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14200 SW FERN STREET n. .i.Mir...., I I 14200 SW N KW STRFM WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL HEALTH AND SANITATION 1.55 N. First Avenue CR# _ Hillsboro, Oregon 97124 Tax Map #1 S1— Ott 648-8722 Read NameGt� 'vv� . X New Construction PERMIT Repzir Alteration An On-Site Sewage Disposal Permit is issued to_ 1��_12 I�?� for a period of one year from the date below. (This Pcrmit is not transferrable) All septic systems must be installed as indicated on the approved plot plan. If any changes are anticipated, a revised plot plan must be submitted to the Washington (",)unly Department of Health and Human Services for approval. The plot plan is part of the permit. Before a drainfield can be backfilled, a pre-cover inspection must be made. The inspection will be made within 7 working days after it is requested. DATF Environmental Health Specialist SEP-7,0-94 FPI 15 :32 SPECIALTY HEFTING h FHi: �- i pWA;�2 e /,/ / /IS >,u1. `-1iGAr v 0� `17l t 3 I nt s��x� �S�i�►1C c � -rA)K lorZ I H 6 1000 a O Sr 0'^1. �.� oh Opp Lore �S C �c K 5 do Inc , I CO A cu � o o VIL -7n, _ Oo `` \ 300 ls'z Y 36- C/47 tijf-T�l � Permit #: 1� , ) - Address: `f � _— DSSJ Issued by: _ Date: .. – -- Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. ,his statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under OILS 701.010(7), need not submit this statement. This statement will be filed with the permit. Dill in the. appropriate blanks and is pial boxes I and 2,and either box 3A or 3B: 1. 1 own, reside in, or will reside in the completed structure. I unndcrstand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A. My general contractor is — (Name) Contractor regi~. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractor-s Board. If I change my mind and hire a gr, itractor, I will contract with a contractor who k registered with the CCB and will ii tie office issuing this building permit of the name of the contractor. I hereby certify that the abov a information is coo i-vt oil :. huo,c react:ind do►understand the Information Notice to Proneriv Owners ajtlait C'un. ruetiof:'ssp.,;:a,i 'ities on the reser:�e ,id,e of this form. tgnature of pe it ap licant) (Date) (White copy to issuing agency permit file, pink copy to applicant) f 1 l 1 I I nfarmation Notice to Properly Owners About Construction Responsibilities f" Al"te. Information r. Nmcr Ire 1'ropertl Ullne:r.s ubout Construction Resprmsihiiiti(V i r', ,Jrr-cloped by th,, Curl ,rnrti,,rl Currlra(-t(,vs Boarel in accorduncr with ORS 701.055(5). If yotl aft. acullg .I',y(III l o.t II� (it traLUu lu 4'oil`tt"tltt a Iit,W Dille til make it tiuhstantial Inlpiove'lllenI to all existing strLIClure, you can 1,reveni many prnblcins by using iftirle of'thy: following respunsibihUeb and areas of concern. EMPLOYER RESPONSIBILITIES. !f you inre persons out regislered Iaith it,, l.unArULh%dn Cuiltt';UCI s Board to do labor in constructing or assisting in the tlmstructlon ()r improvement of a rc,,identlaf structure,you will, in most instances, be ruled to be an employer and the people you hire will he employees. V. the employer,you must cong7ly with the following: Oregon's withholding tax law: AS Ian employer,you irnst withhold ineonic taxt s from employee wages at the time employees are paid. You will he liahle for the rax payments^ven if vote dont nctually withhold the tax from yottr employees. For more information, gall the Oregoo Dept. of Revenur. at 941 5041. Unemployment insurance tux: As an enlple-ver, yoti are required to pay it tax for unemployment insurance ptn'poses on the wages of all employees, f for more information,call the Oregon Z;mployment Division at the Department of Human Resnurevs at 1 -3524. Workers'compensation insurance: Asan employer,;ou are stthjert to the Oregon Workers'Compensation Law,and must j ()blain workers'cumpt:n,atlon insurance for your empioyecs. Lf you fail to obtain workers'compensation insurance,yot.i may lx:subject to penalties anti will he liahle for all claim costs it one(,('your employees is injured on the job. F or tnoreinformation, call the Workers'Compensation f bvision at the Department of Consumer and Business .service,,ar 945-Mg. U.S. Internal Revenue Service: As an employer,you nralst withhold federal income tax from employees'waot!". You will'be liable for the tax payment even if you didn't actually withhold the thx. For more information,call the Internal Reverive Service at 1-8110-819-1040. 9 OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder fort hi,,project,you are responsible f. resolving any Failure to meet code requirements that may he brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to sett if you have adequate insurance coverage for � accidents and omissions such as falling tools,paint overspray,water damage from pili:punctures,tire,or work that must Ile J re-done. Time to supervise employees: ivlake sure you have sufficient time to superviw your employees. Expertise: Nfake cute ylul ha\e the expertise to Al as yourown genernl cemtraclor,to coordinate the work ofrough-in and finish trades, and to notify-huildinp.off kink at the appropriate times co they can perform the trquired inspcctior.- If you have additional quesGtms, write or call the Construction Contractors Board(110 Box 14140.Salem,OR 97309-.`,052, 50"1/178-462 1). The Boart! 1,, located at 700 Summer St. NI Suite 3(M), in Salem prop own.prrl4 1/94 ro NOV-1i-94 MON 19 :41 SPECIALTY HEATING & FkB 5035960718 P. 02 AG t; A AGRA Earth& Envirorrmental, Inc. Eanh & Environmental Portland, SW'ech Genrer Drive Portland, Oregon U.S.A. 97223-8025 Tel (503)639-300 November 14, 1994 0-7501 Fax (503)620-7692 ,John G. Wozniak 11550 S.W. 72nd Ave. Tigard, OR 97223 SUBJECT. FOUNDATION EXACAVATION INSPECTION LOT WEST OF 14160 S.W. FERN S1 REET TIGARD, OREGON Mr. Wozniak: As you requested, we visited the site on October 21, 1994 to inspect the foundation excavation for soil capability to support the proposed resAerce. In general the soils were found to be firm, except in the r_nrner of the east side of the north wall. We recornmended that this area be overexcavated at least an additional toot, ranging about four feet in each direction from the corner. We returned on October 25, 1994 to look at the area of overexcava.tion and found that about two to three feet of fill was resting beneath the soft areas in question. We recommended either removing all the fill, or exacavating a series of piers on about four-foot centers through the flll. We made a final visit on November 1 1, 1994 and found the excavation satisfactory for pouring concrete, with the exception of a few areas of cleanup. We considered this our fu,_I site visit and-fhe- 4y-at. acd canna final approval for pouring concrete. k4w ll_I Ice--_ P, During the course of our conversations, we sug6ested bringing the overexcavated areas up to foundation grade with a "lean mix' in order to save on the a.nount of concrete in this area. In addition, to keep from disturbing the soil in the footing area, a few inches of crushed rock could he placed in aro s of potential distur5anco, These items are optional and should not be ronsidered requirements. We hope this report fulfills your nee(:s on the project. If you have any questions or need further information, ple..se contact the undersigned. Respectfully submitted, AGRA Earth & Environmental, Inc. rr,RTIFrFo OREGON 1i Ri hard '.4n, e ;t, Principal Engineering Geologist F�grNn Geo` I Engineering 8 Enwronmenral Services CITY OF TIGA►RD I, LDEVELOPMENT SERVICES 13125 SW Hall Blvd.,Tigard,OR 97223,1503)6394171 CERTIFICATE OF OCCUPANCv PERMIT #. . . . . . .. 