11974 SW 128TH AVENUE y
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11974 S'A 128TH AVENUE -
CITYOF TIGARDCERTIFICATE�� OF
rr141�TWARD OCCUPANCY
COMMUNITY DEVELOPMENT DEPART( W o OON PERMIT #. . . . . . . ; M5T92—��0028
13126 SW Hell Brnl. P.O.R-a 23307,Tip W,Oregon 97283{603)4�4r
lt:it:;lJE0l 09/10/92
gITC ADDRESS. . . a 11974 SW 128TH AVE PARCELa 1S133DD--17200
SU3D I V I S I ON. . . . a VILLAGE AT SUMMER i i" PT' PARK 5 70N I NG a 9-4. 5
DLOCF. . . . . . . . . . a LOT. . . .. . . . . . . . . . :208
CLASS OF WORK. aNEW
TYPE= OF USE. . . a P;F
OCCUPANCY GRP. aP3
OCCUPANCY LOADr220 4
i
I
TENANT NAME. . . r
Remarks : PATH I
Owner a
DUN MORISSETTE BUILDEwRS, INC,
15555 CW PANGY RD.
#'x'01
LAKE OSWFGO OR 97035
E-h o n e #: 620--7538
Contractor=
DON MOR I SSR TTE ESU I LDEES, INC.
15 555 SW RANGY RD.
#201
LAKE OSWEGO OR 97e,35
Phone #a 620-7538
Reg #. . p 35333
Occupancy of the above referenced building is hereby given, and certifies
the eomplianc.,e with the State Of Oregon Specialty Cortes for the group,
occupancy, and use under which the referenced permit was issued.
FIRE= D':WRlil"ME=NT �1LD1hi1, 7R
EaIJ
POST IN CONSPICUOUS PLAC IE
INS PECTInK,NOTICF
City of Tigard Building Department
13125 Sw Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Ph e)639-4175
Business Phone: 639-41.71
Inspection:
Footing Plbgf/Onderslab Mech. Rough-in Appr/Sdwlk
t
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struc.•t. San. Sewer Framing -Bldg.
Poet/Ream Mach. Rain Drain insulation -Plumb.
Pl.bg. Ilndecfloor Water Lino Gyp. Bd. -Mech.
I
Date Requested: -Io- Time: AH PH
Addrees:rZA � _ Permit 1:
nullder: �2� __-_--
THE FOLL(.OWI�NG CORRECTIONS ARF.-REQUIRED:
el
Inspector:1 ` l ( � �^ Dates`.
APPROVED DISAPPROVED AFPROVFD BUA.TRCT To AA:7VF
_ _Call 1ni Ruinep.
INSPECTION NOTICE
City of Tigard Building Department
1.1125 SW Hal' Blvd. Tigard, Oregon 9'7223, 4".(- .
Inspection Line (Rer.-O-Phone): 639-4175 Business Phor(�✓�/
Inspection:
Footing Plbg. Underslab Mach. Rough-in Appr/8dwlk
Fou -A. Plbg. Top Out Cas Ling FINALt
Poet/Beam Struct. San. Sewer Framing aldDg-__
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbc. Undet f 1o.ir Water Line �j Gyp. Bd. -Meeh.
Date Requei:ted:_ AN
Addreres: /0-/z/�v Perlsit `t
Buil:ler: 4222L
THE FVT.I.OWINC Cr ERECTIONS An REQUIRED:
Inepar.t Date:_
__ RPPROVED DISAPPROVED APPROVED SUZCPTTOABOVE
Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Poonej: 639-4175 Buai_neas Phone: 639-4171
Inspect ion:. _
Footing Pll�§. Underslab Mech. Rough-in �Appr/Sd-lk
Found. P).bg. Top Out Gas Line FINALe
Dost/Beam rtro-:t. San. Sewer Framing -Bldg.
rut/Beam i<ech Rain Drain Insulation -Plumb.
P)1>g. Cndarftc.a; Water Line Gyp. Bd. -Much.
Dale Pequen/..eril. r`W— _Time: / AM pN
Address /�e 7V Perml, f=
Builder:.— i
TBE FOLIA7WING CORRECTIONS ARE REQUIRED:
r
Inspectors .�Li.(.:�'z _ Dates q
1PPA011f0 DIBAPPR D APPROVED BUWRCT To AMOVt
Call For Reinsp.
I
A
INSPECTION—NOT I
city of Tigard building Department
13125 Sw 9all Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phona): 639-41.75 iivaineen Phone: 639-4171
Inspection: - ---- _- — --
Footing Plbg. Underalah Mech. Rough-in Appr/Sdwlk
Round. Plby. Top Out Gaa LSne FINAL:
Poet/Seam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Innulation -Plumb.
rlbq. underfloor water Line Gyp. Rd. -Mach.
