11866 SW 127TH PLACE i
ADDRESS:
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CITYOFTIOAPD
CITYOfT16ARD CERTIFICATE: OF
COMMUNITY DEVELOPMENT DEPARTMENT 02 gem OCCUPANCY
131263W HWI Blvd. P.O.Box 23-97,Tipud,Gogon 97223(503)839.4175 � . e IYIST92 017105
1=�E'RMIT #. . . . . .
DATE: ISSUED: 06/25/92
SITE ADDRESS 11866 SW 127TH PL PARCEL e 1 S 133DD--1 740''--
SUBD I V I S I ON. . . . c VILLAGE AT SUMMER LAKE PARK 4 ZONING a R-4. 5
BLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . . : l. 71
CLASS OF WQRK. s NE:W
TYPE OF USE. . . a SF
OCCUPANCY GRP. :R3
OCCUPANCY LOAD a P'25 4
TENANT NAME— :
Remark w : PA'f'H 1
Uwneri
DON MORISSFTTE BUILDERG, INC.
15555 SW RANGY RD.
#20 1
LAKE OSWE GO GoR 47035
Phore #r 600-7338
Cant ract or a
DCN MORISSE"TTE PUIL.DERS, INC.
l 3n55 SW SANDY RD.
#20 1
L.AI-\F.. D;WE.C.-O 'JR 97035
Phone #: 600--7538
Roo #. . : 355.33
Occupmncy of the above i-eferenced bUi .lrli,ng is hereby given, and mortifies
the compliance with the State Of Oregon spocialty C'ades for the group,
ocol. pancy, ,.and use under~ which the referWnc:ed permit waw itsmed.
F I IRE' DEPARTMENTNt''ftC
80tLDING 0 ICIAL
POST IN CONGP I CUOU a PLACE':
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CITY OF TIGA RD
CRYCWWAIM
COMMUNITY DEVELOPMENT DEPhARTMENT ogle" MASTER PERMIT
13125 SW Hull Blvd. P.O.Box 23397,Tigard,Ore(pn 97223 (603)6j9-4175 PERMIT #. . . . . . . ... MST 92-0005
639-417i DATE ISSUED: 03/321/92
SITE` ADDRESS. 11866 SW 127TH PL PARCEL. I.S133DD-13400
3L)BDIVISTON. . . . ' VILLAGE AT SUMMER LAKE PARK 4 70NINE-5: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . 171
BUILDING
REISSUE: DWELL ING UN ITS: I BASEMENT. . . . . . . . :0 5f
t,'LHSS OF WORK. .-NEW BEDRMS:4 BATHS:3 GARAGF. . . . . . . . . . .605 sf
TYPE OF USc. . . :5F FLOOR APF1.AS------------------ -- REDUIRED SETBACKS-----
TYPE OF CONST. :5N F I RST. . . . : 1100 S f LEFT. . :5 ft RIGHT. ,E: ft
OCCUPANCY GRP. :R3 SEG(IND. . . -910 s FRONT. .2'0 ft REAR. . :42 ft
STORIES. . . . . . . :2 THIRD. . . . -O s REQUI
HEIGHT. . . . . . . . 5 ft TO'1*AL----------:2lZllO 5f SMOKE DETECTORS. : Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . 1913350 PARKING SPACES— :0
Rema -k,; . PATH 1.
