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CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hell Blvd.,17prd,OR 97223 (503)6391171
CERTIFICATE OF
OCCUPANCY
PERMIT 0. . . . . . . s MST96-0192
DATE ISSUEDs 01/02/97
PARCEL s 28104CC--14W00:3
SITE ADDRESS). . . s 14370 SW MISTLETOE DR
SUBDIVI8IOK- . . . s HILLSHIRE WOODS ZOMINGtR-7 PD
BLOCK. . . . . . . . . . i LOT. . . . . . . . . . . . . s003
CLASS OF WORK. sNEW
'TYPE OF USE. . . a GF
TYPE OF CONSTRs5N
OCCUPANCY GRP. eR3
OCCUPANCY LOADs2
Pomarks s PATH I
Owners -------------------------------------
SKYLIGHT
----_---------_---_--------..—_-------
SKYI_IGHT HOME BUILDERS CO
P 0 BOX 2315
LAKE OGiWEGO OR 97035
Phone Its 636-2994
Contractors ------------------------------
SKYLIGHT
-----------------------------SKYLIGHT HOME BUILDERS Cfl
P O BOX 230
I-AKE OSWEGO OR 97035
1-hone Ms 503-636-2994
Reg M.. . a 34086
1 h i r, Certificate grants occupancy of the above referenced building or portion
Ihereof ,and confirms that the building has been inspected for compliance with
Che State of Oregon Sper_iakity Codes for the group occupenc and 1.160 k_1nder
ohir_h the referepr_ed�'perMit was issued.
CL
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BUILDING INSPECTOP BUILDING OFFICIAL.
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L7 POST IN CONSP I C(0)LTS PLACE
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CITY OF TMECHAN I CAL,
DEVELOPMENT SERVICES PERMIT
A, 13125 SWHall BIvd.,Tipard,OR97??3 (603)639aPERMIT #. . . . . . . : MEC97-0066171 DATE ISSUED: 03/?1/97
PARCEL.: z"S 104CC-HW003,
9ITF ADDRESS. . . : 1.4370 SW MISTLETOE DR
SUBDIVISION. . . . : H I I_.L.SH I RE= WOODS ZONING: R-7 PD
BI-ncK. . . . . . . . . . . I-OT. . . . . . . . . . . . . :003
[::;_AFr OF WORK. . :Al_T FL-OOR FIJRN. . . . : 0 FVAP 0001-_ERS: 0
TYI- ` I.ISE. . . . :SF UNIT HEATERS- - 0 VENT FANS. . . : til
997,1- gNCY GRP. . ,R3 VENTS W/0 APPI__: 0 VENT SYSTEMS: 0
9Tf.]RIES. . . . . . . . : 2 BOIL-FRS/COMPRESSORS HOODS. . . . . . . : 0
0-3 HP. . . . : 0 DOMES. I NI'I N: 0
. /ELC/ / / 3-15 HP. . . . : 0 COMhII... I NC I N: 0
MAX INPUT: 0 STU 15-30 HFA. . . . ; Vi REPAIR UNITS- 0
FIRE DAMPERS% . : 30--50 HP. . . . : 0 WOODSTOVES. . : 0
F'7AS PRESSURE. . . 50+ HP. . . . 0 CL_0 DRYE=RS. . : 0
1\10. OF UNITS---------- AIR HANDL-TNG 1.11\1 I TS OTHER UNITS. : 0
TURN ( 100K BTI-I-. 0 <- 10000 r_f m: 1 CAS OLJTI_ETS. : 0
FURN ) -100N BTU; 0 ) 10000 cfms 0
Pemarks : NFW ATR CONDITIONER LIN1T AT REAR OF HOUSE= RFHTND GARAGF//with a/r_ imits
(-,annot he placed ni_ttside seth r,ks
Owner. ------------------------------------------- FEES -----_.—____—_—.
!'FTE` JOHNSON type amount by date rrecpt
14370 SW MIE3TL.FTOF PRMT $ 25. 00 JMH 03/20/97 97-292051.
5PCT $ 1.. 25 03/20/97 97-292051.
