11329 SW BASSWOOD COURT �e.
tat?
VAJ
N
U
Q�
C'l
t�
I�
Ir
I
f
�S
r
11329 SW BASSWOOD COURT
i
Cl,ety of i igard
1 ,4SPEC` ION REQUEST
for
-- t i�Gca4f — �I�DIet]rtc 1L_ SI t�ei-1--1 44" I
1N3PECTIC%N TME: ?E?'MIT ti'0 • I
DATE:
OWVEr,S NAME : I
ADICRESS: P-3c9ti s4� �1sSu. r� CT
CONTRACTOR : 21 I
TEST : Ai- D , »C —it n.ri ^,
RESULT: Apprr•ied�, :i34;':;'--3•fPendii7 D
-- i
s XETCN:
1
i
i P CTOR DATE
`NETS; A•talw f�ar!*,"ontoI feet data bereta� i
_I i gird i
INSPECTION RECUEST
i
fr
INSPECTION TIME : PERMIT N ,). ' ...._.
DATE: . .1 TATE ,SSJED:---
^'NNERS NAME :
AD 0RE03a 3a9
'� R :....� � 7 s _
„DVTr't �"", ' II
TEST' Air C , &-ter [; , Visua; 7" ' I
RZ-3JLT. .:ppr.v3d Z. 3-. ,;rovr d
S'tETMIH:
• III
T
{
ZJ ---�
f l I
I
SPE'TOR DATE
rOTc: At'ach S-iPPAmenlal dila here'I
i
- :r•w,..n+rarm..«ar,M• . fir,war''aw1^►rnn••..q.+�sr�r'm+"�,",y,,...-c;,:w.�a"—,r.� .a.,..-...+.r..�
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE N° 0406
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICAI IONS. OWNER PHONE__— _
OWNER ��+ r�r !r A'Ft . . ADDRESS
BUILDER PHONE
ENGINEER
— ARCHITECT DESIGNER
STRUCTURE ONEW ❑FIE MODE L ❑ADDITION ❑REPAIR _❑RENE.WAL ❑F!RE DAMAGE rr-�� 0DFMOLITIO1`J
RESIDENCE- ❑COMM ❑EDUCATIONAL ❑GCIV'T ❑RELIGIOUSUPATIO DCAR?ORl ❑GARAGE ❑STORAGE OSLAB ❑FENCE
❑BOND EJMOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY .LAND USE ZONE. BLDG.TYPE -FIRE LANE_ PLAN CHECK BY� HEAT—.,
/' r �♦ r I ��1,. .r
OCC. LOAD FLOOR LOAD ` HEIGHT NO.STORIES AREA /' v VALUE
BUILDING D PARTMENI SET BACKS FRONT REAR LEFT SIDE RIGHT'SIDE
Permit -- ------ -------THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THF 6I.111DING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS 4EREHY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEA'ING.
Total
By -
- "- -- APPLICANT OR AGENT
Approved Receipt No.
DATE INSP, TYPE INSPECTION REMARKS PLUMBING DATE
Contrectog,
Permit No.
Rou h-in
Fixture
�0 O 7S - Ze 0A, Final
HEATING i
Contractor O ^ 7 y
Permit No.
G Gas or Oil 40-21-'7
Rough-in
Final
(91< SEWER 9-8.75
Final
DRIVEWAY/n_/--7
Final
Storm Drainage
Rain Drain Final _
E�Approach
Final
FILOG,DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCYCERTIFICATE OCCUPANCY
i
A D DR E S S3.2 ����'°''.� PERMIT N 0. J7/
PERMIT CHARGE ___ none
CONNECTION FEE
OWNER
PAID BY
TYPE OF BUILDING DATE CONNECTED
SERVICE RATE__._._.. _ INaPECTION FEE �`S •
CONTRACTOR /,)-I C t *'`-� __ PAID BY DATE 1;417s
PAID _
SIZE OF CONNECTION ASSESSMENT
i
i
OL
Permit Issued _ CITY OF TIGARD, OREGON Permit No. —
City Hall •,
Application Approved Building Department Cost of Installationt!'<IM&O
AIs1 A=&G" 1"4 n"Avd, nAM ''nd44dida Fee for Permit_ 6,0
Applicant shall fill in cost of installation only,
Date _ above this double line. Street Sewer Permit------
repair
ermit__--_repair Plumbing Pipes or Fixtures according to plans and specifications and
Application is hereby made to alter
Install description as given below:
Location of building—Number and StreNt 11329 SW Basswood Court `
Lot__- _ Block Addition. .
Englewood
Name and Address of Owner Wayne Helliekson, 302 NE 18th Avenue 11illaboro, Orerron
Name and Address of PlumberlLalatin Valley Plumbing & Htg, 845 NW 231st, Hillsboro. Ore
Building (Old or New) new _ _ height In Stories _. 1 _ Occupied as_ Home
SCHEDULE OF WORK
__NUM_BER_ _ I NUMBER
I
FIXTURES New I Move I R'pl'ce _ FIXTURES I New Move FWpllce
} I I I Drinking—_� I Single Family
Water Closets_.._.__—I _ Fountains,
Bath I'ountaina, Yard_______ ._I __
l bath each $25,00
Bath Tub- —.. Fountains, Soda— _ dditlonal Rath $10,0
Basins _._.__—..,_ —i— Hot Water Tank
Sinks, Ordinary - �— -_j _ Sinks, Bar____
Sinks, Dishwashing ------ .
Sinks, Slop
Automatic Dishwasher.____- _—— __ Drains, Refrigerator
I ( I
Laundry Trays Drains, Ice Pox-----I
Drains, Floor_. _�I___��- _�� Urinals
Drains, Area— _—i___i-__ _ _ Catch-Basins, Yard __ _-
Rain Drains— _ _ Catch-Basins, (forage-__._.'
Automatic Washer_____ _ _II—j— Catch-Basins, Sub Soil�lh.__ I+
Water Permit No.` Bldg. Permit No, --
_ a
REMARKS:
PermitX35_,00 3Lo State__-t1._05- —�3 6 05 .
IMPORTANT I—Plumbing shall not be installed in any building, (either new, altered,or repaired), except as shown or designated
on the corresponding building plans as filed with, or regri►ed by, the Building Department In accordance with the
provisions of the Building Code and Ordinance 62.19 of the City of Tigard.
rtpairthe plumbing system according to this description, planXnd ecifica s and he Plumbing Code of the
install
I agree to alter City of T'Sard. _ --
Plumbing Firrn al&itin-Vikll P1>Lmb j nS & HtEe _
— ------� -
Supervisor
_-