12120 SW SUMMER CREST DRIVE 121 SW SUMME.< CREST DRIVE
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INSPECT'ON NOTICE
City of Tigard Building Dapar',nent 11/
P.O. Box 13397
Tigard, Oregon 97;-23
Phone: 639-4175
Type of InspectionL.
Date Requested_ 3U C� _ Time A.M. _ P.M.
Address ./L 1 /; [�' C 1 ]1) )y r L .l.ji Permit va
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Owner, _ ---- ---- Lot #k —
BuilderThe following Building Code d ificiencies are required to be corrected:
Presented to ___ �. —� M Approved
Inspector _ 1�` ❑ Disapproved
Date --
CALL FOR REINSPEC"W_V
❑ YEs D NO
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BtJll..r)I:N(' VSRM.11
CITY OF T167A RD C I TY-�'F TIGARD 1:)Er4M:r.*T' NO . : "00909535
-ITYD 00111H.
ORIGON
COMMUNITY DEVELOPMENT DEPARTMF-N'T
13125 S W.H.11 Blvd..P.O.BOA 23397,Tigard,Oregon 97223.(503)639-4115 15S1.1PM 1.0/89
90901
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111175 . 66
This permit;,9 Issued Subject to the regulations contained in Title 14 PEXE.,1121, NO. /03 7
of the TMC, State of Oregon Specialty Codes. zoning regulations
and all other applicable codes and ordinances, and it is hereby 14%,(AUT FIE:1:1 1N!tiP1i:(:'.-1'l(:)NS
agreed that the work will be done in accordance with the plans arid l::'r'.AMTNG
specifications and In compliance with all applicable codes and Fl NAI
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work is not started within 180 days,or if work is suspended or
abandoned for a pericia of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
'X
Permittee Signature.
Issued By
(.',AI I FOP I.N!i PF.:*CTJON 639--11.75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
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y PLAN CHLCK APPLICATION
C11Y OF TIG. RD 01 cTtf�t�WA PLAN CHECK H s v
,� PERMIT H _ `' c
COMMUNITY UF_VEL.OPMEW OEPARTML-N , DATE ISSUED
17125 S%V.f/wU 8O
1vd_A.O.Flow 23]97.Tigard. 'tgon 9TM.( 1439�'�175
JC`B ADDRESS: _ �l/IqS � �'/ 121x70 :
C'rs__ iAX MAP/LOT
—" LOT: LAND USE
SUB: _ _
VALUATION: , 5� SPECIAL NOTES
OIANER 1 lN I� REISSUE OF:
NAME. I I _ S U N �� - LAST REISSUE:
ADDRESS: / '� _ FLOOD PLAIN/
SENSITIVE LAND:
HONE: L..;' ^ / 00
P
A_PPROVALS REQUIRED
PLANNING:
CONTRACTOR ENGINEERING:Aj
_--
� FIRE DEPT
ADDRESS: _ i.7 0 OTHER: -
- - ITEMS REQUIRED
PHONE: ! c� %3 LIST/SUBCONTRACTORS:
BUS Ti.X: _ -
ARqt/ENGINECR CALCULATIONS:
NAME: - TRUSS DETAILS: _
ADDRESS. - PARKING PLAN:
LANDSCAPE PLAN:
_ --. ---_—
OWER . _ _ —_-
PHONE: _ -- --
C(x'1MEE4TS: -. - ✓17 � I '/. So
DESCRIPTION AMUUNT AMOUNT PD. DAL. DUI.
PERMIT H ACCT H
10--432 00 Building Permit Fees
_ 10-431 00 Plumbing Permit Fees ---- -
_ 10--431 01 Mechanical Permit Fees --
10-230 01 State Building Tax (5X) -`- -
Du i l d i ng
Plumbing
Mech
10-433 00 Plans Check Fee - y`•y 3
Building
Plumbing
Mech _-
_ _ 30-202 00 Sewer Connection ---- --
30-444 00 Sewer Inspection -----
51-448 00 Street :system Dev Charge (SDC)
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrq (GDC)
10-230 09 TRFD -
10-230 OG Washington County fire 01 (95X)
10-2.7.0 00 Amart./Wedgewood -- �
TOTAL
-� r REC H
APPLICANT SIGNATOR[
AP
h'eceived By: _ C � � Date Received:
cn/358713/18P
. SEWER PERMIT
�:
Unified Sewerage Agency CITY DATE l' •z -�r�
of Washington County CITY OF / _
OWNER : c_ f' CG �, ��, - --- PHONE :
OWNER 'S ADDRESS: /."-ZZk-1
TYPE OF INSTALLATION:
' BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑ NEW ❑ SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7- 1-70 ) ❑ MOLT. Ri7S. ❑ INDUSTRIAL
FIXTURE UNITS DWEI-LING UNITS
ADDRESS OF STRUCTURE : �•-�/��' -- e4,I -
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING IOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE--
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR.
FEES:
PERMIT FEE S �c?c -
CONNECTION CHARGE 'Z 'r
SIDE SEWER INSTALLATION /
ISSUED BY
OTHER
TOTAL sem•--� -
APPLICANT DATE
SEWER PERMIT No
ADDRESS OF STRUCTURE %.�'/.�'L� t�Gi� �-r -- �V:Ze
TAX MAP - `/K_7 TAX LOT _ •A 3 _ SYSTEM X — K%
LOT -BLOCK
APPROVED BY DATE ISSUED BY DATE
D. U. 'S REMARKS