE.U:
ME:ZZAN1NlF.:'? IT
FL.00R L.OAD : 410 A 1"t A('..'o E V'IPIH: ALAPM?
F*I..('.)W(('.;PM) VIE TEC'T
HF AT 'I YPE: GAS 1-4M.P . AGX.E.SG'? (:'Opp?
Pl.-AN NY ,
OF NO.
PLISSUE.
0 1 .1 IN 71e1,:50
W .1rel 1;17 V3,r,-.:w
N 1 'F"W 0�'"'' AVE:'A.VE'
E
S1 1^1 1 L. 'T'AX *3.,73
OTHER
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F1 1.2530!5W PNI:) i (4; 11
Attttt CJ197005 PFAKPAID < $-I') 63>
C
T PHONE: (503) 643 Y60k!
NO 6F.IF141 i 11"I'Al *86. 0P
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This permit is issued subject to the regulations contained In Title 14
of the TMC, State of Oregon Specialty Codes.zoning regulations
and all other appl. able codes and ordinances. and it is hereby 1:'001 I:N(*.;
ngrard that the work will be done in accordance with the plans and
specil,cat,ons and in compliance with all applicable codes and PAIN
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city PL 1:1 . t JINDEXV.A.All
F: CNAI..
business tax permits This permit will expire and become null and
void If work Is not started within 180 days,at if work+ssi-nencleclor P1. E.i . 'T'0P(Jt.J I
abandoned for a period of 180 days any i.me after work ham
commenced It shall be the responsibility of the permiltee to assure I*PAM NG,
all required inspections are requested and approved
T N 11111.•A'T'1014
I BOARL)
Permittee Signature
Issued B JT) i
By QAI I I &I 1 11,W6 1"64.14 .--,,.r:;TTS
SEPARATF PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
:CHANICAL
CITY. OF Ti6A PFlQMTT NO. M
: E082060 RD
CITYOFTWARD
COMMUNITY DEVELOPMENT DEPARTMENT ORIG014 OATS ISSUED: 10/17/Fill
13125 S W Hall Blvd..P.O Box 23397.Tigard.Oregon 97223.(503)639-4175 PRIM PM." .NO . IF 9i.990
JOIN 135H5 5W t091+1 AVF
'TAX MAP/LO1- PSI TODD :1.3300 SUB: S(.JMMI--..'PF'IEI-.D PH 1XI L. T' : 103 RK -
I-AND USE : P717)0
I..01' SIZE :
1:I'EM NO : NO:
WORK CLASS: AI' D11*ION FtIPNACE: <100K AIP HANDI.-P (1.0
USE TYPE STNCI.F. F*AMTI..,Y 1:1.111NACE 1.00K+ AIR HANDL.P 10K
CONS'T . TYPE: VN FLOOR F:UPINIACE EVAP .COOLER
Of'(70F.I . G.PP . : P3 HEATER VF.N'T* FAN ie
VENT VENT' SYSTEM P.
IRI P/COMP (31.-IP HOOD
NO . LSTUPIE.5 : 1, BLP/C0.11 3 :1.t5HP INC INERAI'OR(DOM
13WEI I... . UN IT S 1. 81-14/COMP 1.31 301-IP INC I NERATUP(C'OM
I''( "I YPk. CIAS DI P/COMP 30-501-4p REPAIR UNITS
MAX . TNPt.rr 01-A I k'QMP 50+1-113
PIPING OUTLETS
HIGH I,",PIF 5 r.?
IA-MAPKS :
1:h:I Si
0 I-IFT N Prpmlr $10 , 00
W 'I�) $lei. *73
N SW PLAN 141C.'VIEW
E Y FJX T*IJPES $9. 00
R
':,'T A I'F. TAX $ 95
C
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0 $2dI. ro
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This permit is issued subject to the re(p
ul itions contained in Title 14 .......... ........
of the TMC. State of Oregon Specialty Codes,zoninq ri�gulalions ljjjl.),IPF D 1. 15PE N C
and all other applicable cedes and ordinances and It is hereby 't-WNS
agreed that the work will be done In accordance with the plans and LINE
specifications and in compliance with all applicable codes And 1:10!i t & 131i'-:01,11
ordinances I he issuance of this permit does not waive restrictive 1-4171UG 4-1-1 N
covenants Contractor and Subcontractors sue:! have current coy I LNAL.
business tax permits This permit will expire and become null and
void if work is no:started within 180 de-s,or it work is suspended or
Abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
1�, lee
Issued By
6AI...'.. li"44! -4 NSP114;1
SEPARATE PERMITS REQUIRED 7OR WORK OTHER THAN DESCRIBED ABOVE
............
