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CITY
BUILDING PERMIT APPLIc,nATION orTIGARD E
DAT _________. 19___
THE UNDERSIGNED HEREBY APPLIES FOR ; F[W!T FOR THE WORK HEREIN INDICATED BUILDERPH0NFLST%
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE_ _
LCIT NO.__._
OWNER 11i,I10-0 !1,,il3djk'1 -- JOB ADDRESS j jt150 Lu 7^•tt1Z Avis, HOME ADDF ES5 _
ARCHITECT
ENGINEL:R
BUILDER ADDRESS _ rr-�� DESIGNER
STRUCTURE ❑NEW _QRFMODEL El ADDITION C3 REPAIR 4 LJREN_WAL ❑FIRE DAMAGE ❑DEMOLITION
0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑Gr1V'1' 0RELIGIOUS❑PATIO ❑CAR PORT O(,ARAGE ❑STORAGE❑SLAB []FENCE
❑BOND ❑MOVING ❑CONDITIONAL. USE ❑DESIGN REVIEW 01.OUNCIL APPROVED ❑SIGNS
OCCUPANCY_LAND USE ZONE BLDG. TYPE FIRE ZONE. PLAN CHECK BY HEAT.-__
aye 24 x 24 atta: thac to exisim, single Fam.i .L, Qwsjlin,, - �--
a1.� per cede.- — - --- -- - — ---
QCT LOAD `FLOOR LOAD HEIGHT NO STORIES- _$jjEA 576 NQ.BEDROOMS VAL
BUBUILDING DEPP RTMENT SET BACKS_ FRONT REAR LEFT SIDE RIGHT SIDE 36.00
THIS PERMIT IS ISSUED SUBJECT TO THE 9EGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 18,00 REGI't_AIIONS AND ALL APPLIC"LE CODES AND ORDINANCES, ANO IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total 14.UP ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE (URRFNT CITY BUSINESS
itaty Tax 4 1.44 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER. PLUMBING AND HEAPING.
Total S'.)0. 44
BY `-
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Anoroved I R Fill Receipt Nn I
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor —
�� Permit No.
101ok Rough-in -- _— --�--
Fixture
Final - ---- -
HEATING
Contractor
--- -� _--- --_ ___ Permit No.
M
(i85 Of Oil
--_.—_ -- --_— Rough-in — --
Finrl
-- — — --------- SEWER —
----�. -- --— i Final -�—,
�_�—.------------- -------DRIVEWAY Y
- -------•----- —
Final ---
Sto1Mt Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINAL TtMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
L
-'IJILDING PERMIT I .APPLICATION C�Y TIC ARD DATE D -.
�
HE LINDERSIGNEr) HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE__ _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPFCIF ICAI IONS. OWNER PHONE
LOT NO—
MEAUU7C55
9ADDRFSS11FJ6�� i
-�l � L� s -------- ARCHITECT
ENGINEER
DER _ ADDRESS �__ DESIGNER
UCT RE ❑NEW Y:JREMODEI. ❑ADDIIION ❑RLPAIFRENEWAL! ❑FIRE DAMAGE ❑DEMOLITION
rESIDF NCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RE LIGIOl15 DPATIG ❑CARPORT C�GARAGE ❑STORAGE OS;AB ❑FENCE
�POND. ____ DMOVING ❑CONDITIONAL USE — ❑DESIGN REVIEW _C�COUNCIL APPROVED ❑SIGNS v
_FIRE ZONE— PLAN CHECK SY HEAT_
:.COPA/NYL�_ LAND
yUSF ZON —.-_ BLDG.TYPE_ p
_ — NO_STORK---- pfiEA c57L2@.EpR90Ms V.4LU. d—
LQ9D—_-_-.—_f1QQAl.49L1_ ___1iELGH7 --
BUILDING DCPARTMENT SET BACKS FRONT REAR �LFFT SIDE RIGHT SIDE
F'ermlt �—
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CGDE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY A)M IDIAN ET THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANS)SPECIFICATIONS AND IN
ITH
Sub-,mal "( ALL APPLICABLE CODES AND ORDINANCES, THE ISSUAkNCE OF THIS PERMIT DOES NOT WAIVE
RLSTRICTIVF COVENANTS CONTRACTON AND SUB COr`'T'.ACIORS 10 HAVE CUFRENI CITY BUSINESS
Stat? T LICENSE SLPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEA'ING.
