15683 SW SUMMERFIELD LANE 1568: SW SUMMERFIELD LANE
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME . _ �. PERMIT NO.
DATE 4/717 DATE ISSUED .__LL_
OWNERS NAME :
ADDRESS: -- Z—
CON TRACTOR"EST : Air (), Water[1 , Visual [I , Laboratory ❑ I
QESULT: Approved P_;'"Disanprovsd C' Pending 0 `
SKETCH.
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1 CTOR DA-rE
FrI E. Attach supniemental e,.t data hereto]
Address �' � � Permit No.
Permit c'-iarge _ `77 -c,.
Owner L Connectijn foe °-
Paid by
Type of building Date co,inected
Service rate j Inspec. ti,-)n fee
rontractor _ Paid by date —
'size of connection AEsessment Paid _
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OF OC,
A/CC,I FY OF TIGARID
OREGON
Permit No106?
Building Address.....1.560.3..5W -Summer.f ... .......... ...._._ ....
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Certificate is hereby given this....31........day of.January.. . ........., 197. 7.
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that saiO,, building may be occupied and a�
that it complies with r 11 requiminents of
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the Building Code for the City of Tigard, B+�
as approved by the Tigard City Cmincil.
Building Inspector`
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I BUILDING DI-. )AH I MEN'l , -i IGAHD
IORN E. RE6a i,ROf f.CF BIIIG, INC. NO.
P 0 Box 175 PLUMBING PERMIT J �
NEWBERG, HIGH 9102 _ _ _ holder of a valid plumbing contractors license s hereby
authorized to cause plumbing work as herein noted to be installed in acicoru.,nce with the plumbino code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors. a
( �Address6?s
Own -- -�- _.
NUMBER OF rOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT (Office Use Only)
Sin to Fomily-1 both-each ✓� _ _ 25.00Duplex-Each 1 bath unit 25.00
Additionni bnthroorns-each 10.00
Mobile Home Space-each 18,00 —
rNDIVIDUAL FIXTURE FEES
1 to _50 Flxturos in 1 building-each 3.00
_ 51 to 100 i';xtures in 1 buildin -each 2.50
151 to 200 Fixtures in 1 building-each 2.00_
201 or more Fixtures in 1 building-ench 1.50
MISCLLLANEOUS _ _ --
Building Sewor-1st 50 ft. _ 10.00
Sewrr-aech odditioral 100 it. 10.00
Water Service to building _ 5.00
_ Private Water Systerns-each 100 ft. 10.00
Other (Spocify): -�
_ PERMIT Js OLS For Plumbing M4)ection Phone 639.4191
°G_State ('J Pluinhing Contractor By
TOTAL L)! RECEIPT NO. Issued By
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,e4 ?�rdf ;i��1ec:iHnicai Permit Jya_ Permit $100
stew 'rs*_a!•afon 0'-Rep'.ace Relocation I= Addition CA'tera''^� r!, - Fee .00_
! TOTAL i.•Z
CONTRACTORA`t� OWNER -,lA~1s.Tt�.� �.:�.+J • k-0. I�IC- - --
ADDRE�'S �. y� j�S �U►•��A1MA.Z Qtii.�. WORK ADDRESS W.
PHONE icslo — n3APPLICANT— 9 _
Neat Input Rating (BTU Poyr!_ On Vert Size_ �' Flus Size
FUEL 011_ C GAS
77
ELECT ^ OTHER
ITEM NO. FEE ITEM NO. FEE
For Issuance of P-rmi+ 3.00 3uilus Over 50 HP _ _T 25.00
New- Under 100,M0 BTU 4.00 Air Ha:ldlino 10.000 CFNI 3.0C
New- Over 100,000 BTU ' 5.00 Air Handtina Over 10,000 CFM ; ! 5.00
:-'oor Furnace t 4.00 Ev3vorative Cooler 3.00
Wa:' - Floor- Suspended 4.00 Vent Fan 2.01-
install Vents 2.00 ! Vent System 3.00
Repair- Heat & Cot-ling 4.00 Hood ! 3.00
?oilers Under 7 '1P 4.00 i Domestic 'n6nerator 5.0C
Boi:ers 3 to 15 HP ! 7.50 Comm. Incinerator 20.00
Boilers 15 to 30 ,4? 1 10.00 Other Not Listed 1 3.00
Boilers 30 to 50 HP ! 15.00 '
INSPECTOR'S COMMENTS
CITY BUSINESS LIC R 'QUIRED FOR-ALL CON`TRA_-TORS OR SUB-CONTRACTORS
APPROVED BY DATE iSSUED 8Y DATE
RECEIPT NO.
r. — S:-nature of App;r nt
�rC
City of Tigard
INSPECTION REOUEST
for
INSPECIION TIME :.__ PERMIT NO.:
DATE: it ZZ-6- -DATE ISSJED:_LZ
OWNERS NAME : 7 _> . f_-
AODRiS6 : _ L,r-z --
CONTRACTOR '--_..---..._
TEST: Air 0, Water [4 , ViSU01( ] " Laboratory
RESULT: Approved Q- - , Disapprover: C1 Pending L]
SKETCH:
INSPECTOR DATE
LNOTE Attach supplemental feet data heretol
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UNIFIED SEWERAGE AGENCY NO. 10639
WASHINGTON COUNTY DATE 9-1 r,-76
CITy OF ___Tigard
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APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: _ Tualatin DeveJ.6pment Co.
