12820 SW 107TH COURT-1 — 12820 SW 107TH COURT
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CITY OF TIGARD �� 4 �;
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OREGON
Owner:._...Da.ug...Smit.h........ Permit N: . 3 1
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Buildinf* Address........................12820 SW 107th Ct. ;r ti
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Certificate is hereby given this.....29.......day of.....�une 19......7'
that said building may be occupied and
■,I��. 4 that it complies with all requirements of
the Building Code for the City of Tigard,
as approved by the Tigard City Council. "
..�r••"•''•�si/•••. �. .•(r,�--] J..............
Building nT ,Vector
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11.01
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ADDRESS PERMIT NO. o
�Q (va-
PERMIT CHARGE none
OWNER _ CONNECTION FEE _ ?-123��
PAID BY
TYPE OF BUIEL'ING =---� -=— _ DATE CONNECTED
SERVICE RATE INSPECTION FEE
CONTRACTOR _ PAID BY _ DATE
SIZE OF CONNECTION ASSESSMENT _ PAID
! S - / �.
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :,-ZD. PERMIT NO. : �ry_
DATE' !���/ '�� DATE ISSUED*.—,tl _
OWNERS NAME .
ADDRESS :
CONTRACTOR :___--m — _�__.__��
TEST: Air [3, Water p , VisuaA, Laboratory D
RESULT: Approved , Disapproved p , Pending !�
SKETCH:
INSPECTOR DATE
NOTE Attach Supplemental tett data here,jo
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME . _s3 PERMIT NO. :
DATE : _..J-./-2 DATE(ISSUED '. _L
OWNERS NAME : _ ����:to 14
A D D R E S S: _Z-2,' 2
CONTRACTOP :
TEST : Air p, Wmery , Visual d , Laboratory p
RESULT: Approved S�" , Disapproved C Pending p
SKETCH:
I
1
1
IN "ltTOR DATE
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[NOTE . Attach supp!ementnl test data berolt01 I
BUILDING PERMIT APPLICATION CIT TIIGARD DATEOF
THE UNDERSIGNED UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE--�
LOT NO.
ONINER JOB ADDRESS HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
S��-Tt1Q ❑
RUCTURE ❑NEW REMODEL ❑ADDITION REPAIR ❑RENEWAL — F IRE DAMAGE
LJ -]DEMOLITION
RESIDENCE [:]COMMCOMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO []CARPORT ❑G.ARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE LJ DESIGN REVIEW ❑COUNCIL APPROVED [:]SIGNS,
OCCUPANCY I LAND USE ZONE_-_ �� BLDG.7YPE 'J FIRE ZONE-J
PLAN CHECK BY_ r w HEAT
Const. sinlallu fer.ily dwsllinb ..,`ory /w garage UedLaom ? bath
Ta)r hap 251 3AJ Lot 51LIO
- - usuement 880 •q. fte
A)(o ff PJ
OCC,_LOAQ —FJ.4S?R LOAD 40 HEIGHT NO.STORIE ARE..115-1 3 29 2 0.
-v71-101
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE ♦ RIGHT SIDE
Permit
. THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
G3
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- 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
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax °j l} LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HFATING.
Total l�f�•Z1
By APS' IGAN1 OR AGEN1 -
Approved - Receipt No
------- ADopEss - -- -•�"HO"�€---
6w .2 d 3
9
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UNIFIED SEWERAGE AGENCY NO. b 2 0
W-SHINGTO N C(AJNTY DATE
CITY OF---- Tiga _J
APPI-ACATION FOR SEWER CONNECTION PERMIT
OWNER: 00uq Smith
OWNER'S ADDRESS:
_STSTREET
CITY SPATE
BUILDING SITE: LOT_._- .__ BLOCK ADDITION
Tax [,',ap 251 3AD
TAX LOT NO. TYPE OF OCCUPANCY residence
ADDRESS 12820 SW 107th A Ct.
DWELLING UNITS- FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE _575. 00 25... 00
INSPECTION FEE __25. 00 600. 00 DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPI ICANT
SEWER PERMIT
THIS PERMIT Au-rHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER
RECEIVED BY.
(AGENCY OR ITS AGENTJf
-
COMMENTS: Elri;. " H36
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration or-rur.
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Permit Issued CITY OF TIGARD, OREGON Permit No.- —
City Hall
Application Approved littilding Department Cost of L)stallations
4pplsoa&m dat PoWnd, P4iws:44o j 9me,taU4&0^ Fee for Permit
Applicant shall fill in cost of i.istallation only,
Date_ _- _ above this double line. Street Sewer Permit—
repair Plumbing Pipes or Fixtures a,;cording to plans and specifications and
Application is hereby made to • description as given below:
nate►, �� tg
Location of building--Number and Street /_,z 2F - �- --- ------
Lot_.— ---— — Block---.-.-- Adddiitio�n�-- -- -------
Name and Address of Owns r '� ` _-. 1 ---��C�- ---
Name and Address of Plumber /�n�tlX 1�►C- S-Lc% 2114
6fA2,Z Z1�4-97D 49Y
Building (Old or New)-__ L/-.5fHeight in Stories -__�� Occupied as— '
SCHEDULE. OF WORK
- L— NUMBER ---- NUMBER - r 0 V
FIXTURES ( New i Move I R'pl'ce FIXTURES New + move-
R'pl'ce 4 / 0.0Q
Water Closets— -__ Fountains, Drinking—l----
rinking _ —_ /f �J
Bath Shower---__- -_--.— Fountains, Yard_ __I (/
Bath Tub--- Fountains, Sode—
Basins Hot Water Tank ------ - J
— > , J
Sinks, Ordinary____�__i._ _ Sinks, Bar_--_.
Sinks, Dishwashing _-- Sinks, Slop
Automatic Dishwasher _ _ Drains, Refrigerator-____-
Laundry Trays_ Drains, Ice Box__ __
Drains, Floor__ __'I __.—�__.�_-__ Urinals
Drains, Area__ +�`_ i ___ Catch-Basins, Yard_.—_
1 I
Rain Drains_ Calch•Basins, Garage_-_' I �, Z (�
I' Catch•Basins, Sub SoII
Automatic Washer.--- - -----_I_____. _-� __-- - - . ch-B -._
Water Permit No.-- -._.. Bldg. Permit No. _
REMARKS:
IMPORTAN i$-Plumbing shall not be Installed in any building, (either new, mitered,or repaired), except as shown or designated
on the corresponding building plans as filed with, or required by, the Building Department In accordance with the
provisions of the Building Code and Ordinance 62.19 of the City of Tigard.
re)air lho pinmbing system according to this description, plans and specifications and the Plumbing Code of the
1 agree Io Cily of Tigard.
nsiail r
t lum ng Firm_ f1l� -
Supervisor