12616 SW MORNING HILL DRIVE `S
ADDRESS:
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CITY OF TIGARD
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COMMUNI?Y DEVELOPMENT DEPARTMENT
CERTIFICATE OF I` Ids Orcuc�l„�NCY
13126 SW Hall Blvd.Tigard,Oregon 97223»8199 (503)631�-4J71
PERMIT iE» » » . . » • t MST` i 9°i7lh
L ;41 -H.I i 1 DATE ISSUEDI
PARCEL s 2S 104AC—l 0M0@ ; '^
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SITE ADDRESS. . . : 12616 SW MORNING HILL. DR
UBDIVISiON. a . . s MORNING HILL NO. 9 %ONINGsR--25
BLOCK. . . . . . a . . . r, L07. . . .`. . . . . . . . . 112148
CLASS OF WORK. sNEW'
rYPE OF USE. . . IFF
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OCCUPANCY GRP. s R"3
OCCUPANCY LOAD a 116 4
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ff?eroarl«r F�Irarts
.TAY MILLER BL.DR INC
1 ►�, 0 BOX 23P91
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i IrfaRD OR 97281 ,.
'''Ilona! Ns 6134-7543
C,untraaar.tvrc __..__._.__._ __.__.._......_....._.__.. ..._.. _.. _. . .....
{ iAY MILLER
I In BOX a3e9l
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11fsARD OR 91-81
Phone tls 684--754;;
j ftal #. ;30109
11 Oct.:upar-y of -hhe above referenced building is hereby Given, ,and certifive
J the r_ampl. ianc a with the State Of Oregon Specialty C;odee for the group,
111: rUpanr.y, and use under which the referenced permit was issued.
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_..._.._ FIRE rDE PARTME NT A I NG PEC:TOR
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INSPECTION NOTICE
City of Tigard Building Dwparl t
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1.3125 BW Ball Blvd. Tigard, Oregon 972:3
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
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Inspection:— —
Footing Plbg. UndorelaL Mech. Rough-!.n Appr/Sdwlk
Found. Plbg. Top Out Gas Line �slIKALt�
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Post/Beam S} ,uct. San. Sewer Framirq
Poet/Beam Noch. Rain Drain Insulation Flttmh�
Plbg. Underfloor Water Line Gyp. Bd. o Koch
Date Requested:�- 7 C-"-11/ `-Qr
_Times �_ PN
AddrasFrt
(,�I �n M�i((/A i ll`C1�/1(�� ��f Permit #t'1}3 '15 W)
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Builders_ Z t A0 _1 l ( �I i s -
THE FOLLOWING CORRR-TIONS ARE REQUIRED: y
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Fa; Inspector:^ Dates
APPROVED DISAPPROVHD _Y_ APPROVED PPRED BURJHI`T TO ABOVH
Call For Ralnep. k
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INSPECTION NOTICE
city of Tigard BuildLy Departs—t
13125 811 '.Lll Blvd. Tigard, Oregon 97223 I
Inspection Cine ±Rec-O-Phoneys 639-'175 Business Phone: 639-4171
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Inspect:ion --- t ■
Footlny Plbg. Underslab Koch. Rough-in "r/Sdwlk 1
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Found. Plbq. Tap Out Gas Line FINALt j
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Linecf�" Gyp. Bd. -Hoch.
Date Requestedi 2V `1 I Times _A 1►H —/�—PH
Address-1 to VA i V,4�k U .�A , Permit ls� ?,LL-
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Aullder!
TAE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:-- __--^ Dat.
APPROVEL DISAPPROVED AppRoVan SUBJECT TO AJ�OVR
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Call For Reinsp.
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JNSPEgTION NOTICE
j City of Tigard Building Department
13125 BA Ball Bled. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)f 639-4175 Businese Phono: 639-4.;71
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Inspection: _
Footing Plbg. Underelab Koch. Ruugh-in Q, Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL: J
Post/Beam Struct. San. Sewer Friuoing -Bldg.
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Poet/Beam Koch. Rain Drr.in Insu`atic., -Plumb. j
Plbq. Underfloor Water I.Lne Gyp. Bd. --Koch.
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Date Requeeted: r �J L4 Tim.: AM PM
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Address s 1 ,�6,/ G� �/�L2)7,G�-, !' � Permit #1
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Builder: f'
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TRE FOLLOWING CORRECTIONS ME REQUIRED: ,
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Inspector:_ / f � 11�.L_ / — — Dat:sf -? 9r,,,+
APPROVED _ DISAPPROVRD ____/^-1PPROVRD SUBJECT TO ABOVIC
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Call For Reinep.
