14073 SW FANNO CREEK DRIVE ADDRESS:
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i.\recordslmicrotlmltargetstuilding.doc
CITE' OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATE OF
13125 1 OV Hall Blvd.Tigard,Oregon 97223*8199 (503)839-4171 OCCUPANCY
xxMx PERMI1 #. . . . . . . i MST94--0184
S39-4171 DATE ISSUED% 08/23, 94
SITE ADDRESS. . . e 140*73 SW FANNO CREEK PR
SUBDIVISION. . . . i COLONY CREEK NO, 6 R--
BLOCK. . . L01.. . . . . . . . . . . . . 1128
CLASS OF WORK. iNEW
TYPE OF- USE. . . zSF
OCCUPPINCY GRP. a R3
OCCUPANCY LOPP.-PPP 4
TENANT NAME. — :
Remarks PATH I
Owner:
,JAY MILLER
P 0 BOX F-113P91
TIGARD Of? 97
F-Itione flit 684-7543
Jf-'IY M11-L.ER
r1r7 Box 2329
TAJ-30RD OR 97261
Fah,),ip 0i 6A4--7543
PTu #_ 1 30109
Occupancy of the above referenced building is hereby given, And cevtifipe�
the compliwice with the State Of Oregan Special ' y Codes fov, the yraLkpv
o,,,v:i.(pAncy, and use Ul;der which the referenced permit was issupd.
BUILDING S
P
I
—11
B L ILMI
POST iiq CONSPICUOUS PLACE
Y1- ,•_- tom, s
city of Tigard Buildinqt223
137.25 60 Hell Blvd. Tigard, Oregon
Inspection Lino (Rec-o-Phone): 639-4171 Susineu t,hona 39-4171
plbg. Underslab Mach. Rough-in Appr/sdwlk
Footing
To Out Gas Line C�FINl1L:
round. Plbq. p
post/Beam 3trurt. San. Hewer
Framing 11A
post/Beam Mach. Rain Drain
Tna, etion -Plumb•
Nater Line Glp. Bd.
Plbq, Underfloor 'y
i� I �. �� �iTLest AM _ —PM
Data Requested+ n��
O jr
Addreest�^ -
Builder:_q-
TSE FOLI.U'NING CORRECTIONS ARE REQUIRED:
_ - -
Inspector: Date
PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For RRinnp.
"CITE' OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13115 SW Hall Blvd,Tigard,Dragon 97223.8149 (503)E3D•4171
CERTIFIC:A7E.; OF
OCCUPANCY
1 xrexX PERMIT 4' 1 011-094., 031,18
6X59--41.71 BATE`' 1SSUEPe 06/19/94
PaRct.L.� 29112813-15000.
faITE' ADDRESS. • . e 14073 "3W FANNO CREEV DR
3UBDI'VISION. . . . a COWNY (.REEK NO. 6 ZONINGa R-7
BLOCK. . . . . . . . . , e 1_CIT. . . . . . . . . . . . . . 1i?O
CLASS or Wf)RK. aNEW w..__,_._..-____._......_.-...�..._...__._._...._.____.._....__K_.
TYPE OF USE:. . . t SF
OCCUPANCY GRP. 7 R3
OCCUPANCY LOAD a 222 4
TENANT NAME. — a
Remorksa PATH I
JAY MILLER
p 0 BOX 23291
T I GARD O` 97
Phone 4#e 684-.7543
C antrAct nr a
.JAY MILLER
F'0 Box 23291
T I ORD OR 97281
Phone 0: 684-•7543
Peg ##. . a 30-109
Ocrupancy of the above refer`enr_ed building is hereby given, and certifies
the compliance with the Gfate. Of C?r^egon Spec icilty Cut.jes far thW group,
,lcr.upanvy, and use t.mdpl which the referenced pe:-mit w t ,r isaued.
AU I LIf I NC3 INSPECTOR ___..._....._
81-JIL-DING 0. FICIAL
POST IN C ONSP I CUr11Jy PLAC:F
INSPECTION NOTICE
Cit? of Tigard Building Departsent
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rar-O-Phone)i 639-4175 Business Phone: 639-4171
InspectioniA_
Pouting Plbq. Urderslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top out Gas Line _sit'
Post/Beam Struct. San. Sewer Framinq
L.I
Post/Beam Mach. Rain Drain Insulation pluigb�
Plbg. underfloor Water Line Gyp. Bd.