Date Requested: `7 __ _Tim:
Add,, v s ��-. �,�Q1permit i
Builder:
THE FOLIOwINO CORRECTIONS ARE REQUIRED:
T
1
Inspectors --- Date:
APPROVED DI8APPROVBD APPROVRD SUBJICT TO ABOVN
Call Por ftimp.
INSPECTION NOTICE �.-
City of Tigard Building Deprutsecnt
1.3125 UP hall Blvd. Tigard, Mon 97223
Inspection Line (Rec-0--Phone): 639-4175 Buttiness Phone: 635-4171
Inspection:
F,L.oting Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation - lumb6..
Plbg. Underfloor Water Llns Gyp. Bd. -Mach.
Date Requested:_ 4�_4�— /�� __Times AM PM
Addreast
Buildert_,j1_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspectors— Detes
'-�--APPROVED DISAPPROVED APPROVT.D SUBJECT TO ABOVE
Call For Reinap.
�NSPECfION NOTICE
v
City of Tigard Duilding Department
13125 Sp Hall Blvd. Tigard, Oregon 972z, . 1'
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:____ --
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line SINAL`)
Pent/seam struot. San. Sewer Framing Bldg.
Pont/Beam Mech. Rain Drain Insulation Plumb.
P)bg. Underfloor Water LineGyp. Rd. -Koch.Date Roque sted: 1�[r 1-2 Time: AN �[ [M(
Address ��`��� �Z�V���-�� Permit #1 -2
builders Iw�pV t��(JIJ�,..ti 1' vL "'` 2-�3 T r7
THE lOLLOWING CORRECTIONS ARE REQUIREDs
r
1
Inspecto s_ _ bates _
APPROVED �_ DISAPPh,�Vk7'3 APPROVED SUHJ/CT TO AHDVE
Call Por Reinep.
3
INSPPCTION NOTICE
City of Tigard Building DepartAbent I'
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Phone): 639-4175 Suainese Phone: '639-4171
Inspectionz
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL
Post/Beam struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. underfloor Water. Lino Gyp. Bd. _Mech•
Dite Reguostedl_ �Z� T PN
Addreee:_ 24Z Z,2Y' /-4
Permit is
Builders
TBE FOLLOWING CORRECTIONS ARE REQUIREDs
• r
Vl L�
Inspectors /
Dates
APPROVRD DIAAPPRO,_<D APPROVPD SURJRM TO AMM
Call For Relnap.
I
NSP$GZ'ION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation
--Plumb.
Plbg. Underfloor Water Line � pyp, �, -Nech.
Date Requested:__ GO f7 Timet
AM p}(
Address:_ � �j y � ni�f�.
--� � Permit ft
TN9 FOLLOV4ING CORRECTIONS ARE REQUIRED:
Innpector!_
_ - - --- --------- - _ Dnte#
APPROVED
---- DISNPPROVED -APPROVED SDS TD AgM
Call
?Or Reinsp.
I
INSPECTION NOTICE
City of Tigard B.:ilding Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-.Phone): 639-4175 Business Phone: 639-4171.
Inspection•
Footing Plbg. Undurslab Mach. Rough-in Appr/8dwlk
Found. Plbg. Top Out Cas Lino FINAL:
Poet/Beam 3truct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulations -Plumb.
Plbg. Underftooz Water Line gyp. Bd. 1 -Mach.
,� - s -�
Date Requested: �-/� —Tima: AN �f PM
Address-— -�=_-" Permit #: �C� 4/ 1p-'
Builders
THE FOLL(MI lg CORRECTIONS ARE REQUIRED: �C
V
—T
7
AftL
Inepwtors_ - Date:_
D A�'DISAPP D APPROVED RUR.JRCT TO ABOVE
Call For Reinap.
tamMMUM
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Bell Blvd_ Tigard,
Inspection Line Oregon 9/223
(Rec-O-Phone: 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Unaot•slab
Mech. Rough-in Appr/SdMrlk
Fou-d. Plbg. Top out
Gam Lina FINAL:
Post_IBeam Struct. San. Sewer
Framinq-) -Bldg.
POat/BOam Mech. Rain Drain
Insulatlon� _.plumb
Plbg. Underfloor Water Line
Oyp. Bd. -Hoch.