TIGARD OR 97223
Phone #:
F"ontrar.tor. ___.--___.__.._-_..._____-------------
PORTI..AND MF TRO—A I RE
10010 9W S FAVERTON HIL.LSDAL.E HWY
'tEAVFRTON OR 97005 ---_--__ __---._--._._--___.--------------
s h o n e #: 626- 781A E P-6. 25 TOTAL
Peg #. . : 61219
------- RFOUIRED INSPECTIONS ------
-his perait is issued subject to the regulations contained in the Mecl-ianic.al Insp
lioard Municipal Code, State of Dre. Specialty Codes and all other Mi sc. inspection _
applicable laws. All work will be done in accordance with Final Inspection
oauroved p)ans. This perait will expire if work is not started
W w,in;n 168 days of issuance, or if work is suspended for sore
f h-ir 168 days.
W t er�mi.ttee
r-'ql.ted By ; �
639-4175
Plan Check 0
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD, Commercial and Residential Date Recd
TIGARD,'OR 97223 Date to P E _
(503) 639-4171, x304 Date to DST
Print or Type Pefmit" lFcg7--oc�6
Incomplete or illegible applications will not be accepter! called
Name of Dsvelopmenvmj@44 Description
-- Table 1A Mechanical Code QTY PRICE AMT
Job Street Addreu Suites A) Permit Fee 0.
-0- 10.00
Address 14:3-70 5 W M t 5-H �cg
8qp• Crtyisfai• Zip8t Supplemental Permit
3.00
T-1 -1--0'r3 , 0
Name(or name of busenessi 1 ) Furnace to 100.000 STU 600
Owner 'row r.-,Z.YI mc) ducts 3 vents
Mailing Adores e 2.) Furnace 100,000 BTU+ 7.50
(nct.ducts b vents
C tyfStst• Lo 3.) Floor Furnace 600
�) -go incl.vent
Na
(rx'n d x+essl4) Suspended heater,wall heater 8.00 ok'h
or floor mounted heater _
Occupant Mailing Adtxeaa 5) Vent not incl.in 300
appliance permit
Cnyrstne Zlp Phone 8.) Boiler or comp,heat Pump,an Gond. 6.00
to 3 HP;absorp unit to 100K BTU
Nom^^ 7.) Bniler or comp,heat pump,air Gond. 11.00
0 1 1 ' 11vt-t'E�-YU A\T-e% 3-15 HP;abs unit unit to 500K BTU It%
Contractor +fig Address ,�� 1 1 8) Boiler or comp,heat pump,air rend. 15.00
l'' s w
Q•ezw' c�P.., 15-30 HP;absofp unit.5-1 mil BTU
(Prior M City/slate, Zip Phos. 9. Boiler or
�b ) camp,heat pump,air cond. 22.50
issuance a copy iJ Ck zS 6 ' !� ' 30.50 HP;abso unit 1-1.75 mil BTU
of al licenses are Oregon Const.Com Bond Lic M Earp Dat 10.) Boiler or comp,heat pumpiir corM. 37.50
�+
required N !':L)` 1 7 >50 HP,atism unit t.75 mil BTU
expired In C O T COT Sums-Tax or Maim N Exp Date 11.) Air handling unit to 4,50
uata base) i`I 10,000 CFM
Architect Name 12) Air handling unit 7_y0
10,000 CTM+ _
Or M"4ta4O11e 13.) Non portable 450
evaporate cooler _
Engineer C"Risis zip Phone 14) Vent fen connected 3`00
to asingle dud _
Describe work New O Addition O AHeratio Repair O 15.) Ventilation system not 4.50
to be done Residential Non-residential included in appliance permit
Additional Descriptlotnawprk / � A +5.) Hood served by mechanical exhaust 450 �.
tic incinerators - 7.50 _
Existing use of 18.) Commercial or industriattype 30.00
building or property incinerator
19.) Repair units _ 4.50
Proposed use of 20) Woodstove - 4,50
building or property^ _
21) Clothes dryer,etc. 4.50
Type of fuel-oil O natural gas O LPG 0 electric O 22) Other units 4.50
1 hereby acknowledge that I have read this application,that the 23) Gas piping one to four outlets 2.00
information given is correct,that I am the owner or authorized agent of
the owner,that plans submitted are in compliance with Oregon State 24) More than 4-per outlet (each) .50
laws K4 J Pa 1� 3
Signature of givimertAgent Date i QTY.SU13TOTAL
6 :Z. 6 'SUBTOTAL �-
Contact Pe on Name Phone L` ^�5%SURCHARGE j
PLAN REVIEW 25%OF SUBTOTAL
i
TOTAL
i:Wst\mechpmt doc (rev 7196) 'Minimum permit free is S25+5%surcharge
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CITY OF TIGARD
DEVELOPMENT SERVICES EL.E"CTRTCAI- PERMIT
13125 SW Hall Blvd.,i'ISard,OR 97223 (503)5394171 P'F RM I T #: F1_C 97---0165
DATE: ISSUED: 03/26/07
PARL^EL: r^_S 104CC--L-IWi80-
9TTF PDDPESS. . . : 14370 SW MJSTI..FTOF DR
SUBDIVISION, . . . :I4IL_LSHTRE WOODS 7C)NING:R--7 PD
QI_OC!'. . . . . . . . . . : LOT. . . . . . JURISDICTION!