Date Requested: I �1 ( ��_Time- AN —PM
Acldreee•_Z� �^= ��-.If-PI_Permit is C)
Builder.:
THE FOLLOWINo (X)RRECTIOK$_.A= axQUXRED:
r..
Inspectors— Date:---
l.. ttt
PPROVED DISAPPROVED
APPROVED 30 TO ABOVE
Call
For Reinsp.
s,
IIISPECTION m)—mit
City of Tigard Building Departmmt
1.7125 8W Ball. Bltd. Ttgard, Oregon 97223
Inspection Line (Pec-O-Phono)c 639-4175 Business Phonet 639-4171
Inupectiont__
Fuoting Plbg. Underslab Mech. Rough-inA r edwlk
Plb
Pound.. � / -�
q. Top Out One Line lINALs
Post/Benm Struct. San. Sewer Fr.aninq
-Bldg.
Past/beam Mech. Rain Drain Insulation
-Plumb,
Plbq. Undorfloor Water Line Gyp. Bd. -Meeh.
Date Requested: ,7
II.. Timet Pm
(j
Addreut' L1. yLv� K. /Permlt /rr0, kc
Buiidert
TM
!!'OLLOMI CORRECTION3 ARE REQVIREt.i:
< t0 p K00-
kl
Y -
Pro e,*t4
0e, tet _ �c �a to
-----C ``7� — lc r- =L—_
Impactor:
Datet_
1 l
APPROVED DISAPPAOVlD APPROVED SUBJECT To ABOVE
Call For Reinsp.
INSUCT1oN NOTICE _
Cit? of Tigard Bulldi.nq Department.
13125 SM nal- Rlvd.. Tigard, Oregon 9722.3 r
Inspection Line (Rec-o-rhone/- 639-4175 Business Phone: 6 �
Inapection:
Footing Plbg. Underelab Mech. kough-in ApP r/Sdwlk
Found. Plbq. Top Out Gas Lina
FINAL:
Post/Beam 3truct. San. Sewer Framinr
J_ _ \l -Bldg.
Post/Beam Hoch. Ra!n Drain �' Tnsulation /
r. -Plumb.
Plb9• Underfloor Nater Line Gyp. Rd. -Mech.
Date Regveated• ��- 9
/ , 7 �1 /� Tioee AM _PM
Addreast ) /7i7��U l/Zee� pe�yp3�9(/_
Bu i.ider: � Q L O /_-L�_L/ )
THE FOLLOWING CORRZCTIONSS--AM REQUIPEDs
Inspector:
--•rl4PT;tOt/8D - DISAPPROVED -- APPROVRD SUBJECT To AgO{/S
- -Call For Reiusp.
INGMTION NOTICE
City of T' .rd BssUdi.og Department
1.312S W B►,._. Blvd. Tigard, Oregon 97222
Inspectl.on Tine (Rec-O-Phcne)s 639-4175 Buaineaw Phon e 6 1
Inspections
Footing Plbg. Undorslab Hoch. Rough-in .) Appr/Sdwlk
Found. Plbg. Top Out Can LL F1NALs
Post/Beam Struct. San. Bower Framirg -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor >N for Line
s/ ayp. Bd. -Hech.
Date Requested: �/�n/ �/ —Times _,_Z .dt __ PN
Address: I L c/;1-3 3 uJ Permit t..
Builders
TRE FOLLONINC CDRRECT?9NS ARE REQUIRED:
Inspectors ---' �T,-- Date: �O-
PPROVED DISAPPROVED APPROVED SUBJECT TO I.BOVE
---Call For Reinap.
INSP. T_IQN_PIDTICE /
City Of Tigard Building Department F /
13325 RN Ball Bled. Tigard, Oregc_ 97273
Inspect.i.on Line (Rec-O-Phone)s 639-4175 nueiness Phone: 63 1
Inspection: ---------
Footing ---""
p��.q. Underelab -Rfpr/Sdwlk
Found.
Plbg. Top Out Line FINAL:
Post/Beam Struct. San. Sewer �framing -Bldg.
Poet/Beam Mech.
Rain Drain Insulation -plumb.
Plbg. Underfloor
Water Line Gyp. Rd. -Mach.