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INSPECTION NOTICE
Citi of Tigard Building Departsiant ,
13125 SII Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phonal: 639-4175 Business Phone: 639-4171
Inspections
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Footing Plbg. Undorelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out
Gas Line FIN.I.I,: �
Post/Beam Struct. San. Sewer Framing -Bldg. 4 e
Post/Seam Mech. Rain Drain Insulation -Plumb.
Plhg. Und•rPloor Water Line Gyp. � �pM
Bd. -Mech.
Date RequestWt• ►/f 2 Z 3 Lf 5 Timer !
AddreeA:_ Z (LD 'V 1/J1(y�(1/\l� I �� Permit #1 ` L2
Builders .........(
THE FOLLOWIIIr! CORRECTIONS ARE VMQUIRED:
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DISAPPROVRD APPROVED 8Un*RCT TO ABOVE
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IN$PEC UIN NfYfICE 1
City of Tigard Building Department
13125 BO Hall Blvd. Tigard, Oregon 97223
Inspection Lino (Roc-U-Phons): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk E,
Found. Mg. Top Out Gas Line FINAL: y
Post/Beam Struct. San. Sewer. Framing -Bldg.
Post/Beam Mach. :rain Drain Insulation -Plumb.
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Plbg. Underlloo, )) Water Line Gyp. ad. -Hoch.
Date Requested: �L-' -/Lr� 7 , Time: AM�H i ti
Address: J � - f��7V
Builder: ?/ �f
THE FOLLOWING WRRECTIONS ARE RNMIUDt
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Inspector: Dater \ `
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APPROVED - DIBAPPROM APPMM 808"CT TO ARM
`� Call For Rainap.
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XNBPZCTION NOTICE
City of Tigard Building Department 9
13125 SR Hall Blvd. Tigard, Oregon 97223
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Inspection L.Lne (Roc-O-Phone)s 639-4175 Business Phones 639-4171
Inspection:
Footing Plbg. Pnderalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top out ■ Line~ _ FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Much. Hain Dra r Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Nech.
Date Requested I14 ( -3 Times skM PH
Address: ( �L' k VVI,V,(-t,Q '�A ' _ Permlt 8 /'
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Builders_
TRE FOLLOWING MRRECTIONS ARIL REQUIREDs
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Inspector'` V _�--- Dates
TAPPROVED DISAPPROVED APPROVED SUB.TECP TO ABOVE
Call For Reinap. 1.
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Citi of Tigard Building Department�rj 13125 SM Hall Blvd. Tigard, Oregon 97223
oto }{ urs Inspection Line (Rec-O-Phone)r 639-4175 Buainon• Phones 639-4171 #
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Es 't a� aI ,}, Inspections
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�j. looting Plbg. Underalab Mach. Rough-in Appr/Sdwlk r4
Found. Plbg. Top Out Can Line FINAL:
Post/Beam Struct. San. Sewer framing -.91dg.
Post/Beam Mach. Rain Drain Insulation -Plzmb.
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Plbg. Underfloor 'rNater Line Gyp. Rd.
Dats Requesteds I" 1 Time: _ All PH
Addreaai t-1C (A (VI (1.I V`�&IJ Q Permit
Builders Al
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Inspector:
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APnROVED DISAPPROVED APPROVED SUBJECT TU ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Ruildinr, Department
131: - SII Hall Blvd. Tigard, Oregon 97223 /
Inspection Line (Rec-O-Phone): 639-4175 Business Phone. 639-4171
Inspection:
Footing Plbq. Underslab Hoch. Rough-in Appr/Sdwlk
Found. CV-PMK. Top out teas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Pibg. Underfloor Fater Line Gyp. Bd. -Hoch.
Date Requested: 12 J-6t Timo: AM " PH
Address tr Mir V\l{�Y�/�L`_U ��-�1 Permit f: f ` !`
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THE FOLLOWING CORRECTIONS ARS REQUI
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Inspectors Dates _ _r�
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVEt
__—Call For Reinnp.
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INSPECTION NOTICE
City of Tigard N„ildilnq Department
13125 811 Hall Blvd. Tigard, Oregon 97223 1
Inspection Line (ROC-0-Phone): 639-4175 Business Phones 639-4171
Inspection:
Footiw Plbg. Underalab Hoch. Rough-in Appr/Sdwlk /
Pound. Plbg. Top out Gas Line FINAL:
Cet/Beam stru-t. San. Sewer Framing -Bldg.
