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JSSNZS MSIA 77TH MS OF'TOT
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IMS—PSM-9—N.Mr-I CE 4
City of Tigard Epuil-ding Departaar_nt:
1.3125 ON Ball Blvd. Tigazd, Oregon 97223
Inspection Live (Rdric-O-Phone)t 639-4175 Bunineus Phones 639-4171
Inspection: l � 16
Footing Pibg. Underelah Meu),. Rough-in Alspr/Sdwlk
Found. Plbg. Top Out Can Line FINAL:
Pont/Beam Struct. San. 8ewet'�_ Framing -Bldg.
Pont/Roam Hoch. Rain Drain InaUlAtion -Plumb.
Plbsg. Underfloor hater Line �f yr,. Rd. -Meeh.
Date Roqueeted:J —Times -.-----,.VS PM
Address: d / 1/"f-Oe6' Permit
Builder:- _ Vit'j
THE FOLLOW MG CORREC•fION:S ARE REQUIRED:
I
12
I
I
I
I
I
Inspector: �`- _ Date s-
APPROVED DISAPPROVED APPAOVED SUBJECT TO ABOVE
I
`Call For R"Inep.
SEWS_'.R CUNNE C:I-ION
CITYOF BOARD0 Rm l
WYO RD
COMMUNITY DEVELOPMENT DEPARTMENT 911100N WL k M I 1 #. . . , . . .
1.1125 SW Hall HKd. P.O.Box 23397,Tigard,Oregon 97M (503)M Al 75
T r kb.SS. �0 W N I V I �W aT PARCEL i 2S 102CC-O R.OO .�
i k. r�Z �. I�1� 5 �L E
SLIBI)IVISION« . , , r FRELEON hi'LJGHT 1\10. 2 N1NGe R- ,. S
f1LOC.N. « . . . . . . . . ,. L.OT. . . . . . . . . . . . :A
TENANT NAME'. . . . . :
USA NU. . . . . . . . . . a FIXTURE UNITS. . . :
CJ-f:?SS CF. WORK. . . :A1_'T DWELLING UNITS. . 1 i
I YPE OF USE:. . . . 1 S►= NO. OF HU i L.D t NUTS 1 1
INST/1;_.L.. TYPE. _ » . 1SUSWR IMF'ERV SURFPCE. .
Remar'kss Connect existing SFD to sewer. Septic tatnk m!tst tae pt.tmped oi.tt and
filled in with sand (,r- clr'avel. per-mi} t,epr.tir^ed for work in Public ROW
Owner-, ..____ _.__.___ ._ _.__.—_ __..___. _..._._____.._ .______ _..__.____._.__. .__._._.._. FEES
('.34Rl1L JUL IAN t ype amor_tnt toy cat e r'ec pt
101,60 SW MILLVIE:.W PRMT $ 1500. 00 1yCRx06/11/91 0
I Nc`r.' $ 33. 0SCR CR 06/11/91. 0
TIGAM) OR 97223 MISC * 10011. 00 lir.R trf/1. i./91 0
Phone #t 645«-2762
OWNER
4.5:33. 00 TOTAL
Reg �. . .
REUUIREV INSPECTIONS _......___
This Arolic it agrees to comply with all the ruler and regulations Sewer lnsraectinn
of the Unified Sewage Agency. The periit wires 128 days from Se pt it 'r,;Ank Fill
the date issued. The total amount uai'd will be forfeited if the
permit expires. The Agency does not ;�-• rartee the accuracy of t"e
sic. -ewer laterals. If the sewer is not located at the measurement
teen, the installer shall jrospect 3 feet in all directions from ......
tre distance given. If not so located, the installer shall purchase .._......
_._..._ _,...___._......._..
a 'Tap and Side Sewer" Permit and the Acenrcy will in 11 a lateral.
C)c i-m i t t e e S i g n as t u r
Caul for- inspection — 639-4 t 7.5
RECT �
CITY OF T 1x71 RD utzs sw x283 /
PO Box23397397 PLNCK
ligand,Oregon 9'7273 PERMIT #
CONIMUNITY DEVELOPMENT DEPARTMENT (503)639-4171
DATE ISSUED
JOB ADDRESS: :- �' / 3 - / -' � �. _ TAX MAP/LOT A251-CV--Ce- A2 3-0 C+
SUB: .__ _ — LOT: -- LAND USE: �_--
VALUATION:
OWNER SPECIAL NOTES
REISSUE OF:
ADDRESS: I __� 1 LAST REISSUE: _—
FLOOD PLAIN/
PHONE: .� �i-� ~'�;k SENSITIVE LAND: _
CONTRACTOR APPROVALS REQ! IRED
NAME: PLANNING: —
ADDRESS: ENGINEERING: —r—
FIRE DEPT: _ �_-
PHONE: _ ----_ -- OTHER: ---� —_.
