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11650 SW HAZELWOOD LOOP
1
BUILDING' PERMIT APPLICATION TIGARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONEt'o-0-$r89
ORIIA`S'HOWNN AND APPROVED IN THE ACCOMIPANYIN(G�PLANS AND
QSPECIFICATIONS. OWNER PH)14E ___if!!SAMF
F_5L �� moi. �, CJ� Lor No. _p.
v:•:':C� O h e JOB ADDRESS &6'0 S� I �, _
ARCHITECT
"r'ER &4AA S ENGINEER
BUI
_ ADDRESS SNM V. DESIGNER SAT
STRUCTURE ❑ NEW Cl REMODEL aD01TION '1 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
•C RESIDENCE C COMM ❑ EDUCE TICNAL t] GOVT ❑ RELIGIOUS ❑ PATIO ❑ CAR POR ARAGE STORAGE ❑ SLAB❑ FENCE
OCCUPANCY ,LA14D�USE
'ZONE
BLDG.TYPE FIRE ZONE ALAN CHECK BYI1=HEAT
L$
SEWER PERMIT N
OCC LOAD FLOOR LOAD HEIGHT NO.STORIES AREA G r'; f NO.BEDRUOMS / VALU; yy
h— BI!lLDING DEPARTMEr: SET BACKS FRONT ^" REAR /T -' LEFT SIDE l RIGHT SIDE
P`-'rZ _ } y f THIS PERMIT IS ISSUED E'IBJECT TO THE REGULATIONS CONTAINED IN THS BUILDING CODE,ZOrchla
REGULATIONS A140 ALL D PLiCABLE CODES AND ORDINANCES, AND I IS HEREBY AGREED THAT TME
�s✓Isn Check_ %� WORK WILL BE DONE I,. ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CO1itPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. Tr E ISSUANCE OF THIS PERMIT DOES NOT WAIVE
iSub-tatal ?�; I RESTR!CTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CUnF,ENT CITY BUr'NESS
LICENSE SEPARATE PENMITS REQUIRED FOR SEW!ER,PLUMBING AND HEATING.
State Tax •
CDC
Total �,
By -' C�
PDC*"" APPLICANT OR AGENT
_ Receipt No. _
Approved ADDRESS PHONE
SDC -
POC --
SE'IER CONNECTIM S _
SEWER INS13CtTIQN $
SEWER qCHARGE S
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UNIFIED SEWERAGE AGENCY NO. 9574
WASHINGTON COUNTY DATE
11--Y OF--- Tiri_,ard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Bob Smith
OWNER'S ADDRESS: .-892-5-SW Midea Lane
STREET
___912 25
CITY STATE .71P
BUILDING SITE: LOT_137 BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY residencd
ADDRESS 11650 SW Hazelwood Loop
D1IIELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE 530. 00 INSPECTION FEE 25. 00 TOTAL DEPOSITED 575. 011
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fenno Creek
The Applicant �qrees to comply �,Jth all rules and regulations of the Unified Sewerage Agency.
APPLICANTY
SEWER PERMIT
THIS PERMIT AUTHORIZr-.S CONNECTION TO THE SEWER SYSTEM.
LINE SIZE 1 N S'F A 1,L t--R
RECEIVED BY
W,ENCY OR ITS AGENT)
COMMENTS- Bldg. permit # 0085
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
C,ITYOF TI Aft
COMMUNITY DEVELOPMENT DEPARTMENT OFTWARD)oRmoa+
13125 SW Hdl Blvd. P.O.&m 23397,Tigmd,Oregon 97223(503)830-41-5 ✓
PLUMBiNG PERMIT
PERMIT #. . . . . . . : PLM91--10204
639-4171 DATE ISSUED: 11/15/91
SITE ADDRES)S. . . : lit.-50 SW HAZELWOOD PARCEL: 1 S 134BD -049V..0
SUBDIVISION. . . . : ENGLEWOOD NO. 2 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1:37
CLASS OF WORK. . :ADD GARBAGE DISPOSAL-3). . : MOBILE HOME SPACES. :
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . :
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . :2 WATER HEPTERS. . . . . . : CATCH BASINS. . . . . . .
FIXTURES-.___._.-_--.-.-_.._ LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . CREASE TRAw . . . . . . .
LAVATORIES. . . . . : 1 OTHER FIXfURF_S. . . . . :
TUL'k/SHOWEf'%S. . . . : 1 SEWER LINE (ft ) . . . .
WATER CLOSETS. . : 1 WATER LINE (f t ) . . . . a
DISHWASHERS— . - RAIN DRAIN (ft) . . . .