Timet
Date Requested:._ _(���(
��(U 7 1 nat) t.C.C /C Permit
Address: (-
Builder:-- —'� I Ile
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector
PROVED v SAPPRCVZD —_ hPPROVRD IUBJECT TO ABOVE
Cell For Reinsp.
�NS�E�ON NOT1C8
City or Ttgard Iuilding Depsrtm"°t
13125 SW gall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Bus ineas Phon46 -
I n apec.t ion:
Footing Ploy.
Underalah Mecn. Rough-in Appr/Sdwlk
�" FINALt
Pound.
Plhy. 'PoDout
Gas Line
Post/Beam Strutt. Ban. Bewar
Framing -Bldg.
Post/Be+em Hoch. Rain Drain
Inmulatlon -Plumb'
Plbg. Underfloor Nater Line Gyp. Bd. i
-Mach.
/ 7 -
' T Lc:e s PM
Date Requested:
Addrasa: /1Y '-" �-�
Parmtt
TRE FOLLOWING CORRECTIONS ARR REQUIRED:
J
I n e pert or:_,__ — Date:
L�OJRO�VRD DISAPPROVED APPROVED SUBJECT TO A
Call For Reinsp.
�NSPELP1oN NOTICR
City of Tigard Building Depart—nt
13125 x11 Hall Blvd. Tigard, orrgon 97223
Inspection Lioe pec_43-Phone)t 639-4175 r,usinees Phone: 9-4171
Inspection`. -— --- --
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
7ound. Plbg. Top Out Gas Line FINAL:
am Struet. San. Sewer Framing -Bldg.
tPeat/Beam Hech. ; Raln Drain Insulation -plumb.
Plbg. DnJertloor Nater Line p /Gyp. Bd. -Kwh•
Date Requested:
—__.-�� y- / `7 Timet _�AN PM
1 ' /�r�rw C��e�. m
Addrese:_1_ t # qy p�8�
�/ J Reran '
Buildert_ 7 T91, I/er �!Y/�
THE FOLIANING CORRRCTIONS ARE RIWI11EDi
i
Inspe:_cor
�.IPPROVED DISAPPROVED APPROVED SUBJECT TO ABOVL
call For Reinep.
��Ec'TION NOTICE
City of Tigard Building Department.
1.3135 gW Hall Blvd. Tigard, Oregno ^7223
Inspection Line (Rs::-0--Phone)t 639-4175 Business Phonet 639-4171
Inspections— _ ---- -- —
Footing Plbg. Underslab Hech. Rough-in Appr/Sdwlk
Pound. P1 Top Cut bas Lino FINAL:
Post/Beam Struct. aD. 70fLran
Framing -Bldg.
Post/Beath Mach. Rain Insulatlon -Plumb.
Plbg. Underfloor Nate Gyp. ed. -Meeh.
i
Data Requestedt,.,� Timet ^�AM __PM
A:1�ress: / '7 ✓ �- IYM = ��Permit
e
Builder: -- --
THE FOLLOWING CORRECTIONS ARE REQUIREDs
Inspector: A' i � -- - Datwt
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rainsp.
i
Ili2rnCTION NOTICE j
City of Tigard Building Department.
13125 ON Hall Blvd. Tigard, Oregon 97,I
Inspection Line (ReC-O-Phone): 639-4175 Business h e: 639-4171
Inspect Lor::----- ---- — -- --- ..._
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
(round. j PLbg. lop Out Gan line FINAt.:
Post/Beam Struct, San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain insulation _plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
Date Reyuestedt, 2, d y//�� PH
Addreatr��O 7,3 r4l; o 1.� lrek aPermi
Builders
�_1 ;Ile Y-
OTHE FOLLOWING ODRRECTIONS ARE REQUIRED:
-- Mau
i
Inspector: ._ --,----- - --- Date• �_j_��j,�-f- 1
---•-/ -I
APPROvED _ DISAP➢ROVED APPROVED 3URJECT TO 1490VE
Call For Reinsp.
w
. I I
1
I146paCTim NOTLCa
City of Tigard Building Depart�
13128 80 Bali Blvd. Tigard, Oregon 97223
Inspection Line (Roc.-O-PhOns)s 639-4175 Business Phones 639-4171
/Inspection$ _
r i�I/� plbg. Dnderslab Koch. Rough-in Appr/9dwlk
plbg. Top Out Gas Lino FINALt
post/Beam Struot. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line GYP• Rd.
