9839 SW KIMBERLY DRIVE-1 9839 SW KIMBERLY DRIVE
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0 CONNECTION FEE
PAID R
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TYPE OF BUIL01ING DATE CONNECT
C.
SEPU !FE RATE INSPECTION FEE
Ujr,.'TRACTO� PA ID BY DATE
SIL-,F OF CO3"JECTION A_55E55MENT PAID
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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
11 ARD OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
fr)llowing item(s) require correcting:
00
x� Permit No.
Inspector
CALL FOR REINSPECTION
CITY OF TIGARD BLDG, DEPT.
12420 S.W. MAIN STREET
TIGARD 3REGON 97223
PPON,z 639.4171
CONTRACTOR
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
.7
,L
Permit �4o—
Insp,..-ctor
CALL FOR REINSPECTION
w w w
RUILDI,,N, DEPAFlTMENT, TIGARD
PLUMBING PERN1�0ll7 •
holder of a valid plumbing contractors license is hereby
authorized to causo plumbing wore'
as Mein noted to be installer.i in acr;ordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4; hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and suh-contractors.
-/-
`
Owner_. ?�.�.��.>,::�s'---------_---___Addres;.����.�t�_ :���- ' Datt:..__ `•%t
- NUMF3En OF ^t A1. FERh11T NO:S
TYPE OF PERMIT _ ITF.�.15 FEE ON EACH AMOUNT (O Pice t!,e Only)
.-
1 Single Family-1 beth-each L� _25.00
Dupl_gc-Each 1 bath unit _ _. _ 2500
Additi,inal bathrorms-oich _ _ L_i _ ! 10.00
Mobila home Spice-each 15.00 +
.. - - --- ---
INDIVIDUAL FIXTURE FEES �_• _ _ _--_�-
1 to 50 Fixtum3 in 1 building-each _ 3.00
_-51 to 100 Fixtures in 1 buiidingearh -- 2.50 {.{
101 to 200 F:xturey in t build —each 2.00 i
- 201 or more Fixtures in 1 bu;Irl� •_each -- _ 1.50
hl1SCELLANEOU5
8uilciirsg Sawer�tst 50 ft:r_.._ __.r--._--- 10.00_
_Sawer-evch add tional 10U ftp 10.00 11
Wacar Service to building _ 5.00
Private Water Systons-eq(h 1.000_ftp _ 10.00
Othnr (Specify); __
1 P RMIT _ _- '� `ter For PlurnSi,79 Inspertinn Phone 639-4 l/f
S State --_ / -5`�' _ Plumbing Contractor By
OTAL ,,. '� yr RECEIPT NO. Issued By
_.""."""'""'may„'�^'-'^'"�„e',g,,�....,....._.••..,,.�.....___�.-_._.._��,..-..�...„,....
014.1
BUILDING PERMIT APPLICATION 1 FY TIGARD DATE ,9��
THE UNDERSIGNED HERESY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPRGVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE,
LOT NO_
OWNER Oi y A g KQt1YTLlt,, "i �— !OB ADDRESS: "; T HOME ADDRESS
ARCHITECT ---
ENGINEER
BUILDER _ !4!Y MLADDRESS —� DESIGNER _
STRUCTURE ❑NEW __ORI_MODEL C3 ADDITION ❑REPAIRJHFNEWAL _ [:)FIRE DAMAGE ^C [)DEN','-)LITTON
❑ RESIDENCE—EICOMM DEDUCATIONAL ❑GOV'T ❑RELIGIOUSI_IPATIO rr--Il t_ICAR PORT GGARACE_ ❑STORAGE DSLAB OFENCE
❑BOND — ❑MOVING 0CCNDITIONAL USE ❑DESIGN REVIEW OCOUNCIL APPROVED ❑SIGNS —
QCCUPANCY__4i I,AND USE ZONE. BLDG.TYPE_ __.FIRE ZONE_,._ PL,'_J CHECK BY_ HEAT
--- J1FTtIy, ;� � ClLelfi iR1H1��j? tirl&lrjl.lfAt W/��A'. t;llfol,I a�l't flltlliiN --
.NO.BEDHQQk43__3 ALU �3 . CICJ•(•.{i
BUILDING DEPARTMENT SET BACKS FRONT t' " REAR r LEFT SIDE ) RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE PEGULATIONS CONTAINED IN THE BUII DING CODE, :TONING
Plan Check 4«rty� REGULATIONS AND ALL APPLICABLE CC,DE- AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
— WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total t.�'7•(aF,l ALL APPI ICABLE CODES AND ORDINANCES. THF ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE SEPARATE PERMITS REQUIRE[) FOR SEWER, PLUMBING AND HEATING,
y,
Total 'J;J.
---- - -
APPLICANT Cl
Approved II 1 Receipt No.
DATE 1118P. TYPE INSPECTION _ _ %ZMARKB I PLUMBING _�-DA.E
Contractor J-
�!� (�• �/ _ Permit No.
r.�
Rough-in
ii 00 �� Fixture
//-/W/r!• L _ Final ---- __
HEATING
Contractor
_ ✓ �( L�-c�,�T�-- fry Permit No.
Gas or Oil
Roughdn ------
Final
SEWER �-
Final
�- DRIVEWAY
-- _.�� --- Final T— ---
—_ - Story Drainage
I`'(Rein Drain)Final
idevmIk
Curb R Street Final
Approach
IBI.DG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Lands" caping `-._�.----
oning F nal
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