05057 -646 DATE TGSUED: PARCEL: L TE ADDRESS. . . : 142OIZI 5W VERN IiT IBDIVTSION. . . . o HANDY ACRES ZONING:R-7 .00K. . . . . . . . . . : LOT. . . . . . . . . . . . . 1020 JUR I 5r)I CT I ON I'l G ASG OF: Wr)P.1-1,. :NEW ,'PE OF USE. . . x SF' IPE OF CUNSTRs3N GRP. a F7 ';CUPANtcy I-OADIL., USA Gower 1,11DAPEL HOHNSOUM 14160 SW FERN STREXT I(.41R ) OR 97,?.23 1--l-le #3 ,WNEP Ll t,jjs Cj* -encp .t.tific-ate grants ocrujjai-tc�y of the eAbove refet rJ building tioreof and confirms that the building has bPPn inspected for compliance wit!. 1--le State of Orelgorl - .1c antisDecialtv codes f0t. the g"oup, occup,-If -yi ,hich the r "fevenced Pev'mit 144% 199'JerJ- —I AL I N SPEC T 4 S LJ I L 0%119 1 N, PF.C T(D R poST 1h1 CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION ST �'J�,��_, %/ 24-Hour Inspection Line: 639-4ii'41 siness Line: 639-4171eBLD - - J� �' UP af Requested —AM PM Location �o� {�.� n a,1t St!!t�` � MEC Contact Person _ Ph PLM Contractor Ph SWR — x-VOILDING � Tenant/Owner ELC _— Re7aTnmg Wall ELR Footing Access: Foundation FPS _— Ftg Drain LdSGN Crawl Drain Slab /vl• .- SIT _ Post 8 Beam Ext Sheath/Shear int Sheath/Shear , Framing _ —__.--- Insulation Drywall Nailing _ Firewall Fire Sprinkler Fire Alarm �a / nj ry„ Susp'd Ceil;ng ,,,.. Gt�A L1��d--�1LI •��.�4' -- Roof Find�- --- PART FAIL —��`4c� �C��,'� •Yy L,� tGy S�L G4�?J/3C//c�if PLUMBING J C� i A-1 i.y5n41-164t�2 . C�i..e Post& Beam Under Slab e'd 17 r- _�� Top Out Water Services - , ".0 iSe'5 C --- Sanitary Sewer Rain Drains ��arc __ ------•— __-_ Final PASS PART FAIL __— MECHANICAL Post& Beam -- -- :fT / '--"—'�f G.i/�Lc.S Rough In Gas Line Smoke Dampers Final — 1TCr•-r ` PASS PART FAIL ELECTRICAL --_—`- — Service —__-- Rough In UG/Slab — Low Voltage Fire Alarrn _--_ Final PASS PART ."AILSITE Backfill/Grading — Sanitary Sewer Storm Drain [ J Reinspection fee of$ _rc quired before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Gatch Basin Fire Supply Line [ J Please call for reinspection RE:_ --_ [ J Unable to inspect-no access ADA Approach/Sidewalk Other Date / 9 l+ispectar — _ _Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. i 1 FILE COPY October 27, 1998 John and Darlene Wozniak 14200 SW Fern Street Tigard, OR 97223 Re: Extension of permit number 05057848 Dear Mr. and Mrs. Wozniak, Thank you for your letter requesting extension of the above permit. I'm sorry it has taken so long to formally reply, but I have had telephone conversations with Mr Wozniak regarding disposition of this permit. As I explained before, I cannot extend this permit formally as you are living in the residence Extens;on would suggest tacit approval of occupancy, which I could not grant. It appears that you are very close to final inspection except for the retaining wall(s) for your back yard. Your letter did not indicate that this could be done before spring and we- e primary reason for extension. Mr. Wozniak and I agreed that a final inspection would occur no later than November 30, 1998 and that prior to that he would obtain a separate permit for the retaining wall(s) to be completed later. This is acceptable to the Building Department and snakes your completion of the site simpler. It is imperative that you get !;.-sal building inspection approval by November 30. I;, for some reason, you do not, it will become necessary for me to initiate a code enforcement action for violation of the occupancy requirements of the Oregon One and Two Family Dwelling Specialty Code and the Tigard Municipal Code. If you have questions, or I can be of assistance, call me at 6394171 ext. 416. Sincerely, G Darrel flap" Watkins Inspection Supervisor REECEIVED ur ` � N'� CL y P r h .• 1998 / J / Cn"TIli1TY W e. / �°� 7'r/d,.•-• �,fi n S !r, �o��M 7'�y Sy 5 fp�►�c d � e � 00 S U' FerK �8`�� du ,- / 1 :m-s C-�[t'c.1•— L4/ �S y � 8- 9� W'" �✓� �•�u � `ZI !�C G�f++,'C a ( d57 • pe / 11 wrfis roCl ; • �oss a � Sd �� on ct rvP r r T� w -e_ / / QOr � sot* 7, N;s � � s we Ca� s� (' u+`'y/ m1 E' c_�•1 / c. d b/p /v+r i � Gt n H cl c of u i �v/Pct-p- 0 C) 0v s w I PrH %ir cr Or �r°7,� z 3 Sd�4 a a � } 7 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 09-4;71 V�d Date Requested: ,� �p N AM _ P.M. _ MS . LO ation: d Lv �7KJ1.7 l — -- BIJP:- -- Tenant:_ Suite:_ Bldg: MEC:_ Co.1tractor: S _Phone: 5_�- PLM: — — Owner: CY Phone: — i:LC: _---- N-A-S W4(_4,Q S&JT U Ty-(S c.-45 E yr r? FIX: _ SM -jrp/ih1f, _': BUILDING BLDG(con't) PLUMBING HANI ELECTRICAL SITE Site Post/Beam Post/Beam os earn Cover/Service Sewer/Stonn Footing Roof UndFI/Slab Rough-In Ceiling Water Line Slab Framing Top Out Gas.ane Rough-In IDG Sprinkler Foundation Insulation Sewer II<xXl/Duct Reconnect Vault Rsmt Damp Drywall Stone Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found Dr • Pump Low Volt Appi.,ved ApprovLxl ,VZ!: Approved Approved Approved Aper/Sdwlk Not Approved Not Approved — o iprovcd Not Approved Not Approved FINAL, ,riNALFIN : FINAL FINAL O Call for reinspect' n C3 Reinspection fee of S_ _— required before next inspection 0 linable to inspect Inspector:�— _, _. _ Date: y— 8 �/� — Page_—_of Washington ,!:ounty Electrical Permit Call 640-3561 for inspection Date /0 Permit No. Project Address Permitted world-2V r � h �.._.,.vner wiring own residence H meowner's Signature c ;_i�– r' Contracting firm - Phone — Supervising Elec.Signature License No. Inspection' Inspector Date Underground Service "- Wall Cover --- — - Ceiling Cover Final Signature of Inspector indicates approval • Not transferable DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DE*wELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON _ _. INSPECTION REQUgSTS (24 hours): 503/6A'-3699 or 681-3697 Permit #: 05057U48 Pro er P004355L Status. EXPIED 11 PAGE 1 Applied. IsEued : Iia-/13/1994 9`xpires: 2/_0?_/1496 4:? 5/9'7 C6i0o -ompositn Type: COMBO cw)Ttrllction 'Type' N"r_ Permit. Title. `_;FFA — 3 BD 3B J'-T_.-!AR-AQ __ Description- WEST-Ti�"`F`-135TH AT WALNUT Ur-gur,: 09/02/1994 Address. 1.4200 SW FERN ST T'I Location: Location Detail : Reyion D Owner Name: WOZ.NIAK, JOHN G AND LARi_.E. —� Phone: Applicant Name. WOZ.NIAK, JOHN Phone: 620--961.2 1=1LANS EXAM: f3VD Phune: Parcel : 2S1 04BC 01600 Ap; roval# APPR Valuation. Approved,_ Tnspc,- tor Comments: Resected (7- Ar;lr_ IJc `.._�� ! .�' (�, .s.«�� r IVR-RESULTS RE.&E'ST ERROR ! pll . 4� t'=.'s" _ _.__ . -__ _ _�(}A��.• t<<:l r�.. 4 t�cY�tz� C c n%Ac.,A Inspected t,y: Date ! tem-, requested to he In,,pected 1 .! tem# Inspection Description Requestor Area p ;0499 E ranal Electrical M9 L) AP DN IVR 1specti0n HistoTy . '1f1105 S Fnntiny AP DN IVR 11/15/94 Inspector: JM Artian: RI 11/ 15/94 Inspector; ME.. Action: AP APT.VR LU745 I BS IO/x0194 Irsspec to-, TW Ar_ti.or: RI 10/20/94 Inspector: ME Action DN DNIVP LUT45 I BS 0"106 -i t oundation AP DN IVR 013/28/95 Inspector Action RT R] 1VR H5tB H i i i� li � ' _�� WASHINGTON COUNTY RESIDENTIAL Department of Land Use & Transportation Mechanical Inspection Section MECHANICAL PERMIT 155 North First Avenue, 11350-12 Hillsboro, Oregon 97124 Project/Permit Information: (503)6403470 Fax: (503)693-4412 Number ,,fir Date %[ Inspection Requests: (503) 640.3561 or 693-4415 - - PLEASE PRINT and complete all secUotls. PERMIT FEE SCHEDULE —� Name of Development PERMIT ISSUANCE FEE 10.00 Address DESCRIPTION OTY. COST(Ea.) AMOUNT L �� ` FURNACES Map No. Taxof including up to 100,000 BTU 6.00 Job �?S l �eI_/�00 ductwork Thomas Page Section and vents over 107,000 BTU 7.50 Address Map Book iFLOOR 6.00 Directions to Siie,�' �y -T�j HEATEFIS suspended,wall or floor-mounted 6.00 or Cross Street 1 0( / j — AIR HANDLING UNIT up l0 10,000 CFM 4.50 AIR CONDITIONER over 10,000 CFM 7.5G Name 1 MEAT PUMP 7.50 — -- ailing ddress 1 / ALTER EXISTING SYSTEM 4.50 I�,`j jU J(AJ, �,L" (/ REPAIR OF EQUIPMENT LIS-ED ABOVE I 6.00 Owner Cit /State ZIP Non-portable EVAPORATIVE COOLER X4.50 Phone/ VENT FAR connected to single unit 3.00 & LTU_ W L _ VENT not included in Appliance Permit 3.00 Name — -- VENTILATION SYSTEM not incl.App.Pmt. 4.50 Mailing Address HOOD served by meth.exhaust— — 4.50 ___ _. DOWN DRAFT FOR RANGE 3.00 Contractor City/State zip - �--.