PLUMBINC)
LINKS. . . . . . . . 1, FLOOR DRAINS. . . . :Q) BA0-1,FLOW PREVNTRS. . :0
,_AVATORIES. . . . . :3 WATER HEATEPS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
I UD/)HOWERS. . . . . 3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATLR CLOSETS. . :3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
OISHwnSHERS. . . . : 1. WATER LINE (ft '., . - 100 0 THEE R F I X TU RES. . . 0
GARBAC)E DISP. . . : 1 FRAIN DRAIN (ft ) . :0
WASHING MACH. . , : l SF RAIN DRAINS. . - I
I----------------- MECHANICAL FEES
FUEL TYPES— UNIT HTRS'. . -0 type amount by date v-ecpt
/GAS/ VENTS . . . . . :0 T I F $ 1-,60. 00 JLH 03/30/92
11AX JNPUT-lb BTU VENT F---ANS. . .4 BPrRT $ 4435. OV) JLH 03/30/9E'
FU 'N i 100K :Q, HOODS. . . . . . : 1 BPLC $ 287. 95 JLH 01/31/92 E'a',27 5
FURN -I.00K . . . I WOODSTOVE5 . 0 B5PC $ 2 L". 15 JLH 03/30/9E
FLOOR FURN. . . . -0 CLO DRYERS. : I SCSDC 11 280. 00 JLH 03/30/92
BOIL/CMP ( 3HP:0 OT1117-P UNITS:0 PARK $ CSO. 00 JL.1A 03/30/92_
GAS OUTLETS: 1 MPRT s 40. 50 JLH 03/30/9P
Owner, MPLC $ 10. 13 JLH 03/30/9,
DCIN MORISSETTE BU11 DERS, INC:. M15PC $ L. 03 JLH 03/30/92
i 0 - 9L
15555 SW MANGY RD. PRT 4; 14 0. 0 L71 JL1 —1301
#t,21141 P5PC 7. 00 JLH 03/30/9P
LAKE 1:jc.;WFG0 OR 97035
Pt)one #- 620-7538
Contrautov-: ---------------------------------
DON MOFRISSEITL_ BUILDE-IRS, INC.'.
15555 SW RANGY RD.
#1,201
LAKE OSWEGO OR 97035
C.�
Rey 35533 -------------------------
21362. 76 TOTAL
T
iHs permit is issued subJect to the regulations contained in the REQUIRED INSPIECrIONS
Tigard Municipal Code. State of &-e. Specialty Coles and all other Foot./foi-ind Insn Fireplace Insp
Applicable laws. All work will be done in accordance with approved POSt/Flea%M Stt-LlCt Gas Line Insp
U.)
plans. This permit will exciet if wirk is not started within 184 Post/Beam Mec-hari Insulation Insp
devs of issuarze, or if work is for more than 180 days, Plin/undslab Insp Gyp board Insp
I-ILM/Undev,I'l not" Rain drain I T1 S C)
Mectianical. losp Water Line I v i-.;n
Plumb Top Out Appr/Sriwlk Insp
!,-3-,ue(J El , , Ft-amin.q. Insp Merzl-ian i ca I Final.
7N
C'TY®F TIVASEWER CONNECTION
RD ARDPERMIT
01 F i RD
COMMUNITY L7VELOPMENT DEPARTMENT YO TWA #. . . . . . . : SWR92--00':)6
11125 SW FW1 BW. P.O.Box 23397.Tigard,Oregon 97223(SM)639-4175
(77
DATE Tr�GHFQ! 0-Y
:L ODDRESS. . . : 11866 SW 127TH PL PARCEL : 16133DD-13400
SiU01)I V 15 1 ON. . . . : VILLAGE AT P')MMER LAKE PARK 4 ZONING: R-44. 3
BLOCK. . . . : LOT. . . . . . . . . . . . . : 171
TENANT NAME. . . . . :
USA NO. . . . . . . . . . FIXTURE UNITS.
CLASS C'IF WORK. . . :NEW DWELL I NG UN I TS. I
TYPE OF USE. . . . . :SF NO. OF BUTLDINGS t
INSTALL TYPE. RUSWR IMPERV SURFACE.
Remarks:
Owner" FEES
DON MORISSETTE BUILDERS, INC. type 'AMOUnt by date rec:pi
15555 SW BANGY RD. PRMT $ 1900. 00 JLH 03/30/92,
—
#c01 I NSP $ 17 7-J. 011'1 11.,H 0.•s/ 0/9c
LAKE OSWE*GO OR 97035
Phone #: 620-7' 38
Lantrac2tor: ----—--———————————————————---————
CONTRACTOR NO'F ON FILE
———————————————————————————————-
Phone It, 19375. 00 TOTAL
Reg #. . :
T ------- REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspectic)n
of the Unified Sewage Agency. TFe permit expires 160 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy o, the
side sewer laterals. If the sewer is not located at the moisurement
given, the installer shall prospect 2 feet in all directions from
the distance given. If not so locate the installer shall put-chase
"Tao anti Side Sewer" Permit aKfhe Age cy Will install a late al.
