11722 SW 128TH AVENUE ADDRESS:
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CITYOFTIGARD
cnyOF TWARD
COMMUNITY DEVELOPMENT DEPARTMENT OREGON
MASTER PERMIT
13125 SW F W1 Blvd. P.O.Box 23397,TiqmM,Oregon 97223 (603)6394175 #
ijArE ISSUED: 03/0.R/93
SITE ADDRESS— ; 11722 5W 128TH AVE PARCEL: 1SI33DD-08700
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE PARK 4 Z019ING: R-4. 5
BLOCK. . . . . . . . . . ; LOT. . . . . . . . . . . . . : 124
------------- ---------------------- BUILDING ------------------------------------
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :121 s
CI-ASS OF WORK. :NEW BED ROIS:4 BATHS-.3 GARAGE . . . . . . . . . . :420 S f
TYPE OF USE. . . :SF FLOOR -,,REAS----------_ REQUIRED SETBACKS----------
TYPE OF CONST. :51\1 F 10", . . . . : 1100 s f LEFT. . i7 ft RIGHT. : 1421 ft
OCCUPANCY GRP. -.R3 SC.COND. . . .9 10 s f FRONT. -20 ft REAR. . s53 ft
STORIES. . . . . . . s2 TH I RD. . . . :0 S f REQUIRED--
HEIGHT. . . . . . . . s2 ft TOTAL-------a 2010 s SMOKE DETECT 0RS. :Y
FLOOR LOAD. . . . .40 psf VALUE. . . . . $ c 10 14)0 2 0 PARK ING SPACES. . ' I
Remarks; PATH I
--------------------------------- PLUMBING -------I----- ---------------------------
SINKS. . . . . . . . . . ii FLOOR DRAINS. . . . :V1 BACKFLOW PREVNTRS. . .-O
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRPiPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :;3 LAUNDRY TRAYS. . . :0 LAIGH BASINS. . . . . . . :0
WATER CLOSETS. . -.3 SEWER LINE (ft) . :0 GREASE TRAPS. . . . . . . 19,
DISHWASHERS. . . . : 1 WATER LINE ( Ft ) . : 100 OTHER FIXTURES. . . . . .0
GARBAGE D I SP. . . sl RAIN DRAIN (Tt ) . tO
WASHING MACH. . . : 1 SF RAIN DRAINS. . - I
MECHANICAL ---------------------------------- FEES __--_-__._-____
FUEL UNIT' HTRS. . :0 type amount by date -r-,e V)t
/GAS/ VENTS . . . . . :0 TIF $ 1460. 00 JH 03/02/93 -
MAX IMPUT:0 BTU VENT FANS. . :4 BPRI $ A-35. 50 JH 03/02/93 -
F URN
FURN ( 100K . . rO HOODS. . . . . . 11 B1-`LC $ 283. 08 JLH 11/25/9x' 9 2 2 3 4 0
TURN ) =100K . . . I WOODSTOVE.13. 10 B5PC $ a'l. 78 JH 03/01--/93 -
FLUOR TURN. . . . a0 CLO DRYERS. i I SSDC $ 280- 00 JH 03/02/93 -
BUIL/GMF' ( 3HV-0 OTHER UNFISA I PARK $ 250. 00 JH 03/02/93 -
GAS OUTLETSal MPRJ $ 45. 00 JH 0---'/02/93 -
Owner; $ 11. 25 JH 03/02/93 -
JIUR15SETTE HOMES 1V15PC $ 2. `5 JH 03/02/93 -
PPRT $ 140. C0 JH 0,3108/93 -
7. 00 JH 0.3 02/93 -
Phave #P
Lor cractors __-__-__-_ .______._-____.-_-__---
)PN MORISSEITE BUILDERS, INC.
