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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
..GARD, OREGON 97223
PHONE 639.4171
CONTRACTOR
P,lrsi ant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
ol
Date: Permi' No.
Inspector' .;-1_-_-_
""ALL FOA REINSPECTION
PLUMBING PER IT�~ ..J lY 0
�Ar o a� ids lumbin contractors p g actors license is herelty
autho. to cause plumbing work as herei noted to be installed in accordance with the pli,mbiny code of
Tigard. Such installations require inspection by the City Inspector who shall ba notified not less than four
(4) hours, prior to the time the installations are ready for inspection. City of Tigard Busine,s License required
for all c4tractors ands contractors.
Owner 9:�1 �' '� ' �,'_�.LLe Address-,Zf—'C�J0011 �r �
_ Date
tN�IAIIER, TO AL
TYPE OF PERe11TFEE OV EACH PERMIT NO _
Ah10UNT (Office Use_ 2S 00Oupl,;x-Each1 bath un25.00
Addilion.)l bathrooms-each M1000Mobile Home Space—Rdrh �15,00IN6IVIDUA'L FIXTURE i E_ES150 Factures inl buddin 9-each3.0051 to 100 Fixtures in I building-each 2.50_ �—
_I01 to_20_0 fir,tures in I building=each r _ y 2.00—
F—
.00 r
?0 i or mc.a Fix to "_2_1 build,n -rach� T.50
1;M IS C E L! ANE0US _
Buildin Sjwer�lst 50 ft. -' �' � � 30 --
Sewer-each additional f00 ft, `~ I--�10.00
rWater Service to building5.00 —
Privr!e Wa e_r_S sten•.!-each 100 ft.
1000
9 _
PE PrOI T c� �)Gl For Plumbing Inspection Phone 63941 -
_' State L) Plumbing C rrr By
TOTAL S'z� RECEIPT NO. Issi.ied 6y --�
.. — .s. ..
PERM
IT NO.
ADDRESS�_� �
GE nc,ne
PERMIT CHAR .,_.,
=n
•� COj;NECTION FEE
o IJ a�J
PAI 0 8y -- ---
_ DATE CCP;'.E.CTEU
T Y P E OF 3 U I L O i":G �'�� C � FEE —
r� jNSPECTIO�;
SEP.V ICF RATE
PAID 8 Y _ DATE
COr;TR:,�TOR
A55ESSmENT PAID
SIZE OF co piECT I ON
CITY OF TIGARD BLDG. DEPT.
12423 S,#V. MAIN STREET
TIGAR:), OREGON 97223
PHONE 633.4171
CONTRACTOR:
Pursuant to Section(s) of Vie Uniform Building Code, the
following item(s) require correcting:
liate.;--3-&C7' --,7
Permit N,,)._
Inspector -
CALL FOR REINSPECTION
I
S*
BUILDING PERMIT APPLICATION ciTv TIGARD DATE_ �� ��/ _ tg7� 9 � 8(
OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR IHE WORK HEREIN INDICATED BUILDERPHLNE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICAFIONS. OWNER PHONE
.—
LOT ATO. _
OWNER JOB ALIITRESS 4909 51, Aimbar l y HCME ADDRESS _
ARCHITECY --
3 I:f1.X f X191 ,•he9wuOd ENGINEER
BUILDER ADDRESS ' • la DESIGNER
STRUCTURE _ ❑NEW ❑REMODEL _ ❑ADDITIO_N ❑REPAIR_ ❑HFNEWAL _—I (FIRED A MMAG_E— ❑DEMOLITION
❑ RE_;IDENCE ❑CO'viM ❑EDUCATIONAL ❑GOV'T 01"IELIGIOUS❑PAII0 ❑CAR PORT ❑GARAGE ❑S-7RAGE❑SLA13 ❑FENCE"
❑BOND _ ❑MOVING ❑CONDITIONAL USE — ❑DESIGN REVIEW ,OCOUNCIL APPROVED ❑SIGNS--`
OCCUPANCI'_-
7�LAND USE ZONE "' I BLDG. TYP ------FIRE ZONE— PLAN CHECK 8Y �riJ HLA1
JIB `J Lt,►t t. tiYi'11 ).4 ttanitly [{L ;a1L� w/• '1.La]C�Ir-� _1 �i+,�y� ^- a '8910t'oom 3 Hatt).