'Total ^ ��
By J� AVOI CANT pR AGF -
Approved Rec:etpt No _
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City of i igard
INSPECTION REQUEST
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for
_ _ 0
SPECTION TIME: /. -3y P�� PERMIT NO. :---- IN
DATE: -/� IIZDATE ISSUED : 11.__ I
(HERS NAME : ----- ! 0%
A DLA R E S S: 2 2
j N T R A C T O R : 4- *. 'I:e Y" ----- C(
:ST : Air p, Woter[] , Visual 0 , Laboratory p I TI
:SULT: Approved C Disapproved O , Pending p �tl
ETCH. SlI
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INSPECTOR DATE
E: Attach suppiementel fast date hereto] ( LN0
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CITY OF TIGARD
12420 S. W. Main Street
TIGARD, OREGON 97223
APPLICATION FOR BUILDING PERMIT
New Constr.:=tion ® Demolish [] Addition ❑ Remodel ❑ Move El
ZONING DATE I. .;UED •2- 9-7 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ No.
PLAN CHECK $ _
BY OTHER I�C Slrf� $ ,/P VALUAT70N $ Qm°o
TOTAL $ % �L RECEIPT No.uf!i�
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N—jQnD MAP N�S/3(oC� CENSUS TRACT JOB #
Architect or Engineer 6k/, t a J y36 ,V F �ZFSs kyurnAN.;D
(Address s�79iyY/ Phone
\Owner &ae'
(Address _1455D .SW 7q!! ail& Phone-/a3 -O .Z
Builder - `���� C BilkrARP — --- ----
Address-6'0,OSa pzg/j W &A,4 ---- -Phone y 97d��
BUILDING USE Single Res. ❑ Mlilti Res. ❑ Comn. ❑ Industrial❑
OCCUPANCY GROUP No. of Stori.^s Total height Area of Lot/s LC10
Type of Construction I II III IV V Floor Area B _
Set Backs: Front \ Back L.SideR.S.ide`
Private Sewer Pipe Size Sewer_,_ Septic Tank ❑
Water Service Pipe Size Storm Server ❑ Ditch ❑ br�+well❑
Street and Curb Requirements
Driveway Width No. of Parking Spaces __A
SEPARATE PERMITS REQUIRED SEWER A:'^ PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK BY — — —` DATE
PERMIT APPROVED BY _[t._•y�X,.�r.,,.�-
It is understood that all work will conform with applicable codes and ordinances
of. the State of Oregon and the City of Tigard, Otegon, and that the building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector. -�
ellgonaLture of Appi nt
PERMIT TO CONNECT
City of Tigard N Co`'
Permit �Tu
1r . 8 3 DATIP Qj
PERMIT IS GIVEN TO _(y. ._._�'� ice
OF / �U.-- ,��ir� ��_%Z4. ��r ��1�'.1-1G L ''/. or,
TO CONNECT A._& v._ltle
TO THE SYSTEM OF CITY OF TIGARD
THIS PERMIT MUST BE POSTED ON THE D■SCRIAED PREMISES UNTIL CON•
NBCTION IS MADE AND "NSPECTION OF CONNIC71ON HAS BEEN COMPLETED.
PERMIT FBI PAID I--2-d _____ _____ .CITY OFF TIGARD
CONNECTION INSPECTED AND APPROVED
Date Superintendent
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Address. fZ4 – -- --- Permit No.
Name of Occupant Permit charge a�'_`?��p
-- -----�_`—.__.-_--- Connection fee
Paid by-----
- -- -- - --- – - - - Date connected
Type of Building _ Inspection fee___
Service Rate Paid by Date
Contractor --__- Assessment Paid
Size of connection
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