12820 SW GRANT AVENUE-1 12820 SW GRANT AVENUE
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BUILDING DEPr,f�l'r`,l;rl`aT, TICARM Y
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PLUMBING PERMIT
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ho,car of a vat d p!urrbing contrzxtors liccns�i is hereby
authoriz�•1 to taus,- plumbing wort: as herei,l noted to be inst-311c.1 in accordarwa with the plumbing code of i
t-aHations rc' uire inspection b the n hall be notified not less than four
1 Tigard. Such ins -.. y p y City Inspector who s� n
(4) hours prioi to the tinge the int t.21lations are ready for inspection. City of Tiear•1 Business License requir;.d
for all contractors and s1 b•contractor::.
01,V r e rek2!pi
- NUr.13cR OF TOTAL PERMIT NO.'S
ITE:'S FEE Of EACH AMOUNT _!Office U;n Only)
1 TY?E OF PERMIT 1 -4-T IAL — }
Sinal-! Famiry-1 hath-each 25.00 _ 4r
OuDle-t-cath 1 ba-,'v unit 25`00
Additional �j tzhroumi-exh 10.00 -�
Mcbii3 Home Saaca-aa-:%
INDIVIDUAL FIX"rURE FEES
I to 50 Firturat in 1 buildir -axh 3_00
51 w 100 Fia;u,ei in 1 5uildir,-each - _ 2.50_
101 to 700 F:xturei 'n 1 ba;Idirr-edtii 200---.--
- t- ---- - -- - - �` I
or mor, Fix_ur,, in 1 builrl_n�e?ch _ 1,50
MISCScOUi
8ui!dir; S�.v_ .r-Lt 50 f!• - - 10.00- -
StA*,,-etch rd,!;cionel 1C0 !t. 10.00
Iirg to b0d;r.1 5.00
Privet,-P:_Vtar Svr.erri-eich 100 ft. _^ _ 10.eu --- v- - x
Otho• (So�clf•:1: - _- _ _ ___.._._ �
PEn,,r.IT � �o^� ForPlur»91ng in PhorR ei39-4171
I y�3,St•�t'� cC, Plumbing Contractor 8y
ETOTAL RECEIPT NO. Iss;nci By __ t
My
-1 r S YP^
BUILDING PERMIT APPLICATION coF TIGARD DATE.-_
THE UNDERSIGNED .,,-REBY APPLIES FOR APEriMIT FOR THE WORK HEREIN INDICATED LUILDERPHONF_-__
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE �_"
LOT NO_ `L 3 r
UWNER /I 1 I I.t L L .A.0111 ADDRESS 1AJ69U SU GrOlIt HOME ADDR' SS
- ARCHITECT
ENGINEER
BUILDER _1- F&M.:jri1,1 fla _ADDRESS
1r"10 3C NE 02nd. Pf,%r tjVinlj DESIUNER_
STRUCTURE ❑NI=W ❑RR�FNIODEL � l'YADDITION C3 REPAIR— ❑RENEWAL- ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY-If-3 LAND USE ZONE—€t'-7 _BLDG.TYPE �N FIRE ZONE_`S PLAN CHECK BY iJuh Hr-AT IOU*
_ ilistruct a OJLA n 6o Dir uA_q fumiiY I4wrlling per plane and Cudej ---
�;;;I i tiaj or 1 kl�tjroggmr 1 Beth„ slitting rearm and future ka,tch92
sE L cC:,PCC1IUB► SHEEP ATTACHED* _ __— 1 asdruum -- 1 Bath. _-
40 HF �5 � 41OCC L4A2A--,_! QQMS VALUE
BUILDING DEP_AR7MENTSET BACKS FRONT :aE� REAR LEFT SIDES r RIGIIT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT- TO THE REGULATIONS CONTAINED IN THF 9U11 SING CODE, ZONING
Plan Check 34,00 REGULATIONS AND ALL APPI ICABLE CODES AND ORDINANCES, AND iT IS HEREBY AGREED THAT THE
WORK WILL.BE DONE IN ACCORDANCE WIT:-;THE PLANS AND SPEI;IFICATIONS AND IN COMPLIANCE WITH
Sub-total 1021100 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF ;AIS PERMIT DOES NOT WAIVE
RESTRICTIVF COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 4" 2,72 LICFNSE SFPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total— $10 1.72
By P1 APPL-ICAA11 OR AGFNT�-
Approved rir.,rht Rvicelpl NO
DATE (NSP. TYPE INSPECTION REMARKS PLUMBING DATE
�— Contractor
./2 ' u. 04 O/C Permit No. 190 ?-/7-'
t[t�2ausK� a -- _ Rough-in
Fixture
Final
�o_I �_ fo7= (� pi•.r�AsQ;je`�� r� U /2 yAyc �.-
-"-7— HEATING
— Contractor
— Permit No.
--- — Gas or Oil
— - — Rough-in
--- --- ---___- --- Final
-- ----- — --------- SEWER --
Final
— DRIVEWAY
---- ----- ---
Final
---- ---------- ------- StorArDrainage
(Rain Drain)final
---- --- -- ------------ Sidewalk
�— — Curb&Street Final
Approach
BLDG. DEPT.FINAL Tt:MPORARY r CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY I __.— --.-._.._-- --- --
Landscaping
Zoning Final
K
Tax Lot 2 ST 2 BD 2400 23-1.0 North Ti.garc}ville Addn„
Aseessment " 498.56
Lateral. 70.44
569.00
SA 11-1-61 28.45
& 5-1 thereafter
Address_1 y L_0 �. __ � Permit No _
Name of Occupant k_ Permit charge
Connection fee_. Z 00,1)
------ _ -- _ Paid by 1/ % i _----
Date connected___
Type of Building Ins ection fee �.
Service Rate 2., i Paid by DateIJ
Contractor Assessment 416 9" D 0 —Paid. _—
Size of connection-