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CITY OF TIGARD
.t OREGON
.............................................Permit No..1409
Building Address.......9160 SW Summerfio.10...�a►.. .. Lot ,#-4.23 . .................... ............ p::>
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X.•. Certificate is hereby given this.......4.,.....da of ............. • .�A� • ,
' that said building may be occupied and
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that it complies with all requirements of \` .
the Building Code for the City of Tigard, +•�
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`'• as approved by the Tigard City Council.
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( iluilding Inspector
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Permit Na.
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Panni. L cj1,4;C F.'
Connection fee
Paid by
Typo of building DAL, ctintincted
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Inspoction fac
Sorvicn rate
Cnntroctor Paid by D ri t r--,
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City of Tigard
INSPECTION REOU ST I
for
INSPECTION TIME : PERMIT NO. :
DATE: DATE ISSUED:L-J—
OWNERS NAME :
ADDRESS : --- --
CONTRACTO R '_ -- — -�-�- ---- -
TEST*. Air t_J, Water p , Visual EI , Laboratory 0
RESULT: Approved Disapproved O Fending ❑
SKETCH: 1
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} I SP TqR DATE
CNOTE : Attach supplemental 0'0'st dot@ har*401
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ci }/ of ? d''C ,' echanica! Permit r -zPermit 3.Oo
Fee 4.0a.-
New
.GO-_New !nstalleion Replace ❑ Relocation _ Addition 7 Alteration 0.1
TOTAL `l•�L4
CONTRACTOR - �., t V�21►] ',S� L yC, OWNER l
ADDRESS . O t��X �� _ C? airi �_�� WORK ADDRESSQjtG0 �.uti. ZJAUA tlittL'_0 ,r.
PHONE Q4s2. a APPLICANT ;._ / %ILS �-3 gfL.a
Heat I;+xrt Rating (BTU Per g--jr) '1fnff�, cnmo Vent Size Flue Size T
FUEL OIL ❑ GAS 2--11-ELECT C1 OTHER -------
ITEM NO. FEE ITEM NO. FEF_
For Issuance of Permit 3.00 Boilers Over 50 HP I �25.00
New- Under 100,000 BTU i 4.00 11 Air Handling 10,000 CFM 3.0C
New - Over 100,000 BTU 5.00 il Air Hand!ina Over 10 CC-0 CFVM i i 5.0C
Floor Furnace I 4.00 I Evaporative Cooler 3.00
Wall - Floor - Susuended { 4,00 Vent Fan 2.00
Install Vents 1 2 CO `/ent System 3.00
Repair- Heat & Cooling 4.00 1 Hoot; 3.00
Boilers Under 3 HP ( 4.00 Domestic Incinerator S.rx
Boilers 3 to 15 HP i 7.50 Comm. Incinerator 20.0C
Boilers 15 to 30 HP 10.00 Other Not Listed 3.00
Boilers 30 to 5r) HP I i 15.00
INSPECTC!?'S COMMENTS
CITY 31.SlN'ESS LICENSE REQUIRED FOR-ALL :ONTRA,_.r0PS OR SUB-CONT9AC70PS,
APPROVr^ 3Y DATE ISSUED BY DATE
RECEIPT NO. 5;
y
774 Si mature of Appliclr ( Le-
L/
yrs .
i
WN E. REIN►IAM P1119.,BiNC,INC BUILDING DEPARTMENT, TIGARD NO
P. 0. BOK 129 PWmBING PERMIT i
NEWBEfiS, ORION 91131 _ holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work aS herei 7 n�rtucl to be installed in accordance with the plumbing 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 t!,e installations are mady for inspection. City of Tigard Business License required
for all contractors and sub-contractors.