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erm j.t t Pe Si qnAt 1.kre
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Call for inspection 639--4175
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4.175 Business Phone: 639-4171
Inspr. tion:!_
Footing Plbg. Underalab Mech. Rough-iii Appr/Sdwlk
Pound. Plhg. Top Out Can Line / FINAL:
Poet/Beam Steve San. Sewer Framinq /UAY -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Wate_ Linj Gyp. Bd. -Mech. _
Date Reguesteds___j(;� r 2S —/ Z Tima: __ AM _PM
Addreses ZZJ& O -Z-2 Z�Permit I ez". "1_1112:� _
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIREDs
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Innpectors / Data:
/APPROVRD DISAPPROM) APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION N
M
City of. Tigard Building D
13125 SW Ball B1 . Tigard, Oregon 97223
Inspection Line (Rec-O-Phone c 639-4175 Business Phonet 9-4171
Inspection• L- —
Footing Plbq. Underslab tech. Rough-in Ap�k
Founr'. Plbg. Top Out Can Line FINAL:
Post/Beam Struct. Sar.. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Flumb.
Plbg. Unde.•floor Water Line Gyp. Fid. -Nech.
i
Date Requested: /' U Timet / AM PH
Address:
Address:_ G' CG'!� 1.,2
Builders L12)
THE FOLLOWING CORRECTIONS ARE REQUIREDt
� � �1'][)�S'2l.►P P'�v� .i9 ��CL¢l /fix
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Inspector: (_,'q,/vj. eDare:
APPROVED DISAPPR RD _ APPROVED SURJRCT TO ABOVE
Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Dlvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-417b Busii :ss Phone: 639-4171
Inspections
Footing Plbg. Undseralab Mech. Rough--in Appr/Sdwlk
Found. Plbg. Top Out ;as Line FINAL:
Poet/Beam Struct. :tan. Sewe: Framing � -Bldg.
Poet/Beam Mech. Rain Drain insulation -Plumb.
Plbg. Underfloor inter Line
�� Gyp. Bd. -Mech.
�L�_ _ ems' �(/
Date Requested: Times _ AM /\PM
Address: /P. /rmit # D -K e�V'
Builder:----� — V
THE FOLLOWING CORRECTIONS ARE REQUIRED:
��� �+�.t-�-�-�-►+.�.� J7it�-:��� •t.[i ori- .�a��
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Inspectors---- Date: y
' APPROVED DIBAP�OOVRD APPROVtb EDBJRCY TO ADM
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Bt.ilding Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-6175 Business Phone: 639-4171
Inspection•—
Footinc Plbg. Unde.siab Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bld .
r
Post/Beam Mech. Rain Dreln Insulatijn < -Plumb.
L
Plbg. Underfloor // Water Line 3yp. Bd. -Mech.
Date Requested:_ (O _Time: —AM PM
Addroan:�1 t� '-- -,7/6 Permit 9t��
Bufl.der:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: — Date -:52 ? '
1 -APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223 �f
Inspection Line (Rec-O-Phone): 639-4175 Businenn Phone: 639-4171
Inspections
Footing Plbg. Underalab Mech. Rough-in% Appr/Sdwlk
Found. Plbg. Top Out Cas Line FI_ INAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Moch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lina Gyp. Bd. -Mech.
Date Requented: Time: AM PM
Address: / �=Permit #f
Builder: _
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors
A1+PRdV=0 DISAPPROVjctlllGrl'APPROVF.D SUBJECT TO ABOVE
Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 fait Ball Blvd. Tigard, orogon 97223
Inspection Line (Rec-O-Phone): 339-4175 Bueinee3 Phone: 639-4171
Inspection: — —
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Bram Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line C G ad. ) -Meeh.
