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^/��® _CERTIFICATE OF OCCUPANCY
�: PERh,11'#: MST1999-00210
DEVELOPMENT SERVICES uATE ISSUED: 06/28/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110BA-08500
ZONING: R-4.5
JURISDICTION: TIG
SITE ADDRESS: 14198 ; .'V 116TH TERR rILE
�
SUBDIVISION: EVERGREEN SPRINGS
PY
BLOCK: LOT:011
CLASS OF WORK: NEW
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: New SF - Path 1
Final Building Inspection and Certificate of Oca:,)ancy
Approved 12/23/99 by George Steele, Buildi% Inspector
Owner:
RENAISSANCE CUSTOM HOMES INC
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068
i'ho�-le: 557-8000
Contractor:
RENAISSANCE CUSTOM HOME:
1672 WILLAMETTE FALLS DR
WEST LINN, OR 97068
Phone: 557-8000
Reg #: LIC 049955
L1
Of
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N
T
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This Certificata grants occupancy of the above referenced building or portion thereof and
w confirms that the building has been inspected for compliance with the State of Oregon
J Specialty Codes or the group, occupancy, and use under which the referenced permit was
issued.
BUI ING INSPECTOR / BUILDIN OFFICIAL T
'�'�37'"
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION /,i MST Vic_
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ,
r BUP
Date Requested 6aL44�•—fc) AM PM BLD
Location /`l' 6�e� -SU/ /p��� --re YY'a.60,2 . _ Suite MEC
Contact Person � I_S ���>'D� �KG'1lSS6�tc�C.Ph 57�`�Sly FLM
Contractor Ph SWR
UILDIN- Tenant/Owner ELC
Retaining Wall ELR
Footing Access: —
Foundation FPS
Ftg Drain
Cra.vl Drain Inspection Nates:
Slab / �� C3-ei LL SGN `
�- _ SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
RoofUrr-
- --
-- RT FAIL -
PL
Post& Beam
Under Slab
Top Out -- - --
Water Service .1x•a� , �/��1 / '�?U j c�
Sanitary Sewer
Rain Dreirye --
Fin K�
PART FAIL
Post& Beam
Rough In
Gas Line.RLI ------
oke Clampers
t Fji - ......
PAF T FAIL
EL CTRICAL _. __.- -------------- -- - --
Service _
Rough In i
n UG/Slab
Low Voltage
v Fire Alarm
} Final
�- PASS PART FAIL
SITE
Backfill/Grading - - --
w Sanitary Sewer
Storm Drain ( J Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Liar ( ]Please call for reinspection RE'. -_ [ ]Unable to inspect-no access
ADA
Approach/Sidewalk Date 2- -
Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION �, MST ��l5-OydfC�
24-Hour Inspection Line: 639-4175 Business Line: _639-4171 —
1= BUP
Date Requested AM.�� _PM BLD
Location/ q f 9 Suite MEC
Contact Person (��111 S ��Y��Y�CC���S�C��'�--!'h ��"� PLM %�'� 10-rD ;c_, L.
Contractor Ph c �� _ SWR
BUILDING renant/Owner ELC _
Retaining Nall !� ELR CIO
Footing Access:
Foundation FPS
Ftg Drain _ SGN --
Crawl Drain Inspection Notes: —-
Slab _ 14 SIT
Posy:& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing C ///�,��• )
.-- - - e e, _
Insulation Ic
Drywall Nailing �I�� .i w < fes+-�t� — cc►cY-i/
Firewall r_
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling ( ��^ �tvz��' ,y .�• / _`—
Roof
Misc: --
Final
PASS PART FAILI . - ---- - _ --
PLUMBINr,
Post& Beam -- — --- ---
Under Slab
Top Out
Water Service .,
Sanitary Sewer - - —'
Rain Drains
Final ?