Post/Seam /tech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Hoch. F
Data Requestede� Tima: ;', 417(—�AH '7 PM
Address: 11 ��. � 1r` -,� Permit 1
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Builder:.
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector � -
Date:
PPROVED DISAPPROVED`yA APPROVED SUBJRCT TO Ar"!x
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Call For Reinsp.
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IMPECTION NOTICE t %
City of Tigard Building Department
13125 BW Ball Blvd. Tigard. Oregon 97223 .
Inelection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Fc,-ting Plbg. Underslab Meuh. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
et/Beam 9trucY�/� San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drair Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Ed.
Date Requested: , \ —� —Time: AM PM
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Address s 1 (0 (\� W',�f'`1�^�.�., �^'"`.� � Permit
Bu.'lder:
TNM FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: V /`I` CJ ' --Dater
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_APPROVED DISAPPROVED ✓ APPROVED SUBJECT TO AAOVt,
Call For Reinep.
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INSPECTION NOTA /
city of Tigard Building Qstpartment (✓
13125 OW Ball Blvd. Tigard. gregon 97223
Inspection Line (Ree-O^•Phono)t 639-4175 / Bueinoss Phone: 639-4171
Inspections_ 1 C
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Footing Plbg. Underslab !tech. Rough-in Appr/Sdwlk
Plbg. Top Out Gap Line
Found.
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Post/Beam Struct. San. Sewer Framing -Bldg. £
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/B .. Rain Drain Insulation -plumb. s
(Plbq,_Under ZL-� Nader Line ciyp. Bd. -Hoch.
Date Requestads
Petit #1 - -7
Addresss / �r,uyd� �
Builders
THE FOLLOWING CORRECTIONS ARK REQUIREDs �wlQ
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Dates
Inspectors _._ -
DISAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinep.
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LN^,ACTION NOTICE
City of Tigard Building Depert—t !
+ 13125 S11 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 539-4171
Inspection:___ — — gl
Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
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Post/Beam Struct. San. Sewer Framing -Bldg. �I
Post/Beam leech. Rain Drain Insulation -Plumb.
Plbg. Underfloor , Nater Line, GYP. ed. -Mech.
Data Requested: �, I� -_-Time: _ AH PN
Addre■■:- l.lnl Permit #1 X13 `.r`, 70 t
Builders- 1k,
THE FOLLOWING CORRECTIONS !\RE REQUIRED: l
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Inspectors --- Date:_ /1�1-4`
APPROVED DISAPPROVYD APPROVED NUBJRCT TO ABOVE
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Call For. Reinsp.
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Y(' INfiP=ION NOTICE 4
,, r Citi of Tigard Nnildl.ng Department
1312S SO Ball Blvd, Tigard, Oregon 97223 ;
Inspection Line (Rec-o/-Phone)s 639-4178 Business Phones 639-4171
r t' Inspections_ 4:5ZI
7 ' Zooting Plbg. Underslab Mach. Rough-in Appr/Sdwlk
FY(fY fk. 1
rl�aG h OYnd. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. Ban. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
iik ry Plbg. Underfloor Nater Line Gyp. ad. -Mech.
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Date Requested ��-1�2 - / Times _ _MAK -PM
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�xda A' Addreses OCG 4 Permit #3!23-9570
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THE For INC CORRECTIONS ARE REQUIREDs
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Inspectors Date ?' 9
APPROVED DISAPPROVED APPROVEO SUB.TECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE (✓
City of Tigard Buildiaq Depart=isat
13125 sR Ball Blvd. Tigard, Oregoa 97223
Inspection Lina (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
,rooting_ Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb. S;
Plbg. Underfloor Mater Line Gyp. Be. -Koch.
Date Requested: I / II Time: AM ` PN
Icy" ��ny �\!v���,.� t #1.113)
Address: P" � Permit
Builder:' -� C I
THE FOLLOWING CORR..CTIONS ARE REQUIRED:
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Inspector: _ -- Date:
____APPROWJ ^_ DISAPPROVED PROVED SUBJECT TO ABOVE
Call For Reinsp.