� WATER HEATER VENT 4.50 Phone INCINERATORS domestic type 7.50 -- -- — WOOD STOVES FIREPLACE 4.50 State ---•— Negistration No SOLAR SYSTEM 4.50 ►hereby acknowledge that I have read this application, CLOTHES DRYER 4.50 that the Information given Is correct, that I am the owner GAS PIPING 1 to 4 outlets 2.00 or authorized agent of the owner, that plans submitted are In compliance with State laws, that i am registered each additional 50 with the State Builders' Board, that the registration OTHER number given Is correct. (If exempt from State registra- tion, please give reason here.) OTHER SUBTOTAL. 5%of subtotal for State Surcharge f'rin — _7 1V Receipt No, TOTAL FEE DUE Authaflzed Ignatur- EZ_ _ Date APPROVED BY Describe work new addition alteration re air to be done [-1 f I [Jrepair Date Date SUbrnitted Issued By__.__ NOTICE: This permit becomes null and void if the work or construction authorized Is not commenced within 180 days, or if construction or work authorized is sus- pended or abandoned at any time after 1crs3 work is commenced. WASHINGTON COUNTY RESIDENTIAL Department of Land Use & Transportation Plumbing Inspection Section PLUMBING PERMIT 155 North First Avenue, 11350-12 F;tllsboro, Oregon 97124 Project) Information: (503)640-3470 Fax: (503) 693-4412 Permit Number5izl Date �( Inspection Requea% (503)640-3561 or 693-4415 permit FeeSchedule • com•�Wall sections. DESCRIPTION CITY. COST(Ea.) AMOUNT RESIDENTIAL- SFR(1) BATH $210.00 Name of Development -�NEW SFR(2-BATH 275.00 Address SFR(3) BATH325.00 Job , 2uo S ) �,��;; SINK (KITCHEN) 9.00 Address Ma;No. Tax Lot - WATER HEATER -� 9.00 - �- DISHWASHER - 9.00 DISPOSAL 9.00 Thomas Map: PageGAS y Sect on ,-�_ WATER CLOSET 9.00 Directions to e- _ � BASINS 9.00 Site or Cross Street td a-7 p�. /��ST�a hAej✓7 TUBS - _ 9.00 _ SHOWERS _ 9.o0 --- - ---- CLOTHES WASHER 9.00 Name LAUNDRY TRAY Y _ 9.00 (fid-!J r SCJ - Mailing Address MISC. 9.00 Owner 0 -5 REMODEL EACH FIXTURE City/ ate Zip (minimum fee-$25.00) 12.50 I __ I lfnn Cl 7?e -3 FLOOR DRAINS 9.00 PhonRAIN D_RAINIDOWNSPOUT 9.00 Z � -- Name DRY WELIJLEACH LINE 10.00 - WATER SERVICE first 100' 30.00 _ Mailing Address T= - _WATER each addnl 100'_ 25.00 REPLACING in building Contractor City/State -Zip water supply lines Phone --- FIRST FLOOR _ _ 30.00 ADUN'L FLOOR-each 12.00 State Registration No Plumbing -7c. No. SAN CONNECTION T SEWER first 100' 30.00 I hereby acknowledge that I have n,ad this application,that the each adc,tl 100' 25.00 information given is correct,that I am the owner or authorized ----- agent of the owner,that plans submitted are In compliance with seperate lermit to prevent State laws,that I am registered with the State Builders'Board,that two contractors from working the registration number given Is correct. (If exempt from State registration,please give reason here.) off same permit _- 40.00 BACK FLOW PREVENTEH 9.00 _ STORM up to 4'diameter per 100' 10.00 Prrnt SEWER over 4'diameter per 100' -15.00 ' q for ea.addn'I 100' _ _ 30.00 CATCH BASINS/AREA DRAIN 10.00 Aut orized Signatu - _ Date MOBILE HOME UTILITIES_ _ 60.00 Describe work - addition alteration []repair INSP. OF EXISTING PLUMBING to be done new p er hour _40.00 _ SOLAR- MINIMUM _ 30.00 HEAT EXCHANGE_ _ 9.00 COLLECTOR/PANEL 9.00 _ T_ANK NOTICE: MINIMUM FEE 25.00 This permit becomes null and void if the work or SUBTOTAL _ construction authorized is not commenced within - - -- - - --- --- 180 days, or if construction or work authorized is 5%of subtotai for State Surcharge suspended or abandoned at any time after work is commencecr. TOTAL FEE DUE 10/93 DEPARTMENT OF LAND USE&TRANSPORTATION WASHINGTON LAND DEVEP.OPMENT SLRVICES DIVISION 155 NORTH FIRST,HILLSBORO,OR 97124 COUN'T'Y' INSPECTION REQUESTS: 503/640-3581/693-4415 OREGON NOTICE This permit becomes null and void If the work of construction for which It Is Issued Is not commenced within 180 days. Once constructlon has started, the permit becomes null and void If cor struction Is Interrupted for a period of 180 days. I certify that the Information presented by the applicant and his aqent or agents In support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance upon false and misleading information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use of this building or structure will be compiled with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge Chat the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of the structure or building permitted depends upon my calling for Inspections at various times during the pi)cess of construction and the building inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to ap, r val by the Building Department Is solely at the risk of the applicant and such use or occupancy is revocable untll all inspection requirements" a sathifled and approval Is given b! the Building Official. I further acknowledge that a i may he placed on the title of the property upon which tha permit is issued specifying that the use or occupancy of the building or structure is provislonal and revocable until the satisfactlon of all inspection requirements. "L�ju —Wl PLICANT'SSI(INATUA^ A * C'OND.T.TTONS OF r)T RMT'r nPPROVAL k k PATE: 10/04/94 PA'-,E: 3 Permit: # : 0505784(1 TYPE: COMBO Lo(:,-itlon : 14200 SW FERN ST TI '8 inches in. cross-sectional. dimension, or the shape I provide an additional gril:)ping surface . The ha grip p.- t ic,n of the handrails shall have a Smooth surfa with no am earners . Handrails projecting fr,nm rt wa shall have ::pi.tc'e of riot less than 1 1,12 inches: tho ].l. and t-he handrat i . Section R-214 . 1 0044 - GUARDRAIL.. Parches , balconip.:, , or raisc-1 loor surfaces located mar - than 30 inches above the fl( r car grade down below shall aver quardrAils not more t tri 36 inr:her: in height , Open d 'des of stairs with a t tal. rise of more than 30 inches above 1e floor or grade b ...low ::ihall have cluar.dr. ails not .le :, then 34 inches n height meanured vertically from the o^ing of the traadr, . Required guardrailS on open s 9e::: of sta' ways , raised floor areas , balconies anci porches , hull ha e intermediate rail^ or ornamental closures whie t wi.l . not allow passage of an object. 6 inches, or more i c. amete.r. . Horizontal between the vertical membe in reguired guardrails !-,hail be .i maximum of 4 inr:hpr: .7t . 1r.- noarestpoint between the members , EXCEPTTON: This tr.ang. u. r open cls formed by the riser. , trr:a-1 and bottom nail of a guar,. Ott the open side of .;t,-jirw,iy may he of r ch a :-:i ze th,- a sphere 6 inches in di amef er cannot I:,as through . Sec t on R-214 . 2 C;uarr?r.-i s rshaI l clepigned to rp^ f :- a ^ i.nyle ronc-ntrate,i 1,-,ad applied in -ty fliroc-t ion at any t, irtt. .along the top. T.�thl e R-201 . 