12745 SW 111TH DRIVE 12745 SW 111TH DRIVE _
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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
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Permit No
Inspector
CALL FOR REINSPECTION
ADDRESS �W PERMIT NO.. l T V 0
PERMIT CHARGE none
OWNER ( CONNECTION FEE � -
PAID BY
TYPE OF BUILDING _AgA2`- DATE CONNECTED
SERVICE RATE /c L� • INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION _ SSjSESSCIENT PAID
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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
_-rte _,
Date: `�'— _ � _ Permit No.
Inspector'
CALL FOR REINSPECTION
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BUILDING PERMIT APPLICATION COFY TIGARD DATE_ e_ 19 7 ..
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THI. UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONF f
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.—
OWNER
O.OWNER JOB ADDRESS �,��yi }+J.�L HOME ADDRESS _
ARCHITECT -
BUILDER ADDRESS. ENGINEER
SW Beef Dand R04d DESIGNER
STRUCTURE ❑WEW ❑REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL UF:IHE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB []FENCE
❑BOND C1 MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCC UPANCY_.i',,.LAND USE ZONE. -10 BLDG.TYPES FIRE ZONE_ PLAN CHECK BY-- HEAT—_j�8
sinu.le i-SMi.ly r1W&1. .1 , w/attachpcy lore ta. 4 bedrucims — 3 Hathm.
+ai�sAbiI- anti Msachtaarmitm vitigtlirecl,
/ww ,r, Lt L'I?l11:. 1i175f3Q
6.62!,00
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OCC LOAD FL09F1 �QA� ��� HEIGHt �� N4�sSQLi ___ `.AREA �36'fh ,
—NO, EQROO.M,S—___YALUE_ _
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BUILDING DEPARTMENT ?�„
SET BACKS FRONT REAR 'Ja LEFT SIDE RIGHT SIDE
Permit J„ -- -
Plan Check
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, A1jO IT IS HEREBY AGREED THAT THE
Sub-total WORK WILL BE DONE IN ACCORDANCE WITH THE Pt ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
') ALL APPLICABLE CODES AND ORDINANCES. THE 13SUAMCF OF THIS PERMIT DOES NOT W Vfi_---
RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT (NESS
State Tax !i A ' LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 00'
By
I 1«LTr—
" ..e........,.,.......... ._ /76 �. AA LIPID CANT 0A AGE I,-i
Approved Receipt No '
r`
DATE INSP. TYPE INSPECTION RE'4ARKS PLUMBING DATE +'
Contractor _-_
Perr.lit No. _
4 _9 i --- Rjujltan
y��7f ` - - Fixture
-`� Final
HEATING
Contractor a
Permit No. /j/ 7 9/ y�;7
Gas or Oil
l�Lt'
>v
vim . ae—1 Rough-in
7� ----- Final ---
SEWER
-- '- Final
�- �— DRIVEWAY
Final
M Storm Drainage
(Rain Drain)Final
w V � Sidewalk
Curb 6 Street Final
--- -
Approach
131 OG. DEPT.FINAL TEMPORARY J C ERTIFICATE O:CUPANCY Final
CERTIFICATE OCCUPANCY -
Landscaping
Zoning Final
rl - -
MRA
3JILDINu PERMIT APPLICATION cUF 1 -�� tD DATE___.__ __ _ . ���._�_ N2 p
--IE iINDERSIGNED HEREBY APPLIES FOR APERM IT FOR THE WORK HEREIN INDICATED BUI.DER PHON'r
I,R AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF ICA1 IONS. OWNER'*'nNE
LOT
R JOB ADDRESS LQ_�_qs sw. i.0141*Ce HOME ADDRESS
(� ARCHITECT
ENGER- _ NEER
eel. . `n..�_ ADDRkSS l7;5_iw 1°�C r_L �'_'^�LI'— _.�.DESIIGNER ------
URE 1_✓JNEW ❑FIE MODEL OADUIT10N RE PAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
k C, NC'.F 104-MM ❑EDUCAT IONAL ❑GOV'T ❑REI 'GIODUSOPAT10 ❑CAR PORT ❑GARAGE []STORAGE DrySLAS OFENCE
�1QOND ❑MOVING ❑CONDITIONAL USE ODESIGN REVIEW OCOUNCILO
APPROVED SI,3NS
C �1
+.4NCv�/.�3 LAND USE ZONE e:/Q__._BL DG TvPF �t�/.�vFIRE ZONE PLAN CHECK BY++� HEAT. -__
(M.C. LQ9Q __UIQHT ./a tLA_._jI_Q Ej__ 1A.MA. fV_Q Q.EQROOMS _d VAl 6:►�
BUILDING DEPARTMENT SETBACKS I FION1 Q REAR LEFT SIDE RIGHT SIDE a
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check =� i 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-llotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- �Z• RESTRICTIVE COVENANTS. CONTRACTON AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax y-' - ( LICENSE, SEPARATE PERMITS REOUIRF.D FOR ; 'WER, PLUMBING AND HEATING.
Total i
Bv, �+ --- —.�
P i jCANT OR AGF NT
Ap lowed Receipt No
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