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INSPECTION NOTICE
City of Tigard BUilding Department
12420 S.W. iNain S'..
Tigard,Oregon 9722:1
Phone: 633-4171
Type of Inspection
Date F'equested 4 D Tlr.�e � A.M. _P.M.
Address _-& (i
Perr; .;
Owner r- > Lot # 1
Buile?er
f
The following kililding Code deficiencies are required to be corrected:
or
17 IJ
Presented to � � Approved -
Inspector
Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
W
��a.]Lt�.om+Ealz C�ou.uty, Qres'�asaz
TO
Date—__=1
WIJILr YOU WE ► O,yr
01
L
)ELEP 0 PLEASE CALL
RETURNED YOUR CALI WILL CALL AOA114
WANTS TO SEE YOU RUSH
Message_
o n 51 L By:
• ' A
1.01 I.F4M
1,111 1 131
I
PHONE 839.4137
�Cash's AV.
V
111194L tSTATt AND BUILDING GKRVICt
O. C. (JRPRY) CA014. §RORtR 12527 9.W. MAIN
Rn s».Ists TIOARD. OREGON 97293
CITY OF TIGARD--12420 S.W.MAIN-TIGARD,OREGON 9223
l^ECEIPT
DATE: �- �- S 3
- —A\MOUNT:$
1
DCLLARS
NAME: _ i�+s� '�' 4) CASH:
ADDRESS: EC _
M.O.:
�Of
POR: A00T. 0 PIRMITS SURC_HAROR AMOUNT
SEWER BILLINGS 40-364
BUSINESS CENSE 05-331
".UM81NG PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333s-y �- �-
SEWEP CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV.CHARGE#1 30-367 _
PARK DEV. CHARGE #2 30-368
7ZO ING ADJUSTMENTS 011.1-242
---
TOTALSa
RECEIVED BY
PERMIT NUMBERS
Number AmeuM Number Amount Amount
RECEIPT •14482
BUILDING PERMIT APPLICATION TIGARD DATE '%`'' -list "� �e_ •4'54.4
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOk THE WORK HEREIN INDICATED BUILDER PHONE _ {
OR AS SH( 4N AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE__
LOT NO. A L
OWNER Oar l:+•.t estj.tt:l ' JOBADDRESS 15050 iso 1901 P1• - ir!!0AtI
ARCHITECT
ENGINEER
BUILDER ADDRESS y''*) F.• ritgt St+ DESIGNER
STRUCTURE L NEW O REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL I_] FIRE DAMAGE LJ DEMOLITION
❑ RESIDENCE ❑ COMM 11 EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB FEN-E.
OCCUPANCY _ `.-7 -LAND USEZONE BLDG.TYPE r' FIRE ZONE_ PLAN CHECK BY HEAT__ +
Crnxtruct 'Iinrl.e I"amily "wel.lii 4fw/attiACI'o,I
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 1, HEIGHT 13 NO.STORIES I AREA i NO.BEDROOMS VALUE
BUILDING DEPARTMENT SETBACKS FRONT r REAR %•' LEFT SIDE_ ' ' RIGHT SIDE
Permit I'•,1'' THIS PEIIMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONMIG
14FGULATIONS AND ALL APFLICABLE CODES AND ORDINA"CES, AND IT IS HEREBY AGREED THAT THE
Plan Check WORK WILL BE DONE 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•tital 16•4't RESTRICTIVE COVENANTS. CONTRACTOR AAD SUB CONTRACTORS TO HAVE CURRENT CITY BUShNESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
SDC
Total .
PDC# 11 I(H)•vv APPLICANT OWi AGEN�� �-
By _
Approved - -— ti,; - Receipt No, A- 8e----—_—�_- --�___�- PHONE
DATtE�2 INSP. TYPE INSPECTION / REMARKS I PL.UMBING`D, DATE)
�'i G 7 ✓" C_y� r� `> r< contractor (-J-"' ._ ']" �` J/ 0
Permit No. ss J
Rough-in _—
��— Fixture
10:4�� CI!— —awl—A1Oh M —_ Final
— HEATI
Contra or
—'-- Permit No. —
Gas or Oil-
-.
-
- - --SEWER — — -
Final
Firal --� —
Storm Drainage
(Rain Drain)Final
Sfdewei k
Curb i+Street Final
Approechi—
�LLtDG. DEPT.FINAL. TEMPORARY CERTIFICATE OCCUPANCY Final
T4RTIFICATE OCCUPANCY .—
landscaping
Zoning Final
i
SEWER PERMIT N? 25794
V
Unified Sewerage Agency
of Washington County CITY OF DA-1 F _
OWNER: _ PHONE :
OWNER 'S ADDRESS,
TYPE OF INSTALLATION:
❑ SIDE SFWER ❑ L(NC= TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW ❑ EXISTING �_� SINGLE FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS__ DWELLING UNITS
ADDRESS OF STRUCTURE : _
" Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling !or inspection, please refer to the Permit dumber. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at
the measure„lent given, the installer shall prospect t'iree feet in all directions from the distance and depth given.
If not so located, the installer shall purchase F 'Tap and Side Sewer' Permit at the current charge and the Agency
will install a lateral at the location specified by the installer.
FEES:
PERMIT FEE
CONNECTION CHARGE
LINE TAP INSTALLATION
OTHER ISSUED BY
TOTAL s
APPLICANT DATE
Ao09ri TICE: �` `z�OMTNE SEWER PERMIT w�: 25794
CNIIRG� ; i 0k THIS PERMIT.
ADDRESS OF STRUCTURE
TAX MAP I ,' I l SYSTEM
LOT _ [',LOCK -- — OF
APPRO\/FD BY DATE ISSUED BY
DATE
D. U . ' S REMARKS
r
I I Cyr
F
BUILDING PERMIT APPLICATION TIGAPO DATE------ _Ita
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN IND:CATED BUILDER PHONE ,
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. O•NNER PHONE
LOT NC. O
O'NNER .t�`�-LCLci . r JOBADDRESS
"— -- ARCHITECT
i, ENGINEER
BUILDER —ADDRES!e '21-T- %i 2� ` DESIGNER
STRUCTURE ANEW ❑ RF►AC IEL ❑ ADDITION `Q REPAIR ❑ RENEWAL ❑ FIRE DAMhGE C3DEMOUTION
RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV-T ❑ RELIGIOUS ❑ PA110 ❑ CARPORT ❑ GARAGE ❑ STOPAGE ❑ SLAB❑ FENCE
sn��sansw�wn�nwwn�i���4awwnoinnr�un+v�sw�n��
Ou.l1PANCY _._ LAND USE ZONE % G.-_BI.AC,.TYPE '�� FIRE ZONE- PLAN CHECK BY HEAT �=
.,,,.,:,�.,,.�.!
_. •ter•-�--- -- -
SEWERPERMITM
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA/-'i NO.BEDROOMS .r VALUE , q ,
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Parmtt THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING COOED ZON!h6
j==
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED TEAT TF!E
Plan Check �. y' WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CUMPLJANC:
- WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV!
Sub-total RESTRICTIVE COVENANTS.CONTRACTOR AND SUR CONTRACTORS TO HAVE CIIRRENT CITY BUSINES'
�— LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax '
_�. SOC—
Total
P" APPLICANT OR AGENT
By _ _
Recelpt No.
Approved ADDRESS PHONE
S_0 C
PDC - � -
SEWER CONNECTION 5
SEWER INSPECTION
SEWER SURCHARGE _ 5 i
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