4 0()4r, - .:'I'AIRW.AYS : e 8 1/4 inchf: !i mini. atm tread width e r tin 1 9 incl s , headr..)orn 6 feet 8 inches , mit 'mum width 36 iIIcI1,--n . W en ri r..er s are c_ loved , all trp,a(is :n. have a unifr)rm tp ojection nc,t to exceed 1 1/2 inches , e greatpc the rise height within any flight of stairs shall of cxr gar} l -he .smal.lost by more than 3/8 inch . Stairwa sha1.1 n,,t- 1,- less t.ttrtn 3 feet: in cloar width . EXt'EF1 . 10N.- The = tairw ty clear width may he> reduced to t I +^: r than 30 i ttrhr whprr i l ac,z n .are served by one 36 i rh wir : stairway . Handrails may project from each side of ,:,t.,irway a Oise-ance t,f 3 1.!2 inch.-n into t.hta required wid t . tion R 211 . 1 an 3 fir-,V n 1„Lnn(:�rtt. ('(.)nd i. t i e-) : STANDARD RESTDF'NTJAL F.111Jr,DTNG PERMIT No SW. :-;T TR. : t . tb,acl;s s Fifteen ( IS ) foo` front yard, twenty ( 20 ) f(:)ut yarcl tc. garage vel;is-le entrance=, f. ivp ( F, ) foot sirip y,11•d, fifteen f 1 F) ) foot- rr.ar yard . No t-,+tti .lding >n or over ea:-,nmc,ntn . i . Sincle-family clwell.in r only . 4 . Identify all proper, +s P- ' r t, Iti,l rui,at :i '>n inspe,('tinn. / App i l,-ant i g n a f-u r e : W Department of COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation Electrical Inspection Section APPLICATION 155 North First Avenue #350-12 Hillsboro, Oregon 97124 Information: (503) 640-3470 Fax: (503) 693-4412 PermitPLEASE �r � PRINT Number ". J/ Ll Date Please complete 4. Complete Fee Schedule below 1. Location of installation Number of Iner:tctions per permit allowed Address /` ' UC .:1 i� Service included: Items Cost(ea.) Sum Building A. Residential- per unit City-L t M f o -- Suite No,_ 1000 eq.fl.or 1655 $110.00 -- _ a Tenant Name Each additional 500 sq ft (if commoreiall —_ or portion thereof $25,00 _-- / Limited Energy --_. $25.00 _ 1 Map No.. Z_` I 4160 Tax Lot OU Each Manuf'd Homo or Modular I,� Dwelling Service or Feeder �— $68.00 --- 2 Thomas Map Book: Page:�.Z1_."._ Section:�Z— Directions_—_ ____ --_...._"- -- B. Services or Feeders Installation,alterations or relocation 200 amps or less $60.00 2 Commercial Residential 201 amps to 400 amps $80.00 2 401 amps to 600 amps $120.00 _ 2 2a. Contrp Ior installation onl : 601 amps to 1000 amps $180.00 2 Y Over 1000 amps or volts $340.00 _— — 2 Electrical Contidc.or Reconnect only -- $50.00 — 2 Address Date_—__ Job Numb,�r .._.._ _ ____. C. Temporary Services or Feeders Property Owner _ _--- __ _.`__ _ Installation,alteration or relocation Contractor's License No. 200 amps or less ___— $50.00 2 Contractor's Board Reg. No. 201 amps to 400 amps $7500 2 401 amps to 600 amps $100.00 _ A 2 Signature of Supr. Elec'n Over 600 amps to 1000 volts see'B'above _ —_ _ License No. Phone No. _ D. Branch Circuits New,alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with t� � purchase of service or feeder fee.i.J/jl .��I-tl:.NJL�C�"._ —__1�`--o.no No.--�.� Each branch circuit $5.00 2 Print Owner'ss Name Phone N �ah� U —� �,v0 ✓r _--_ b) The tee for branch circuits without regs purchase of service or leader lee. 6 > > First branch circuit $35.00 — 2 1 l� ' --- --;talo Z L S - Each add'nl branch circuit $5.00 2 y r p E. Miscellaneous (Service or Feeder not included) The installation, is being made on property own Each pump or irrigation circle_— $40.00 2 Which IS flOt Intend r Sal , leases or fent. Each sign or outline lighting $4000 _ 2 Signal circuit(s)or a limited Owner's Signature _ — -- energy panel,alteration or extension $40,00 2 F. Each additional inspection over the allowable in any of the above F3. Plan Review section (if required) Per inspection $3500 _ Please check appropriate kern and enter tee In section 5B. Per hour $55.00 In Plant _.__...___ $55 00 4 or more residential Units in one structure _Service and feeder, 800 atolls or more 5. Fees Cc System over 600 volts nominal A. Enter total of above fees $ I. � _Classified area or structure containing special 5% Surcharge (.05 X total fees) $ _. occupancy as described in N.E C. Chapter 5 Subtotal $ B. Enter 25% of ling A for Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $ --- -- above apply. Not required for temporary construction Subtotal $ services. $ "---"— Less Bulk Label Fee —_— Balance Due $ For inspections call This permit becomes null and void if the work•uthorired by the permR is not commenced 640-3561 or 693-4415 wHhln 180 days from date of Issuance of such{womb or It the work•uthorlred Is suspended or abandoned at any time after work Is commenced for a period d 180 days. 24-hour recorder, one working day in advance of need F.leMrlcal Permits are non refundable and non transferable. 4,194 DEPARTMENT OF LAND USE &TRANS70RTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO, OR 57124 COUNTY, PHONE: 503/640-3470 0REG0N INSPECThON REQUESTS (24 hours): 503/681-3699 or 681-3697 r nit: # u:)Q'., 64b Project #: P0043551. Sf a-tus: APPROVED PAGE 1. 4p,+ t3.ed . Issued 10/13/1904 Expi.r4i. 1 .t/02/1996 11/ 13/96 06 21 ;mpr; ;,tt:n Type (.:,'OMBO C'onstT�UCtion Type: NEW rerrni. t- TitleSFR •- :3 130 3 DA ATT GARAGE l:os;.ripti.crn. Wkr3T (If" 135TH AT WALNUT Begun: 09/0 / 1994 Ail JrPS: 14200 5W FERN '.::,T Tf LfjC1-3r LUn' ,t i•,ir Ditto i I Region D 'i.,nei, Name: WOZNIAK, ,JOHN (. AND DAM-ENE M Phone l c.int Name WOZNIAK, •JUHh•I Phone: 620 'r._AWc) EXAM- SVD Phone: F',3rreI. i3sl 04130 01101) 0c.c . R:i � "�• App,+ , :,i1#: ALIPP 'Ja1.uation, Approved., ,, tf;i• �mment eJnr. :.:. c! 1"'?P-. r)r7Fj1ff TS REQUEST I=RPOP. ! t! Area t != bvrird NealI AP DN IVk r :! ,,�1 Buildino AP DN IVR Plumbinp AP DN IVR :t f ii H1 Eloctrical. AP T)h! I4IR f s!,N] Mechanical AP PN IVR mporary :3er�ice AP DN IVR C r-t 17 i c k S AP DN I VR DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO,OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit #: 0505784EI I' i o sect #: P0043551 Status: APPROVED PAGE: .1 Appl _ ed . Issued : 10/13/1994 Expires: 11/02/1996 09/84/96 (16: 00 ,.:rmpositn Type: COMBO C :)nstruction Type: NEW Kermit Title: SFR — 3 I3D 3 BA ATT GARAGE Description: WEFT OF 135TH AT WALNUT Degun: 09/02/1994 Address: 14200 SW FERN ST TI Location: 1-oc—ation Detail: Region D Owner Name: WOZNIAK, JOHN U AND DARI_ENE M Phone: Applicant Name: WOZNIAK, JOHN Phone: 620-9642 PLANS EXAM: SVB Phone: Parcel 2S1 04BC 01600 ` V/' Approval# APFIR Valuation. Approved Lnsper.tor Commonts: s c r •S M-4 _ yl Sys _ .S' I�Jmwvc Rejected— A f Lo vim- IVR—RESULTS C-Al L--t . Q y _-._.__.. REQUEST ERROR ! 1 �1 1A 4 J U r,spected by: Date ---------------------------------------------- tFms rerinested to bz Inspected . . trmit Iri rtion Description Re(Iuestor Area 100. E ServicesD AP DN IVR Comments: Requested thru IVR pection History. . . -:.o O5 S Footing AP DN IVR 11/15/94 Inspector. JM Ar.tion RI 11/15/94 Inspector: ME Action: AP APIVR 1_UT45 I DS 10/20/94 Inspector: TW Action: RI 10/20/94 Inspector: ME Action. DN D.NIVR LUT45 I DS -'JL06 5 Founds tion AP DN IVR DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST,HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit # 05057949 Project #. P0043551 Status: Ar' .+!l.JvEr, PAGES 1. Applied 1s$ued 10/ 13/1994 Expires 1. 1 /02/1.996 09/24/96 06: 00 ,,,,rnpcasitn Type COMBO Construction Type NEW Pel-mit 'Title : SFR - 3 [3U :3 13A Al-7 GARAGE Descr•iptaon WEST' 17F 135TH AT WALNUT [iegun: 09/02/1794 Addr'F?ss . 14200 SW FERN ST T [ Lorna tiall Miran Dotai1 kpyfon 1) Owner Name . WOZN I AK, !laHhl G AND DARLENE M Phone a�,lali.caarrt Name WOZNIAK, JOHN 'hone 620-964P PLANS EXAM. GVC3 1='hone1 P r r.e I PS 1 04L1C 01.600) Afiprc�vaI#: APPP Valuation r rove R e j e c t fr cl 1.VR-.REGUL..I to REOUEST ERROR ! i� , __......... i-e d _ Date �- G n� re(JueGted to be Inspected m#r Inspec tion Description Requestnr Area c, Framing C; D nr- 17N IV omment5: Requested thrr.r IVR ` + n Insulation I) AF UN --TVR i Comments Requested thr'u IVR • :" '� Exterior Sheath .