W FW
CITYOFTIFARDZ/ _ PLAN C`-CK APPLICAT;ON,
CITYOFTI4 RD PLAN CHECK #
COMMUNITY DEVELOPMENT DEPARTMENT OREGON PERMIT #
13125SWRialI13Arct. P.0.8ax23397,rVaM.Or*90n 97223(5U3)&19-4t75 �' DATE ISSUED _
JOB ADDRESS:
'TAX MPP/LOT LOT S l /0 OD 133w
SUB: �����vtv�c���`�,l�r LOT: 74-;'--5 ^� LAND USE: 7 Ae
VALUATION;
OWNER SPECIAL NOTES
NAME:: g ei,., REISSUE OF:
ADDRESS: /S `3=!PS� � ��7 LAST REISSUE:
- _ FLOOD PLAIN/
SENSITIVE LAND:
PHONE:
APPROVALS REQUIRE
CONTRACTOR , PLANRRING:
NAME: --,�-Y t, Ae 64,, y 1�uC)� ENGIKEERING:
ADDRESS: o f:, t FIRE DEPT
'-=LY.t�� OTHER:
PHONE: ? _�� c�C� �'t, ITEMS REQUIRED
LIST/SUBCONTRACTORS:
LARCH/ENGINEER BUS TAX: _ _
NAME: CALCULATIONS
ADDRESS: _ - TRUSS DETAILS: _
PARKING PLAN:
LANDSCAPE PLAN _
PHONE: OTHER;
COMMENTS:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees - .
10-431 01 Mechanical Permit Fees --L��C, j;
10-230 01 :tate Building Tax (5X) �..�sl' e
Building 7 3
Plumbing
Mech _
10-433 00 Plans Check Fee S 3.1F
Building _ •� .t '�
Plumbing _
Mech
30--202 00 Sewer Connection
30-444 00 Sewer Inspection
51-44B 00 Street System Dev Charge (SDC)
52-449 01 Parks I System Dev Charge (NUI:) _
52-449 02 Parks I1 System Dev Charge (PDC) _
31-450 00 Storm Drainage Syst Dev Chr•g (SSDC)
10--230 09 TRFD
.'0-230 06 Washington County Fire #1 (95X)
11-220 00 Amart/Wedgewood --
-: --� 4 TOTAL
REC N
APPLICANT SIGNATURE C
Received fly:
ht/3587P/19P Date Received:
---
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�T,„' i�,`+•��b"r...- ;• Yt��•��'' �✓`t1�� a�1aF� Vr�}l1Ju�� ►� +�Y '1i:�JU���� .l�.r�«�e. � ,0
w i �t.' ip � i �i w�> i y rM iM;••.. ��yy
1N IE 11 mzwmm
Cip$v= of Tigard Mechanical Permit NO.
