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4n-4CA� CITY OF TIGARD 142. � � (:`.
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DRAWING IS LESS CLEAR THAN —�•.. _
THIS N CE;-` IT 15 DUE TO
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14215 sw 112TH AVENUE
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I
BUILDING PERMIT APPLICATION TIGARD DATE___^1- �i __ _ ,�e 4953
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE _041-41239—
OR
41-{1..139OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE _.. .hZL--2135
LOT NO.
OWNER Flr. b Mrs. Fero JOB ADDRESS 14215_ SW 112th
ARCHITECT��
Wheeler. Wale 12430 SW 12th Beaverton ENGINEER
DESIGNER
BUILDER ADDRESS
STRUCTURE ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE U DEMOLITION
I RESIDENCE U COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE C STORAGE ❑ SLAB FENCE
OCCUPANCY LAND USE ZONE- BLDG.TYPE FIRE ZONE---PLAN CHECK BY HEAT —
Const. Siin&le stgt Room addition to existion sire family dwellit_i_
SEWER PERMIT 0 none _ Noplwfaing or External iiiech.
OCC.LOAD FLOOR LOAD 40 HEIGHT 16 NO.STORIES 1, AREA :-a,7 NO.BEDROOMS VALUE S,UUO
BUILDING DEPARTMENT SETBACKS FRONT .0 REAR '' LEFT SIDE ' RIGHT SIDE 7
Permit 68 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
44.53 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HER, AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND :N COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE_ ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 1113801 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax
2.74 LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
Total 115.77 SDG—
_
PDC# APPLICANT OR AGEN 1
By _
Kr Receipt No.
Approved ADDRE r++uN r
DATE INSP. TYPE INSPECTION REMARKS
PLUMBING DATE
Permit No.
Rough-in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
— SEWER
Final
DRIVEWAY
Final
Storm Drainage
___,(Rain brain)Final
Sidewalk
Curb ON Street Final
Approach
IILDG. DEPT. I ----FEMPOPARY CERTIFICATE occu,,%Ncy
CERTIFICATE:OCCUPANCY Fine
Land-caping
Zoning Final
BUILDING PERMIT APPLICATION TIGAPO DATE 1`,ts__
THF-UNDERSIGN ED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONEe�
ORAS SHOWN AN APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHON6
f�Z�•
LOT NO. _
OYINER ��( 44-id JOBAOORESS �Lf�/s"('!� ��.�� _
ARCHITECT
ENGINEER
BUILDER , ,[/ AOORESS,/XVjfJS&/ rl* SIGNER _ i
STRUCTURE O NEW ❑ REMODEL___,&OOITION J REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIOENCF ❑ COMM ❑ EOUCATIONAL ❑ GOV•T ❑ RELIGIOUS ❑ PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCI
OCCUPANCY — LAND USE ZONBLDG.TYPE �'li�FIRE ZO�_PLAN CHECK BY
-
SEWER PERMIT M
OCC.LOAD FLOOR LOAD k HEIGHT jk* - NO.STORIES ' AREA egf'r NO.BEDROOMS
BUILDING DEPARTMENT SETBACKS FRONT REAR , -�
� ��LEFT SICE , RIGHT SIDE
Permit THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE.ZON'N
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HERc3Y AGREED THAT TI',
Plan Cheek WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS "ND IN COMPLIANCI
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERICT DOES NOT WAIV
�I
Sub-total � RESTRICTIVE COVENANTS.CONTRACTOR AND SUS CONTRACTORS TO HAVE CURB=NT CITY BUSINES
LICENSE SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
._ SDC —
Total
PD(# APPLICANT OR AGENT—_---_-�_�..._.__.�
By
—i— Receipt No.
ADDRESS ----- PHONE
SOC -
PUC
SEWER CONNECTION $
SEWER INSPECTION $
SEWER SURCHARGE S
Address 14215 S.W. 112th Ave. Permit No, 480y
Permit charge
Cerner Connection fee 425
Paid by
Type of building liasidenae Date connected
Service rate �.00 n.s °1°.. ......... Inspection fee 25
Contractor
—.....�...w„i..,......., __.......�._ Paid by Date
Size of connection lig
Assessment Paid
� � C) — � �� 04A�
I
City of Tigard
NNSPECTION REQUEST
I for
IINSPECTION TIME : —/—,'00 PERMIT NO. : Zit _
DATE : " DATE ISSUED:_LL
OWNERS NAME .
I yam- cy4
ADDRESS : - - - —
CONTRACTO R :--- _ _--
(
{ TEST. Air ❑ , Water ❑ , Visual j�, Labara ory p
i RESULT. Approved Disapproved L7 , Pending � ]
I — ,
I SKETCH.
I
I
7 t�F
-l� 1
i INSPECTOR DATE
COTE : Attach supplemental teat data heret]
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