�r,�, I) AF' Dhl IVR Comments. Requested thru IVR , r, :1,Nction History . . —105 S Footing AF' DN IVR 11 ,'15/94 Inspector JM Action RI DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS(24 hours): 503/681-3699 or 681-3697 i`0rmi t #: 05057848 Project #: P0043551 Status; APPROVED PAGE 1 Applied . Issued: 10/13/1994 Expires: 11/02/1996 09/ 18/96 06: 00 � ompositn rt/pe: COMDO Construction Type: NEW Permit Title: SFR -- 3 SD 3 IIA ATT GARAGE Description: WEST OF 1351H AT WALNUT Regun: 09/021,1994 AddrPas . 14200 SW FERN ST T I Location: ration Detail , Region D Owner Nome: WOZNIAK, JOHN G AND DARLENE M Phone: r)pplic:ant Name. WOZNIAK, JOHN Phone: 620-9642 F'L.ANS EXAM GVB Phone: P,:arr.el. 2131 0413C 01600 j Approval#. APPR Valuation: ADDroved [r,aapectar t:amments: 7 �W 'ejecte _ '� { VR—RE SU _r...L--_- j� 'n ._._ +. ____. ____ ____ REQUEST ERROR ! s v I ris.Fiec,ted _h / V+____ Date: i requested i:I, hp Incpected . I tem# i .i.iyt,J)esCr 3ption RegUestor Area 7 ramina D AP DN IVR Comments Requested thru IVR r I ,,spection History . . . �]U5 S Footina AP DN IVR 11 /15/94 Inspector: JM Action RI 11/15/94 Inspector: MF Action AP APIVR I_UT45 I 13S 10/20/94 Inspector : TW Action. RI 10/20/94 Inspector: ME Action: DN DNIVR LUT45 I DS )1.Ob S Foundation AP DN IVR i DEPARTMENT OF LAND USE &TRANSPORTATION WASHING'T'ON LAND DEVELOPMENT SERVICES DIVISION#350-12 .� COUNTY, 155 NORTH FIRST, HILLSBORO,OR 97124 OREGON PHONE: 503/640-3470 INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit M: 05057848 Project P0043551. Status: APPROVED PAGE 1 Applied : Issued 10/13/1994 Expires: 11/02/1996 09/17/96 06: 00 (.:c,mpositn Type: COMBO C;onstrriction Type: NEW Permit Title. SFR — 3 BD 3 BA ATT GARAGE Description: WEST OF 135TH AT WALNUT Begun. 09/02/1994 Address 14200 SW FERN ST TI Locution: Cation Detail : Region D Owner Name: WOZNIAK, JOHN G AND DARLENE M Phone: Applicant Name: WOZNIAK, JOHN Phone: 620-9642 PLANS EXAM: '-',V 13 Phone. Parcel : 2S1 04BC 01600 _ Approval#: APPR Valuation. roved _ it spector Comments: Reier. ;ec ,__.._.__—_._ d n.. AVL IS REOUE.ST ERROR I 6 v 17 pec_ted hc,: i . Date toms reques tem# spec + l i*i !!p crip i Requestor Area . M Rough—Tri Mer.hanir_al D AF DN TVR n siPequested thru IVR °-PE( tion History 05 S Footing AP DN IVR 11 /15/94 Inspector. JM Action: R' 11/15/94 Inspector. ME Action: F- APIVR l-UT45 I BS 10/20/94 Inspector: TW Action RI . 10/20/94 Inspector. ME Action: DN DNIVR LUT45 I BS t' 106 S Foundation AP DN IVR + DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH COUNTY, PHONE: 503/640-3470 �SBORO,OFt 97124 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit #: 05057848 Project #. P0043551 Status: APPROVED PAGE I Applied : Issued : 10/13/1994 Expires: 11/02/1996 09/06/96 06: 00 C ()mpositn T,-pe: COMBO Construction Type: NEW ''ermit '' itle: SFR – 3 BD 3 BA ATT GARAGE Description: WEST OF 135TH AT WALNUT Begun: 09/02/1994 Address: 14200 SW FERN ST TI Location: Location Detail : Region D Owner Name: WOZNIAK, JOHN G AND DARLENE M Phone: Applicant Name: WOZNIAK, JOHN Phone: 620-9642 PLANS EXAM: SVP Phone: Parcel : 2SI 04BC 01600 Approval#: APPR Valuation: Approved._ ] nspector Comments: Rejected_ TVR–RESULTS) REQUEST ERROR ! , 4 in_....,pec.ted by. - CI _ MDate: — _ ------------------------------------------ ltPmy requested to be Inspected I tam# In - AFfTR tion Requestor 4��3 E .over & Service i) AP DN IVR Comments: Requested thru IVR -------------------------------------------------------------- i.n pection History . . . 1. 1109 S Footing AP DN IVR 11/15/94 Inspector: JM Action: RI 411/15/94 Inspector: ME Action: AP APIVR LUT45 I BS 10/20/94 Inspector: TW Action: RI ; 10/20/94 Inspector : ME Action: DN DNIVR LUT45 I DS 00106 S Foundation AP DN IVR I DEPARTMENT OF LAND USE 8,TRANSPORTATION WASHING'T'ON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit #: 05057846 Pruiect #: P0043551 Status: APPROVED PAGE 1 Applied : Issued : 10/13/1994 Expires: 11/02/1996 09/03/96 06: 00 (-ompositn Type: COMBO Construction Type: NEW Permit Title: SFR - 3 BD 3 BA ATT GARAGE Description: WEST OF 135TH AT WALNUT Begun: 09/02/1994 Address: 14200 SW FERN ST TI Location i. ocation Detail : V Region D Owner Name: -WOZ'IVIAKr JOHN G AND DARLENE M Phone: r^ ,)plicant Name. WOZIVIAK, JOHN Phone- 620-9642 PLANS EXAM: SVB Phone: Parcel . 2S1 04B(' 01600 Approval#- APPR valuation: Approved Inspector Comments. S - Rejected_ _ a ^fel r'�lj ULb.ig ____ (3C1.1" O � /S_ IVR-RESULTS Q ,L CA REQUEST ERROR ! '.S /ALy1=Z. - 60ri o AxJ(r 5.4 I cC l0 J Ir1spected by Date: _-- -------------- - ------ -----P- ---------------___ Itemsrequestedto be Inspected . . 2a�.t� Item# Inspection Description Requestor Area )0409 E Lori Voltage Cover D AP DN IVR Comments: Requested thru IVR 10403 E r I4 D AP DN IVR Comments-. Requested thru IVR Inspection History. . . . 105 S Footing AP DN IVR {: 11 /15/94 Inspector: JM Action: RI 11/15/94 Inspector: ME Action: AP APIVR LUT45 I BS 10/20/94 Inspector: TW Action: RI DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 Permit. fit: 05057848 Project #i: P0043551 Status APPROVED Page 1 of 1 Applied : 09/02/94 Issued 10/13/94 Expires (14/11/95 10/20/94 05 : 56 COMBO Permit Title SFR - 3 BD 3 BA ATT GARAGE: NEW Description WEST OF 135TH AT WALNUT Begun: 09/02/94 ,lob Address 14200 SW FERN ST TI Owner Name WOZNIAK, .JOHN G AND DARLENE M Region Applicant Name : WUZNIAK, JOHN Phone number 620--9642 Valuation: 197,743 Approved--_------ Inspector Comments : Rejectec>�1'__ L. .S.:- CR2IVR--RESIJLTS �1— v7�7!`� `i�EUE T E: Ror Inspected by c �� - ' t .____ Date: .Inspection Requested.- Footing equested:Footinq AP �N j I VR 10/20/94 Pi W DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICE: DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 ^, — COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 Permit #: 05057848 Project # : P0043551 Status APPROVED Paqe 1 of 1 Applied : 09/02/94 Issued 10/13/94 Expires 04/11/95 11/15/94 07 : 38 COMBO Permit Title SFR - 3 BD 3 BA ATT GARAGE NEW Description WEST OF 135TH AT WALNUT Bequn: 09/02/94 Job Address 14200 SW FERN ST TI Owner Name WOZNIAK, JOHN G AND DARLENE M Region t Applicant Name WOZNIAK, JOHN X Phone number 620-9642 Valuation: 197,743 Approved Inspector Comments : Rejected---- V ejected---.- Vn-RESULTS W RIMIZ�- CCTL-)L—Z L2--� REQUEST ERROR ! i To i i R , l G Inspected by : Gate10 : Inspection Requested: * Footing u 1 u��, �E DiJ V1? 11/15/94 RI JM 10/20/94 RI TW h. 10/20/94 DN ME C,NIVR LUT4I RS Ii DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 Permit_ # 0505784f% ro ject # P0043551. 8tatu.:; APPROVED Faye Applied 09/02/94 10/13/94 Expires . 04/11/95 02/ON/- , r COMBO Permit Ti t.l e SFR - 3 BD 3 IIA ATT c-11ARAGE NEW Desr.,rxpt:, on WEST OF 1 .15TH AT WALNUT Elegun t) /c;ri 4 Job Addrens 14200 SW TERN 37' Ti. Ownar Name WOZNIAK, JOHN G AND DARLENE M Region Appl.ica,nt Name WOZNIAK, JOHN Phone number 620-9642 Valuation 197, 743 Approved Inspector Rejected_ REQUEST Fk'P' P 1 umb i w-1 Mecham,~ i StructruaI General I n s p e c_t e d InspeCtin�, �� '� Foundat , 0106 u AP itAWl, ARF". DRAINAGE DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 rlr,r,lt ✓'f 1)Su�i'�1i41S i1z.: it PUDai�'; 1 .;t,it:a : „ : •, . ,, ;,_ r'ay-� , I. Appliod ('9/02/94 Ij.