-Koch.
[ AN PM
- 1
Data Aequestods _.�/--
t
r- n'it Sy D/frY
Address: C71// Parmit f
Builder: L
TNM FOLLOWING OORRECTIONS ARE REQUIRED2
00
Date:
Inspector• ---- -
ROVED DISAPPROVED APPROVED SUBJISCT Tu ABOVE
Gall For Raimap.
MASTER PERMIT 4q
C11Y OF T196AR" PERMIT #. . . . . . . : MST'34--0184
COMMUNITY DEVELOPMENI�R TVATF ISSUED: 05/13/94
13126 8W H&N dkd.Tigard,Orpon 9722304199 (603)430-4171 PARCEL: 2S 1 12BB 1 5000
CITE ADDRESS.. . . : 14073 SW FANNO CREEK DR
SUBDIVISION. , — : COLONY CREEK NO. 6 ZONING: R-7
HLUL�:. . . . . . . . . . .
LOT. . . . . . . . . . . . . . 1 c8
---- _ ______------ - ---------- BUILDING -------_____-__---------- - ---------- -
RFl SSUE:MST9 4--90t-`;6 DWELLING UN 1 T S: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :430 sf
TYf E OF USE. . . :SF FLOOR AREAS-----•-------- REQUIRED SETBACKS------------
TYPE OF CONST. :5N FIRST. . . . . 102:3 sf LEFT. . :5 ft rIQHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . .-8132 sf FRONT. :20 ft REAR. - :37 ft
S l OR I ES. . . . . . . ..: THIRD. . . . :0 sf REQUIRED---------------------
HEIGHT. . . . . . . . :&
EQUIRED----------------------
HEIGHT. . . . . . . . :& ft TOTAL------: 1905 sf SMOKE DETECTURS. :Y
FLOOR LOAD. . . . :40 ps f VALUE. . . . . f ; 95370 PARKING SPACES—:1
Remarks : PATH I
....---------_.-----_..._--_--_ PLUMBING
SINKS. . . . . . . . . . . 1 FLOOR DRAINS. . . . :0 BACKFLOW OREVNTRS. . :O
LAVATORIES. . . . . :4 WATER HEATERS. . . - 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . ::_ LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . %0
WATER CLOSETS. . .-3 SEWER LINE (ft) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE ( ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :0
WASHING 1 TACH. . . : 1 SF RA 11-4 DRA I NS. . : i
-----------— MECHANICAL - -___._.__.__....._._-_._.____ ______._--__-_-- FEES
I UEL TYPEF)--......_._...__..__-._..- UNIT HTRS. . -0 type amount by date recpt
/GAS/ / / VENTS . . . . . :0 TIF t 1520. 00 SW 05/13/94 -
MAX iNPUT:O BTU VENT FANS. . :4 BPRT S 421. 00 SW 05/13/94 -
FURN ( 100K . . : 1 HOODS. . . . . . : 1 BPLC $ 50. 00 SW 05/10/94 94-252221
TURN ) =100K . . :0 WUODSTOVES. :0 p5PC $ 21. 05 SW 05/13/94 -
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 280. 00 SW 05/13/94 -
IAOIL/GMP ( 31-IP:0 OTHER UNITS: 1 PARI: $ 500. 00 SW 05/13/94 -
GAS OUTLETS: 1 MPRT $ 43. 50 SW 05/13/94 -
ilwner .._MPLC 1� P-A. 88 SW 05/13/94 -
JHY MILLER M5PC f 2. 18 SW 05/13/94 -
P U BOX 23291 PPRT $ 147. 50 SW 05/13/94 -
P5PC $ 7. 38 SW 05/13/94 -
TIGARD OR 97
Phone #: 684--7,943
Contractor -
JAY MILLER
PO BOX 23291
TIGARD OR 97281
Phone #: 6134-7543
Reg #. . : ;30109 ---------------------------------------•--
$ 3003. 49 TOTAL
This pewit is issued subject to the regulations contained in the - - ---- REDUIRED INSPECTIONS ------ -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp rireplace Insp
applicable laws. All work will be done in accordance with appruved Post/Beam Struct Gas Line Insp
plans. This pereit will expire if work is not started within 180 Past/Beam Mechan Insulation Insp
days of issuance, or if work is suspended For sore than 180 days. Plm/un.dslab Insp Gyp Board Insp
PLM/Underfloor Rain drain Insp
Permittee Signature. � �' Mechanical Insp Water Line Insp
Plumb Top Out Appr-/Sdwlk Insp
Issued By : Framing Insp Mer.hmnr.cal Final
Gall for inspection - 639-4175
SEWER CONNECTION
PEPMI. . . .. . I
P['RP'iI T #. . . ,. . . aWH94-01(30
CITY
OF II
COMMUNITY CEVELOPE'1ENT
RR;XT DAT
COMMUNITY 05/13/94
13125 SW Mall Blvd.T19ard,C►pon 97223.6199 (603)639-1171 PARCE=L: 2S 1 12BB-15000
�;T TE ADC►RESS. . . : 14073 SW FANNO CREEK DR
SUBDIVISION. . . . : COLONY CREEK NO. 6 ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . • . . . . . . . . . . . 126
TENANT NAME. . . . . :
LISA NO. . . . . . . . . . . FIXTURE UNITS. . . .