Date Regi:eetod:�p�`7 -4 J�
Time: AM <-PN
Address.-- 14 ")y I _
� emit fL/��'�
Bulkier:_9� �Zx
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r
---------------
fie- i r
Innpectcir: ✓ p
-'D
_.APPROVED �`-•/b�/`—DDISAPPROVED
APPROVED SUBJECT TO ABOVE
Call For Rainsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Rec•-O-Phone): 639-4175 Bus'-nese Phon . ^639-4
Inspection:,_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line .[NAL:
Post/Beam Struct. San. Sewer L Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:_ 7I�- Time: AN ,1_PM
Address / ,ey
�U 1 Permit f: D1 a
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspect t Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rei.nsp.
KXKM MUM
1
INSPECTION NOTICE
City of Tigard Buildi-ng Departw&tnt
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (11'ec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__ __ __
Footing Plbq. Underslab h. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Q-_
Pont/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hech.
Date Requestedc7 - �/� c TivRt /}__AM (PQM
Address: '
_ /� / /y
Builders_
THE FOLLOWING CORRECTIONS ARE REQDI
i
Inepe,-ter. DA—tat 7-/L—' Z
-----APPROVED - - DISAPPROVED "PROVRD SUB.IRCT TO ABOVE
Ca:l For Reinap.
INSPEOYON 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 P1bg. Qnderslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Ga Line FINAL:
Post/Beam Struct. San. Sewer Framing -Illdg.
Post/Beam Mech. Rain Drain Insul,%ion -Plumb.
Plbg. Underfloor )Watery Line Gyp. H-'. -Mech.
Date Requested: / (j — __Time: x ) PM
Addresst 1 -7� I� )
Permit �2 'V� �
�:
Builder: ,
THE FOLLOWING CORRECTIONS ARE REQUIP.ED:
I
Inspector: / --- — --- -- Date:
1, APPROVED niSAPPRnVRD T APPROVED SUBJECT TO AB(?VF.
x Cal. For Reinsp.
i
INSPYCTIOII I!OTICE
City of Tigard Building Department
13125 SW Ball. Bled. Tt-gavd, Oregon 97223
Inspection Line (ROC-O-Phone): 639-4175 Business Phone: 639-4171
Inspections__________
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. PIL-T. Top Out Gas Line FINAL=
Poet/Beam Struct. fan. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg Undarfloo� Nater Line Gyp, Bd. -Meeh.
Date Requeetedt Time
Addreee:__ ,/ /C� l Permit
Builder:—��f�THE FOLLOWING CORPBCTIONS ARS REQUIREI,t
4
'00,
ji
i
I
i
J
/ APPROVRD - DISAPPROVRD APPROVES SUBJECT To ABOVE
Cell For Relnep.
INSPECTION NOTICE
City of Tigard Building Department
13122 aw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inapecti.on: ----
Footing Plbrg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech- Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: I(I Time: — AM PM
Address: < < 1 � () Permit #:
' Zy3 JI-7 b
Duilde: J _
THE FOLLOWING CORRECTIONS ARE REQUIRED: J
If18peCfnr: _ � Dat92
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
—_ Call For Reinsp.
IHI E9TIPN NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Dusiness Phone: 639-4171
Inspection:
Footing Plby. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top nut Gas Line FINALS
i
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. ain Drain, Insulation -Ply.
Plbq. Underfloor Nater Line Gyp. Bd. /_' -Mech.
Date Requested: Times/% i
AM PM
Address:
Builder:__ G
7%1 FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector
"�--
APPROVED DISAPPROVED APPkoWD SUBJECT TO ABOVR
Call For Relnvp.
APIM
INSPECTION NOTICE
City of Tigard Building DeparjAent
13125 SW Ball Blvd. Tinard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-,',175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
to( und• Plbg. Top Out Gas Line FINAL:
POORt/Seam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Pbimb.
Plbq. Underfloor Water Line Gyp. Bd. -Rech.
Date Requested: �j -��� Time:
Address:_,-__,—//-- 1�
Permit t_ �
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
_._.—_.------._..---------- Date:_(; -
A�/110V/b DISAPPROVED APPROVED SUBjMrT TO ABOVE
^Cetl For Relnsp.