owrmr
c _. fdress, _i�GL1d.1/J//% _ fate
NOMBER OF TOTAL PERMIT NO.'S
TYPE OF PcRMIT ITEMS FEE ON EACH AMOUNT (Office Usn Only)
I L
Siinlile Family-1 bath--each _ �� 25.00
Duplex—Each 1 both .init 25.00
Additional bethrooms—each —2 10.00 ' • o o
Mobile Home S oca—oath 15.00 _
INDIVIDUAL FIXTURE FEES_
1 to 60 Fixturos in 1 builrfing-_each _ 3,00____ —
51 to 100 Fixtures in 1 building—each 2.50
101 to 200 Fixtures in 1 building—each —� s 2.00
201 or more Fixtures in 1 building—each 1.60 _
MISCELLANEOUS _
_B_uildlnq Sawar�l st 50 f t. _ 10,00 _
Sewer—eech additional 100 ft. 10.00
Water Service to building_ — _ 6.00
Private Water Systerns—each 100 ft. 10.00 _
Other (Specify): �^ _ —
PERMIT L1 For Plumbing Inspection Phone 6394191
3% State '` Plumbing Contractor By
TOTAL. `=' RECEIPT NO. Issued By
I
'17, 411
�- SEATER PERMIT N? 12175
V
Unified Sewerage Agency Tigard DATE 5-31-77 _
of Washington County CITY OF _
PHONE
OWNER = —
OWNER ' S ADDRESS:
TYPE OF INSTALLATIONi
L^JBUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
uNEW ❑ SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7-1•-i'0 ) ❑ MULT . RES. ❑ INDOSIRIAL
FIXTURE U�IrS
DWELLING UNITS
PERMIT CONDITIONS: THE APPLICANT• AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION , PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION
EXPIRES IN ONE--HUNDRED A14D - WENTY ( 120 ) DAYS . THE AMOUNT PAID WILL_
BE FORFEITED SHOULD EXPIRATION OCCUR .
FEES:
PERMIT FC-_E R 25. r-—
CONNECTION CHARGE 575. ---
SIDE SEWER INSTALLATION - ISSUED BY
01HER — —
/ TOTAL /3_ 600.
APPLICANT DATE
SEWER PERMIT N 1.1 1217 5
ADDRESS OF STRUCTURE 9160 .SW 5%;mmerfield_Ct.
—
TAX LOTSYSTEM Fanno Creels
TAX. MAP—
LOT
AP_LOT 423 B I- OC K _ OF_------
---
--- ISSUED BY DATE
APPROVED BY DATE
REMARKS 6-9—
CITY OF TIGARD
ORDINANCE 077-26
STREET SYSTEM DEVELOPMENT CHARGE
FaATE : �' 77 !'y-i
ESTIMATED SALES PRICE -�_
APPL I CANT NAME ( D •r ____TELEPHONE
309 ADDRESS_/(o<> ow S %r�r1r. �" ��jZa el ,7- aLDG. PERMIT
AMOUNT OF FEE FOR S. D. C . �
DESCRIPTION OF IMPROVEMENT
EXEMPTIONS -PER ORDINANCE
FEE RATES:
A. Single family dwelling unit under $60, 000. --------- $300. 00
B. Single family dwelling unit over 5560, 000. --------- $400. 00
C. Mobile Home Eourt Space (New Development) ---------- $150. 00
D. Multi—Family 0ew1lings---per unit-------------------- $240. 00
E . Commercial , Industrial & Institutional (Park. Space) $ 50. 00 each
F Sinn,le family unit under $40, 000. ---------------- - $250. 00
BUILDING PERMIT APPLICATION cor DATE—TIGARD b-11"77
19_
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOf, HE WORK HEREIN INDICATED BUILDER PHONE_. 639-3101
OR AS SHOWN AND APPROVED IN THE ACCOMPANY Ir!' PLANS AND SPECIFICATIONS. OWNER PHONE -
LOT NO.-
OWNER
O.OWNER t �:. . JOBADDP.ESS �16U SU iumaira r f i old H�14@ADDRE::S
�- ARCHITECT
ENGINEER
BUILDER '3riT.__lADDR@':SS DESIGNER
R
STUCI URE Ynn --
ip W _Q Nf MODEL ❑_ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
RESIDENCE ❑COMM ❑EDUCATI )NAL ❑GOV'T ❑RELIGIOUS❑PATIO [CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING DCONDITIONAL USE El DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
I
OCCUPANCY 1 __LAND USE ZONE_ r7 _BLDG_TYPE FIRE ZONE_J PLAN CHECK BY HEAT
_ Lyt 4?3 Mk ru-12SUR same as 1;ioi;L.��mmvrfjhld Lane
rari� ill��,si;;�,th, 1,t »d ra _Z bedroom 3 both
OLC. LOAD . F1Q ._ HEIGHT NO,STOR I ES1.3 ;AHEA2060 _!��_l�{�E3QQ�'��111<���clC3Cl.