CLASS OF WORK. . . :NEW DWELLING LIN ITS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL. TYPE. . . . .BLISWR IMPERV SURFACE.. . : :sf
'Remarks: PATH I
Owner: ------------------------------------------------------- FEES
-JAY MILLER type amount by date recpt
W O BOX 23291 PRMT $ 2200. 00 SW 05/13/94 -
INSP $ 35. 00 SW 05913/94 -
TIGARD OR 97
Phane 0 : 664•-754:3
Contractor: --_-----------._.___..-------------
CONTRACTOR NOT ON FILE
----------------------------
Phone ii' $ 2239. 00 TOTAL
Reg
REQUIRED INSPECTIONS -------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer 'Aterals. If the sewer is no. located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase _
a "lap and Side Sewer" Permit and the Ag ncy will install a lateral.
Per~mittee S"i gnat ure 1A A <� )3PU
Issued B y
0
Call for inspection - 639•-4175
IV PLUMBINL, PRMI I
PE M . . : -
CITY OF TICARD DARTEI ISSUED: . 05/13/MS94T94 0184
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL:
V125 SW�q
,!I,qlvd.Tigard.Oregon 97224@8199 031639-4171
SITEI T
ADD S. . . - 1,q073 SW CA N J CHLEK DR
SUBDlVISIUN. . . . : COLONY GREEK NO. 6 ZONING: R-7
BLOCK. . . . . . . . . . . LOI.. . . . . . . . . . . . . 128
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. . : l
TYPE OF USE. . . . ;SF WASHING MACH. . . . . . . il BACKFLOW PREVNTRS. . :O
OCCUPANCY GRP. . :R3 [=LOUR DRAIN'33. . . . . . . :0 TRAPS. . . . . . . . . . . . . . .o
STORIES. . . . . . . . :2 WATER HEATERS. . . . . . .. I CATCH BASINS. . . . . . . :0
FIXIURES--------------- LAUNDRY TRAYS. . . . . . : 1 SP RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . . 1 GREASE TRAPS. . . . . . . :0
LAVATORIES. . . . . :4 OTHER FIXTURE5. . . . . :0
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . :0
WATER CLOSETS. . :3 WATER LINE (ft ) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . :0
Pomark- :
OWNER:
JAY MILLER TIF $ 1520. 00 SW 05/13/94 —
P 0 BOX L,6G:91 BPRT $ 4 :1. 00 SW 05/13/S4 —
BPLC $ 50. 00 SW 05/10/94 94--252221
FIGARD OR 97 B5PC $ 2:1. 05 SW P5/13/94 ---
Phone t: 684-7543 SSDC f 280. 00 SW 05/13/94
PARK $ 500. 00 SW 05/13/94
111.umbing MPRI t 43. 50 SW 05/13/94
I llfillv,& MPLC $ 10. 88 SW 05/13/94
Name 4 M5PC $ 2. 18 SW 17-5/13/94
Address PPRT $ 147. 50 SW (7.15/13/94
C i t State: P3PC f 7. 38 SW 05/13/94
Zip-__ —Phone#:-
Reg
-------- REPUIRED INSPE(,'TIONS
! his permit is issued subject to the rey-
1-ilAtions contained in the Tigard Municipal Foot/found Insp Rain drain Insp
State of Ore. Specialty Codes and all Pest/beam btruct Water Line Insp
other applicable laws. All work will be done Post/Beam Mechan Appr/F-Idwlk Insp
in accordance with Approved plans. This Plm/undslab Insp Mechanical Final
permit will expire if work is nut started FILM/Underfloor P'llumb Final
within 180 days of issuance, or if work is Mechanical Insp Buildiiig Final
suspended for more than 160 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain
Fireplace Insp
Gas Line Insp
Insulation Insp
Gyp Board Insp
Aut"horized Plumbinq Contractor SiqnAturp
Call for inspection 639-4175
Contractor Notnsl
L
CITY OF TTGARD OF 1-'AYMENT P.F'(...EIPT NO. y Y 4-.25 23,5 5
CIAECV.'. AMOUNT a niss. 49
-J(,)I,IE v JAY MJLLER. DILOR TNC.' CASH AMOUNT a C).00
i?DF'ESB i PO T3C)X PAYMENT DATF- C.)5 i '!9/4
ns.,
nr PAYMENT A110LINT PATD PURPOSE' (.11"' F"A'YMENT AMOUN-1 PA I D
..........
