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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 rf GIS—� —
Date Renuestedd 'A. A.M.
Address _ G IJ l���. — Permit #_ —
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presenter) to Approved
Inspector _ G �� Disapproved
Date
CALL FOR. REINSPECTION
[] YES NO
i
BUILDINuPE.RMIT ;PPLICATION TIGARD DATE ticttg)er_4 10 — 5051,
THE UNDERSIGNED HERI=BY A"PLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE.----.--
LOT
HONE._--_.__LOT NO.
_OWNER Jay Hiller JOB ADDRESS 7g1��w ;#�t,�tr�gi� jinrxiPk II
ARCHITECT �.
ENGINEER
BUILDER ADDRESS _ DESIGNER
STRUCTURE [I NEW _ ❑ REMODEL — ❑ ADDITION O REPAIR O RENEWAL _ ❑ FIRE DAMAGF _ ❑ DEMOLITION
G1 RESIDENCE ❑ COMM EDUCATIONAL ❑ GOWT ❑ RELIGIOUS Ll PATIO Cl CARPORT D GARAGE ❑ STORAGE O S'.ABCI FENCE
OCCUPANCY ___-LAND USE ZONE _R-12 BLDG.TYPE _25_�FIRE ZONE-__PLAN CHECK BY _�iS:N__._HLA T_-_Si88_
Ccnstruc:t-eiyUln family dwallirvi ►+/attfichetl yerrtue. .--_ - -. ---__-- �
RE-Ianua of Flermit 44747 See Lot line c;tttiestment H 6md,4
3 I+athro(ri 3 6edruon
SEWERPERMITO 27980 Caraae 487 —
OCC.LOAD FLOOR_L.OAD___ U HEIGHT j NC.STORIES 2 AREA 1522 N0.BEDROOMS j VALUE 01 ( .
BUILDING DEPARTMENT SFT BACKS FRONT _211_ REAR 5J LEFT SIDE 1_3 -JRIGHT SIDE r�
Permit 316.UQ 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 AGREED THAT THE
Plan Chock 411.00 _ WORK WILL BE DONE IN. ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINAVCES. THE ISSUANCC OF THIS PERMIT DOES 140T WAIVE
Sub-total __ 3Sfi.UO RESTRICTIVE COVENANTS CONTRACTOR ANU SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 17..64
I SDC— , , . . 11Total 3k;tYuf)4 ' •� ` —_— _
PDCO-1 0 A� *N
I 150.0h. T r
By CZ SSDC 250.00
Receipt No. - —
Approved FICR ADDRE88 - i— - PHONE
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