Date Requested: 5- ! �^ Time: -7/—AM
]—AM PM
17
Address:�Z b�l� Permit I __- —
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Builder: !/J J )/THE FOLLOWING CORRECTIONS ARE REQ:IIRED:
Inspector:___ __�_� Dater 9-/
APPROVED —_ DISAPPROVED " APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of. Tigard Bui]Lding Department
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Ptsone): 639-4175 Business Phone: 639-4171
Inspection: _
Footing P1b7. Underalab Mech. Rough-in ��ppr/SdwlkFound. Plbg. Top Out Can Line FI N-AL,'�
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Unde:floor Water Line/ Gyp. Bd. -Meeh.
Date Requeeteds_ �: � -Y J2 _Time:
AddLess: � � Permit 1:_ 1.� -✓" �`,
Builder: 1 -
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors Date: 5'
APPROVED DISAPPROOD APPROVED SUBJECT TO AHOY!
Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
131 5 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bueinees Phone: 639-4171
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Inspect ion: _ tea)
Footing Plbg. Underelab Koch. Rough-in Appr/Sdwl.k
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer !rami -Bldg.
Poet/Beam Meco. Rain Drain Insula -Plumb.
Plbg. Underfloar Water Line Gyp. Bd. -Meeh.
Date Requeeteds A5 1 ` Time: _Y1__AN PM
Address: lY�F �G � ` Permit
Builder: �u4�1' G ✓ ��V
THE FOLLOWING CORRECTIONS An REQUIRED:
Inspectors T nate:
"MOVED DISAPPROVED ��APPROVED SUBJECT TO ABOVE
__Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Departnont
139.25 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out GasLine FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. MOch.
Date Requested:_2- Time: _A'AN PM
Address:- > Permit f oL 2--
Builder:-
THE
Builder:_
THE FOLLOWING CORRECTIONS ARE RR D:
Tnepector:_ •- �_- _ Dates
APPROVED //DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: _ --
Footing Plbg. Und-i:.-Iab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain insulation -Plumb.
Plbg. Underfloor (later Line Gyp. Bd. -Mech.
Date Requented: 1[J/Y2!;� _Times -AM _ PM
Address:__ Permit
Builder. _
THE FOLLOWING CORRECTIONS ARE REQUIRED-
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Date:__?
11PPROVF.D DISAPPROVEDAPPROVED SUBJECT TO ABOVE
Call For ReLnep.
INSPECTION NOTICE / ✓
City of Tigard Building Department
13125 Sw Holl Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: _ --
Footing Plbg. Underel�-: Mech. Rough-in Appr/Sdwlk
Found. / 1 Top Out' Gas Line FINAL:
�_.._-
Post/Beam 3truct. San. Sewer Fra.aing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underrloor Water Lin/e% Gyp. Bd. -Meeh.
Date Requested:- 1 _Time: AM PM
SAddreen:— r� Permit i:G /` -l��
Buildar• 2d
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspecto L!rC/ r I _- - — Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 LN Ball. Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-•Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
oat/Beam Structs, sen. Sewer Framing -Bldg.
('ont/Beam Nech.� Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Mach.
DntoRequeeted: �� _ —Times
AM PM
Address: tr Permit is zo e,5--
Builder: ? /,�_ `
THE FOLLOWING CORRECTIONS ARE REQUIRED: /J
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Inspector: x —---- -- nate:
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APPROVED DISAPPROVEDy APPROVED 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 Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line FINAL:
Post/Beam struct. Ban. Bower Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor ater Line Gjp. Bd. -Mach.
Date Requested: Time: /AAAM �}�f PM
Address: Cf' (!/' / Permit
c
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date:�_-
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
LNSPECTION NOTICE
City of Tigard Building Department
13125 ON Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: ——
Footing Plbg. Underslab Hech. Rough-i-+ Appr/Sdwlk
f.)
Plbg. Top Out Gas Line FINAL:
l
Post/Beam Struct. San. Sower Framing -Bldg.
Poet/Beam hec_a. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Hach.
Date Requested:— 4— Times / PH
Address: Z�G7 .2 L_ /G Permit #:
Bu f l pier: --
THF. FOLLOWING CORRECTIONS ARE REQUIRED:
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1 neE:ect or Date!
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE i /�'\
City of Tigard Building DeFar+m.nt
13125 SUI Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection•
Footing Plbg. Underalab Mach. Raugh-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
i tlbg. Underflo; Water Line Gyp. Bd. -Meth.
