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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 ..0"-
Date Requested_— ��"" 2 _ Time a.M.-
�� � P.M.
Address .='`& �dvt`permit
Owner-- --�— lot #-- —
iBuilderThe f�ollllow�ing�Building Code deficiencie_ area ree�pired to be corrected:
--�=�".-"y'`f-s''<_ �-,'��,--t.. ��2'�s--'L�t_;u-sem. ✓
Presented to Approved
Inspector _
• _ _ �_� Disapproved
Date
CALL FOR REINSPECTION
ED YES E NO
CITY OF TWA RD No. 063J
12755 S.W. ASH C
P.O.BOX 23397 Data
r TIGARD, OR 91223
71
Lot V Block/Map Subdivision/Address
_7 7�/s �S
Permit pi's bldg. Plumb Cash Check
L(
Sewer Other — Other F -e-c`. By) ,
Acct. No. —De scrl tion 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 -ie)
10-435 Other Licenses 6 Permits --
30.443 Sewer Connection r
30.444 Sewer inspection
24-448 Street S st, Dev. Charge
25.449-610 Parks Last. Dev. Charge
i 25.449-620 Parks II Syst. Dev. Charge r C)CJ
31-450 Storm Drainage Syst, Dev. Charge
10.430 Business Tax
10.434 Alarm Permit —�
10-227 Ball — - —
10
.455- — Fines - Traffic/MisdlPrrking g -
0.230- — CPTA TraffictMisdlVic. Asst.
0 458 Indigent Defense-
30 448 401 Sewer ServicJUSA —
30-446.402 Sewer ServlcelClty —
31.447 Storm Drainage_ '--
40.475 _ Bancroft Prin, Pymt
40.471 _ Bancroft Int. P mt --
10.451 Other Charges for Services
TOTAL
DEPT.
r�
BUILDING PERMIT APPLICATION TIGARD DArE— ✓c►.mt+ec 5 ___,ts �14 5084
THE UNDERSIGNED hEREBY APPLIES FOR N PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THF ACCOMPANYING PLANS,AND SPECIFICATIONS. OWNER PHONE
LOT NO. -- ----
,, nWNER Jay -Her_ -- JOB ADDRESS Z - w Lkmd s BL — -------- id Srli — ---- —
ARCHITECT
ENGINEER
BUILDER Sams ADDRESS 0.0. box 23291 DESIGNER
STRUCTURE ® NEW ❑ REMODEL ❑ ADDITION LJ REPAIR L RENEWAL ElFIRE DAMAGE CI DEMOLITION
12 RESIDENCE Ll COMM ❑ EDUCATIONAL ❑ GOWT 1:1 RELIGIOUS L7 PATIO E CARPORT ❑ GARAGE ❑ STORAGE U SLAB[] FENCE
OCCUPANCY _ it-3 LAND USE ZONE '�p�BLDG.TYPE 5" _FIRE ZONE____ PLAN CHECK BY En HEAT Gab
Construct single [andlydweAling w/attached _-
2 Bathroom 3 hvdrucm
SEWER PERMIT 0 17997 Garage 46U
OCC.LOAD FLOOR LOAD_4U HEIGHT ZU♦ N0.STORIES 2 AREA 1491 NO.BEDROOMS 3 VALUE 35 p000•
BUILDING DEPARTMENT SETBACKS FRONT /_0 REAR 29 LEFT SIDE S RIGHT SIDE 5
Permit 296-- _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AUREED THAT THE
Plan Check 193.70— WORK WILL BE DONE IN ACCORD4NCF. WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND OAU1NANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRAC rORS TO HAVE CURRENT CITY BUSINESS
11 9Y LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
•
State Tax _
Total 103,62 SDC—
_ _ —
PDCN I I I U.UU APPLfCAIOT dA ACS€6If�_
By CZ SSoC 25U.1K1
Receipt No. ---_—-_ -
Approved __ STW _-- ADDRESS rHclNl=
DA Tr SP. Ts'pr IN,r'1'Cl'If?N NEMAPK9 I',-UM►,.No - uATE d
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klLtid DEPT, FINAL TEMPORARY — CkRTIV."AlC OCCUPANCY
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