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INSPEC"PION NOTICE
City of Tigaru Building Department
12420 S.W. Main St. t�
Tigard,Oregon 97223 1
Phot e: 639-4171
_
Type of Inspection —_-- ' ti'1 —
Oate Requested Time A"AV j ---P.M.
C
I Iq S
Address Permit #_"// _
Owner ---- O��wd I Lot #
BuilderThe following Building Code deficiencies are required to be corrected-
Presented to '� Approved
Inspector ___ _ � ❑ Disapproved
Date
CALL FOR REINSPECTION
I r�
YES 2f NO 1
i
CITYOF TIOARD No. 124.)
12755 S.W. ASH
PBOX ODate TIGpRD, OR 9 97223
Name
6)4
' Address
i Lot Block/Map Sub/Olvision/Ad/dr ss/
jow
Permit Ws Bldg, Plumb Cash Check r—
Sewer Other — Other Rec. By i)
Acct. No. Description Amount
10-432 Building Permit Fees _
10.431-600 Plumbing Permit Fees
10.43_1.601 Mechanical Permit Fees---'-
10-230-501
ees •10.230-501 State Bldg Tax
10-433 Plans Check Fee : ,.
10.435 _Other Licenses & Fermits
30.443 Sewer Connectior
30-444 Sewer Inspection I,v
24.448 Street Syst. Dev Charge
25.449-610 Parks I Syst. Dev. Char e
25-449-620 Parks II Syst. Dev. Charge 6 &C,
31.450 Storm Drainage Syst. Dev. Charge
10.430 _ Business T,oA
10.434 Alarm Permit
10-227 Bail
10-455 Fines- Traffic/Misd/Parking
10.230, _ CPTA Traffic/Mlsd/Vic. Assts —
10.456 _ Indigent Defense �-
30.44E-401 Sewer Service/USA `-
0-n:d-402 Sewer Service/City
31.447 Storm Drainage "
40-475 Bancroft Prin. Pymt
40-471 Bancroft Int. Pmt. —V
10.451 -_ Other Charges for Services
----— ---__---- —�� TOTAL
—�
DEPT.
�� 1
BUILDING PERMIT APPLICATION TIGARD DATE_ "� "'�r 14 ,19 ''A 5118
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK.HEREIN INDICATED BUILUERPHONE 6.39.5742 —
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—
LOT-N0._,4__ _.. _
OWNER g1 4 xrQ__ r. JOB A[)DRESS 7947 Sit 49tlCl Sr, ARCHITECT _.lion n_j!irfc IT
ENGINEER
BUILDER 5=;'w A DDRESS ��j�4 ��,./. DESIGNER--
STRUCTURE Ejr NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEW—A41 ❑ FIRE DAMAGE Y ❑ DEMOLITION
RESIDENCE ❑ COMM [I EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS 1-j PATIO ❑ CARPORT ❑ GA4GE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY .A-3 LAND USE ZONE _ "Z__BLDG.TYPE FIRE ZONE _PLAN CHECK BY °_T4-HEAT— Gas
Consttact sine fwni11r 1well.2 v/atta!- (:sryge.! _
3 Ijegrog�,, : :iat1Lro9oi
SEWER F'EhGll' ` .:'" i I r_ a"ge 4402 -------- ---
OCC.LOAD FLOOR LOAD 4U _ HEIGHT I NC.STORIES AREA 1341, NO.BEDROOMS 3 VALUE 5()•000.
BUILDING DEF 4RTMENT SET BACKS FRONT REAR ; LEFT SIDE RIGHT SIDE 10
Permit 2z13.uu THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGUI ATIONS AND ALL APPLICABLE CODE'y AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check WO' „ WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
W fH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 6ti.45 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING,
State Tax 11.32
— SDC— `�UU•�� ✓1 j J
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tal 4?zi.27 ' '
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PDC#1L 15U100APPLIC- ANT OR AGENT -�^
t:Z SsUC 2SU.
Receipt No.
nved ---
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