Date Requested: Time: � _AM _ PM
Address: /Z Z, �� 7py' Permit is 4 ,7
Builder.-
THE
uilder.•THE FOLLOWING CORRECTIONS 7011E REQUIRED:
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Inspector:
_APPROVED DISAPPROVED _ APPROVUU SUBJECT TO ABOVE
Call For Reinap.
CITY Cif" T I GARD RECEIPT OF PAYMENT RFC;E I F''T NO. 02-2a5363
CHF-CK AMOUNT a 4547. 7
NAME a MOR T SGF 1-T F,, DCN CASH nMOUNT - 0. 00
ADDRESS a @AYME`NT DATE;
SUSD 1 V T S I ON
PURPOSE. Or PAYMENT AMOUNT PAID F'IIRPO'3E OF PAYMENT AMOUNT PAID
d EXU I L_D I NCS PERM 443. 0Qf PI_UMB I NG PERM 140» 00
ML C:HAN I CAL. rE 40. S0 ST. BUILD GFR :31. Is
v~i PV4N CHECK FE. 46. 08 13Ei,WER USA 1900. 00
>- SEWER INSPECT 13!5. 00 RESIDENT LAL '144AFF=IC FEES Ipak1. 160
PARKS SEDC r".'.`50. 00 STORM DROIN SEDC ;'Z30. 00
r
MASES TRANSIT TIF FEES 100. 00
co
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LOT 171 GLIMME RI-APF 4
I tS66 SW 127TFE Fit.
10TAL. AMOUNT PAID _ _ ._7 4547. 76
CITY OF TIG(MI) — RECEIPT OV elOYMENT RECEIPT NO. 7 70 6
01ECR n1viOUNT 00
WIME MOR TSSUTTF, DON CASH AMOUNT 00
ADDRESS a VAAYMr-NT DATE a 01 /31/92
SUBDIVISION
PURF"'Mr OF PAYMENT AMOUNI PA I D PURPOSE OF POYtlt..NT riMOIJNT [=IAID
P1 ('11,4 CHECK F 17. 250. ki)o
11866 SW 127111
TOTAL AMOUNT PAID 00
PLNCy�RECT # , �-
CITY OF TI GAR.D PO Box z33m 13125 SW 23397all d N
PERMIT / t '7
COMMUNITY DEVELOPMENT DEPARTMENT Tlpr4omson9=
(W)639-4171 � DATE ISSUED
JOB ADDRESS: SS' i��•� � /- � P l TAX MAP/LOT l5/ 3 DD l3yw°
SUB: LOT: I / LAND USE: _
VALUATION:
WVy SPECIAL NOTES
NAME: REISSUE REISSUE OF:
ADDRESS: P-)o/'- '2?0/ LAST REISSUE:
" FLOOD PLAIN/
SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: — PLANNING: o -
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER: T/r-
�ONTX. BOAP0 #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: y�Q� I LIST/SUBCONTRACTORS:
MECH: _ ?E 711#S TAX:
ARCH/ENGINEER o 0. CALCULATIONS:
NAME: – - —
TRUSS DETAILS:
ADDRESS: P Cie FOX — — OTHER:
PHONE: LP ac
ccG
PROPOSED BLDG. USE: — -- --
COMMENTS: _
w
Af'PL�CANT SIG IAIURE
Received By: Date Received:
Pf RttIT ACC # DESCRIPTION AMOUNT AMOUNT PD. I3AL: DUE
,o,5 10-432 00 Building Permit Fees y =
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees _ 4/�", �2
10-230 01 State Building Tax (5%) ,�1 �y , Y
Building
Plumbing 7, Lj
Mechanical .� 3
i
10-433 00 Plans Check Fee c'�Y
Buildings"
Plumbing
Mechanical /v. 1 3
10-230 06 Fire
_),�R2-vLS6.30-202 00 Sewer Connection �'�' _ �e
3n-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 /ZY�' 12r
25-448-05 Mass Transit TIF Fees _��'� — /6-L)
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL ' -v-- lam
nm/3587P.W'PF