New Installation LQ Replace ❑ Relocation E] Addition Alteration CD DATE:
HEATING
CONTRACTOR( . !—'
Y � A1u _-
6- - '2.Jaf_- t OWNER
ADDRESS 2-'' �'- cr JOB ADDRESS `"
r
PHONE X- APPLICANT kZ MEW 112
T
Heat hput Ratin4lBTU per Hourl rL� QQC� Vent Size '_* 1 Flue Sizs_
FUEL OIL 0 GAS 0 ELECT [] OTHER
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permi: SEE BELOW Each Air Handling-Unit or Duct System 750
.t-up to & ind. 1(10,090 BTU _W 6.00 Commerci;;l Hood Sister i _ 7.60
New 100.000 BUT's & over _ 7.50 Other Equipment - Each 4.50
Woodburning Stove _ _ 4.50 1 Trip Inspection 4.60
Wall-Floor- Su!anded _ 6.OJ Air Condition Compressor - HEto&incl. 3 H.P. 6.00
Vent System w/Fan r 4.60 Air Condition ^.om% sso_r-3.1 to 15. H.P. incl. 11.00
Reoair .Haat Cooling _v 6.00
CITY BUSINESS LICENSE REQUIRED BY ALL CONTRACTORS OR SUB-C.)VITRACTORS ! I
PERMIT ISSUANCE 10.00 Comment„:
FEES
U TQJAL
STATE Issued By
�5%PLAN CH
SQT._A 't~ REC. 0
JOHN E. RE11jHNnD1 PILtiBING, IKC,BUILDING DEPARTMENT, TIGARD
P. 0. BOX 129 PLUMBING PERMIT N0.
I
NEWBEfiG, CUM, 97102 � h0der of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspe:tion by the City Inspector who shall be notified n.)t less than four
(4) hours prior to the timl3 the installations are ready for inspection. City of I igard Business License required
sur all contractors and sub-contractors,
Owner L/GL'ti./Il L� ' - Address/25S15 5� �► �D`�{�L(,e�' )ate `� -
NUMBEh OF TOTAL` PERMIT NO.'S
TYPE OF PERMIT _iTEdS FEE ON EACH AMOUNT (Office Use Only)
DLLN I IA L
Singv Femme 1 bath—each _ c 25.00 J
_ Duplu c_—Each 1 bath unit 4 25.OU
Additional bathrooms—each T� 10,00 G�
Mcblle Home Spoc•—each 1600
INDIVIDUAL Flx'runEE FEES
1 to 60 Fixtures In 1 building—each r 3.00 _
61 to 100 Fixtures in 1 building—each _ 2.60 —
_101 to 200 Fixtures in 1 billding—eech r --� 2,00
201 or m^re Fixtures In 1 building—each _ 1, O
MISCELLANEOUS ,—
Building Sewer-1st 60 ft, 10.00 ^
Sew,r—eech additional look —_ 10.00
Water Service to building _! 6.00 5 lei
Private Water S estems—eech 100 ft. 10.00
r
PERMIT 1 O.C'D For- Plumbing Inspection Phone 63.94191
% State / 0 Plumbing Contractor rjy Qtr<,t to �t c
TOT/1l_ p— rF r'rIPT R!r1 lenin-1 ['v
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if
103 - 3UMMERFIELD
BUILDING PERMITAPPUCATIOII TIGARD DATE- 4/10/ 19 01 _ 3679
THE UNDERSIGNED HEREBY APPLIES FOR h PERMIT FORTH E WORK HEREIN INDICATED BUILDER PHONE 639- 1
OR AS SHOWN AND APPnOVED IN THE ACCOiAPANYING PLANS AND SPECIFICATIONS, OWNER PHONE
OWNERTual. Dk.:v. _ a. , InOABADDRESS -LJJB�J SW 109th LOT NO.__-Summer fiy24
ARCHITECT
ENGINEER
BUILDER same ADDRESS 15300 SW 116th DESIGNER rPC,
STRUCTURE LXNEW U REMODEL 11 ADDITION ❑ REPAIR ❑ RE14EWAL ❑ FIRE DAMAGE ❑ DEMOLITION
13 RESIDENCE C-1 COMM [-I EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS C, PATIO ❑ CARPORT ❑ GARAGE U STORAGE ❑ SLAB❑ FENCE
OCCUPANCY F"3 _ LAND USE ZONE BLDG.TYPE 5N _FIRS:ZONE— PLAN CHECK BY dW�1 HEAT_ 988
Construct single family duelling w attached garaye, ! Aki drooms 2 Bathe.
SEE CORRECTION SHEET ATTAC4;ED,
SEWERPERMITM 2331.= `�75Q,00 ua.
• -- - $jam@ `—.j7k--$-Llif L• ----
OCC.LOAD FLOOR LOAD_40 HEIGHT 12 NO,STORIES 1 AREA_l i 4U NO,BEDROOMS 2 VALUE 1 .50,160.