Plumbin; mnwl '1ec h�ta11E�L I��x'mi� � Ui>: 114. - - -
T 0 Q
Q(;C- O .12 ;_��Qfl OA ... .__�iEJGHT a+ N9.$?.Q.HJ AREA 22GNU•
BUILDING DEPARTMENT 21 LEFT SIDE RIGHT SIDE
SETBACKS FRONT REAR ' '� � SLI
Permit
THIS PERMIT IS I.;SLIFD SUBJECT CC THE REGULATIONS CONTAINED IN THE BUILDING CODE, 70NING
Plan Check � '.aJ REGULATIONS AND All APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- -- WOPK WILL. BE DONE IN ACCOHDANCE WITH THE PI ANS AND SPECIFIC!.`IONS AND IN COMPLIANCE WITH
Sub-total ALL A,rL!CABLE CODES AND ORCINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
--- RESTRICTIVE COVENANTS. CONTRA(JOR AND SUB CONTRACTORS TO HAVE CURRENTCITY BUSINESS
State Tax LICENSE. SEPARAIt PERMITS REOUIRED FOR %OWER, PI..UI IVIG AND HFATING.
p�36116•A.I�.
Total a:.1_ $100,ou
By P1
, APPLICANT OR AC:LNT
Approved Receipt No.
.. NOKr+ __. -
a nlw .. ns � Ili iti sa 1�
r
DATE INSP. TYPE INSPECTION REMARKS �! PLUMBING DATE
- 7:
ontractor
— -
17 Fixture — _ —
_S2/- - r -x Final
► /� C __ _
T1s1 ---Lt�-CGS 1.►� c tJ� _ H E A T I N C4
Contractor
Permit No 1 5�;'�' 'A
— — — Gas or Oil
Rough-in
Final W^_
— �_ --- SEWER --
Final / -J
-- -- -- DRIVEWAY
— — --- Final
- —` Storon Drainage
" — (Rein Drain)Fivel
-' Sidewalk
—� — Curb&Street Final
Approach
PLD6. DEPT.FINAL TEMPORARY CERTIVICATE OCCrIIPANCY Final
CERTIFICATE OCCUPANCYU�_+�`J -
Landscaping
7_oning Final
CITY -• � { --^ p
'JILDING PERMIT APPLICATION UF I IC,, ,RD DaTEs�-� ____, i9z,�. N_ �
F,2S-
�E HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONFOWNER
;jR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, LOT NO Iio 3-3- _
Lor No 3-�r.._ ._
A..T. - JOB ADDRESS�—,` (�Q 6f/� HOME AF�DRE55
r / ,Ca -- ARCHITECT
624T
" ^/Cp ENGII EER
ADDRESS ,i�1i DESIGNER _ _
•U'~t_ - N14LW t^-�OREMODE OAUUITION FC-�tRZPAIR _-_ [:]RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
)( C NCF I.JC' MM-EIDLICATIONAt ❑GOVT DRFLIGIOUSQPATIO CCARPORT ❑GARAGE ❑STORAGEOSLAB ❑FENCE
I-IROND _ QMOVING -OCCINDITIONAL USE — ❑DESIGN REVIEW ❑COUNCIL APPROVED [-]SIGNS
..•uPANClt2�-3 LAND USE ZONF !�- 7 BLDG 7vPE_j w`FIRE ZONE 3 PLAN CHECK BY-� HEAT--:g,----
Ile
EAT-- --- =
_ _ _. c eGCt1�d�_t,�cC.�--..d'1�e�__���Q.�ua�:�y.:_..`t .-•' .f6e� itAa�'.�'��=L.�e����'—' _..
clr:� 1 Q9Q __. �'_FL_QS2�L4?IZ_-.Y_CL__H!S:I�T_.� j --_►ALO. $I4RIF, ARt—AZ.Zf_f.NQS BEDB .4NJ1_VAL.ULf-Z ,7 f.--
BUILDING DEPA,iTMENT SETBACKS FRONT .Z / REAR �� - LEFT SIDE X O RIGHT SIDE -3 d
'PImIt2 0 .3
-" 'FHIS PERMIT IS ISSUED SUBJECT TO THE REGULA`IONF CONTAINED IN 'SHE BUILDING CODE, ZONING
Plan Check / •S RFGULATIONS AND At L APPLICABLE CODS AND 'aRDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK VnLL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Suh total �� ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— --- 00y RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE. SEPARATE PERMITS REQUIRED FOR SEVER, PLUMBING AND HEATING.
Toial
BY
APPI ICAN1 OR AGFN7
ACED,oved RPceipi No.
SD
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