CONTR. BOARD #: �_ __ EXP DATE:
ITEMS REQ IRF:J
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS: _
MECH: BUS TAX: --
ARC ENGINEER CALCULATIONS: —
NAME: __ TRUSS DETAILS: —
ADDRESS: _ __�__�___ _ OTHER: —
PHONE:
PROPOSED BLDG. USE: -
� ! y
COMMENTS:
<.---�,T!Z �:1•'_t� _�t'i�f.� !/u�a F�L� ;.w ! �` c.� � C_ b cr /r"E�L�
APPLICANT SIGNATURE
Received By: _ Date Received: _
PERMIT # ACGT Il DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
_ 10-432 00 Building Permit Fees
10-431, 00 Plumbing Permit Fe4!s
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5io)
Building
Plumbing
Mechanical
10-433 00 Plans Check. Fee
Building
Plumbing
Mechanical
10-230 06 Fire
30-2.02 00 Sewer Connection
30-444 00 Sewer Inspection
25-448--02 Commercial TIf Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52--449 00 Parks System Dev Charge (PDC) _
31-450 00 Storm Dra;n-;e Syst Dev Chrg
(SSDC) _--
24-445-01 Water Quality (Fee in lieu of)
t4 .445-02 Water Quantity (Fee in lieu of)
TOTALS ,
nrti/3587P.WPF
CITY OF TIGARD RE.-'CEIPT OF PAYMEN-T RECEIPT NO. R 91 --2'J 4186
CHECK AMOUNT R 4535. 00
NAME % JLJUAN, CAROL P. CAESH AMOUN'r 0. 00
ADDRESS ; 10130 SW HILLVIEW PAYMENT DATE R 06/11/91
SUBDIVISION
CIR "SAME"
PUPPOSE OF PAYMPNT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
F-3EWER LISA SWP91-0107 1,500. 00 SEWER INSPECT
tsw, ci-io-i-IEU OF ASWESS 3000. 00
TOML. AMOUNT PA 11'i 00
�h CV,4,JNSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Gregon 97223
Phone: 639-4171
r
Type of Inspection
Date Requested_ TimeZ--IC _
P.
A11._
Address _ _ �, �J f�� � �
—�" Pa,mit
Owner— `-� r
---.-----=="'`-" Lot #_
Builder
The following Building Code deficiencies are required to be corrected: '
Presented to
- � — pproved
Inspector t� r
/t�,
Disapproved
Date
CALL FOR REINSPECTION
DYES l] No
= �y�/S
3897
City of Tigard Mechanical Permit
New Installation 1:1 Replace ❑ Relocat',on E] Addition Alteration DATE _� ✓`�
HEATING t
CONTRACTOR � ( _ OWNERd/1 to J L
ADDRESS —,�./� p�.�,Z�_ �tr�'�"`� `- JOB ADDRESS
PHONE __-___�__4 e.�=tZL�' APPLICANT` -----
Heat Input Rating(BTU per Hour) Vent Size.__ _�— Flue
FUEL OIL GAS ELECT l _J OTHER
ITEM-� --�NO FEE ITEM— NO. FEE
Fa Issuance of Permit SEE BELOW Each Air Handling Unit or Duct System 7.50
N_ew.up to & incl. 100,000 BTU 6.0( Commercial Hood System _— 7.50
New 100,000 BUT's & over 7.50_ Other Egu�ment - Each 4.50
yy�b in Stove 4.50 1 Tri Inspection 4.50
Wall-Floor Suspended _ 6.00 Air Condition Compressor up to& incl.3 N.P, 6.00—
Vent_§stem w/Fan — 4.50 —Air Condition Compressor-3.1 to 15.H.P. incl. 11.00
Repair Heat Cooling 6.00 — —
CITY BUSINESS LICENSE REQUIRED BY ALL.CONTRACTORS OR SLIB-CONTRACTORS ! !
PERMIT ISSUANCE 10.00 Comments:
FEES _ �_ --- — — --- ----- -—
SUB-TOTAL I 7
STATE e _ �> Issued By I e
15%PLAN CHECK
TOTAL -- _S r:3 REC. 40 ��—
Sig ature of Applicant