5555 SW BANDY RD.
4201
LAKE OSWEGO OR 97035
Phone #: 620-7538
Reg #. . 1 35533 ----------------------------------------
$ 2935. 86 10TAL
This pertit Is issued subject to the regulations contained in the -------- R.FUUIREP INSPELtIONO -------
Tigard Municipal Code, State of Dre. Specialty Codes and all other Fout/foLmd Insp Fir'eplar--e Insp
applicable laws. All work will-W-dono In accordance with approved Post/Beam StrLICt Gas Line Insp
plant. Chis ptreit will txpirCif work not started within IS@ f`ost/Beam Mechan Insulation Insp
not
days of issuance, or if wors suspended for RoMrhan�180 d s. ;/
Pl. Lindslab Insp Gyp Board Insp
-mittee `Q`i� PLM/Underfloor Rain dt-ain Insp
Signati.tt, : Mechanical Insp Watet, Line Insp
PILimb Top 01.it Appr/Sdwlk Insp
Issued By . Framing Insp Mechanical Final
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CITYOFTIGARD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT 06119M PERNI'T
13125 SW HWI BW. P.O.Box 23397,Tkpwd,CA,Von 97223 (503)63[.-4176 PERMIT #. . . . . . . : SWR 92-0378
639-4171. 1);:�il'E lSbUF_D. 01'31'02193
Sl"['E ADDRESS. . . : 1172.�? SW 128'TH AVE PARCEL: IS13.31)D-08700
SURD I V I S I ON. . . . : V I LL AGE AT SUITIMER LAKE ('ARK 4 ZON*NG. R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . 124
I ENANI' NAME. . . . . :
USA NO. . . . . . . . . . z FIXTURE U1'4111�. . .
CLASS OF WORK. . . :1\11::W DWELLING UNT'l-S. - : I
T'YPE OF USE. . . . . :5F NO. OF BUILDINGS: I
INSTALL TYPE. . . . : 3USWR IIYIF-,LRV SURFACE. : Sf
Remar-ks: 1:41"M 1
Owner-: FEES
1Yl0RISSET'*I'E HOMES t ?pe amal-trit by date r,e c.,p t
PRMT $ 2 10 LA. 0 Lh JH 03/0E/y3 —
I NSP $ 35. VILA J11 1113/02/93 -
Prone #:
Contractor—
CON-1RACJ*OH NO1 ON FILL
------------------------------------------
Pliane 4i . $ 2:,135. 00 "TOTAL
Req ft.
REGIUIREI) INSPECT I UNS
This Applicant agrees to comply with all the rules and regulations Sewer- Inspec-tiun
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forteited it the
permit expirt,:. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions f-om
the distance given. If not so located, he installer qhal) purchase
a "Tap ano Side Sewer" Germs and the Nd ncv wil -stall a later 1.
Permittee G.iqnatl
ISSI.(PCJ Byd.
Cal I for-, inspect ion a39-417`3
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATE OF
131-3 SYS Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171 OCCUPANCY
u;<r.,( ! ,CRMIT #. . . . . . . . MST'i
631.--4171
DATE ISSUED: 06/16/93
:3ITE ADDRESS. . . 11722 SW 128TH AVE PARCEL: 1513:3DD-087101
!3UBDTVISION. . . . VILLAGE AT SUMMER LAKE: PARK 4 ZONING: R-- zi. 5
:;LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 124
(.;LASS OF WORE. a NEW
I YPE OF USE. . . -.SF"
,)CCUPANCY GRI c R3
(.)C(.-"UV'ANCY LOAD:225 4
1 ENANT NAME:. . .
r,;emarks . PATH
Owner.
i,10RI SGE tTE HOMES
I
Phone #:
I)ON MORIS)GETTC BUILDERS, INC.
15555 SW DANDY RD.
#x_'01
LAKE OGWLGO OR 970:35
Phone #: 6LO -•7538
Reg #. . : 35533
OccUParivy of the above referenced building if; hereby [Liven, anti certifier;
t'ne r_omplianc:e with the 1:itate Of Or,egnij :3pecialty Codes for the grol,,tp,
occuparl(-:y, sand use under which the.+ rfferenced Permit was is5L1pc.1.