Remarks : Constri-1ct secund st t-y addition to SFD. Hobby Roam ADDING BATHRO(3M
Owner: ___._______._.__.__._._.____._____________ _-----__._.-_---_._ FEES
JOHN SEDEY type amol.lnt ty date recpt
11650 SW HAZELWOOD LP PRMT $ 25. 00 JLH 11/15/91 -
5p'C:1 t, 1. 25 JLH 11 /15)/91
TIGARD OR 97223
Phone #:
Contractor:
OWNER
Phone #: !' 26. 25 TOTAL
Rey -------- REDU I RFD INSPECTIONS
This permit is issued subject to the regulations co,itained in the Top-out Insp
Tigard Municipal Code, State of Ore, Specialty Codes and all other Final I n 1a pact i on
applicable laws. All Mork will be done in accordaace with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signat1..lre
Call for inspection 639-4175
BUILDING PERMIT
C17YOFTIGARD IDERMIT #. . . . . . . ... BliP91-0249
COMMUNITY DEVELOPMENT DEPARTN ENT
11125 SW H111 BW- P.O.Box 23397,TOW,Onigon 97223;80318 194175
41�/! r)nTF ISSWEIL: 09/aQ/91
S) 1. TE ADDRESS. 1. 1650 SW HAZELWOOD 1 ,(-)RCEL: 1S1 346D-04900
SUBDIVISION. . . . : ENGLEWOOD NO. 2 i(INING: R-4. 5
BLOCK. . . . I. . . . . . : LOT. . . . . . . . . . . . . : 137 -------
RE1r,SUE: FLOOR EXTERIOR WALL CONSTRUC,rION-
CLASS (IF' WORK. :ADD FIRST. . . . s N: S: E- W:
TYPE OF USE. . . :5F SECOND. . . :672 ;f PROTE :T
TYPE OF COWT. :5N TH!RD. . . . s N: S E: W:
ncCUPANCY GRP. : R ;
OTA1---- 72 :i f ROOF CONST: FIRE P1.
sf AREA SEP. RATED-
,'ICCUPInNCY LOAD: sf OCCU SEP. RATED-
'TOR. :2 HT. -Ft GARAGE. . . REQUI RED-----
SSMT') :N MF-.'ZZ?:N REDD
1-1-00P LOAD. . . . :40 psf LEF-T.- ft RGHT: ft F1 R SPKL: SMOK DET. . :'Y
DWLLLING UNITS- FRNT: ft REAR: ft FIR ALRM: HNDICP ACC.
BEDRMS: BATHS: IMF, SURFACE: PRO CORR' PARKING:
VALUE. $ .- E'.15000
Remarks : Construct second story addition to SFD. Hobby Room
OWTIer'. FEES
JOHN SEDEY type amount by date rtLp.
11c,1:50 SW HAZELWOOD LP P P.M T $ 170. 50 JLH 09/30/91
PLCK $ 110. 83 JLH 11719/30/91 17
TIGARD OR 97223 5PCT $ 13. 5 3, JLH 09/30/91
Phone #:
C.ontractor.
PROGRESSIVE BUILDERS NW
8575 SW BARBUR BLVD
PORTLAND OR 9722'3-0000
Phone #: 503--&46-1950 $ 86 TOTAL.
Reg #. . : 35628 REWIRED IN5PE,3TIONS
This no-sit is issued iubiect to the regulations contained in the Fo()t/found Insp
Tigard Municipal Code., State Of Ore. 5,-Pcialty Codes and all othe- Framing Instj
applicable laws. rii! work will be done in accoroance with Tnsulation I n s p
approved plans. 'this permit will expire if work is not started t-,yp Board Insp
within 180 days of issuance, o,, if worn is suspended for wore F incl Inspection
than 180 days
Permittee
Issued By -
Call for inspecticir. - 639-4175
fpe
0
`I 13125 sw►fall[It,J. PLNCK/RECT #
CIT-Y O T I:GARD 1'0 Box 23391
Tigard,Oregon 97123 PERMIT # ��`3/ - Q 2 y
CuhiMUN11'1 1)}s'VGLOP>V�1?N'1'1)1?1 AR"1'A11�;N'1' B
(503)639-4171 DATE ISSUED
JOB ADDRESS: —1 I�%��: r,L�i �—�!,[ � TAX MAP/LOT /J/ 3Y,&D 7L. EX(l)
SUB: _-- LOT: r > 7 LAND USE:
VALUATICN: � C&�%
OWNER SPECIAL NOTES
NAME: _ f�C �' �� t— REISSUE OF:
ADDRESS: _ �72%_��� f'f��EZ_f�t. ��T - LAST REISSUE:
I.,"a I _ FLOOD PLAIN/
PHONE:__ ' S SENSITIVE LPND:
CONTRACTOR APPROVALS REQUIRED
NAME: Vu L,bc-V �' �"' PLANNING:
ADDRESS: eS75' rw r ' ' VUVi ��-.� ENGINEERING:
�?1�
lei� FIRE DEPT:
Pt!ONL: -i�S �'�ID'. '!`1�U OTHER: – -- –
COtiTR. BOARD # (o-47 Pi EXP DATE: 3 r y
ITEMS _!-QUIRED
SUBCONTRACTORS: PLUMB: _— _ LIST/SUBCONTRACTORS:
MECH: _ BUS TAX:
ARC. /ENGINEER CALCULATIONS:
NAME: _.___ .__ TRUSS DETAILS:
ADDRESS: _ _ OTHER:
PHONE: --_--�-- __ --
PROPOSED BLDG. USE: --- -------
COMMENTS:
c
AP04 AAIJT SIGNATURE
Received By: _ __ Date Received:
PERMIT N ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAI
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
_ i0-431 01 Mechanical Permit Fees _ _10-230 01 01 State Building Tax (5%)Building
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing _
Mechanical
10-230 06 Fire __---
30-202 00 Sewjr 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
25-418-01 Residential Traffic Fees
25-448-05 Plass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) -----
24-445-01 Water Quality (F in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3581P.WPF