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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W.Main St.
a Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection —
Date Requested A — Time A.M._ P.M.
Address . �f, 2 0 t'f� �.Parmit #
Owner /27.7 Lot #
Builder
- —I
The following Building Code deficiencies are required to be corrected:
Presented to __ ❑ Approved
Inspector —.- �L _ _ 'Disapproved
Dater --
CALL, FV,f REINSPECTION
YES ❑ NO
r INSPECTION NOTICF
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
`I Phone: 639-4171 '
Type of Inspection
i
Date Requested__ 1112 `/ Time�_ A.M. P.M.
I _ L
Address --I1 /-7D Q nW �� / rf'.{'"r%f(yam Permit -t (J
4 Owner__ -y-- ti; p,� Lot # r�
Builder
The following Building Code deficiencies are required to be corrected:
I
I _ _
t
1
Presented to - ✓✓ I-kApproved
Inspector _ ' c. ❑ Disapproved
Date
CALL FOR REINSPECTION
D YE2 &NO
BUILDING PERMIT APPLICATION TIGARD DATE_ ' r'r'_'�r_�__ ,19 5050
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE b2ll—]M i„
JR AS oHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE __.._.
I-OT NO.__--_�-.
OWNER_,_ 1;un ::iIle x•_-__.__JOB ADDRESS 117110 SG; 134L!, .'err tc� �`:_:1 r•+rin:ra —
ARCHITECT
ENGINEER
BUILDER Sam ADDRESS 15270 SW bomws Ferry —DESIGNER
STRUCTURE �) NEW M REMODEL ❑ ADDITION ❑ REPAIR C RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
EJ�RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO 0 CARPORT ❑ GARAGE ❑ STORAGE ❑ SL1B❑ FENCE
OCCUPANCY _ [ALAND USE ZONE 1 M48LDG.TYPE —5N—FIRE ZONE PLAN CHECK BY ' HEAT Gas .�
—_-- -- Construct single family daellis w/attached narage. —
2 Nil
ScWERPERMIT# 19 9 Garuge 42U
OCC.LOAD FLOOR LOAD 40 HEIGHT I611, NO.STORIES I AREA 1214 NO.BEDROOMS 3 VALUE`U,', i11.
BUILDING DEPARTMENT SET BACKS FRONT ZU REAR J� LEFT SIDE S RIGHT SIDE y
Permit _ 283.UU THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 183.95 WORK WILL BE 'ONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS .AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 460*95 RESTRICTIVE COV-NANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 11.32 LICENSE.SEPARAI E PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
SDC— }f u.UU
Total 478.27
PDC#1 1 sa'� APPLICANT, .AONT —�—
By ----- GZ [fC 250*00
Receipt No.
Approved LTW Ab REQS ------ --- PHONE
. ..........
IIATL INSP. TYPE INSPECTION REMARK! PLUMBING DATE
I Contract
Permit No
492 Rou9t. n
f7&C I Fixture
g Final
&a 1A • HEATING
YU; C."Vasto
Perri0i No.
tj Zz� Gas or Oil
R01-gh-in
I inal SEWER
fnal
`---DRIVEWAY
I
Final 4
Storm DrOnap
Main Drain)Final
Sidewalk
fCurb&Street Final
Approaeh
BLDG. DEPT.FINAL —T—TEMPORARY CERTIFICATE6CC_LIPANCY
CERTIFICATE OCCUPANCY y Final
L mi idscaping
jZon gFonal
Building Permit No.
Location //�
�A —
Date
Certification of Registration
With the Builders Board
I '(Z��
LN[ doing business as (dba) ,
X am registered under the provisions
of ORS Chapter 701 Oregon Nomebuilderaw).
toy Builders Board Registration Number is
Ply registration is in full force and effect and expires on
tgnatur�J
THE UNDERSIGNED HEHLUY AI'rLIES full APFHNII I I-t)I/ IIIL .WiiN rlLli�16'4 ILu
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OVINER?I'O _
/ �yq �f (�� -J�-- LOT NO
JOB A0014!:55 //;1'0 ..1 /.Sy 1&4dm. * _ i(
/ !!!4( ARCHITECT
J'� ENGINEER
Aul�-Oz'7 _ _ Y• AOORES5 � _� i �')l('r, y OESIG'v£R
' STRUCTIIRE _ _vEw ❑RFAInDEI_ 0ADOIrio-4 _ 0rizP.;In,-ORE_EVIAL DFIRE DAMAGE QOEmOLI
r_r1ESll�C"ICC ❑CO►iAl ❑EOVCATIONAI C�GOV'T ❑RELIGIOUS CIPATIO UCAR PORT CIGAR- , r]STORAGE❑SLAB UFI
�J PDO
CCS l'PAr:•�Y Rte; LAND USE 10rlEL� 7�! p Ol(?G. TYPE��I� PIAN I;NECA 6y—S46—' —_ NEq(
_ CONSTRUCT SINGLE F, M� II�Y UW'I.I.I N(; WJATTA(')lI•:I)GARAGE-
El1ER HERMIT J# :27q
.L0_D FL09gJ A NEIG►1� f�SI RI PSE LI� NO.IiEUflOQA1S VACS
SIJwMir
IL41 v•�OEPnR rME?NTSEr BACKS FRONT �lD REAR �,+ LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE 81,ILOING CODE, IC
I iR r.~ ck REGULATICNS AND ALI. APPLICABLE CODES AND .ORDINANCES. AND IT IS HEREBY AGREED TNA'
(-� —�-- WORK WILL BE DONE IN ACCOROANCF WITH THE PLANS AND SPECIFICATIONS AND IN COLIPLIF.NCE
J Jti't�tJl I S-' ALL APPLICABLE CODES. AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT Y
RESTRICTIVE COVENANT:;, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURPENT CITY BIDS
}r;at.! Tax / 3 L LICENSE. SEPARATE FEVOTS REOUIRED FCR SEWER. PLUMBING AND HEATING.
TotalSOC -
r I PDC#
APPLICANT OR AGENT '—
A( Receipt No.
%nnAFiS
DC (Storm -S Vp LrCaL�
PDC - -- / .1. ry �( 73-` d
SEWER CONNECTION $ 9 L
SEWER INSPECTION S
SEWER SURCHARGE $ �A a ,,2
SEWER
Comments • '�" ~ � �40 " IM
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