U
FIRE DLPAR TM( NT 7 1 INC SPECTOR
_._.___ _.._✓ BU I LDNCL
POST IN CONSPICUOUS PLACE:
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INSPECTION NOTICE
City or Tigard Building Department
13125 80 Hell Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-•4175 Business Phones 639-4171
Inspection:
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwik
Found Plbg. Tog Out Gas Line PINALx
Post/Beam Struct. San. Sew- Framing � -nldq.
Post/Beam Hoch. Rain Drain Tnaulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch, i
Date Requested,x C["� // � Time:
AN PH
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-� f1
Address: / � � -- Permit
Builder: �. J• /
THE FOLLOWIN%; MRREC°'TnNS ARE REQUIRED:
j
Inspwctori Date:_
APPROVED !� DISAPPROVED APPROVED RUBJECT TO ABOVE
_~_Call For Reinsp.
jNSPECTION NOTLCE
City of Tigard Building Department
13225 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business phone: 639-4171
Inspection:
Footing Plbg. Underalab Mech. Rough--in Apnr/Sdwlk 1
Found. Plbg. Top Out (Sas Line FINAL!
Post/Beam Strv- . San. Bawer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requasted: �5 V Time: AM PM
Address: C1 Zz - Zd Permit 1t`1
guilder:�F
THIT FOLLOWING COPRRCTIOMS ARE RSQC(RED:
Lw6S; 7O
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oyEL"tTs -- aAE is l�sru D�
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Inepectar: L-�7r'��t��/ _ Datec
APPROVED DISAPPROVED V APPROVED AUJJECT TO AWNS
Call For Reinsp.
I_NSPEIOf7 NOTICE �� r
City of Tigard Building Department
13125 60 Hall. Blvd. Tigard, Oregon 97223
Inspec.-tion Line (Rec-O-Phone)t 6339-4�17/55 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Outas Line FINN.:
Post/Beam Struct. San. Sewer trsal / �Q- -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Plater Line Oyp. Rd. -Hoch.
Date Requested: ( /_7)d li 2l met AM PM
c�
_LL-L z_ lam- ,�' i -cue— Pormitt i
Address: 9
Builder:
THE FOLLOWING MRRICTIONS ARE REQUIRED:
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Inspectors LI �_ � 4 -- Date 3
/IA APPROVID DISAPPRovxn APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NO'CIGE
City of Tigard Building Departaent
13125 93W Ball Blvd. Tigard, Oregon 97227
Inspection Line (Roc--O-Phones 639-4175 Suaineee Phone: 639-41 1
Inspection:
Footing Plbg. UnderelabHoch. Rough-in' Appr/Sdwlk
cnrnd. Plb<!. Top Out ciao L ns FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Pl.bg. Underfloor Nater Line Gyp. 8d, -Hoch.
Date Requesteds,qr.2 Timet AM PH
Aedraea: c R� sk Permit !e
Builders
THE FOLLONIM OORRBcTIONS ARE REQUI s
.� il�ern
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to r) .-"-� -� �„✓ ----
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Inepeelert i"V Detet
11PP D DISAPPROVED APPROVED SUXTRCT TO ABOVE
Cal) For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
13125 SR Ball 87.rd. Tigard, Oregon 97223
Inspection Line (Rbc-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:.
rooti)g Plbg. Vnderelab Hach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. Ban. Sewer Framing -Bldg.
Post/Beam Meeh. Rain Drain Inoulation -Plumb.
Plbg. underfloor Nater Line app. Bd. -Koch.
Oats Requested$ '•l �(U� -`i —Times AN q PM
nddreee: O
Permit #t.,
T
TRE FOLLOWING CORRECTIONS ARE REQVIRED:
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Inspectors. Oates l 7
APPROVED DISAPPROVED APPROVED 8V8JECCTT TO ABOVE
_Call For Rainsp.