rr•o.ject DFescr-ipti.on: NEW PTR CONDITIONER UNIT AT REAR OF HOUSE BEHIND GARAGE
-------------------
V W_-R)`STl1ENTIAL UNIT---- ---TEMP SRVC/FEEDERS------ --------MISCELL.ANEOUS•------
1.0100 `:y F" Or: LESS. . . . 0 T -- 200 amp. . . . . . . : 0 PUMP/TRRIGATTON. . . . ; 0
F AC1-I ADD' L_ 5009F. . . ; 0 201. - 400 amp. . . . . . . r 0 SIGN/O(JT LINE LTC. . : 0
L_]'MTTEE f NEPGY. . . . . 0 401 - 600 amp. . . . . . . : 0 STGNA1.-/PANE=L. . . . . . . . 0
MANE. HM/ SVC/FDR. . : 0 601.+amps-1.000 volts. : 0 MINOR L.AAEI_. ( 1.0) . . . : 0
- -.-GERVTrE/FEEDER--_-- _..__...TARANCH CIRC'LJTTS-_-__.-- ___-ADD' l.. TNSPErTIONS._..._-
0 - P-00 amp. . . . . . . 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 — 400 amp. . . . . . , 0 ist W/O SRVC OR FDR. : i PER HOr_I17. . . . . . . . 0
4.01- -- 600 ,-amp. . . . . . : 0 EA ADDI L PRNCH r T RC: 0 IN PL.ANT. . . . . . . . . . . : 0
r,o' - 1000 amr. . . . . : Q' ________..____.______..-r,l_AN REVIEW SECTION-
1000+ z+.m p/v n l t. . . . . : 0 ) =4 RES L1N 1 TS. . . . . . . . : ) 60121 VOLT NOMINAL. . ;
Rerronne('.t; only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC, OCC. :
C)wner. -_.______________.___.______,.____.________._________. __ FEES
PETE JOHN50N type amol.int by nate recpt
14370 SW MTSTLETOF PRMT $ 35. 00 JMH 03/26/97 97-292051
T T CARD OR 972,21 9PrT $ 1. 79 ,TMH 01,/"F,197 9-7.-;=`-1 17151
Corth r^art or^; --_—___________________________-.______-__------__—_....___—_-----___.__.—._ .
$ 36. 75 T Ol.
--- REQUIRED INSPECTIONS --....-_
Ceiling Cover Undergr-ound Cove
Phan +I c Wali Covet, Elect' I Servi.r e
Reg ��.. , .
r �
'his �ersit is issued subject to the regulations contained in the cot_ ,QT��-1_
Tigard Municins) Code, State of Dre. Specialty Codes and all other Pe+rmi tte . i gnati.irP
apnlicsble laws. All wore will be done in accordance with
IL aocroved plus. This perait will expire if work is not started
within 180 days of issuance, or if work is suspended for wore
U) I 'hap 198 days. I ., , d-6 y
nWNER INSTAL_LATTn ON
"!;r? ins;t;allrition is bei.ng made on property I own which is not intended for
1p.ase, or^ rent.
C9 'IWNERI S SIGNATURE: _. . _ _._. _ DATE:
a
INSTALLATION
,?C;NATURF OF' SUPIR„ ELEC+ N: TJf� rr: .
.ICF:NSF' 1\10.
Call for ins=pection - 639--4175
CITY 6F TIGARD Electrical Permit Application Plan Check tt
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 L �� Date Rec'd.�
Date to P.E.