BUILDING DEPARTMENT SET BACKS FRONT W—_— REAR SIDE RIGHT SIDE
Permit L)61 0€gip _ —. ---
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 106 011 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- WORK WILL BE DONE. IN ACCORDANCE WITH THE PLANS AND SPZiCIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES FHE ISSUANCE OF THIS PERMIT DOES NOT NAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINFSS
State Tax 5028 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total 181.28 ;, atigm Ui3vujupmett. 01;.,jVjtr r:fOG. i1
By _.� —----- -
__ APPI (CANT OR AGENT
Approved ItW Receipt No. .�
AOOit 5�
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UATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
4za J , — -- Permit No.
Rough-in
-�� V' Gl Ate. Fixture
gei�y — Final
NEARING
Contractor
Permit No. '7
Gas or Oil
Rough-in
Final
— �------ -- — SEWER
_ — Final ------ —
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
BLDG DEPT.FINAL TEMPORARY — CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
U1L L; PERi\1lfT APPLICATION TIGARI) `_r. N°
THE UNDUISIGNED HERCOY APPLIES FOR APE RM IT FOR THE WOilK HEREIN INDICATED � � f
OR A,; ::1I01,VN AND APPROVED IN THE ACCOMPANYING PLANS AND SPMFICATIONS. OL'iNE;I I,i!OtlC
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F-NGINFC11
IIS11I rr� AM:)III Fc- DFSIGNCII
nU0TUrlC POM ❑nEMODEL ❑ADDITION ❑Rr"AIn ^ENGNAL ❑rinEDAVAGr ❑DEMOLITION
'.V--RES!DCt.ICE ❑COIkIi:1 ❑EDUCATIONAL ❑GOV'T ❑nELIG10USOPATIO LJcnfiPOnT OGAnAIGE OSTORAGEL�SLAB ❑PENCE
�I11ORO EIMOVING L_tCONDITIO_N_A_L_U_5_C ❑DESIGN nr:yirw 1COUNC1L APPROVED !_�_SIGN_S
t'.l:'CUnANcY � __i-n NO USF ZON_r-- 0LDG. TYPE F I n E ZONr3_ PI AN CHCC;< n HCAT� G
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1,*-.(._,_! nnt) FI_Qnn LOAD HEIGHT NO.ST(1nIES Mf_.t= VALUr/=� r ��
E— I-WILDING DLI'AIITNIT":C SET HACKS FRONT 13 PrAn �.p LEFT SIDI'_ �7 Lc, nIG!IT SIDE
fl�i5 PERMIT IS ISSUED SUBJECT TO THE'nEGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
P:;In Chcct, �� �0lpc�) REGLILATIONS AND ALL APPLICAIILE CODES AND ORDINANCES, AND II IS HEPEIlY AGREED THAT TIIE
YlOnK 19ILL BE DCNE IN ACCORDANCE WITH TIiC PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Ncrord;�tg Ir ALL APPLICABLE CODES AND OIIGIN.ANCES. THE ISSUANCE OF THIS P IMIT DOES NOT WAIVE
t' ncSTnICTIVE COVENANTS. COPIT!IACI.OR AND ;UD CONTRACTO1117, TO HAVE CURRENT CITY GLISINCSC
Z State L'.CCNSE. SEPARATE PLHNIiTS REQUIRED FOR 1ErWER, PLUMBING AND HEATING.
` ToutA U
_
Rcecipt No. AUPLiCA�IT 014 1\4,-
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