INSPEC I t NOTICE
Citi. of Tigard Building Departalent
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 DuainasR Phone: 639-4171
Inspection:
Footing PUN. Undarslab Hoch. Rough-in Appr/Sdt+lk
Found. Top t> Can Line FINAL:
Past/Beam Struct. San. Sower Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor f Line Gyp. Bd. -Mach.
Date requested: /CJ)� �l T"WS Am pN
Address: 1 7,2 ' APP
C7 Y-1 /�rlit 1f 1 V
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THE FOLLOWING CORRECTIONS ARE 1tlQ IP"I
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Impactor: Dalet���
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�( APPROVED DISAPPROVED APPROVRD SUBJSCT TO ABOVE
�� Call For Rainsp.
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 Hoch. Rough-in Appr/Sdwl.k
Found. Plbg. Top Out Gas Line FINAL:
P Beam BtruCt. San. Sewer Framing -Bldg.
t/Beam Hoch. Rain Drain Insulation -Plumb.
Underfloo water Line Gyp. Bd. -Hoch.
-7
Date Requested: �JC Times _AH PH
Address:_ / 4 "S Permit i
Builder: r/� —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: _ Dater___ r
APPROVED DISAPPROVED // APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECT L' 1 NOTICE
City of Tigard Budding Departaent
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Re n-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Poet/Beam Struct. AnCh. sewer,., Framing -Bldg.
Post/Beam Mech. Ineulrtion -Plumb.
Plbg. Underfloor tatorjLLn Gyp. Bd. / -Mech.
Date Requested: Tlme� V(�AM —PM
Address• 1 � 2 O ,. Permit 1: �O
Builder: ---
THE FOLLOWING CORRECTIONS ARE REQUIRED:
7
Inspecto
`r:
N} APPROVED DISAPPROVED _ APPROVED SUBJECT To ABOVE
��CC Call For Relnsp.
SPECTION NOTICE
City of Tigard Building Department
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Ree-O-Phone)s 639-4175 Busineee Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: / Time: - / AM �J�-PM
Addroea: 1�1 / c� / a Permit ►: G�'L
Builder:--, �-�-�-- — -
THE FOLLOWING CORRECTIONS ARE rdQUIRED:
Inspectoor: — -_�r.--,--- Date:
APPAOVlD DISAPPROVED _— APPROVED SUBJECT TO ABOVE
Cell For Reinep.
P" TD:iARD kECLIPT UF POYME.N1
ki-C'Eli'T NO. 3 6
CHFX;K AMOUNT 8�
NAME Dl)ij CASH AMI JUN f
IN) PAYMENT DATE 0,:�/Oc'../9 3
GULAG I V I IS,11.]N
PURPOG)r.-` OF A1Y1OU1\1 T VIA I D P'JHP0,.-,r. OF PAYMEW AMOUNT PA T 1)
LA i I.A.. ING PERM 435. 50 Pi-UMAING PERM 1. Q.%. 1A 0
o 1,11 C.41ANTUAL PF 45. 00 t.,T. BUILD PER :.1. 0
F-IAN CHECK r-F-' w_'`;4. 33 sEwrp UGA ,100. 00
DC: 00
I.-J. WER TNS;PF(,`T i5. 00 PARKF, ;)
S T I I R 1v1 1 N S r.',C QIQ RESIDENTIAL TRAFFIC, FEES 1350. 00
N(1�15 TPAN: 11 TtF FF(-t-, i 10. 047