-:u-ul JO/ 13/94 Exp1t'A!:; COMBO Permit Title FR - 3 131) 1 BA A'CT ('ARAB-E NEW L*scription WC:;T OF 13r cF{ AT' WALNUT k3eyur, 09/U2/ T �b AdJresa 14201) :aW WEAN : 'T T! ')wne. Name W(,ZNTAK JOHN t A.NL i.,ARLF:NC M R-ryaan I Applicant Name WOZNIAX, JOHN Phcane number e20- 9b42 VaIuat1,; ' ".43 Apprc,v- - inepertor C'ormpmentr P jest. FC __.. REC)IIEST L kf1!,A ' P 1.umb 1 rig 1rIe-har,Icai. 1: 1 ectr., cai :;rructr.ua.l Jeriera1 L)8t @' _..._ ._.._. "'.�.. [.� .. 1 r,�pert is r, ker�f.,NSt Rain Ucaine AF' tv' W; 26/Qr t<1 p.� �_ � , DEPARTMENT OF LAND USE & TRANSPORTATION WASHING=TON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503,640-3561 or 693-4415 NEW �G'rilkYl ;i� ' flea t 1 ! de Alt 67 LA._ 61A kA' 1%5 'l� r ., e. tet •_. Gtl�, ��e C2.)l � C�-rte•-d w-e�A-/� �.�I F��,.�� o� DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 F'�r.rin; 05'184tt F'r: j*c.t 11 PC1U43's'. 1 stat.vs AP +py,Iied '1)9/0i/r4 1vrm&C1 ] 0/13/144 Expirer- f� tlfill2/gra C)!' CC)MBC. 1,Ftr:n.t t Title ;Flt 3 BIHA A'1"P NEW !e r1pt,.ion WEST jF 1, 35TH AT WALNUT 1~er;ur, lc+ Addrasr. 14200 SW FERN ST TI ,,wz,er Names WOZN 1 AK; OHN 13 ANT) ' ARLENE 17 k c n r! Applir,ant Name W0ZN1AK JOHN Ph'. n e rIurntvr 620-9642 V 43 Apy,r; v _. nioct,or U w / l rt�l 1Jark/ltn.g� . �. G2U'7 F' .A 1-' IN 0NIV1+ 1,11Ti4 lJater�,rc.t�fin�t r.l , _fi r (11�/tl/ ri T21 k? 1tib' N518 I DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 1350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REGIUES'rS (24 hours): 503/640-3561 or 693-4415 6'd^ti t a a4i i AF:g i iwc� "i/(17; i4 IF:'.�rr:i lU/l :i/'?4 Expires: :OMA(" Penni t. Title i,F1i :': �tD :3 El'. A.TT !: Ak7k(3vL NLW r)escx 1pt Ion WEFT :)F i :3,T}1 AT WALNUT BegLin (19/ Jot, AddrevL--, 14200 .,W rERN ST TT Owner Name WOZNIAK, J()}iN G AN1� I>ARLENE V1 ItE�iCn Ap'pllrant Name WOZNIAK , JOHN Ph,,ne number 620--9642 Vsluat ao , 7n .3 Ax��xc . . :!_ Cn� peKk.ar ".>rnrnFnt.F Rejertee F„c'r a 1 1 r:: }�g^t a rr; 11•.•,ael�t ell :,rc)..,nd Wark/tinderg-r< und 0207 P 06/ 1. 2/95 KI RIIVl2 W- 18 li (l6110s/9ci T)N CR t+N1VK 1-11Tr4 Pt'' + Wat r.prr.oi inj 06/12/95 R ItI1VLk' i51A `1 -I DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 C DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 00—m^LS' — 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 1agF. 7/0 ,i NEW begiir; H p S C jet 1� �f l 3 3 1yj A, CJ ,/ 44 'P{�� Lt1 S � C /t/]a[ ((J-r l X '�c'�►�/` 7 � � n DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 3cacr -s ?c G i'S t /1-eyc• 1t 1< �Y, fr C v PROJECT NO. Y S+S WASHINGTON COUNTY INSPECTION CARD DEPARTMENT OF LAND USE AND TRANSPORTATION PERMIT NO. FOR INSPECTIONS CALL: 640-3561, 24 HOURS FOR INFORMATION CALL: 640-3470 DATE ADDRESS Y! G — PERMITEE _ DIRECTIONS PHONE NO. BUILDINGMISCELLANEOUS PLUMB,NG ELECTRICAL _ fig post/beam nail_ mobile home arour`I , rain drain temp service fdn frame apron/ woos stove post;heam storm sewer cover b service sidewalk slab insul FINAL HVAC top-out FINAL FINAL gas test sewer USA No. OTHER APPROVED FINOTRAPPROVEDANDECT D REG APOSEEDD NVSPEC�TION DTESTOP WORK UNTIL: REPAG INSPECTED By �_ '�' _ DATE DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415 �'rrtnit # flr�l)4 ''Fi4c x ' fir ] i+�� ., .t irt7 / �A f ._ �•,:G t ;ft1 r, T 1. C Lt,Vt z'.i.p t i a n 14200 SSW FERN ST TI .4r Nam .'.J. .c ant Nf;•irnr � +�� r�umb�r• 1� 1 � y Rough-In PIumbintj 1 1 /20/9''; RI 06/09/9a Ri s 17»in 1!rw.enc. DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 05057848 Pr,.,;ect # P00435,51 St a tur APPROVED Page 1 0£ 2. Applied 09/02./94 Issued 10/13/94 Expires 05/18/96 02/20/96 05 : 31 COMBO P«-rrnit Title 'FII - 3 AD 3 BA ATT ,ARAOE NEW Des-cription WEST OF 135TH AT WALNUT Begun . 09/02/94 Job Address 14200 SW FERN ST TI C:wner Name WUZNIAK, JOHN !? A)qr' DARLENE M Re i o a Applicant Name WOZNIAK, JOHN Phone number 620-9642 Valuat-ton : 197 43 Apr—c,ve,3 Approval # APPR Inspector Cormnents . Re I Luc IVR-REt�ULT�� s REQUEST FRROR ! ) 1 ) 1 I'1 u mb i ng Mechanical Electrical : t.ructrual 0e n e r 31 «w,-ted b C!a t p)* 1 ,._�p Y .._ ._ lnsper-ti ;,n Regua?ta0 R �� RI IV& 115 DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO,%R 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REQUESTS (24 hours): 503/681-3699 or 681-3697 Permit #: 050••7841 Project #: P0043551 Status: (''PROVED PAGE 1 Applied. ICsued : 10/ 1'3/1994 Expires: 11/02/1996 OP/26/96 06: 00 Compositn Type: COMBO Construction Type: NEW Permit 'Title: SFR - 3 BD 3 BA ATT GARAGE Description: WEST OF 135TH AT WALNUT E'S.5 A Begun: 09/02/1994 Address 14200 SW FERN ST TI Location: location Detail . Region D Owner Name: WOZNIAK, JOHN G AND DARLENE M Phone. ,pplicant Name: WOZNIAK, JOHN Phone 620-9642 PLANS EXAM: SVB Phone: Parcel : 251. 04BC 01600 Approval#: APPR Valuation. Approved_ _ Inspector Comments. W01a-ci ( �YT�7 Si 11 SL.J , Rejected___ '1Wo ceKvuwn� 16' L1AJ% I ! _ IVR-RESULT ��•t .-`J�,,4J�..•Q-�' '; -.'` mow �f]iI — REQUEST ERROR s u z vt-(c° r wI j,, G✓yotct 6l-'` - _IPt-Vt Li 441 n Cal 2 C 4< 004 s Wj � 00 � s ,� � ��,q-� s Inspected ;:)y __-�- Date: Items requested to be Inspected . . Item# InsrHLt; nn nLescription Requestor Area 00403 E Cover & Service D AP DN IVR Comments: Requested thru IVR ------------------------------------------------ Inspection History . . . . . 00105 S Fuoting AP DN IVR 11/15/94 Inspector: JM Action RI 11/15/44 Inspector: ME Action: AP APIVR L_UT45 I BS 10/20/94 Inspector: TW Action RI 10/20/9,0 Inspector: ME Action DN DNIVR LUT45 I B9 00106 S Foundation AP DN IVR DEPARTMENT OF LAND USE &TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION#350-12 155 NORTH FIRST, HILLSBORO,OR 97124 COUNTY, PHONE: 503/640-3470 OREGON INSPECTION REOUESTS(24 hours): 503/681-3699 or 681-3697 2� RESIDENTIAL PERMIT APPLICATION WASHINGTON COUNTY BUILDING SERVICES DEPT. OF LAND USE AND TRANSPORTATION 155 N. 1ST, #350-12, HILLSBORO OREGON 97124 PH. (503) 640-3470 Please print the information clearly for fast and accurate computer entry SITE INFORMATION : ADDRESS FEE: (YES) r.' (NO) Address:_ �y,��j� .ri%P .l- City: Tax Map & Tax Lot 5 I ' I QC IL, M Development/Subdivision: Thomas Map Book: Page: Section: Directions to Site: J)Jc JT 1.4,nCA11/1 RESIDENTIAL PROJECT DESCRIPTION:_ (Please circle a propriate category/ies) 1 plan to: ((build (add to) (remodel) (demolish) a new (existing) (accessory) (farm) building at the above site. - AREA/SQ/FT: 1st � 'i! l 2nd 3rd BASEMENT: l_�c'U GARAGE: 7Z� CARPORT: NO. OF BATHROOMS: , NO. OF BEDROOMS : ESTIMATED VALUE:#I,;�)ou __USE OF BUILDING: Dr�'rLLI�iIG MOBILE HOME: (Check whether) DOUBLE:_ _ or SINGLE: ----------------------------------------------------------------------- OTHER: (Please check) Mechanical Plumbing Woodstove PEOP�.. PROPERTY OWNER: 6---J O W 1,(IOZAJ1A1( PHONE NO., G l0 ADDRESS : ll�5u �SL1� .'1`� Lf� �, .ice Ok-, `17« S _ ENCINEER/ARCHITECT/DESIGNER: J Cllr% DESIGN NU: _ f Lh!j KS" PHONE NO: ADDRESS : ZIP CODE: BUILDER: _�Qtjb) 1.)d&)1Ax PHONE NO: ADDRESS : _,,At,r" ZIP CODE: BUILDERS BOARD NO: EXPIRATION DATE: NOT'E`S: To obtain your permit you will need tha following: 1) Approval for your septic system frau the Health Denaztment or approval W install your sewer from Unified Sewerage Agency (USA) , 2) Electrical pertmit application filled out by your electrical contractor-*, 3) Plumbing permit filled out by your plumbing contractor*. (* Unless State law allows you to take out these permits) This application, together wil-h the plans, specifications, and exhibits, comprise the application. False or misleading information may be grounds for invalidating a pexmit. The applicant is responsible for eoarpliance to all applicable codes. Land Development services, checking the plans frr omplianae to building codes tend coordinating with other departments, does not vd ieve the applicant of this responsibliity. NAME Of APPLICANT: )L I G� (�kZUi k' REPRFSENTING• -;FF Address: /��,�UD �,� /�'/'� rLCity: Tax Map & Tax Lot 2 5 'Ll QC IL 01) Development/Subdivision: Thomas Map Book: Page: 6,54-- section:,=L/ Directions to Site: (,J Jr OF /SS r �i A T 1a atAIUT RESIDENTIAL PROJECT DESCRIPTION: (Please circle ropriate category/ies) I plan to: (Lbuild) (add to) (remodel) (demolish) a new (existing) (accessory) arm) building at the above site. AREA/SQ/FT: 1st 1377 2nd 3rd BA$EMENT: I~ GARAGE: 7Z8 CARPORT: NO. OF BATHROOMS: NO.NO. OF BEDROOMS: ESTIMATED VALUE: 0IZO,000 USE OF PUILDING: AaLLI.)G _ MOBILE HOME: (Check whether) DOUBLE: or SINGLE: -------------- ------------------------------ -------------------------- OTHER: (Please: check) Mechanical Plumbing Woodstove PEOPLE 1 PROPERTY OWNER: _-- QtW t QZ.J1A1( PHONE NO: �,u) V6,yL ADDRESS : ILS` U _5&J iZ`�nf�l/�. �117/b.'