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12395 SW CORYLUS COURT
An
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR
PUI-SLiant to Section(s) of the Uniform Building Code, thr
following itern(s) require correcting:
ZZ
-)ate: 3--Z
Permit
Inspector
CALL FOR REINSPECTION
ADDRE55 PERMIT N0.
PERMIT CHARGE none
btu":" R jl?, ;✓yj CONNECTION FEE 6010
PAID o Y r1�T.ht
TYPE OF BUILDING DATE CON`:E.CTED _
SERVICE RATE r _ INSPECTION FEE S
CONTRACTOR PAID BY DATE
5IZE OF CONIIJECTION ASSESSMENT PA IO
BUILDING DEPARTMENT, TIGARn
PLUMBING PERMIT
holder of a valid plumbing centractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector wW: shall be notified not less then 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.
Owner. _ __ __ Address . _ _ Date
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS rEE ON EACH AMOUNT (Office Use Only)
Single Family—I beth—each 26.00
Duplex—Each 1 bath unit _ 26.00
Additlonel bathrooms—each _ 10.00 _
Mobile Home Space--each r 16_.00 _
INDIVIDUAL FIXTURE FEES
_ 1 to 60 Fixturae in 1 building—each 3.00
61 to 100 Fixtures;In 1 building—each _ 2.60
101 to 200 Fixtures in 1 building—each 2.00
201 or more Fixtures in 1 building_—each _ 1.60 T
MISCELLANEOUS
Building Sewet-1st 60 ft. 10.00 T
Sewer—each additional 100 ft. 10.00
Water Service to building _ w _ 6.00
Private Water S Items—each 100 ft. _ 10.00
Other S ecif : _
PERMITFor Plumbing Inspection Phone 639 4171
3%State _ Plumbing Contractor By
TOTAL RECEIPT NO. Issued By
,- ._ ,.w:.e.« -w+w�.M.w�n,yekvr«..r�Y-..w^.•v -_f•-..rr- ..-..,-.�•..•o�....,...�4gyFl,. "gj�/l'T°,�4R�"Ri
BUILDING PERMIT APPLICATION `OF TIGARD DATE 19 7 '
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOii THE WORK HEREIN INDICATED BUILDERPHONO'�
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF ICAI ICNS OWNERPHONE
I,� �y LOT NO. I.(Ti V d 777757-
OWNER! � C `llta f, JOB ADDRESS 12395 *L: Lary3Ub L;;7 NOME ADDRESS
ARCHITECT
ENGINEER
BUILDER .(.• Rf81^efll8tt iqc AppC)fAUDRE55 i'J.Q. c.`+--..TX I5yI !Q3lo! 1.1Illl DESIGNER
STRUCTURF CINEW ❑R1 MODEL ❑ADDITION ❑REPAIR QREI;EWAAL OF-IRE DAMAGE 00EMOLITION
RESIDENCE ❑COMM COEDUCATIONAL OGOV'T ORE LIGIOUSOPATIO ❑CARPORT ❑GARAGE 0STORAGECISLAR ❑FENCE
❑BOND C1 MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY✓ _LAND USE ZONE-------'
__BLDG.TYPE FIRE ZONE ''"a PLAN CHECK
&in4le faMily UwellitIg w/atksQh!rq garstjo -- ,.1oroam - a&tht;:,uao
!.',swer Pormit „,.17393 - y62wr.00
0"-LQ-AD ----f"-QELLOAD _ Fi€LGHT 4 NO.STO til -$-_2 AREA 16A'_NSZ.�E�ROOMS — :f- r
BUILDING DEPARTMENT SE T STACKS FRONT 100 REAR LEFT SIDE RIGHT SIDE
'— -- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 139,L)I1 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY A.CREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WI rH THE PLANS AND SPECIFICATIONS AND IN COMP' IANCE WITH
Subtotal 41 ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE. COVENANTS. CONTRACTOR AND SUB CONT7ACTORS TO HAVE CURRENT CITY ROSINESS
State Tax LICENSE SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 429,66 1009 on
BY
--� APPLICANT OR AGFNT
Approved ”: Rm:pipf No
r
t
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
o +Z ��` ('q ow' Q Contractor
-- y Permit No.
S7ulS Rouph•in J / 2fjJ
Fixture
..... ' Final
HEATING
Contractor ^
• Permit No.J l J/
Gas or Oil �-�
Rough-in
-- Final —
SEWER
Final
DRIVEWAY
Final
Stone Drainage
(Rain Drain)Final
Sidewelk
Curb&Street Final
_ Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUP
CERTIFICATE OCCUPANCY / , p Final
Landscaping
Zoning Final
i
i
f
City of Ticiard MCC11tMiCal Pertnit \T9 Pa.mil--- S
)0--
0 Fee
New Installation Re.-)!ace Relocation El Addition ❑ Alteration ❑ 01"t-,tq-
TOTAL
•Ce%%ITRACTOR 7 OWN E R
A
ADnRES:S_ -- WORK ADDASS
PHONE APPLICANT
Heat Input Rating (BTU Per Hour) Vent Size Flue, ze
FUEL OIL CJ GAS ❑ ELECT OTHER
ITEM NO. FEE ITEM NO. FE
E
For Issuance of Permit 3.00 Air Condition Compressor 15 to 3Q HP C
New- Under 100,000 BTU 4.00 Air Handling 10,000 CFM
New- 100,000 BTU &over "Air Handling 0yor 10,000 C."M 5.(
Floor Furnace 4.00 Evaporative Cooler 3.0
'- -d-d -- 4
Wall - Floor - Suspended .00 Range Vent Fan 2.1
2.00 Van', System 3.r
Install Vents Only
=.?7. Repair . Heat & Cooling Hood Commercial _3
Air Condition Compressor Under 3 HP 4.00 Commercial Duct System 10(
Air Condition Compressor 3 to IS HP
INSPECTOR'S cord,
1CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB
-CONTRACTORS
A A* r IX
APPROVED BY- DATE ZISSUED BY VATE-d
RECEIPT NO.