PASS PART FAIL __ �_ / � /!/ / - /7ey 7--��* C�3
MECHANICAL
Post& Beam ------ --- ---
Rough I-
Gas Line -- - — —
Smoke Dampers
Final -- - ----- —
PASS PART FAIL
ELECTRICAL - -
Service
Rough In - --- — — — - -
UG/Slath
"- Low Voltage - --� - �--- -- —
v' T Ina
h ART FAIL - ----- -- -- ------ --- —
_j SI
m Backfill/Grading — -- - - -
''' Sanitary Sewer
La
W Storm Drain I J Reinspection fee of$ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin i
ll f
Please call reinspection RE:
Fire Supply Line Pl
[ ] p- ,_ [ j Unable to inspect-no access
ADA
Approach/Sidewalk
Other Dale _ ` �, .inspector �1122
_ _,Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
r
ELECTRICAL -
CITYI�� OF: TIGARD _ RESTRICTED EN RIGY
DEVELOPMENT SERVICES PERMIT#: ELR1999-00230
13125 SW Hall Blvd..Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/4/99
SITE ADDRESS: 14198 SW 11 ETH TERR ORIPARCEL: 2S110BA 08500
SUBDIVISION: EVERGREEN SPRINGS GIN ZONING: R-4.5
BLOCK: LOT: 010 ALURISDICTION: TIG
Proiect Description: All encompassing permit
A.RESIDENTIAL _ _ B.COMMERCIAL _
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL# OF SYSTEMS:
Owner: Contractor:
RENAISSANCE CUSTOM HOMES GARY'S VACUFLO INC
1672 SW WILLAIAETTE FALLS DR 9015 SE FLAVEI_
WEST LINN, OR 97068 PORTLAND, CR 97266
Phone: 557-8000 Phone: 775-2042
Reg #: LIC 069047
ELE 26-728CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT DEB 10/4/99 $4.80 99-318803 Elect'I Final
PRMT DEB 10/4/99 $60.00 99-318803
Total $64.80
L—This Permit is issued subject to the regulations contained in the Tigard ML,nicipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans This permit will expire if work is
riot started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requir YOU to follow rules; adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01-0010 through PAR 95 -001-0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246- 987. '
Issue y i Permittee Signature
N Q1—
s_ OWNER INSTALLATION ONLY
—' The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: _ _ _ _ DATE:
w
J
Cr_NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:_
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
CIT'T OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd _
1:3125 SW HALL BLVD nate Recd: /61-
TIGARD OR 97223 PRINT OR TYF t:
V - 503-639-4171 X304 Permit ot.,
F - 503-598-1960 INCOMPLETE OR ILLEG113LE APPLICATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE GF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee....,.... .................... $60.00
(FOR ALL SYSTrMS)
JOB cr t dyes Ste#
ADDRESS _ .f—�- Check Type of Wnrk Involved
to Zip Phone# LJ Audio and Stereo Systems
NamedSiv Alarm
OWNER Mailing Address Garage Door Opener
City/StateZip Phone# Heating,Ventilation and Air Conditioning Syslerr'
Nam
------ I_ -- Vacuum Sys S.
Nan* ,p
I Other
CONTRACTORlinonego res
E TYPE OF WORK INVOLVED -COMMERCIAL ONLY
- —._
(?rtor to issuance a Sta Fee for each system...........................—................. $60 00
copy of all licen;as (SEE UAR 9 18-260-260)
are required if Oregon Conl . Fj d Lic 0 Er Da
expired In C G.T. — W/� Chacit Type of Wo^k Involved:
�—
data beset, Ele c'di Contr Lic.# M
-j-+
Audio and Stereo Systems
C.O.T. or Metro is #C 1-F— _
Mu Boiler Controls itif �
Owner's Name
Clock Systems
OWNER - Mailing Address IJ r�-�
APPLICANT Data Telecommunication Installation
--
City/Staff Zip Phone ti
Fire Alarm Installation
This perm i►is issued under OAP 916.320•;.70,This applicant agrees to
make only restricted energy installations(100 volt amps or less)under this LJ HVAC
lomrm'.t and to do the folliwin9
Instrumentation
t. Only use electrical lirensed persons to do installations where requited
Certain residential and other transactions are etempt from licensing, 13 Intercom and Paging FyStBms
Theca have asterisks(') All oth-rm need licensing,
landn,coprt Irn;iation Control'
2. Gall for inspections when installation under this permit are ready for
inspection at 603-639-4175; Medical
3 Purchase separate permils for all w,lallations that are not ready for an Nurse Calls
inspection when the inapedor is out to Inspect under this permit;
q- 4 Assume responsibility for assuring that all corrections requirod by the Outdoor landscape Lighting'
inspecdor are done and,
CC C� Protect ve Signaling
5 Assume responsibility for cailinq fur a final inspection when all of the
>- corrections are completed Other
—A Pernits arP non-transferable and non-refundable and expire if work is not
started within iso days of issuance or if work is suspended for 1110 days _.Ni,mber of Systems
LU The person signing for this permit must he the applicant or a person No i tenses are,�Imrad licenses aw rNurrnd for all other 1nstafla40nx
--� authorized to bind the applicant
F�t"cS.