`}-eP OAC `1 7223 , ENGINEER/ARCHITECT/DESIGNER: –1 OHIJ .�IcJT_,�1r►�r DESIGN NO: PHONE NO: ADDRESS: ZIP CODE: BUILDER: _ r ��tlr� 1AJ0l1J1A,r PHONE NO: ADDRESS : �O"Ih r- _ ZIP CODE: BUILDERS BOARD NO: EXPIRATION DATE: NOTES: To obtain your permit you will need the following: 1) Approval for your septic system from the Health Department or approval to install your sewer from Unified Sewerage Agency (USA) , 2) Electrical permit application filled out by your electrical contractor*, 3) Plumbing permit filled out by your plumbing contractor*. (* Unless State law allows you to take out these permits) This application, together w.i'-h the plans, specifications, and exhibits, comprise the application. False or misleading information may be grounds for invalidating a permit. The applicant is responsible for compliance to all applicable codes. land Development Services, checking the plans for oaplianoF to building codes and coordinating with other departments, does not relieve 'the applicant of this responsibliity. NAME OF APPLICANT:— REPRESENTING: I I have read andel ag_rge wi h thes- conditions: SIGNATURE: r� DATE: y r OVER - for street tree option. Please ask for a copy for your records. WASHINGTON COUNTY I'llrr-Ilrpar r rn,nr nrr Il�r AFFECTIVE September B, 1992 To Bruce Warner, Director Ffnm Joe Grillo, Land Development Services Manager Subs°" BOULEVARD TREE REQUIREMENT - FINANCIAL GUARANTEE ALTERNATIVE At the Board of County Commissioner's meeting of August 4, 1992, the Board gave direction to the Department of Land Use and Transportation to create a financial guarantee alternative for the CDC requirement of planting boulevard tree(s) (CDC 407-9). This alternative is designed to be in lieu of planting the boulevard tree(s) prior to final inspection request. It should be noted the builder will still be responsible for the planting. As such, this alternative is broken into two subsets to reflect builders and developers. A. For a developer request: 1. In lieu of planting the boulevard tree(s) for an approved development, the developer may either, (a) post the financial security with the County for the appropriate amount per tree as determined by the :ounty, or (b) assign the County the appropriate financial amount set aside through private agreements (such as escrow set asides as part of home/lot closings). B. For a builder request: I. In lieu of planting the boulevard tree(s) for an approved plot plan and building permit, the builder may post the financial security with the County for the appropriate amount as determined by the County. C. Method of Financial Security Calculation 1. For a developer, the total number of boulevard tree(s) per approved development times $200 per tree shall equal the ;imount to be posted with Building Services - Land Development Services Division. 2. For a builder, the total number of boulevard tree(s) per approved plot plan times 52.00 per tree shall equal the amount to be posted with Building Services - Land Development Services Division. D. Administration of Financial Security I. For a developer, the financial security shall be in the form of cash, check, letter of credit, or a County approved financial surety. Any financial surety must be valid for a minimum of twelve (12) months from final plat approval. Lhe financial surety must he posted with the County prior to Ina -P-)at a rove.. 2. For a builder, the financial security shall be in the form of cash or check. The financial security will be held for four months after final inspection. The financial security must be posted with the County as part of building permit issuance. E. Boulevard Tree Planting Responsibilities; I. A builder or developer shall be responsible for planting the boulevard tree(s) per County requirements even if the party has posted a financial security with the County. 2. if a developer has posted the security, he/she is responsible for planting such boulevard tree(s) within four (4) months after a builder has received final inspection. Failure to plant within this timeline will require Washington County to utilize financial security to plant boulevard tree(s). No refunds shall occur to the developer +f the County draws upon the financial security. 3. If a builder has posted the security, he/she is responsible for planting such boulevard trpplcl withina fnur (41 nranths after rpcpivinp final inspect,aa. Failure to plant within this timeline will require Washington County to utilize such financial security to plant boulevard tree(s). No refunds shall occur to the builder if the County draws upon the financial security. 4. If a builder or developer plants the appropriate boulevard trees) within the four month period in an area where the County has received financial security, the County shall, after site inspection, release the financial security less $50 per tree to the appropriate builder/developer. The $50 retained by the County shall cover the cost of site inspection and adiA nistrative overhead. AL lywrr ., direction to the Department of Land Use and Transportation to create a financial guarantee alternative for the COC requirement of planting boulevard tree(s) (CDC 401-9). This alternative is designed to be in lieu of planting the boulevard tre,:(s) prior to final inspection request. It should be noted the builder will still be responsible for the planting. As such, this alternative is broken into two subsets to reflect builders and developers. A. For a developer request: 1. In lieu of planting the boulevard tree(s) for an approved development, the developer may either, (a) post the financial security with the County for the appropriate amount per tree as determined by the County, or (b) assign the County the appropriate financial amount set aside through private agreements (such as escrow set asides as part of home/lot closings). B. For a builder request: 1. In 1.eu of planting the boulevard tree(s) for an approved plot plan and building permit, the builder may post the financial security with the County for the appropriate amount as determined by the County. C. Method of Financial Security Calculation 1. For a develope•-, the total number of boulevard tree(s) per approved development times $200 per tree shall equal the amwint to be posted with Building Services - Land Development Services Division. 