MST*'a4--('.)184 421. 1')0 PLUMLITNIG PERM 5")
rCI--)ANICAL PE 43. 50 ST. DUILD PER
CHECK FE
1.0. 0 E-1 SEWER USA 801PQ4 Q 180
'FWF.'P INSPECI 315.r)rl POWS' 15DC
-ITORM DPAIN S.I.)C 2 0C). REISIDENT IAL. TRAFFTC F,'F.-'ES :1. 1 C)(N
'ri,.ANr..,Il 'T'.1:F- FEE!3
PANNO IN
121 H
1 ! 01. AMOUNI I"A 1 '9 1
Residential Building Permit ApE li„atlon ,
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
�Jobsite Address: P-10-73
ooffi
4 Subdivlslon:lrr b m i,C 1. ` e I.ot r b � Use Only
•� Plan cWRec. _
Valuation
1 Perrlut# 7Y"a -
Owner: _ �l 1��'� (�Y� 1'i1C Reissue of
Address: " I Msp&`1L.a
tt Approvals Required
Phone: —
Planning
Contractor: Engineering
Address: — Other _
<items Rok uLirea
Phone: _
Subcontractors
Contractor's License #
(attach copy of current Oregon license) .;1 rUss Details
w
Subcontractors: 1 <Uther
Plumbing: �'V� � E*-�f Vt I �1
✓Mechanical:
':&
(attach copy of cu nt OR Contractor's Ucense)
Architect/Enghwer:
Address:
Phone:
COMMENTS:
AppliCdnt Signature x Phone iiumbei
Rived by: — Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
yi��y Bldg. Perm+t (BUiID) l2(-00
Plumb. Permit (PLUMB) , _✓ _
Mech. Permit (MECH)
State Tax (TAX) JO. G `
Bldg: 01� .off
Plumb: 38' ✓
Mech: .2. �� V '
Plan Check (PLANCK) 40. SH,
Bldg: S� J
Plumb:
Mech: �U
Sewer Connection (SWUSA) C22dd 27•�u
Sewer Inspection (SWINSP) •3� ��
Parks Dev Charge (PKSDC) .Se,0 S� `J 4
Storm Drainage Chg (SDSDC) 'I."_ -
Residential TIF (TIF-R) H/u 1 0✓
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WOUAN i)
Fire District (FIRE)
s o
TOTALS:AL.S: / '� JON" �. l
CITY OF 7100RD Fr'la: 31. 011 M 5'FIY14V141 RF_(,*IG'f No.. 094
('F ECK 1•aWAIN F' n `,`.it'),
1(tl I! K JAY M:C1,.,L.[::Fi CE�f311 At'1(01,11 N» 411;1
al DUD, {;)., n PO PDX V 3k,91 Psl Y ll1.N t U11 1 1 05 10 14
PORTLAND, (are ta(11:�)1.t.v:l .ilull
.4f1J�
'(IFSK'OSl:: OF'� PAYMF�.Nr AMOUNI PAID t4IR1�'l)S OF' PAYMENT AMOUNT FAJI)
'1.Ahl C:11F [:14 VV 5 --PPR
4073 �W F'•AWN11 CRFF,14 1)Ft
i�1 0 14 Y (:RV K F sl*A Tf S
1 o I AI. AMOUNT POM > "iM M