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PLUMBING PERMIT
CITY OF TIGARD DATE PERMIT ISSUED: i l/@9/933-957@
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)630-4171 PARCEL: 2S 104AC-•10500
SITE ADDRESS. . . : 12616 SW MORNING HILL DR
SUBDIVISION. . . . : MORNING HILL NO 9 ZONING: R-25
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :248
-------- - ---•------------------- --
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. . : 1
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . :O
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :0 i
STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . 30
FIXTURES-------------- LAUNDRY TRAYS. . . . . . : 1 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . : 1 GREASE TRAPS. . . . . . . :0
LAVATORIES. . . . . :3 OTHER FIXTURES. . . . . :0
TUB/SHOWERS. . . . : SEWER LINE (ft) . . . . :0
WATER CLOSETS. . :2 WATER LINE (ft) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . . :0
Remarks : PATH I
OWNER: -----------•------------------ -----------------FEES---------------
JAY MILLER BLDR INC TIF f 1520. 00 JH 11/09/93 -
P 0 BOX 23291 BPRT t 406. 00 JH 11/09/93 -
BPLC $ 263. 90 JLH 11/05/93 93-245752
TIGARD OR 97281 BSPC f 20. 30 JH 11/09/93 -
Phone #: 684-7543 SSDC $ 280. 00 JH 11/09/93 -
PARK $ 500. 00 JH 11/09/93 -
Plumbing Contractor:----------------- MPRT >1 40. 50 JH 11/09/9 -
MPLC f 10. 13 JH 11/09/93 -
Name: I . . Cc')( LL-' M5PC 11 2. 03 JH 11/09/93 - f
Address: PPRT $ 140. 00 JH 11/09/93 -
City: States _ P5PC f 7. 00 JH 11/09/93 -
Zip: Phone#:
Reg
•afi
------- REQUIRED INSPECTIONS ------- °
This permit is issued subject to the reg- ".
ulations contained in the Tigard Municipal Foot/found Insp Rain drain Insp
Code, State of Ore. Specialty Codes and all Frost/Beam Struct Water Line Insp
other applicable laws. All work will be done Post/Beam Meehan Appr/Sdwlk Insp
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in aceordarce with approved plans. This Plm/undslab Insp Mechanical Final ; •,
permit will expire if work is not started PLM/Underfloor Plumb Final
within 1801 days of issuance, or if work is Mechanical Insp Building Final k ,
suspended for more than 180 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain `z
Fireplace Insp � -
Gas Line Insp
1 Insulation Insp _
GYP Board Insp
Authorized Plumbing Contractor Signature �-
Call for inspection - 639-4175
Contractor Notes: s --
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CITY OF
TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT D&ft W�VMNT PERMIT #. . . . . . . : MST93-9570
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13128 SW Hall Blvd.Tigard,Oregon 07223.8100 (503)830-4171 DATE ISSUED: 11/09/93
SITE ADDRESS. . . : 12616 SW MORNIN G HILL DR PARCEL: 2S104AC-10500 1
SUBDIVISION. . . . : MORNING HILL NO 9 ■
BLOCK. . . . . . . . . ZONINGS R-25 h
--------------------------------
BUILDING BUILnING I
----- -------------
REISSUE: DWELLING UNITS: I BASEMENT. . . . . . . . so e,f
CLASS OF WORK. sNEW BEDRMS:3 BATHS:2 GARAGE. . . . .
� . . . . . 1480 s�
TYPE OF USE. . . :SF FLOOR AREAS----------- REQUIRED SETBACK',
TYPE OF CONST. :SN SETBACKS----------
FIRST. . . . sf LEFT. . s 13 ft R':GHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . .-0 sf FRONT. 120 ft Rl'AR. . :24 ft ■
STORIES. . . . . . . : 1 THIRD. . . . :0 sf REQUIRED-----------__-
HEIGHT. . . . . . . . s16 ft TOTAL------11780 sf SMOKE UETEC:TORS. sY
FLOOR LOAD. . . . 840 psf VALUE. . . . . $ : 90520 PARKING SPACES. . : 1
Remarks : PATH I `
-----------------'-----------------•- PLUMBING ----
SINKS. , . . . . . . . . : 1. FLOOR DRAINS. . . . : -----
0 BACKFLOW PREVNTR5. . :0
LAVATORIES. . . . . s3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . .
