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BUILDING PERMIT APPLICATION CITofY TIGARD ,ATE_ 14 ' 6ar�—Cll)tl�
THF UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE "•r.
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AiID SPECIFICATIONS. OWNER PHONK.
y IAT Nn--.—
OWNER 1'ed1T';'V 7",-It.Z t.rlrt.! Ci*F1= }.i'aGipi. �(p_
.108 ADDRESS_ NOME ADDRESS
ARCHITECT _
BUILDER ADDRESS LNGINEER
II -1� ��yy _ DESIGNER__
STRUCTURE EINEW� ❑RL MODEL _ OADDIITtION �—ItREPAIR ❑RENEWAAL_ ❑FI�R—tE DAMAGE ❑DEMOLITION
❑ PFSIDENCE ❑—COMM ❑EDUCATIONAL OGOV'T URELIGIOUSDPATIO ❑CARPORT OGARAGE LJSTORAGEOSLAS ❑FENCE
CIBOND ❑MOVING ❑C 'IDITIONAL USE ❑_DESIGN REVIEW ❑COUr.CIL APPROVED +0SIGN�SIS
OCCUPANCY..—_LAND USE ZONE RLDG,TYPE FIRE ZONE_ PLAN CHECK BY_ HEAT
4 kJ v, .ia uu� a�Icl +itaanu �Ixlntitly aalny� �� , family u'.Iwl.lmn
All per P14nr
Q"-LQAD .__E-W—QF LOAD _— HELCNL NQ STORY$ L1_7_N0.8EOR44MS--VA1.0
BUILDING DEPARTMENT .11 !—
SET BACKS FRONT REAR
LEFT SIDE gIGHt SIDE
?ermit 1 ----- - _
THIS PERh.1T IS ISSUED SU13JELT TO THE RFGULATIONS CONTAINED IN THE BUILDf'IG CODE, ,ZONING
Plan Check REGULATIONS AND ALL APPLICAALE CODES AND 01DINANCES, AND IT IS HEREBY AGREED THAT THE
WORK Wll L BE. DONE INACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WfT4
Subtotal _ .(1� ALL APPLICABLE CODES AND ORDINANC'S. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
''-- RESTRICTIVE COVENANTS CONTRACTOR AND SUB CON'RACTORS TO HAVE CURRENT CITY BUSINESS
State Tax fj LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total ; rI -- y 1;0 FC YAIJ4
REMARKS PLUMBING DATE
DATE INSP. TYPE INSPECTION —
CunUector
Permit No.
Rough-in _^
Sri - ------ -
Fixture
Final
HEATING
s - _,a Contractor
Permit No.
-
Gab or Oil --
Rough-in
Final
SEWER
Final y
DRIVL:WAY '
Final
Storm Drainage _
(Rein Drain)Final —_
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
r.ERTIFICATE OCCUPANCY
Landscaping
1
�I�j
BUILDING PERMIT APPI_ICA,rION cOF TIGARD DATE-.. -�. —�, 1q-[7
°
THE UNDERSIGNED HEPEBY APPLILS FUR APE RMIT FOR THE WORK PIER EIN INDICATED BUILDER P:-
OR AS SHOWN AND APPFICVED IN THE ACCOMPANYIN,; PLANS AND SPECIFICATIONS OwNLF>,-I,• ,t 6;i O-O/..2l1
/"��y1� f�M �°`y� ��//�J %KL.OT NO 2-r".-All� SAS P
�wNEP Adiji.__ .IQf3 ADDRESS /D 0.20 ✓0 1 AW �� L.c.4 IC. wi�p11I►�f`
\ ARCHITECT
11�_OERADDRESS
ENGINEER
:,TRUCTURE I]NEW Flf�,tnDEL ADDITION EIREF'AIR QRENFWAL ❑FIRE DAMAGE ( ]C,(mot
riLSi9ENCL QCOMM ❑EDUCATIONAL 13GOV'T Or-� USL JPAT10 C�CAR VORT ❑(eAFaAGE ❑STORAGE CSL A�; �F tr;C
RELIGIO
O(, '�-ra!aCy 1t'7 .LANDUSF 7iIiv= R-1Q. OLDG TYPE •. FIRE ?DNF 3 PLAN C. FI'F R�
_. �ir►,� �' .2 .64vivid_ a6"60 44�►+�.-�ow- t104--gallk FA"14
SEWEF _PERMIT. --
OCC (OAD FLOU: t r'.,n #0HEICjHT % NO STQF,IES 1_ 7RfA87NU 6F,0RQ0R';_12.._VAIUc �Dy 00
- "BUILi7Iiv , CtFFAl,r'.IFRACKS FRONT 23 HEAR LEFT SIDE RItJHI , t '�
Jr160 00
,S t,ERMIT IS ISSUED SUB-IFCT TO THE REGULATIONS CONTE INFD IN THE SUILnING CODE. ZONIN
I PITh Check 2& , Ov IJI.ATIONS AND ALL APPLICARLE CODES AND ORDINANCES, AND IT IS ►'EPESY GGREED �IIAT IF
TK WILL BE DONE IN ACCORDANCE WITH THE PLANS AH'D SPECIFICATIONS ANO IN CGNIVI 'bN,",E