ENTER FEES S _
Signature
Y.SURCHARGE 1.06 7t TOTAI ABOVE)
Authoilty If other than Applicant tOteL
4ier4ftmnr"sal.doe 3/90
�.it'd 6S:80 6661-b�1-1 )0
CITY OF
TIGARD ___ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM1999-00306
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED:
SITE ADDRESS: 14198 SW 116TH TERR PARCEL: 2S110BA-08500
SUBDIVISION: EVERGREEN SPRINGS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRA7S:
STGRiES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF FAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVA i DRIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSET S: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Residential backflow prevention device. _
FEES
Owner: — --� —�
— Type By Date Amount Receipt
RENAISSANCE CUSTOM HOMESType
KJP 09/24/'1 99E $25.00 99-318599
1672 SW WILLAMETTE FALLS GR
WEST LINN, OR 97068 SPGT KJP 09/24/199 $1.75 99-318599
— �_-
Total $26.75
Phone 1: 557-8000
Contractor:
MOODY ENTERPRISE INC
PO BOX 98
ESTACADA, OR W023 REQUIRED IW'PECTIONS
Phone 1: 631-2918 RP/Backflow Preventer
Reg #: LIC 00005973 Final Inspection
PLM 11717
ORIGINAL
cl�
>- This permit is issued sub;ect to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This oermit will expire if work is not started within 180 days of issuance, or if work is suspended fog mor(-,,
w than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: '�'�'v.L.[t,� _ Permittee Signature: 6'ti- ���uvt-c-�.� - 2Y7c dz L
—ZLZCall (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
TY OF fIGA Phimbing Application Rec'dByU76z
t 25 �W,MALLL BLVD, Comr,lercial and Residential
Dale Rac_
GAFiD, OR 97223 d ! L
Date to P E.
03) 639-4171 Date to DST
Print or Type Pennit s_k -no Iy 9cc.- co
Incomplete or illegible applications will not be accepted calms
Name of DavebpmenVPropct F RES_ ndlvldual �� �►+,
Job ✓��/ re!/S .a - ' l s .n . ) y. ,.•. i�J '1 tpn tP6lcE: � �
Addre33treet Ad reu Suite Lavatory
9.00
141 s �i l��° Tub or 7r° 9.00
TuWShower Comb.