Phone(503)639-4171, x304 Print or Type Date to DST
Type
Inspection (503)639-4175 Incomplote or illegible will not be accepted Permit tt
Fax (503)684-7297 Car.,e,: n
1. Job Address: 4. Complete Fee Schedule Below.
Name of Development _ Number of Inspections per permit allowed
Name(or name of business) Q��e. �d���bt'1'1 Service Included: rtems Cost Sum
AddressJ_ 70 S.Lt/. M 1S 1ll e 1 01-1111- 4s. Residential-per unit
1000 sq.ft.or less $110.00 4
City/State/Zip T c �a� Each additional 500 sq.It.or
Commercial El Residential thereof $25.00 1
Limited
Energy $25.00 -_
Each Manut'd Flame or Modular
2a. Contractor Installation only: Dwelling Service or Feeder $68.00 2
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical ContractorPoi-t, r1�x�.
Installation,amps
oraltle tion,or relocation
Address f0010-M; kiM,V. 50 200 amps or le,s _ $80.00 2
�- 201 amps to 400 amps $80.00 _ 2
city_XRO'V, State_ Zip »S 401 amps to 600 amps $120.00 2
Phone No. tT2 (r7119 601 amps to 1000 amps $180.00 2
Job NO. 1 Over 1000 amps or volts $340.00 2
Elec.Cont. Lice. No. 3 q---A L Ex .Date - 17 Reconnect only $50.00 _ 2
OR State CCB Reg. No. 6 r--3-1 �Exp.Date-_ - 4c.Temporary Services or Feeders
COT Business Tax or Metro No. [>U`Exp.Date.-11 Installation,alteration,or relocation
^ 200 amps or less $50.00 2
Signature of Su r. Elec'n 201 amps to 400 amps $75.00 _ 2
g Supr. �- 401 amps to 600 amps $100.00 2
,U , r� Over 600 amps to 1000 volts,
License No. .� 1_, Exp.Date t see"b^above.
Phone No. - 4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a)The fee for branch circuits with
purchase of service or
Print Owner's Name feeder Me.
Address Each branch circuit i $5.00 _ 2
b)The fee for branch circuits
City _ State_ Zip without purchase of
Phone No, service or feeder lee.
First branch circuit _l_ $35.00 35 _ 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 _ 2
3. Plan Review section (if required): Signal circuit(s)or a limited energy
4. panel,alteration or extensioni $40.00 2
�
Please check Appropriate Item and enter fee in section 5B. Minor Labels(10) $100.00
4 or more residential units In one stnicture 4f.Each additional Inspection over
Snrvice and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00
J Classified area or structure containing special occupancy Per hour $55.00
FD as as described In N.E.C.Chapter 5 In Plant ---
J "Submit 2 sats of plans with application where any of the above apply. J• Fees: ry�
Not required for temporary construction services. 6a.Enter total of above fees $ `�
5%Surcharge(.05 X total fees) $ f• 7 5
NQTICL Subtotal $ -
5b.Enter 25%of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reg Irt o(Spr.3) $ ---
NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account 0 = 36
Total balance Due
19nSTSELCMi APP Rm Q/9ri
MASTR
C17Y OF TIGARD PERMIT #ERMIT. . . MST96-0192
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/10/96
13125 SW Hall Blvd.Tigard,Creon 07223.0199 (503)939-4171
PARCEL: 2S104CC—HW003
I IL ODDRECiS. . . : 14370 SW MISTI...LTOE DR
�-AJI{DIV1510N. . . . : FIILLSlAIRE WOODS ZONINGS R-7 PD
BI_.GI.;K. . . . . . . . . . .. LOT. . . . . . . . . . . . . .00 '
,a
Remarks: PATH I
------------I--------------------------------------------------- BUILDING -----------------------------------