:0
TUB/SHOWERS. . . . s3 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . so
so
WATER CLOSETS. . :2 SEW-R LINE (ft) . :0 GREASE TRAPS. . . . . . . s0
DISHWASHERS. . . . .. 1 WATER LINE (ft) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . si RAIN DRAIN (ft) . -0
WASHING MACH. . . si SF RAIN DRAINS. . : i
- ---------- MECHANICAL.
---------------------------------- FEES
FUEL/TYPES----------- UNIT HTRS. . :O type amount by date recpt
VENTS . . . . . :0 TIF $ 1520. 00 JH 11/09/93 -
MAX INPUT:O BTU VENT FANS. . :3 BPRT t 406. 00 JH 11/09/93 -
FURN ( 100K . . 11 HOODS. . . . . . s1 BPLC $ 263. 90 JLH 11/05/93 93-245752
FURN ) =100K . . s0 WOODSTOVES. :0 B5PC t 20. 30 JH 11/09/93 --
FLOOR FURN. . . . ..0 CLO DRYERS. : 1 SSDC t 280. 00 JH 11/09/93
BOIL/CMP ( 3HP:O OTHER UNITS: 1 PARK $ 500. 00 JH 11/09/93 r
GAS-OUTLETS: 1 MPRT $ 40. 50 JH 11/09/93
,TAY MILLER BLDR INC -
Owners ------_.-_.____-___- ---���_ _---MPLC $ 10. 13 JH 11;09/93 -
_
P 0 BOX 23291 M5PC $ 2. 07 JH 11/09/93
PPRT 0 140. 01a JH 11/09/93
-
TIGARD OR 97281 P5PC t 7. 00 JH 11/09/93 -
Phone #1 684--7543
Contractor: --------------------------------
JAY MILLER i
PO BOX 23291
TIGARD OR 97281
Phone #s 684••-7543
Reg #. . - 30109
This per@it is issued subject to the regulations contained in the __ _$_-3169. 86 TOTAL
Tigard Municipal Code, State of Ore. - REQUIRED INSPECTIONS -----•---
Specialty Codes and all other Foot/found Insp Fireplace Insp
applicable las. All work will be done in accordance With approved Post/Beam StrUct Gas Line Insp
plans. This permit Will expire if work is not started within 180 Post/Beam Mechan Insulation Insp
days of issuance, or if work is suspended for @ore than 180 days. Plm/undsleb Insp Gyp Board Insp
Permittee Signature: �_�.,.��
PLM/Underfloor Rain drain Insp
MecIssued Bys '`'
PlUmbnT'oplInsp
OutAppr e%/SdwllInsp
Framing Insp Mechanical Final
Call for inspection ••- 639-•417
CITY OF TIGARD SEWER CONNECTION
BERMIT
PERMIT #. . . . . . . : SWR93-0492
COMMUNITY DEVELOPMENT D98WVAJT DATE ISSUED: 11/09/93
13126 SW Hall Blvd.Tigard,Oregon 07223.6100 (503)839-4171 ,
PARCEL: 2S104AC-10500
r SITE ADDRESS. . . : 12616 SW MORNING HILL DR
SUBDIVISION. . . . : MORNING HILL NO 9 ZONINGS R-25
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :248
------------------------------------------------------------------------------------
TENANT NAME. . . . . s
USA NO. . . . . . . . . . : FIXTURE UNITS. . . :
CLASS OF WORK. . . :NEW DWELLING UNITS. . sl
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . s : sf
i Remarksa PATH I
Owners --- FEES
JAY MILLER BLDV INC
type amount by date rec t
P 0 BOX 23291 PRMT $ 2200. 00 JH 11/09/93 D—
INSP $ 35. 00 JH 11/09/93 D—
TIGARD OR 97281
Phone #s 684-7543
Contractor: -----------------------------
CONTRACTOR NOT ON FILE
i
i
-----------�------.------ -----
Phone #: $ 2235. 00 TOTAL _ —
Reg #. . s
------ 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 laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from 4
the distance given. If not so located, the installer shall purchase
+ a "Tap and Side Sewer" Permit and the Agency will install a lateral. _ t