Bldg• ty/state ZI - 9.00
� ,��) ^` � -, Shower Only
t. CJ/
N Water Closet
9.00
9.00
iv�i :r� ,v-�� CLSI °''lr"'aher 9.00
Owner me surto C'"s D4posal
9.00
/slate / 9.00
e 4 Waa1Wg MSChk*
��P �,�� Phone (, �locr Drain 2-
Name J, -'govt/ 9.00
- 3• 9.00
Occupant ��^9 Addrou -' Sude Water Heater 4- 9.00
't.00
C7ty/Stato LIP Phone
Laundry Room Tray 9.00
urinal
'- 9.00
Name � f�T' - other Fuctteea(SPeufy) 9.00
� n,s P --',v
Contractor me Ada u Style 9.00
_ 9.00
(PTlor to Issuance ity late --
applicant mu-.,t ,.��sr `` Phons 9.00
'•�d kfA �� 023 �� �7 tll8 9.00
Provide an Onrgon Const.Cont.Board Lic,ji Date
contractors (JU 9.00
licunso information Phrmbwhq r rc a Exp- to Stww t 900' 9.00
30.00
for CUT COT Business Tax or Metro tl �,&• a �i sdd tional 100
database). Date 23.00
- yg3 �U 00 1Y�tet ServlcA-1st 100'
1Vame 30.00
Water Servicb-eat9t additlonal 200'
Atchitect 25.00
stone 8 Ranh lawn-to 1otr'
OrMarfrtg Address Suite Shim d Ra....Drat-each awmonal 100' 30.00
l 23.00
Moble Fkxtte
Engineer -Et Slate Lip Pnone _ 25.00
CormrercW Ba-"Jw F•reve+htion Device or Ants 25.00
rnbe worts Pollution Device
es
New Ad"O Alteratwn O Repair O Residential Ba*;ipw pro
he done: Residential&' Non-residential O Devow 15.00
u.Iionil descMijon of work AnY TraP or Waste Not CoroteCted to a Fixture 9.0p
Catch Basin
9. 0
Inap.at Fambrg Plumbing
_ �X let Qnc/I flat✓ .o.oo
cL slang use of SPecia'fy Requested Inspections per/hr
kiug ro
or pperty 40.00
F- Rain Drain,single ramify A-Bing PerOhr
n
Dc-ed use of Grease Tra s - 30.00
> wrrg or property P 9.00
ti --
QUANTITY TOTAL 33
J you capping. moving or repl,adng any fixtures Yes O No ClIswwak or res dragrart b reauvea a Y{
'
Yes see basic of form) a++r+h Tea b >9 I . ,
'SUBTOTAL
C-D ^relay acknowkdse that 1 have read this application.that the information 1 ,fir
W 'n-s correct,that I am the owner or authorized agent of the owner.and
-� ^lam submitted are in comofiance wr�preyon State Laws. 5%SURCHARGE
001MAaAj;t--
Do PLAN REVIEW 25%OF SUBTOTAL
Neaurea rnry t t6etyM toe 3>9
/ I
ritact Person Name TOTAL
Phone
r� E i Minimum permk tN is S25•S%surcharge.excepl Resdenual Badcttcrw
CJ► CJ "Zy�(� Prevention Device.wtvch is S15•5%surcharge
1:lphnapp.doc 12196 (ist)
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�� O� �����® � MASTER PERMIT
PERMIT#: MST1999-00210
DEVELOPMENT SERVICEMD� Q)N A L DATE ISSUED: 6/28/95
13125 SW Hall Blvd., Tigard, OR 97223 (5 4
SITE ADDRESS: 14198 SW 1 16TH TERR PARCEL: 2S11013A-08500
SUBDIVISION: EVERGREEN SPRINGS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
REMARKS: New SF - Path 1
BUILDING
REISSUE: STORIt.:,: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: .^:3 FIRST. 2.a26 of BASEMENT: at LEFT: 17 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 849 sf GARAGE: 761 at FRONT 36 PARKING SPACES:
TYPE OF CONST: 5N DWEL LING UNITS: 1 FINBSMENT- sf RIGHT: 18
VALUE: $224,68945
OCCUPANCY GRP: R3 BERM: 4 BATH: 4 TOTAL: at REAR: 55
PLUMBING
SINKS: 2 WATER CLOSETS: 4 WASHING MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 'TRAPS:
LAVATORIES: 6 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 10G SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: 5 GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<10OK: BOIUCMP<3HP: VENT FANS: 5 CLOTHES DRYER: I
FURN>-100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: blo i.00R FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FELDER TEMP SRVCIFEEDERS BRAI'^.H CIRCUITS MISCELLANEOUS ADC'L INSPECTIONS _