;Ai
7
0
CITY OFTIFARD
0 F TUMM 110D
COMMUNITY DEVELOPMENT DEPARTMENT 0110M MASTER PERMIT
13126 SW Hidl 8kd P.O.Scm 23M.TIpM,Onwn 97 (SW)630.4175 -JERMIT #. . . . . . . .. MST92-01028
639-4J.71 DATE ISSUED: 06/04/92
`iITE ADDRESS. . . : 11974 SW 128TH AVE IDARCEL: IS133DD-17200
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE X44PLK, 5 ZONING: R-4. 5
2
5L LOT. . . . . . . . . . . . . .. 08
_OCK. . . . . . . . . . :
BUILDING
PEISSUE: DWELLING LIN ITS: 1 BASEMENT. . . . . . . . :0 s
LLASS OF WORK. :NEW BEDRMS:3 SATHS:3 GARAGE. . . . . . . . . . .390 Sf
I-YPE OF USC-. . . :c;F FLOOR AREAS------ REQUIRED SETBACKS--
IYPE OF CONST. c5N FIRST. . . . : 1024 e LEFT. . ..21 ft RIGHT. :7 ft
OCCUPANCY GRP. :RSECOND. . . : 748 !,f
FRON F. .20 ft REAR. . -33 ft
STORIES. . . . . . . .2 THIRD. :0 s REOUIRED-•------------•-_--------
HL
ED-------------------
HL I GHT. . . . . . . . :20 ft 'TOTAL - 17722 S f SMOKE DETECTORS. :Y
PLOUR LOAD. . . . :40 psf VALUE. . . . . $ 885321 PARKING SPACES. . :O
Remarks: PATH I
PLUMBING
`SINKS. . . . . . . . . . : I
FLOOR DRAINIG. . .. . :0 BACKFLOW PREVNTRS. . :O
L"VHTORIE5. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETs. . :3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 1.00 OTHER FIXTURES. . . . . :q,
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :O
WASHING MACH. . . : 1 13F RAIN DRAINS. . : I
--------------- MECHANICAL FEES
FUEL TYPES------ UNIT HTRS. . -0 type kmouylt by date r e C.,.n f
/GAS/ VENTS TIF t 1380. 00 JL.H 06/04/92 -
MAX INPUT-0 STU VENT FANS. . -4. BPRT 4oi00. V10 T1.1a 17)6/04/98 -
FURN ( 100K . . : I HOODS. . . . . . : 1 FPLC $ 260. 00 JLH 02/26/92 22376-
1--URN > -.100,< . . -.0 wnODGTOVES. :0 P5r1c $ 2'41. 00 JLH 06/04/921 -
F LOUR
FLOUR FURN. . . . .-O CLO DRYERS. : 1. SSDC I- r'-.1 10. 00 JLH 06/04/92 -
BUIL/CMP ( 3ViP:O OTHI R UNITS.0 n)RK 1 250. 00 J 06/04/92 -
JLH 00!04/92
GAS OUTLETSil MPRT $ 39. 00 JLH 06/04/92 -
Owner-; MPLC $ 9. 75 JL.H 06/04/92
DUN MORISSETTE BUILDER5, IN--. M5PC $ 1. 95 JLH 06/04/92
15555 SW BANGY RD. P P R T $ 14111. 00 JLH 06/04/92
#201 DSPC $ 7. 00 JLH 06/04/92
LAKE OSWEGO OR 97035
Phone #: 620-7538
Conti-ac-tfor:
DON MORISSETTE BUILDERS, INC.
15555 SW RANGY PD.
#1201
LAKE_ OSWECO OR 97035
C':'h a n e #: 62:0-75 3 0
Req #. . s 35533
$ 2787. 70 TOTAL
This permit is issued subject to tit regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code. State of Ore. Specialty Codes and all other Foot/found Insp Fireplace Insp
avolicable laws. All work will be done in accordance with apo-oved Post /seam Stt-1.1(.,t Lyras Line Insp
plans. This permit will expire if work 's t started within 180 Post/Beam Meehan Insulat .on Insp
" s
r N*)
days of issuance, or if work is Vended or @ore than 188 dave. Plm/undslab Insp Gyp Boat-d Insp
r.'1--M�'Undet-f 100V_ Rain drain Insp
e
-,r Mittee SJqnatuv-e *. UM Mechanical Insp Water Line Insp
Plumb Top Out Appr/Sdwlk Inso
jed By: Ft�aminq Insp Mechanical Final
Call for ins pection - 639-4175
CITY OF TIGARD RFCEIPT OF PAYMENT RECE I r:,-r NO. 19E—a27998
NAME: a DON MOR ISSETTE CHF CR AMOUNT c 250. 00
ADDRFSS 1 15555 SW SANGY ROAD CASH AMOUNT 0. 00
PAYMUNT DATE 06/04/92
1--AKE OSWEGO OR 9 7005 9- (JBD I V I ci ION
PURPOSE OF PAYMENT AMOUNT PAI D PURPOSE OP PAYMENT AMOUNT PPID
PLAN CHECK FE 250. elO
Pt..AN CHECK #6-9R
11993 SW IPRTH AVVIltir: LOT 206 VILLAGE AT Eil,,#F)
TO TAI._ AMOUNT' PAID ?50. 00
CITY OF TIGARD REC'Elf.*,T 01- PAYMFN',- RECEIPI 190,
NAME t MOR ISSETTE, Dopl CHF--'Ci< AMOUN*T 253 7. 70
ADDRESS x CW'JA AMOUNT 0. 00
I'AYMENT DATE 06/04,192
SUBDIVIS[ON
PURPOSE OF PAYMF'N'f AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
iTl -P,--,iw- ----------
mECHANIGAI. PE 400. 00 PLUMBING PERM 140. 00
Pt-AN CHECK FE 39. 00 ST. BUILD PER 28. 95
19. 75 RESTDENTIAL TRAFFIC FEES 1280. 00
MAWi 'TRANSIT TIF FEFS, 100. 00 PARKS GDC
rT0Rl" DRAIN SIX ,H0. 00 00
208 VILLAGE AT SUMMERLAKE !s
11974 q6l 128TH AVF
TOTAl- r-itylOUNT PAID 2537. 70
ri,r,v OF TIGAPI) RU-(-E,.'IV'T OF PAYME1-1- RE('-,Eip"r t40.