OWNER'S ADDRESS: --
--�-•- ---- -- STREET ^---
-� CITY STATE - J_ ZI
BUILDING SITE: l_OTSl— BLOCK _ _.__— ADDITION ,—
TAX LOT N0. . __._____-____ TAPE OF OCu CY .-_._----
_-
residenee
ADDRESS _ 1 11r,83_ .SU-Suinmerf de_ kmax kea
DWELLING Uf 1TS -1-- --- ------ -- FIXTURE UNITS
SURCHARGE IF APPLICABLE _----- ---_ ---- ._-------------__.._.-__------`---.__-_--
PERMIT FEE - 575.00 INSPECTION FEE .-..___— TOTAL DEPOSITED . 575.
(NE=W) (EXISTING) BUILDING SEWER SYSM4 _._f- nnn.-Cr.e-Ek
The Applicant agree: to comply with all rules and regulations of the Unified Sewerage Agency.
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APPLICANT � � —
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE __. _ ___ INSTALLER _-__�.�--------__-- _ - --._ ---- ------�_._ -._--
�`-= - -- -
RECEIVED BY-._ - _ _ _�____.
(AGENCY OR ITS AGENT)
COMMENTS: Building ;;1059 X25. 00 Insp. fee paid 9-17-96
This Application and permit expires in one hundred and twenty (120) days.
The amount paid wi I be forfeited should expiration occur.
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✓'
BUILDING PERMIT APPLICATION CITY TIGARU DATE—
THEU C ON o�
TH'E UNDER:;IGNED HEREBY APPI IES FOR APE RMIT FOR THE WORK HEREIN INDICATED BU!LDER PHON6 3 go 3101
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OVINCRPPONF
pp 1
LOT NO.
OWNERTe0*C• JOB ADDRESSI3Et4 sCf3if7dr4:'}��> !FTOMEADDRESS
- ARCHITECT
051111V
ENGINEER
BUILDERADDRESS DESIGNER
F1RUCTURE ''ONEW 0REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL OFIRE DAMAGE ODEMOLITION
C1 RESIDENCE ❑COMM ❑EDUCATIITO11NAL ❑GOV'T ❑RE; IGIOUSOPATIO ❑CAR PORT ❑GARAGE ❑STORAGE DSLAB C.IFENCE
L1gOt._
ND ❑MOVING JCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED DSIGNS _
I -=— -- T---_.3-XX gas s
OCCUPANCY LAND USE:OP!= BLDG.TYPE FIRE ZONE PLAN CHECK BY — HEAT_
at t"M1 MX ANK' r rata dualling w/attached yaraye 2 bedlrom ' bath
�le
1t 1490 Z 26, URC.
QC�,_j,QgQ FLOOR LOAD ISI JGHt � y0.STORIES AREA NO,jj�DROJMS VALUF��,___
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 121.00 -- _-- - ---- - -___---_ — -----_----
A.�y{� THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS :ONTAINED IN THE BUILDING CODE, ZONING
Plan Check 1� �.EGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGRt ED THAT THE
WORK WILL RE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMF'_IANCE WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCF OF THIS PERMIT DOES NOT WAIVE
3 g3 RESTRIC—IVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
.
State Tax LICENSE. SEPA4ATE PERMITS REQUIRED FOR SEINER, PLUMBING AND HEATING.
Total
13403 I
P r' -
--� - - - API 'ANT OR AGENT
Approved Receipt No
ADITRESS ""- ----_ ---- - - PHONE------
v 76
CITY O ? I
BUIL JG PERMIT APPLECATiON TIGArM - s . f N°THE UNDERSIGNED HUIC-SY APPLIES FOR APE RM IT FOR THE WORK HEREIN INDICATED 1
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND PECIFICATIONS. OWNER PHONE-1; f-3/�
OtVNER . �/i iia Go ADDRESS �3 CY l'iLDER PHONE
ENGINEER GI
BU!LDcR 4a...c ARCHITECT EIRENEWAL
STRUCTURE ZINEW ElREMODELOL
ADDITION ❑REPAIR JRENEWAL []FIRE DAMAGE Ci DEMOLITION
,0R�IEttS!CENLE ECOMM ❑EDUCATIONAL ❑GO•"T E9ELJGICUS OPAT 0 F—ICAR PORT ❑GARAGE ❑STORAGE OSLAB ❑FENCE
'DRONE _ ❑M,,VING ❑CONOITIONALUSE nD_SI�'v REVIEW ❑COUNCILAPPrZOVED ❑SIGNS_
CCCUPANCY _I_AND USE 70":F_ BLDG TYPE L FIRE ZONE;_ PLAN CHECK BY HEAT
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t7 �✓oir1 G L'+o f�
OCC. LOAD FLOOR LOAD HE;GHT NO STORIES / AREA 4j� VALUE
ULPA, TMENT i SET BACKS FRONT of —
AFi LEFT SIDE RIG!AT SIDE
—
'�� 1 THIS PERMIT IS iSSUEO SUBJECT TO THE REGULATIONS CONTAINED IN THE 13UILDING CODE, ZONING
/O /5-10 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL DE DONE IN ACCORDA%CE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording I ALL APPLICARLE CODES AND OIIOINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CON-MACTOR AND SUD CONTRACTOZS TO HAVE CURRENT CITY BUSINE;S
3.�State 7 3 � LICEN`':. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
TOfat
--� APPL!CANT OR AGEPC
Approved 1 Receipt No.
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ADORESS PHONE