5_7_iQtaly ��• pQ L APPLICABLF. CODES AND ORDINANCES, THE ISSUANCE OF THIS PEF.MITtj' E5 '407 WAtk
` . �� �rRICTIVE COVENANTS. CONTRACTOR AND SU8 CONTRACTORS TO HAVE CURI'ENT LI r, CLq,IIiIE'
State TAX z `�;E. SEPARATE PERMITS REOUIRED F'JR SEWER. PLUMBING AND HEATING
Total ^ .. _ 0 , i * -'I: —
e,
aI � I! P aGENY
LQr u,uvF-d I�r No
SDC
P D C
`;VWAR :`ONNUTION $
3FWER INSPECTION
SEWER SURCHARGE
Comments : �(,� 00 L __
ADDRESSPERMIT N0,
, `
PERMIT CHARGE none_
CONNECTION FEE
OWNER
PAID BY --- --
TYPE OF BUILDING _ DATE CONNECTED
INSPECTION --
SERVICE RATE _,,,4 -"�
PAID BY __._ DATE
CONTRACTOR
'/ ASSESSMENT PATD
SIZE OF CONNECTION 41'
City of Tigard
INSPECTION REQUEST
for
INSPECTION 'TIME '� PERMIT NO. :
DATE:+ _l DATE ISSUED'._._LJ
' OWNERS NAME : (�K--IAf) ---
ADDRESS :&
CONTRACTOR :—/-00 2 1-416"L)
TEST. kr [❑, Water r' , Visual f- , Laboratory C1
RESULT. Approve Di.approved [7 Pending Lj
SKETCH:
l �
i
I 9PtC16R _ DATE
COTE : Attach supplemental lost data heretoo
s/
CITY OF A— No 0250
BUILDING PERMIT APPLICATION TIG ARD DAT'=
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE —
t (wl Cl ti r* ��,,�,++ "•'tib*.F�l"",►�r!��'
ADDRESS BUILDER PHONE
ENGINEER
flll1LDER _ -- __6BCHITECT DESIGNER
STRUCTURE ❑NEW QREMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGEDSLAB ❑FENCE
OBOND ❑MOVING OCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED OSIGNS __
Q':(_UPANCY—_---LAND USE ZONE— BLDG.TYPE--FIRE ZONE—� i"-AN CHECK BY -- FIEAT _i
dwsl,ii,,ig and sttautlsa -------
plant
QGC.LOAD FLOOR LOAD HEIGHT NO.STORIES _-_ AREA, VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEF 1" SIDE RIGHT SIDE
Permit
—" THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE 9UILDING CODE, ZONING
Plan Check RFGUL ATIONS AND ALL APPLICABLE CODES AND ORDINAW:ES, AND IT IS HEREBY AGREKD THAT THE
-- — WORK JHILL BE DONE IN ACCORDANCE WITH THE PLANS:ND SPECIFICATIONS AND IN COMPLIANCE Will H
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
1%State LICENSE. SEPARATE PERMITS RFOUIRED FOR SEWcP, PLUMBING AND HEATING.
Total
BY --
__ APPLICANT OR AGENT
1 A proved Receipt No.
ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING U 11 F
Contractor
G`1�"� ✓ Permit No. 0111f
�•1s-� ` �/f r�.our� / r� Fixture ---
lal
HEATING
Contractor ,
_ -- Permit No. r�•t> `y /�S/�
Gas or Oil _—
Rou—,h-in
_ Final
SEWER ,•/r?•KL A &E,
_ Final
DRIVEWAY - -
'�'"� _fel___�� :— !_>y C�= Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
_
Approach
BLDG.DEPT, FINAL a TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
1C2 �-7 —7s Landscaping
iZaning Final
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City of Tigard
INSPECTION RECUEST
for
INSPECTION TI AAE : 'n ._.- PERMIT N ,). ' -
3 A T E:
1. 'SATE: Z /._._ld 17 :ATE (BSUED:_�
^'N N E R S N A til E : �4 1a•t 1 c /440
TEST' Air Wrter G , Visuai , �a5oral�•y
rRc3ULT: Hpar-�y3d
SXET3: f Ht;c l,' 0-,,.ti, 605;7j 0 10 A r VL
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� cCg7 o a i�Jnr wr�G c rr�r✓ arr L /��: .,,,;r"'
I
M SPE CTOR DATE
IOTI: Attach 6upp4menta1 1064 'd ate hese
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