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I City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME PERMIT- NO. :
9 DATE : //-&I DATE ISSUED:-/- L
� OWNERS NAME :
II ADDRESS : GU���r- c- --
�I C ON T PA CT O R :-- ___--
TEST. Air p, Water p , Visual D , Laboratory []
RESULT: Approved U Disapproved p Pending p
SKETCH:
I
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INSPECTOR DATE
I
NOTE : Attach supplementnl feet data hereto,
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CITY Of ,, / N° 0083
BUILDING PERMIT APPLICATION TIGARD DATE_-_ 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHAWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNER i ;%1 J ADDRESS �-
BUILDER PHONE
.dr�` rr I' ,.�.� .� ENGINEER
BUILDER _ ARCHITECT DESIGNER _
STRUCTURE _ONEW ❑REMODEL_ ❑AUDITION El REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑OEMOLIrION
❑ RESIDENCE ❑COMM ❑EDUCATIGNAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE 16 STORAGE[:]SLAB [:]FENCE
❑BOND_ OMOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
l
OCCUPANCY—.._..._.LAND USE ZONE _BLDG.TYPE � FIRE ZONE_ PLAN CHECK BY__-_-- HEAT___
X
OCC. LOAD _ FLOOR LOAD _ HEIGHT NO.STORIES AREA VALUE
BUILDINGPARTMENT
-- ' SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit ---
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE COVES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TNF
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPL IANCF. WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
196 State �' LICENSE. SEPARATE PERMITS REOUiRED FOR SEWER, PLUMBING AND HEATING
Totals r
-- r
By
APPLICANT OR AOINT
Approved ����� Receipt No. _
DATE INSP. TYPE INSPECTION REMARKS PLUMBING OA"fE
r u 3.7 tt --- — - --.�
Contractor
Permit No.
_ Rough-in
La � v. Fixture A ----
0 E 71h� G' ✓�K� r7�G 2� / Final
WAC n/0 - C'G P 'F7" ftu'7- 1,41 v1 c Ar HEATING —
rv0 >` CoyC`" �1SS:Csa�• I�u. flisF Contractor
/ Permit No,
�tYLC•"'�-f7 Gas or Oil ---
Rough in
Final _
- -- SEWER ---
Final _
- — DRIVEWAY
- - — -- Final
-- — -- — Storm Drainage___ ^�
(Rain Drain) Final
-- — — Sidewalk
Curb&Street Final
'
8L G.DEPT, FINAI. TEMPORARY CERTIFICATE OCCUPANCY _Approach
CERTIFICATE OCCUPANCY Final
Landscaping —
Zoning Final