Permittee Signature . " �_• ��d�' --
Issued Bys
Call for inspection — 639-4175
i
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Residential Building Permit Application
City of Tigard
t -
13125 BW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: 17-40140 S w M o( i)q 44*11l�✓ Z S/ '1190— I D S DO R-05—M
IOtflce Use Oniy j
Subdivision: Mo✓ilwc, W/I 9 Lot # 2.518
Planck/Rec#
Valuatlun•
Permit # 95
Owner: SCLC Mt 1/¢-✓ 131d r , :L/7 c, Reissue of
Address: ?0 !3o x 232-9 1
7i c G.rd 61a g 7 2 8/ �►pprovals Required
Phone: (a 8 y - 75 3 Punning
Engineering
Contractor: m 11 e r
Other
Address:
Items Required
r
+ UGOntfaAWS
Phone: , }
�4 ••Y v � ` - J �j
Contractor's Llcei,se#
(attach copy of current Oregon license)
Subcontractors: /
Tree RPmo�f f4itro( r
Plumbing: Ken Wats (YmvJa I pF �1 rf\*s w ,'1 ti A� lv ”
Mechanical.• 1-2'ell d)A m or j r-r er --IL y' i n h e;jkl'
(attad7 copy of current OR Contractor's License)
Architect/Engineer:
Address: _
Phone:
COMMENTS: j' (PtiF aZn!.., „per- K,/u-�
C
Applicant Signature & Phone number
Received byi2-Iz,_ ___ Date Received:
�",• •, XwMA4,NA#."MYgMt11+WMypfulW,aury�yyy�
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Permit# Account Description Amount Amt. Pd. Bal. Due
5 j y5�U Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) �? .3,' AJ,3
Bldg:
Plumb: UL)
Mech: U
Plan Check (PLANCK) .2.
Bldg: ;ALL
Plumb:
Mech:
.Oq�Z Sewer Connection (SWUSA) �2 2� �' 6,V
Sewer Inspection (SWINSP)
` Parks Dev Charge (PKSDC) _.>c. _ Soo
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R) v
Mass Transit TIF (TIF-MT) /�4I / J l U
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WOUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
TOTALS:
I
I
`1
I
GI 1 Y (W. 'I I(AMI.) W J A V,I Ul PAYMENT Rr C+-*1P1 NO
C:HE:C K AMOUNT' a 5174. Ab
c4f"AME: 1 II MIL -ER, ,)'AY G34SH AMOUNT a 0. 00 •
FAT)DRE-SS o PAYMF:N1 1)A1F.: a I. 1/09/93
11.40801 V 181 ON e
i
I'1.1RILLP(lSE: OF PAYMENT AMOUNT PA 10 PURPOSE" OF PAYMENT AMIJUN1" PA 1 D �
LAI1T,1...U1NC1 PTW.---_,.__ 406. 00 E'I.AIMFIINII 1=PEARM 140. 170
IYIFL;HANICAL FPU: 4111. 50 hT. PLII1.,.1) PER �.9. 33 w
KLAN CHECK. FE 24. 03 9EWF hl USA ;.,? ofA. ow
SEWP.R INSPECT 1315. 00 LPAF1KFi SDG 1500. 00
l';TL.IHM DRAIN 81)f3, r.lio. 00 HE.Ii11)E:N1 iA1... THAFTF IC t-kV.G 141111. 0111
MAIIF3 1 BANS I T 1 1 F FTF::S 110. 00
1 ./J T 248 MCIHN I NU HILL 9 -
A ;:'E,1E• SW MORNMU H11 1)R
f fJ'F AL.. AMCILINT F'fa 11') -. •., . . >
51/4. t
C I T Y IPI I Ii-0 11 if 1 I .1111 Lit 1'11 1 MF NI 111 1.•1 1 P 1 N1 J. a 9, it -i
i � t;liF•L.I; fIhI1.lI1NI' s ,-:"1111, 1It1C
1: !1'4f4MF: a M 1.L.L.1z.-M,1 IAY 1.:N'.:ilA 1-1111M IN I
fA1)1:)FTE;.f�;:; a 1 P1aYD11 NT Irc1TF a 1 ] � M`,;'LP,•.
I'1 IHEPOSE LIF PAYMEN F 001111.JN I Pf•A T 1) P1 lRfJW;E OF I P 4yM'-,IVF f•AMI.II..IN I I.,W 11
.......... _ _._ _._ _.-..._.._._...._,.. _......_.._................_ -...........
11_41N GHFCK FE 00
•� a
.gypp.
c,6
111 I 248 M1110N 1 IVl r HILL 9 r
i ; 'f,16 bW MLIRNINIT HILL, 1..111
11 t l f 11 . MOUNT I 'r 1.l 1 r - -) °i►1t, 00
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