cs
tJJT 11 4 VILLAOC AT SUMMERLAKE 4
1174!*r, F',W 12FID1 AVE'
TOTAL AMOUNT PAID 11301,30. A6
Cff oCITYOFTiARDrForm
COMMUNITY DEVELOPMENT DEPARTMENT
19126 SW HdI Bvd. P.O.&IR 23307,TOW,O"m 97223(6W)63"176 RD
o
#. . . . . . . : I+I E, ( ),:• kt�- �) i
DATE ISGUF:U: O3/Oc/9a
5:1'1 F. ADDRESS. . . I 11722 SW t 8TH AVE PARC:F.:'L.I 1SJ 3.3DI.)--0E17i;
MBD I V I S I ON. . . . : VILLAGE AT SUMMER LAKE PARK 4 7'ON I N13 s R-4. 5
CrL.00K. I . . . . . . . . . LOT. . . . . . . . . . . . . 8124
4
BUILDING
RE I SSUE I DWELLING UNI'rs: 1 PASE'ME:NT. . . . . . . . to s f
CLASS OF WORK. :NEW BEDROIS:4 LAPT HS 13 l Ar' AGE'. . . . . . . . . . 1 420 s F
TYPE Of USE. . . I SF" FLOOR REQUIRED
TYPE OF CONST. :5N F1 RST. . . . : 1 100 s f LE;F'T. . s7 f t R I GENT. 110 f't
OCCUPANCY CRF"'. I R3 SECOND. . . s910 S f f-RON`r. :20 ft REOR. . 153 f
>TORIES. . . . . . . o2 T'HIRD. . . . :0 S PEW I RED-
HE_I CHT. . . . . . . . a25 ft TOTAL_ :I.010 S f CUMOKE: DETECTORS. I Y
FLOOR L_t_,AD. . . . s 447' pe f VALUE.. . . . . $ : t 1100210 PARK 1 NG SPACES. „ : I
Remetr•14s a PATH I
S I NKS. . . . . . . . . . 0 1 FLOUR DRA I N53. . . . 10 BACKFLOW PITC:VNTRS. . :0
LP)VATORIES. . . . . :3 W(--4T'E'R t1E:ATI-RS. . . 21 TRAP'S. . . . . . . . . . . . . . I11)
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . s►h_ CATCH BASINS. . . . . . . .0
WATER CI_OSNTS. . t3 E;f::WE:R L..INE ( Ft) . s0 CRENSE TRidPS. . . . . . . 10
DISHWASHERS. . . . . 1 WA'TE'R LINE (ft) . : tO0 OTHER E`.IXTURES. . . . . :0
GORBAGE: DTC1='. . . : 1 RAIN DW)IN (ft ) . so
WASHING MACH. . . : 1 JF RAIN DRAINS. . 0 1
MEtHANICAL ___._.._.._ ...___M___...__._.__.__..___.____.._ ... FEES __..__._.._�._.._ .._... _
FUEL UNIT MRS. . :LA type amom-it by date vQt—,pt
1 GAS/ ! / VE:'IJ`r:r . . . . . :0 T I I'' t 1460. 00 JH 03/02/93
IvlF1X IPIPUT:0 D'TU VENT FANS. . 34 E:1F"RT' s 435. 50 JI•I 03/02/93
r URN ( 1.0011% . . -0 HOODS. . . . . . : J SPLG $ P83- 08 JLH 1 1/25/9 ' %?--c!340
FURN ) -100K . . : .I. WWDS'T'(]Vr".'-i. :0 E15PI-1 t r='1. 7E3 JH 111:3/OP/9.3 _
F I-0OR FURN. . . . :0 CLI-) DRYER:., I 1 SSDC $ 2,80. 00 .11O3/W-'/9,3 -
[TUIi_./Chip < 31 P20 01HER UNITS: I PARK $ 250. 0471 JH 0.3/02/93 -
UP.6 OUTI..E:.TSo 1 MVIRT ♦ 45. 00 JH 03/O2/93 -
Ownet,s _..______...__.._____ .._._._.__._.______._.__._.__.. ...._......_.___.._.IMF'LG ! 11. 25 JH 03/&;.''/93 -
h10RISSF.TT'I-� HOMEE M r-,c ti 2. c.".5 JH 03!1[X"/93 -
Pr ^7' i 140. 00 JH k-3/O�'/9.3 -
F'Sl'L $ 7. 00 J14 0.3/02/93
F'ttone it:
C;c�ni:raatwt ur I .•-___._.._.___...___..___........__......._.___. ._._._..._-.___..,_.
DON MORISSE'TTE BUIL.DF:RS. INC.