REISSUE: STORIES.......: 2 FLOOR ARErS---------- BASEMENT...: 8 sf REQUIRED 5-*TBACKS---- REQUIRED---------
CLASS OF WORK.:NEW HEIGHT........: 34 FIRST....: 1433 sf GARA6E....... 798 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE ..:SF FLOOR LOAD,...: 40 SECOND...: 1917 sf FRONT.........: 20 PARKING SPACES: I
TYPE OF CONST.:5N DWELLING UNITS: I FINBSMENT: 8 sf RIGHT.........: 5
OCCUPANCY GRP.:R3 BDRM: 5 BATH: 4 TOTAL------: 3351 sf VALUE..1: 231257 REAR..........: 85
-------------.--.•----------____------------------- PLUMBING ------ __— ----------—------------------
SINKS.......... I WATER CLOSETS.: 4 WASHING MACH..; 1 LAUNDRY TRAYS.: I RAIN DRAIN ft: I TRAPS.........: 1
LAVATORIES....: 6 DISHWASHERS...: 1 FLOOR DRAINS..: 1 SEWER LINE ft; 1 SF RAIN DRAINS: 1 CATCH BASING..: 1
TUB/SHOWERS...: 4 GARBAGE D1SP,.: 1 WATER HEATERS,: 1 WATER LINE ft: 111 BCKFIW PREVNTR: 1 GREASE fRAPS..1 0
OTHER FIXTURES: I
-------------------------------------------------------------- MECHANICAL ---------__—_—_____-------- ----- ------- ----------
IFUEL TYPES----------- FURN ( 1111( ..: I BOIL/CMP ( 3HP: 1 VENT FANS.....: 5 CLOTHES DRYERS: 1
/GAS/ / / FURN )=111'( ..: 1 UNIT HEATE'iS..: 1 HOODS.........: 1 OTHER LIMITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 1 WOODS,TOVES....: 0 GAS PJrLETS...: I
----------------—-------------.------------------------------ EL.ECTRICAL ---------------- ---- __—___------•--------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER----- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- -MISCELLANEOUS---- --ADD'L INSPECTIONS--
1110 SF OR LESS: 1 1 - 211 amp..: 0 0 -- 200 amp..: 0 W/SVC OR FDR,.s 1 PUMP/IRRIGATION: 0 PER INSPECTION: I
EA ADD'L 500SF.: 7 eel - 480 Rep..: 0 201 - 406 amp..: 0 1st W/O SVC/FDR: 8 SIGN/OUT LIN LT: 1 PER HOUR......: 0
LIMITED ENERGY.: 1 491 - 600 amp..: 1 401 - 610 amp..: 0 EA ADOL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT....... 0
MANF HM/SVC/FDR: 0 681 - 1100 amp.: 0 601+amps-1111 v: 0 MINOR LABEL -18: 0
1010+ amp/volt.: 0 ---------- ----------------- PLAN REVIEW SECTION ----------------------------------
Reconnect only.: 8 )=4 RES UNITS..; SVC/FDR){225 A.: ) 600 9 NOMINAL: CLS AREA/SPC OCC:
------------------------------------------------ ELECTRICAL - RESTRICTED ENERGY --------------------------------- ------------
A. SF RESIDENTIAL-------------------------- B. COMMERCIAL----------------------------------—--------------------------------------------
AUDIO A STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM...... INTERCOM/PPGING: OUTDOOR IN% LT: ,
BURGLAR ALARM,.: 0TH: :: X 891LER.........: HVAC...........: LAM?)SGAPE/1RRIG: PROTECTIVE SIGNLi
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: ss
HVAC.,.........: DATA/TELE COMM.: NURSE CALLS....: TOTAL t SYSTEMS: I '
Owner: -------------------------------------Contractor: -------------•----------------- TOTAL FEESsf 5023.16
SKYLIGHT HOME BUILDERS CO SKYLIGHT HOME BUILDERS CO
P O BOX 2315 P 0 BOX 2315
LAKE OSWEGO OR 97035 LAKE OSWEGO OR 97635
Phone 8: 636-2994 Phone 1: 583-636-2994
Reg #..: 34886
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 181
days of issuance, or if work is suspended for more than 180 days.