NAMIC a MORISET sE, DoN CHECK APIOUlql 250. 00
ADDRESS >t 1555 SW RANGY R0 #pol CASH AMOUNT a 0. 00
PAYMENI DATE OR/26/92
LAI<E 0SWr--G0, OR 9713,35- SUBDIVISION
PURPOSE OF PAYMF-NT AMOUNT PAID PURPME OF PAYMENT AMOUN T VIA 11)
PLAN CHFCK FE 2!50. LAO
Ii
2O8 SUMMERLAME 5
t 1974 SW 188TH AVE
101*Al. AMOUNT PAID 00
SPOEMAKER'S PLUMBING INC.
350 S.W. ZOBRIST
ESTACADA, OR. 97023 (P.O. BOX 250)
TO: CITY OF TIGARD
13125 S.W. HALL BLVD.
P.O. BOX 23397
TIGARD, OR. 9-1223
TO WHOM IT MAY CONCERN,
SHOEMAKER'S PLUMBING INC. GIVES THEIR PERMISSION TO
I.ET DON MORISSETTE HOMES INC. SIGN ALL PLUMBING
PERMITS FOR SHOEMAKER'S PLUMBING INC.
SINCERELY,
HAROLD B. SHOEMAKER PRES.
i9
630-7728
CITYOF T11FARD ®F[YOFMOIFMOM :af�WER CONNkCTIpN
CD PERM I T
COMMUNITY DEVELOPMENT DEPARTMENT mew E RM z T #. . . . . . . : sw 91—�
13125 SW HWI Blvd P.O.Bac 23307.Tip M,0"M 07223(603)W9.4176
SITE. ADDRESS. . . : 11974 SW 128TH AVE PARCEL: 15133DD-•0F P0t7T
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE PARK 4 ZONING: R-4.
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 125
TENANT NAME. . . . . s
USA NO. . . . . . . . . . : FF'I X TURE: UN 1 TS. . .
CLASS OF WORK. . . :NEW DWELLING, UNITS. . : 1
TYPE OF USE. . . . . :SF NO. OF BU I LD I NGS: 1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE— : : Sf
Remarks:
Owner: ____________________.____-----__..._ 1 . date
.p
PON 11ORISSE:TTE BLDERa, INC. , tvue Ramo rnt by ate'r----rec_!t
15 555 5W BANGY RD F'RMT $ 1500. 00 NCR 06/28/91 O
#20i INSP t, ;1':5. 00 E1CR 06/28/91 0
LAKE OSWEGO OR 97035
PIone #: 503-620-7538
Contractors
CONTRACTOR NOT' ON FILE
Phone sl.r,j.�-3_
. 00 TATA!
Rey #. . :
— REOU I RED INSPECTIONS -----
This AprIicant agrees to coeply with all the rules and regulations Sewer—Inspection
of the nified Sewage Agency. The oere[t empires 120 days froe _
the date issued. The total aeaunt paid will be forfeited if the ���
perait expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewn is rat located at the eeasureeent
given, the installer shall orosoect 3 feet in all directions froe
the distance given. If not sn located. the installer shall purchase
a 'Tip and Side Sewer' perait and the Anencv will install a lateral.
+ ermi t L ee Si[lnattirre :
I S S is e d N V:
Call for inspection — 639-4175
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