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City of Tigard
INSPECTION REQUEST
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INSPECTION TIME: PERMiT NO—Al�--
DATE * DATE ISSUED ._._._L1._
OWNERS
ADDRE S S
TE ST '. Air E-j, Wnter El . Visual [3 , Laboratory C
RESULT* Apprcv 'Disapproved r'J Pending
SKETCH:
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City of Tigard
INSPECTION REQUEST
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I INSPECTION TIME : `4e' PERMIT NO. : T
DATE: �I42AI; 5 DATE ISSUED:
OWNERS NAME : _
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ADDRESS : - V
CONTRACTOR � A• +�• �c �- 1 �` _ _ _
TEST' Air 0, Water ❑ , Visual, Laboratory ❑
J RESULT: Approved Disa
pp.___�_.. Qprove," C7 , Pending L7
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INSPECTOR DATE
EOTEAttach supplemental test dato hereto
ADDRESS Y , ,r,�_.�a�� PERMIT NO•_ _._._ �`'��'/ ___ _
PERMIT CHARGE n� ne
O!J N E R _ CONNECTION FEE
PAID BY
TYPE OF SUILf. NG DATE CONNECTED
SERVICE RATE rl �..-li; - - -- - - !NaPFCTION FEE
CONTRACTOR .= „r PAID BY DATE
SIZE OF CONNECTION ��� PSSES.;MENT _��� PAID
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City of Tigard
INSPECTION PEQUES"r
for
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INSPECTION TIME: 9'OV PERMIT NO. :
DATE: J �S. DATE 13SUED :__1�.
OWNERS NAME .' —
ADDRESS:
AME :ADDRESS:
CONTRACTOR *.
TF ST : Ai► p, Water[] , Vieuol [I , Laboratory J
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CITY OP �.;. '.. •� NO 0299
BUILDING PERMIT APPLICATION TIGARD DATE - --- 19_--
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE_
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OWNER dob Smith ADDRESS lot i:S E.f•I;jA.iSwuuO ;;ubd BUILDER PHONE --
ENGINEER
BUILDER 381711B) __,_� ARCHITECT _ DESIGNER
STRUCTURE ANEW 1:1 REMODEL ❑ADDITION C3 REPAIR ❑RENEWAL -❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM []EDUCATIONAL ❑GOV'T GRELIGIOUSCIFATIO ❑CAR PORT ❑GARAGE C1STORAGE❑SLAB ❑FENCE
OBOND ❑MOV INC, ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPR-)VED ❑SIGNS
OCCUPANCY__.—.-.LAND USE ZONE. �' l SLOG.TYPE —� FIRE ZONE 1 PLAN CHECK BY r f e HEAT---—
-unstrurt 1455 oqa ft. fr+sms dwelling with a.h1;echsd
---- - — --- gorego — no basement aacardirig to uppravod plans.
Q.C, LOAD FLUOR_LOAD 40 lb ,HEIGHT � - � NO.STORIES l_ AREA 1939 VALUE o
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 12�',Ap — -= -- -----_- ---------- ---- ---
THIS PERMIT IS ISSUED SJBJECT TO THE REGULA,fONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 63,50 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-' RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State 1. 21' LICENSE, SE-A.RATE P:RMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total 1,91,27
BYr __ --- -- _---
--------- - APPLICANT OR AI:ENT -------
--------------
Approved Receipt No.
ADDRESS - III1ONf
LL DATE INSP. TYPE INSPECTIDN REMARKS PLUMBING DATE
4e: -C Ole— Contractor & O
Permit NO. (V/3/ 5_ W`/Y->>!
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Fixture
Final
10 HEATING
ContractorOl —
�E�r�/ _ Permit No.
Gas or Oil
Rough in
Final — —-
---- -- SEWERj6. 2p• -
Final
DRIVEWAY �- -y-7-
Final
Storm Drainage
(Rain Drain) Final
Sidewalk -75-
Curb
jCurb&Stree! Final _
-- _
Approach -7,:,
01_QG.QEPT, FINAL JTEMPORARY CERTIFICATE OCCUPANCY
9 tt CERTIFICATE OCCUPANCyi final
✓ / '.J J ��//' / / `%` landscaping
Zoning Final
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