--------------------------------------------- -- REDUIRFD INW.CTIONS
Footing Insp PLM/UndFrfloor ) Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Erosion Control
Foundation Insp Mechanical Insp Low Voltage Gyp Board Insp Electrical Final
Past/Beam Struct Plumb Top Out I Fireplace Insp Rain drain Insp Mechanical Final
Post/Beam Meehan Electrical *vi/' Gas Line Insp Water Line Insp Plumb Final
Crawl Drain Framing Ins Gas_b"place Water Service In Building Final
Prr mittpF i.:Itrtr N i 1ss1_lad Ly':
Call for inspection — 639--4175
SEWER CONNECTION
CITY OF TIGARD PERMIT
PERMIT #. . . . . . . S SWR96-0182
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/10/96
13126 8W Ham 9lvd.Tigard,Oregon 97223•8190 (609)M41171 PARCEL s 2S 104CC-HWO03
SITE ADDRESS. . . : 14370 SW MISTLETOE DR
SUBDIVISION. . . . : HILLSHIRE WOODS ZONINGS R-7 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . 1003
__-_-_._---------__.-------------------------------------------------------------
TENANT NOME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . S 0
CLASS OF WORK. . . sNEW DWELLING UNITS. . s 1
TYPE OFF USE. . . . . :SF NO. OF BU 1 LD I NGS s 1
INStALL TYPE. . , . :BUSWR IMPERV SURFACES 0 sf
Remarkss PATH 1
Owner: _____________
---------------------------_--__-_--_ FEES -_-_--__------
SKYLIGHT HOME. BUILDERS CO type amount by date recpt
P fl BOX 2315 PRMT f 2200. 00 JSD 05/10/96 96-279x55
INSP $ 35. 00 JSD 05/10/96 96-279255
LAKE OSWEGO OR 97035
Phone #: 636-2994
Contractor:
CONTRACTOR NOT ON FILE
--------------------------------------
Phone #: f 2235. 00 TOTAL
Req #. . :
------- REQUIRED INSPECTIONS -------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from _
the date issued. the total amount paid will be forfeited if the _r
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not loca ed at the measurement
given, the installer shall prospect 3 feet iX all directions from _
the distance given. If not so located the nstaller shall purchase
a "Tap and Side Sewer" Permit and t /A�y will install a lateral.
Permittee Signatut-e .
Bys
a Call for inspection - 639-4175
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Residential Building Permit Application
ity of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: z"��V sv �t ribL-ro 2. p�
N%\jISN)r"c r reit Lot#
�"' Offlc u�seonly
Subdivision:,/��„p�.; �-
valuation` ,)J 1 -r _ Contact Date 1 1 Initials-
Result
New Construction Only: (Square Footage)
Planck/ReC
House: D Garage: Permit# I 3
Reissue of A
Corner Lot? Y � Flag Lot? Y Map&TL# 2 ► °yc N`J°"
Zone_ 77 --
Owner: S f«ls6WT--1� "'li2 E. f5y-tA"_CV 011- Plat# fol-7-7,C-7T
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Address: -- -TL! ADCIQVQIs Required
Ll� a TWIF60, OR- Planning SetbacksL'Solar V
Engineering S r r-
Phone: (S-03 _1 3 6-Z49y Other
Contractor: 1 I Items Required
Address: _ _ Subcontractors —
Truss Details _
_ Other
Phone: L ) - Motes
Contractor's License#_ b —'
(attach copy of current Oregon license)
Contact Name. _ 01--02I SM I'TIL — --
Contact Phone: ( 63 6-14 9-1--
Subcontractors:
ySubcontractors: ArchltecVEngineer:
v~i Plumbing: 1„�0)ie T.r PIA'9'. 01` Address:
JMechanical: ✓Q M e 'f; ��� _
op (attach copy of current OR Con ctor's License)
C7 Electrical: le,11%%r+, 1` Phone: L-1—
W
.JOB DESCRIPTION:
Applicant Signat4j Applicant Phone number
Date Received:
Received by:
i »9nemvaesoo
Permit d Account Description Amount Amt Pd. Bal.
niSir - ' Z Bldg. Permit (BUILD) d, SO (rp,
Plumb Permit (PLUMB) v o
Mach. Permit (MECH) p•vv t/r
(tea0',
Bldg:
Plumb: 2. u
Mach:
El'tctrncol /G__t ff
Plan Check (PLANCK)
Plu
Mach:
S'wdSewer Conner n (SWUSA) uU vv
Sewer Inspection (SWINSP) ; 3�.—
Parks Dev Charge KSDC) 1050 o -TV
Residential TIF (TI ) 19 ZQ ild
Mass Transit TIF (TIF l 2 U 1 U
Commercial TIF (TIF-C)
Industrial TIF (TIF-1) _
Institutional TIF (TIF-18)
Office TIF (TIF-0)
a. Water Quality (WQUAL)
N Water Quantity (WQUANT) _/G0 D
Fire Life Safety (FLS)
J_
m Erosion Cntrl Permit (ERPRMT)
C7
W
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
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