12645 SW KATHERINE STREET ■. iw �sr a�n � srr �r � � e
12645 SH 'j ThERiNE STREET
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: 1 N��� ,. PERMIT NO. , _
DATE: 7 A�3/:'S DATE C m,-AUED :__L�
OWNERS NAME : rnvL,_
ADDRESS:
CONTRACTOR :
TEST : Air CJ, Woter[I , V sual p , Laboratory p
RESULT: Approvers Disapproved 0 Pan ting p
a KETCH:
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S CTOR DATZ
ENOTZ: Attach supplemental felt data herpta]
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City of Tigard
IPNSPECTION REQUEST 1
for
INSPECTION TIME: le ' �� PEPMIT NO. : I
DATE: /P L��� DATE ISSUED : I Z j
OWNERS NAME : ��'>`� 5' le
ADDRESS: ' � _�� �'G�/, �r 'v�'��✓ _ I
CONTRACTOR :
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TEST : Air 0, Water C7 , Visual, Laboratory p I
RESULT. Approved , Disapproved O , Pending
SKETCH.
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INSPECTOR DATE I
NOTE: Attach fupplemifntai +sit data harrio,
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City of Tigard
INSPECTION RE.QUES T
for
INSPECTION TIME: ) '#lRMIT NO. :---
DATE:
O. : _-DATE: 4-� //A/ '5 DATE ISSUED
OWNERS NAME
ADDRESS.
CONTRACTOR : .-.-,-,--.----.----- _- -- ---------
TE$T : Air 0, Wntor[] , VitualX Laboratory C]
PESIJF T' Anr, " ,d f7 niq%r prov -,, Pending O
SKETCH;
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City of Tigard
I
V" SPECTION (REQUEST
for +Lx�4tjc-
INSPECTION TIME: ZZ PERMIT NO. :---
DATE: 3'- Z/X/;Z>
O. : —_DATE: �1/f/1.> DATE ISSUED :--Z Z I
OWNERS NAME
ADDRESS: .? e,- cit
CONTRACTOR : •S'`�� '�____ ___ I
TEST : Air p, Water❑ , WSUG1� Laboratory ❑
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RESULT: Aparn,/nd 0 , Disapproved Pending ❑
SKETCH: /�, v �'M
/ M OA'
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INSPECTOR DATE
FrTEAttoch 11ju, h-rf'tp-
City of Tigor'd
INSPECTION RFQk' f:,, E
for
INSPECTION TIME :J__ �1 , PERWT
DATE-. _-�'3__,Alt2!Z'nATE
OW N E R S NAMEP I
A 1)DR E__S S
10OH-TRAC"'OR
TENT: Air D., Water Visur',e, I_aNirmfo
RESULT.' 6rrovrd Uisapprov-9d 0
SKETCH:
INSPECTOR
CN07E'. Affimch to.4,t
.va.�, . ,.,,.,r•,.r.waw,,rr..� Rt.tirer^.+Maw.�.y.yw«...r..
LOT CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE N� OISO
p
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THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
M!'bT�1C:'i P -+`�* ••% • BUILDER PHONE
QWNERADDRESS_ UI
---------
ENGINEER
BUILDER - ARCHITECL -t DESI3NER
STRUCTURE O� NEW _❑REMODEL _❑ADDITION ❑REPAIR ORENEWAL ❑I IRE DAMAGE_ ❑OE,a,OLITION
❑ RESIDENCE 1.�COMM ❑EDUCATIONAL 0GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE []STORAGE.:DSLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN RSVIEW ❑COUIJCII. APPROV'cD ❑SIGNS
OCCUPANCY_—LAND USE ZONE__ ;`7 BLDG. EYPE__ FIRE ZONE 15 PLAN CHECK BY- � HEAT._-___-.,_—_,
residence! to be cwe)nstruct9d ac,curd.tng to plwls submit,- —
OCC. LOAD —_FLOOR LOAD —40 ILI _HEIGHT^ e NO.STORIES AREA _VALUE
-- BUILDING DEPARTMENT SET BACKS FRONT REAR '_EFT SIDE 3 0 RIGHT SIDE 13
Permit - ---- •- --- — ---------
THIS PERMIT I5 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPUrABLE CODES AND ORDINANCES AND IT IS HEREBY AGREED THAT THE
--v'-' WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. '(NE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS. CONTRACTOR AND SUR CONTRALTO-5 T'O HAVE C:,HHtVT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total
By
nrni irnnt C)n n.erv7
Approved Receipt No.
nnnnr;5 I•���,Nc
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor,
V r'o 00 Ole-' -To PuLA,2—
Itev Permi• NoeoS;-.-j
Rough in
Fixture
Final
4 HEATING
cf
clo. Contractor
Gas or Oil
Rough in
Final
SEWER lu' A4��_-
f�1�411 1 Final---- 4 C
DRIVEWAY
Final
Storm Drainage—
(Rain Drain) Final
Sidewalk
------- Curb&Street Final
Approach
BLDG DEPT, I INA( TEMPORARY CERTIFICATE.OCCUPANCY
CERTIFICATE OCCUPANCY Final
FzLandscaping
.'�"'y Final
^GDRESS _ �� �i'S CL4-�� ticc�lcc�c-t.c_� �r'pERMIT NO. Sy
PERMIT CHARGE none
OWNER CONNECTION L
FEEPAID 8Y A/ ,t; &LL� 1i_� `
TYPE OF BUILDING ;e DATE CONNECTED _
SERVICE RATE �z11t��A-tJ- INSPECTION FEE
CONTRACTOR � ti:�_ /1)A.�, ,�i r1r PAID BY �1G-tut_ DATE
SIZE OF' CONNECTION 4' ASSESSMENT PAID
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