1000 SF OR LESS: 1 0 - 200 amp: 0 200 amp: WISVC OR FOR. 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 400 amp: 201 400 amp: let W/O SVC/FDR: 00 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY. 401 600 an-.p. 401 - 600 amp: EA ADDL BR CIR: SIGNALWANEL: IN PLANT:
MANU HMISVCIFDR: 601 - 1000 amp: 601tamps•10oov: MINOR LABEL:
1000+amplvnll:
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVCIFDR>=:25 A.: 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDF14TIAL _ B.COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO, FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: "".ER; HVAC: LANDSCAPEIRRIG: PROTECTIVE SIGNI.:
CARAGE OPENER: LICK: INSTRUMENTATION: MEDICAL: OTHR:
HVAr„ DATA t E COMM: NURSE CA-LS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,577.92
RENAISSANCE CUSTOM HOMES INC RENAISSANCE CUSTOM HOMES This permit is subject to the regulations contained in the
1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR Tigard Municipal Code,State OR. Specialty Codes and
all other applicable laws. All woo rk will be done in
WEST LINN,OR 97068 WEST LINN,OR 97068 accordance with approved plans This permit will expired
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION'
Phone: Oregon law requires you to follow rules adopted by the
i Oregon Utility Notification Center Those rules are set
Reg N: I forth in OAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion 844-8444 Plm/undslab Insp Electrical Rough In Gas Fireplace Electrical Final
E
E Footing Insp PLM/Underfloor Framing Insp Insulation Insp Mechanical Final
Li Foundation Insp Mechanical Insp Shear Wall Insp Rain drain Insp Plumb Final
J
Siab Insp � Plumb fop Out Low Voltage Water Line Insp Flral Inspection
Un,orloor insulatf0tl Electrical Service Gas Line Insp Appr/Sdwlk Insp Building Final
IssLd By : Permittee Signature :
�'�---- Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
\ CITY OF TIGARDORIGIN A
EEN CONNECTION
PERMIT
DEVELOPMENT SERVICESRMIT#DATE ISSUED: SWR19
-00125
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S 110BA-08500
SITE ADDRESS; 141-8 SW 116TH TERR
SUBDIVISION: EVERGREEN SPRINGS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
TENANT NAME: RENAISSANCE CUSTOM HOMES
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL_TYPE: LTPSWR IMPERV SURFACE:
Remarks: New SF - Path I
Owner: FEES _
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT DEB 6/28/99 $2,300.00 99-316441
INSP DEB 6/28/99 $35 00 99-316441
Phone: 557-8000 Total $2,335.00
Contractor
Phone:
Reg#:
Required inspections
Sewer Inspection
d.
~ This Applicant agrees to ,; , with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the daW r?:`Itiod The total amount paid will be forfeited if the permit expires. The Agency noes not
guarantee the accu+acy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not se located, the installer shall purchase a"Tap and
J Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oreg4n_U-tility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain c> ,ies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issu�d by: Permittee Signature:
T-fy r
- Call (503)639-4175 by 7:00 P.M. for an Inspection needed the next business day �"
e
,CI'> Y OF TIGARD Residential Building Permit Application Plan Check 75
13125 SW HALL BLVD. Alteration - Interior Remodel Only Recd By 77-
TIGARD, OR 97223 Single Family � p �Detached or Attached Du lex Date Recd �5 t
Date to P.E.10 ' � Iq
V 503-639-4171 Date to DST
F 503-084-7297Pc mit#11SC I°`1^( OBILI D
Print or Type Caned b-t
Incorr ;tete c illegible applications will not be`acceptead OOIZ''
Name of Project _ Name
Job rr: r S %��, L o� / `l) 140-w //k✓�A(/.!
