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INSPECTION_NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Drib Requested_ t. Time _A.M. P.M.
Address -2-2,12 -s�'�'' �' _ Permit
owner___�_. .._-- -.-.-----------__._-- _ Lot #
Builder
The following toil�r,,,l :,'ode deficiencies are required to be co-rested:
Presented to _e— _ Approved
Inspector �� LI Disrpproved
Date
CALL FOR REINSPECTION
Q YES V,/NO
CITY OF TWA RD No. 1229
12755 S.W. ASH
P.O.BOX 23397
Date1 ' U
TIGARD, OP 97223
Name _- �—
__
Address
Lot3BIock/Map Subdivlsion/Address ){ Jun( ; 11 �-J't,PermiBldg. f v T Plumb Cash Check
r
Sewer 2 g .j C„ ( Other Other Rec. fly
i ? S
Acct. No. Description Amount
10.432 Building Permit Fees
10.431.600 Plumbing Permit Fees
10.431.601 Mechanical Permit Fees
10.230-501 State Bldg. Tax __ _ --
10.433 Plans Check Fee 1p
10-435 — Other Licenses & Permits
30-443 Sewer Connection
30.444 Sewer Inspection 1
24-446 Street Syst. Dev. Charge
?5-449.610 Parks t Syst. Dev. Charge _
25.449-62_0 Parks II Syst. Dev. Charge 1
31.450 Storm Drainage Syst. Dev. Charge_
10-430 Business Tax
10.434 Alarm Permit
10.227Bail _ ---
10.455- Fines - Traffic/Misd/ arking
10.230• CPTA Traffic/Mis,i/Vic. Asst.
10-456_ Indigent Defensrj _ --
30.446.401 Sewer Service/USA —
30.446.402 Sewer Service/City
31-447 Storm_Drainage _
40.475_ Bancroft Prin, Pymt._ —
40-471 Bancroft Int. Pymt.
10.451 Other Charges for Services
TOTAL
C)
DEPT.DEPT. -
: �s �
I
I
4�
4
BUILDING PERMIT APPLICATION TIGARD DATE. ud=2lBLF: '!,ta 84__ G .5110
THE UNDERSIGNED HEREBY APPLIES FOR A PE9MIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER Jt� :,ILLL�;_ JOBADDRESS j72i SW BOlil .. _� _
ARCHITECT u�—
ENGINEER
BUILDER SdP3E ADDRESS 1-11-201 2329�j���j! 995�j NER T _ --
STRUCTURE Or NEW 1-1 REMODEL. ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIHE DAMAGE Cl DEMOLITION
RESIDENCE ❑ COMM Cl EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB FENCE
OCCUPANCY -9=3_LAND USE ZONE - _BLDG.TYPE FIRE ZONE PLAN CHECK BY DTW HEAT—Bhs_
CONSTRUCT SINGLE FAMILY DWELLI14G WTATTACHED GARAGE.
3 BATHR0011 Z BLUKUUM
SEWER PERMIT# 28265 G.ARAGI? 410
OCC.LOAD FLOOR LOAD I IU HEIGHT 20 } NO.STORIES AREA 1235 `NO.BEDROOMS 3 VALUE,i4-3rOOV
BUILDING DEPARTMENT SET BACKS FRONT _ REAR 33 LEFT_SID_E 10" RIGHT SIDE b"
Permit _ 251.5U THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
163.48 REGULATIONS AND ALL APPt(CABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check_ _ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
4I4 9(i WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal • RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE.PERMITS REOU1RE0 FOR SEWER,PLUMBING ANn HEATING.
State Tax 4 1U.06
425.04 SDC—
Total LI 60.(10
PDCM -
APPUCANi'OA A�€i3T— _----
By 1e,A SIX .50.00
Approved ecelpt No.
GATE nr ST TYP[ P�JM6�NG A fE _._...
l i
- HEATING
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