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16660 SW QUEEN MARY AVENUE
-KING CITY
INSPECTION NOTICE
City of -Tigard Buildinq Departm,?nt
P.O. Box 23397
Tigtrd, Oregon 57223
Phone: 639-4175
Type of Inspection
Date Requested -1 Time--A.M._. �'� P.M.
Address
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to
- ---- Approved --- ----
Inspector _ L"J_
Disapproved
Date
CALL FOR REINSPF,CTION
L7 YES [n No
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone- 9-4175
Ty�i of Inspectio --�
Date Requestsd Ti A.M
a . _�Pm
Address ermit # � -
Owner __ _/ -- -- Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ — L1 Approved
Inspector r� _ Disapproved
Date —
CALL FOR REINSPECTION
❑ YES 0 NO
cQ KING CITY CMC ASSOCIA'T'ION
3 APPLICATION FOR ARCNITE,CrUlIAL AND MUCT•JjtAL CIV NCE S
If
kq
ADDRESS
ti`s �Z
TYPE OF Ck1 NGE REQU' M:
ATTACH A PROPERLY EMOMDRAWING, SHC�Ii1G P► N AND ELEVATION, TO '1111S Fm"'
NAME OF CO IUMUCTION F IR11 (IF' On" 'THAN RESIDF14T):
— MILL BE INFORE IFD OF DIE kF�QUT .STED C,WX;E. IF TH X IS
1. ADJACENT PROPEny OWNERS
AN OBJECTION, 'THE OBJECTION WILL BE REE.AYM TO 111E RFSIDEill ASKING FOR I1IE
CHANGE.
Z. SUBMITDEIS FORM AND AGC�•pA[VYIbiG ;)RAWING(S) To ��r K.C.C.A� A.
CK�D OF
3. HAJOR STRUCTURAL CHANCES ARE' SUI'-I ' TO RFV]-F�1 BY
DIRDC"IIT\S.
4. A BIIILDIN(a PERMIT MUS' BE Ofl'�AINFD FEta•1 'THE CITY OF 1�1GAEtD FLOP. A11. IPiE'RCVF7 S
COSTING (NF�I $500.00. COPITACT EA WALDEN - G39-4171.
APPRpItCHI EVIEW tX t TITFE:�_._,-----"--_
APpRCNED DATE
ROVF�)
APPBY NEIGHBORS'
r7 - �Afl
BUILDINGPLUMBING PERMIT
IGAFiI NO. 056
holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations ,sire inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the tirr : i, stallations are ready for inspection. City of Tigard Business License required
for all ccntractors and su' a :`r .tors., r -
.J/1"W C )`
Owner Address ', .1;_'%% i ��- __DateZ=.::
NUMBER OF TOTAL 7 PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE l.W EACH AMOUNT (Office Use. Onlyl
Single Family-1 both-each —_ 7.5_x`0—
Du'Idx--Each_', bath unit _ 25.00
Additional bathrooms-each _ 10.00
Mobile Home Space--each 15.00 _
INOIVIVUAL FIXTURE FE'S
�1 to 50 Fixtures in 1 building-each � 3.00
11 to_100_Fixtures in 1 building-each 2.50
%:I to 200 Fixtures in 1 building-each _ 2.00 _ �-
201 or more Fixtures in 1 building-each ;' _1.50
_MISCELLANEOUS _
Building_Sevter--1st 50 ft. 10.00
—Sewer-each additional 100 ft. _ 10.00
Water Service to buildingv_ 5.00 _
Private Water Systems-Poch 100 ft. —_T 10.00___
Other SgecifvL
PERMIT '- For Plumbing lnspertion Phone 639.4191
1% State —` Plumbing Contractoi By
TOTAL _ RECEIPT NO. Issued By