2. For a builder, the total number of boulevard tree(s) per approved plot plan times $200 per tree shall equal the amount to be posted with Building Services - Land Development Services Division. D. Administration of financial Security 1 For a developer, the financial security shall be in the form of cash, check, letter of credit, or a County approved financial surety. Any financial surety must be vatic for a minimum of twelve (12) months from final plat approval. The fi ancial surety must be posted with the County prior to final plat approval. 2. Fir a builder, the financial security shall be in the form of cash or check. The financial security will be held for four months after final inspection. The financial security joust be ,cited with the County as Dart J77 ing permit issuance. F. Boulevard Tree Planting Respo,itibilities; 1. A builder or developer shall be responsible for planting the boulevard tree(s) per County requirements even if the party has posted a financial security with the County. 2. if a developer has posted the security, he/she is responsible for planting such boulevard tree(s) within four (4) months after a builder has received final inspection. Failure to plant within this timeline will require Washington County to utilize financial security to plant boulevard tree(s). No refunds shall occur to the developer if the County draws upon the financial security. 3. If a builder has posted the security, he/she is responsible for planting such boulevard treelsl withing four 141 mnnths after receiving final intpecti,in. Failure to plant within this timeline will require Washington County to utilize such financial security to plant boulevard tree(s). No refunds shall occur to the builder if the County draws upon the financial security. 4. if a builder or developer plants the appropriate boulevard tree(s) within the four month period in an area where the County has received financial security, the County shall, after site insp±[tion, release the financial security less $50 per tree to the appropriate builder/developer. The $50 retained by the County shall cover the cost of site inspection and administrative overhead. F. In the event a builder/developer fails to plant the appropriate boulevard tree(s) and the subsequent land owner refuses to permit the boulevard tree(s) to be planted on their property within 5 feet of the property line, the financial security shall be placed into a separate revenue account in LUT - Land Development Services, to be used for planting trees/shrubbery in alternative public spaces owned by Washington County. The Land Development Services Manager shall recommend from time to time to the Director of DLU1 potential landscape projects to utlize such funds The Director shall approve such projects and inform the Board of County Commissioners of such projects. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 6394171 Date Requested: —1�_f�-' _ / —,—_ A.M. _ jN1j _ MST: 51Z)5 7 Location: C� _00 ,Iz 11r_ Tenant: g:_. Suite: Rldg MI'.0 : : —_— Contractor / Phone: J — PLM: Owner: ' �Z"/l'c � plr�', _C Jlf" ELC: BUILDING BLDG(con'() LUMBING MECHANICAL ELECTRICAL SITE Site Post/Hemn --Fn*Henm Post/Dietun Cover/Service Sewer/Storm Footing hoof UndFl/Slab Rough-In Ceiling Water Line Slab Framing 'I op nut Uas line Rough-In 1JG Sprinkler Foundation Insulation Sewer Ilood/Duct Reconnect Vault Hsmt Damp Drywall Storni Furnace 'temp Service MISC. Masonry Ceiling Rain I)rain A/C (1G Slab Shear/Shtatth I-ire Spklr/Alm Crawl/Found Dr I le.t Pump Low Volt Approved Approved Approved Approved Approved Appy/Sdwlk Not Approvedround Not Approved Not Approved Not Approvrd FINAL. FINAL FINAL FINAL FINAL n CRII for reius1wi—tion n Reinspection fee of S_- i01114TCd N11,07 nfextinspection r7 Unable to inspect Inspe ctot. Date� `� --L--�--- Pie —of ✓ SEWER CONNECTION 'F.. . . R M I T CITY OF TIGARD PERMIT #. . . : 5WR96-0352 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/24/96 131125 SW Hall Blvd.Tigard,Oregon 9722398199 (.-,03)639.4171 PARCEL: 2,S10413C-01700 SITE ADDRESS]. . . : 14200 SW FERN 51 SUBDIVISION. . . . : HANDY ACRES ZONING: R-6 BLOCK. . . . . . . . . . .I LOT. . . . . . . . . . . . . : 111 I E N A NT N A lyl . . . . . :DARLENE WOZNIAK USA NO. . . . . . . . . . : FIXTURE UNITS. 0 CLASS OF WORK. . . :NEW DWELLING UNITS. 1 1 YPE OF USE. . . . . :SF NO. OF' BUILDINGS: I TNSTALI- TYPE. . . . I-TPSWR IMPERV SURFACE. 0 Sf Remarks : SANITARY SEWER (CITY) FOR ANNEXATION SITE, ENGINEERING TO VAC TEST CTS LATERALOFTE--R CITY PLUMBING INSPECTOR INS (.)wner-: FEES 11(IRLENE WOZNIAK type amol-knt by date V-ecpt 14200 S. W. FERN STREET PRMT $ 2200. 00 JMH 07/24/96 96-26205f, INSP $ 35. 00 J111-1 1717/2i,4/96 96-28205(� lj(:iARD 013 97223 Phone #: 62121-9642 t.ontt-actov: MILLER & SONS ,:,3860 SW MIDDLETON RD ')HE- PWOOD OR 97140 T-,h n e #: $ 2235. 00 TOTAI- Fera #. . : 003644 REOUIRED INSPECTIONS This Applicant agrees to comply with all the rules and regulations 5ewev-, Inspectiun of the Unified Sewage Agency. The permit expires 188 days from the date issued. The total aLount paid will he forfeited if the vermit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement u!yen, the installer shall prospect 3 feet in all directions frog the distance given. If not so located, the installer shall purchase a "lap and Side Sewer" Permit and the Agency will install a lateral. /---) rn LV f i i t. t,ee Si qT),At i.tr-e _d, ----—------------ 1..ked By c.a I I for, inspection 639--4175 City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # ' 13125 SW Hall Blv(- . Permit # Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE Name.r D••VAt �c-fit t New Single Family Residences Only y�-w (�/��__ Aack••• ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00 Job /N100 Fe rr►+ S7` ❑ 3 BATH HOUSE $225.00 Address L"131.r. w Fee includes all plumbing fixtures in the dwelling and the first 100 feet f` Q✓ In r of water service, sanitary sewer and storm sewer. See fees below. Na FIXTURES QT) PRICE AMT ( Q Z N r'Q f( Sink 9.00 MWIhq Ad*••• rfi•^• Lavato, 9.00 Owner 0 S W 7 Tub or Tub/Shower Comb. 9.00 c.ns.• zp Shower Only 9.00 Water Closet 9.00 14.m.j.qw..r Dishwasher 9.00 Garbage Pisposal 9.00 Occupant 141.6,g A"••• Ph.. Washing Machine 9.00 Floor Drain 9.00 �r�•• �• Water Heater 9.00 Laundry Room Tray 9.00 N••• Urinal 9.00 Other Fixtures (Specify) 9,00 M..a A"... Ph— 9.00 Contractor 9.00 crtps.0 to 9.00 Sewer 1st 100' �— 30.00 SI.I.R•p..Y,a1 Nn UN B.. T..N. Sewer-ea. Addit. 100' 25,00 Water Service 1st 100' 30.00 I hereby a knowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 information given is correct, that I am the owner or authorized agent of — the owner, that plans submitted are in compliance with State laws, that Storni &Rain Drain 1st 100' _30.00 I am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit. 100' 25.00 number given is correct. (If exempt from State registration, please — give reason below.) Mobile Home Space 25.00 Back Flow Prevention 7 -,2_2- 96 Device or Arti-Pollution Device 9.00 -9• . .. •.o• • Any Trap or iVaste Not Connected to a Fixture 9.00 Describe work new W addition Q alteration O repair v Catch Bann 9 CO to be done residential O non-residential O Insp. of Exist. Plumbing 40.00/hr Specially Requested Inspections 40 00/hr Existing use of Rain Drain, single family dwelling 30.00 building or property — Residential backflow prevention devices 15 00 Proposed use of building or property '(Except residential backflow prevention devices) d NOTICE 'Minimum Fee $25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25°o OF SUBTOTAL COMMENCED 17TAL Special Conditions `J -- --- ---- Dzile ssuerl -- --- by i �� ,