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9053 SW BURNHAM ST'REE'T'
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INSPECTION NOTICE evre
City of Tip^.d Building Department C,Ctu c�J
12420 S.W. Main St. /_ 1
Tigard,Oregon 97223
Phone: 639.4171
Type of Inspection
Date Requested —LLL�( 7
sr-
Time A.M. 1"."�P.M.
Addresq ��tJ ✓� ��^' / l
yv�S-—. Pe.mit
Owner—_l(/ I fc t.L '��1. �`l �.�' --- Lot #_�
BuilderThe following following Building Code deficiencies are required to be corrected:
i
Presented to — �{
Approved
Inspec,ror
❑ Disapproved
Date
CALL FOR RVAISPECTION
❑ YES 'eNO i
CITY OF T1FA RD No. 0416
12755 S.W. ASH
P.O.BOX 23397 Date '
TIGARD,OR 97223
Name
Address
Lot Block/Map Subdivision/Address
Permit k's Bldg. Plumb Cash Check
_ 5Gh
Sewer V Other Other Rec. 13 i
IrAcct. No. Descri tion Amount
10-432 Building Permit Fees _ 2 ,
10-431.600 Plumbing Permit Fees
10-431.601 Mechanical Permit Fees —
10.230.501 State Bldg. Tax _
10.433 Plans Check Fee
10.435 Other Lirenses & Permits
30.443 Sewer Connection
30.444 _ Sewer Inspection
24.448 Street Syst. Dbv. Charge
i 25.449.610 Parks I Syst. Dev. Charge _
25.449.620 Parks II Syst. Dev. Charge
31-450 Storm Drainage_Syst. Dev. Chargr.
10.430 Business Tax
10-434 Alarm Permit
10.227 Ball
10-455- Fines-TrafficlMl_sdlParking
10.230- - CPTA Traffic/MisdlVic. Asst.
10-456 v Indigent Defense
30.446.401 Sewer Service/USA---
30-446-402
ervicelUSA—30.446.402 Sewer Service/City`
31.447 _Storm Drainage
40.475 Bancroft Prin. Pyrq. _
40-471 _ Bancroft Int. Pymt.
10.451 Other Charges for S.;rvices
TOTAL C)'
"- ' DEPT.
BUILDUNG PERMIT APPLICATION TIGARD DATE_ OCGOber ;.'..' �g u�� 5007
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHCNE
OR AS SHOWN AND APPROVED IN I HE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNEI3 PHONE
LOT NO.— 1501 _.
OWNER Wilbur Syobm JOBADDRESS 9053 SW Burnham 2S1-2AD _
ARCHITECT
ENGINEER
BUILDER NiCkli `ADDRESS ---T-_—__ --_DESIGNER --- - _ - -
STRUCTURE ❑ NEW ❑ REMODEL ® ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIR-'!'OAMAGE ❑ DEMOLITION
[A RESIDENCE I.] COMM ❑ EDUCATIONAL ❑ GO_WT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAIE ❑ SLAB❑ FENCE
OCCUPANCY -lit _LAND USE ZONE CBW-____BLDG.TYPE FIRE ZONE_— PLAN CHECK BY BC1t 0EAT__
CvalltrtaCt jL4sye addition to existing Single imEly dwallit%*
SEWER PERMIT M
OCC.LOAD FLOOR LOAD CO{LG.HEIGHT 14 NO.STORIES 1 AREA 929 NO.BEDROOMS VALUE
BUILDING DEPARTMENT SETBACKS FRONT REAR ---5-- LEFT SIDE RIGHT SIDE 6
Permit 1i 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 Check WORK WILL BE DONE IN ACCORPAt S:E WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
acll•j3 mm ALL APPLICABLE CCDES AND L,RDIr1ANCES, THE ISSUANCE OF TWI' PERMIT DOES NOT WAIVE
Subtotal _ RESTRICTIVE COVENANTS CONTRACT )H AND SUB CONTRACTORS TO HAVE Lun^'FNT CITY BUSINESS
State Tax
•9U LICFNSE.SEPARATE PERMITS REOUIREU FOR SEWER,PLUMBING AND HEATING.
ZU�.1).: SDC-
Total --- -— .-
-—-- —�
By CZ PDCM 'APPLICANT OR AGENT
_
Receipt No. ( J(r -------
Approved BCR ADDRESS PHONE
z
DATE INSP. T PE INSPECTION _ REMARKS —— PLUMBING Dp i E
li Contractor
AEiPermit Nov—_—
Hough,-
d2 ough 1 _
_ HEATING
I j
Gas or Oil
--r
R.)uoh ^
—�--{ ------- i' Final
T SEWER
Find I '
DRIVEWAY
Final
— — -- Main Drain)Fwal
Curb 3 Street Final
Approach
— RLDCt. DEPT. IrINr.L 1'EMPORPRY —TCERTIFIc PTE OCCUPANCY Final T�
CKR.' ICATE OCCUPANCY __ __--.—«—
u
� Landscai:,•ig
zoning Final