15555 SW 00146Y RD.
I.AI:E C1�'Wr1:3CJ OR 97035
0. 35533
J"-, F4torte 11: 6�?0- 75;sB
2'935- 86 T 0 T'AI_
Thit ptrait is issued subject to the regulations contained in the ------ RE UUJREU IIJ:SI='C:.C_`rICIIJE3 -- -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Font/found insp F"ireplAre Inst,
applicable laws. All work will be done in accordance with approved P05t/Hemm Str'ur_•t 6aas Lirre InRT,
J plans. tnis permit Millexpi if work Is not started within 109 E''r. st/Beatm Merhaan irrsil.lat i errs InF l
'iay; of iss�a�ance, or if Work is suspended for sore thea 180 days. Inst, Gyp l:%uArd Ir►sp
F�l..hl/I.Jrt+Jer fln1:r► Rairt rt --aaln Ittsp
I er'ntitteP tiiyn t�t 'e.� _ _T Ntmc: h-anir_atl flrgp W-�atet- 1__irte ln«sp
Plu.lmb lop put Fpjor'/4"dw114 1115P
tssr.iaca EaY ; .. _. _._ Fr-aming In,,p Merharrir a►1 F1rta1
- 4.1 ' f eoa ".ra a 1-0c0t i or,
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ulu sw Hall arra PLNCK/RECT
CI T QF TIGARID POBox 2»97 PERMIT f eSWrZ- 4-z I�l
COMMUNITY DEVELOPMENT DEPARTMENT TwrA0-9°Ogr
(503)63M171 DATE ISSUED
JOB ADD�R��S: i t 7ZZ W �45� y� AVP, . TAX MAP/LOT 1505 DD -
SUB: I- ' `TT �C4 LOT: 1 _ _ LAND USE:
VALUATION: 1061,02 y
OWNER SPECIAL NOTES
NAME: JDL _ s�P � YYl� � REISSUE OF:
ADDRESS: P S S LAST REISSUE:
--LallyLrr,4,e FLOOD PLAIN/
PHONE: 3 _ SENSITIVE LAND: Y
CONTRACTOR } ` 1 APPROVALS REQUIRED
NAME: .�D Vn6YpsSsc l CC Hoyn ,j t oc , PLANNING:`.
ADDRESS: 0--7"V\,' kYAQENGINEERING:
C) o` _ FIRE DEPT:
PHONE: 1 OTHER: l r
CONTR. BOARD f: _ EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS:
MECH: inyrVuS TAX: _
ARCN/ENGINEER CALCULATIONS:
NAME: -Z'7-)/ TRUSS DETAILS: _
ADDRESS: P. _Ig o K e 3 OTHER:
lam- ? a'1 --
PHONE: C.P�J�f 3r/�C`�f!r s
PROPOSED RL.OG. USE:
COMMENTS: _
APPELLANT IG�IATURE
Received By: — Date Received: ^_
PERMIT R ACCT / DESCRIPTION AMOUNT AMOUNT PD. BAL.-DUE
Ksi� - 2y(10-432 00 Building Permit Fees jam. )
10-431 00 Plumbing Permit Fees 68
10-431 01 Mechanical Permit Fees 5 "' � 3 X00
10-230 01 State Building Tax (5X) 3/.v 3 _3/. -3
Building '
Plumbing 7 v
Mechanical o�• Z�/
10-433 00 Plans Check Fee
Building 4��3• u� Ff-
Plumbing
Mechanical
10-230 06 Fire
5wP47-v V30-202 00 Sewer Connection
30-444 00 Sewer Inspection ✓�'� 3 S�
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 Z13 L' 3S a
25-448-05 Mass Transit TIF Fees //0 //a
52-449 00 Parks System Dev Charge (PDC) .2 ST 2 _S U
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) v _—
24-445-01 Water Quality (Fee in lieu of)
L' 24-445-02 Water Quantity (Fee in lieu of)
TOTAL SV U , So 3 OT
W
J
nm/3587P.WPF