9110 SW PINEBROOK STREET WN w WN
9110 SW PINEBROOK STRFET
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CITY W9 2��8
BUILDING PERMIT APPLICATION OF TiGARD DAT I- -"ev_rtm�r h I�b
THE UNDERSIGNED HFREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILOERPHONE -----
OR
_--
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PI ANS AND SPECIFICATIONS. OWNER PHONE-
LOT NO.
OWNER JAU§ KAYOJ[ _TOB ADDRESS `)110 SW Pineb>rook, Tigan, TOME ADDRESS
ARCHITECT
ENGINEER
BUILDER F°�1>}1 11$LUMU111 Wilder ADDRESS DESIGNER�I--11
STRUCTURE ❑NEW QREMODEL ❑ADDITION _❑REPAIR ❑RENEWAI. - LIFIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE OCOMM ❑EDUCATIONAL ❑VOV'T ❑RELIGIOUS❑'ATIO ❑CARPORT ❑GARAGF ❑STORAGE❑SLAB ❑FL'NCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL.APPROVED ❑SIGNS
OCCUPANCY__LAND USE ZONE _BLDG.TYPE FIRE ZONE_. PLAN CHECK BYT-_,_-_______ HEAT
--
free StsMina Fir"Isar for *bore •ddrsss.
N0.11 ARIES __ ,.,-AREA NO,ffED QQMS____�/AJ.S1E___—_.�. .
!`UILDING DEPARTMENT SET PACKS FRONT REAR LEFT SIDE _RIGHT SIDE
Pe rmit ---
1 THIS P9:5iM1T IS ISSUFD SUBJECT TO THE REGUL.ATI•)NS CONTAINED IN THE BUILDING CODE, ZONING
Flan Check I REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCE', AND IT IS HEREBY AGREED THAT THE
i WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE.
— RCSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRFNT CITY BUSINESS
Stat-,Tax I.ICENSF. SEPARATE PERMITS REOUIRED FOR SiWE;,. .^LUMBING ANn HEAPING.
Total 5.00 --
4,_ APPLICANT OR AC➢FNT
Adnroved I v m4slAvIl Receipt No
rj
W W1 I
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639-4171
CONTRACTOR:
Pursuant to C;ection('s) ol the Uniform Building Code, the
following itern('s) require corregjjy:
z�
o
le
00
Permit
Inspector
CALL FOR REINSPECTION
/ N 2,273
J
BUILDING PERMIT APPLICATION COF TIC ARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR ]HE WORK HEREIN INDICATED RUILDERPHONE.
OR AS SHOWN AND APPROVED 'N 1HE ACCOMPANYING PLANS AND SPLCIFICAlIONS OWNERPHONF
L01'NO.______._____
OWNER Jim Mayer .IDR ADDRESS 9110 SW k1in Brook HOME ADDHE55
4RCEIC.ECT
,NGINEER
BUILDER ADDRESS DESIGNER _
��STRUCTURE ❑NEW ❑REMODEL 'fl ADDITION C3 REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOOLIT ON
0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT OGARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND EJ MOVING ❑CONDITIONAL USE CI DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY_ 'i .AND USE 20NE'k`7 BLDG.TYPE 1 . FIRE ZONE-L PLAN CHECK BY N7)' HEAT--
i-n t
EAT _r'-nt art. side i tion V# •:,, 25 to existin �' a e A�tT , O11 PQ%' Miles AJI~ 1. b#adr#.►aatt
all !.TI>apvc tions e�e:�,. Plumbin i'wty l c i�eq. � � t bath
40
OOAD FLOOR LOAD ___HEIGHT _En LyQ�'IORIES AjjEA UO
CA LVALUE
BUILDING DEPARTMENT SET BACKS FRONT;)M REAR JK _ LEFT SIDE 60
RIGHT SIDE
Permit 64.00
THIS PERMIT IS ISSUED S(IRJECT TO THE REGULATIONS CONTAINED IN THF BUILDING CODE, ZONING
Plan Check 32.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
i�b.Gll WORK WILL BE DONE IN ACCORDANCF WITH THF PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total
ALL APPLICABLE CODES AND OmO!NANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
_ x.SSI - RESTRICTIVE COVENANTS. CONTRACT.)R AND SUB CONTRACTORS TO HAVE CIIRnFNT CITY BUSINESS
State Tax LICENSE SEPARATE PERMITS REOUIRL°O FOR SEWL7, PLUMBING AND HEATING
Total 9b.55
By -
--• APPL:rANT OR A(:FN I�
Approved Receipt No.
DATE IPSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor —
C ! Permit No.z—LAZZ
%/v ` • / — Rough-in ---
LQ a ✓� —_' Fixture
Final
HEATING
pI Contractor
oQX
Permit No.
f Gas or Oil
Rough-in
Final
SEWER -- --`
Final
DRIVEWAY
Final
Stom Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT.FINAL 7�NIPORARY� CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY ------
Landscaping
Zoning Final
Address Permit No.10�'�(O
Name of Occupant__ Permit charge
—------------ — --------- Connection fee Z S D
-- -- --- --- Paid by------ — --- -
--_-_----- _-- — -------___-- Datc connected
Type of BuildingInspection fee - �'(a_
Service Rate _ Paid by Date
Contractor Assessment _- --- - ---Paid
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
4
F�ERMIT V 1036 DATE 1
PER511T IS GIVEN TO
OF j
TO CONNECT A
TO THE sys,rEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAW ....TIGARD SANITARY DISTRICT
0
By
-- - - - -- - - -
CONNECTION INSPECTED AND APPRO
Date Superintendent