11935 SW NORTH DAKOTA STREET L1935 SW NORTH DAKOW STREET
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME." d ""
PERMIT X10. :
' CATE: r.2L222�ZDATE ISSUED:--l--L—
OWNERS
SSU a:--l—.LO'id11NERS NAME:
ADDREE l: 7'
CONTRACTOR :_...
TEST.Av �1, %}Mier (3 , 11 Cl , Laboratory
RF-5S ES'Aj!j7-ov, �''� Disspproved O Poinding
SKETCH.
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1 ECTOR DATE
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CITY OF
BUILDING PERMIT APPLICATION TIG ARD DATE_ May 20 ,9 � 0839
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_
'';nary Gentsmann 11935 3.W. North Dakota(?YVNER ADDRESS � BUILDER PHONE
t1•i0r ENGINEER
BWI_DER ARCHITECT DESIGNER
��STRUCTURE ❑NEW ❑REMODEL ❑ADDITION C1 REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
L.JRESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED _❑SIGNS _
OCCUPANCY--_LAND USE ZONE _.BLDG.TYPE FIRE.ZONE__ PLAN CHECK BY i f `r �_ 4 HEAT I"luc trl.0
r.oi, :rust lU1:A320 Prams alldltlun on rear duelliny according to
plans — 1 hater separatlon batwFeen garage and living unit
C LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE J
_ BUILDING DEPARTMENT SEI TACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIr'PIS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ArCORDANCE WITH THE PLANS AND SPECIFICATIONS ANIl 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
IN State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 37.Tj 1
By J',tU.. C --
APPLICANT O AGENT
Approved -,r _ ._ Receipt No.
DATE INSP. TYPE INSPECTION nEMARKS PLUMBING DATE
Z& Contractor
2
7jI
Permit No.
b Rough-in
2—2*-A& iewc�u Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Final
SEWER
Final
DRIVEWAY
Final
Storm ljraEaae
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
9 LED)G.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
PERMIT TO CONNECT
Tigard Sanitary District Pc>
PERMIT N? 925 DATE
PERMIT IS GIVEN TO
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DFACRI$ED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
7 .
PERMIT FEE PAID 1........ ......" ...............TIGARD SANITARY DISTRICT
to ( > > _...-
rr_ By
CONNECTION INSPECTED AND APPROVFy1
7 5 p
Date Superintendent
Address L/9, yS ,�(.( _��Imo -__ Permit No. .?�,�
Name of Occupant _ Permit charge
Connection fee
-- - -- -- ---- — Paid
-----__- -- .-_-. -__- Date connected 1- G
Type of Building Inspection
Service Rate_ _ Paid by _. _ -__ _ Date
Contractor Assessment Paid
Size of connection
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