Address Site Address
Architect Mailing Address
/ r� City/State Zip Phcne
Name
IKe,.tom 1p"eV (I.f�..�, No,.HYJ --
Owner Mailing Address Name
City/State Zip Phone Engineer Mailing Address
,, -' 1170(9 !9000
-
General Name City/State Zip Phone
Contractor Snr-,e A_J Describe work NewsO Addition O Alteration O Repair O
Mailing Address to be done:
Prior to permit Additional Description of Work: V )
issuance,a copy City/State Zip Phone
of all licenses c (J
are required if Oregon Const.Cont.Board Exp.Date PROJECT 1Z G/
expired in
COT Lic.# IDD N9g�" s//6-Av o, VALUATION
databaMechanical Name NEW CONSTRUCTION ONLY:
Sub- ,., C fro/ Sq. Ft. Hous: / Sq. Ft. Garage
Contractor Mailing Address
Prior to permit 3 G S/ S A'-,';41 Indicate the restricted energy installation by the electrical
issuance,a copy City/State Zip Phone subcontractur in the followin9 areas
of all licenses C Ilkc.l,•-^nf 97SIS- 6•SU- 3115- Restricted Audio/Stereo
are required if Oregon Const.Cont. Board Exp.Date Energy System Alarms
expired in COT Lic# / Installafiors Vacuum Irrigation
database �7 1,6 7 .3 4 Z� System S stem
Plumbing Name (check all that other:
Sub- _a pl )
Contractor Mailing Address Corner Lot YES NO ,:lag Lot YES NO
(check one) check one
77Y6 Has the Subdivision Plat recorded'? N/A YE NO
Prior to permit City/State Zip Phone
issuance,a copy l ?,0 1 7ncf <z/- Syr 0 Solar Compliance
of all licenses are Oregon C(,ast.Cont.Board Exp.Date Calculation Attached) _
required if Lic.# ,)) 1 hearb acknowledge that I have read this application,that the
expired in COT 7'�(�� 2�/ /�O y g PP
database Plumbing Lic.# Exp. Date information given is correct,that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
_ 7_14- /I11S1�A _ _ '�'��� Oregon State laws.
Name Signature of Owner/ e,it Date
�'�1`�- S
Cif „Electrical ,� , G. /.t-� L �-�.-� � "f/ 79
Sub- Mailing Address Contact Person Name one
#
� --
� Contractor _ ®� 3 cv �1l?(1FOR
OFFICE USE ONLY: _
City/State Zip Phone Plat i Ma /TL#: p
Prior to permit I 1_ , T"_-
- issuance, a copy ��i,�4 4"",s f}7J /S' (:'S 1- Dl y
Satb .ks Zone: Sol7r:
w I of all licenses are Oregon Const.Cont.Board Exp.Date I ) ��.✓�
--� required if Lic.# � f?,
� ,
expired in COT �3 Sy'!� `y�r/ r E_ ngineeri g Approve Planing Approval: TIF:
database Electrical Llc.# Exp. Date [ '�� r.. �
I:SFREM2DOC(DST)8/1
,
NOTE: CENTERU14E CONCEPTS, EROSION CONTROL:
SURVEYORS,WILL PIN ALL EXl ERIOR 1.PROWDE 8 MAINTAIN 8'(min)THICK
FOUNDATION CORI4ERS AND PROVIDE GRAVEL-PAD 8 DRIVE UNTIL PERMANENT
SUBSEQUENT MORTGAGE SURVEY. CONCRETE DRIVE IS IN PLACE. I4v— Ora,^
2.PROVIOC 6 MAINTAIN SOIL SEDIMENT
FENCE AS INDICATED.
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EL 302EL v ' J 29� - MOVED HOUSE PER CLIENT
• � \ a ��- - - - - - -� _ - 6/2/99 MEC.
N 8910'0 " E 112 8 c z 9h s
c� P(.E Uulo�rr9r.N� \.
SCALE DRAWING LOT 10, EVERGREEN SPRINGS
i N.W. 1 4 SEC. 10, T.2S., RAW., W.M.
i
w CITY OF TIGARD
% WASHINGTON COUNTY, OREGON
� I
MAY 27, 1999 Cera tc�rline Concepts Inc.
DRAWN BY:. MEC CHECKED P_Y: WGDiII
,AN EIGHT FOOT PUBLIC UTILITY EASEMENT SCALE 1 ,920' ACCOUNT 115 640 82nd Drive Gladstone, Orcyar. 97027
SHALL EXIST ALONG ALL STREET FRONTAGE �
M:\MLI\L10EVRGS - 503 650-0188 fax 503 650-0189