BUILDING DEPARTMENT SET BACKS FRONT 10 `RFAR 6 - LEFT SIDE 19 RIGHT SIDE 4. .")
Permit $1d9.00 _ �- - - - --
_ THIS PERMIT IS I UED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
RFGULATIONS ANLj ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 940i FI
WORK WILL qE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODE AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 2 33•a0 RESTRICTIVE COVENANTS. rONTRACTOR AND SUB CONTnACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 4; 7• =)b
LICEN°&E.SEPARATE PERMI- ,REQUIRED FOR SEWER,PLUMBING AND HEATING.
�
_ 91,06 SDC_ 1�00.O(;
Total 2
_%*-
— — PDCN � " 100.Or APPLICANT OR AG_ENT —__.__..__-
By
Receipt No. - .
�'�
Approved doth ADDRESS -- ---- -- --- PHONE
DATE INSP. TYPE INSPECTION REMARKS PLU GING DATE
Contractor u �
S� Permit No.
Rough-in
-
Fixture
9240
Final
r HEATING
r Contractor
Permit No.
a:5
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Stumm Drainage
(Rain D,sin, Final
Sidewalk
Curb&Street Final
Arxoseh
BLDG. DEPT.FINAL TEMPORARY�I CCRTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY II n✓ fes(^/
Landscaping
Zoning Final
wi■[ w w w ww w
BUILDING PERMIT APPLICATION TIGAr7 DATE_ _ Tgg
THS UNDERSIGNED HEREBY APPLIES FOR A PERPAIT FOR Tf iE WORK HEREIN INDICATED BUILDER PHONE
O-RR AS H WN AND APPROVED IN THE ACCOIvtPANYING PLANS AND SPECIFICATIONS. OWNER,PHONE
�:.PIER 1( 1�, �� OB ADDRESS/ - LOT CIO.
ARCHITECT
Sa'WIG •. ENr IN[:I'I
3UILCERa �rerar' ►cDRESS/ S(() /l[..� ys, DESIGNER
iTRUCTURE NEW ❑ REMODEL _r ADDITION ❑_ RFPAIFi ❑ '9ENEWAL FIRE DAMAGE ❑ DEFlOLIT10
ESIDENCE C COMM ❑_EDUCAT;ONAL 1:1GOYT r, RELIGIOUS C: PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLAg❑ FEND
i%t,iir-ANDY _LANs USE ZONE _-7 BLDG.TYPE 1 ,--FIRE ZONE_ PLAN CHECK BY HEAT
------------
;EWERPERMITN ^_ y �y�p_ J�'7,2 ///1b
01
)CC.LOAD FLOOR LOAD HEIGHT /.Z NO.STORIES - AREA N0.BEDROOMS Z VALUE;�D-A�Q
BUILDING DEPARTMENT SET BACKS FRONT �� REAR 9 _ LEFT SIDE ,q
�Qp+� / RIGHT SIDE �� -
^rmit 7 THIS PERMIT IS ISSUED SUBJECT TO THE RI GULATIONS CONTAINED IN THE BUILDING CODE,ZOWN:•
15W 3.0 RECULATiONS ANU ALL APPLICABLE CODE.' AND ORDINi►NCES, AND IT IS HSREBY AGREED TF;AT THE
Tan Check WORK WILL BE DONE IN ACCORDANCE WI'H THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDIN MCF'. THE ISSUANCE. OF THIS PERMIT DOES NOT WAIVE
=,u`l,tal _ • RFSTRICTIVE COVENANTS. CONTRACTOR AAD SU? CONTRAC UAS TO HAVE CURRENT CITY BUSINES:
G LICENSE SEPARATE PERMITS REQUIRED FOR SEWcR,PLUMBING AND HEATING.
�A Tac • .i
Dotal - - SD
PDCM AFPuC� ITT
3y - n-'
Approved Receipt No. 1ft 1QQ_s'�'Ci�//(i�/�y _ /� 9��iaL
AJDRESS ---FiON
)C
)c - $ /CIO
VER CONNECTION $ 72JT
:WER INSPECTION $ ZS
:WER SURCHARGE S
f LSD
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ASAP)
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